I Couldn’t Control My Compulsive Exercise, And Now I Need A Spinal Fusion To Fix The Damage

One of the unique elements of my condition is that I never felt any pain, which might have acted as a warning sign or indicator that I was getting worse.

Aug 31, 2012 at 10:00am | Leave a comment

I couldn’t control my compulsive exercise, and now I need a spinal fusion to fix the damage.

When it comes to eating disorders, I was a late bloomer. It wasn’t until I was 16 that I started cycling back and forth between months of existing on a 500-calorie-a-day diet, then eating normally and puking it all up. I hated puking: it was hard, violent, and often unfruitful. Anorexia won out.

The thing is, no one calls it anorexia if you’re fat. I started off at 5’9”, 180 pounds -- I had been a chubby kid, but my weight ballooned after spending a year recovering from a car accident that put me in a coma. On my coffee-crackers-cauliflower crash diet, the pounds peeled off. Rummaging around in the garage, I found an old exercise bike and started to ride that for a few minutes a day. To allay the boredom, I watched “Airplane!” Soon, I was riding through the entire thing. (I have seen Airplane in its entirety at least 150 times). I dropped pounds like mad.

My adoptive parents rewarded my weight loss with a gym membership. Within two months, my workout became 90 minutes of Stairmaster, 90 minutes of exercise bike. And a couple days of the week, I went back to the gym and rode the exercise bike for another hour.

Again, no one calls it anorexia when you were recently fat. 

When I was 20, I moved out for college, and I could barely pay tuition. Even though the gym was my life, I was too broke to pay dues and I decided to take up running. 

image

I used to run on trails, just like this one, for up to three hours a day, every day.

Running was harder than I thought, and my gym fitness didn’t take me very far. After the first few times I attempted to run for about an hour, I came back in so much pain that I spent my nights slathered in Ben Gay. But I kept at it, like my life depended on it.

When I was about 27, running finally clicked into place, and I kept getting faster, more efficient and generally enjoyed my runs more and more, which means I ran more and more. At my peak, I ran about 17 miles a day before work; then, on my lunch hour, I went to the gym and ran an additional five miles on a treadmill. This was my life, six days a week. My eating habits had normalized a bit, and I felt fantastic, both mentally and physically. By now, running wasn’t so much about my weight as it was about love: because running well at that level requires real nutrition, my weight was up to 130 extremely well-muscled pounds (on top, I was still scrawny enough to take a size 4 but because my butt and thighs were so thunderous, I wore size 6 pants). 

As a runner, I never experienced any major injuries -- blown-out knees or sprained ankles, but I’d had niggling back pains starting around the age of 30. No big deal -- after all, I ran when I was sick; when I was 28, I’d been hit by a car, launched headlong into another car and busted my collarbone, and I only took a day off before I ran again. I didn’t think the back pain amounted to anything. 

When I was 38, I started having a really subtle, hard to articulate problem. My left foot felt a little floppy, but at the same time maybe a little stiff? The problem seemed so minor it didn’t affect anything but my running. I figured new shoes were in order; when those didn’t work, I tried orthotics that didn’t correct the problem either. 

I got a referral to a podiatrist, who, after hearing how much I ran, looked at me like I was insane. He examined my foot and told me there was nothing wrong. I started crying, and he wrote me a referral to a neurologist. He performed painful nerve conduction tests and then sent me for an MRI. My back was bad -- I had significant disc generation at one level and a little narrowing of my spinal canal -- but not so bad considering I’d been running 100+ miles a week for several years. When he was ready to release me without a follow-up, I threw a fit and he reluctantly sent me to an orthopedic doctor.

From December 2010 to September 2011, I went to about 20 different doctors -- podiatrists, surgeons, electro-diagnostic doctors, chiropractors, physical therapists, pain management doctors (I am not including the five chiropractors I saw in this total, since most people don’t think they’re doctors) -- and while no one had a concrete diagnosis for me, the overall theme was “Your back might be seriously injured.”

