Saturday, February 20, 2016

but it popped back open

I hate to call this an update, because, well, update reminds me that I haven't been taking time to be in this space for a while.  Last summer, when everything in life was crazy, I kept on posting because I like the overly-public journal that I've created here with all my babbling and selfies and random quotes over the last six years.  It's become part of how I process; that's the only reason I'm still writing, because it's important to me and not for anyone else.  And I've had an inkling that I wanted to sit down and record what was going on as I've worked through this mess but then there would be another low and I'd be spitting fuck it to anyone that would listen and suddenly seven weeks has gone by and it's all kind of a blur.
January.  As a whole: a wash.  After the first of who-knows-how-many-by-now rounds of aggressive dry needling and yank-thunk, I got the okay to try an easy run.  I think I did forty minutes.  Two or three days later I optimistically headed out to try an hour (based on my response to the two flareups I've had over the last two years plus following instructions) and I made it about three miles away from my house (in six degrees at the crack of dawn, natch) before my hip completely locked up.  Of course I didn't have my phone with me and of course I was out running on dirt roads where there are no coffee shops or gas stations or anything except weeds and cows (none of them had their phones on them either).  Shivering and sniveling, I hobbled back home and shot off an email to my poor physical therapist as soon as I got back in the door, proclaiming doom.  He kindly called me and talked me back off the ledge.  But that was the first pretty shitty day.
To be honest, if I talked through every high and low detail of this injury we would be here all fucking night so I'm not going to do that.  I took time off.  A lot of it.  I had a promising week of gradually increasing my bike volume from zero to thirty to forty-five minutes to almost two hours but then a bit of hard kicking in the pool dislodged my sacrum and we started, again, from the bottom.  One of the more frustrating things about this has been that every single medical professional I have seen, without exception, has told me that I need to keep moving to heal.  I'd try ten or fifteen minutes in the water, or on the bike.  And that would hurt a lot, well past the "2 or 3 out of 10" that I'd been told was acceptable.  So I'd take several days off, and nothing would improve.  Then someone else would tell me that I needed to get moving, and I'd try something else, and repeat from the beginning except with patience worn slightly more thin.  I was diligent about the exercises my PT had prescribed for me, diligent about not sitting for too long, checking and self-adjusting when I could, I had an obscene amount of dry needling and stimulation and manual therapy and it just seemed - still seems, sometimes - like nothing would break the cycle of flare/improve/flare/setback (Hopefully Charlie does not mind that Amy took this picture of me saying ow seven thousand times in a row).
At some point, it stopped being about racing, or training, or even turning those damned boxes green.  It became so much more about the pain that I was living with simply walking around, standing, driving, trying to sleep at night.  And the thing about this injury is that it's not an issue of strength. When I first went through this all those years ago right before the half marathon that almost wasn't, then, everyone in the world was quick - and correct - to point out my weak glutes and hips and core and promptly dispatch me home with twenty minutes a day of bodyweight homework.  But those aren't a problem anymore.  At least three different doctors in the last month have strength-tested and pronounced me strong, surprisingly strong for a triathlete one said (thanks?).  It's not an issue of overuse, either, and plenty of arm-chair quarterbacks have leapt to that.  When this first happened, I had just spent a month recovering from ironman.  My volume was low, intensity was low, and I hadn't even done something incredibly stupid in the weight room that I could blame it on like last time.  From what I understand, and I'm being honest when I say that this is only my translation of what I've absorbed from doctors, it's an issue of ligament laxity around my SI joint.  No matter how many glute bridges and clamshells and shit-that-strengthens my TVAs I do, no matter how many times per day I lay face-down on the ground turning my multifidus on, no matter how much time I take off from sport, those ligaments are never going to "calm down," ligaments don't get bigger or stronger or pop tiny biceps.  I can make everything around them physically resilient but as long as they are loose and mobile, the joint is going to continue to slip and piss off everything in the vicinity, over and over and over again.
A friend back in DC, Cris, reached out to me at some point to chat about her challenges with a nearly-identical issue and how she has been managing it - initially with PRP and then later with prolotherapy.  She was incredibly helpful in sharing her experience.  I started to do my own research, and discovered a ton of individual case studies with similar issues and resolution with this type of treatment.  I talked through it with some of my brilliant people that I trust, and after a handful of requests for a recommendation all pointed to the same doctor in Boulder, I scheduled an appointment to get evaluated over at CU Sports Medicine.  

