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James Wanless

this is where I write

Gut Instincts

It’s amazing how quickly five days can evaporate when, between delicate personal issues, work and other distractions, you don’t get anywhere near your daily journaling.

Anyway, as I’ve alluded to a little, my preoccupation at the moment happens to be my digestive system. Always a little bit sensitive, I’ve had three fairly significant IBS-like episodes in the past 4-5 months. Since a significant GI change after 50 can be indicative of something more serious than food sensitivity, I’m treating it with respect. Not in the OMFG way, but giving it the attention it deserves.

Oversimplified, but a start …

I’ve been playing with reducing my intake of FODMAPs a little over the past week or two, but you can really only go hard on low FODMAP when you’ve a) eliminated the possibility of more serious things going on, and; b) consulted with a dietitian to do it correctly. There are some foods I’m very sure are significant triggers for me, so I’m pretty much eliminating those and then playing a little with the ones that may be issues, but which I haven’t paid much attention to. FODMAP sensitivity is a real killer when you’re a fairly strict vegetarian, as they’re mostly found in plant foods, with some in dairy.

In a nutshell, it’s the fermentable aspect that’s key. If you can’t digest these sugars, when they reach your lower intestine they ferment and can cause everything from excess gas, to diarrhea, constipation or both.

More on FODMAPs:
FODMAPs are a collection of short chain carbohydrates and sugar alcohols found in foods naturally or as food additives. FODMAPs include fructose (when in excess of glucose), fructans, galacto-oligosaccharides (GOS), lactose and polyols (eg. sorbitol and mannitol).

Anyway, I had a blood test for some markers a week ago and I’m meeting with my doctor next Tuesday to discuss the results, ask about any additional tests I might consider and to probably push for booking a colonoscopy. I’m on the bi-annual FIT plan, but that only determines if you should be tested for colon cancer by detecting hidden blood in the stool. It doesn’t help in flagging other digestive or gut conditions. My doctor is also a little passive for my liking and I tend to need to push for certain things. I don’t have any red flag symptoms (lethargy, dropping weight, blood, etc), but I believe the symptoms I am experiencing are worth scoping things out properly.

This all brings me back to the dietitian. I’ve got a line on what seems to be a pretty good one, who is well-versed in FODMAP elimination and reintroduction diets, and she specializes in vegetarian/vegan diets. Not only do you have to be careful about nutrients when you’re not eating meat, fish, poultry, eggs or much dairy when eliminating a bunch of stuff, but you have to reintroduce things properly to identify triggers. Doing low-FODMAP properly is basically a restrictive diet + meticulous journaling + following process.

Whether I can go there soon will depend on where things go with my doctor. We’ve had some back and forth by email and if my medical approach shows nothing serious, I’ll likely be hiring her.

Wow, I’m impressed. I managed to write a journal post about my health and not even talk about my back problems.

Tepid

If there’s a word I hate, it’s tepid. Nothing but a negative connotation, I always have a mental image of a cat gingerly dipping it’s paw in water, shaking it off and walking away.

From dictionary.com:

adjective
1. moderately warm; lukewarm:
tepid water.
2. characterized by a lack of force or enthusiasm:
tepid prose; the critics’ tepid reception for the new play.

For my purposes, let’s go with a lack of force or enthusiasm. In describing the last month, tepid really covers all the bases. 2017 was to be a year where I began making several personal changes aimed at thinking differently, writing, reading, playing music more, and the like. It’s only nearing the end of February, so the year is nowhere near a write-off, but the past month was a beast, capping a pretty awful winter season, overall.

I already documented the bug I caught at Christmas in its early days, but what that post doesn’t describe is the two-plus week plague that finally went away a week into January. As I recovered, I got the year rolling with some solid running and cycling base work, and felt like I was off to a pretty good start. Yeah, well, the best laid plans and all that, right?

Tepid Sinuses

While the nasty cold ended up leaving eventually, a minor sinus infection lingered so I still spent the month of January … kinda gunky. I’ve got bad sinuses anyway, and have been down this road a few times. Let’s just say I spent a lot of time with saline rinses, treating my olfactory with kid gloves and looking for any kind of relief I could find. As the cold went away, the sinuses subsided somewhat, but not completely throughout January.

Tepid Shoulder

After a month of decent easy running and trainer riding, as February rolled around I was having a lovely jaunt through fresh fallen snow just over three weeks ago. Hidden black ice hidden isn’t good for much, but apparently it’s excellent for dislocating a shoulder.

Tepid Immune System

Damned if I didn’t pick up an additional gift in the hospital when getting my shoulder put back in place. It wasn’t much of a cold, but it triggered my sinus infection so much that by the weekend after the dislocation, I finally gave in and went to the doctor for some antibiotics. With my shoulder keeping me out of action, for a few days my forehead and cheek pain was excruciating. Well into my second month of sinus infection, I knew it wasn’t going away on its own.

Tepid Everything Else

With my arm in a sling for a few days, and with weakness and limited mobility in the joint lingering still, pretty much everything else in my life has also been tepid. For a couple weeks post-dislocation, lingering ice and the risk of re-injuring my shoulder had me totally sidelined. I missed a week of work, three weeks of anything resembling normal cycling or running and really haven’t been able to do much involving my upper body.

