The View from Sports Center

Spencer's in the Worry Bucket

Worrying is borrowing trouble from the future and I'm doing my best to not borrow any more.

On Saturday, I finally strung my 15 to 30 second jogging intervals together for a full 3 minute run. Run three walk two.  I felt light. My steps had a little bounce reminding me of my competitive athlete days and it felt good. My heart rate didn't take off like a fighter jet so the whole time I felt as if the effort was just a little harder than a fast walk.

I have spent several months working toward this goal. Not just to jog for the sake of jogging or health or fitness but to do it with Spencer, our Dalmatian.

Jogging with Spencer brings me joy (and his brother Cirque too!). Why? Well, maybe it's because he seems so happy and his excitement pulls me in or maybe it's because for 30 or 40 minutes, I'm just me and get lost in the delight of being. I know that may sound like I'm dining on ethereal cereal but I don't know how else to describe it. I love the time, the thing we're doing, being outdoors, the effort, and I love that he loves it too.

But, something's wrong with my buddy Spencer.

Dalmatians love to run and depending on the breed, they can run a long ways. But, on Sunday, Spencer quit running and slowed to a walk after just two rounds of jogging.  His head was down; not up and perky. His back was arched and his gait had a stiff, mechanical quality. He looked stressed as if he had just finished a marathon. I decided to head back to the house. I thought I might have to carry him.

Later that day, he seemed to improve but he was not normal. Low energy, ornery, the arched back and mechanical gait returned. He couldn't go down the stairs; I had to help him. We had just taken him to the vet last week for his check up and all was fine so what is this?

Spencer has had bladder problems - many Dalmatians do - in the past but his symptoms were different. He's had a fracture of his left leg so perhaps he's now arthritic? I found my self trying to diagnose him without enough information or knowledge. I found my mind scooping up buckets of worry. What if he has bladder disease? What if he's going into acute renal failure? What if it's too late? What if....what if...

I've counseled thousands of people over my career and now it's time to take my own advice. There's no amount of worry that will change the situation. Action might. There's no guarantee but you'll empty the worry bucket a lot faster if you take action. So, I called the vet and we're going today.

When you find your self worrying, try remembering that it doesn't help you at all. Instead, start thinking about what you can do and start doing it. Every time you scoop up some worry into the worry bucket, dump it out. It's an effort. You'll refill it a lot. But, just keep doing it. It's action and action is what you need.

Make today count.
Doug Kelsey

One Brace Fits All

I'm always there but sometimes hard to find; supportive but difficult to motivate. I can be very protective but if you ignore me, I will wither away.

Who am I?

Most will call me the "core" - a group of muscles that form a dynamic brace around the mid-section of the body.  Unfortunately, the term means different things to different people. Some think of the core as the abdominal muscles while others include trunk muscles and still others include abdominal, trunk, and hip muscles.

For our purposes, the "core" is the region of the body between the mid-chest and upper thigh.

In my last post, I talked about the internal and external bracing options for lower back pain. The muscles of the core act as the internal brace increasing the stability of the lower back. From injury, surgery, or disuse (from a largely sedentary lifestyle), these muscles atrophy in some cases fail to function at all leaving you spine without sufficient "mooring".

The spinal muscles, though, are not under your conscious control - you can't make them do their job which poses a problem. If these muscles need strengthening, will not fire on their own, and you can't make the fire,  how do you ever get them working again?

Like Ringo Starr once sang, "I'll get by with a little help from my friends". If you tighten certain muscles in the abdomen, the spinal muscles will contract as well. The abdominal muscle is the transverse abdominus (this muscle courses over the abdomen from side to side). You make this muscle contract by pulling in your stomach or bracing as if you're going to get punched in the stomach. When the muscle fires, it's like having a direct, high-speed connection to the spinal muscles.

I  think the contraction is better if you imagine being punched in the stomach rather than pulling the stomach in (although I taught that for some time). In either case, you need only a slight tightening of the muscle to fire up the spinal muscles. So, imagine that some one is about to really smack you in the stomach. Tighten up your abdominal wall as hard as you can and call that a "10" on a scale of 1 to 10. During the day, just moving about, you need a "2" or "3" level of force. This is a conscious effort on your part and is difficult to master at first. If you bend over to pick something up, increase the tightening to a "5" and if you pick up something from the floor or over head, move the level of tightening to "7". All day long, you slide the degree of tightening to match your effort in whatever task you're in. Even just sitting at a desk, you need a "2" or "3".