I showed up armed with a detailed summary from a physical therapist and my finest set of puppy dog please fix me please eyeballs.  The doctor I saw was terrific - one of the people who recommended him called him the "SI joint guy" which is probably also what his friends call him in bars - and while he was examining me, said something along the lines of, hmmm, you must really be in a lot of pain.  And it made me really emotional (barf) to hear that.  I didn't figure out why until much later, but this whole time, this whole experience, everyone that I've been working with has been so focused on figuring this out, trying to help me heal.  I'm not saying anyone did anything wrong, simply that was the first time someone, ever so briefly, paused and acknowledged my pain.  That it was valid and real.  

I wasn't sure going in if I could be treated that same day or if it was a schedule an appointment for a week from Tuesday sort of situation.  So when he suggested prolotherapy and said that we could do it right away, I squeaked and babbled and probably would have hugged him if we hadn't met nineteen minutes earlier and I wasn't in gigantic paper hospital pants (You can keep those! at least three people cheerfully informed me as my appointment went on).
The medical assistant came by, and she stood in the doorway for a second like she was going somewhere else and I said something inane along the lines of oh haha who are those giant needles for that sucks and she looked at me like I was from outer space and said these are for you.  The doctor drew on my ass with magic markers for a while and then they got started.  It hurt, a lot, and I was prepared for it from all the reading I had done but holy mother of FUCK did it hurt (sorry, people that stumbled here from internet research).  He treated both SI joints and the inflamed side was about six hundred thousand times worse.  Which makes sense to me, if the wasps are already mad they will sting you faster.  I asked a pile of questions about what to expect and how to handle the next few days (and promptly forgot all of it), got seventeen band-aids plastered all over my butt, and that was that.

My appointment was unfortunately scheduled about two hours before training camp kicked off.  And camp, damn, camp was amazing.  I need to find time to write up an entire recap of it but in short, out of the handful of camps that I have hosted, it was easily the best, start to finish.  This group of athletes was phenomenal, there was a huge spread of experience, age and fitness and it didn't matter.  While every athlete spent time outside of their comfort zone - some athletes more than others - I didn't see a cranky face or hear a negative comment or get even a murmur of a bad attitude all weekend.  People flew in from all over the country, dealt with poor road conditions and single-digit temperatures and a trail run that turned into an ice hike and a coach that coached from a standstill for three days and couldn't pick up things she dropped and they handled all of it plus their own personal challenges with grace.  From my point of view everyone left happily exhausted, pleased with the things they had learned about themselves and the sport over the weekend.  Spending face-to-face time with athletes is so precious to me.  My goal is to provide a rich experience which means that I spend the entire week before camp starts working through my checklist, running all over Boulder making sure everything and everyone is ready and that results in some muttering to myself about how this is crazy, it's too much work and I'm never hosting one ever again.  But then everyone shows up and it recharges my batteries, working with people in person fires me up and motivates me and when they leave I miss them all and can't wait until the next time.
I had expected to be able to do some running with the group that weekend but instead got a flat-out nope when I asked the doctor about it and to be honest, once I was treated, I had no interest.  I walked Thursday evening with two athletes that were on the slight-reduction plan for the weekend due to sickness/injury, I think I made it a mile in twenty-three minutes: 1 NEW RECORD! said my Garmin.  Friday morning I woke up to find everything back there incredibly stiff and sore; moving too quickly in any direction brought on sharp & intense hold it right there pain from around the inflamed joint.  By Saturday evening enough of the soreness had gone away that I tried a very light and easy jog.  It felt fine - albeit terrifying - to move but afterwards I got a couple more of those very intense, freeze-me-in-my-step zaps of pain.  I think I waited another day before attempting ten incredibly careful minutes of swimming with a pull buoy and again, that was okay but afterwards the same bad blasts from around the joint.  