Needless to say, some of the other things I’ve been trying to change or improve upon (particularly writing) have also taken a hit.

As of this writing, with a few physio sessions under my belt, I’d say the shoulder is around 75%. I’ve been running carefully and easy, and riding the trainer for a week now. I wouldn’t trust the shoulder road riding just yet, though. Work or extended arm use of any kind is still a bit fatiguing at times, but I’m doing some level of just about everything now.

I’d say the only things that benefited from this February adventure were my reading and meditation, which I’m happy to say are now pretty much daily occurrences. I guess those are small victories, but they take nothing away from a month that I’d prefer to avoid repeating.

Cemetery Dislocation

Bad run routing choices in a big snow storm and a little hidden ice begat a hospital adventure on icy roads, a gnarly upper body injury, a week off work and at least three times that long off cycling and running.

“Cut through the cemetery” I said to myself. “It’ll be quieter and safer” I mused … this was about 5:15 pm last Friday, February 3rd. Vancouver has had an unusually cold and snowy winter and another heavy dump of the white stuff – one that would last all weekend – had started earlier in the day. Running in fresh snow is usually very enjoyable.

Getting back to the cemetery, I was roughly 8k into a 10k run and pretty much on the home stretch. I just needed to go about a kilometer west to Boundary Road and a little bit south home. My routing choice was a traffic-choked road with headlights in my eyes until I got to my hood, or a quiet jaunt on a twisty road past a funeral home. Choosing the latter would prove to be my undoing. A few hundred meters in, as I approached the funeral home, both feet went out from under me forward on slick ice hidden by fresh snow, and the rest of me went backward and down.

As my right shoulder blade bore the entire impact, the electric-like jolt and audible crunch told me something wasn’t right. I couldn’t put any weight on my right arm to get up and was reasonably sure, at minimum, I’d suffered a dislocation. I walked up to the funeral home and through the front door. Normally closed at this time on a Friday, they were preparing for two late viewings, and so they made me as comfortable as they could with a rolled up blanket to support my arm and another around my shoulders for warmth. This was most fortunate, as a walk home of well over a kilometer in the cold and heavy falling snow would’ve been pretty miserable.

Given the horrible road conditions with the day’s snow, I expected it might be a while before I got to the hospital. They called an ambulance for me, while I did my best to left-hand text my wife and son to see if anyone could come get me. Though she was home, unbeknownst to me she was shovelling the driveway, while my son was on the other side of Burnaby. Eventually I had both of them en route to get me, along with an ambulance, or so I thought.

Turns out there was a bit of miscommunication between them, with my wife saying she’d meet them at Burnaby Hospital, thinking he was closer to me than he was. He was definitely on his way, but actually got his friend to drive him. I was very thankful for the effort, but the gripless summer tires made for slow going, and had me a little white-knuckling in places. Unfortunately, quick texts under stress can sometimes get misinterpreted and my badly misspelled left-handed messages weren’t much help either. All in all, it was probably about 6:30 or so by the time I got to the hospital.

At the Hospital

The x-ray shows my right Humerus probably an inch high and three inches forward of its normal location

Emergency was busy, but I did get prioritized fairly high, given my protruding Humerus and all. After registration and triage, I suspect it was only about 15 minutes until I was sucking on Nitrous and being cut out of my running shirts. Given that shock had worn off by this time, the agony my arm was causing made it feel like I was in the waiting room for an hour. Unable to sit forward or back, nor to put any weight on the dangling appendage, I also couldn’t risk walking around and falling on it again, either. I was sort of a hunched-over lump of kill-me-now.

I can’t recall if I’ve ever needed Nitrous before, but even if it’s short-lived, the speed with which it eases the major discomfort and relaxes you is pretty amazing. I’d say I went from despondent to not bad in about five minutes flat. While it got me through having my shirts cut off and my shoulder x-ray, it only takes you so far. At that point, I was probably doing my best to empty the tank just to stay somewhat even-keeled. Something stronger would be needed to put the shoulder back in place.

I guess if you’re in a lot of pain, laughing gas is really just bemused gas

Enter Morphine, a double-dose in fact. Once that had set in after about ten minutes, the main doctor attending me attempted to put the Humerus back in place manually. Guessing it was purely the morphine, but this really wasn’t all that uncomfortable and, in fact, pulling back and down on the arm actually felt pretty good. Unfortunately, it wasn’t budging and, after a good ten minute effort, the decision was made to put me out.

I don’t recall what they gave me, but the only time I’ve ever experienced something similar was when I had Demerol many years ago before surgery. As the second doctor introduced himself to me, I quite rapidly spun into a dizzy, delirious and thoroughly enjoyable haze. Never feeling like I was truly out, I recall asking when they were going to put my arm back and was informed that they’d already done it and it took about six minutes. Apparently, I was asking this question right on cue. It happens to almost everyone.