Like all muscles, your transverse abdominus will tire out from use. That's a good thing. When you notice that you can't seem to hold the contraction for very long or can't increase it, rest. Lean back in a chair, lie down, or lean against a wall and just let the muscle get a couple of minutes of rest.

In addition to the "punch in the stomach" imagery, you can use the plank exercise to help strengthen your core muscles. The goal is to hold the position for two minutes and you might want to start on knees and elbows if you've never done this before. Breathe normally during the exercise. I usually suggest doing one set for up to two minutes a few times a day.

There are a number of books, videos, websites, etc., promoting "core" exercises. Here's one that's fairly good but it includes "superman" - skip that drill (yes, even the famous Mayo Clinic suggests the superman drill).

For more information on abdominal muscles and the core, read:

• Stop Sit Ups and Save Your Spine

Make today count.
Doug Kelsey

 

Chapter 21: The 54 Things I Did to Recover from a Disc Herniation

This is long.

Just sayin'.

You might want to print it out and take it with you.

We (clinicians) like to compartmentalize process. We like to think of treatments and procedures and sometimes fail to see that the injured, hurting person is not a collection of compartments but a whole being and that being is what needs help; not just his back or his knee or his shoulder. In other words, your back doesn't hurt. You do. And, you need to do a lot of things to put your "self", your whole being, back together.

I did at least 54 things to get to my current state of "being".

The result? I feel a lot better. In fact, over the past month, I found my self wondering if I actually had an injury My Oswestry score ( a measure of functional disability due to a spine injury or surgery) is 4% (minimal) compared to over 60% (severe) in March 2008. I know I had an injury, but the pain and misery of the past few months seems very distant. I still am careful though and in particular about seating. Restaurants, meetings, a friend's home may or may not have seating that I feel I can not only be comfortable in but also not injure my self. So, although I feel a lot better, I know I'm not completely recovered. However, the memory of pain has faded (what a great thing that is - once again something I would probably not think of had I designed the human body).  When I run into people I know, they always ask, "How are you? How's your back?" and I think they expect me to say, "Well, not so hot really. I blah blah blah......" but when I tell them I feel good, have no symptoms, have put almost everything back into my life, they really seem stunned.

Then they ask," What did you do?" and what they're looking for is something simple.

But, the answer is I changed my life and it's a change that will be with me forever.  I didn't do just one thing: take a pill or, have someone yank and twist my spine or, do one particular exercise. Anyone who tells you that if you just do this _______________(insert technique, surgery, pill, exercise, machine, etc) and that one thing will fix you, is seriously misleading you (you'll see why in a minute). And, there's no shortage of claims running amok over the Internet.

If you want to know what I did, you can get an overview by clicking on "Rebuilding DK" under the categories section on the right hand side of the The View. This will sort through all of my writings and return only those related to my injury and recovery. But, some details are missing, I know, so over the next few weeks, I'll be adding more information about the exercise regimen, activity modifications, environmental modifications, medicines, other practitioners and the people who helped me. Bottom line though, I did a lot of stuff.

Here's the summary of what I did to avoid surgery and come back from a large L4-5 disc herniation (a sort of table of contents and not in order necessarily) which covers the time period from the injury in February 2008 through July 2008. Future Views will expand on some of these topics and I'm sure there will be more to explain as I move into the next phases of rebuilding.

