Sunday, February 28, 2016

rebuilding

I bounced back from the second round of prolotherapy much more quickly than the first.  By the time I was 48 hours out, I was starting to feel okay, although still very sore and fragile around the joint.  I tentatively did a pretty short jog and swim on Wednesday afternoon/evening and both went better than I expected (i.e. I didn't turn around or get out after three minutes).  
My hip on that side has been locking up on and off over the last few weeks and with that, I think I am starting to finally understand how the various issues I've had all over my body are related to this central instability.  Nothing near or around my right hip was touched when I had the second round, but the next two days my TFL and piriformis flared up, hard.  I believe that what's happening is that when the joint is particularly unstable, those hip stabilizers are working twice as hard to try and provide stability around the loose joint.  As the week went out and my SI joint started to calm down, so did those other issues.  The same thing happens at the hamstring attachment on the opposite leg.  As soon as the joint rotates or gets stuck, the hamstring is working a little harder to provide strength/power where something else - I think the glute - is being inhibited by the joint instability.  Fascinating, likely, to only just me.  

With the help of my PT, I've put together a pretty solid mobility & strength mini-workout that I've been doing daily for about six weeks now.  Some of the exercises are things I was already doing except with a lot more intention and focus, which of course makes the exercise much more difficult now that I'm actually paying attention (shocker).  Some of the exercises are new to me and have really directed focus to a lot of the small stabilizers around my core and my glutes.  As this last week went on, I was able to add to & expand these small sessions and that felt like good enough progress to warrant a loud pants yes-I-still-lift-barefoot no-I-have-never-broken-a-toe selfie.  
Swimming came back fairly quickly, enough that on Friday I tentatively swam two rounds of 8x100 without any gear, and I was stoked to get through both sets without needing to open an interval or remove my kick.  I've been using the buoy in almost all of the swims that I've done for the past month because kicking seems to irritate the joint.  But recently I've been slowly weaning it out and by Sunday afternoon I was able to do a workout 100% as written (to be fair, a significant chunk of it was with gear but still...!).  As I worked through the set, I wasn't feeling great moving through the water but what I was seeing on the clock was more familiar than anything I've seen in a long time.  A broken set of 10x200, and when I was able to pull 2:39 :37 :35 off for the last three, I did a quiet little fist-pump to myself (as opposed to an Olympic-medal-winning-style water-slam).  It feels good to swim hard, to work hard (Rosalyn was less thrilled about it).
The run is coming back a bit more slowly but it is coming back.  Watching pace and heart rate has me pretty tuned in to where my fitness is (or is not) but I remain enthralled by the first weeks out, likely because training is so low that I need to fill up my spare time in some way other than binge-watching Fuller House and playing TsumTsum as soon as my hearts fill up.  I'm enjoying the high-frequency-low-intensity right now, short little runs that I can squeeze into my schedule with ease and none of them are taking too much effort or bites out of me.  I ran over an hour on Saturday morning and finished feeling tired; things in my hips and low back felt crunchy and used but right now the barometer is set at nothing feels worse than before I started so it was a success.
The bike, I'm afraid, is going to take a while to come back, and that makes me a little bit sad and also I'm not sure that I completely understand it.  I think part of it was that I had my fit updated in early January when I was first trying to troubleshoot this issue and some of the small & incremental moves just aren't working well with where my body is currently.  I've pulled my old TT bike out of the basement and am going to test it out a bit this week once I get all the cobwebs off to see if that improves the issue at all.  We've been having some warm spring weather here in Colorado and I am longing to get out and join the millions of cyclists happily clogging up the roads; it's been hard on that end to be patient, although a very short ride this weekend left me crunchy and inflamed and that makes it a bit easier to lean on the brakes.  I am admittedly not very good at patience in general but I am doing what I'm told in terms of recovery and rebuilding.  How very boring and grown-up of me.
Part of the reason that this whole injury has been such a struggle is that it has really affected my entire life, not just the training piece, but all of it.  I couldn't take the dogs to the dog park, or go for walks, or hikes, or really do much outside of sit and watch the world go by.  And as my body has oh-so-slowly calmed down, I've thankfully been able to add some of those things back in.  A friend was in town for the weekend and we set our alarms for 4:30am Saturday morning to make it to the top of Sanitas in time for the sunrise.  A decision that is rough when the phone starts buzzing but is always, always worth it.
I've been able to take the puppies to the park and on little walks and go out to dinner with the poet and finally, I feel like I am starting to enjoy my life again.  That's pretty big.  I have used this blog for a while to generally discuss training but the other stuff I was missing, outside of swim bike run, that was worse.  I missed having the rhythm of the schedule, of being able to use training as time to take care of myself or time to blow off some steam or time to just simply enjoy life, that's absolutely true.  However the little things, the stuff that makes life good, I missed that even more.  
And life has not been perfect, life never is.  I've experienced what feels like an overwhelming amount of loss over the last few years.  Some of it out of my control, like in death, and some of it simply the way life steps forward.  Some of it in relationships, some of it in lost opportunities, experiences; I have felt it keenly most recently.  For the most part, when people have chosen to move on for whatever reason, I've discovered after the fact that it almost always improves my life once they are gone.  It never makes the loss less acute, or painful at the time, and it's probably true that grow a thicker skin will be on my invisible end-of-year self-evaluation for the rest of eternity.  But the question always arises, should I stuff down my big-hearted extrovert, close down the circle, protect myself instead of always trying to create more joy out into the world?  I don't know.  I do know that I open my life, my heart, my home, I am inclusive always, I extend invitations and want to bring people into greater experience and share into my friendships and relationships deeply.  My husband said it to me today, you and I, we have high expectations, we believe there is a certain way to do things and a way to treat people, we are loyal and caring and that is why we are married to each other.  My family is certainly always going to be my highest priority and I will fiercely protect it, but I would hate to believe that outside of the walls of my home, I will never find friendships in which I can feel safe.  What I do know, now, is that my body is trying to heal, and my mind along with it.  It sometimes feels inappropriate to still be saturated in grief over the death of my grandparents last summer, but it pops up and surprises me with the intensity of it, still.  Maybe the crash had been a long time coming, maybe it took something as severe as that to send my journey flying off in a different direction, but whatever the root, the flaw, I am not the same person I was a year ago.  Sometimes that makes me feel hopeful, sometimes I simply feel lost, but for the most part, I have no idea what I want from life right now.  Other than, simply, joy.  

