The View from Sports Center

Chapter 18: The Dreaded Tube

"I've been fooled before with something like this so I think it's a good idea," explained Dr. White.

"Really? Well, ok, I don't mean to challenge your logic, well, I guess I am actually, but what will  another MRI show us at this stage? What's the algorithm?" I asked.

"If your MRI is the same or better, then I think we consider an injection, an epidural. If it's worse, then we'll need to talk about surgery," said Dr. White.

The words came out in a casual, matter-of-fact manner like he had just invited me to dinner. I sat there for a minute and then asked, "So, you think surgery is a real possibility?"

"Well, I doubt it. Your nerve function is better but, like I said, with the symptoms of burning, you could have extended the lesion," said Dr. White.

Extended the lesion. That's med-speak for "your herniation worse." My mind was pacing back and forth like a lion in a cage. I had completely re-structured my life, my work, my, well, everything, thinking that this was my best chance for helping the injury heal and if now, after all of this, all of the effort and time and sacrifice, I ended up right where I didn't want to be....I....just.....wanted....to roar.

But, I didn't. That would have completely freaked out Dr. White. I said, "Ok, MRI then. But, really this time, I need either drugs or one of those really big tubes. The last one felt like a coffin."

Dr. White chuckled. "Sure. No problem. We'll set it up for you to be medicated."

"So, what does the medication do? Knock me out?" I asked.

Again, another chuckle. "Well, you won't have many memorable events. You might feel sleepy and some people do fall asleep and you'll need someone to drive you home," he said.

Great. I won't have many memorable events. That, of course, doesn't mean I won't produce memorable events. I'll probably be one of those people who under sedation say all sorts of stuff that they otherwise would never say like, "Whoa, you're hot!" to a complete stranger and then become the centerpiece of discussion for the radiology department for the next week.

I sat with this in my head for a day or so and then thought, "You know, I could probably handle an open MRI." So, I called Peggy.

"Dr. Gordon White's office," said Peggy.

"Hi, Peggy. This is Doug Kelsey. I've been thinking and I could handle an open MRI. I'm sorry to inconvenience you but could you switch my appointment to an open?" I said with words peppering Peggy's ear.

A pause crept over the line. "Weeeellllll...Dr. White doesn't like to use open MRI. The resolution isn't good enough for him. I'm sorry..." and Peggy's voice trailed off.

"Well, ok then. Back in the tube, I guess," I replied.

"Yeah, I'm sorry. Remember, nothing to eat or drink for four hours prior to your arrival at the facility," said Peggy.

"Got it. Thanks Peggy," and I hung up the phone.

It just keeps getting better. With any luck, I'll fall asleep from low blood sugar and the drugs and miss the whole thing.

And, it's happening today.

Why Fixing Posture Alone Rarely Fixes Pain

Tiger - a Verb? (READ THIS ONE)

"Hey, buddy - you might want to think about that first. You don't want to tiger your knee, do you?"

Tiger played for a year on an injured, unstable knee; a knee that with each powerful swing, chipped away at the protective lining of his joint - the articular cartilage. And a lot of people are left scratching their heads wondering, "Why?"

Maybe it's because no one sat down with him and had "the talk": eye to eye, close up, intense, in-your-face honesty about what was coming if he chose to play without reconstructing his knee. Or, maybe someone had the talk but Tiger chose not to listen. We don't know but I suspect it was a blend of both.

I understand the power of emotion behind the drive to prove your self, to be the best, to never let up. Those are the character traits of winners. And, ironically, they are the same traits that can put you on the sidelines for a very long time when faced with an injury like Tiger's.

I would hate to see Tiger's choice to play on an injured knee, to play wrapped in denial, become a verb in everyday life; to become a word that describes a misguided personal choice rather than a word the describes a masterful golfing choice. He can make a come back but only if he can channel his competitiveness into behaviors that help him rather than hurt him.

Make today count.
Doug Kelsey

P.S. - so I goofed on my last post. I had started it and saved it and sent it without it being completed. Sorry you got this one twice.

Tiger is Out

Tiger is out for the rest of this season.

