Surgery Consult

Dr DSO, who did a minor and totally successful outpatient surgery on me 10 years ago. Go to a surgeon, and she’ll recommend surgery, right? Not if it’s a surgery that she doesn’t perform. The scheduler had assured me that Dr DSO does hernia surgeries, and she does, but not on a “sports” hernia, which is not really a hernia but a muscle pull, technically an "abdominal wall strain."

This requires a laparoscopic procedure, she believes, because it doesn’t make sense to cut through the strained muscles in an effort to strengthen them. She does laparoscopic surgery but not on the abdomen - she doesn’t believe in that treatment for an abdominal wall pull at all, and in fact doesn’t think it has a high success rate. Mine, in particular, is high on the lower abdomen, making such a repair even less appropriate. Huh.

She advised:

• Continue the physical therapy that I’m currently getting.
  
• Warm up properly before any run. I usually do warm up before a short race, though not for a marathon.
  
• Stretch properly after a run. I do my set of stretches frequently, if not after every run, but until recently I haven’t done a stretch that works the lower abdomen at all. She mentioned yoga.
  
• This particular injury is unlikely to turn into a real hernia or any other major problem, regardless how much it hurts. So just SUCK IT UP and run! She didn’t say it exactly that way. Good to know, though.

That is one surgeon’s opinion. The buzz in the runner community is that a surgical repair is simple and permanent, though, so I may see another surgeon and get a second opinion from someone who actually does them, like maybe the surgeon that my sports doctor recommended!

Maplewood Mall again today, the third time in four days. We three walked 4.5 miles in 1:04:30, for a pace of 14:20. No pains! Nothing more than a hint of the abdominal wall strain and the hip-flexor pain. Maybe this upcoming marathon will be OK. We’ll go to the mall again tomorrow if the weather permits. No running until the race, though, just walking. Fast is fine.

What a way to train for a marathon - yikes.

There is oatmeal under there:

More Hope

Again today we walked in Maplewood Mall. The doors open at 8 am, or a little after, but the stores don’t open until 10 am, and during that time we walkers pretty much have the place to ourselves. We walked for an hour at a pace of 4 mph, or 15 minutes/mile, speed confirmed by another frequent-walker who has the place all measured out. 60 minutes = 4 miles.

Last Thursday and again last Saturday I did the same walk and felt a serious pain in the right hip flexors, but today that pain appeared later and was minor. That gives more hope for finishing the upcoming Annapolis Marathon. I did feel the sports hernia just a little, but it wasn’t bad at all. We’ll go to the mall again tomorrow. Wednesday would be better, but the weatherman is cooking up a storm for Wednesday. Also tomorrow, I have a surgical consult regarding the sports hernia.

Snow is coming. Or slush, maybe. Anyway I love it. With a forecast like that I know what my exercise program will be for Wednesday.

A Better Walk Today

Two days ago I walked in a soccer dome and had significant hip-flexor pain on the same side as the sports hernia. Today we walked at Maplewood Mall, actually a lot nicer for walking than the soccer dome, though maybe a bit too civilized for running.

Anyway, we walked for 60 minutes, the same amount of time as two days ago, and we probably went a little faster, but the pain was less. It started after about 30 minutes, as before, and increased steadily for a mile or so, but then didn’t get any worse. In fact, it might have been a little less at the end than it was a mile before. Still only four miles, way shy of a marathon, but it’s a little ray of hope.

Peaches, cherries, blueberries, strawberries, all organic and all frozen. Organic walnuts and yogurt, on top of gluten-free oatmeal:

Mississippi Blues Marathon Has Great Age-Group Awards!

Friday, February 24, 2012:

I received mine today - third of eight in 70-74. It’s a little smaller in diameter than a DVD, but a quarter of an inch thick, solid metal, with my name, the award, my time, race name, and everything on the face. It weighs three quarters of a pound! There was no awards ceremony - they mailed ‘em out. That’s a good way to do it.

I used the elliptical machine today, maximum resistance, 27:14 minutes, 404 calories, 68 RPM. I found this a little harder than usual, I think because I did the elliptical after an hour and a quarter of core and upper-body resistance training. So I stopped the elliptical at 400 calories - enough for the day. Now weary, showered, and ready for bed - I love that feeling.

Thursday, February 23:

We three went to the Stillwater Bubble, where we walked together for an hour, at a fairly brisk pace but probably not quite as fast as 15 minutes per mile. The good news is that the abdominal wall strain (sports hernia) didn’t bother much. That’s no real surprise, though, because it usually hurts only when I’m running. The bad news is that the hip flexors on that side did hurt, quite a bit toward the end. That’s not a good sign, with a marathon only 10 days away. Only 3.5 miles or so, and I couldn't even travel at the slowest-allowed marathon pace of 13:44. I’m just a little concerned.

So what’s happening to the hip flexors? My theory: The abdominal wall is healing, and despite my regular stretching, it's tightening up a bit as it heals. Then, as I walk, it pulls the hip flexors a bit farther than it used to do. I’ve changed the stretch to include the hip flexors as well as the abdominal wall. I hope that works.

