Diagnosis

I got the results of my MRI today.  Not as bad as it could be.  Stress response of the Lateral Tibial Plateau.  Pretty much on the good end of the scale of stress response, stress reaction, stress fracture.  The plan is to keep the miles down for the next 3 weeks and see how it goes.  I've already backed off for over a week and saw some improvement.  I don't want to draw this out but also don't want to do TOO little.  It is more art than science.

The injury is hard to fathom considering the little amount of running I've done.  Doctor Davis could not confirm if biking might be able to cause this.  Perhaps that is part of it, but also could have something to do with changes in my stride now that I have a torn hamstring.

My last 6 weeks of running seemed to be reasonable (in hours):

1.6
3.3
6
7.3
8.6
6

 

Tom Walton race

 

I did the Tom Walton Memorial race but didn’t “race” it.  I really wanted to support his cause.  It was so strange and sad doing a race at NHTI and not seeing Tom there.  I did see so many familiar faces and had a chance to chat with many volunteers and racers.  Tom and Ellen Raffio and Tom Walton’s family all gave some nice pre-race speeches about Tom.

Me and Ellen

 I did an hour on the bike earlier in the morning and was definitely not feeling in race mode.  I checked out the course as a warm-up and came out with 3.18, not surprising for an NHTI race 😊.  My knee felt like crap but I figured I could run around 7’s (I’d done 4 miles a few days before at 7:15 pace).  I went out in the top 15 and thought “I want to get into the top 10”.  Funny how dumb things like that can be motivating.  Jonathan Kovar gave a hearty welcome back as I caught him.   I moved up to 10^th by the mile and was feeling pretty decent as we headed down the button-hole section.  I gave Andrew Tuttle a high five-as he cruised by on his way back.  He was high-fiving and offering encouragement to everyone as he flew by (good kid and good genes). The course was an out/back a bit of a tailwind (10mph) for most of the out meant a mostly headwind for the “back”.  My ½ mile splits: 3:15, 3:17, 3:17, 3:26, 3:26, 3:35.  I was really only bummed about that last split where I was struggling and didn’t feel up to pushing it.  I held onto my 10^th place only until 2 miles when Mark Laprade went by like I was standing still.  He put 56 seconds on me in the final 1.17 miles!  I ended up running 6:46 pace for the long (3.17) 5k.  No complaints about the pace, well under what I thought I could do.  Now I just need to figure out what is wrong with my knee.  MRI on Monday (07/31) and results on Thursday.

 

Place	Time	Pace	Name	Category	City, ST
1	18:06	5:42	Andrew Tuttle	Male 20-29	Alton, NH
2	18:48	5:55	Tyler Mclaren	Male 20-29
3	19:12	6:03	Mary Klene	Female 30-39
4	19:19	6:05	Austin Patenaude	Male 15 & Under	Henniker, NH
5	20:01	6:18	Graham Hayslip	Male 30-39
6	20:29	6:27	Steve Nelson	Male 50-59
7	20:34	6:29	Mark Laprade	Male 50-59	Bedford, NH
8	20:41	6:31	Michael Bisbee	Male 30-39	Nashua, NH
9	20:43	6:32	Stephanie Burnham	Female 40-49	Hudson, NH
10	21:14	6:41	Ryan Kelly	Male 40-49
11	21:30	6:46	Dave Dunham	Male 50-59	Haverhill, MA
12	21:36	6:48	Max Rossignol	Male 20-29	Contoocook, NH
13	21:50	6:53	Jonathan Kovar	Male 50-59	Contoocook, NH
14	22:04	6:57	Jennifer Mortimer	Female 40-49
15	22:05	6:57	Johan Hogne	Male 50-59
16	22:05	6:57	John Mortimer	Male 40-49
17	22:37	7:08	Benjamin Strauss	Male 50-59	New Boston, NH
18	22:43	7:09	Jennifer Caracoglia	Female 50-59
19	22:51	7:12	Pam Moore	Female 50-59
20	23:14	7:19	Peter Heslam	Male 50-59	Belmont, NH
21	23:22	7:22	James Green	Male 40-49	Dunbarton, NH
22	23:28	7:24	Tom Moore	Male 60-69
23	23:30	7:24	Mike Barry	Male 60-69
24	23:35	7:26	Christopher Baerman	Male 50-59	Laconia, NH
25	23:44	7:29	Jeff Reed	Male 60-69	Norwich, VT
26	23:59	7:33	Fergus Leclere	Male 20-29
27	24:12	7:38	Ellen Raffio	Female 50-59	Bow, NH
28	24:27	7:42	John Tuttle	Male 60-69
29	24:31	7:44	Sean Coyle	Male 60-69	Salem, NH
30	24:44	7:48	Lisa Colgan	Female 40-49
31	24:57	7:52	Nicholas Thalheimer	Male 40-49	Townsend, MA
			146 finisher
			19 M50-59

