I've been working as hard on my recovery as I did in my training, and it's paying off! Catch up on my health debacle by reading my first blog here, then read this update below.
Bone Stress Injury
I am officially off the crutches after using them for 4 weeks and weening off of them for an additional 2 weeks. I can walk around without any achiness returning in my hip, which I haven't felt in over 4 weeks. I can even ride my bike again! I did two rides, one in Lake Placid where I went for a "training camp," and one with the Mapso Tri Club near where I live, that were pretty hard and both over 50 miles. I'm happy to be off the crutches even though they did give me an opportunity to drop some jaws...I could walk without pain and without a limp, so sometimes I would be crutching down a sidewalk, and suddenly pick up the crutches and walk completely normally. Onlookers were shocked and it made me a little bit happy.
You may ask why I needed the crutches if I didn't have any pain. The simple answer is that my doctor said so. The more robust answer is that my bone stress injury is in a place of "high risk" and continued stress on the area, especially since I have osteoporosis, could lead to osteonecrosis, where the bone essentially dies and requires surgery. Not ideal! To play it safe, we kept me on the crutches longer than many would consider necessary for a standard "low risk" stress reaction. I have also begun pushing off the wall in the pool, which is allowing me to keep up with my old lane! I still can't run because the force your joints must withstand is approximately 4-5x your body weight when running, far greater than the ~1.4x your body weight when walking. I'm hoping to return to the Alter-G at Dr Todd's and then hopefully return to the roads soon thereafter.
I had blood work done last week and the result came back at 308 ng/dL, a 41 point increase from one month ago. I'm pleased! Though I would have loved to see it jump faster than that, this new number puts me in the range of "normal" (albeit at the low end). The symptoms of low T have abated dramatically since I stopped training. The fatigue that I used to experience on the train after work is all but gone, and I'm almost back to my old self in the bedroom. This jives surprisingly well with my doctor's comment that most men experience symptoms of low T if it is under 300. She also mentioned that men feel the full benefits of this hormone at around 600, so I still have work to do if I want to situate myself in the best way possible for triathlon performance.
Another interesting thing I learned about testosterone (from a smart friend of mine) is that a discovery has been made linking certain gene mutations with low testosterone. We've known that one's natural testosterone levels are influenced by genetics, but now we know which genes have the highest correlation with those levels. The men studied had somewhere between 0 and 4 genetic mutations termed "risk alleles" and those with 3 or 4 mutations had a far greater chance of testosterone under 300 ng/dL (30%) than those with 2 mutations (15%), 1 mutation (12%) or 0 mutations (5%). We all have access to whether we have these risk alleles by doing genetic testing through 23andMe, which I will do soon. I'm mainly interested because it will educate me on whether I had a compromised starting point or not, which is something I don't know right now because I never had baseline testosterone measurement done before I began training for Ironman.
My bone density is going to take some time to return, many months to be more specific, but in order to monitor the progress, my doctor gave me a test kit that would tell us at what rate I'm breaking down bone. It was a urine test that I did about two weeks ago and I should be receiving the results any day now. I am optimistic that the trend has been reversed, partly because of my higher testosterone levels, and partly because my blood work revealed an interesting genetic mutation that makes me susceptible to low bone density. I have a double mutation in the MTHFR gene, specifically in the C677T variant, that means my body isn't very good at converting inactive folic acid and B12 to their active forms. I'm 10% as efficient at creating the enzyme that does the conversion as compared to a person with no mutations in that gene. It's actually a fairly common thing to have at one, or even two, mutations and the good news is that it is easily treatable. Just take methylated (activated) forms of folic acid and B12 so your body doesn't have to do the conversion. I've been taking that for about a month now as part of a special multivitamin I'm taking.
I'm also doing a few other things to help strengthen my bones...I take magnesium and strontium and will be doing weight-bearing strength work that will encourage my body to develop greater bone density (not yet though because I still need to be careful with my bone stress injury).
I'll be "racing" this weekend in honor of my brother, Justin, who died of cancer in 2008, at the Lake Waramaug Sprint Triathlon in Connecticut. I'll likely do just the swim and bike, and then drop out before the run to avoid re-injuring my femur. Each year, we do an event like this one, and raise money from family and friends for St Jude's in his name. Please read our one page letter and consider a donation! We are grateful for any amount!