According to his web site, he will undergo reconstructive surgery for a torn anterior cruciate ligament and then go through rehab for it as well as a double stress fracture of the tibia. The stress fractures were discovered just before the Memorial tournament last month. "The stress fractures were attributed to Woods' intense rehabilitation and preparations for the 2008 U.S. Open." The arthroscopic surgery he had roughly six weeks ago was for torn cartilage caused by the tearing of the anterior cruciate ligament in 2007 (while running near his home in Orlando).

I'll have more thoughts on this later......

Anyone care to comment? Click the comment link below if you do.

Tiger's Winning. Is His Knee Losing?

"I'm gonna' get outta' here and ice this thing."
- Tiger Woods at the post-round three news conference of of 2008 U.S. Open

With every swing, I cringe and cheer. Launching a powerful tee shot that nearly brings him to his knees, limping down that fairway using his driver as a cane, chipping in to hole a birdie..it's Hollywood at its best. Watching Tiger charge from behind to take the lead with a wounded knee is inspiring...until I snap back into reality.

I cringe because I fear that Tiger either doesn't know or chooses to ignore that a joint injury is simply not the same as a muscle injury. Commentators made comparisons to the great Willis Reed of the N.Y. Knicks who in 1970 shuffled onto the court dragging an injured right leg behind him to lift his team to victory over the Los Angeles Lakers. What they fail to mention is that Willis had a torn right thigh muscle and that just a little over a year later, his career was essentially over.

A joint injury is a more difficult injury than a muscle injury. Ice does little to help a joint injury and forging ahead despite the pain can create a life long battle that sometimes is career ending.

I'll watch the U.S. Open tomorrow and cringe and cheer for probably the best golfer ever. And hope that somehow, someway, his joint heals and we'll get to enjoy the Tiger of our time for a long, long time.

I Feel Like A Spoon

Today has been, well, not so good. Yesterday, great. Yesterday I was spouting off to my friend Mark about how great I was doing; how stunned I was at my progress. Today, sucks. Just being honest. And why is that? I feel like a spoon. I have the mental acuity of a soup spoon. I can't concentrate, am struggling to get this written as my mind sputters and now and again sort of shuts down and I forget where I was going with all of this and then it fires back up again and then down it goes.

It makes me mad. I mean, it drives me mad and makes me mad all at once.

So, I've decided. It's official. I need to write more often, study music more, play guitar more, stand on one leg more. Maybe learn how to draw and take up a new language and for sure read at least one book a month. And did I mention meditation? I need to do that too.

I'm concerned that if I don't do these things my brain will shrink; that I will age before my time. I already have signs of it. I set off my friend Ross' alarm today at his house and the really scary thing is that I have no idea how it happened. I'm guessing that the part of my brain responsible for remembering such details as when you enter a code and when you don't is now the size of a wasabi pea. Sorry, Ross. The police were kind to me.

Which brings me back to the spoon problem. Today's a spoon day and I think I know why.

People with chronic back pain lose brain density. That means their brain shrinks. And, you lose 1.3 cubic centimeters for every year of chronic pain up to 10% - meaning your brain shrinks the amount equal to aging 10 to 20 years.

I can't think of something really clever to write here because all I can think of is that my brain could already be shrinking like the Wicked Witch from the Wizard of Oz; that my head will rattle.

I probably forgot to mention that I'm a card carrying member of the chronic back pain society (I don't think that actually exists but maybe it should). I've had back pain for way longer than the current definition of six months and now, with my more recent injury, I've wandered into the Sahara Desert of back pain: burning pain.

I knew that folks with back pain for six months or longer often have changes in brain chemistry in the area of the brain that helps you make emotional assessments, decisions, and controls social behavior but I wasn't aware of shrinkage. So, I just figured that the reason I make really stupid decisions sometimes, like ramping up my training program or sitting way too much, was altered brain chemistry. Isn't blaming great? But now, I'm not so sure.

Well, the study was small, 26 people, and the brain is still very plastic into old age so if I get started, get serious about this, maybe I can have fewer spoon days. I know if you read, if you use your brain, you make new connections, build new synapses, like a whole new highway in your head. And, that's also true about playing an instrument, learning a language, and even balancing types of exercise.

Perhaps I could play guitar while standing on one leg and sing in a foreign language and hit the brain trifecta.

I'm feeling less spoonish already. Now if I could just get a tea in the Sahara.....with you (I'm singing this).