1. I said, "Ok, I need help. I can't figure this out on my own." Of course, this was after I tried and failed first.
2. I found out what was wrong and why I felt the way I did.
3. I decided what I really wanted (this is actually much harder than it sounds).
4. I was coachable (mostly - you can ask Christine...she'll tell you).
5. I worked on my attitude and it looks like this will be a life-long adventure.
6. I admitted my fears.
7. I acknowledged my feelings.
8. I removed sitting from my life ( as much as possible) for over three months.
9. I added spinal decompression (in the form of an inversion table) and used it everyday.
10. I consulted with someone I think of as a "Life Coach" - Dale Goldstein - to help me process the mental and emotional injury.
11. I obtained two surgical opinions.
12. I enlisted the help of a chiropractor, Trish Gregg, who is a member of NUCCA (and Dale said had "healing magic" in her hands).
13. I changed my work environment allowing me to lie down and still use a computer.
14. I did no lifting, twisting, pushing, pulling of anything heavier than about 5 lbs. for nearly four months.
15. I focused on staying well hydrated.
16. I used supplements.
17. I cried.
18. I walked nearly everyday.
19. When I laid down on the floor, I had found the exact angle for my hips and knees as well as the amount of lumbar support to prevent nerve pain and remained in this position for extended (hours) periods of time.
20. I took pain medication to help me sleep.
21. I took an anti-inflammatory for the first several weeks.
22. I took an oral steroid in the first two weeks to reduce the inflammatory response.
23. I spent time with people who cared about me; who would listen to me but not try to solve my problems or tell me what I ought to do.
24. I tried to get perspective of the magnitude of my problem relative to other people.
25. I wore a special brace nearly all the time including when I slept (at least initially).
26. I spent a lot of mental and emotional energy staying focused on the "now" and not the past or the future.
27. For my rehab program, I started working from the inside out. I had to master the basics like getting my transverse abdominis muscle to work and using exercises to facilitate disc healing.
28. I did not stretch - especially my hamstrings.
29. I mentally worked on letting go of fear: the fear of pain, lack of sleep, weakness, loss of independence. I learned that fear's tactic is to make you believe an illusion, something that has not yet happened, is real and as soon as you buy that lie, you suffer needlessly.
30. I listened to music to help me relax, to inspire me, to sooth me. A lot.
31. I avoided bending first thing in the morning (because disc pressure is already high in the morning) which meant I had to get dressed without bending forward to put on pants or shoes.
32. I got rid of regular shoes and wore shower shoes so i wouldn't have to bend over to tie and untie the shoes.
33. I didn't wear socks for weeks (for the same reason in #31).
34. I was disciplined (well, mostly - except for #35).
35. I used a crutch in the house for the first few steps after sleeping or lying down although I put up a pretty good fuss over it.
36. I didn't cook, go to the grocery store, or clean the house for over three months.
37. When walking was no longer a challenge aerobically, I added Chung Shi shoes to increase my speed so I could increase the physical demand with a mild increase in physical load.
38. I bought a pair of Spira shoes to wear for everyday use to reduce the impact of walking on my spine.
39. I train 6 days a week for three weeks and take a one week recovery cycle.
40. I have follow up tests done regularly to tell me where I am physically and what I need to work on.
41. I read "Emotional Resilience", "Emotionally Free", and "Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life" to help me better understand the emotional elements of healing.
42. I practiced my guitar lying on my back. It made me feel good.
43. I used (and still do) a lower back support in chairs and in cars (this is actually a Zafu - something you sit on while meditating but i use it as a lower back support).
44. I change the pressure of my mattress (a Sleep Number bed) based on how I feel.
45. I use three pillows to sleep: one king size, extra firm, to place between my legs; one regular size, firm, to place in front of my chest; one tempurpedic pillow for my head.
46. I have three work areas: a zero-gravity chair with a special support stand for my Powerbook; one on the downstairs bar so I can sit on the edge of a bar stool; one at a regular desk where I sit on a swiss ball.
47. I work for no more than 45-60 minutes then get up and move around.
48. I sit and stand in meetings.
49. When I sit without a support, I always use the "Cello Pose".
50. I pushed my self too hard more than once but discovered the "edge" and then learned to respect it.
51. I looked at set backs as challenges; not failures (but I wasn't 100% on this...plenty of times my mind would win the negativity war and someone, something would yank me back).
52. I meditated on what I wanted to achieve.
53. I started a gratitude journal.
54. I wrote about the whole process and was as honest as I could be.

There may be more things, probably are, but these are the ones I could recognize easily and say with certainty that they made a difference.

