Tuesday, January 28, 2014

Bone Scan, AlterG, & Future Trail Adventures

So last Wednesday I went in for a bone scan to determine whether the doctor's (and my) suspicions were correct & I was dealing with a stress fracture in my left fibula. If you've never had a bone scan before, it's pretty cool. First, you get an injection of Technetium-99m, which is a radioactive isotope that gives off gamma particles. Also in the injection is a bone-binding agent, which will cause the Technetium to bond to bone tissue. When a bone is injured and trying to repair itself, there will be more uptake from blood flow than usual; this area will receive more of the Technetium and the bone binder will help it to "stick."

(Also, if you have a Geiger counter at home, the 2-3 days post-bone scan can be pretty entertaining.)

Right after the injection, the technician will put you in the gamma camera for a Phase 1 scan in order to verify that the tracer is circulating & bonding properly. In some tests, the Phase 1 or 2 scan is the diagnostic one, but if a stress fracture is suspected, you'll have to go wait ~3 hours for your body to fully metabolize the tracer & give it enough time to bond properly to any healing areas. (This is a Phase 3 scan.)

The scan itself takes half an hour to an hour. When you return for the scan, the technician will position you in the camera, and then have you hold completely still for 10-15 minutes while the camera detects the gamma particles emanating from your body. I want to say that the technician said the camera takes ~10 images per second, but because there is so much variation in the radioactivity that's emitted, they record say twelve minutes' worth, then "stack" or average the hundreds of images to construct a more accurate picture of what's happening.

There's nothing painful about it except getting the shot (which looks a lot scarier than it is since the cannister is covered in a larger, lead cannister to protect the technicians); for me, the hardest part was holding completely still in one position for twelve minutes, and then another position for eight more minutes. They turned the monitor to where I could see it, but the images are so grainy that it was hard to make out much. These were also in color with all sorts of black and white and gray and red and orange and yellow dots, so I really had no idea what I was looking at.

My doctor was on vacation until Monday, but when he released the report that morning, the results were pretty clear, even to me:

The bright white patch on the little bone? Stress fracture.

When I saw the doctor that afternoon, he didn't have much to add. No question about the diagnosis. No, they have no idea what caused it. No, there's nothing to do but stay off of it. (He did echo RoadBunner's creed that bones heal 100%.)

It happens occasionally that I go to doctors and only realize much later that I'm unclear about something or think of questions I wish I'd thought to ask. Initially he said after about six more weeks I could start trying some short, easy runs and see how it felt. When I reminded him that I'd already been off of it for five weeks, he kind of did this half-shrug-sigh & pointed out that it was still showing up white-hot on the bone scan and I've still had some achey-ness after ~2 hours of walking, which are both signs that there is still a lot of healing to do.

"But the good news is that you can do anything low impact. Biking, elliptical, swimming, all of that is fine," he continued. "At this point it will all be symptom-driven. If it doesn't hurt, it's not doing any damage." The question I wish I'd thought to ask is if running for a few minutes at a time didn't hurt in say, 3-4 weeks, does that mean it would be okay?

(Obviously I'm not going to try to run on it any time soon. Not until all of the aching & tenderness is completely gone. But from everything I've read 11 weeks seems excessive.)

On Thursday I went to see my PT & updated him re: visiting the sports doc / orthopedic / stress fracture / bone scan / etc. He did some more work on my left calf & said he would not be surprised if the primary issue was the tight knotted-up-ness of my calf muscles, and that had led to a strain, which had in turn led to the stress fracture. So, in his opinion, the best way to prevent a repeat is, just as with my hip flexors & quads, to stretch stretch stretch and roll baby roll.

We talked a little bit about the prognosis, which just depressed me, and about how I'd been doing what I could on the bike & elliptical. Then he gave me a sad, pitiful look.

"Would it make you feel better if I let you run on the AlterG for like 20 minutes?"

I could have cried. That pretty much made my day.

If you have never had the experience of running on an AlterG treadmill, I encourage you to take the chance if you ever get it. Basically it lets you run at a given percentage of your body weight (which you can set) so that you can get the cardio, neuromuscular, form, etc. benefits without the impact. First, you put on a pair of super-tight neoprene shorts with a kind of hoop around the waist with a zipper attached:

Then you climb into the treadmill, which is like a regular treadmill except sort of encased in a giant bubble with a circular opening in the top. You step through the opening, and then the zipper on the shorts zips you into the opening.

First the treadmill weighs you & calibrates; then you enter the percent body weight you want. (I was doing 50%.) The air-tight compartment around you inflates accordingly, causing the neoprene shorts to lift your body ever so subtly so that they are supporting part of your weight. At first, this feels kind of like walking on the moon--you can take giant, leaping steps & feel like you're just floating through the air. Just like a regular treadmill, you can adjust the speed & incline.

After a few minutes on the AlterG, I noticed a few things. First, when you're only supporting a portion of your body weight, you can run STUPID fast. I found I could run at 5K pace & barely breathe hard. Second, the lack of impact made it really easy to focus on form stuff--I could really pay attention to leaning forward with good posture and using my hamstrings & glutes to get a nice solid follow through with my shin coming all the way to parallel with the ground. Third, there is a camera down on the belt in front of your feet that feeds to a monitor right in front of you so that you can watch what your feet are doing, which also meant I could see how effective my efforts to land more on the inside of the ball of my foot/midfoot were & adjust accordingly. Fourth, I could immediately tell which muscles running uses that spinning & elliptical do not.