Because no one told me otherwise, I assumed it was OK if I just kept running, even though running was getting progressively harder and less enjoyable. I experimented with new gaits, new terrains, new strengthening exercises, and I kept getting worse. The problem had gotten so bad that I couldn’t feel my toes, I had lost noticeable strength in my foot and leg, and I walked with a minor limp. 

Why did I keep at it? One of the unique elements of my condition is that I never felt any pain, which might have acted as a warning sign or indicator that I was getting worse. Even though I was hobbling, I still got that mental buzz. And as much as the process had become laborious, frustrating and sucky, I just plain loved being skinny. 

image

When you’re running 100+ miles a week, you burn through shoes at a rate of a pair a month.

Finally in September 2011, I had a minor breakthrough and an electro-diagnostic doctor concluded that a pinched nerve was cutting off strength to my calf and reflexivity in my ankle. Hallelujah! A pinched nerve didn’t sound so bad.

I started a conservative treatment plan that included physical therapy (mostly worthless), chiropractic (did more harm than good) and cortisone epidurals, which means they insert a long needle into your spine and shoot it full of steroids. The steroids work well: they shrink the nerve a lot, so I regained both strength and muscle reflex. But they don’t work very long: within a few days, I feel good as new, and I go too fast, too long or too hard with the exercise, and I’m back at square one. The epidurals had some nasty side effects, too: in the 11 months I’ve been getting them, I’ve had four periods that lasted for 16 days or more, including one that lasted 24 days. 

But the shots allowed me to keep pounding out the miles -- my gait had deteriorated into a knock-kneed, herky-jerky gallop. By this point, the muscle imbalance caused by the pinched nerve was stressing the other side of my body and my pelvis was so rotated, I could no longer ride a bike or do the elliptical at the gym. 

As I neared the six-month mark without much real progress, I was referred to an orthopedic surgeon. I readied myself for more inconclusiveness, ambiguity and paranoia. And then he took an X-ray that changed everything. 

The film showed a broken pars interarticularis, one of the little bony things in the spine that hold the vertebrae into place. One of lumbar-region pars was fractured and allowing that vertebra to slip forward onto another, which battered a disc and allowed my nerves to become smooshed by the pancaked vertebrae. This pars defect may have been hereditary, or, more likely, it might have fractured when I was a child.

My first reaction was relief: I finally had a diagnosis. And I realized it wasn’t entirely my fault. Of course, I might have been fine if I had quit running at the first sign of trouble. OK, so it was maybe 90% my fault, but at least it wasn’t 100%. 

Then came the horror of hearing the solution. I am looking at the mother of all back surgeries, a spinal fusion. The exact surgery is an Anterior Lumbar Interbody Fusion paired with a Posterior Lumbar Instrumented Fusion. Doctors will make an incision in my abdomen, shove my guts aside to get to the spine, scoop out the defective disc, then jack the disc space up with synthetic bone. Then they’ll cut open my back, slide the muscles and stuff aside, and put screws into my vertebrae from the back. They may augment the fusion by shaving bone off my hip and grafting it on. The healing time is, conservatively, six months, though it may take up to 18 months for my nerve to heal completely (if it does at all). Though the surgeon told me that he expects I’ll make a speedy recovery, the length it takes to return to normal life varies. It could be up to six months (or longer) before I can return to work, drive a car, have sex, pick up my cats.  

And it was finally at this point that I asked: “Should I stop running?” Duh. 

The thing about my situation is there’s no sure answer. Without surgery, I might never get any worse, but I will never get any better. Or over time, and who knows how much, I could get a lot worse, to the point where I’d have crippling, 24/7 pain and I’d need a cane or a walker. It’s possible the nerve has been pinched too long, and I might have permanent nerve damage that the surgery might not resolve. And there’s a not-inconsiderable chance that the surgery might make me much worse. 

I need to go back for one more test, but I want to do the surgery ASAP. I’ve talked to a few doctors who have warned me not to do it, but a few more doctors are telling me to do it now while I’m young and healthy. 

And in case you’re wondering, I may not be running, but the morning I wrote this I went for a nine-mile hike.