Sunday, February 21, 2010

training 2/21-2/28

2/21- I really was planning on resting for 2 more weeks but I really believe that my Achilles is healed and the prolotherapy has worked. I am getting tested for low testosterone, which is a fairly common problem for someone who has had adrenal fatigue. I feel physically stronger since the initial treatment. Vestavia Mile in 6:49.2 (1:53-1:49-1:47-1:20). The final lap was my fastest 400 of the year and got on my toes without pain. I'm guessing that this would have been 30 seconds faster if I had gone out harder.
Grade:C-/1 credit/distance=1.5

2/22- Veteran's Park 2 untimed at a leisurely pace until a mild kick at the very end. My Achilles held up very well and I actually forgot about that injury. My hip pain was more annoying than usual and the location of the pain was higher on the leg than usual. I wish my next round of prolotherapy was sooner. Until then, I will reduce the taurine and hope that it doesn't make me feel jittery, which it probably will. Maybe the low testosterone is the reason why I am so sensitive to that supplement. The doc did say that it will feel better on some days than others. I can't take this much longer.
Grade:D+/1 credit/distance=2.0

2/23- Planned rest day. Hips are still quite sore.

2/24- Reduced taurine and the hip pain diminished but as expected, I got jittery and had to take some more then felt the hip pain again. It does seem that I am trending back down. Trak Shak 3 in 22:30 (7:30 pace). Splits: 7:48-7:28-7:14. I'll take it.
Grade:C/1 credit/distance=3.0

2/25- Vestavia Mile in 5:56.8 with no trace of Achilles pain. Best time of the year. I am clearly trending down regarding the taurine. I took 1/2 pill less today and still had some hip discomfort. I should do a hair test soon. Splits: 88-93-91-84. Can I run 40 seconds faster this summer?
Grade:C+/2 credits/distance=1.5

2/26-Planned rest day.

2/27- Brownell/Lakeshore run with Scott and Cary. Made it 6.5, which is my longest run since the injury. My injured Achilles was fine. I felt a trace of soreness in my non-injured one. I'm not too worried about it. Even if I do hurt it, I know that prolotherapy will fix it and round 2 is on 3/12 anyway. No taurine today before the run and no ill-effects. Overall pace was on the slow side at 8:14 but the final 1.5 was at 7:20 pace. I'll take it. Felt about average.
Grade:B-/1 credit/distance=6.5

2/28- Planned rest day.

Weekly summary:
On the mend and it sure feels good to be back. It'll be even better if I can somehow get freedom from that taurine. I did order a hair test. No more than 30 next week then Crazy J will be back.
Distance= 14.5/ GPA= 12.3/6= 2.05

