Slipping Jimmy

I had my appointment with the spine specialist yesterday. Do you want the bad news first, or the good news? (Of course, he didn't say it this way to me.)

The bad news is that it is a herniated (or "slipped") disc, not just a protruding (or "bulging") disc. This means that some of the liquid in the disc has leaked out of disc into the medulla, and is compressing the nerves there. I always wondered what a "hernia" was, as it seemed to refer to all sorts of different complaints - it appears to be a medical term for being in the wrong place at the wrong time. I believe that this is harder for the body to fix with the help of physiotherapy than a simple protruding disc.

So what's the good news? Well, according to the doctor, about 80% of patients in my condition manage to improve without the need for surgery; the remaining 20% end up going under the knife. And this coming from a surgeon who presumably has a natural inclination to surgery. If I think that that 80% includes people of all shapes and sizes, ages and levels of fitness, it makes me think that I have a pretty good chance of making that 80%. After all, I am in good shape and, when I put my mind to something (like following the exercises my excellent physiotherapist recommends me), I take it very seriously.

So how did this happen? The doctor said it could just have been down to bad posture. I can't help wondering if one of the sessions with an osteopath was the straw to break the donkey's back (or Rob's neck). It doesn't really matter. The point is that, until the symptoms have gone away, I am to avoid any impacts (no running), avoid lifting heavy weights (no more painting of sheds and, in general, a great excuse not to do anything I don't feel like doing ha ha) and avoid bad postures. I have to have a EMG (Electromygraphy) test to see if I have any nerve damage and to monitor my progress.

Meanwhile, my physiotherapy is focusing on strengthening my shoulders and neck, as well as stabilizing my pelvis. It's been a few weeks since I last bought a gadget, so let me introduce the latest in my collection: The Stabilizer.

By inflating the cushion and placing it under your lower back as you lie face up with the legs bent, you can make very controlled movements monitoring all the while the pressure gauge. This allows you to - say - practice lifting the legs while focusing on keeping the pelvis perfectly stable. I bet my wife I could do it better than her (based on her poor posture when running) but I had underestimated the power of Pilates, and she absolutely trounced me. When we got married she still had a "six pack" and was able to support my entire weight standing on her stomach. Having two kids meant that these muscles separated but I think some of her postural problems come from having overworked the exterior core muscles (doing crunches and the like) and ignoring the internal core muscles (by not doing "planks" etc.). As you know, I love anything that is measurable, especially something like this that gives you instant feedback on how well you are doing.

I've also been losing weight more rapidly even than when I have been training for a Marathon. In this graph you can see the first dip as I started my training for New York City Marathon, reaching a minimum on the date of the Marathon itself, then climbing back up to when I started up my training again, this time for the Madrid Marathon. Then, when I got injured, my weight naturally went back up until the last few weeks in which it has gone into a nose dive. People tend to put on weight with steroids (even with the non anabolic kind I have been taking because you get the "munchies").

I've been off the steroids for over a week now and I have been continuing with my Mindfulness Based Stress Reduction course (now in week 6 out of 8). I am still getting away with 1-2 hours less sleep a night than before, feeling much more awake and infinitely less stressed. Of course, I still feel stress from time to time but being more aware of it helps not to fall into that vicious circle of getting stressed about being stressed.

Here's to making the 80% cut (or should I say "no cut"?)!

IV Carrera Popular Ciudad de Pozuelo

This year, all four of us (me, my wife and both my kids) "ran" the 5K race. I put "ran" in quotes because, of course, I am not yet allowed to run anywhere in my condition, so I decided I would power walk it with my youngest. As he was too young to officially take part in the race, I signed him up for a shorter race and he entered the 5K race with a race number for the shorter distance.

I had had to get up early to go the hospital to get my (last) steroid jab before the race. As we were the slowest in the race, the coche escoba (the car that marks the end of the race) - which was, in fact, a police car - was in hot pursuit of a guy who was doping accompanied by an underage boy who had not paid the entry fee. Just as well I didn't get drug tested at the finish line.

I enjoyed walking and talking with my son, while my wife and other son were running ahead. In the end, they didn't have to wait all that long for us but, for some reason, my chip didn't register so I'm not even sure what time we did. Not that it matters.

Enjoying it was the main thing, but I couldn't help feeling pangs of competition. The last two times I have run it I have been 4th in my category and fairly high up the overall rankings. This year, much less people were running because it coincided with a very popular 10K in the centre of town. This would have been the year to get on the podium! Still, if I ask myself what that would have meant, I would say that I would have liked for my kids to be proud of their dad. I think they are more proud of me spending good quality time with them and not being in such a bad mood.

I do miss running though. A week today I have my appointment with the spine specialist. It will also be a week without medication, so it will be interesting to see how both my symptoms and my sleep patterns evolve, not to mention my mood.

MBSR / Mindfulness on steroids

I'm now starting my forth week of the 8 week MBSR (Mindfulness Based Stress Relief) online course that my wife got me for my birthday. I don't want to come across all gushing or - worse - tell you that you HAVE to do this because it will change your life. After all, the proof will be in how I am, not in how I say I am and, everyone is different. But as this is a blog that started life as a document of my journey from a midlife crisis to becoming an Ironman, there are a few things that I want to share as well as writing them down so that I can refer to them later.

