Epidural-Ville

Joe had his epidural this afternoon. It was rather painful for him for two reasons. First, he has a high and narrow pelvis, which restricted the amount of space the doctor had for inserting the needle, and secondly, since the herniated disc along with it's jelly goo is taking up most of the space where the injection needed to go, it caused a lot of pressure as the doc pushed in about a teaspoon worth of fluid. The doctor and assistants all said Joe was amazing - that he has a high pain tolerance and deserved an award after getting through this epidural.

Epidurals work rather quickly, so lets see what happens. Within 24 hours of my first epidural I had relief. Epi’s only work about 50% of the time, so cross everything (fingers, toes, legs, etc.) that Joe is one of the 50th percentile to get relief. He’s not in much pain anymore, but his range of motion and ability to do certain things is compromised right now. The nerve stuff and pain is two-fold. First there’s the jelly goo from the herniated disc sitting in his spinal column taking up space and applying pressure to the nerves. Second there’s the trauma from the herniation itself causing inflammation. So the epidural is meant to take the inflammation away by calming the immune system down, and then over time, white blood cells rushing to the injury will clear out some of the jelly goo and hopefully relieve the pressure to the nerve, and that process can take up to a year. This explains why I still have nerve issues 9 month in. It also means that by the end of this year, if I still have nerve issues, I may always have them. Joe’s year clock begins ticking now.

Joe has his PT assessment at the spine clinic tomorrow, and will see Dr. Nelson in 2 weeks to follow up on how the epidural is working, and what course treatment will take next.

Who Wants to Lose Weight?

I’d like to lose 8 pounds. I don’t need to. My BMI is good, I’m healthy, I’m fit. But I’d like to have my clothes feeling looser and 8 pounds gets me to the beginning of a decade on the scale, instead of closer to the next decade! Our Spin instructor gave us a cool formula he’s using to shed a few pounds, so I decided to check it’s validity via the Internet. He was pretty much on, so if you wanna lose weight, get a pen, paper and calculator and find out how many calories you need to intake.

Determine your basal metabolic rate: Your basal metabolic rate is how many calories you burn in a day just living your daily life. The calculator differentiates between men and women because men and women, even those of the same height and weight, have differing caloric needs.

If you are a woman, you will need to multiply your weight in pounds by 4.3, multiply your height in inches by 4.7, add those two numbers together and then add 655 to that number. Now multiply your age in years by 4.7 and subtract this number from the first number.

If you are a man, you will need to multiply your weight in pounds by 6.3, multiply your height in inches by 12.9. Now add the first two numbers (weight calculation, height calculation) and add the number 66 to that. Now multiply your age in years by 4.7 and subtract this number from the larger number. You will get your basal metabolic rate from this.

Now factor in your activity level. Multiply your basal metabolic rate by the number that corresponds with your activity level.
· If you are sedentary, do not exercise at all and sit at your job all day, use a 1.2 multiplier.
· If you are somewhat active, meaning you exercise 2-3 times a week or walk while on your job, use a 1.375 multiplier.
· If you are moderately active, meaning you exercise 5-6 days a week, use a 1.55 multiplier.
· If you exercise every day and are active at your job, use a 1.725 multiplier.
· If you exercise strenuously every day and are extremely active all day, use a 1.9 multiplier.

Your basal metabolic rate multiplied by the activity level multiplier will give you the number of calories you need to maintain your weight each day.

Use the example as a guide.Example: If you are a woman who is 5’3”, weighs 146 pounds and is 39 years old, your numbers would look like this:
146 x 4.3 = 627.8
63 x 4.7 = 296.1
627.8 + 296.1 + 655 = 1578.9
39 x 4.7 = 183.3
1578.9 – 183.3 = 1395.6

This woman’s basal metabolic rate is 1395.6.

Let’s say this woman is moderately active because she exercises five days a week for between 20-45 minutes at a shot. 1395.6 x 1.55 = 2163.18.This woman can eat a little under 2,200 calories a day and maintain her weight.

However, let’s say this woman wants to lose 15 pounds in 15 weeks. This means she will need to subtract 500 calories a day from her intake, allowing her to consume just under 1700 calories a day. If she wants, she can choose to burn an additional 250 calories every day (in addition to what she usually burns) and only reduce her calorie intake by 250 calories if this is easier than cutting 500 calories.