None of the things on my list were just random choices. I've met and talked with thousands of people over my career with a lower back injury and in nearly every case, their stories have at least one common theme: experimentation. They've tried lots of things: acupuncture, massage, stretching, icing, traction, and the list goes on.  When you chase pain, the process can quickly succumb to entropy. Before long, you're ordering some weird, wacky gadget off the Internet and look like Kevin Costner in "Tin Cup" as he tried to fix his golf swing (and some of the things I listed do help people who hurt - no argument from me on that one).

I own a particular "lens" through which I view injuries, surgeries and the complaints that often come with them. It's something I developed over my career, understand, and I know it works more often than not to resolve complaints and return people to a higher level of function. It's based on science but is, in many ways, an art form (as all art is the implementation of science). This lens has woven itself into me in such a way that I no longer notice it. It's me and I am it. Nearly everything I look at, I'm looking for the connecting threads. An exercise, a technique, a surgery, an emotional angle, books, movies, music - whatever - I seem to always look for the essentials that form, create or restrict movement. How does this work? How can I use this? Where's the framework? Where's the difference? Similarities? But, it's not the only lens in the world; not the only way to look at injuries and certainly not the only way to deal with pain.

I believe you have to have a lens though; something to help guide your decisions.  If you don't, then the process turns into just a whole lot of guessing-gobbildygook; trying one thing after another followed by periods of intense frustration and doubt. I can't think of something else, that really works, that is based on such randomness. Well, dating, maybe. No, wrong about that. I take that back. 

Each thing I did connected to some part of the underlying decision framework. So, rather than just try something, I (or Christine) would first determine if the item fit and how (now, that is not how I first started out in practice...I was much more in the "let's try this today" group). For example, I knew that the herniation was large, posterior and lateral (meaning the protruding disc material had moved to the back and side of the spine). Lying on my back would make this worse as the force of gravity would cause the disc material to slowly seep out since my lower back was unsupported or slightly arched off the floor. The force of gravity would stretch the injured area (imagine how stretching an ankle sprain would feel). But, if I used a support under my back, I could reduce or eliminate the stretch by filling in the space between the lower back and the floor.

And to give you an example of how powerful emotion was (and always is) in this whole thing, had I really processed the data, the facts, through my "lens", I would have used crutches or at least one crutch right from the beginning. But, I refused. I refused because I felt it made me look old, weak and made me face my own vulnerability and it was too intense. Of course, all I said, as my lovely bride gently reminded me that help was in the corner, was,"I WILL NOT use a crutch" and then stumbled across the room as if my ankles had been hobbled.

So, this is probably enough for now. I have more to share and hope it helps you. Thank you for reading. Thanks to all of you who have sent me good wishes, good vibes, and your comments.

It all helped and it's all good.

Make today count.
Doug Kelsey

How to Feel Like an Olympian

I'm running.

Well, jogging actually.

And, unloaded (sub-gravity - see image for example) about 30 lbs.

For 60 seconds.

And, I'm tired after 25 minutes of intervals consisting of 60 second jogs at 6 mph followed by a two minute walk but thrilled to be doing it even if it's only about 8 total minutes of jogging. Six months ago, I was on my back unable to do much of anything.

Jogging again made me remember just how fit the marathoners are in the upcoming Olympics. The men's world record, held by Haile Gebrselassie, is 2:04:26. Think about that for a minute. That's a running speed of almost 13 miles per hour for over two hours! Our treadmill top speed is 10 mph and trust me, I would be sprinting.

Haile and I are really similar though. We both have the same muscles, bones, tendons, ligaments. We both have lungs and a heart. We both pump blood through our bodies and distribute oxygen to our working muscles. But, we have at least one major difference. Haile delivers oxygen to his muscles like Federal Express while my delivery is Pony Express.

World class athletes have a very high Max VO2 (the maximum amount of oxygen that can be consumed per unit of time). Haile's max VO2 is likely 75-80 milliliters while mine is probably no more than about 40. And, while some people have a genetic pre-disposition toward higher Max VO2, the main determinant is training. High performance athletes train long and hard to reach the peak levels needed at the Olympics.