Oh my god, I wish I could run on that thing every day. Not only because it would let me do something that more closely resembles training while my leg heals, but because I think it would do wonders for my form and for strengthening the muscles that need the most work. The next time I have $75,000 to blow, that's totally where it's going.

* * *

Grand Total: 55.35 miles

    * 22.25 easy (bike)
    * 4.75 speed (bike)
    * 5.75 tempo (bike)
    * 20.1 elliptical
    * 2.5 AlterG

Monday:

Sick again; lay on the couch / drink tea. God I am so *over* this.

Tuesday:

a.m. elliptical, 5 easy / p.m. elliptical, 2.1 warm up, 4 x (5:00 @ 5K effort / 3:00 easy), 1.85 cool down = 8.5 speed. I find it a lot easier to do speed / tempo workouts on the bike than on the elliptical, but there were no bikes of the brand I like to use available and working and I could not figure out how to use the other brand, so I did the best I could on the elliptical. It worked better than I remembered, actually, but I still prefer the bike.

Wednesday:

a.m. strength work / p.m. 17 bike. Again my preferred bikes were unavailable (HMPH), so finally sucked it up & figured out how to work the other ones. From this, I learned two things:

1) Apparently not all spin bikes are created equal. Both of the two brands have 25 different difficulty levels, but this new kind was definitely WAAAY easier than than ones I usually use. Level 7 on the new bike felt like Level 2 on the old bike, so I upped it until I was getting about the same RPMs at the same level of effort as usual. However, whereas on the old bike this would usually translate into 85-90 Watts, on this new bizarro bike it hung out around 130 Watts the whole time. So either Watts is something different than I thought it was or one of these bikes is broken. Also, where as an hour on the old bike at ~90 RPMs at moderate effort usually gets me ~13-13.5 miles, on the new bike it got me 17. So....yeah. This is why I never trust cardio equipment. It makes no sense to me. Whatever, an hour at moderate effort.

2) The seat. Has sharp ridges on it. Why???? So, so much losing.

Thursday:

a.m. 6.6 elliptical / p.m. 2.5 AlterG.

Legs were tired Thursday morning, but it still ended up being the fastest elliptical session I've ever done, so I'll take it.

Friday:

a.m. strength work / p.m. bike, 3.3 warm up, 3.85 @ marathon effort, 1.9 @ LT effort, 1.95 cool down = 11

Don's parents were in town this weekend, so we spent most of Saturday & Sunday tooling around San Francisco with them & eating fabulous food. On Sunday we spent some time in the Presidio, were I discovered the Presidio Coastal Trail.

If you've ever been injured on the multi-week scale, you know how depressing it is to see people jogging happily along a beautiful trail.

Clearly this warrants some investigation once my leg is better.

14 comments:

  1. All fancy science and technology coolness aside, I'm sorry about the stress fracture. Hopefully knowing is making it a bit easier to handle because now you know that there is an endpoint in sight. And I've been on that trail...quite lovely!

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    1. I'm really looking forward to it! It's motivating me to rest up.

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  2. I think the doctor would have answered your "can I run for a few minutes if it doesn't hurt?" question this way: "Only if it doesn't hurt and you've been pain-free." As for the number of weeks, that can really vary, so I don't know if he'd want to -- or should -- put a specific time limit on it. But you WILL heal, and your return to running WILL be glorious. This I know. Hang in there.

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    1. Thanks! :)

      Yeah, that sounds about right. I feel like another couple of weeks of not trying anything would not be amiss, but if it's totally pain-free after that, I might try a couple of jogs down the track just to see how it's feeling (while also keeping up the spinning / elliptical).

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  3. You have a Geiger counter at home?

    Also, the AlterG is kind of cool and can be fun to mix in with running when you're coming back from a stress fracture/to avoid too much impact. Not that this happened to me. There's places around here that rent them by the hour.

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    1. Oh believe me, I'm definitely thinking about it. I know Presidio Sport & Medicine will sell you 10 half-hour sessions for $200; mainly it's just whether I can justify the cost. I think I'll be able to do at least a little in physical therapy each week, so there's that, at least.

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    2. (Re: Geiger counter, my housemate got it back when people were panicking about the Fukashima disaster irradiating our fish. Happily, we concluded they were perfectly normal.)

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  4. I feel your pain. I know exactly how jealous you can get passing runners when you can't. I have had to stop running a couple of times for a couple of months at a time and knowing that you can't run makes you crave it more than chocolate.

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  5. Sorry to hear about the stress fracture, but glad you've figured out what it is. Sometimes the uncertainty is nearly as bad as the injury. Rest well - eyes on the prize! (The prize being the ability to run those gorgeous trails long-term, of course.)

    Somewhat nerdily: Have you tried your Geiger counter on bananas? On a plane http://xkcd.com/radiation/ :D

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    1. Lol, I forgot about that comic. That would probably be entertaining as well!

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  6. Well, I'm sorry to hear about the stress fracture, but it sounds like you're on your way to total recovery, which is good news!! Plus you got to experience some cool technology along the way - the Alter G sounds awesome.

    I'd love to check out that Presidio Trail - we should add that to our growing Bay Area Trail Exploration list that Cathryn and I have been compiling. :)

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    1. YES! When I'm all healed I really want to go.

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  7. YES to adding the Presidio Trail to our list - it looks wonderful.

    I'm sorry about the stress fracture...that's rubbish but wow, how clearly visible it is on the scans! And I'm also jealous you got to run on the Alter G...this week, that's the third reference I've seen to it and it looks amazing!! Silver linings, eh?

    Heal quickly...we want to run with you x

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