Good times for a change
I went to Toronto to see Dr. Ogilvie-Harris today. I had to wait a while to get this appointment as my original one was scheduled for when I was in South Africa and then it made sense to wait for my X-rays (which I got yesterday) and see him with updated images. Ogilvie-Harris is great! He took the time to review my x-rays and explain exactly what was going on with the fracture. He went over rehabilitation and what I should and shouldn’t be doing. He said I can start running in two weeks although my build-up is going to be very conservative from that point. I’ll start out with 1km and stay on the indoor track for the softer surface.
I got lucky going without the pin because my healing is going as well as can be expected and the calcification that occurs with natural healing will be the best thing for future bone strength. A pin would of been warranted if I had been in a rush to get to a major competition. In that particular situation it might be worth taking on the risks in order to get back running quicker.
Below are three X-rays in chronological order from the day I broke my foot until yesterday (Jan. 20th).
Here is the first X-ray from November 6th, 2008
November 22nd. This image is a little larger and easier to see the crack.
Below is an X-ray from January 20th, 2009. You can see there isn’t such a gap anymore and there is some good calcification going on. The inside portion of the bone is healed (it’s easier to see with the viewing program which allows high resolution magnification). When I look at this image I think “my foot feels better than that“.
Now I kind of have a timeline in my head. I’ll start running on February 6th with a single kilometer. It may take three months until I’m running at full capacity. From there it may be six more weeks before I return to competition. I’m very motivated to lay down some good times on the track, at some point, this year. I know I have to be patient, which will probably entail me watching the Payton Jordan 10 000m on May 3rd. You see, I was planning on running that same race last year so, I purchased a round-trip ticket from TO to SF. Now I have a credit for that trip which has to be used within a year from when I was supposed to fly. So I might as well fly out to San Fran for a few days and watch a race instead of letting it go to waste.
It’s nice to be able to walk normal again.
There is a light and it never goes out
I was hoping to hear the words “you’re good to go” this morning.
As I was sitting on the hospital bed waiting for the doctor to come and see me I could see my X-ray’d foot on the screen. I went over to take a look and the image appears a lot worse than the way my foot actually feels. My foot feels pretty good but, the image is still quite a mess at the fracture point. There has been significant healing since my last X-rays six weeks ago, which is promising. Obviously I was hoping to see a fixed foot, but I was actually expecting to see it too. ‘Hope for the best and expect the worst’, I should of remembered.
The doctor said it’s 50% healed. I asked him is that 50% of the time to 100%? Or, does that mean the bone is 50% done and perhaps the second 50% takes less time? “It’s 50%”
He then said I have another 6 weeks before I’m running. Then he has the nerve to tell me I didn’t need a screw after all. I just left instead of explaining to him that the point of getting a screw is to decrease the time to return to running, not simply to eventually heal.
Needless to say the information I got this morning has put a damper on the day. In general the last few weeks have been good because I’ve been able to improve the quality of x-training as well as the strength of my foot. And I know the worst is behind me now. I just have to get my head around not being able to run for longer than I hoped.
I have an appointment with a specialist tomorrow. We’ll see what he has to say. Hopefully better news, but I’ll expect the same.
X-C skiing has been a nice addition to the X-training regime. It has been cold out.
See the luck I’ve had can make a good man turn bad
Being able to walk has raised my spirits. When I couldn’t put my foot on the ground without experiencing pain, or even as much as put on a sock without pain I felt very far from being able to run. It was hard to see the light and stay positive especially since I wasn’t able to make inroads with cross-training. For the past week now I’ve been able to walk pretty normally and I even got in two workouts in the pool. Building towards my running goals again and not being too far off (relatively) from running again I now feel that I’m in the homestretch of this injury.
It’s hard to gauge how much I should be using my foot these days. I seem to be able to walk fine on flat ground whereas snow covered sidewalks pose some problems. In the past few days the unevenness hasn’t given me any sharp pains like earlier in the week, just a dull ache. I know that putting some weight on my foot will promote healing but there’s obviously some point where too much weight bearing will make the fracture site worse. I going to go ahead and believe that I’m giving it the proper amount of use.
Here are a bunch of pics I put up on facebook from the SA trip:
http://www.facebook.com/album.php?aid=2271788&l=bde27&id=120802091
I seek to cure what’s deep inside
Flying to South Africa is a lot of flying. Our trip on the way back went like this: Cape Town to Dakar, Senegal 8 hours and 15 minutes in the air. While in Dakar we don’t actually get off the airplane for the 1.5 hour re-fuelling stop. Then another 8 hour and 40 minute flight to NYC. Go through customs and pick up luggage before a short flight to Buffalo.