The good news is that you can boost your max VO2 if you want to by training and if you do, guess what? You also boost your working speed.

I love that I can jog even though it's one minute and I need an anti-gravity machine to do it safely. I know that if I keep training though, I will one day jog with my buddy Spencer again and that makes me feel like an Olympian.

Decide what you really want and then start training for it at the level you CAN train; not at the level you think you SHOULD be able to train or NEED to train. Embrace your current ability no matter how far away you are from where you want to be. That's they key to feeling like an Olympian.

 

Train on.

Did I Make it Through the Movie?

It was a great night at "The Dark Knight" this past Monday. I made it through nearly three hours of sitting, no symptoms, and felt fine the next day and this morning.

So, this opens up a few more options in my world. I can probably travel by car or plane. Sure, I'll still be careful and use a lower back support, get up every hour or so and move around (which makes car travel a little longer) but having the option is a very liberating feeling.

Several people have asked me, "So, do you think you'll still need surgery?" No. I think that door is now closed.

Onward....

Chapter 20: Less is More

When I looked at the MRI film, I wasn't sure. Was I was looking at mine? Or, maybe I was looking at the wrong level of the spine.

"Gordon, that looks a lot different to me. Am I seeing what I think I think I'm seeing?" I asked Dr White.

"I know. It's remarkable. I had the same feeling when I first reviewed the films. I expected the films to be better because your nerve function is good, muscle strength is good, but I never expected this," replied Dr. White.

My MRI showed a small bulge of the disc where three months earlier there had been a huge herniation cascading down the back of the L5 vertebral body. This sort of thing is not supposed to happen in three months. (In the image, the left is my MRI in March 2008 and the one on the right is June 2008. The herniation is outlined in red. Notice the difference in size.)

Disc herniations like mine - large and non-fragmented -  rarely shrink according to conventional medical views. They almost always require some type of invasive procedure; epidural injection or surgery because of the pain severity and degree of disability.

"So, then, what does this mean going forward? What do you think? Do I still need an injection?" I asked.

"I think, with this kind of improvement on your MRI and your physical improvements, you should just keep on doing what you're doing and we should just wait on the injection. I don't think you need it and it's an invasive procedure," explained Dr. White.

I'm a controlled sort of guy on the outside (although learning how to let go) but inside I was turning cartwheels, jumping around, yelling, laughing, crying all at once. I just nodded, smiled and said, "Awesome. That's just so awesome."

So, where did my herniated disc go? Well, research over the past decade has shown that about 60% of people with herniations will experience what is called, "disc resorption." The extruded disc material is treated like a foreign protein by your body and your body, basically, digests it. But, to do this it needs access to blood and it turns out, paradoxically, that the larger the herniation, the better your chances are for resorption (and keep in mind that convention wisdom and practice is often 10-20 years behind research which is why so many people will disagree with this view). Since my herniation was large and even pushed on the spinal cord, I had statistically a good chance but I still had to maximize the blood flow to the region.

You might be wondering if there was one thing that helped me shrink my disc herniation and the answer is yes: a complete overhaul of my lifestyle and not just for a few weeks but forever.

I'll get into that soon. For now, I'm just going to savor what I have, how I feel, and where I'm going next.

Any guesses?

Make today count.
Doug Kelsey

References:

Mochida K. Regression of cervical disc herniation observed on MRI. Spine   1998;23(9):990-997.

Ellenberg MR. Prospective evaluation of the course of disc herniations in patients with radiculopathy. Arch Phys Med Rehab 74; Jan 1993, p. 3.

Bozzao A. Lumbar disc herniation: MR imaging assessment of natural history   in patients treated without surgery. Radiology 1992;185:135-141.

Chapter 19: Drugged in the Dreaded Tube

Friday morning arrived at the front door of my mind carrying with it plenty of sluggish luggage. When I didn't answer, it just knocked harder, louder, longer. Finally, I chugged and sputtered out of bed feeling like my brain was coated in a thick jelly.

Hung-over is too gentle a description.

"Coffee - that'll help," I thought.

As I sipped my third cup, the true length of the day settled in. "I hate MRIs," reverberated in my jelly filled head.

My druggie hang over was induced by MRI Guy.

