I have found myself revealing to my patients more often that I have had two spinal fusions and that I have significant daily pain and limitations. I used to be quite selective about when I would share this and at some point this year it started to become more of a part of how I practice medicine. It seems that prior to this year (and quite possibly 2015) I was still deluding myself into thinking and feeling that if I pretended to be in less distress on a day to day basis that my mind and body would follow suit. . . that I would be able to feel more normal more often than I do and thus be able to do ,with the same injuries, what I could do in my 30s. This used to work better than it has in recent years. The simple reason is twofold:
1) The non patient care demands of my chosen profession are larger. I find myself sitting in front of a computer clicking away due to governmental and insurance ‘rules’ and mandates that have close to zero benefit on the work I do in front of living people. One of my migraine triggers is sitting: in the car driving, at home too upright, at the office in my work chair, sitting in meetings or conferences. I simply will not compromise my work any more than I have by adding more non patient care computer work. I have also started to communicate more with patients (vent) about what we are being asked to do by people we do not technically work for. For example it takes 12-14 clicks on the computer to simply print out a Shingles vaccine prescription. Ridiculous.
2) I am feeling my own morbidity, recognizing it more realistically and feel VERY tired. Even the daily pain in my neck and back is wearing away what I consider life-years that I may have remaining. In addition in the past few years the migraines and headaches have really taken a toll much like concussions do (I have had 5 of those as well during my athletic endeavors). I don’t know if I am not as tough as I used to be or if what I am going through is a natural consequence of beating up my body with my work and training trying to stay in shape.
As a result my day to day life is a series of inefficient behaviors and maneuvers. Folding clothes to help my back at full time work spouse is torture. Sweeping the patio or indoors is another simple task that cannot perform without either a headache or stiff neck as a consequence. All of it is tending to lead me to being more angry, frustrated and negative. I am going to focus in these next two months on staying grateful, positive and thankful. It has worked for years and I hope to squeeze more functional time out of it.
After a few years we think we are ready to push towards marketing our Brand to our target audience. This is new territory for us but are hopeful that what we are doing will resonate with spinal fusion survivors, older athletes, joint replacement patients, ex military. . . Thus far we have just been trying to build the foundation and continue living the lifestyle which is about pushing past your boundaries and not letting aftermarket body parts (Metal Parts) create more restrictions than necessary.
We finally identified 3 local folks to be ‘brand ambassadors’ so to speak. One has a spinal fusion from an accident suffered in the military. One lady is a scoliosis spinal fusion survivor who is very athletic and the last lady has a prosthetic leg and competes triathlon! Amazing people and our target for sure. We’ll see what happens! ! !
Hoping we can reach enough people to start a word of mouth grass roots type campaign.
I said last post that this year has felt so long. Most years seem to zip by so fast that there is barely enough time to realize all that has happened. There is still over 1/3 of the year left and there are SO many events, activities and plans for the rest of the year so why I am I literally dreading most of it? Is it because my back and body are trying to tell me things that may no longer be prudent to ignore? Stewing about this too much has never worked for me and it when I start to stagnate so. . .
Two weeks ago we bought some new furniture since we hadn’t done so in over 13 years. The first week of moving, rearranging, organizing etc. wasn’t too bad. Then all of a sudden I remembered why those simple types of activities really upset my back. This time it was my mid back with some of the worst pain and spasm I have had in years. No missed work but I did have an afternoon where I needed help in the pm with a few patients. It doesn’t happen often especially since I have cut back my schedule but when it does it is very embarrassing for me. Mix in having to take time away from exercise, race preparation and general movement and my moods start to suffer. Instead of getting down about it I seem to be getting more angry. . . at a lot of things. I have to figure out why. To compound this someone who I am in no way close to but familiar with said something to me I believe in jest that really pissed me off. We aren’t friends but she got too familiar with a flippant comment and called me an a/xhole. Still deciding where to go with this since it came of left field.
This past weekend I went on a trail run with a great friend, just 9 miles with some climbing and rocky terrain for only the 2nd time ever at this level. The first time I went with him I was in no way ready and hurt myself quite a bit. This time with a bit more preparation, a much smarter pacing strategy and better foot striking on sharp rocks I was feeling amazing. Six plus miles in on the way back down and my left foot drop finally reared it’s head. I clipped a rock, fell hard hurting my left knee, aggravating my SC shoulder joint and bad left ankle. I shook it off, kept going but much slower and proceeded to continue falling and tripping, kicking rocks and punching a cholla. A got a big gash on my left knee and thus cannot swim ’til it heals, I am not sure if I can bike and running sounds painful for the next few days. I happen to have had family in from LA and we had a great though short visit which kept me from getting too down Sunday after the run. They are safely back home in L.A.
Today as I lay here working remotely, doing some honey dos as my wife is at work and catching up on sports talk shows I don’t feel angry. I feel oddly optimistic despite feeling so achy and despite the fact that I just realized I also bruised my ribs! Oy. There is a busy week ahead, time with friends and my lovely spouse’s birthday coming up so NO time for a pity party or even for anger. I don’t know if I will be able to even attempt the rest of my ’16 race goals but in all honesty they are a bit too lofty anyway. I am ok with that and look forward to the rest of today and the coming fall and winter. Survive then Thrive if you’re lucky and keep pressing.