Runner Seeks Experienced Hernia Repair Surgeon

Really. I've lived with the sports hernia (Abdominal wall strain) since last August, and I hate not being able to really run. I can do marathons because I walk a lot and only jog when I do run, but I can't run faster, nor can I run continuously at any speed.

I'm trying therapy right now, and doing it very religiously, the full regimen every day, no exceptions. I want the therapy to work, because surgery carries some risk. This therapy doesn't have a reputation for success, though, and we three have an 11-week marathon-free interval coming up soon, so it can't hurt to find out about the surgery option too, and maybe even schedule it, on the likelihood that it will be necessary. Surgery has a reputation as the final fix for a sports hernia, basically the same surgery that is done for a real hernia.

If you know of an experienced surgeon with a good record in hernia repair, or if you had a successful hernia repair, I'd love to know.

Therapy Regimen. Four exercises and one stretch:

• "Clamshell." Laying on one side with knees out and bent at about 90 degrees, raise the top knee, hold it a few seconds, and lower again, using a resistance band to work the muscles harder. Repeat 20 times.
  
• "Bridging" Lying on back with feet near butt, push butt up, keeping stomach and butt muscles tight. Hold 10 seconds, repeat 20 times.
  
• "Hip Abduction." Lying on side with legs straight, raise the top foot 8-10 inches, hold a few seconds, repeat 20 times.
  
• "Rear Extension." On hands and knees, tighten the stomach and raise one leg, straightening it out behind. Hold for a few seconds, repeat 20 times.
  
• "Hernia Stretch." Standing with one knee on a chair, move forward to pull that knee back. this stretches the quads, but more importantly it stretches the hip flexors and that side of the abdomen. This hurts me a little, but only on the right side.

I have been doing two sets of these exercises every day, along with additional upper-body exercises and some runner's stretches most days. I have five more therapy appointments, and hope this therapy works.

In the event that it doesn't work, however, I'd like to know the name of a really good hernia-repair surgeon.

Elliptical Yet Again

Elliptical machine again, this time at resistance level 6 instead of 8 (max), and 40 minutes instead of 30. 428 calories, 4.8 “miles,” 7.2 average MPH, 72 average RPM.

The sports hernia is getting better every day. Several times a day I do a particular stretch which helps the abdominal wall heal properly. Today that stretch didn’t hurt much, which is a good sign. Another measure of healing is absence of pain during a situp. That “situp test” test failed this morning, there was some pain, so I still need to hold off from running. I’m hoping to do the first walk/run early next week. I’m going bonkers, not being able to run.

The next marathon, in Annapolis, will be eight weeks after the previous one, in Jackson MS. Usually, with such a long interval, I’d do at least one long run about three weeks before the upcoming marathon. This weekend is at that three-week mark, however, and a long run seems unlikely. Ah, well.


100% grass-fed beef, organic beets with pineapple. organic broccoli & cheese:

Elliptical Twice

Wednesday, February 8, 2012:

Elliptical machine, 30 min, 462 cal, 3.5 "miles," 7 mph, 70 RPM avg. Right now I’m trying to heal the abdominal wall strain (sports hernia) before the next marathon, just over three weeks away, so I’m not running. The elliptical machine is a decent alternative. It doesn’t hurt the sports hernia at all, for some reason, and even though it isn’t a perfect replacement for running (nothing is), it certainly can provide a good cardio workout.

I’m a little surprised at how nearly-identical this workout was with the one two days before (below).

Monday, February 6, 2012:

Elliptical machine, 30 min, 461 cal, 3.5 "miles," 7 mph, 70 RPM avg.


Organic stuff mostly. The yellow vegetables are parsnips and carrots:

Elliptical machine, Schwinn A40.

Because of the sports hernia, I’m not going to run for a few days, or perhaps I’ll do a walk/run with only a little running. Today I’m glad that we invested in this little elliptical machine, the Schwinn A40. I’ve used it now enough to appreciate it’s features and failings.

Features:

• It has enough resistance for me and is comfortable enough to use.
• I believe the calorie count - it compares well with other ellipticals and with my running.
• The “distance” display shows a value that is fairly consistent with the calorie count.
• It’s one of the least expensive elliptical machines, at $330, yet it is quite sturdy.

Failings:

• The display is very hard to read. Even in a lighted room I need a flashlight, and I’ve attached one with Velcro, but it’s awkward to use.
• The machine makes some squeaking and clicking noises. They’re not so bad that they interfere with listening to TV, however, and might be less if the machine were on a more-stable floor.
• The little battery-powered fan, aimed at the face, is laughable. There is no breeze.

The unit is powered by ‘D’ batteries, and an optional AC power supply is available. The batteries seem to last for a while, so we haven’t looked for a power supply.