****************************************************

"So, what are you, about 6'2"...6'3?" asked MRI Guy.

"Yeah..about that," I replied.

"You know, at that height, I mean, we could, ya' know, do this without meds. Your head will be outta' the tube and it's only a 20 minute test so, if ya' wanna' do this without meds, I mean, we could. Of course, up to you," said MRI Guy.

"Yeah, well, I hated the last one. I'll stick with meds," I said.

"Ok, but, like I said it's only a 20 minute test and your head will be outta' the tube and everything, so ya' know, you could," said MRI Guy.

I wondered if  "WIMP" had magically appeared on my head like some sort of stigmata.

"Like I said, I hated it. Meds for me," I replied tersely.

He escorted Elle and me into a "SEDATION" room (and, why not call this RELAXATION and be just a pinch more consumer centric is beyond me) where I donned paper pants and shirt and skid free socks. You never know how many people will break out into a Tom Cruise Risky Business Hall Way Slide while waiting for an MRI.

MRI Guy comes back after 10 minutes or so and asks, one more time, if I might, just might want to try this thing without meds. I want to punch him. He doesn't understand of course how nasty I can get without food or water; how tasty his right arm really looks right now. I have a strong urge to bite him.

But, I just say, "NO" and chew up a specially formulated ZANEX which has the most bitter taste I can ever recall.

MRI Guy asks me to lie down and then covers me up with a blanket. It's 102 degrees outside, and I appreciate this token gesture of customer service, but I would rather have a chilled rag.

After about 15 minutes, MRI Guy pokes his head in and says,"So, how ya' feelin'?"

I hate that; ask me some generic question and expect a specific answer. How the hell do I know? I'm on ZANEX, remember? So, I say, "I don't know. Ok, I guess. How am I supposed to feel?"

To which, MRI Guy replies, "Well, wanna' give it a try?" as if I'm about to get on a ride at Six Flags. Yippeee! The MRI Daddy! Can I ride? Huh? Huh? Can I?

These are things that float through your mind when you're on ZANEX.

So, off I go into the MRI room. I lie down on the table and suddenly, as if he popped out the Dreaded Tube, I see what might be a troll standing next to me. I think the ZANEX is kicking in big time.

"So, Hey there Big Guy! Are you ready? Here's the deal, now, as you slide into this tube, I'm gonna' ask you to just lift those big feet up a little 'cuz, ifya' don't, well, your knee caps are gonna' rub on the top the tube and that's not gonna' feel too good so lift'em up when I tell ya', Ok? And, don't cross your arms but keep'em up 'cuz as big as you are you're gonna' rub the side of tube too," Troll Guy booms in a big, baritone voice with the speed of one of those announcers at the end of a commercial reading all the fine print and disclaimers.

Troll Guy slides me in the tube, tells me to life my feet, which I do but not enough as my knee caps jam into the top of the tub so I lift them higher until Troll Guy says "Ok, that's it." And, my knee caps are firmly pressed against the top of the tube with each shoulder snuggly packed in on the sides. Sardine comes to mind.

But, I don't care.

ZANEX is king.

The absolute King of Never Caring Land. I laid in the tube for 30 minutes with all sorts noise and movement and rubbing on my knee caps and pressing on my shoulders and at one point I looked up and was ALL THE WAY IN THE TUBE! You LIAR!

But, I don't care.

Once the test was over, I stumbled back into the SEDATION ROOM, and made a poor attempt at dressing my self. I managed to do it but from the way Elle described it, I was aiming poorly for various leg and arm openings in my clothes.

By the time I arrived home, I was trashed. As I got out of the car, I tripped over a plant, careened off one of the cars in the garage, bumped into a shelving unit and finally came face to face with the door. Big Guy was walking a like a little guy; like the 3 years old kind of little.

I don't remember too much else that happened that afternoon other than trying to eat a sandwich and having a hard time figuring out that my mouth was not on the side of my face.

I fell asleep for a little over three hours, got up, not sure what I did and went to bed to wake up with Friday morning knocking on my door with plenty of sluggish luggage.

And, the results from all of this? What did my MRI show?

That's next.

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.

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.

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?