Resilience.

I haven’t written lately about the running. I think this is mostly because I’m afraid of jinxing myself.

While I was off on vacation in cottage country, I did a few short 3-4 km trail runs. The area we were in was pretty hilly so I did walk most of the hills. My endurance sucked but the previous weeks’ rest overall helped the groin injury.

When we returned from vacation I set out for a slow 6 km run to test the legs. And man, was it ever slow!! My groin did ache a little bit right at the end but the pain never persisted. I was very, very cautiously optimistic. I stretched after the run and foam rolled and hoped for the best. I also added back another short run of 3-4 km during the week.  And the groin cooperated.

My next long run was 9 km.  Again, I felt pretty good for most of it but the groin ache kicked in around 8 km.  While it was frustrating to experience that ache again, it was also reassuring that it only happened near the end of the run.  It’s the little things, right?

The following week’s long run was 12 km. No groin pain, just a little bit of lower back stiffness at the very end. Last week, I ran twice during the week; a steady 3.5 km run and then a 5.1 km run.

Yesterday, I set out for 15 km.  My girlfriend had just given me a new running shirt for my birthday and I was excited to wear it.

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I ran all the way downtown and back.  Around 13 km, I started getting real tired and hungry!  Thank goodness for traffic lights. I was able to stretch my legs at the red lights.  In the end I completed 16 km and felt pretty darn good.

Today, not so much.  Today, everything hurts, even my upper body from supporting myself while foam rolling my legs. Oy. I can’t quite tell if it’s the good muscle soreness or the groin injury rearing its ugly head.  I leaning towards the good muscle soreness.

I also realized that I should probably take the next day off work after the half marathon.

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Meh. Ugh. A Funk.

I’ve been in a funk lately and it’s really starting to annoy me.

I’ve been struggling with a groin strain, likely an overuse injury from running.  My hip flexors are not happy with me and despite active release therapy and a week of rest, it still isn’t better.  I ran for the first time this week after 8 days off and by the end of the short and pathetically slow 3 km, I was having discomfort. I’m even feeling the discomfort walking around today.  The half-marathon is 3 months away and I am seriously considering selling my bib as I feel like this just isn’t going to get better.

I also suddenly realized that I desperately need a vacation.  I have two weeks off coming up and am looking forward to it but it will hardly be that restful with three kids in the country.  I shouldn’t complain. I know that.  The kids have been waiting for our annual trip to the cottage we rent and they are going to have such a fun time. I just don’t anticipate feeling all that rested when I return.

I woke up this morning to find that some a#**@e ripped out a stalk of my beautiful sunflowers.  Why would someone do that? Makes me want to pack up my house and move.  This is the second time this month that my garden has been vandalized. I love my neighborhood but there are some unsavory characters just a block or two in all directions from my house and it’s disconcerting to know they are walking the streets at nighttime messing with my flowers. I really love those sunflowers.

I thought I’d feel better after writing this all down.

I don’t.

Perhaps a Starbucks Frappucino will do the trick.

Playground Strikes Again. 

I received a text from husband this afternoon. 

“She fell off parallel bars and dislocated her elbow. I popped it back in. Going to emerg.” 

I promptly left the office before my last patient arrived and met them at the ER.  

Deja vu. 

Elbow swollen. At first I thought she suffered a pulled elbow but husband says she landed on an outstretched arm. The same arm she broke 9 months ago. 

Sigh. 

Thankfully the ER  was pretty quiet. We were triaged, seen, x-rayed and casted within two hours. 

While there was no obvious fracture seen her X-ray showed a class “sail sign” which in children is suggestive of a supracondylar fracture.  Leave it to my kid to have a textbook xray. 


She’s in a cast/splint until our next visit to the fracture clinic where they will re- xray her and see where things are at. She’s already decided she wants a pink cast this time. 

Kids.  

The bright side of injury.

If there’s an up side to being a doctor who runs and gets injured it’s learning about the new therapies out there for sports-related injuries.