My family and I went to Cape Town because my brother got married there on December 20th. From there we spent five days in Knysna (along the southern coast) where my brother’s wife is from. We were back in Cape Town until this past weekend. Here are some pics of the trip…
Camps Bay, Cape Town
Boulders’ Penguins
Cape of Good Hope. With walking stick.
University of Cape Town
Shot from atop Table Mountain. If you look closely you can see the running trails that I didn’t get to run on.
It’s been such a f*#ked up year
This year started off really well for me. A PB of 7:53 over 3000m and a 3rd place at the US 15km Championships in March. Throughout March and the begining of April I had some great training and was really looking forward to racing. Of course that all went down the drain with a freak sciatic nerve injury. By the time I got back to training at a decent level it was October. I really liked where I was with my running this fall, building up mileage, feeling strong and running a lot of trails. After the nerve injury and missing out on racing during an Olympic year I found I had a new outlook. Running felt much more refreshing and enjoyable than it had earlier. After a couple of workouts and a rabbit job of 16km at 3:07/km pace I felt I was getting my stride back and it was time to begin serious training again.
And then I broke my foot at the begining of November and also ended my participation streak of National XC championships, I hadn’t missed one since 1998. It’s been a tough year and I will still be dealing with a broken foot for the first part of 2009.
I get another set of X-rays on Jan. 20th and after that I should get a better idea of what timeline I’m looking at to return to running. I don’t suspect that I’ll be running before February, and at that point it will take a while to get my running legs back under me.
I’m in South Africa right now and I wish I could be running the trails opposed to using a stationary bike. It’s a shame that the weather is perfect for running and I have to be indoors. I’ll post some pictures when I’m able. My brother got married here on December 20th and since it’s a heck of a flight you might as well spend some time here.
Happy New Years!
40 days and 40 nights and its still coming down on me
Looking at the X-rays from my last post you can see that there is still a significant crack in my foot. I was hoping to see less of a crack after five weeks, but this is a very slow healing site because of the lack of blood flow in the area. The good news is that there are signs of healing (calcification) and I’m getting some mobility back. My next X-rays are in five weeks from now. By then I should have more information on a timeline. Needless to say it will be a while before I’m running again. For much of this fall I was focused on getting back into the swing of things and getting after a 10 000m at Stanford in early May, at this point it does not look promising.
In the meantime I’m able to use a stationary bike. I was biking with one foot for a couple of weeks, but I wasn’t doing much of it because, to put it bluntly, it sucked. Now that I’m able to use both legs I usually just put a movie in and bike for the whole thing. I figure I’ll be able to XC ski before I’m able to run. In January I’ll buy the whole kit and get going with that, snow permitting.
I’ve seen my hopes and dreams lying on the ground
NOVEMBER 6th X-RAY
DECEMBER 9TH X-RAY (below)
I did NOT screw up the order.
Well nothing’s dead down here, just a little tired
The first two are from November 6th and the last two are from November 22nd.
The fifth metatarsal (long bone on the far right) is broken.
Nov. 22
Hard to laugh
Here is a funny story, well it will be funny if everything turns out OK.
When I went to see the Orthopedic surgeon, Dr. Ogilvie, a few days after I broke my foot he didn’t really seem to care that running was actually a priority for me. In fact, he pretty much just told me to stay off it and come back in five weeks for X-rays. I had to ask him some more questions and I explained my situation that recovery is pretty important for me as an elite runner. He didn’t even mention that pinning (getting a screw put into the bone) was often the way to go when an athlete gets a Jones fracture. I thought at least he would of said, “this type of injury often requires inserting a pin, but in your case you don’t need one because…”
So I told my sports Doc in Guelph that Dr. Ogilvie told me to non-weight bear for 6 weeks and didn’t say anything about pinning. I also said I was a little concerned he didn’t look at my injury from an athletic point of view. My sports doc said that Dr. Ogilvie is very highly regarded and that is who she would of recommended seeing anyways.
I also told Dr. Stewart in Hamilton who looked over my X-rays that I was seeing Dr. Ogilvie and he said “that’s who you want to see.”
A few days ago I was emailing the National team doctor and physiotherapist. I told them my story and who my doctor was. The national team doc said that if Dr. Ogilvie said that I don’t need pinning than he trusts his judgement. And then he said something like, “you are talking about Dr. Ogilvie-Harris, right?”