GOOD LUCK!!!!

Joe's Scoop

All of you should know my blogging style well enough now to guess that I've started this entry off with a picture of Joe flying through last October's trail 10k as a sign that he will run again! Joe met with Dr. Nelson this afternoon and learned that he has a rarer kind of herniation that protrudes laterally more than posteriorially, this is why he is having so much trouble with his left side. The doc says this may make running more difficult or uncomfortable for Joe, but Joe can definitely give it a whirl in 6-8 weeks, and of course Joe will do just that. Naturally, the point of Joe's appointment wasn't to find out solely about running, but I'm just saying :)

Joe has a referral to the spine clinic's PT department mainly for assessment of movement and some guidelines for stretching and exercising with the herniation. Joe will not be doing PT on a regular basis, as he can follow through on what they show/tell him in that first assessment. Joe took me for my epidurals, so I'm happy to return the favor now. He will also have an epidural next week Tuesday or Wednesday, which will hopefully relieve his pain and discomfort so he can begin doing the restorative exercises that will return him to full functioning - epidurals work for about 50% of people, so fingers crossed that he is one of them. Everything will work out fine.

No Hunger

Yesterday our 45-minute Spin class was a 90-minute Spin class per our request. It was an awesome work-out equaling about 25-30 miles of road. The Spin room was a steamy, salt-smelling mess by the time we were done! The rest of the day I had no appetite, which is something I often experienced during my long runs while training for the Napa Half Marathon. I also lose my appetite when we backpack – hiking for 4-7 hours everyday. Have any of you experienced that suppression of hunger after intense or prolonged exercise and wondered why? Well, I did, and what I learned is that intense cardio work increases your body temperature which activates hormones that impact hunger. In particular, a hormone called ghrelin that makes us feel hungry decreases during these powerful work-outs, while a protein called Peptide YY (PYY) which cues a sensation of satiety, is increased. Who knew? So work-out hard if you want to control that appetite.

Regular exercise often stimulates the appetite, and many people who work-out our regularly end up eating more calories, and get frustrated by the lack of weight loss. People feel they should be losing weight because they exercised, and since they’re likely eating more calories, they don’t lose, become discouraged and stop the exercise. Not good. This is why we need to focus more on overall health, energy, stamina and quality of life over the numbers on the scale and the BMI charts. Okay, let me get off my soapbox, and share one more thing with you. Today I ran 2 miles without walking. Yay! This is the furthest I’ve run since 11/17/08, when I covered a chilly 6 mile loop in my neighborhood. While the 2 miles challenged me, I don’t believe it was long enough to suppress my ghrelin! Time to go eat something.

P.S. Joe sees Dr. Nelson today, so I’ll post another entry later with the contents of that appointment.

Grrrrrrrrrrrrr!

I rarely check home phone messages from work, but for some reason I had the thought to do so this afternoon, and it’s a good thing I did. There was a message from the spine clinic calling to reschedule Joe’s appointment this afternoon. Had I not checked messages Joe would have fought traffic to get there, only to be told there was no doctor. So the whole thing is frustrating cause #1), they should be calling Joe at work, not at home, #2) Joe’s already had to wait a week since the MRI for this appointment, and #3) if he’d known it was going to take so long to be seen, he could’ve gotten a referral to the pain clinic for an epidural from Chiro-Med (he planned on getting the referral today from the neurosurgeon) last week after the MRI showed the herniation! He can still get to the pain clinic via Chiro-Med, but it takes 1-2 weeks sometimes to get an appointment there too. Again, I say Grrrrrrrrrrr.

Goodbye Summer

Tomorrow Autumn begins and my blog enters it's third season. Hard to believe I've been writing for 9 months, and harder yet to believe there are still readers!
I hope to keep this going indefinitely with fresh updates, interesting tidbits and pictures to spice things up. This past weekend Joe and I celebrated 10 years in our house. The time has flown by, and yet we still love this house as much as the day we moved in. Ten years ago, we had the idea to plant some pine trees at the bottom of the front lawn as a buffer from the street light across the way, as well as to block our view of the street - giving us more of the secluded sense we get when we look out of the back of our house. Anyway, we finally got around to getting those trees this past weekend. We are now the proud owners of two 7-foot tall Colorado Blue Spruce. They're fat and gorgeous ... can't wait to see the first winter's snow sitting on their branches (adding to the beauty of a winter photo like the one of our house posted above).

