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Saturday, November 23, 2013

how it all began: part 1

A brief snapshot into the last 10 days or so before I back pedal to the very beginning...

Today marks the last day of week #7 of my 12 week medical leave from my job as a health coach at University of Arizona Integrative Health Center. Yes, health coach. The irony is not lost on me. Even though I'm off work, my appointments have kept me pretty busy. In the last 2 weeks I've seen spinal surgeon Dr. Yeung (team surgeon for the LA Dodgers), Dr. Freeman in the pain clinic at Mayo, plus my weekly acupuncture visits with Dr. Williams and two cranial sacral therapy sessions with Carol Ristau, PT. I've also had one of my regular PT sessions with Veronika Campbell (who does manual therapy and visceral mobilization - super fascinating, more on that later), a meeting with the amazing Patti Milligan, RD to review some test results, an orthodontist follow up, another follow up appointment with physiatrist Dr. Porter to review the results of my recent motion x-ray, four rehab sessions with dear friend Anna Hartman at Athletes' Performance, and two sessions with Dr. Beran at Evolution Physical Therapy. And that's a pretty standard 2 weeks. So, if you're wondering what's wrong with our healthcare system...it's me. Hah! Just kidding, most of it's out of pocket so joke's on me!

On days of reduced pain, I've squeezed in a few good mountain bike rides but have decided to take a bit of a hiatus from the bike to help my spine spend some time in a more favorable position. Right now, in addition to all of my rehab, I'll just be doing some yoga, sprints on the versaclimber, and hiking (I'll go crazy if I can't get outside to do something). One of the really nice things about being off work though is that I can schedule my workouts in if and when I'm feeling up to it.

This week Craig and I missed 2 concerts that we had tickets for, Pearl Jam and the Black Crowes, which was kind of a bummer but I just didn't have it in me. The last show we were at we had to leave early anyway because my pain was too out of control - and that was my favorite band, The Avett Brothers.

So how the hell did this happen? I'll do my best to map out a timeline of the last 2+ years, starting with the incident that got this whole party started...

July 2011: Kansas City, MO
I was out for a mountain bike ride in Swope Park with a K-State student who had just moved in to the apartment above me. The singletrack we were on wasn't technical at all - a few flowy turns here and there but easy enough to pick up some speed. As I saw the tree lying across the trail in front of us and watched him effortlessly clear it, I prepared to do the same. As is often the case, I remember realizing there was no way my front wheel was popping over the log in that split second before I had reached it but it was too late for plan B. So there I went, full speed, straight into the tree, whiplash-style. I was thrown off the bike and knew my quad was banged up pretty bad, but other than that it was nothing too out of the ordinary. I was riding a GT Zaskar (hard tail) at the time and had been spending my summer mastering the art of going over my handlebars. We were only 15 or 20 minutes into the course, so after bandaging up my bloody hand and dusting off my bruised ego, I got back on to finish the ride. Little did I know how much that silly bike wreck would alter the course of my life.

I went to work the next day at Cerner's Core Performance Center (my interim position with CP before moving on to my actual job with CP at State Street). My Adidas shorts never did suffice in covering them, so my weekend battle wounds had become a pretty lighthearted conversation piece with coworkers and clients. Still feeling that "just got kicked in the quad with a soccer cleat" ache, I skipped my lift that afternoon and called it a recovery day. I spent a few minutes stretching out my quad on the Power Plate (vibration training is thought to help speed healing by increasing circulation and decreasing inflammation). Not long after using the Power Plate, though, I started feeling a bit dizzy. The "I think I need to sit down" dizziness soon progressed to me curled up in the gym's bathroom stall with my head in the toilet and the walls spinning all around me. How bizarre - I figured the vibration must have just completely thrown off my equilibrium.

A coworker drove me home that afternoon and I spent the next few days in my apartment, trying to figure out which was making me throw up more: laying down with my eyes closed or standing up (it seemed to be a tie). I can only liken it to the worst morning-after-you-just-got-the-most-drunk-you-ever-have-in-your-life-and-you've-promised-yourself-you'll-never-taste-alcohol-ever-again feeling. Finally after about a week of that nonsense, my coworker, David, kindly took me to the ER. I sat in the drivers seat throwing up into a trash can while he tried not to dry heave. It was a fun Sunday.

After the St. Luke's ER intake nurse eyed my total-body bruises and asked me if everything was okay at home, I was hooked up to an IV (it had been a looong week of fluid depletion) and examined by a doctor. He was concerned that my week of straight vomiting may have caused a rupture of sorts, so they performed a stomach ultrasound to rule anything out. In retrospect, how CRAZY is it that a week post-bike accident didn't warrant imaging of my noggin? Or even any neurological tests? I was still just attributing my symptoms to the vibration but am pretty certain now that I had to have suffered a non-impact concussion.