I was a little frustrated at that point (and a little weary of being unable to blunt the pain - prolotherapy means no anti-inflammatories of any sort afterwards).  Despite being clearly told that it would likely take a few rounds of treatment, I had hoped that this would be a magic fix because I am stubborn and also maybe not good at listening when it's not what I want to hear.  Way back in December, I had planned a trip to Hawaii for a week of riding my bike with Michelle.  I was scheduled to depart the Friday after my camp was over, and, crazy or not, I was still holding out hope that I might be healed enough to go.  I finally saw a physical therapist on Wednesday; she was exactly what I needed and when I needed it.  She gave me a few more exercises to do, she gently helped me reset my own expectations for healing and outlined how I should build back up from this mess.  And most importantly, she told me not to be afraid of the pain.  It was a powerful thing for her to say, it has stuck with me, obviously I could dissect it and apply it to my whole life, but her point was that pain will come with healing in this case and I need to just keep living with it for a while longer.  Since then (over a week ago), I finally feel like I have started to make small progress in the right direction, despite how sad I was to cancel my trip.  And yes, it's an enormous first world problem, boo hoo I couldn't go to Hawaii to ride my bike for a week, but you know what, it was a vacation that I had planned and saved up for and was looking forward to immensely, and having to cancel it at the last minute, adding it to the pile of everything else that had been missed, that sucked.  But instead I stayed home with access to my doctors and my gym and all of the amazing people that have patiently walked me through this (one of whom said, on seeing my backside covered in bruises and needle holes said succinctly it looks like someone tried to staple your butt closed but it popped back open).  And when I was able to run for almost an hour this past Monday morning, not pain-free but within the acceptable range, I knew the decision was the right one.  I really need to get back to putting on the eye cream at night.  
Almost a month ago, I flew to Atlanta to spend the weekend with one of my oldest and closest friends for her birthday.  And it was a blast, I wish we lived two miles apart instead of two thousand, she is good for my soul.  On the flight home, when I finished my book and then realized that my Fruit Ninja game no longer worked without an internet connection (more first world problems), I started messing around with iMovie on my phone.  First I made a trailer for a horror film starring the puppies, I couldn't stop giggling and it's hilarious (at least to me).  But then I realized that I had all these random little video clips on my phone of training & racing & nonstop gait analysis from the last six years (thanks, iPhoto & iTunes for automatically making this happen).  So I put together this little trailer of them, dating all the way back to right after I had IT band surgery and would go to the gym to walk on the treadmill.  And sure, it's self-absorbed and vain although maybe you wouldn't think that if you saw the first few clips (why did I think it was a good idea to spend so much time only in a sports bra?), but the last little clip in there is the moment when I crossed the finish line in Arizona a year and a half ago.  To date, that finish line is the most triumphant I have felt in this sport, most powerful, most alive.  And that moment, and a million more, is the reason why I haven't just said fuck it to the nth degree through all this, closed up shop on moving my body at all and moved onto another hobby, maybe one that requires less showering three times a day and bitching about my saddle at the height of it.  I've watched this silly ninety-second trailer a handful of times over the last month.  To remind myself of what I love.  Moving my body, what it feels like to dive into the water, to come flying down a mountain, to pick 250 pounds off the ground, all of those things are my happiness.  If I could never race again, I could live with that (and we would certainly save money).  But if I could never clip in and roll out to explore the world on two wheels, I wouldn't be as happy.  And I can get over this, I think I can get through this, if I want to, but I also know that it's up to me.  
A few blogs that I read have popped back up in my feed recently, posting shorter but much more frequently.  More honest, more stream of thought, less of a perfectly delivered package to the internet and more of this is what I'm thinking today and I have been really enjoying these writers.  Inspired, if you will.  I don't know if that means I'll be harassing the internet more often myself or if I simply want to note that it's something I'd like to do.  But it certainly beats ignoring the blog for so long it takes five tries to log in and then writing seventeen pages that no one reads but my husband (sorry babe, that comma was for you).  But this is where I am.  Today.  It's that simple.