Ruling out options

ImageI’ve been battling some injuries this month, and for longer than I think some of them should last, so this week was the week to rule things out. To briefly recap, I flew to Chicago for the Trans 100 event at the end of March (somewhat relevant). On April 2, I had pain in my right calf – a new spot, and never a previous source of pain – during a run. I ran on it twice more, thinking it was a tight muscle or that it would loosen up over time, but after April 6, I stopped running altogether and put it to rest. The pain in my calf persisted, it moved, and eventually was waking me up from sleep before my alarm.  On April 22, I started to get a pain in my lower left back, which started swelling. Last night it was more swollen than ever, with my wife saying it looked like “a little fist” was poking out of my back.

Gremlins!

On Wednesday, I had an appointment with an orthopedic specialist, who said he felt a bump in my bone with his hands. He showed me on the x-ray where the oddity was, but said it was inconclusive. He ordered an MRI. I did it at 6:15 am Thursday, and got the news Thursday afternoon: no stress fracture. (WHEW) I asked about the pain in my leg and other causes, and he said I need a “good PT and maybe run on the AlterG.” My thought was that a calf strain should have healed by now.

Somewhere in the middle of this – the day I woke up from leg pain – I had the thought of deep venous thrombosis (DVT) and got worried. My brother had a vein removed from his leg after two episodes. I also had two TIA episodes when I was 20, which made me concerned. I spoke with some runner friends who said DVT was common in endurance athletes, and the flying part just before the first pain was concerning. Another ambassador for Empire Tri Club is a doctor, and recommended I get it checked out; he sent me the exact tests to ask for at the doctor and urged me to do it sooner rather than later. I did mention all of this to the orthopedic, but he quickly dismissed it.

ImageLast night I set out my kit and nutrition for a long solo ride today. My club is doing a brick, and since I can’t run, I thought I’d get an easy 80-100 miles in and enjoy the weather. I woke up and felt the pain in my back and my leg, and thought about my shortness of breath in the past few days; I put on real clothes and went to the doctor to rule out DVT.

Being a generally healthy (although somewhat injury prone) person, no one there was too concerned about me, which was both comforting and unsettling at the same time. I got an EKG to start, and freaked everyone out with a resting heart rate of 39 BPM. A nurse practitioner did a physical exam of my leg and back and ordered an ultrasound. I got three tubes of blood drawn for a complete blood panel and D-Dimer test to rule out clots, and then got the ultrasound. Then I waited on a stretcher in the hallway.

I’ve been very good about tracking all of this. I’ve been getting antsy to run but to be honest, it hurts too badly to even try to push it. I’ve even been weary of the bike, which has hurt a bit when I pull up on the pedals. My Strava tells the full story of the amount of pure rest this calf has gotten:

4/2 first felt pain on run, stopped halfway through. 4.8 miles
4/3 easy jog to Empire run, did not do workout because of pain (thought maybe it would loosen up with easy run). 4.9 miles
4/4 rest
4/5 bike
4/6 ran to work, 5.4 miles. did not loosen up. 
4/7 saw PT, advised to rest
4/8 rest
4/9 rest
4/10 bike
4/11 bike
4/12 rest
4/13 bike
4/14 bike
4/15 rest
4/16 rest
4/17 rest
4/18 rest
4/19 bike
4/20 rest
4/21 rest
4/22 rest
4/23 saw PT, light soft tissue work, advised to see orthopedic
4/24 rest
4/25 rest
4/26 rest (ran half block for bus, hurt for 3 hours)
4/27 swim
4/28 bike (woke up before alarm because of pain)
4/29 rest
4/30 rest, saw orthopedic, got x-ray (negative)
5/1 rest, did MRI (negative)
5/2 rest

Four and a half hours after walking in, I walked out with a paper that says, “Myalgia, Adult: Myalgia is the medical term for muscle pain….” The tests ruled out blood clots, which is great; it is certainly good news that I don’t have a stress fracture or DVT, but I’m still not sure of the cause, which is concerning for my calf, but even more for my lower back, which has the swelling. They said to keep an eye on it, and if it gets red, warm, or worse, to come back.

So the plan is to ride my bike those 80-100 with friends tomorrow, still not run, and see my PT asap to try to work it out. I do feel relieved that it is not serious, but the frustration of having it still be a mystery is a bit upsetting.

Here is my official “no shit, Sherlock” diagnosis:

Image

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