Tuesday, February 23, 2016

round two

I had a second round of prolotherapy done yesterday.

Backing up.  The week after the first round was horrible (I'm a walking commercial for this treatment not to mention lifestyle, I know).  I had read plenty of cases where an athlete was treated and then happily back at her life a few days later and that did not happen to me.  I slept like crap the first 3-4 nights because I couldn't lay on my back and I couldn't turn over and I couldn't lay on any one side too long and at some point Graham stretched and poked me in the injection site and I woke the entire house up shrieking.  I don't remember when exactly but at some point I was in so much pain that I stood in the shower letting tears leak out of my face, convinced that I would never swim/bike/run or even walk/stand/sit again.  I spent a lot of time in January trying stay reasonable and calm and not fall off the ledge but failed a couple of times, and that was one.

I came through Heather's office & healing hands, though, and that helped.  She told me to stay off the bike for a while and that I could run a tiny bit every day, like twenty to thirty minutes, and to coexist with and not fear the pain.  For whatever reason, that visit sticks in my mind as a turning point and it certainly looks like one in the pages of my training log.  I went from eighteen minutes of jogging to thirty to forty to almost an hour in the week that followed.  I do not give a single solitary fuck about pace right now but it was interesting to watch it drop, little by little, as I got moving again.  It started out on the far end of what I recognize as oof I am so out of shape and came back down to a place that looks more like well it is February.  Every time I come back from a break I'm fascinated by the process, watching what happens when I keep my runs truly easy/aerobic and how every time I go through it, my body comes around a little bit faster.
And then I came home from the pool one night with a scratchy throat.  Woke up the next morning feeling like my body was fighting something, which I'm sure isn't even close to a surprise after hosting run camp + hugging so many sniffling people + some stupid life stress in the week that followed + broken nights of sleep + injury anxiety, but it annoyed me nonetheless.  I bailed on a day or two of any attempt to "train" to work from bed with my laptop and my pile of golden retrievers and stuff plants down my throat.  That seemed to knock most of it out, I was a little congested for another few days and my heart rate was back up to sky-high when trying to jog my easy twenty or thirty minutes but as I came out of my sniffles, my body suddenly (it seemed) came back to me.  I went from swimming 200 yards & carefully flip-turning at the speed of molasses to swimming 600 yards and then 800, 1200, 1500 before putting the kick away and starting to pull.  Kicking seems to irritate things and by the end of every day I was hurting a bit from my activity level.  But the next morning I would wake up feeling okay again and I got a little bit further each day.  I also dug a new swim buddy out of the walls of Boulder & I think we will be pretty closely matched when I am in shape which I am not right now so having to not be a weenie in front of someone I don't know very well helped too.  I think they call all of this progress.  