P.S. - today's insight was inspired by my friend, colleague, and coach Christine Springer. She gets the credit for the term "spoon". Just right on, C.

ref: Apkarian, A. V., Y. Sosa, et al. (2004). "Chronic back pain is associated with decreased prefrontal and thalamic gray matter density." J Neurosci 24(46): 10410-5.

A Tiger in Trouble

"...it is what it is and you have to deal with it."

So says Tiger Woods after finishing five strokes back in round one of the 2008 U.S. Open.

For those of you who might not know, Tiger underwent arthroscopic knee surgery at the end of April of this year for persistent knee pain. What actually was done in the surgery is as mysterious as my golf swing. I'm guessing, based on his prior knee problems, that he had a cartilage injury - either the meniscus or an articular surface (the cartilage that lines the end of the thigh bone, under the knee cap, and on top of the shin bone) , or both -  and had the tissue debrided. You're probably saying, "What the heck is that?" Some people describe it as having the knee "cleaned out" or, "cleaned up". An injury to the cartilage creates fraying and small chunks of the tissue float through the synovial fluid in your knee. Your knee will hurt, ache, swell, and generally feel lousy. Debriding removes the offending flakes.

But, what I wonder is how will Tiger "deal with it"? IF he had a cartilage injury and surgery for it, how much healing has occurred in roughly six weeks? Not much. Surgery does not change the health of the cartilage. The joint is cleaner, fragments are gone, but the tissue is still weak. And, cartilage heals slowly because it has no blood and no nerve supply to organize the healing process. Tapping into the body's natural healing potential for this kind of injury requires a precision level of load and motion control. The cells only know what to do through the application of force, in other words, pressure. But, for the first few weeks, the new cells are still as fragile as the flaky crust of an apple pie. Too much force or pressure, and the new cells will be sheared off to float through the synovial fluid setting the knee up for persistent swelling, aching, pain and decline.

Tiger winced in pain more than once today. So, something's not right. Does Tiger really need to play the U.S. Open? Honestly? No. Does he need the money? I doubt it. But, Tiger is not immune to the sirens of success and may suffer from a bit of "hemotion" too.

I wouldn't be surprised to see Tiger withdraw and he should. The smart play here is to not do a "Tin Cup" and go for it. The smart play is to listen to your body, tap into it's healing potential, heal your body, and then go for it.

Chapter 17: James Brown Days

How did I feel after the first half of May?

Watch this......

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I had a follow up appointment with Christine in early May. She thought that my numbers looked really good; that I had made remarkable progress. And, I felt that way too. I had a lot of days that were a  "James Brown Day". So, we talked about what to do next.

"What do you think? What's on your mind?" asked Christine.

"Well, I would like to press things a little. Increase my work loads, add more sitting time, handle dinner a few nights a week, maybe help with house work. Seem reasonable?" I replied.

"Yeah, yeah, it does. That's a lot of stuff though; a lot of change. Maybe think about making changes in one area at a time and then gradually adding things back in," said the wise Christine.

That's not what I wanted to do. I wanted to run; just let things really go. Take my new found freedom out for spin and see what she could really do on the open road. Run the engine all the way to the red-line and then some. See if the frame would hold together or just come shattering apart blown to pieces skipping through the sky like leaves on a light breeze.

Of course, I never said any of this. In fact, when C reads this she's probably going to be surprised. But, instead, I followed the rules.

Sort of. I'm not very good with rules.

I added in more sitting. I had a lot of meetings, driving to do and although I would love to drive in a prone position, and maybe I'll invent such a car, right now, I have to sit. So my sitting time per day and days per week started climbing. Then, I upped the pace on the treadmill, still unloaded but moving faster and up a steeper incline. Then, I added in a set of drills I call a matrix. This is a series of drills that are all focused on one major movement pattern like push-pull or squat-lift. I ran all this by Christine first and she signed off on it although in retrospect, I think what I saw flash across her face was, "Hmmm....I'm not so sure about this but you taught me, know more than I do, have more experience than I do,  but maybe I should say something...no, it's probably just fine...no, it's not fine...yes, it is...." and what she said was, "Well....yeah, I think that will be ok but pay really close attention to your form and any symptoms."

Armed with my new plan, off I went to crash and burn.