Thursday, February 18, 2010

2 days after prolotherapy

Note: This is my my most widely read post on this blog so I want to thank y'all for your interest in the subject. The Achilles was cured within 1 treatment. The groin and hip required several visits because it was long standing low-grade pain but today I declare that to be cured as well. 3 weeks after the initial treatment, I finished the Georgia half marathon in 1:38. As of 2012, my PR is 1:28. I strongly endorse this treatment. My only caution is that hormonal or mineral imbalances may impede the healing process so I encourage testing prior to treatment
Disclaimer: A good doctor can be a great benefit or even a life saver and the prolotherapist that I am seeing is an MD and I trust him.
I posted a message on the subject on RWOL and predictably, it was met with skepticism or no response at all. One person said that it would do as much good as sticking a dry needle into the area. Another said that it is controversial and should only be used as a last resort. I'm sick of all the naysayers and people who are so close-minded regarding any form of alternative medicine.
I once posted a message about neurotransmitter testing to someone who was struggling with depression. Someone with a normal serotonin but low dopamine would not do well on a selective serotonin drug. Another poster replied that what I posted makes no sense. Okay, I suppose that giving a powerful drug to a vulnerable patient without regard his/her brain chemistry makes more sense. Are you kidding me? My friend Noel told me that a mainstream doctor suggested that he take a drug that is intended to boost noradrenaline even though a medical report showed that the level was already too high. He replied:"You guys don't know what you're doing." I'm sure that they really appreciated that. My friend Chase brought his tissue mineral analysis into a doctor's office and was greeted with laughter. Even if you don't agree with that treatment or feel that it is a waste, that type of disrespect really makes my blood boil. It is not only rude and condescending but extremely unprofessional.
As for my decision to go ahead with prolotherapy, I had not exhausted all of my other options with my Achilles. I had seen a podiatrist, who wasted my time and would not listen when I told him repeatedly that his orthotics made the pain worse. I had not tried running with heel seats and had only taken 2 1/2 weeks off before attempting to run again. Shutting it down for another 3-4 weeks may have done the trick but if I could speed the healing and end up less vulnerable to re-injury, I would do it.
As for the groin/hip, I had been to a mainstream doctor who brushed it off as not a big deal. I had taken NSAIDs, amino acids and OTC anti-inflammatories such as boswellian root extract and none were completely effective. Then a medical report showed that inflammation was not a problem for me. So why the heck was it still painful and what else could I do about it? Getting the thyroid/adrenals in balance may help but that's been a difficult battle. Again, the pain was usually mild and could be ignored on the run. Sometimes, it would actually feel better after I got warmed up. However, it was also annoying. Whenever I stretched it, I heard a loud pop or cracking sound and sometimes I would get a brief stabbing pain when I sneezed. Obviously, I wanted to be free from this pain. It probably would never require surgery but could inhibit my running down the road and could progress from merely an annoyance to a lifetime of mild to moderate pain. I could not think of a better option than prolotherapy.
Are there risks involved? No medical procedure is 100% percent guaranteed to be without complications but from what I've read, prolotherapy is among the safest treatments. There is a small risk of hitting a nerve or causing an infection but that happens in about 1 out of 1000 cases and permanent damage is extremely rare. NSAIDs and most other prescriptions have a much higher reported incidence of side effects. If you go to a highly skilled prolotherapist as I did, the risk is almost nill. There were no prolotherapists listed in Alabama but even if there were, I would gladly travel 3 hours to see the best in the field. I've said before that it's over 80% effective but the solution that was used in my case is close to 90% effective and consider that most patients choose prolotherapy only after conservative treatments and even physical therapy has failed. That number would be higher if mild cases were treated.
How am I doing 2 days later?
Pretty good right now. I was limping pretty badly immediately after getting the shots in the groin area but that pain faded within hours. The popping has not stopped but the tissues already feel smoother upon examination and the area seems to be a little stronger overall. More treatments can only mean more improvement. The Achilles felt fine after the shot but the inflammation kicked in and peaked about 12 hours later. I was a bit concerned about that at first but should not have been. Some soreness can persist for up to 5 days. A lack of a strong inflammatory reaction could mean that the body is not able to heal itself. I was limping around the office yesterday but am walking normally now. Tissues that were soft have hardened and thickened nicely. I did some stretching and the injured leg in some ways felt better than the non-injured one. I should not need any more shots in the Achilles. I feel tempted to test it out but will wait as planned until March 6. The first few workouts will be very easy so it will be 4 full weeks since my last semi-quality workout and 7 weeks since the initial injury.
Unfortunately, most insurance plans do not cover this treatment but it is my hope that as it gains popularity, that will change. I read that NFL star Hines Ward had prolotherapy and was very pleased with the result. This blog is just one small attempt to spread the word and I am aware of others with the same purpose. If multiple sessions are required, the cost could be in excess of $1000. It's really a shame that money is preventing some from being free from chronic pain. Fortunately, I am in okay financial shape and my parents would step in if need be and I am grateful. I have offered to help people financially that cannot afford medical treatment and would do it again if the situation presented itself.