I looked up this Dr. Ogilvie-Harris and saw that this hyphened version was in fact the foot guru.
I emailed Dr. Stewart and told him that there happens to be a great foot specialist named Dr. Ogilvie-Harris in the GTA. Dr. Stewart replied to me that he assumed I was talking about Dr. Ogilvie-Harris this whole time! Well shit son, even a Doc from Hamilton thought I was seeing Dr. Ogilvie-Harris in Toronto.
Then I emailed my sports Doc and told her that the National team Doc and Dr. Stewart both thought I was talking about Dr. Ogilvie-Harris and I just wanted to make sure you know I’m seeing Dr. Ogilvie. She emails me back saying that she too thought I was seeing Dr. Ogilvie-Harris!!
So now it makes sense why everyone was saying that Dr. Ogilvie was the man, because all three were talking about Dr. Ogilvie-Harris. What are the chances that two orthopedic surgeons within 45 minutes…
Since all the Docs I’ve been confering with really respect the opinion of Dr. Ogilvie-Harris I now would like his opinion on my broken foot. So as funny as this story might be, I won’t be laughing if I find out in a couple of days that I actually need a pin that I should of had inserted two weeks ago.
Here is a Journal article about Jones fractures, the other Journal articles I’ve seen have similar results:
First published on May 11, 2005, doi:10.1177/0363546504272262
This version was published on July 1, 2005
The American Journal of Sports Medicine 33:970-975 (2005)
© 2005 American Orthopaedic Society for Sports Medicine
Early Screw Fixation Versus Casting in the Treatment of Acute Jones Fractures
Timothy S. Mologne, MD*, Jeffrey M. Lundeen, MD, Mark F. Clapper, MD and Thomas J. O’Brien, MD
From the Department of Orthopedic Surgery, Naval Medical Center, San Diego, California
* Address correspondence to Timothy S. Mologne, MD, Sports Medicine Center, 277 Altenhofen Drive, Appleton, WI 54913 (e-mail: drmologne@thesportsmedcenter.com ).
Background: There is considerable variability in the literature concerning the optimal treatment of acute Jones fractures.
Hypothesis: Early surgical fixation of acute Jones fractures will result in shorter times to union and return to athletics compared with cast treatment.
Study Design: Randomized controlled clinical trial; Level of evidence, 1.
Methods: Eighteen patients were randomized to cast treatment, and 19 patients were randomized to screw fixation. Success of treatment and the times to union and return to sports were calculated for each patient.
Results: Mean follow-up was 25.3 months (range, 15–42 months). Eight of 18 (44%) in the cast group were considered treatment failures: 5 nonunions, 1 delayed union, and 2 refractures. One of 19 patients in the surgery group was considered a treatment failure. For the surgery group, the median times to union and return to sports were 7.5 and 8.0 weeks, respectively. For the cast group, the median times were 14.5 and 15.0 weeks, respectively. The Mann-Whitney test showed a statistically significant difference between the groups in both parameters, with P < 001.
Conclusion: There is a high incidence (44%) of failure after cast treatment of acute Jones fractures. Early screw fixation results in quicker times to union and return to sports compared with cast treatment.
FLOAT ON 
the winter gets cold in ways you always forget
One year ago…. January 26th, 2008 was my last track race. It was an indoor 3000m in Boston in which I ran 7:53 in a controlled manner. At the time I thought it was just an early season race before a big summer campaign, it never occurred to me that it would be the last track race I would run in over a year.
In other news.
Maybe I should of had a poll at the beginning of the year in which people could of wagered which would come first, the unveiling of the 2009 Berlin Mascot or the unveiling of the qualification standards set out by Athletics Canada in which to get to the 2009 World Championships in Berlin. I’ll give you a hint which one came out first.
“This mascot will make people look forward to the World Championships even more. I am sure that athletics fans will like the mascot,” added Clemens Prokop, President of the German Athletics Federation DLV.
I really don’t complain about Athletics Canada too much but, year in and year out I’m always complaining about why they don’t publish standards on a timely manner. They calculate the standards off of past Olympics and World Championships so you would think they could get the calculator out soon after the summer season and let the athletes know.
My biggest complaint came in 2005 when I ran a 10 000m in 28:39 and a month later they published the standards for Commonwealths which was also 28:39. The AC standard just happened to be .20 quicker than what I ran. Information I could of used going into the race as my goal was 28:40. It turned out that running the 5000m at the Commonwealth games with bronchitis was quite enough for me.