The A40 has several different programs, but I have so far only used it on “quick start” and simply set the resistance to maximum. At that setting, the user burns 13 to 14 calories per minute at a turnover of about 70 RPM. A stronger person can run it faster, but might also prefer an elliptical with higher resistance. Oddly, it doesn’t develop the maximum resistance immediately when started and set - the resistance doesn’t build up until several seconds have passed.

Today I ran the elliptical. Time: 30:03, calories: 433, distance: 3.39 miles, speed 6.8 mph. I care about the time and the calories - the rest of the information is a curiosity. I forgot to write down the average turnover rate, but I think it was 68 or 69 RPM. More interesting is my own breathing rate, which indicated a strong aerobic pace, comparable to running at a near-race pace.

Sports Hernia Advice & Treatment

I went to see Dr. Y last September, and he then suggested some time off from running, or very easy running without pain, to see if the sports hernia (abdominal wall strain) would heal. It sort of DID heal, and then a couple of weeks ago I decided to see if I could push it, ran four miles at almost a race pace, then another at a slightly faster pace, and the pain was back again, just like that. Oyeah. Hence today's doctor visit.

From Dr. Y, two choices:

• Consult with a surgeon. This is "general surgery," not orthopedic; or
  
• Try therapy for four or five weeks first.

Surgery is not the most conservative treatment right now - therapy is. Unfortunately, the therapist that the doctor prefers is not available at the moment, because she had a baby girl yesterday. Congratulations KL! However, I got an appointment with another therapist, two weeks from now. Huh. Wish it were sooner. KL is very good - I hope this therapist is.

Other information from Dr. Y:

• The sports hernia is most likely not pulled muscles but pulled tendons. I assume that tendons take longer to heal.
  
• Sports hernia is a "rule-out" diagnosis - it's a sports hernia if no OTHER problems are found, such as a real hernia or hip problems or whatever else, and there is still pain in the right place. He found nothing except the tender abdomen.
  
• The first step in conservative treatment is to stop the injurious activity (running) for a while and see if the injured abdomen heals. I did that, because I was able to run nine marathons since September, mostly without pain. So, on to therapy.
• Be sure to get back to him if the therapy hasn't helped within four to five weeks. Actually, it'll be hard to know, because I have a marathon in four weeks, so I'll be doing a longish marathon-pace walk/run in a week and then tapering. I'd expect the injury to get better during the taper with or without therapy, so I may need more than five weeks.
  
• I asked how quickly I might expect to heal from the surgery, and he obviously couldn't give an exact answer, but I think I heard him say eight to ten weeks before running again. Less, perhaps, because I'm in good shape, but more because I'm 71. I'm surprised at that length of time - it seems like I've seen people bounce back from a real hernia repair much more quickly. If surgery is required, I want a doctor who has done a LOT of hernia repairs and can do them laparoscopically.
  
• This doctor advised ice and Tylenol for pain control, not ibuprofen, "as it may inhibit the healing process." I don't use much pain control anyway - I'd rather know what's going on in my body.

Up to now, I've been able to keep the pain at bay by simply walk/running very slowly, so slowly that a marathon takes 5 1/2 to 6 hours. Training has been at that same speed. The run part is at a good pace, about nine-minute miles, but only for 30 seconds at a time, followed by a rapid walk lasting at least that long before the next run. The result is a pace of 12 to 13 minutes per mile, and the walking somehow prevents re-injury to the abdomen even though I do end up running lots of miles at a nine-minute pace.

This morning I ran in the Stillwater Dome, walking only the corners to avoid re-injury to the adductors. The resulting pace was about 10 minutes per mile, and that amount of walking was not enough to keep the sports hernia happy. It hurts. Next time I'll try running the long sides and walking the corners plus the short sides, see how that goes.

The photo has nothing to do with anything, but I like it.

Painful Runs

Thursday, February 1, 2012:

Stillwater Dome. I had an appointment with the sports doctor later in the morning, so I wanted to run hard enough to make the sports hernia hurt - it’s easier to diagnose an injury when it hurts. Therefore I ran most of the way, walking only around corners, to spare the adductors. Sure enough it hurt, right from the start. It didn’t get much worse though, so I didn’t have to slow down, and I made a pretty good pace considering the walking.

Later, at the doctor’s office, it did hurt enough for diagnosis. More in the next post.

Splits: 10:12, 10:04, 10:08, 9:59, 10:10, 9:40, total 1:00:15, six miles, pace 10:03.

Tuesday, January 31, 2012:

In 42-degree temps, we three ran in the park today, on the mostly-dry paved trails. Nice - I wore shorts, and a long-sleeved shirt under a runner’s wind jacket - perfect. Running wasn’t perfect, though. I started running 60 seconds and walking 30, but my sports hernia (abdominal wall strain) was painful from the beginning, and got worse. At about 4.5 miles, it hurt enough to make me walk more and run less. Later I was able to go back to the original pace, but not without pain.

Six miles in about 65 minutes or so, and I’m calling the sports doctor tomorrow. February will be a new month.


Simple breakfast: