Monday, April 09, 2012

Back to the Grind...

My husband and I are in a competition for April: whomever does the most running/walking mileage wins. I don't know what we're shooting for, but I think he wants a Kinect and I want to get bikes so we can cross-train. Either way, we're still working out. But I realize now that I, at least, have to be working out differently so that I can continue to run throughout and beyond this time of injury.

What keeps athletes going through an injury? Is it desire to win, or an addiction to the "runner's high"? That's not even a fiction. According to Gina Kolata, in her article in The New York Times, she suggests that
The runner’s-high hypothesis proposed that there were real biochemical effects of exercise on the brain. Chemicals were released that could change an athlete’s mood, and those chemicals were endorphins, the brain’s naturally occurring opiates. Running was not the only way to get the feeling; it could also occur with most intense or endurance exercise.
The problem, though, was that to test runners on this, researchers would do spinal taps (think epidural but testing fluid from the spine, not injecting numbing medication), which for some reason cannot be performed immediately prior to a workout. But Kolata notes that German researchers 
using advances in neuroscience, report in the current issue of the journal Cerebral Cortex that the folk belief is true: Running does elicit a flood of endorphins in the brain. The endorphins are associated with mood changes, and the more endorphins a runner’s body pumps out, the greater the effect.
The more some people run, the better they feel. Kolata reports in her article that the researchers, who studied long-distance runners, could "even see it in [the runners'] faces"--that the runner's high was not only psychological but manifested physically as well. But not all researchers interpret the "high" in the same way. According to Lenny Bernstein in his article "Endorphin-Fueled ‘Runner’s High’ Is Taken as Fact in the Gym World. But Is It?" in The Washington Post, he notes that
Researchers then blocked endorphin receptors in some subjects but found no difference in the effects of exercise on mood changes. Others tested the blood of subjects after strenuous exercise and discovered lots of endorphins, which are also produced by the adrenal glands, Raglin said. The problem is that these hormones don’t effectively cross the barrier that keeps most of the blood supply out of the brain. And there are other hormones, as well as temperature and blood pressure changes, that may be part of unusual feelings after a hard workout.
So it could be endorphins, or it could be "an increase in body temperature" (Bernstein), or any of a variety of factors. The truth of the matter is that "runner's high" is a combination of our present mood, succeeding a difficult workout, body temperature, endorphins, and the natural mixture of our very individualized chemical make-up. 

So no matter what the combination, if you feel better after a workout, you can call it whatever you like. I prefer to keep mine "runner's high," and I'll probably never know the exact reason it happens, just that it does often enough to keep me working out for 6-8 hours a week in my laundry room. I think "runner's high" brings injured runners back to the sport, including myself. There is something to be said about getting up, going into my laundry room, and running for two hours a pop that doesn't generally make a lot of sense unless there was a reward of some sort. The lighting is dingy and fluorescent; I stare at shelves; the laundry is often loud and knocking around. And it's pretty hot in there, too. But I run, now, 20+ miles a week (last distance: 9 miles). If it's not runner's high, then, what could it be?

Works Cited
Bernstein, Lenny. "Endorphin-Fueled ‘Runner’s High’ Is Taken as Fact in the Gym World. But Is It?" Washingtonpost.com. Washington Post. 14 June 2011. Web. April 7, 2012.

Kolata, Gina. "Yes, Running Can Make You High." Newyorktimes.com. New York Times, 27 Mar. 2008. Web. 7 April 2012.



Friday, March 30, 2012

There Are Plenty of Options...

Yesterday I had my MRI review meeting with my orthopedic surgeon, Dr. Andrew Parker. I brought in the MRI, and we went over the radiologist's interpretations before Dr. Parker showed me the actual MRI images of my right knee.

There are multiple issues at play: (1) bits of cartilage have broken off and are floating around (but they're quite small at the moment); (2) I'm losing cartilage, esp. behind the kneecap; (3) I'm developing osteoarthritis; (4) I have a lot of fluid build-up all around the patella; and (5) I have scar tissue buildup from my previous 1,984 other knee surgeries (slight exaggeration on the number), in addition to some calcification of tissue around the kneecap. 

Dr. Parker suggests that this means: my knee is an utter and absolute mess. But I have options. They are: (1) knee replacement (not quite yet--like "killing an ant with a bazooka"); (2) arthroscopic surgery to clean out debris, calcification, and some of the scar tissue (but this won't guarantee lessening of swelling and/or pain); (3) injections of OrthoVisc, a "joint fluid treatment" that treats osteoartritis for months at a time; and (4) taking Glucosamine Condroitin and Aleve (for inflammation). 

As you can see with the above list, I've organized it in order or horrendousness (worst first). But the good news is that I start with (4), move to (3) in a few months, and keep repeating (3) for the next few years. I have been told I can continue to run. But, alas, I cannot run "a lot": maybe 20 miles a week, or 25. But I'll never marathon or ultramarathon, the real hope I had when I started blogging on this topic. 

It's funny: in the last ten years I've had no problems with my knees whatsoever. I knew I had these surgeries and I have the scars to prove it. But I had bounced back, and I felt a bit bionic. I laughed when my mother cringed as she asked me, "how many miles did you run today?" As if it was all a dream, the previous injuries. But at my age (38) it was just a matter of time. Those injuries would eventually come back. I think this is akin to hearing my grandfather-in-law, at 93, just this week was diagnosed with lung cancer. He quit smoking in the 1950s, but it eventually caught up with him.

In my research I've found plenty of articles on overuse injuries for ultraendurance athletes. Consider the article by O'Toole et al.: Overuse Injuries in Ultraendurance Triathietes from the American Journal of Sports Medicine. The injuries to the athletes were common and random (not all athletes had the same injuries). The bad news is that I am not an Ironman competitor: my last actual elite sports competition was in 1994. 

The good news is that these athletes, who do dangerous and outrageous sports feats, keep doing it. So I might have to get injections with a horse needle into my knee every couple of months to keep running. And I will.

Tuesday, March 20, 2012

All the Excuses in the World...

All the excuses in the world won't get a runner ready to be an ultrarunner. Excuses of mine so far: injuries. Time. Dissertation. Family. But there are plenty of runners out there with families and jobs and injuries who become world-class (or even just consistent) ultrarunners. For me, injury has been the key interrupter in my training.

Roy Stevenson, an exercise physiologist and writer for ultraRUNNING online, says of DOMS (Delayed Onset Muscle Soreness), "It is very common for out-of-condition or beginning runners to experience DOMS. Its severity depends on how much and how intensely we exercise, and whether we have performed that exercise before. But it’s not just beginning runners who are susceptible to DOMS – even well-conditioned runners who’ve been training consistently for several years can experience DOMS after a race or vigorous training session, especially a lengthy downhill-running workout."

I can attest to having suffered DOMS. And Stevenson is right that those of us who think we're conditioned but are not. I was only running 25 miles a week when I pulled my right calf muscle, and that's not nearly enough mileage to consider a marathon, let alone an ultrarunning event. 

One of the most important things I can learn from Stevenson is that the actual damage done to muscles is real. Stevenson says, "Traumatized muscle is a war zone! Your leg muscles are under siege after repeated eccentric contractions and the descriptions of the damage sound horrifying. Here are some of the main protagonists: disruption to the muscle sarcomere; breaching of cell membranes; swollen muscle fibers; wear and tear on connective tissues (ligaments and tendons); calcium spillage from muscle tubules; cell inflammation and increased production of superoxide free radicals..." The pain we feel has a cause and can be medically identified; and so my month off, while it might not be the length of time required for full rest, was one of the smartest things I've done for my ultrarunning dreams.

Stevenson finishes by suggesting that "Apart from using the modalities recommended above as preventative methods (warm-up, ice, compression, some antioxidants, and post-training carbohydrate/protein mixtures), stimulating DOMS to a minor degree in training will prepare the runner better for DOMS muscle trauma." And this makes sense: runners, like all athletes, need to be fully prepared for the difficulties of DOMS during training and events. Knowing how muscle soreness feels and how to mitigate the damage will help me keep running even when DOMS flares up.

Wednesday, March 14, 2012

Monday, March 12, 2012

The Waiting Game

Some good news on the medical front: my injury to my knee is not major; so minor, in fact, that I've run twice this week. But the good news isn't great for one reason: I still have a scheduled MRI on Thursday. What the orthopedic surgeon saw on X-Rays and through mobility of my right knee is that it could be a small amount of scar tissue that makes me feel the "pop" behind my right knee when I climb stairs. That would be great news. The tissue will dissolve eventually and won't harm me in the long run.

But the potential bad news: it could be loose cartilage, in which case a minor surgery would be needed to remove any cartilage that's hanging out in there but not in place. As cartilage is the "cushion" for the knees and absorbs the impact of contact sports and the stresses of running, I need all I can get. So for many reasons I'm crossing my fingers for scar tissue. When in the world will I ever say that again?

There is also hope for me in that while I was informed that, at 38, I have arthritis in my right knee due to all the trauma of previous injuries/surgeries, that arthritis will not limit my running. "They're not incompatible," says Dr. Parker. And, if you think about it, running and staying healthy will help my joints by limiting weight gain (a real bear on the joints), creating endorphin rushes to help with mood, and work on my cardiovascular system, which supports overall health. 

The most amazing thing I learned at my appointment last week was that there is a new treatment for runners (NFL players, basket ballers, basically anyone who is super active and tough on their knee joints) called Synvisc. Synvisc is a joint lubricant that an athlete can get (injected into the knees, yes) once or twice a year to work in sync with the cartilage and to work as a "shock absorber"; it also does wonders for pain relief.

Now, the question is, to research Synvisc and runners; who uses it? What have been their results with it? Also, will my insurance cover the costs?

Health care is expensive; but I think it would be more expensive, in the long run, not to run...

References Cited
Parker, D. Andrew. Interview: March 9, 2012. http://commonwealthorthocenters.com/

Wednesday, February 29, 2012

Logical Fallacies

Check out "The Unapologetic Geek's" blog and see whether you agree with him about these Top "10" logical fallacies in our current political climate...

Wednesday, February 22, 2012

Bloggers in Harm's way

Hi Everyone:

Check this New York Times Blog link about a Syrian blogger who was killed during some intense shelling in the city of Homs.