 

Loon injury

 
I was pretty sure I hadn’t had too many ‘traumatic’ injuries (where one specific event caused the injury).  My injury log seems to agree.  Leaving aside the 46 ankle sprains.  Only 16 injuries over 43+ years of running that I could pick the specific moment that the injury happened.  Slippery footing being the major factor in 7 instances (mud/ice).  I only included injuries that lost me time and not when I tweaked something and was able to run through it.
 
As always…be careful out there!
 
Ankle sprain 46 times
Hamstring 5
Knee 3
Ribs 3
Foot 2
Shin, Calf, Quad each once
 
Of the non-ankle injuries, the cause of the injury:
Mud puddle - 4
Fell due to ice - 3
Pothole – 2
Stepped off a sidewalk
Dog tripped me
Speed bump
Ran into: Guard rail/ Bike rack/Sign/Fire Hydrant

Biking and running the last 15 weeks

 It has been 15 weeks since I had hip surgery.  I got in a lot of biking over the last 4 months!  Hoping to be done biking in the next few weeks as I slowly increase running miles.

Big week

Last week was my biggest week (measured by time) with 25.5 hours all on the bike.  I actually tied my biggest mileage week ever (unintentionally) with 552.7 miles.  I only had 15+ miles outside, the remainder were in the basement.  I also finished 4 books this week, which may also be a record.  With EIGHT more weeks before I can start running again I seriously doubt I can top my mileage.  I may actually end up with less if I mix in walking and the ElliptiGo.  Time will tell.

Hip Surgery

 A little over two weeks out from hip surgery.  I go in today and get the sutures removed.  Hoping to get off the crutches.  I've been literally itching to get the stiches out.

Yes, I'm f---d

I’m definitely not looking forward to all of the down time I have ahead of me.  I’ve had a lot of injuries over the years but nothing has kept me down this long (projected 12 weeks).
 
Longest day off streaks:
July 1997 – 161 days (Fractured navicular)
December 1985 – 79 days (Torn meniscus)
September 2008 -56 days (Stress fracture sacrum)
October 2019 – 56 days (Stress fracture sacrum)

Artie retires!

 
Congrats to longtime athletic trainer Artie Poitras on his retirement!  I got a nice shout-out in the article in Tuesdays Lowell Sun:
 
From the Lowell Sun article (07/20/21) LOWELL — For the past 40 years, he has been the man behind the scenes of UMass Lowell’s athletic department, the guy responsible for keeping the school’s more than 400 athletes healthy. Now Artie Poitras is retiring.
 
Sun: Who were among the toughest UML athletes you worked to keep healthy?
 
Poitras: Distance runners, without question; they just don’t or think they can take a day off.  Every other athlete will take a day off or more, if necessary, not distance runners. They will hide issues just so you won’t tell them they can’t run. They are the most self-disciplined, self-motivated athletes we have. Dave Dunham was probably the toughest kid to come through.
 
Full article here.

MRI results

 Got the results of my right ankle MRI (the left one has been the worst for quite a while).  I've been keeping an eye on a cyst since June and it became much more inflamed and painful.  The  cyst is less of a single lump now and more like a swollen ankle.

Results weren't too surprising.  Wear and tear from nearly 150,000 miles.  Nothing to really do about it now unless the pain becomes too much.  Time will tell.

Study Result

Narrative

EXAM DESCRIPTION: MRI ANKLE RIGHT W WO CONTRAST

CLINICAL HISTORY: 56 y/o M with right ankle arthritis presents for evaluation of the palpable abnormality, question ganglion cyst.

COMPARISON: Right foot MRI dated 06/19/2014.

TECHNIQUE: An MRI of the right ankle was performed without and with intravenous Dotarem. Multiplanar imaging includes T1, PD, T2, and STIR weighted sequences.

FINDINGS: Imaging was treated by metal reduction techniques.