It wasn't long after I added all of this stuff back into my life that I had the return of the Painster. In the middle of the night trying to sneak back into my life, there was the old familiar imprint of hip and leg pain. I woke up wrapped in Regret and soaked in Discouragement. I spent the whole day fighting this mental - emotional straight jacket. I just needed to find a place to dump it but it stuck to me like fly paper.  It was like UPS showed up on my front door, rang the bell, and when I answered, I suddenly owned a whole ton of crap; emotional crap.

The Painster slinked away to be replaced by Bitching. My term for burning and itching. My legs, both, sometimes in the lower part, sometimes in the upper, sometimes in my ankles, burned and itched. It felt like twenty generations of ants, all on fire, were marching up and down my legs. It didn't hurt. It was just completely, totally annoying and distracting. I found myself wondering again, "Is this good or bad? Does this lead to surgery or injection or both? Is this normal or do I have something else wrong with me? Is this even real? Am I just imagining this?"

Other than the Bitching, I felt quite good (and that probably sounds like, "Well, other than the stick in my eye, I see pretty well").  I slept fairly well most nights. I could play my guitar again. I could sit through dinner. if I could just get the Bitching under control, I'd be set.

I went back to see Dr. White who suggested an anti-inflammatory. His thought was that a specific part of my nerve was irritated - reason for the Bitching and why I felt it in both legs. He felt I may need an epidural injection of steroids. Yikes. Big needle plunging toward my spinal cord. Not my first choice. Or, second, third, or fourth for that matter. I went to see Trish. She thought the symptoms could be a healing response; kind of like when a wound is healing and it itches.

The Bitching continued through the end of May and moved into full steam ahead BITCHING on Memorial Day. At this point, I took a pain pill - Ultram. Bam! And, two hours later the BITCHING was more like, "Where are you?" I can see why people take drugs. But, it's not the answer. I know that. I just couldn't take the flaming ants marching up and down my legs any longer so I pointed a huge fire hose and blasted the whole lot of them away.

I finally figured out that the culprit, once again, was gravity. If I lived on the moon, I would be just fine. But, until my disc heals, whenever it's exposed to too much force (like sitting too long, or bending, twisting, sweeping), the Bitch, Bitch, Bitch, the Bitch is Ba-a-a-ack! I can sit about 3-4 hours every other day and the Bitching is no where to be found. If go over 4 or do too many days in a row, whoosh! Gates open, ants march!

So, now what? Trish feels my alignment is good and she has decreased my visits, really check-ups, to once a month. I can control the Bitching by controlling my sitting. Dr. White thinks I may need an injection which we'll discuss near the end of June. So, in the meantime, I have to keep the Bitching to a minimum (so, read "Don't sit so much") and to help my spine heal, increase the aerobic exercise component. But, walking isn't hard enough anymore. I can walk a long ways, feel fine and sing the whole way so it's not hard enough. But, if I run, perish the thought, not only will my wife divorce me and Christine shoot me, I suspect my disc would crumble like a stale cracker.

How do I get my heart rate up to flood my spine with oxygen without pummeling my spine? And, can I get my self back into pre-skiing shape? Will my spine hold up?

Does Aging Mean Doing Less?

If you're a regular reader of The View, you know I am rebuilding a battered, bruised and busted up body, head, and heart from a skiing accident. Some people I talk to seem to conclude, without actually asking me, that I will never set foot on a ski slope again. Nope. I will ski again. I love to. But, not until I'm ready.

The thought pattern is not unusual. It's sort of a mixture of "You're getting older and have a busted up body. Be smart. Slow down. Take it easy. Don't take any risks." It's consistent with this recent Reuters news article on Baby Boomers. Bottom line: Baby Boomers need to do less as they age so they won't get hurt.

Here's my take on all of this. You don't need to do less as you age. But, what you do need to do is pursue excellent joint health, great flexibility, awesome balance and coordination, superior strength and endurance, emotional wisdom, and mental agility.  If your body moves with fluid, elegant motion and you have sufficient strength and endurance for the task, and your wise (or, in other words you're fit), you can do all sorts of things.

Stuff happens. Accidents happen. But, I don't think you should give up the things you love for fear of doing too much as you age. Keep pursuing the things you love but prepare your mind and body for it.

And, while you're at it, make today count.

Doug Kelsey

How About Leaving First?