Tuesday, February 16, 2010

Initial Prolotherarapy treatment

Sunday was the Mercedes Marathon and I was a spectator, which put me in a foul mood for most of the day. Fortunately, I had something in which to look forward. The next morning, I hit the road for Nashville, TN, which is one of my favorite cities, to see a doctor who has lots of experience with runners who have struggled with chronic pain. Have any of y'all heard of prolotherapy? I didn't think so. Then again, adrenal fatigue is not exactly well understood in the medical community and tests such as neurotransmitter and tissue mineral analysis are almost never done yet are far more effective than conventional treatments. I had heard about it through one of my alternative medicine contacts. Noel from California, a triathlete who is also being treated for adrenal fatigue. He really recommended it. Then a prolotherapy doctor who is also a runner found this blog and made a comment. After that point, I went with my gut. If I tweaked the Achilles tendon again, which I did, I would make the appointment for prolotherapy. Also, I wanted to get my hip/groin area examined. I hurt it when I was 19 and because of the hormonal imbalances (I was hyperthyroid at the time and that condition would worsen in subsequent years), I felt that it never properly healed. The pain was usually about a 2 on a scale of 1-10 and yes, it was there when I set my most recent 13.1 PR of 1:32:57. I could usually feel it during the day but it was never any worse when I ran. Amino acids would help but the fact that it never fully went away made me feel uneasy. I thought that it was an inflammatory condition but my latest medical report proved that it was not. Perhaps it would improve when I got my thyroid/adrenals in balance but that has not been an easy task so I listened to my gut and made the trip up to Nashville.
Monday- I slept in as long as I wanted and would not leave until about 9:30. For breakfast, I simply picked up a Special K protein bar at a gas station in Fultondale (just north of B'ham). From there, it was a smooth ride up I-65 to Nashville. It was in the 30s in B'ham and it would be even colder in Nashville. It never got out of the 20s and there was a couple of inches of snow on the ground when I arrived. As planned, I got there before 1:00 and hoped to have lunch at Nashville most famous bar and grill, the Wild Horse Saloon. Unfortunately, it was closed and I did not have many other options. I ended up going to a basic bar and grill and ordered a beer and a double cheeseburger. The place was almost empty so I chatted with the bartender for a bit then took a short tour of downtown to preview a night of fun after the Country Music half with my friend Nick (I hope). Broadway seems to have a lot of fun spots so I can look forward to that race and man, I better be healthy. For dinner, I stopped at a truck stop stop on the west side of town for fish and fries then headed back to my hotel in Brentwood, about 10 miles south of town and just a few minutes from the doctor's office.
Tuesday- The appointment was at 9:30 and I got there 15 minutes early. So, what is prolotherapy and when is it useful? The short answer is that it is an injection of a special solution into the site of the injury. The contents of the solution vary based on the nature of the injury and the doctor treating it but my doctor most often uses platelet rich plasma. It triggers an inflammatory reaction which "tricks the body" into treating it as if it's another injury, which frequently results in newer and stronger tendons, ligaments and connective tissue. My doctor claims a success rate of over 80%, which is well above the long term success of standard treatments such as NSAIDs, cortisone shots and physical therapy. If the problem is connective tissues, ligaments or degenerative wear on the tendons, not inflammation, it follows that treatments geared toward reducing inflammation will not produce the desired result.
Here are some links of interest:
I probably would not have gone for prolotherapy if I had not injured my Achilles. I found out that Achilles injuries are usually not tendinitis but tendinosis, or micro tears in the tendon which cause degeneration. Still, most Achilles injuries heal on their own through a rest period of 4-6 weeks followed by a gradual build up but there is a higher risk than most injuries that it develops into a chronic condition. Because of my imbalances, I felt that my risk was higher than most. I take Sam-e to fight the low dopamine associated with not running and it helps but I still don't feel as well plus most of my social life revolves around group runs so stopping running is not a good option. The doctor found little tenderness upon examination and gave me a shot in the affected area. I'm not worried at all about the Achilles. Even now, I can handle a 3 mile run. I just can't go longer or run on back to back days. I had planned on resting for another 3 full weeks and my doctor actually cautioned me against resting for too long. He expects that I will have full connective tissue healing within 3-4 weeks and I can and should be running with decent intensity by then. I'll set my comeback date at Saturday March 6 with a gradual buildup.
Sat- 1 mile, Mon- 2, Weds-4, Fri-6, etc.
As for the groin/hip area, the doc found significant tissue damage to the point in which it could develop into a serious degenerative condition if left untreated for a few more years. I will spare my readers the grisly details about getting multiple shots near a very sensitive area but let's say that it was about as painful going to the dentist for a root canal. I asked if the tissue damage could be hurting my performance and the answer was "I would not be surprised." Could I develop into a stronger runner after all of this is over? Only time will tell.
I liked my doctor from the get go and he even prayed for me before he started the treatment. I told him about my adrenal fatigue website and my devotionals and he said the he would "definitely check it out." I hope I can lead other runners to healing and if I do, then missing 2 races is a small price to pay.

Monday, February 8, 2010

training 2/8-2/14 race week after all.. NOT!

