Monday, March 18, 2019

Coastal Trail Series Sussex 55km race report

After every race I make myself notes of what went well and what I should have done differently. Sometimes the should-have-done-differentlys are on the ridiculous side ("don't, on a whim, triple the amount of coffee in your sports drink") and sometimes they're more substantial ("I needed more hill training for this course"). After the Coastal Trail Series Sussex 55km, I am, for the first time, completely at a loss for what I could write in the errors section of the notes. I've spent the better part of the plane ride home thinking about it and the best I could come up with is that I should have taken only half a water bottle instead of a full one at mile 15, since it was only three miles from there to my next support stop. Not exactly a disastrous mistake!!

prerace sightseeing along the course

Most of my prerace concerns had to do with weather. The race is over exposed ground right on the coastal cliffs, and it was supposed to be around 30mph winds with gusts up to 50mph. It was freezing cold at packet pickup just before the race start. The guy manning the t-shirt desk wordlessly handed me a size medium. When I asked for a small instead, he gave me an incredulous look and asked if I had seen what the small size was like. I was confused for a second, then realized I was wearing 8 layers of clothing and was not looking particularly small at that moment.

Actually I guess I spent most of the prerace period looking ridiculous. While every other runner wandered around stretching and jogging and generally looking professional and prepared, I was the one wearing overly short pink children's sweatpants and scraping hard caked mud out of my shoe treads with a hotel room key card. One day I will nail the not-looking-ridiculous part of racing, but that day was not yesterday.

After the world's longest briefing, we finally started running. The first section of the race is straight into the wind, over the Seven Sisters hills on the coast. It's beautiful but it was like trying to run into a giant hair dryer--there were a lot of runners chasing after lost hats! Fortunately I had been out here for a training run so I knew what I was in for. I took it pretty easy on this section, then sped up to race effort after 5km when we turned inland and briefly got a bit of shelter. And the reward for surviving each headwind section was an amazing tailwind section, or at least amazing until a sudden tailwind gust nearly blew me off a cliff.

we ran past the Long Man.  it was very long.

People were friendly at this race, and getting to talk to a few people made the first third go by quickly. Divesh, my support crew extraordinare, met me at several places for water bottle exchanges, and never being far from one of those also made the miles fly by. I also had a nice half mile or so with Alice, who won the accompanying half marathon.

My first 25 miles were basically spent in suspense, wondering if and when I was going to hit a wall or bonk or possibly go insane from the uncomfortably loud roaring of the wind in my ears. But by mile 25, none of those things had happened. I felt oddly... good. Like really good. I was running up hills I would have thought I would have had to walk. I never got nauseated. The math changed from wondering if I had a shot at the course record to knowing that, absent some sudden injury, I was going to get it by a decent margin. 

And that was it really! Nothing dramatic to report, just a nice steady race with possibly my most even splits ever. I feel like a completely different runner from my pre-injury year.  So what's different than in the past? First, I've sorted out better training through coaching from David Roche. Second, I've put in hundreds of hours of nutrition research and have finally reached what seems like the right answers. Conclusion: it's definitely still possible to get faster when you're old and missing foot parts! 

Monday, August 27, 2018

Peroneal tendon surgery part 3: the end?

I keep waiting for some sort of obvious "finish line" to signify that it's time to write a final wrap-up of the outcome of my injury and surgery.  But since I don't have a good idea of what that finish line would look like--running a race?  not thinking about how much my foot hurts every time I walk anywhere?--I decided that the triple achievement this week of wearing normal running shoes instead of hiking boots for a run, finishing a hard race, and filling out a weekly training log that wouldn't be too out of place in my pre-injury training would be good enough.

