“We have no idea” and other things you don’t want to hear from your doctor.

I do not understand why my body does not seem to like to fit into traditional medical boxes.

Well, okay. My ITBS was pretty much a text book example of ITBS. Same with my meniscus tear back in college. So maybe it’s just my foot that misbehaves.

I finally went to the orthopedist yesterday, to get a prognosis and expected time frame for returning to running. The doc had to attend to some kind of emergency in the morning and was running about 45 minutes behind, which was kind of funny, in the roll-your-eyes-and-sigh kind of way. Lately, I’ve been having insomnia partly because I’ve had to wait forever to figure out if I can even run this year. I waited a week for the general doc appointment, a few days to get the MRI, and over a week from MRI to orthopedist appointment.  This entire time, I was dreading some horrible news – You won’t be running for another year because you have a tumor and your foot is haunted… – so I had to laugh at the fact I had to wait yet another hour. To kill time I decided to sit outside, enjoy the wonderful day, and read the latest Running Times I still hadn’t gotten around to reading.

So about 2 hours later, after I’d gotten into the exam room and had an assistant take the quick rundown of what’s going on, I finally met with the doctor. Let me say I’d been referred to this guy (1) because I go to the university and this is the university’s sports medicine center; (2) because he’s the best guy for runners and running injuries; and (3) I’d been told he was a pretty good doc. I’m glad I knew those factors, because his bedside manner wasn’t… well… awesome. I guess I only have 2 real complaints. I’ll share the first one now: He had that white crap in the corners of his mouth. For the entire two or three hours I was there, with him coming in and out of the room.  Wouldn’t you tell your boss there’s something gross on his face? Ick! Thank goodness I could spend most of the appointment by looking at my foot, or looking at my films on the light board.

Neat. Also not disgusting. (Yes, this is actually my foot)

My doc decided that the middle cuneiform bone marrow edema on the MRI wasn’t enough to get “worried about”, saying that it’s negligible and looks like “leftover edema from a previous injury”. He also said that the pain I kept pointing to in my foot isn’t really in the area of the edema, which is what I said in the first place (not that I expected them to listen to me, as I am not a doctor and really have no place making diagnoses, even on myself). His hypothesis? That I have a stress fracture. That’s what the first assumption was a month ago. So much fun when everyone goes back to the first thing they ruled out. So off I went to get some X-rays taken.

The gent taking and reading X-rays – a 6 foot tall, muscular black man in his mid 50s or so, with a slightly greying short beard – was quite possibly the most soft spoken man I’ve ever met. Because of his soft spoken manner, I couldn’t make out his tone half of the time, and therefore couldn’t tell if he was irritated with me, tired, or super nice. I’m going to go with super nice, because he was speedy and efficient. I had my x-rays taken, processed, and diagnosed in less than 30 minutes from start to finish. If only everything in health care systems were this easy and fast.

So what, you ask was my second issue with my doc’s bedside manner? First thing my doc does when he comes back in the room after getting my x-ray results is tell me there’s no obvious fracture of any kind and the bones all look pretty good. Then he says, in a concerned manner: “There’s a disease called [the name escapes me] where there is spontaneous avascular necrosis of the head of the metatarsal.” Spontaneous bone death disease!? These words are coming out of his mouth and I’m starting to panic. Big time. He then continues “No one knows why it happens, but it’s hypothesized that it could be triggered by repetitive impact activities such as running.”  As he’s saying this, my heart is racing and I’m staring furiously at my x-ray, trying to recall any of the training from the week we learned to read x-rays in my college anatomy and physiology class… Then he says, almost as an afterthought: “But there’s no sign of this in your films.”

Great. Thanks for the heart attack, buddy. Glad you got to share the spontaneous bone death disease with me and get a wonderful little spike in my heart rate. Maybe you were trying to give me a little cardiovascular exercise. Either way, I hope you get a hangnail this weekend as karmic punishment.

The only thing that actually showed up on my x-rays was an anomaly on my 3rd metatarsal. However, this didn’t help anyone with a diagnosis or prognosis. Of course. The little bulge on my metatarsal could be just a genetic anomaly, or could be a stress fracture that has healed over.

Mystery bone anomaly on lateral side of 3rd metatarsal (in red box).

In retrospect guess I should have gone into a doc closer to when I first thought I had an actual injury – I’m pretty sure the fracture happened at the Mercedes Half Marathon about a month ago – but honestly I ignored all post-half-marathon pain as being just that, not an actual injury. (I suppose it should have raised a flag when it was excruciating to stand on that part of my foot 72 hours after the race…)

Since he couldn’t find any discernable cause for my pain, he (we) made the call to put me in a walking boot for the next 2 weeks in an effort to take as much pressure off of my foot as possible to enable it to heal faster. He really didn’t push the boot on me, but my repeated hinting about wanting to be running by the first because I am registered for a half marathon on April 16 might have nudged him over to the decision. Don’t worry – I’m not a complete idiot – if the doc says no, I won’t be running next month. But I’d much rather miss a PR by 30 minutes or have a DNF than have a DNR.

Neat fact #1: In order to not have uneven hips when walking, I have 3 inserts stacked in my left shoe. Neat Fact #2: Having a walking boot on your right foot makes it incredibly hard to drive.

After fitting me for the boot, he sent me over to the physical therapists to do some quick diagnostics. He wanted them to check if my legs were of different lengths (either due to bone length or due to hip torsion) and check out some ankle flexibility. Results: my legs are fine, my ankles are a little weak but okay, but my pelvic girdle muscles are really inflexible. Yes, that’s right. I have been medically diagnosed as being a tight ass. My hips and glutes are a little stiff, and my hip flexors are exceptionally tight. My hip flexors are inflexible to the point that the physical therapists are worried that running with them as tight as they are could plausibly have caused increased impact during my foot-strike, leading to the stress fracture. (Their explanation: You don’t want to run without bending your knees, right? You’d land so hard your feet, hips and knees would be sore after a half mile. Similar thing when you run without allowing your hip flexors to bend) So they want me to come back in after my foot is healed to do some work on them. And it’ll be covered by my health insurance! Hooray!

So it looks like I’ll have a re-tooling of my gait coming up in the next few months – to relax my hip flexors and to keep me from damaging my body further. I swear with this much work, I should have the perfect gait in the next year. That is, as soon as I’m given permission to run again.

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2 Responses to “We have no idea” and other things you don’t want to hear from your doctor.

  1. SuzyQ says:

    You have cute feet. Even if they’re a little messed up right now. 🙂

  2. Carly D. @ CarlyBananas says:

    I’m glad you had your appointment and it looks like you’ll be able to return soonish.
    I burst out laughing at “Yes, that’s right. I have been medically diagnosed as being a tight ass.” 😛

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