Monday, June 06, 2016

Between injury and recovery

On Friday I had carpal tunnel release surgery in my right hand. The procedure required a long vertical slit through the palm, where the surgeon cut the transverse carpal ligament to relieve pressure on the median nerve, and also removed a fair amount of scar tissue from the area. The scar tissue was especially surprising. A majority of people who suffer from chronic CTS - many for years before they seek treatment - never build up scar tissue and have better nerve response than I did after three months of symptoms. Everything about my case points to acute CTS, except for I never had a damaging wrist injury. Or did I? The long tunnel of scars and bruises is becoming increasingly murky.

What the surgery did determine is that this was never going to get better on its own, and may not still. It's up to the nerve to heal now that the compression has been released. It was, however, badly compressed. As soon as the wound heals I can employ massage to prevent scar tissue buildup and hand exercises to improve strength, but most of the actual healing process is beyond my control. Knowledge of this has admittedly brought me down, but that sad feeling could just be the pain and fatigue from surgery, and dealing with what is currently an utterly useless right hand. I lost my temper today when I failed to wrap a band around my hair - so I threw my hat across the room and stomped all over it. Childish as it is, sometimes a temper tantrum feels good.

When my mom heard about my surgery, she offered to spend her birthday driving across Colorado with my dad so they could drive me to the clinic and stay by my bedside as I woke up in a recovery room, groggy and begging for apple juice. My mom was very sweet to take care of me over the weekend, and I feel lucky to have her. It was especially fun to show my parents our new home and the surrounding mountains.

The hat-stomping incident occurred after they returned to Salt Lake, when I decided to get some fresh air by walking up to my neighbor's house to deliver a check. The process of getting ready - changing into outside clothes, adjusting my new arm sling, writing and signing a check with my left hand to a satisfying level of third-grade-penmanship, applying sunscreen, and putting on shoes and socks - took a frustratingly large amount of time. By the time I got to the hair tie and hat, I'd had it, and let my hair whip and tangle in the wind. Dark clouds built overhead as I walked. After three miles I still hadn't found my neighbor's house (turns out he moved his street sign) but by then there was thunder directly overhead, and I needed to hurry home. When it started to rain I tried jogging, but that was far too painful and ill-advised. Then the sky opened with heavy rain and nickel-sized hail, and all I could do was duck beneath a pine tree and hold my good hand over my neck as hail pelted my head and back, and rain soaked the bandages I wasn't supposed to get wet.

"Mom would not be happy with me," I thought. (Sorry, Mom.) I felt like crying, but I'd already spent all my tantrum energy on a hat.

Instead I waited for the hail to subside, then walked the rest of the way home in a downpour to change my bandages and dispose of the disintegrated check that I'd spent such a long time writing and carrying up the road for nothing. Sometimes it just feels like there's a dark cloud hovering overhead. But things get brighter. I know that.
Monday, May 30, 2016

Blame it on the Tetons

 Beat and I are often accused of failing to take "real" vacations. Every time we leave home, they say, it seems to be for some kind of difficult endeavor, steeped in suffering. Of course this isn't true, but any such argument requires dredging up philosophical musings about the subjective nature of enjoyment, and reasons why one woman's day at the beach is another woman's slow-roasting torture of sunburn and boredom.

Memorial Day brought an opportunity for a classically enjoyable vacation in the form of a Google employee retreat in Teton Village, Wyoming. There would be relaxing in a spacious suite, big breakfasts, nice dinners, a wine tasting, a rodeo, and access to any number of luxuries that come with a resort destination. Attendees were encouraged to enjoy scenic floats on the Snake River or bus tours to Grand Teton and Yellowstone national parks, but warned that late May is still the pre-season and outdoor opportunities would be limited.

On Wednesday Beat and I drove from Boulder to Jackson, and the scenery and wildlife viewing was great right along the highway (Over the course of the weekend we saw elk, deer, bison, pronghorn, bighorn sheep, osprey, and a grizzly bear, all from the comfort of the car.) We enjoyed a few nice meals with Beat's colleagues. Somewhere in there I developed a crushing headache, which I can't even blame on the altitude as Teton Village is a thousand feet lower than our home in Boulder, but I'll go ahead and blame the altitude anyway.

I was feeling quite lousy, and sulked through Thursday's long breakfast followed by an afternoon wine tasting, where I drank bottles of water and struggled to hold down a light lunch of barley soup and salad. (If you're wondering how there's a winery in Jackson Hole — because I certainly was — it works because they grow their grapes in Sonoma County, California, and truck them into Wyoming for fermentation. Reportedly the high altitude and cool summers aid in this process.) Anyway, by mid-afternoon I was all relaxed out, so I angled for some fresh air and a short hike before dinner. Nothing too difficult — we could just walk up the ski hill, look out over the valley, and jog down.

