Forever Rehab

I am just over a week removed from an accomplishment that I still cannot wrap my head around.  I qualified for the Ironman World Championships in the 70.3 mile distance.  When I first started triathlon about 9 years ago I did so in an attempt to keep myself lean and moving while trying to maintain my competitive drive.   I never imagined that I would have the success that I have had given my spinal fusion.   It is because of this success that I can say (given my make up) that it has all been worth it despite the extra wear and tear.  I can also say that I feel VERY comfortable officially calling it quits for long distance triathlon!

I am also just over a week away from my cervical rhizotomy which will hopefully take the edge off of often debilitating stabbing neck pain and awful tension headaches and migraines.  Also as I very much expected after this last race my low back hardware and low back pain is acting up and cannot be ignored.  If it weren’t for the decades I have been managing and dealing with this pain I would think it unbearable.  It is not though it often feels that way.

I look forward to some modest pain relief, continued focus on exercise and healthy eating while doing a little more reading and possibly writing.   It wouldn’t hurt to be able to continue working as well!  In addition I will have to find other more relatable ways to reach out to the Metal Parts community in order to be a source of encouragement, motivation and perhaps even inspiration to press for living life to it’s fullest despite our limitations.

October, Fall

How?  It seems as if every year the same thing happens.  We work, live, survive and thrive and then SO much time has passed.  Thankfully despite a very difficult year full of highs and lows I find myself feeling very grateful about where we are as of 10/4/2017.  I believe that this is part of how I am able to grind through awful and near debilitating pain on a regular basis: my philosophy regarding how the universe will balance itself out if you allow it.  Whether by practice, experience, genetics or some combination I find that I don’t get either too high or too low.

This approach helps in that when things get really bad I don’t allow myself to ask “why me?” questions or get so bummed out that I go catatonic.  A few months ago a dear aunt was diagnosed with metastatic cancer.  Though I experience death and dying in my medical practice often due to seeing predominantly elderly patients I have yet to experience this type of loss in my personal life (not counting dogs but that is another story).  Then this entire year my neck arthritis, bone spurs and headaches have made it necessary to further reduce my work hours and the number of patients I can see.  I just completed a series of 4 insurance mandated painful test injections in the neck to determine if I should proceed with a nerve burning procedure.  This appears to be happening next month so hope is alive.

Where this approach may be harmful is that I know that I am missing out on some feelings at the extremes that may actually be beneficial.  I am not a crier so I don’t often release pent up feelings or emotions with tears.  I have tended to value this stoicism but it can’t be the only way to handle very low lows.  Also I realized after Ironman Arizona 140.6 in late 2015 that I also don’t experience a lot of joy and jubilation.  As is the case with many of my accomplishments in work life and athletics I have lost the Joy and satisfaction that I should be feeling from what I am still able to do.

This May  I went with my wife and friends for the first time to Utah and Zion for a Ragnar trail race.  The experience was amazing except that the travel was rough and I ended up dislocating my pinkie and it is crooked forever plus I have to relocate it periodically quite painfully.  I then was able to compete in Escape from Alcatraz in June which is a tough race to even get in to.  Last minute they cancelled the swim due to dangerous currents so I did not experience the actual race the way it is designed plus the course is very hilly (San Francisco) and thus, of course, my body took forever to recover.

Gratitude for me comes from knowing that things could always be either better or worse in all areas of life.  I find myself at this time thankful for it being a Wednesday in October where I was able to wake up, work a little, exercise a little, come home early to play with my dogs and then lie down to rest my neck and back so I can have a chance to do it all again tomorrow in pain but alive.  Carry on.

Endorphins vs Chonic Pain

I,  by pure luck, ran into a local triathlon legend at the LA Fitness near my house.  I had planned to go to our community pool but when I saw the traffic in the swim lanes I detoured to LA Fitness.  It was a great mental boost coming off of months of dealing with fibromyalgia pain, my worse than expected dislocated but ‘healed’ pinkie, my cervical spine spurs and a worsening low back.  Thank God that my headaches have been a minor issue for months.  This guy and I started in triathlon around the same time 7 ish years ago but he was BUILT for it and he trains like an animal.  He qualified and is racing at the WORLD Championships in KONA this October.  I felt the adrenalin kick in as I was racing in the lane next to him.  Felt as amazing as swimming can to me.   We had a quick but per usual good chat about our days.  It amazes me when people can be as busy as he is with work and with training PLUS with children.  Great parents get much respect from this childless gentleman.

I am taking it as a good sign as also today I had already decided to jump into week 5 of a training plan for Ironman Arizona 70.3 in October.  I can’t follow any training plan due to my issues but it is a nice distance guide on what I should be trying to do.  We’ll see. . .

Once the endorphins wear off of a great exercise session it is usually a matter of hours before my body reminds me of everything I already know but try to forget often.  On the horizon (in one week) is a diagnostic neck injection called a medial branch block that will determine if I am eligible to get a nerve burning procedure called a rhizotomy.  I still have to ask this Dr. that IF it goes well if he thinks it is even safe (just for my neck) to pursue racing in the fall.   If I were superstitious I would cross my fingers.

Happy work and survival week to everyone

44th birthday

This long overdue post is not really about my birthday.  I tend to forget about them and lately find myself wondering about what I have YET to accomplish as another year goes by.  The truth is I have been in survival mode for years and each year brings a new set of. . .well I guess i’ll call them challenges.   One can also call them obstacles or hiccups.    Further one can go more negative and refer to them as trials and tribulations , or disabling life circumstances.  None of these is inherently wrong and there is overlap between all of them.  However one of the ways I have survived while at times thriving is by attitude and gratitude and by not trending towards the negative.

I will admit that these past few months have been some of my darkest in years and I fully realized that I was leaning towards going more negative than I generally like to.  I always feel grateful but as my pain issues affected my activity and ability to work in new ways my attitude has turned to crap.  I say all the time that motivation and inspiration is all around us and despite my pain and limitations I tend to find it.  This past weekend however in the midst of my own darkness I was able to exchange a few text words with someone who is newly spinally fused.  These days are also dark for different reasons than having lived with two fusions for over 15 years.  At this point in my life I KNOW what i am still capable of and of what i have been able to accomplish with spinal fusions and all the other musculoskeletal sequelae that have developed over the years.  After chatting with this gentleman and thinking back on when I was 4 months post op (both times) I quickly remembered why I started Metal Parts Life.

My entire goal with the project was not to sell shirts or caps but to create a symbol that represented hope and create some inspiration for injured, reconstructed, older, surgically repaired people.  I always thought my way to inspire was through sports and competition and by being able to do things that I should not be able to.  However I forget often that it is also about managing the pain and limitations while maintaining relationships, working, living life in all the other ways we are supposed to.  This man’s concern rightfully so was about healing enough just to get back to work which I have no doubts he will.  It just takes a mindset that calls for more toughness than most people believe they have.

I found the spark I needed in this recent exchange and hope that I can again create some momentum for myself and then for others.

Efficiency arrested

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.

Metal Parts Life

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.

Carry on

 

still 2016 with Pain but also with Hope

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.

A PAINFUL realization

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

 

Change in Philosophy. . . Maybe

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

 

42.5

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.