Sometime in June I got completely fed up with my situation and was saying to a friend that it had gotten to the point where it felt like I would never get back to normal running.  He replied with the excellent point that it might well not ever go back to normal, but that it might not be better or worse, just different.  And this is exactly what I've found.  Unless I get a revision surgery (more on that below), my ankle is always going to be weak.  This is just what happens when you're missing a major ankle tendon--you can only train the surrounding muscles so much, and you can't train something that's not there.  I may never be fast on technical ground.  I may have to wear my heavy, uncomfortable hiking boots in races for the foreseeable future.  I may be even more pathetic than I was pre-injury on steep downhills, even though my pre-injury standard is a standard that's difficult to fall below!

But...I may have been forced into a decision about what types of races to focus on, which might make me faster in those races eventually.  Since I can't run downhill very well yet, I've started running some uphill vertical races, which I'm not totally sold on yet but may grow into liking.  I am becoming more efficient about making my mileage count, because I can only do a fairly limited amount of miles.  And possibly most importantly, I discovered that there's nothing like being unable to run for six months to teach you exactly what kind of running you missed the most, which is very useful for deciding what type of running to do when you are finally able again!

So, it's different.  If I could choose, I would opt to have not lost a foot tendon, along with vast sums of money spent on medical care, not to mention six months of my life.  And it certainly grates on my mental well-being every time I think about how the outcome could have been improved had I not picked such a lazy and/or money-hungry surgeon.  But given that this is the situation that exists, it's not all bad by any means, just different. 

It's not yet clear whether this is the end of the saga or not.  When I saw surgeon #2 in March, he was somewhat appalled at what surgeon #1 did ("Why did he do that?!" was the exact reaction, which definitely made my heart sink a bit...) but he wasn't particularly positive on the idea of a second operation to try to repair the damage.  His thought was that he might be able to fix what surgeon #1 did by creating a new peroneus brevis out of my FHL tendon, but he felt there was a good chance I could come out of a second operation in even worse shape than I'm in now.  His advice was to only get the second operation done if I were very unhappy with my running ability after 9-12 months of rehab.  This was exactly the same advice I got from another good foot surgeon via email, so it's promising having the two opinions coincide.  I'm currently at 7 months post-op, and given the massive progress my foot has been making the past few weeks, I think it's unlikely I'll go for the second operation, unless running in the mountains proves to be too much for the current repair and it fails.

I'm never one for the whole "just be optimistic" outlook--you don't build new tendons out of optimism.  But I do have to mention one of the big positives that came out of this injury, and that is the people who were a part of my recovery.  That started right from day 1, when two now-friends who I had only known for 12 hours came to rescue me from the hospital on a cold winter night, followed shortly by Divesh rescuing me from my hotel room of doom. Then there was all the help and support from friends and family while I was on crutches, and finally there were the new people I met because of the injury, such as my injury twin Diana, and Jordi, the world's best physical therapist, who is a rehab expert and all-around excellent person rolled into one.  If there is at all a good part of being injured, this is it.

And now?  I've made a list of all of the things I missed out on while injured, and I'm going to be making my way through it over the coming months.  And if all goes really well...I'm entered in the 110km Ultra Pirineu for September 29.  Even 40km is currently a very long way for me, so I'll have to see what my ankle says about the idea of 110km in only a month's time, but if it's possible, I'll be there!


Wednesday, May 16, 2018

Peroneal tendon rupture, surgery, and rehab, part 2

It has only been two months since my post about part 1, and already it feels like several lifetimes have gone by...

Lifetime 1:  visit with surgeon #2 and improvements

Surgeon #2 was excellent and it was well worth going.  For a start, he gave me 15 minutes of uninterrupted appointment time, practically a miracle compared to my experience with surgeon #1.  Surgeon #2 was concerned about the fact that surgeon #1 had placed a tenodesis anchor right on the site of my metatarsal fracture and thought that might be the cause of all the pain.  He did an x-ray to check that the anchor hadn't caused the fracture to re-open, which fortunately showed that it hadn't, although it could still have been causing the pain.  However, surgeon #2 also did an ultrasound, which did show a large bone fragment stuck right next to the tendon repair, making it a prime candidate as a pain cause. 