Progress to the point where, over the weekend, I started questioning whether or not I wanted to go through with another round of treatment.  I checked in with some people that I trust about where I was & how I was doing and, hilariously, got completely logical but opposing responses.  On one hand, it seemed like I was finally starting to incrementally heal and let's not mess with that because injections would be a step back, however small.  On the other side, I've been down for this long and I'm still not 100% so let's just do it because it might be the push to heal completely.  Both made complete sense to me; the research backs up the latter just a hair more than the former and it matched what I felt in my gut.  So I decided (obviously) to go through with a second round especially once I got the surprising note in the mail from my insurance that they were covering almost all of the procedure, which I wasn't expecting but took quite a bit of anxiety away.
My appointment was for first thing in the morning which meant I set my alarm obscenely early so I could go to the sunrise masters swim that I haven't been able to attend for a couple of months now.  The universe heard that I was coming and ALL of my favorite lanemates showed up and I even managed to just barely survive in my normal lane (still pulling quite a bit more than usual which helps).  I forgot how happy it makes me to be around my swimming friends and all of a sudden over the last two days I feel like my life might return to what I consider normal.  I'm sure that sounds quite dramatic but I've missed all of these things over the last two months and missed them terribly.  I had enough time after swimming to squeeze in a very quick jog before my appointment, and it was freezing and I forgot my gloves and my sunglasses and my legs were actually a tiny bit tired from running the night before and all of it was fantastic.  
I got to wear the amazing hospital pants again, which I think I'm going to start wearing at home or maybe to dinner and apparently I only have one pink shirt, before chatting with the doctor a bit about how I had been doing.  He made some terrifying noises about a sacral stress fracture being a possibility at this point but I think that might be partly due to how bad I am at explaining myself, my brain ceases to function when someone asks, so how have you been doing?  It's similar to what happens when someone is giving directions or reading through the specials in a restaurant.  We decided to table the scary discussion and see how I did after one more round.  He only treated the right SI joint (the inflamed one) this time and it was a lot less painful than the first time.  I got loaded up with butt band-aids and dispatched home to heal (no picture, you're welcome).

Even since the first treatment, I've noticed some small differences in the way my body is aligned and stays aligned so I feel hopeful.  Finally, hopeful.  At some point about a month ago I got weary of the rollercoaster and I think I gave up on hope for a bit.  But the run I did Sunday night and the swim I did Monday morning and in general how I've been feeling only as recently as the last 2-3 days, it feels like I'm going to come out of this.  And even the non-training things are so much better, like being able to run around at the dog park Sunday morning with my pack of puppies and have dinner with the poet without spending the whole time shifting and wincing and afraid of whether or not I'm going to be able to stand up without pain.  Plenty of people have said to me, you aren't going to be injured forever and while that may be true, that's never how it feels from rock bottom.  (And it really isn't helpful to hear although I can appreciate the positive intent behind it so maybe it is actually helpful after all).  Even as I start to look forward, though, the things that I can't wait to do have nothing to do with racing.  Swimming with my friends this morning, cracking jokes and making sure no one said fuck before 7am because that's the only rule of masters, having to grit down a little out of fear of getting lapped and thank god the longest interval we did was a 400 or I would have, that's the best and happiest I've felt across anything related to swim/bike/run in such a long time.  Watching the miles split on my watch (and decouple like crazy due to my paper-thin fitness) on Sunday night, it felt scary, like I was waiting for the other shoe to drop, but also amazing.  Even realizing how out of shape I am doesn't bother me, it thrills me because it means that the pain has receded enough that I am thinking about fitness again and not how long until I end up back on the couch.  And I'm so thankful.  To be able to move my body, to be able to go searching for (and quickly find) the limits of my fitness, and to be feeling like I am heading in the right direction, finally.  Onwards.  

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.