This 1/2 year has felt like 1 1/2. It started with the Migraine month of January where I had ZERO headache free days into a point early in the year and a decision to cut my patient schedule way down to essentially 3.5 days. I ended up in a new specialist’s office for a timely set of injections for. . . wait for it. . . occipital neuritis, cervical disc degeneration with end plate sclerosis (neck arthritis) and horrible muscle spasm contributing to migraines. There is another diagnosis I have that I have known about for a few years but that I had not really had time to digest emotionally.
I walked into one of my Rheumatology appointments a few years ago and was chatting with my Dr. I had not been feeling amazing and was exceedingly tired so in addition to finding out I had Valley Fever from a backyard project that kicked up a lot of dirt I was told that I had Fibromyalgia. Literally “fuck off” almost came out of my mouth due to the shock. We talked about it, I shrugged it off and went home. . . on the drive home however it hit me that she was exactly right. The burning pain in my neck, back, hip, quads. . . literally ALL the muscles on a bad day was from this very problem. Start with a few childhood traumas no one knows about, add a few early adulthood ones and then the lost battle with the tree where I broke my back and there it was.
I won’t go into it in detail but Fibromyalgia is a chronic nerve pain condition that also is typically associated with trauma, severe fatigue, insomnia, muscle aches and the deep burning pain that is the hallmark. I always figured it was my normal for the #spinalfusion X 2 and the training and exercise I make myself do. It probably contributes as another common symptom is a crash after overdoing certain activities. Anyhoo. . .
Half the year is almost gone. I have a race this weekend and am in cram mode trying to get ready. I need one of those weeks where I Survive AND Thrive so here we go. Looking to make the 2nd half of the year more about outreach to my pain and joint replacement community and to try to push the Brand for Injured Athletes. This stuff is hard!
#injuredathletes #chronicpain #Fibromyalgia #smallbusiness #CarpeVitae #triathlon #running #swimming
I have been at this stage before, many times in fact but usually am able to move on and keep pressing. The stage I refer to is having to recover from a relatively short stressor to my back, neck etc and wondering if I am going about it the right way. The stressor was a short trip to New Orleans for 2 days of the Jazz and Heritage Festival (4 days total). We did this 3 years ago with friends and the traveling was not miserable. This year unfortunately it was.
Sitting too long, standing too long and not being able to lie down when my neck starts to warn me of an impending migraine is generally a bad idea. I did get a few moderate headaches but the main issue was near debilitating pain in the low back and upper mid back after the 2nd Festival day. I am nursing some type of tendonitis in my foot I presume from running so I have not been able to run or keep my body loose with exercise so I believe this to be part of the problem. We ate and drank too much as we expected but after a long night’s sleep and a nap my body is trying to tell me that I have to change some things. I was fully expecting to be able to ride, lift or do something active today and I have only been able to lie around. I am not used to it and really have to wait until tomorrow when I go back to work to see what I am going to get.
Rest, more recovery and not stressing about the inevitable weight gain is going to have to be something I am more OK with than I have in the past. . . maybe. My goal for the rest of the day is to not fret or beat myself up over it and make sure I also get sleep tonight so I can be sharp for work tomorrow.
On a brighter note before we left for the trip I did have a patient of mine who was 3 months post hip replacement. He also has pretty significant lower back arthritis and pain and I was worried about how he would be doing. He told me that he was motivated by my story and decided that he was not going to let pain ruin his life. He has a new relationship with it and had a completely different attitude about what it meant for him and about how he would deal with bad days. #littlevictories
I look at my age and two things enter my mind. 1. I have been blessed enough to experience a lot both good and bad. Four decades plus is a lot of time to make mistakes, learn from them and hopefully learn also how to enjoy the life one has. 2. 42 is really not that old. While I say away from ‘why me?’ type thinking as it relates to the chronic pain more time is spent wondering how long it can be kept up. It does get difficult to make many long term plans when the struggle really requires literally ‘one day at a time’. . .some days a few hours at a time.
Due to the severity of the migraines I had to reduce my work hours. I am somewhere between 2/3 and 3/4 time I would say seeing patients in my practice. While it will lead to a big hit in the budget I am able to survive the days with more ease. I am able to manage migraines without feeling the pressure of falling further behind and also I am feeling less dread about the pain and headaches that are sure to come. Only this year have I realized how much torment the anticipation of feeling horrible later in the day was causing.
Thankfully the lovely wife has taken it upon herself to go back to work full time. Her benefits situation is GREAT compared to my own I just found out about it so that is also a stress reliever. Adjusting to having her around less to handle all that needs to be handled with Metal Parts Life and our doggies hasn’t been miserable. Gotta roll with the changes.
As for racing. . . has been a great year though this past weekend I got lost on a trail race. I fell (per usual due to drop foot) and scraped myself up pretty good and strained the hardware in the low back. Trail running due to the dust (asthma and chronic allergies) the terrain and frequent falls my NOT be in my best interests. It is tough because I love trail running more than I think everything else other than basketball. . . 42.5 is great but I have to be smarter still.