Remembering back to when I started this stage of my life, I had realized that I had invested all my self-esteem into my work so that, when something happened that was out of my control, it threw me completely off-balance. Most jobs have a large component that is out of one's control and so it might seem surprising that I should not have been used to this, but I was writing mathematical models and, as far as I was concerned, my yardstick was an unbending but utterly rational and objective one. I scrabbled around desperately for something to plug the self-esteem gap and, after a few un-recommendable attempts I found that running was an excellent complement. It took me several years to get it under control, going through the typical boom-bust injury cycles that I've written about at length, until I was recently forced to stop for an extended period of time. Unlike the previous time - when I got a stress fracture in my foot in 2009 - this has been more insidious. When I started building up to running again after my stress fracture I used the opportunity to retrain my running gait; this time I am retraining my mind - or, if you like, my mind-body relationship. (It's hard to say this without sounding all mystical but, if you think about it, the mind and body are all part of the same organism.) Most significantly, I am deriving a source of self-esteem just from being able to react differently to situations that normally drive me crazy - from things as stupid as headphone wires getting tangled up, to having to wait in a queue. And, consequently, the need I have to run or compete has diminished (but not the desire).

The other thing that I have noticed and already commented here is a tremendous increase in energy and decrease in need to sleep. I'm beginning to wonder if it is possible that the energy I am saving from not going over and over things, not getting frustrated or, indeed, not trying to sleep mean that I need less of it. Or it could just be the steroids - I will have my last dose this Sunday, so I'll soon know (although my mum says they stay in your bloodstream for a couple of weeks). Having said that, I am not aware of one of the secondary effects of steroids being a dramatic reduction in stress - so dramatic that I have only just begun to appreciate how stressed out I was. My family almost don't recognize me (my son said this morning "Rob Smith 2016"). Hell, I almost don't recognize myself. I am just a little scared that this is only temporary. We'll see in a few month's time whether the effects are lasting or not!

One thing to be "mindful" of is not to get too obsessed with the whole thing. I have a tendency to do this. If I find something works then I tend to take it to such an extreme that it stops working. In some sense, it is almost impossible to be obsessively mindful by definition, as the whole practice is one of being in the moment. I think the only danger is becoming obsessed about analyzing and talking about the effects of practicing it... So if I get boring please tell me.

For now, my objective is not to enjoy life, but to experience it as fully as I can.

'Roids

So in spite of taking Valium to get to sleep last night, I woke up at 3 am and have been awake since then. Given the - let's say - unpleasant environment at work, you'd think I would have been up going round and round conversations I had had or worries about what was to come, but it wasn't like that at all. I felt really awake (and still do) - in fact, had the family not been at home I would have gone downstairs to do some nocturnal deejaying. Instead, I watched a film and tried a bit of meditating (which just woke me up even more) and even some yoga for goodness sake. In a way I enjoyed it and knew that I was somehow resting, even if I wasn't sleeping.

I don't know where this energy is coming from. It could be the steroids or it could be the release from annoying but fairly constant pain / discomfort. Another explanation is something I have experienced one or two times in my life when I am faced with a point of inflection in my life: a change of girlfriend, a change of country or a change of job. I don't think I will be doing any of these things but I believe that my organism goes into a kind of hyper-alert "survival mode". In the past I have had up to months of needing very little sleep, feeling very energized and alert, but also aware I am living on borrowed time. It could also be the Mindfulness that I am doing that is somehow waking me up. I've certainly noticed it bleeding over into daily situations like driving, waiting in doctor's to be attended, meetings, etc. It's too early to tell, but just two weeks in to the 8 week MBSR (Mindfulness Based Stress Reduction) course my wife got me for me birthday it really seems to be starting to have a positive effect.

The drugs are definitely helping too, and my symptoms have all but disappeared, which means that I can do my rehabilitation exercises that much more effectively and hopefully put this thing back in its box. I suspect I will have to "manage" it, just like I have to manage my Morton's Neuromas - something to be aware of, a warning to be heeded but not necessarily a stopper. My physio pointed out something interesting to me. I have two protruding discs - one between C5 & C6 and one between C6 & C7. The point is that the one between C5 & C6 is on the right hand side and yet I have no symptoms on that side of my body. It is quite possible I have been living symptom-free with these underlying problems for years without realizing it. This paints a much more optimistic picture. It may be that the "crisis" I had which lead to my back and neck locking up concentrated the pressure from the protruding disc on a small area of a nerve, leading to its inflammation and the subsequent numbness and referred pain in my left arm. This would be consistent with the order of events, because I only noticed this once the other problems had gone away and, in spite of not running, before I started medicating it just got worse and worse.