The initial "vertigo" subsided over the next few weeks, but I couldn't seem to shake the dizziness completely. I started becoming more conservative with my workouts, as explosive movements like plyos, med ball work, and sprints seem to set it off the most. Lateral eye movement seemed to also be a trigger (ex: quickly shifting my glance to the left before switching lanes on the highway). Having relocated to KC just a few months before, I didn't have any tried and trusted docs or bodywork practitioners so I began researching the least invasive ways to alleviate vertigo symptoms. I've always had positive experience with chiropractic, so that was where I started.

After reviewing my x-rays at Advanced Sports & Family Chiropractic & Acupuncture, the doctors explained that the whiplash motion during my bike wreck could have actually been the mechanism responsible for this cervicogenic vertigo, which is defined as "a syndrome of disequilibrium and disorientation in patients with many different diagnoses of neck pathology including cervical spondylosis, cervical trauma, and cervical arthritis (kind of a broad and somewhat subjective diagnosis). Spinal joints are heavily concentrated with proprioceptors that send information to the brain about sensory information (including body position in space, balance, etc). Chiropractic adjustments can be helpful in treating vestibular disorders like cervicogenic vertigo by addressing that joint dysfunction. So I started out with a few upper cervical adjustments per week for a few weeks, tapering to once per week for the next 1-2 months. The dizziness seemed to be calming down too.

November 2011 : Kansas City, MO
Throughout the fall, I had started feeling this tension at the very top of my neck, right at the base of my skull. What I would have first described as a stiff neck was also developing into a (relatively low grade) headache. It felt like the chronic tightness I was recently experiencing in my traps and rhomboids (more so on the left side) were somehow also tied in. It probably didn't help that I was pushing through it and lifting 4-5 days per week. In need of some serious soft tissue work, I started seeing a massage therapist at Praxis Wellness, while switching over to another chiropractor who used Active Release Technique (ART), which I've had good luck with over the years for different sports injuries. ART consists of evaluating the texture, tightness, and movement of muscles, fascia, tendons, ligaments, and nerves and then treating the abnormal tissue by combining precisely directed tension with very specific movement protocols. After a weeks of treatment, though, I didn't seem to be making much progress. Fortunately, Christmas was right around the corner and since I'd be back home in Massachusetts, I'd be able to pick the brain of the amazing chiropractor I'd been seeing since I was 15, Dr. John Marchese.

December 2011: Boston, MA
After observing my eye movement, Dr. Marchese knew right from the start that there was some neurological element to this. In the world of functional neurology, eye movements are considered to be "windows into brain dysfunction". Unfortunately, continuity of care with Dr. Marchese wouldn't be possible since I was headed back to the midwest post-holidays, but his insight was helpful in mapping out the next step. I remember Craig and I spending our first New Year's together that year and making a resolution to get to the bottom of my headaches ASAP. Little did I know this was only the beginning.

January 2012: Kansas City, MO
Craig and I had just started dating in the fall. Even though he was in Phoenix, he was still doing everything he could to help out. His colleague, Mark Verstegan (President & Founder of Athletes' Performance) is also Director of Player Safety & Wellness for the NFL Player's Association. Mark connected us to Dr. Joe Waeckerle, former team physician for the Kansas City Chiefs, chairman of the Mackey-White Return to Play Subcomittee, and veteran of the NFL's concussion wars. Dr. Waeckerle kindly agreed to meet with me and after listening to my story and examining me, felt confident that I was experiencing post-concussion syndrome. He recommended I lay off manual manipulation before getting some imagining of my head. At that time, I didn't follow his advice on getting an MRI but I'm not actually sure why. I don't think I disagreed with his assessment, but I just had this feeling that there was some mechanical dysfunction going on in my neck and if I could just figure out a way to fix that, everything would be fine. In retrospect, that decision was part intuition and part stubbornness.

February 2012: Kansas City, MO
So I trudged on, finding yet another chiropractor, Dr. Luke Stanker, who used ART and had a lot of experience working with high level athletes. I saw Dr. Stanker for a few months and was finally starting to get some relief with my headaches, which had seemed to be creeping up in frequency. Unfortunately, we couldn't get the relief to sustain more than a day or so between treatments. Over the course of the previous few months, I had also developed this weird popping in my jaw. It was more just annoying than anything else, but we thought perhaps it was connected to my headaches. Dr. Stanker tried some ART on my jaw but without much luck so I decided to see a dentist to get their take.