 Our friend Liehann, who is racing the Freedom Challenge again in two weeks and has been exclusively bike training for the past six months, made the arguably poor choice to join us. Up we marched in a biting wind and intermittent sleet squalls. I wasn't anticipating an epic and was wearing a T-shirt and hiking pants, with only a 2-ounce Mountain Hardwear shell, a knit hat, and a fleece buff as extra layers. When I started to feel chilled, I put on the hat and buff but opted to leave my arms bare, relishing the sensation as the feeling left my extremities. See, ever since I developed carpal tunnel syndrome in late February, I've lived with a low-level pain in my hand that can partially be described as a mild case of the screaming barfies. Now that three months have passed, I've grown more accustomed to living with this constant tingling, but I do notice when it goes away. It feels wonderful. And the only thing that makes the pain go away is reduced circulation or actual numbness in my hand.

As we continued gaining elevation and the wind grew more fierce, I debated where to draw the line between my enjoyment of pain-free fingers and the increasing discomfort of the cold. It was about then that I took a sip from my Camelbak and drew a mouthful of slush — meaning the ambient temperature was below freezing.

"Windchill has got to be near single digits," I thought, and decided it was time to put on my jacket. The paper-thin material whipped wildly in the wind, and the fingers on my good hand were too stiff to open it up. Basically I'd become too chilled to put on my own coat, which was not a great coat to begin with. It's quite a dumb thing to do, and of course I knew this. At the same time, I knew enough to understand my body was uncomfortable but not dangerously cold, and that warming up would be quick the moment I turned around and sprinted down to sheltered elevations. So I stuffed the jacket in a pants pocket and continued marching up the hill in a T-shirt.

 It was all quite exhilarating, fighting those primal fears that spark at the edges of survivability. I wasn't yet shivering and actually my body was doing a great job of circulating warm blood through my core and legs — only my arms were icy cold. The frigid wind roared and sleet squalls hung like curtains from surrounding clouds, but overhead there was a patch of almost-sunlight, and I relished it all.

At Rendezvous Mountain, Beat and Liehann had ducked behind a closed tram station. Beat helped me put on my jacket, which was definitely better than a T-shirt but not great, and then we all pressed into the brunt of the wind for one more view of the snow-capped skyline beyond the summit. Running downhill, I managed to warm up quickly. After a half mile Beat graciously leant me his mittens to expedite the real screaming barfies feeling in my fingers (which is a lot worse than what I feel all the time. Lesson learned.)

We returned from what turned out to be a 14-mile, 4,200-feet-of-climbing outing just in time for dinner. My headache had finally abated, so I used up all of my bar tickets on glass after glass of Diet Pepsi.

 On Friday we cast a hopeful eye on a canyon loop in Grand Teton National Park, but we weren't well-equipped for spring conditions. (I did have a better jacket, which I carried on every other outing this weekend.) After parking on the wrong side of Jenny Lake, we'd already hiked nearly eight miles by the time we arrived at the mouth of Paintbrush Canyon. Slush line started at 7,500 feet, and by 8,000 feet we were post-holing to our knees. Over scree fields this kind of post-holing can be dangerous, because you don't know where your foot will land. It could be a deep crevice between two rocks, which could easily end in a sprained or broken ankle.

 The weather was volatile as well. It went from raining to sleeting to blue-sky sunshine in the span of about thirty minutes.

 We found a nice basin to have some lunch and called it good.

 Heading back down to String Lake, where we hitched a ride with Liehann and Trang. We could have trekked all the way back around Jenny Lake, but we were committed to our lazy resort weekend. This hike ended at 13.2 miles. Later that evening went out on the town with a large group of Googlers. There may or may not have been overconsumption of a massive funnel cake and the purchase of a fur-lined jock strap. (Beat was not the one who made this purchase, and wanted me to clarify this, although he did go on about how well a fur jock strap would work in Alaska.)

 Saturday morning, we weren't willing to brave the crowds in the national park, so we traveled to the other side of the valley to scope out a route to Jackson Peak. The best views came on the road walk to the trailhead, where clear skies revealed the entire Tetons skyline.

 Snowline consumed the trail at 8,500 feet and then it was a slog. We should have brought snowshoes to Wyoming. Wide backcountry skis would have been the way to go of course, but even snowshoes would have greatly improved our chances of getting to the places we wanted to see.

 Beat inadvertently volunteered to be the trail-breaker, and carefully tested every step. At this point were were all frequently collapsing into hip-deep crevasses.

We decided to turn around when we found ourselves on rotten snow atop table-sized boulders, where falling through might end in a head injury. This was also a nice lunch stop — Goodwin Lake.

 Beat's colleague Ben in one of the many leg-swallowing holes.

 Ben penguin-ing downhill. This helps solve the postholing issue, but it also results in a face full of snow.

All in all, it was a pleasant holiday weekend with lots of relaxation and hardly any exercise. I don't know why people assume we don't like to have fun.
Monday, May 23, 2016

Broken, not broken

Beat with our Iditarod-inspired tripod. He collected the markers from downed trees off the trail in March.
This week I've been less enthused about my runs, dragging around a sore leg and the knowledge that my hand is not going to get better on its own. Last Wednesday, a doctor performed a nerve conduction study and concluded I have "very severe" carpal tunnel syndrome. The numbers point to grade five, which is as advanced as this injury becomes before the nerve stops firing altogether, and the damage can be permanent. There's already muscle atrophy. My distal motor latency has actually deteriorated since I had a similar test done in March, even though I gave up the activity that prompted my symptoms (cycling), wore a wrist brace, performed PT exercises, and took anti-inflammatories. At this point, the cause is impossible to determine — my case is definitely not typical, and there's no way to say whether it's overuse from the race to Nome, acute injury from a crash, genetics, a combination, or something else entirely. All I know is it's bad, and getting worse. Both the doctor who conducted the test and the surgeon I originally consulted were adamant that I not mess around with this.