The next month was full of slow, steady improvements.  Of course, there were plenty of "bad foot" days, and I still suffered from perma-red foot from all the inflammation, but it was definitely an upward trend.

The mental crux that I hadn't been expecting was the time period where I was able to walk but not yet able to walk far enough or fast enough to get any aerobic exercise.  As depressing as it was, I had to resign myself to going out on the crutches or the pegleg for the "exercise" portion of my activities, and then practice walking separately.

Somewhat ironically, I got less and less fit aerobically as my foot improved, since I started doing more walking and stopped doing my uphill crutching repeats!

Finally, at 13 weeks post-op, I did my first outing that could, if you were feeling unusually optimistic, be called a run:  5 miles on a vertical k course, mostly walking the steep uphill, running the gradual uphill, and running nearly all of the downhill.

Lifetime 2:  infection

The improvements came crashing to a halt when my surgical wound got infected at 13.5 weeks post-op.  An infection that shows up that late in the game is a very worrying thing, since it makes it highly likely that the infection is a deep one.  Cue total rest, elevating my leg, hours of frantic research and quality advice from the most qualified medic I know, and a trip to the doctor, who prescribed antibiotics and never managed to answer my question about when I should come for follow-up care if the infection didn't clear. 

It didn't clear.  After 5 days of antibiotics and no improvements, I sent a panicked email to surgeon #2, who was kind enough to look at a few photos of my foot and then told me to get it seen sooner rather than later.  Two days later, I was in surgeon #2's office.  He did an ultrasound to check if it might be a stitch abscess (it wasn't) and then confirmed what I had already suspected from my reading:  the doctor I had seen a week ago had prescribed an incorrect choice of antibiotic.  So I moved on to antibiotics round 2, took a deep breath, and talked myself into handling the mental pain of going back on crutches for exercising.

I'm not wearing the orthopedic boot because I need it for walking, I'm wearing it to prevent walking.  It's the runner equivalent of the cone of shame.

It's funny looking back on my changes in perspective since the injury.  When the accident happened on December 2, my first thought was "will I have enough time to train for Transgrancanaria?"  TGC is in late February!  After finding out I needed surgery and then getting delayed for a couple of months on that, my worry was whether or not I'd be able to race this summer.  After finding out I had been robbed of a key foot tendon whilst unconscious during surgery, I was concerned about whether I'd ever run on technical ground again.  And by late April, with a late-onset surgical site infection, I was ready to consider it a win if I didn't have to have my foot amputated.

Luckily for the chances of continued attachment of my foot, the second round of antibiotics worked, but...

Lifetime 3:  sural nerve issues

...getting rid of the infection did nothing to change the unbearable level of pain I'd been experiencing.  Neither did two weeks of total rest, so it was clear it wasn't a simple case of overdoing it on the newly-repaired tendon.  The type of pain--white-hot, coming and going in flashes--didn't feel like tendon pain, either, and I did more reading and starting thinking it could either be an allergic reaction to the biocomposite material in the tenodesis anchor (shows up, if it's going to happen, when the anchor starts to degrade around 3 months post-op, so the timing fit, plus the inflammation seemed to respond a bit to an antihistamine) or damage to the sural nerve. 

I finally deployed the weapon I should have deployed two weeks earlier:  a visit to my amazing physio.  He was almost sure the problem was with the sural nerve; it runs alongside the peroneal tendons and it's common for it to get damaged or entrapped in scar tissue after peroneal tendon surgery.  I left after an hour of serious poking and prodding to try to extricate the nerve, with instructions to perform twice daily exercises and to wait at least 5 days before trying to run.

And today, 5 days later...I ran!  Four repeats of 5 minutes each, on very flat and soft ground.  There was still definitely nerve pain going on but at a much more manageable level than before.  It's a start...