2/8- Vestavia Mile. Time was 6:10.5 (best time of the year). Ran in racing flats and had no pain until I got on my toes and tried to sprint home. The pain went away as soon as I went back to flat footed running. Again, I will not yet declare myself healthy but I am optimistic this time around.
Splits: 1:32-1:35-1:33-1:30.
Grade:C+/1 credit/distance=1.5

2/9- Veterans Park 4 in 29:19 (7:20 pace). Ran in my normal training shoes without orthotics. I had no trace of tarsal tunnel pain and minimal Achilles pain. Faded badly in the 2nd half. Splits were 14:15-15:04. That's still 18 seconds per mile better than last week. Can I hold up for another 9 miles? I don't know. We'll see how the rest of the week goes. I will come to a "go/no go" decision by Friday.
Grade:C/2 credits/distance=4.0

2/10- Trak Shak 3.5 in 27:35 (7:53 pace). I slowed down today but it wasn't enough. I felt the pain towards the end of Mile 3 and it gradually got worse so I shut it down and completed the demoralizing 1.5 mile walk back. I am out for Mercedes and Atlanta is questionable. Groin was sore as well. I'm going for prolotherapy in Nashville on Tuesday.
Grade:F+/1 credit/distance=3.5

2/11- Planned rest day

2/12- Unplanned rest day.
Grade:F/1 credit/distance=0

2/13- Rest day before my scheduled marathon PR attempt. I would have broken 3:25. What a bust! I did get some new orthotics at the expo. They're not custom made but supposedly suitable for my foot type. Hopefully, they will do. A podiatrist is liable to tell me to use his orthotics even though I will tell him explicitly that they won't work. Not a total waste.

2/14- Mercedes Marathon- 2nd DNS in as many races. It's bad enough that I'm lonely on this day. This is a double whammy.
Grade:F/4 credits/distance=0

Weekly summary:
I hardly overdid it on the training. My body has failed me again. What a roller coaster! After Monday, I felt vindicated then got knocked down again. Regardless of whether the orthotics played a role in the AT or not, I have to deal with this injury. I will post a report on prolotherapy next week but there will be no more training log posts for another 4 weeks regardless of the outcome. After that point, I have 2 weeks to get ready to suck in Atlanta but I just want to participate. I don't care if it takes me 2 hours to finish as long as it is injury free.
Distance= 9.0/ GPA= 6.6/9= 0.73

Rant: Visit to podiatrist

One thing about which I can be proud is that I do not give up easily. Anyone who knows me will attest to that fact. This episode is no exception. When I am faced with certain symptoms, I spend hours online doing research in search of the answer and this research will continue no matter how long it takes until the problem is solved. Some people say that there is no way that anyone who has had adrenal fatigue can finish a marathon let alone run one in 3:35. I am living proof that it is possible.
Back in 2001, I was diagnosed with tarsal tunnel syndrome, an irritation of the post tibial nerve, by a bone and joint surgeon. My symptoms including numbness, burning, tingling and worse, shooting pain in the area between my ankle bone and achilles tendon. It was the official end to my days as a competitor in my first running life. More than a year later, my continued research led me to believe that my taking Synthroid, which I never should have been prescribed, was a major contributing factor to my development of TTS. I proved to be right. Fortunately, thanks to custom made orthotics and reduced mileage, I was able to continue running. Once I began treating my adrenals, my connective tissue healing improved and I had no significant problems with TTS from 2004-2009 despite the fact that my mileage was higher than ever in '09. I did continue wearing the orthotics as a precaution and found that I might have a mild flare up if I went too long without using the orthotics. Usually, I wore orthotics on my long runs and weekday easy runs. For speed workouts, races and some tempo runs, I opted for racing flats with no orthotics.
Unfortunately, the man who designed my first orthotics went out of business in 2008 so on the advice of a coworker, I went to a local podiatrist who designed a new pair of orthotics made with a material that was harder and more rigid than my old pair. Until about a month ago, I did not have any real problems. When my TTS flared up, I initially wrote it off as being related to my hyperthyroid condition. Maybe it did play a role but my current thyroid function is not half as bad as it was when I was on Synthroid. You know the rest. A few days later, I went down with an Achilles tendon injury. I wondered if the conditions were inter-related.
About 3 weeks after I began researching Achilles tendon injuries and tarsal tunnel syndrome, I finally came across something that was intriguing about TTS. An article stated that yes, orthotics are recommend as a treatment for TTS BUT you may develop TTS by using the wrong type of orthotics, particularly those which are hard and rigid rather than soft and flexible! Bingo! That makes a lot of sense to me. On my first run back, I ran a mile in racing flats with no orthotics with a last 200 at sub-6:00 pace without any significant pain. The next day, I wore the orthotics on a 4 mile Trak Shak run. The TTS flared up in Mile 2 and it wasn't long until I felt some Achilles pain as well. True, 4 miles is a lot harder on the body than 1 mile but on the Trak Shak run, I never ran faster than a 7:20 pace at any time on the course.
Today, I went down to Monty to see the podiatrist in hopes of getting some answers. I had to wait an hour to see him then he told me that under Alabama law, he is not allowed to examine my Achilles tendon. I'll let my readers choose the properly offensive adjective to describe that policy. Yes, I did say that the Achilles was the problem when I scheduled the appointment so the doctor essentially wasted my time and charged me $30. He also that the orthotics were still good!!?? If I can handle a longer run with the racing flats, that will vindicate me. I asked him if there is a chance that the TTS contributed to my strained Achilles. He replied that it is possible just as I suspected. I may have altered my running gait to minimize my TTS pain, which may have put extra stress on my AT. In short, the whole point of this post is that this injury may never have happened if I was given proper orthotics. I am angry as I should be. Good doctors do exist but they sure are hard to find. This is not the first time that I've been burned by a doctor on a matter directly related to my running. I once had a stress fracture misdiagnosed as shin splints despite the fact that I had clear symptoms of a fracture including a lump that was painful to the touch. I was told to start again gradually and turned a 6 week injury into a 3 month layoff.
I will try not to dwell on this. I am happy that I may be able to salvage a racing season this Spring after all. I won't do well at Mercedes but just finishing will be a major victory. I should do fairly well in Atlanta then by the time Nashville rolls around, I could be back to PR shape. By Wednesday, I will be back to running moderate mileage. Despite my nearly painless 6:10 mile tonight, I will not declare victory yet but it sure is looking better than it was 5 days ago.