April 2012: Kansas City, MO
At Lighthouse Dentistry, the dentist agreed that I had indeed developed some good ole' TMD (temporomandibular disorder), a common result of whiplash injuries. I was also experiencing some discomfort inside my mouth from my wisdom teeth, who were finally deciding to make their grand entrance. Perhaps the crowding was contributing to my jaw dysfunction? With my headaches continuing to increase in both intensity and frequency, it seemed like it was worth finding out, so off I went to the oral surgeon for extraction. Those was a humorous few days to say the least. Since I was living alone, my coworker Ernie dropped me off and picked me up from the morning procedure. I've had a few other surgeries before (all sports injuries), including my arm, both hips, and nose. I'd always attributed my post-op vomiting-all-over-the-place to painkillers, but I didn't take any meds for my wisdom teeth and finally figured out it's the anathesia that my body doesn't tolerate too well. At one point I tried calling my mom and accidently left her a voicemail of me throwing up. She tried calling me back but I had already passed out and that's when she also realized she didn't have the phone number of a single person in the city where I lived. Ah, lessons learned. The need to take care of my wisdom teeth would have just been a matter of time, but unfortunately didn't put a dent in my headaches. I wasn't ready to give up on the jaw thing completely, though. It had to playing a role somehow.

Summer 2012: Kansas City, MO
I knew there were chiropractors out there who specialized in TMD, so I scheduled an appointment with another (whose name I can't remember for the LIFE of me) and started seeing her on a regular basis. I remember feeling really frustrated at that point with chiropractic. Many of the practitioners I'd seen until then had integrated soft-tissue and movement work into the treatments, but this chiropractic office felt like more of a "crack, snap, and see you 2 more times this week" philosophy. On a positive note, she was actually putting a glove on and doing some work from the inside of my mouth and at that point, anything I hadn't tried yet was worth a shot. To supplement those adjustments, I was also getting some deep tissue work at the Wolford Clinic, which included some fire cupping.

The tightness in my traps was lingering too, and I was convinced there was some connection to my head pain. I continued making modifications to my workouts, as it seemed that upper body, overhead pulling in particular would really get things fired up. I was up to 3 sets of 10 bodyweight pull-ups too! Damn. Now, when I start thinking about how much stronger my back used to be, Craig eases the pain by telling me he can get his arms around me in a hug more easily now than when we met. Hah!

Despite the jaw work with the lady whose name I forget and the additional deep tissue massage, I still wasn't making any progress with my pain! On a separate note, summer would be coming to an end soon and after 10 months of long distance, it was looking like Craig and I would finally be able to close the geographical gap. I had caught wind of a new integrative health center opening up in Phoenix (Thank you Anna!!) and sure enough, they were looking to hire a health coach. After flying out for an interview, I accepted an offer to join the University of Arizona Integrative Health Center, which was scheduled to open in early fall and would be the first integrative primary care medical model in the country! I was so excited for this new chapter of my life. My only disappoint was that I had promised myself months earlier that this whole headache bullshit would be taken care of before I ever moved to Phoenix.

September 2012: Phoenix, AZ
After Craig and I packed up my Civic and road tripped west, I took advantage of the few weeks I had before the clinic opened and started some rehab work with Anna Hartman, MS, ATC, CSCS at Athletes' Performance where Craig works. Anna was quick to discover one dysfunction that certainly couldn't be helping: my breathing, as demonstrated by the movement (or lack there of) of my ribcage. When you inhale, your ribs are supposed to expand - not just in front but also to the sides and back, as your diaphragm contracts. And then as you exhale, your ribs should stay connected to your abdominal muscles as your diaphragm relaxes.


Instead, I would puff my chest out on the inhale and pull my stomach in on the exhale. My rib cage was flared in front and didn't really stay soft and move with my breath like it's supposed to. So Anna, along with one of her PT interns, Brittany, was using some Pilates-based rehab to help improve expansion of my ribcage through diaphragmatic breathing. The day after one of our visits, I woke up with sore intercostal muscles all down my back (weird feeling) and pain at a 2/10...the LOWEST it had been in a LONG time. I continued with my breath work, but unfortunately, I couldn't seem to replicate that same relief again.

Anytime I refer to my headache after fall 2012, it's really just in the singular tense because the pain hasn't broke since then. For anyone that's still reading, I'm sorry this is such a long post...but it's a long story. I'll stop here for now and in my next post, will pick up with winter 2012.

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