I've continued to make an effort to improve my posture and people have commented that I look taller and sit straighter. In fact I have more or less stopped using my Lumo Lift as I feel that awareness of my posture (and the typical causes for breaking it) has been internalized now (here Mindfulness helps with the awareness too). So I'll probably lend it to my wife for a bit, as she could do with minding her posture a bit more. My Shoulders Back brace did arrive after all (albeit with an unexpected customs bill of about 30 €...) and I really notice that it helps me stand up straighter and taller. It's comfortable to wear during the day under a shirt (and I have found a way of taking it off and putting it on discreetly when I get changed in the gym) but I think that I would have to wear it on the outside of a t-shirt if I were to run with it, because otherwise it would cause too much chaffing. I expect that it will help strengthen some of the muscles that are indirectly implicated in a more upright posture - such as the internal neck muscles I have been exercising recently - but others, like those that help stabilize my scapulas, are probably having too much of an easy time of it and need to be strengthened separately. I'll see what my physio has to say on the matter. Lastly, I bought yet another gadget to help me on the road to recovery: a goose-neck support for my Kindle, so that I can watch movies and series while on the elliptic, without having to crane my neck. I hope that all these measures (plus the new chair I mentioned last time) will help me be in better shape for when I come off the meds and - hopefully - gradually re-introduce myself to running and cycling.

Whoopsie

I got the results back of the MRI - which, by the way was a form of torture as my nerve was compressed during the entire 20 minutes which seemed like an eternity. So it turns out that I do have a slipped disc. Actually, it is not a herniated disc but rather a protruding disc (slightly between C5 & C6 and more "voluminously" between C6 & C7) which is pressing against my nerves. So I have been prescribed a course of corticoid injections for which I have to present my bum to a nurse every morning for the next couple of weeks. I'm also on anti-inflammatories (Enantyum) and have a follow up appointment with the spinal column specialist at the end of the month. I hope that the combination of the meds and the rehab prod the disc back into its little space and that I can avoid surgery.

It's been a difficult time one way and another. At work there is a dour mood as about 25% of the workforce will be cut in the next couple of weeks: we are just waiting for the axe to drop. If its not you, it might be a friend or someone you count on to be able to do your work. Also, my mum has been in hospital for over two weeks, recovering from (her second) bone fusion in her lower back to conserve the discal space lost to degenerative disc disease* and to relieve pressure on the sciatic nerve. It's funny that I should have a similar (less serious) problem at the same time as her. When she had her bunions operated I was having problems with mine; she had problems with Morton's Neuroma at the same time as I did. I wonder if I am suffering from some form of maternal stigmata.

Still, when patience is called for, I can be patient, and this is one of those times. My wife gave me a course on Mindfulness for my birthday which requires a fairly serious commitment (I am meditating for almost an hour every morning). I have to say I don't feel like taking anything else on right now, but I think it is helping. It's time to look after mind and body.

I got a new chair at work, which is much better for my back than the previous piece of crap. I had to go through some bureaucracy to get assigned one and, by a strange coincidence, the whole floor got given a new ergonomic chair (worth about 700 euros) the day before. This at a time when we are wondering whether we will be moved to another office or shipped out of here altogether. Unfortunately I found this chair (a Steelcase "Think") to be worse than the chair I had before, as it is impossible to block in an upright position, so you end up leaning backwards. Looking around the room, not a single person is sitting with good posture: some are leaning back with their necks craning forward, while others are slumped down in the chair as if they were watching the TV. I had to make an extra special fuss to get assigned one of the other orthopedic chairs - a Karnapps - which I think is much better.

I mentioned in my previous post that I had ordered a "Shoulders Back" brace to try to help with my posture. It hasn't arrived yet due to a peculiar limitation in Spain whereby individuals are not allowed to take delivery any item that is classified as "for medical use" - even if it is just a piece of cloth - instead, you have to order through a pharmacy. As I understand it, the pharmacies in Spain operate under a slightly communist regime in that you can only open a pharmacy where there was one before or, in rare cases, if the local government decides there is enough demand to open a new one. So, in practice, they get handed down through families and are a bit of a monopoly. Once I get my money back for the two failed attempts so far, I'll have it delivered to the UK instead.

You may remember that I bought a little device - the Lumo Lift - some time ago, before the problems with the pinched nerve were noticeable. This gadget buzzes every time you slump in your chair or while standing. I've just realized that the pinched nerve has exactly the same function, although it is a good deal more effective: whenever I lean forward or assume a bad posture, my thumb and first two fingers on my left hand go to sleep and I get referred pain in the triceps and the lats. It is doing wonders for my posture, I can thoroughly recommend it. The only difference is that I can decide not to wear the Lumo Lift but I can't turn off the pinched nerve just yet.

Having said that, the steriods (corticoids) I am taking are already having a noticeable effect. On the plus side, the symptoms from the pinched nerve have retreated to where they were 2-3 weeks ago after just one injection. On the minus side, I was totally hyper last night (and in fact, still am this morning) and only slept 3 hours. The best (or worst) thing about it is that I don't even feel tired. I feel almost euphoric, like running a marathon which, of course wouldn't be a good idea right now.

* I discovered in that place of all true knowledge more commonly known as the internet, that "degenerative disc disease" is neither degenerative - in the sense that there is no reason why the discs will necessary degenerate further - nor is it a disease. It just means that your discs have degenerated, but you already knew that.