Monday, February 1, 2010

Rehab 2/1-2/7

2/1- Slight discomfort when walking for the first time in more than a week. Did my normal stretches and it felt about the same. It looks iffy that my next attempt to run will be successful. I am worried that my imbalances will impede my tendon and connective tissue healing. No running today. Tomorrow will be no more than 1 mile very easy.
Grade:F/1 credit/distance=0

2/2- Vestavia Mile. I ran this faster than I planned. Time was 6:43.9, which is about 90 seconds slower than my goal. The good news is that my Achilles held up during the run and the cool down. My groin was sore during the run but I know that's a symptom of low adrenaline levels, not an injury. Splits: 1:43-1:46-1:42-1:32. That's a new 2010 best for the Mile. I did have minimal pain just after I finished so it's too soon to declare myself healthy. I will continue my stretching exercises. The pace will be slower tomorrow. It will be a Trak Shak run but I am unsure of the distance. My dopamine is rising and that sure feels good.
Grade:C-/1 credit/distance=1.5

2/3- Trak Shak 4 in 30:32 (7:38 pace). I felt great in the first mile then it was downhill from there. 1st half @ 7:27, 2nd half @ 7:49. I felt my first trace of achilles pain around Mile 1.5 but it never got any worse. If I keep building gradually and keep doing my exercises, my achilles might be okay. The tarsal tunnel pain was a different story. It was much worse and I really don't have any explanation. This injury hasn't given me any serious trouble since early 2003. WTH? I will call my podiatrist in Monty tomorrow and hope to get an appointment ASAP. My orthotics are about a year old. We'll see what he says. I'm worried. If this doesn't go away, I will be relegated to being a recreational runner limited to 5Ks and 10Ks.
Grade:D/1 credit/distance=4.0

2/4- Turn for the worse a few hours after the run. The achilles hurts nearly as much as it did when I first hurt it. I am out for a month or more. AAARG! I am getting desperate and will try some ultrasound treatments even if I have to pay through the nose. If I still can't run in a month, I will seriously consider prolotherapy. I am out of Mercedes and Atlanta looks questionable at best.
Grade:F/1 credit/distance=0

2/5-2/7- Disabled list. I need some type of antidepressant to counteract crashing dopamine levels and I'm going with Sam-e, which was effective in the past
Grade: Automatic F.
Weekly summary:
You already know how I feel. I'll post about the doctor's appointment but after that, this blog shuts down until further notice.
Distance=5.5/ GPA= 2.7/6= 0.45 (all time low)

I am going to Monty on Monday to see the podiatrist and we'll see about the prognosis.