Along with the marker of a new season, I'm reaching a new milestone this week in my running. My training schedule calls for a 2 mile run this Friday, which will be quite the challenge even though I've been building up to it. Last year at this time I was running 6.2 mile trail races with relative ease, and now 2 miles on the treadmill kicks my butt! It's all relative, I guess, and ultimately, I'm grateful that I am able to run again.

It's been difficult for Joe to have yet another blip in his running schedule. First it was the 2 month interruption for the stress fractures, and now it's the prolonged time off with his herniated disc. Joe's been keeping his cardio up at the gym with the bike, but misses the cardio punch running provides. Just as when my disc herniated, he has not been able to do much lower body weight training, but he continues to work that upper body like a mad, and is maintaning his cut physique :)

More news to come after Joe sees Dr. Nelson Wednesday....

Deja Vu!

Joe had his MRI this morning and though his neurosurgeon won’t see him and discuss the results with him until next Wednesday (9/23), anyone can plainly see that there is at least one major disc herniation at L5/S1 , and possibly another at L3/4. It’s the L5/S1 herniation that’s bothering his sciatic nerve and creating the numb big toe and upper foot, as well as the ankle pain. What are the freakin’ odds that we would both have left sided lower lumbar herniations within 9 months of each other???? My MRI was 12/17. Joe’s 9/17. Coincidence? It’s likely Joe will need a surgical epidural just as I did to take away the pain. Then perhaps a 3 month period of conservative activity to let the herniation begin to heal. Of course this is speculation at this point – we will have to wait for Dr. Nelson’s complete diagnosis and recommendations next week. On the positive side, we know all there is to know about this condition, and through my trial and error we know what does and doesn’t help the healing process.

What or Who Is Next?

Let me take a moment away from chronicling the trials and tribulations of my life and Joe's life, to share what's been happening in general in the past month, and you tell me - Does stuff just happen all at once? Are the stars misaligned? Is someone practicing voodoo? In order it goes like this:

1. Joe's saga began in late July and continues to the present moment (MRI is tomorrow!)

2. My sister's long time best friend was diagnosed with an aggressive brain cancer.

3. My mom's cortisone shot to the knee has worn off,and she's gimping around in a bit of pain.

4. My Uncle Tom had a heart attack. Four years ago he had quadruple bypass surgery and had been doing well. He's also been dealing with Parkinson's for a decade or so. He's only 61.

5. A co-worker/friend who is around my age is in her second marriage and has two grade school aged kids. She has a daughter from her first marriage who is a freshman in college. Well, her current husband who builds houses, fell off a roof and shattered ALL the bones in his feet. Then a nasty infection developed and he lost all the muscles and connective tissue in that foot. The infection has persisted and now an infection expert from Africa is coming to treat him. He obviously can't work, and her salary will not be enough to sustain the family, as well as the daughter in college.

6. Joe's dad had knee surgery for a torn meniscus (he's fine).

7. My Aunt Shirley's hematocrit level is half of what it should be, and she's lost 20+ pounds without trying (doctor's never like that!). She's having blood transfusions and an endoscope to look for stomach bleeding.