2016 has been thus far ROUGH. A cold sandwiched between horrible headaches from my neck arthritis problem has made it a challenge just to function. Exercise, running, athletics have been de prioritized by necessity. Per usual the less I move the more the Spinal Fusion and back pain problem becomes. Nothing new for day to day, week to week life but headaches of this nature present a completely unique set of challenges. Since 2014 and 2015 were filled with migraine days this is also not new. However (unlike my spinal pain issues) migraines are not something I am finding one can get used to and deal with as effectively.
Having said that I still was able to press to get in (in the month of January) 88 bike miles, 34 run miles, some weight lifting and even an hour long heavily taped and protected half court basketball session. The latter felt amazing but the adrenaline high was too short lived and tweaked other joints that have been conditioned for straight line movement of triathlon for a few years. February has arrived and it is time to survive and plan for another month. I just realized that a month’s worth of planning is better than day to day or week to week as it FEELS less about survival and more about management without the guilt of looking too far ahead. . . I am going with this and suddenly FEEL energized about having a better less painful and higher functioning month than I just had.
Dewit. #injuredathletes #olderathletes #migraines #spinalfusion
As I sit here 3 weeks after Ironman Arizona dealing with the injuries, pain and fallout I realize it is well into December. If we’re lucky we’ll make it to the end of the year to take stock of how it went. I won’t commit to a full assessment yet but I will say that like most others being alive, being active and managing my pain while being able to work and take care of my responsibilities is something to be grateful for. As cliché as it sounds (it is) I really don’t want to lose my sense of gratitude.
I see my Orthopedic today since my ‘good’ ankle is not really improving at the rate I am accustomed to. Is it the sheer wear from the distance? Is it that I am 42 and I better just get used to healing slower? Is it because I am pushing a bit too hard because it was I am used to from dealing with my back pain and fusion issues? Probably some of each. I went into IMAZ knowing that there would be fallout and I HOPE that nothing is permanent. We’ll see. . .
Everyone out there getting older but still needing to move you have to listen to your body, learn how your body is changing and know the difference between simple pain from life VS pain from an injury.
Long story short, we did it. After 13 hours, 6 plus minutes of survival/racing I can call myself an Ironman. The weeks leading up to the event were a mixed bag of all kinds of feelings and circumstances. I was grateful that the migraines were under decent control. I was worried that 3 weeks of relative rest and making sure I wasn’t hurt going into the event would not lead to being unprepared. A friend who I had just ridden with on my 1st ever century ride ended up having a massive stroke later that week and is in a brand new race to recover strength and speech. Another acquaintance from my running group died from cancer. Our best couple friends got a divorce. . . lots of stuff. Thankfully I was able to also feel optimism that after a full year of waiting and training that the opportunity was present to complete a once in a lifetime accomplishment.
The previous weekend I spent with at the time relative strangers camping and participating in my 1st Ragnar Trail Run. What a great experience it was and despite knowing now that it sapped much needed strength from my legs from Ironman I wouldn’t have changed a thing. I had agreed to do the trail race when I was very much struggling with my back and migraines and I figured that Ironman was really not possible. I somehow did both and I really cannot explain it other than I am blessed with rapid healing and know that God watches over me more than I deserve.
Several other friends also completed Ironman and MANY friends actually came out to cheer on a cold, rainy day which made the race even tougher. Thoughts of them and my other friends and family supporting online was integral to keep pushing this beat up, reconstructed body to finish. Despite cancelling our trip to Vegas to nurse to my wounds and staycation at home I am feeling settled and satisfied. I can’t however say that I feel accomplished or that I did anything ‘special’ and I cannot really explain that. My best guess is that I generally have to set expectations for myself that are beyond what my pain levels and injuries would otherwise allow or else I stagnate and end up feeling MORE tired, have MORE pain and start to feel unproductive. Fourteen years after my spine saving 1st fusion and 12 years on my 2nd and hopefully last set of fusion hardware it is working. It won’t last so I will try to enjoy and appreciate the now.
2 or so weeks ago I committed to a mindset of no negativity as it related to my pain, the training and the work that had to be done to get my battered reconstructed body ready for a full Ironman. It has helped me embrace a new level of discomfort which I think will help me if I make it into my 50s, 60s etc. I have several patients who I understand a little better after realizing how LONG they have been dealing with pain issues that I have only had to deal with a relatively short time (as long as lifespan is concerned). Anyhoo. . .
I was able to get through my longest ever swim during the week, my 1st Century bike ride (100miles) and then run 4 miles right after on Saturday, then a Personal Record 18.25 miles run on Sunday. . . Monday (today) sucks major arse but I have committed to just lay around, doing some light honeydoos while Mrs Metal Parts works all day and of course work remotely from home. I hope tomorrow will be a little better as I have to get back to my busy clinic. There are less than 3 weeks to go to a true test and hopefully a successful attempt at this 140.6 mile Ironman Arizona. Wish me luck ya’ll and support friends and family who are battling their own obstacles but want to be more active.