Being trans-generational, which either means I’m old but refuse to behave as such, or simply that I live in Massachusetts where anything trans goes, save trans-fats, I tend to use both phrases roughly evenly. This week proved that playing a doctor on TV, or in this column, or even sleeping in that hotel chain really doesn’t qualify me to read an MRI. So while last week I was worried about the sport-legality of medications and carefully did the research to declare myself Not Guilty on that count, I must re-visit the portion of that column where I seemingly skillfully interpreted those ghostly images, and state that while Not Guilty, I was Not Right Either.
Having done the MRI-of-the-tendon thing a few years back, and having scoped out various respectable web resources like WebMD and the Mayo Clinic (which I cite here due to my one loyal reader there…woot!), I’m pretty well versed that injuries, swelling, and other tendon-nasties generally show up as unwelcome white spots. Check out last week’s images, representative of the hundreds of images on the handy CD that the staff of my local hospital always cheerfully provides, and to me at least, they looked clean. This was both a relief and a concern, since neither Dr. Foot Doctor’s initial diagnosis of a partial vertical tear, nor his preliminary recommendation of a surgical (minor, yet still surgical) fix, were welcome. Seeing nothing on the MRI hinted instead that I was clear. On the other hand, seeing nothing on the MRI hinted that I had no idea what the route to recovery was. I spent the week during which the good doctor relaxed on a beach somewhere cooling my jets and finishing my meds. But come Monday morning, Doc was back, and it was time to get the official skinny.
I always like to say that I love physics until I open my old college physics textbook and I remember why I didn’t like it then. It’s all Greek. Literally. I can say the same thing about medicine. It’s fascinating, until you go about reading the stuff that doctors write. It’s not only Greek, it’s often apparently non-sensical. I quote to you from my report, HIPPA rules be damned:
The Achilles tendon is enlarged with a rounded cross section configuration centered approximately 4 cm above the posterior calcaneus. There is no abnormal increased T2 signal within the area of thickening. There is no discrete disruption of fibers or surrounding abnormal signal. Findings compatible with partial tear/tendinopathy.
I translate this as…first, my Achilles is big. OK, that might mean it’s swollen, which is bad, or just that it’s big. I’ve been told that my heart is big (physically at least, metaphorically is a separate discussion). I’ve been told that I have great cambium on my tibias. You train, things grow. Right, but we’ll assume that they mean swollen, and so it’s puffed up about an inch and a half above that posterior bony thing, a.k.a. my heel. Hey, that much I knew without getting an MRI. Oh, and its round. Isn’t it supposed to be round?
Then the language gets interesting. There’s no increased T2. I take a guess and read this as meaning there are no white spots, as previously noted. I agree. But the next part is most curious: there’s no disruption of fibers. Getting past the wisecrack of whether the fibers are sleeping peacefully, undisrupted, wouldn’t a tear be a disruption of fibers? And they say there is no such disruption? So with this, the last sentence left me scratching my head. Findings compatible with partial tear/tendinopathy. All of this means it’s torn? Or, there’s that word, tendinopathy, which simply means its beat up. So, umm…
OK, Dr. Foot Doctor will have to explain this to me. The swollen part I get, but isn’t the idea of an MRI to see the “increased signal” and “fiber disruptions” to identify an injury? That’s certainly how it worked a few years back when I really snapped one. I just don’t see how we get from this to that. But they’re the doctors, and I merely slept in a Holiday Inn Express. I have to trust they know something that I don’t.
And that leaves me not knowing something else, that being, what to do? A quick chat with Dr. Foot Doctor makes clear he advocates aggressive treatment, read, surgery. This isn’t just about his boat payments; he suffered through the same issue personally, opted not to treat aggressively, and found it took eight months of inactivity to heal. He’s trying to save me from that.
But aggressive treatment means six to eight weeks entirely out of commission, back to the crutches, the Dreaded Boot, the long road back, the works. Other than the momentary joy when the Vicodin hits your system, there’s nothing attractive about it. Unless it works, of course.
I told him I’d sleep on it. I sat out a couple more days to let the meds clear my system so as to get a good read on reality, then yesterday I began my own diagnostic test: I hit the road for a few miles at a pace that I couldn’t call fast, but was at least respectable, well above the “tenderness jogs” of late. And I did it again today. Not trying to break things, but to see if maybe, just maybe, the time off in combination with those magic meds did what I hoped they’d do, and promoted healing without breaking skin.
After the second stage of the Tour de Tendon, I’m wearing the yellow jersey. Though my legs were a bit sheepishly sore after yesterday’s mini-spurt – oh how quickly things like fitness wear off – the Achilles is so far holding up. It is of course way too early to tell. I’ll give it a few more days and hope for the best. If it degrades, I’ll have to lean toward the aggressive treatment; that option will always be there. But like a Cubs fan, I hold out hope, maybe, just maybe…
Sudden Topic Change / Amusing Small World Incident Department: It’s one thing to meet up with someone you’ve heard of in the running world while you’re circulating in running circles. It’s amusing when it happens randomly in the real world. I posted an item for sale on Craigslist, an item with utterly no connection to running, and who ended up responding? None other than the author of the standing nutrition column in New England Runner who it turns out is married to the gentleman who created that fine magazine itself before retiring a couple years back. What an honor to be paid a visit by such a distinguished pair! Thank you both for your fine work on the best running magazine, period.