8. My personal trainer's marriage is falling apart.

9. My employer has announced two mandatory furlough days for 2010.(could be worse)

10. A friend's husband has a muscle eating virus attacking his legs.

Reports From the Spine Care Clinic

Here's another vacation picture of Joe along the Cascade River in the Grand Tetons. Showing his picture means this blog entry is all about him. I wish I could say it is with relief that I'm not the one going to Froedtert's Spine Care Clinic now, but since it's Joe, there's no relief to be had. Joe met with Dr. Nelson today for an initial assessment. Dr. Nelson, incidentally, completed his pre-med undergrad at Purdue, so he and Joe had a Boilermaker's background in common. Anyway, you want the goods from this appointment, here's the summary. The doctor does not feel Joe's problem is related to the SI joint. He suspects the issue is primarily with the L4/L5 and/or L5/S1 vertebrae (just like me). He bases this preliminary assessment on the source of Joe's pain and numbness which is connected to sciatic nerve impingement. The million dollar question is: What Is Causing The Nerve To Be Pinched? The best way to find out is with an MRI, so Joe will go to the same place I had mine this week Thursday. His MRI will be at 7a.m. on the 17th ... mine was at 7a.m. on the 17th as well (December for me) - spooky similarity, eh? Dr. Nelson will immediately receive the results of that MRI and Joe will have a follow up appointment next week Tuesday, 9/22. Dr. Nelson was a bit dubious that the cortisone shots Joe received could have helped, as they were not given surgically. The best shots are surgically given with the aide of radiology so the doctor can see precisely where the injection is going (this is how my epidurals were done). Joe may need an epidural, but until his appointment next week, it's too soon to know. In the meantime, Dr. Nelson has prescribed more Vicodin. The Vicodin can't help with nerve pain or numbness (and it sure hasn't!), but it can dull the edges of it, and aid Joe with sleep. So, that's the scoop.

Good Food

Another gorgeous day in Wisconsin. This day was spent having a late summer's lunch in mom's lovely urban backyard. If my hair looks short, it's not deceiving - yesterday I had many inches taken off as the vacation cornrows destroyed my hair - leaving damaged and broken locks to be hacked off. It stresses me a little to have my hair only shoulder length, but I'd rather have healthy shorter hair than crappy looking long hair. Anyways, enough about my hair. Many of you know my mom is the culinary queen. She needs no recipes, and intuits what flavors will work together. Today's light lunch included miso soup, baked tofu satay, a colorful medley of steamed veggies with a hint of sesame, bruschetta with vegan pesto, a cold salad comprised of avocado, tomatoes, chickpeas and olives, a fruit cup of lightly spiced nectarines, green grapes and blueberries, AND lastly, chocolate brownie cookies. The food was complimented by a warm breeze, a lush garden with a cityscape backdrop, squirrel antics and stories from our mutual vacations.

Doctor Appointments

Today was my yearly physical, which went swimmingly. First off it was fabulous that I didn’t have to have a pap smear. Current medicine stipulates that women meeting special criteria only need a pap every 3 years. I fall into that category, so I don’t need to endure that ever embarrassing event again until I’m 40. Since my family has no history of breast cancer, I also have 2 years to go before the first dreaded mammogram and 12 years before the first colonoscopy.

So, I hate to gloat (but here it goes), but truly, I am a doctor’s dream client. I do all I can with preventative medicine, and because of that, I am the picture of perfect health. I don’t smoke, I don’t drink, I wear a seatbelt, I wear sunscreen, I’m an avid exerciser, I have a super healthy diet, a great BMI, good lipid panels, Vitamin D sufficiency (most Americans are deficient – you should take at least 2000 IU’s/day) and I have no current health risk factors. Once this was established, Dr. Diehr had no suggestions for how I could be any better, so we talked for 45 minutes (unheard of these days, right?) about various things related to my health, such as new birth control options, and my past year dealing with the herniated disc. I confided that I have resumed running despite the advice from my neurosurgeon not to, and Dr. Diehr shared with me that she herniated a disc once and had drop foot along with it. Her doctor recommended surgery, she said no way, and began running. To this day, she’s not had any further trouble with her back, and actually gets a tight back if she misses more than 3-4 days of running. She fully supports my running, which reinforces my own beliefs about getting back in the saddle.

Joe heard back from his primary physician who gave him direction to make an appointment with Froedtert’s top-of-the-line Spine Care Clinic – the same place I went to see my neurosurgeon after my herniation. Joe has an appointment Monday (9/14) afternoon for further assessment (with a different doctor than I saw), so stay tuned folks ….

Back to Life, Back to Reality

Today was the first day back to the grind. I was blessed with a gentle glide into my life – sometimes, it’s a slam dunk into the abyss when we return. I had an easy gym day – 45 minutes on the elliptical, 30 minutes core work, 45 minute Spin class. At work I learned there were no major client crises in my absence, so I could leisurely go through my 186 emails, respond to my 16 phone messages, share my photo album with co-worker’s and catch up at my own pace.