The results must have been concerning enough to fast-track through an overbooked schedule, because the surgeon offered an appointment next week. The next available dates weren't until July. I booked it, because the odds of full recovery after transverse carpal ligament release are high. Without surgery, the odds that I'd have to manage this for the rest of my life also are high. That's nerve injury. I learned a similar lesson in 2009 — "Frostbite is forever."

I did not expect busy Boulder doctors to expedite this process, so I'd already registered for what I hoped would be my first trail race in Colorado, the Golden Gate Dirty 30. The race is June 4, so clearly I won't be able to participate. Disappointment about this is among the many emotions the prospect of surgery has ignited.

Of course there's anticipation. (No more invisible spiders crawling all over my fingers, no more electric shock pain!)

And there's fear. (Unless you count wisdom teeth extraction when I was 15, I've never had surgery. I might die. That possibility is noted in the manual.)

There's disbelief. (Given my risky and high-impact sporting activities, I would have never guessed my first surgery would target a stereotypical typing injury.)

And hope. (I might be able to hand-write like an adult, draw, eat with a fork and knife, and ride bikes again by July!)

 I was bummed out after Wednesday's nerve conduction test. Beyond the bad numbers, the phrase "it's getting worse" is especially discouraging after you've spent two months avoiding something you loved because you believed abstinence would make your injury better. Adding to this helpless feeling was the full limp I was sporting after slipping in mud and bashing my leg on rocks during a run on Tuesday. A bruise the size and shape of a softball ballooned out from my shin, and hurt quite a bit. But it was "just a bruise," and I was feeling defiant about this pathetic array of limb injuries, so I took a couple of lunchtime hours to march up Fern Canyon.

Fern Canyon has become a personal nemesis, because it is perhaps the meanest of the mean (standard hiking) routes in the Flatirons. I maintain concerns that I will always be a flailing, stumbling, inadequate mountain runner/hiker. This is particularly sad if I continue as a non-cyclist, and my only running options are mountains. I love mountains. But they do not love me. At least, I believe they might be conspiring with gravity to knock me around a bit. I was thinking about this the other day as I crept down Gregory Canyon — no matter how much I practice this, I may not improve because the issue isn't limited skills or strength, it's balance perception. If I descend Gregory Canyon enough, eventually I'll have a stronger core and ankles, but I'll likely still feel the pull of vertigo with every step. How much training does it take to realign proprioception?

But yes, Fern Canyon. My leg hurt, but I tagged Bear Peak, and this weirdly made me feel a lot better.

 The rest of the week involved some running around with a painful bruised leg, because I was in training for the Dirty 30 and wanted to make sure my proprioception was dialed. Beat guided me on a tour of a couple of the semi-secret routes on Green Mountain, which were steep and fun but shattered any confidence I may have tenuously gained.

At least my writing projects are going well this week. I am really enjoying working on my Iditarod book, although a few hours of submersing myself in it often leaves me more exhausted than a long run. I'm also negotiating a contract to have "Be Brave, Be Strong" produced as an audio book. No, I won't be the narrator — therefore, it might actually be okay. The adventure genre is a challenging market for books, because a fair percentage of the audience are not regular readers. Audio books are great for busy folks who perhaps want a diversion while they're commuting or out for a long run. I've resisted offers to work on audio books in the past, because — full disclosure — I don't enjoy and don't listen to audio books (for me, something is lost when I'm being talked at, rather than reading. Perhaps I'm too attached to having full control of my reading experience. Or have too short an attention span.) But this is a good opportunity. I'm excited!

After my consultation with the surgeon on Monday, I was again bummed out, because there was admittedly a sliver of hope that she would look at my results and say "hey, I think a cortisone shot could fix this." (A cortisone shot probably wouldn't even mitigate the pain of grade 5 CTS.) It was again lunchtime, so I again went to the Cragmoor trailhead for another go at Fern Canyon. My leg was finally feeling less sore after I took a day off Sunday and the swelling had gone down, so I marched happily up to Bear Peak through intermittent rainstorms. My goal was to do the descent a bit better, so I furrowed my brow in concentration and employed my trekking pole for a little more stability as I hopped down rock steps. Near the bottom of Fern Canyon, when the 1,900 feet-in-0.8-mile-descent veers onto a nicely runnable doubletrack, I stepped up on a boulder and clumsily bashed my sore shin on the rock.

!!!! There were loud swear words.

I may have lost my temper and stabbed my trekking pole violently into the rock, multiple times, with enough force to make deep gouges in the surface. It's amazing the pole didn't snap. +1 Black Diamond carbon Z-Pole.

The bruise is swollen again, and larger than before.

Well. Clearly it's my turn to feel broken right now. I'll find another way around it.