After another x-ray to confirm my arm was back in place, that my blood pressure and vitals were normalizing and that I could walk without falling over, I was released. All told, I left for a 10k run around 4:30 pm and got home almost exactly six hours later.

Post-hospital

I gave my neck a pretty good wrench when I went down and spent all day Saturday with something close to a migraine, and it’s still tight as of Wednesday. Finally able to kill the headache by Sunday morning, mostly I’ve been doing very little since. I couldn’t get into see my normal physio on such short notice, but did get into see someone else at the same place, Fortius Sport. They’re integrated, so everything we went through will be there for my appointment with my regular physio on Friday.

I should note that I got a lovely Polysplint from the hospital upon release as well. Mostly to immobilize the arm to remind you to not engage your shoulder much, I found its adjustability and comfort to be somewhat lacking. After trying to sleep with it for two nights I pretty much gave up. I kept my arm pretty immobilized with my Humerus close to my body all weekend and beyond, anyway.

My Polysplint hasn’t exactly been much use

I was pretty happy when on Monday, the physio suggested that I really only use the splint when going out in public, as much for notifying other people to avoid contact, as anything. Her inspection and initial treatment suggests my shoulder is in pretty good shape. We went through some massage, light range of motion exercises for home and some TENS and ice treatment. While the hospital gave me a pass off work through at least today, given the repetitive lateral mouse motion of sitting at a computer all day, the physio strongly recommended I give it the week and return to work after the holiday Monday. Who am I to argue?

Given that it’s gone back in place pretty well, this was my first shoulder dislocation at 52 and I don’t play contact sports, she seems to think repeat dislocations aren’t a big concern for me, but once you’ve done it, statistically it’s far easier to do it again.

At any rate, I’m playing it smart and want the tendons and muscles to tighten up properly. I don’t expect to test driving stick until well into next week, with a return to cycling and running some time after that, entirely dependent on how physio and progress goes over the next while.

Bugs

I won’t even go into the persistent tightening of my lower right back, which according to all medical reports and treatment I’ve had thus far, is due to my QL muscle. I’ve lost enough riding and running to that alone, particularly in the second half of 2016, as I’ve eased up on volume and intensity to avoid it getting really unpleasant.

Holy crap, though, if this fall and winter hasn’t been the “bugs from hell” season. From mid-September until now, it’s been one thing after another for both Connie and me. I doubt I’ve strung together more than two or three decent weeks of training/fitness in the past three months.

Over the course of any winter, I’m usually good for one decent cold. As I have allergies and sinus problems, I often get several small congestion flare-ups per year, so I’ve learned to only accept something is a cold or flu when full-on symptom-maggedon hits.

I’d already had to back off my planned Victoria Marathon and do only the half due to an ill-timed calf pull injury in late summer. Then, right after the half the bug I got seemed like two, though I suspect I had a particularly nasty three or four days of the aforementioned sinus issues the week immediately following the race. It was really just a pressure-fest with no other symptoms.

The weekend of October 15th was our annual family attendance at the BC Craft Beer Awards. I know it’s hard to believe, but it seems like Connie and I both got a cold from that. Hundreds of people milling around, touching things, drinking and leaving germs all over the place. Or maybe it was that my younger son, not wanting to miss out on one of his two true loves, decided to come sporting a mini-plague of his own.

Moving on from all that, while the dates are a little fuzzy, Connie and I each had another bug of sorts in November. Hers was of the mini, 3-day sniffles and throat variety, while in mid-November I suffered from a really strange digestive issue, whereby it felt like the beginning of a stomach flu but only really generated symptoms more like IBS than a full-on bug. I had rotating runs and bloat for about a week, then things slowly subsided. In addition to sinus and allergy issues, I do have a bit of a history of food sensitivities, so this is also one of those things I won’t assume was anything more than bad digestive issues.

And now, the week before Christmas we’re each suffering yet again. Connie with another head cold and me with a more standard flu thing; more traditional with upper body muscle stiffness, a 24 hour round of bathroom fun and the like. I started feeling symptoms late Monday night, they really came on hard for 24 hours starting Tuesday night and I’m starting to feel pretty good as of Thursday mid-day. I hope I don’t regret that optimism with some sort of resurgence tonight.

Much like how my sinus and allergy issues can complicate colds with sinus infections and give me plenty of false alarms, Connie’s asthma tends to give her lots of lingering coughs and ongoing chest and throat sensitivity. To add to Connie’s headcold misery this time, she took a little dump on black ice a day ago on the dog walk, and now has a tight, red hip.

Unlike diminishing athletic performance or back and nostril hair, I can’t blame this run of luck on getting older. Just seems like it’s one of those years. Given the number of times colleagues have been away sick this fall and winter, it seems common.

OK, mother nature, you win. Can we just dispense with the bugs for 2017 please?

When the treatment causes the pain

One of the less pleasant aspects of going through my 40’s has been the development of allergies. As of my last allergy test, I was allergic to dust, pollen and shellfish. While you don’t see too many clams flying around, the dust and pollen in the air has made me very sensitive to the change of seasons. Over the past few years the bad sinuses I’ve always had have also intensified, and I’ve noticed a general propensity for more frequent headaches.

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