Joe’s basically back to square one with his hip pain, ankle pain and left foot numbness. First thing this a.m. he contacted the chiropractor’s office to get records of his treatment to send to his doctor for further follow up. He’s still waiting for a call back with an appointment date. Joe wrote me: “I got the fax from Chiro-Med with which they included my file notes to date, including the radiology report. I’m surprised by the latter, which states that I have ‘severe disc narrowing’ at L5/S1. It also indicates the formation of a Schmorl’s node http://www.medterms.com/script/main/art.asp?articlekey=14007 at the superior endplate of L4 with adjacent disc narrowing. They didn’t mention any of this to me at Chiro-med. Regardless, from what I understand, disc narrowing is common as we age and can lead to compression of the nerve. Schmorl’s node doesn’t appear to be anything significant based on the definition (see link above).” So we’re a pair. Joe with his Schmorl’s node and me with my 13th rib!

Vacation Summary

Yes, Joe's cortisone shots made vacation possible. We tromped around the wilderness from 8/27-9/4 without any significant problems. Joe's hip, ankle and foot numbness were controlled enough for him to perform well on the trail. My back/hip gave me no problems either - a real milsetone for me in solidifying that I am healed and can do whatever I want to do.

We had a fabulous vacation. Perfect weather every single day with sun and highs in the low 70's. The nights were never too cold with lows in the upper 40's. We hammered out 50 hard miles in 5 days in a self-created loop with a different site each night. This picture was taken on the first day during a 9+ mile ascent - can you imagine walking uphill for close to 5 hours? That's what we did.

The Grand Tetons offer beautiful sights and difficult terrain. In Wisconsin we usually hike 4 mph. In most mountain settings we hike 3 mph, in the Grand Tetons 2 mph was very respectable. The Teton's have a large bear population - both grizzlies and black bears. In recent times there have been more human-to-bear contacts, so the park service requires backpackers to carry a 3 pound bear proof container for holding food and scented items, rather than putting a food bag in a tree. Thus, our backpacks were a bit heavier than usual. Joe was around 40 pounds, and I was around 33 pounds (this includes the weight of the water we carry).

We had a close encounter with a bull moose, saw the requisite pikas, marmots, squirrels and deer - no bears, which is fine with us! We heard owls who-who, and coyotes yelp. The night sky was stunningly bright with a near full moon and Venus shining close by. We have close to 200 pictures - if you're interested in seeing them let me know - we'll schedule a time to get together, or you can request a link to see them.

We finished our trip a day early, so our last day was spent in 95° Salt Lake City where we toured Temple Square - seeing the Tabernacle, and learning about the Latter Day Saints. It's quite the monopoly they have there! The money in the LDS church is amazing - the buildings and sites we saw were more impressive than anything we've seen before. It's that money, which has created a beautiful downtown (the church owns everything). That being said, spending a few hours there was more than enough! I was Mormoned out by the time we reached our hotel.

We returned home yesterday much to the excitement of Dio who really suffers when we're away. It's wonderful to be home - to sit on a couch, to have a bathroom (no more digging holes), to have water from a faucet, to be clean. On a less sunny note, I have to report, Joe's cortisone shots seem to be wearing off - they're usually good for 2-4 weeks, though some people have long-lasting relief and others have none. Joe will see his doctor next week to work on this matter more - perhaps having an MRI.

I'm Back

Hello everybody! Sorry for the cliffhanger. We lost our Internet connection a week before vacation, so I couldn't keep you updated on Joe and our trip preparations. This will be a quick summary of what happened prior to vacation. As you can see by my picture, I had my hair cornrowed for vacation. I usually do this for long backpacking trips so I don't have to deal with greasy itchy hair. There is no hair or body washing with soap in the wilderness. These braids suit me fine - they don't hurt, they keep hair out of my face and I can literally get up and go. I do need to keep my head covered in the sun though, so I don't burn my scalp! On to Joe. Joe was to get a cortisone shot on the Friday before our vacation, which would give him 7 days for it to sink in, BUT the appointment was cancelled at the last minute and rescheduled for the Monday of the week we were leaving. Joe discussed his symptoms at length with the nurse practitioner giving him the shots and they agreed that a shot to the SI joint, as well as to the L4/5 facet joint would be the best. The two shots would take 3-5 days to take full effect, which put us into vacation time. We were both hopeful that the shots would fix things - both for the trip and the long-term. Did they work? Check the next blog to find out .........