Bones: There is extensive marrow edema of the navicular with what appears to be osteochondral lesions at the talonavicular joint (for instance sagittal FSE STIR image 10). With subchondral marrow edema scattered elsewhere throughout the midfoot such as the talar head (sagittal FSE STIR image 10), the TMTs (sagittal FSE STIR image 12), and the anterior process of the calcaneus (sagittal FSE STIR image
18).

Cartilage: Overall well maintained.

Joints: Pes planus.

Ligaments:
-syndesmotic: The tibiofibular ligaments are favored intact.
-lateral: Grossly intact ATFL, CFL, and PTFL.
-medial: The deltoid ligament is favored intact as well.

Muscles and tendons:
-posterior: Normal Achilles.
-anterior: The extensor tendons are favored intact and normal, though there may be splaying of the flexor digitorum tendons near the expected location of the extensor retinaculum.
-lateral: Intact peroneus longus and brevis.
-medial: Intact PT, FHL, and FDL. A small amount of fluid in the tendon sheaths is favored physiologic.

Potential spaces:
-tarsal tunnel: Not effaced.
-sinus tarsi: Partial effacement.

Plantar fascia: Unremarkable.

Superficial soft tissues: Near the skin marker placed by the patient at the site of palpable abnormality is a multiloculated T2 hyperintense and nonenhancing cystic structure just anterior to the lateral margin of the tibial plafond and measuring 1.0 x 1.0 x 0.6 cm (sagittal FSE STIR image 14). This contacts and favored to partially
splay the extensor digitorum tendons.

Post-contrast enhancement: No abnormal postcontrast enhancement is identified, though evaluation is difficult.

IMPRESSION: 1. Palpable abnormality at the anterior ankle appears to correspond to a multilocular T2 structure, presumably a ganglion cyst, just anterior to the tibial plafond. This abuts and favored to partially splays the extensor digitorum longus tendons.

2. Pes planus with degenerative changes of the midfoot.

Podiatrist appointment

My arthritic ankle had been bothering me for all of May.  I knew I'd need to back off a little in June, but also wanted to get in to see my podiatrist (the excellent Dr. Gauthier at Reading Foot and Ankle).  I was able to get an appointment and got a cortisone shot for my left ankle and had the right ankle checked out.  Turns out the lump is a gangaloid cyst.  Since it isn't bothering me I just need to keep an eye on it for now.

Ganglion Cyst

What Is a Ganglion Cyst?  

A ganglion cyst is a sac filled with a jellylike fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means knot and is used to describe the knot-like mass or lump that forms below the surface of the skin. 

Ganglion cysts are among the most common benign soft-tissue masses. Although they most often occur on the wrist, they also frequently develop on the foot—usually on the top, but elsewhere as well. Ganglion cysts vary in size, may get smaller and larger and may even disappear completely, only to return later.

Causes

Although the exact cause of ganglion cysts is unknown, they may arise from trauma—whether a single event or repetitive microtrauma.

Symptoms

A ganglion cyst is associated with one or more of the following symptoms:

·        A noticeable lump—often this is the only symptom experienced

·        Tingling or burning, if the cyst is touching a nerve

·        Dull pain or ache, which may indicate the cyst is pressing against a tendon or joint

·        Difficulty wearing shoes due to irritation between the lump and the shoe
 

Diagnosis

To diagnose a ganglion cyst, the foot and ankle surgeon will perform a thorough examination of the foot. The lump will be visually apparent, and, when pressed in a certain way, it should move freely underneath the skin. Sometimes the surgeon will shine a light through the cyst or remove a small amount of fluid from the cyst for evaluation. Your doctor may take an x-ray, and in some cases, additional imaging studies may be ordered.

Nonsurgical Treatment

There are various options for treating a ganglion cyst on the foot:

·        Monitoring but no treatment. If the cyst causes no pain and does not interfere with walking, the surgeon may decide it is best to carefully watch the cyst over a period of time.

·        Shoe modifications. Wearing shoes that do not rub the cyst or cause irritation may be advised. In addition, placing a pad inside the shoe may help reduce pressure against the cyst.

·        Aspiration and injection. This technique involves draining the fluid and then injecting a steroid medication into the mass. More than one session may be needed. Although this approach is successful in some cases, in many others, the cyst returns.
 

When Is Surgery Needed?

When other treatment options fail or are not appropriate, the cyst may need to be surgically removed. While the recurrence rate associated with surgery is much lower than that experienced with aspiration and injection therapy, there are nevertheless cases in which the ganglion cyst returns.