As I mentioned in my last post, yesterday was an eventful day. It started out with my 6-month post-op appointment with the sinus surgeon. As expected, he said I am officially discharged and he sees no reason to ever need to operate on my sinuses, any newly formed mucoceles, or orbital space again. Yay! He did mention that he could see irritation and secretions up there, confirming my seasonal allergies are back. Well, it’s been 90 degrees in Boston this week after the longest and coldest (but not snowiest) winter I can recall in my adult life. Who DOESN’T have seasonal allergies right now?
After my appointment at Mass Eye & Ear, I headed to a coffee shop in Cambridge to get some work done before my appointment at Spaulding. I actually found this super cute place, which just so happens to be inside Lamplighter Brewing. Coffee shop by day, brewery by night? Genius!
Finally it was 10:15 and time to head on over to Dr. T’s office. I met with his fellow first. He was really smart and definitely knew his stuff. We reviewed my history and then he poked around in the trouble area. I was definitely sensitive to the touch in the usual spots, but also at the top of my shin on either side, just below the knee. He was a little surprised by this. I wasn’t – because Ben the PT pokes around in there enough to make me want to kill him.
He told me that his (and Dr. T’s) plan was to do an ultrasound first. They wanted to see if they could locate the Baker’s cyst the MRI found so they could drain it and then inject the steroids there. But based on how painful that shin area was, he actually decided to start the ultrasound there and found a LOT of swelling and fluid. Makes sense, right? Well he actually found almost the same amount of fluid and swelling on the right leg, which is not at all painful. My biggest complaint about my right side is my tight glute medius. But given how goddam tight BOTH calves are at all times, I guess I’m not surprised that there is bad stuff going on in both shins. Everything is attached.
The fluid and swelling is called pec ansenine bursitis. The pec anserine is essentially where the hamstring and tibia meet, and so it’s colloquially referred to as the knee tendon (I think I am getting this right?).
After consulting with Dr. T, they both came back in to talk to me about my options. They said they could try the steroid injection, but weren’t convinced since they couldn’t see the cyst or anything else structurally wrong during the ultrasound of the knee joint itself. Dr. T said, “Wanna go for a run?” And I was thinking, “Uh, run with my doctor who just finished Boston in 3 hours? Yeah, no thanks.” But he meant me. By myself. On the one time I’ve EVER shown up to his office in jeans and Chuck Taylors (brought shorts for the appointment itself, but that’s it).
So he told me to go home, get sneakers, come back, go for a run until the pain set in, and they’d redo the ultrasound to see if aggravating the injury showed up visually. I couldn’t do that right away, so I went back after work.
I have never run around this area of Cambridge before, so I parked at the hospital and basically started running the route I would drive home. But because I knew the goal was to flare up my injury, I pushed a lot harder than I normally would. My plan was to bring on the level 10 pain as quickly as possible. This resulted in my first 10:00/mile in…a very long time. Probably since the Cambridge Half. I limped back to the hospital after just over a mile, but because he was squeezing me in between other appointments, I waited about 30 minutes. I was worried the injury would “cool off” too much by the time they scanned me again, but the gnawing pain told me otherwise.
Unfortunately, there was no difference on the ultrasound. This was frustrating as hell. BUT it meant that there was still nothing structurally wrong with me, so they weren’t going to tell me I needed to stop running in order to heal.
Instead, the fellow – Dr. A – told me he strongly recommended trying Voltaren gel, a topical NSAID cream that you can apply up to 4 times a day. My mom actually used to use this for her insane back and leg pain (she has severe, degenerative arthritis all sorts of other ortho issues, and level 9 pain 24/7). I remember her loving it, but also having a really hard time getting insurance to cover it. Dr. A said this would eliminate the need for me to take ibuprofen 3-4 times a day for my hamstring pain. I said my stomach would be relieved. He did say I could still take it for something like a headache or cramps, but hopefully wouldn’t need it for my injury.
Dr. T came in and agreed, but was strongly pushing me to consider the gait retraining program. He believes since my issues aren’t structural, they’re mechanical. Meaning the way I run is causing this injury and preventing it from healing. I totally believe in the value of at least assessing my gait, but the steep price of $525 that insurance doesn’t cover is a tough pill to swallow. At this point, I’m not sure it’s worth it. I’ve been running for years and only in the past 18 months did I have issues with my hamstring, and only in the last 6 months have they been this severe. Nothing about my gait or shoes changed, and (sadly) my weight has been fairly consistent for the last 5 years. The other drawbacks of the program are that there’s a waitlist currently 2-3 months long, and they don’t let you run outside of your 18-24 appointments in the clinic. This makes sense, because they don’t want you going back to old habits/poor form when you’re running by yourself outside, but months of runs only on a treadmill with a doctor correctly every step sounds awful. Especially during the summer, with a docket full of races I’ve already paid for.
But what’s the alternative? Run in pain? DNS or DNF those races? And remember folks, the end goal is run Boston 2019 pain free.
So for now, the gameplan until after the Covered Bridges Half on June 3 is as follows:
- Use the Voltaren gel 4x/day for 7-10 days, then as needed
- Run/walk ONLY on all runs, even short ones – this is because I told them my long runs typically go a sh*tload better than my shorter runs, which I try to run straight though instead of following intervals
- No steroid injections if the Voltaren helps – the risk of tendon rupture means I’d have to completely stop activity for 1-2 weeks after the injection and this is not worth it to me
- Revamp my PT program to focus on improving strength and stability in my foot & ankle – a bottom-up approach as opposed to the top-down approach we’ve been using to strengthen my hips & glutes, which has definitely paid off in general but not for this injury in particular
- Get on the waitlist for the gait retraining program (but secretly hope by the time a spot opens up, I don’t need it)