I had my second chiropractic treatment yesterday for my lower back/hip issue. Since my first visit over a week ago I have felt about 80% better. Unfortunately there wasn’t much change in the range of motion of my left hip joint.  He suspects I have a deep ball and socket joint, meaning I was born this way and will just have to accept it and work with it.  After a rather vigorous ART therapy session he decides to use a Graston tool on my tender fascia.

Say again?

A Graston tool?

Medieval torture device?

You can see it has a few different edges – one sharp, one dull and one somewhere in between.  The traditional method of working the fascia left patients battered, bruised and bleeding, this according to my chiropractor who told me the history of the tool.  Honestly I don’t recall a lot of what he said, I was too focused on bracing through the new sensation of this tool working on my fascia.  It didn’t hurt per se, it was more of a grating sensation.

The Graston technique is described as :

an instrument-assisted, soft tissue mobilization therapy. It is beneficial in breaking up fascial restrictions, scar tissue adhesions, and detecting areas of chronic inflammation and/or fibrosis. Graston has been known to help conditions such as a cervical sprain/strain, tennis elbow and golfer’s elbow, lumbar sprain/strain, rotator cuff tendinosis, and even Achilles tendinosis.

At the end of treatment my skin felt raw and was red. I expected to wake up today completely bruised but I wasn’t.  The area is sore today but not nearly as bad as I expected.  Apparently there is no real consensus on what causes fascial pain or why working on fascia relieves pain. But talk to any athlete or casual runner and they’ll tell you that manual therapy on their fascia worked.   Confused yet? I certainly am.  I read this article on fascia science and I am still not clear on anything.  I have no idea what is ultimately the cause of my pain but I do know that after ART and this Graston tool, things are feeling better.

A few months ago, I saw a patient with chronic neck/shoulders and upper back pain.  He’s in his 60s and gets horrible tension headaches which he believes comes from the pain in his neck and shoulders.  When I examined him I noted that his trapezius muscles were very, very tight. There was almost no give to the muscles at all.   I suggested he see a chiropractor or physiotherapist who does ART. He didn’t like the idea of a chiropractor but agreed to see a physiotherapist.  I found one in the area who does ART and told him to book an appointment.  He came back to see me last week raving about his experience.  His shoulder and neck pain is still present but it’s a lot better than its been in years and he feels like he can move his neck much more than he could a few months ago.  But more importantly, his headaches have completely resolved.  “I don’t know what she was doing and it wasn’t a pleasant experience, doc, but it worked!  Thank you!”

In the end, it doesn’t matter that the science of fascia is still iffy. What matters is that therapeutic tools have developed that help patients feel better.

Road to A Thousand.

This weekend I had back to back 5 km runs.  It wasn’t planned at all.  I ran yesterday in -11ºC (-22ºC windchill) and had zero knee pain.  This after a particularly weird week where I had one day of excruciating anterior knee pain so bad I could barely walk which disappeared the very next day.  In fact, I don’t think I’ve had any run in the past month or two where my knee didn’t bother me.  In any event, the knee felt great yesterday and I considered a short run today as the weather warmed up to a balmy -3ºC (-7ºC windchill).  As I got going, I realized the knee was feeling pretty darn good, so I aimed for 5 km and accomplished my goal.

Two runs in a row with no knee pain.  What gives?

Honestly, I have no idea.  All I know is that it feels damn good to go for a run and not feel pain.  Haven’t experienced that in a long, long time.

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I accepted a challenge from another blogger to run 1000 km in 2015.  Consider I only ran 640 km last year, this is a tall, tall order.  I had set a goal for myself of 750 km.  I’ll be happy with that; but a thousand?  Stay tuned!

We have callous!

Day 19. National Blog Posting Month.

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The image on the left is the acute fracture through the distal radius. Image on the right, healing callous formation is visible as the fracture line starts to shrink.

Daughter’s cast came off yesterday.  I couldn’t make it to the fracture clinic appointment because of work (cue the mommy guilt) but husband took a lot of pictures.  Her bone is healing, there’s good callous formation, so off came the cast and no more follow-up is needed. Her little forearm has atrophied as she hasn’t used those muscles in a month and she has some bruising on the underside of the forearm where the fracture was.  She insisted the discoloration was from her putting a chopstick in there to scratch an itch but really, it’s from the fracture.

I reminded her a lot today before school that she has to be careful with her arm especially in gym class.  She seems to get it but the mommy in me still worries.  Shouldn’t they have casted her again? Isn’t it too early for an almost-6 year old with a freshly healing bone to be running around with no cast?

 

Open Letter(s) Wednesday

Dear Cast Technician,

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Thank you for the wonderful job you did yesterday changing my daughter’s cast but we, her parents, didn’t really appreciate being completely ignored.  In the future, both my husband and I would appreciate you also explaining cast care to us because although the patient, our daughter, may appear to be listening to you and nodding her head, you have to realize that a 5-year-old has the attention span of a newt and she isn’t going to remember anything you said.

Sincerely,

Dr. Mom

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Dear Resident in the ER,

Thank you for seeing my patient, however, how you managed to confuse a brain tumor with a skin condition is beyond me.  Your consult note says my patient had a brain tumor removed a few years ago.  Really? Are you sure it wasn’t a basal cell carcinoma?  Suddenly my patient’s weakness and dizziness takes on a whole other thing when you write that she had a brain tumor.  She did not have a brain tumor removed. When she pointed to her forehead and said she had a cancer removed, you should have asked her to be more specific.  Getting a patient’s medical history is the first thing we learn in medical school!

Please amend the patient’s history.

Sincerely,

The Family Doctor

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Dear Gilad,

I love your workouts.  I did the Abs workout last night and oh.my.dear.god.in.heaven, 18 hours later I can barely move my stomach.  Yes!  Thank you so much for kicking my ass last night.

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Sincerely,

The SixPackIsComingBack!

Perils of the Playground.

I suppose it was bound to happen the way she swings around on those monkey bars.  Last Friday after school I got a call from my husband that she fell off the monkey bars and probably broke her wrist.

You know that sudden feeling in the pit of your stomach you get when you know something is wrong? That’s the feeling I got when I heard my husband’s voice. He is not one to panic or think the worst so for him to say he thought it was broken I knew it was serious and I knew he was probably right.

I’ve never broken a bone so I have no idea how painful it is but I know it hurts. I’ve seen both adults and children with broken bones.  When I got home and saw my daughter’s tear-stricken face and the tell-tale swelling of her little wrist my fears were realized. She was cradling her arm so carefully and refused to allow us to touch it or put it in a sling. My heart broke for her. I never wanted her to experience that kind of pain. What parent does?

The six-hour wait in the ER was long. She wasn’t allowed to eat in case she needed conscious sedation to set the fracture. It took two hours after the x-ray to see the doctor who ushered us into the orthopedic room where the casting supplies were. The ER doctor was a lovely young female resident in her second year of training and she was very calm and comforting to my daughter.  I asked her how many casts she’d done that day and she smiled when she answered. She’d done five including my daughter and all were children who’d suffered injuries on the playground.   My little girl was so brave and admittedly scared when the cast was being applied. She didn’t want anyone touching her arm because it hurt.  Thankfully the doctor ordered some Advil and Tylenol to take the edge off a bit and it seemed to work.

She suffered what appeared to be a greenstick fracture of her distal radius. From www.kidshealth.orga greenstick fracture is a partial fracture in which one side of the bone is broken and the other side bends (this fracture resembles what would happen if you tried to break a green stick). It is a common fracture in kids and is considered an incomplete fracture as their bones are softer than adult bones. Children’s bones are more likely to bend than break completely.

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She was put into a thumb radial gutter cast because she had a bit of tenderness in one of the wrist bones as well so the ER doctor wanted to make sure to immobilize the thumb in case there was a second fracture that wasn’t visible on the x-ray.  It is a temporary cast and is open on the ulnar aspect of her arm in order to allow for swelling.  In a week or two we will go to the fracture clinic where she’ll have another x-ray and likely be put into a fiberglass cast for a few more weeks.

I’m thankful that she landed on her left arm as she is right-hand dominant and loves to draw. Within 12 hours of the cast being put on she had already started decorating it.

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My little girl is one tough little cookie.  While I never want her to experience physical pain ever again, my husband reminded me that this was an important lesson for her to learn.  She is vulnerable and can get hurt.  I hope she is a little more careful the next time she climbs those monkey bars again but I realize that every time she falls off, she will be determined to get back up again, even if I want don’t want her to.  If I had my way, she’d never climb those monkey bars again!  😉

Saturday – I’m encouraged.

It’s been really hard not running. I tested the knee a few days ago. I’ve been doing quad sets and wall sits at work, between patients, and after a few days the pain in my knee virtually disappeared. So, of course I went for a run.

I was very cautious and took it very slow and only did 2km. The knee held up rather nicely. There was only the subtlest of aches and no searing pain afterwards. I iced it that night and continued to do the quad strengthening.

I’m doing about a hundred squats a day and have done so for the past 5 days. My legs are starting to notice. I had planned on going for an early morning run this morning but just couldn’t make it out before the heat set in.

My running friends have all told me, in not so many words, that I am playing with fire. I should not be testing the knee. That if indeed I do have the dreaded “runners knee” that I need to lay off the running and cross train.

If you’ve been following my blog you know that patience when it comes to running and injuries is definitely not one of my virtues. Running is important to me for so many reasons. The thought of not being able to run is unbearable really. Sounds dramatic, I know. But it’s true. I love the way it makes me feel and it helps keep me in great shape.

So tonight, after the kids were in bed I went out for a run. I’ve had a headache all day and just needed to get out. I had no idea what to expect and in fact had no expectations whatsoever. I quickly realized it was going to be a good run. I had ZERO pain in the knee the entire run. I was so thrilled but told myself to keep it short. My plan by 2 km in was to wrap up around 4 km. I decided to head to the local trail for a bit and saw this little guy along the way.

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Tonight’s run was very, very encouraging.

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Doctor Heal Thyself

A few months ago, I saw a young woman in my office complaining of knee pain. She had just started running and after several 30-45 min straight runs developed anterior knee pain. Even before I examined her knee I knew she had developed patellofemoral pain syndrome (PFPS).

She had been a competitive swimmer in high school and hadn’t done any running before this. She just decided one day she was going to start running. I admired her.

Her knee examine was pretty straight forward. I was able to elicit pain along the inferomedial aspect of her patella; she had a very minor joint effusion, but otherwise the rest of her exam was normal.

I spent the rest of the visit counseling her on what PFPS is and how it happens. I spoke about imbalance in the muscles around the knee and showed her specific quadriceps strengthening exercises. I suggested she take a regular dose of an anti-inflammatory medication for at least a week if she was in pain. I advised her to get a proper gait assessment done for her running shoes and told her she had to stop running for a few weeks at minimum. She obviously didn’t like that last part but I reassured her that she would get back to her running if she listened to her body and took the proper steps to heal and strengthen her legs, particularly the quadricep muscles.

She returned to see me about six weeks later for a different reason. I asked how the running was going. She told me she took my advice and her knee feels great.

Remember that saying, “doctors make the worst patients”? It really is true. Ten days ago, at the first sign of knee pain, though I did “rest” I didn’t take any medication and I didn’t do the exercises. Granted I was on vacation with my family so having any time to myself to exercise was difficult. There were a few mornings I found myself alone on the deck so I did squats and yoga but it clearly wasn’t enough.

But, since the run two days ago, I have been faithfully doing my quad strengthening reps and taking acetaminophen for the pain. Normally I would be taking Ibuprofen but it’s been upsetting my stomach of late. I’d forgotten what a good painkiller acetaminophen can be; there have been moments when I think I could run again, my knee feels almost back to normal.  Gone is that annoying ache I experienced walking down the stairs! But I know that is the Acetaminophen working.  Not to worry, I told myself no running for another week, at minimum.

These particular quad sets, I find, are very helpful, but there are many more that are equally important.  Not only should I be strengthening the quadricep muscles, I also need to remember that the gluteus muscles and the hamstrings are key to a healthy knee as well.  I found this PDF to be particularly helpful. And just to prove that I am practising what I preach this time, here is a short video of me doing a quad set.  (And yes, that’s Katy Perry in the background and at the very end, my son demanding attention.)