Today is another guest blog by Melissa, Nate's wife. This is the first blog in a series about Nate's loss of coordination problem and how it was addressed.
“And I will try to fix you.” - Coldplay
Over the past seven years, Nate’s kryptonite was the “loss of coordination” (also known as the “hip/hammy” problem) in his right leg. It first began at the end of a very hard workout, and he understandably assumed it was caused by the exhaustion and hypoglycemia that happens during these workouts. But then it occurred at 30 kilometers in the Olympic Trials. A year later in the fall, during an attempt at the New York City Marathon, it occurred at 10 kilometers.
By the time I started dating Nate in 2009, he was not able to complete his favorite workouts without losing coordination of his right leg. As a new, cocky nurse practitioner with a background in chiropractic and a former frequently injured collegiate runner, I promised Nate on our first date that I would fix his injury. My no fail plan was to fix Nate and win his heart. Little did I know the lengths he had already gone to trying to fix his injury. I’m lucky he didn’t slap me! (Nate’s a gentleman so he would never do that sort of thing, but somebody should have) Thankfully for me, I won Nate’s heart long before fixing his coordination problem.
Of course Nate had already tried the shiny new tools in my toolbox: kinesio taping, Graston technique, even physical therapy, chiropractic, and yoga. All the techniques that I learned about in school and used on my own injuries had tried and failed. In fact, his injury worsened in spite of these therapies. How meager my shiny new tools seemed. Nevertheless, I was certain that the reason why Nate wasn’t getting better was simply because he didn’t have a practitioner like me on his side! With my brains and resources, surely it wouldn’t be long before Nate was back running marathons.
Nate’s original description of the hip/hammy problem, along with the prolific posts about “loss of coordination in the leg” on the Letsrun.com message board, initially led me to believe that Nate’s injury was vascular in nature. A quick internet search will turn up scholarly articles about vascular abnormalities and occlusions in various arteries that were misdiagnosed as musculoskeletal injuries in athletes. These conditions, though rare, are often misdiagnosed for years and don’t respond to traditional treatments for musculoskeletal injuries (because they require vascular surgery). There was a short stretch of time when I was convinced that this was the cause of Nate’s problem.
While I was researching what vascular specialist to send Nate to, he was training (in vain) for the World Championships Marathon. At the time, we were living in Chestnut Hill (at the 21 mile mark on the Boston course), and Nate planned a workout around the Chestnut Hill Reservoir. He was certain that his right leg would “go” during this workout, so I took it as an opportunity to see what actually happened when Nate lost coordination. I thought for sure I’d be able to see some sort of imbalance in his stride that I could remedy.
Watching Nate run around the reservoir at 5 minute mile pace was like watching any of the great masters work. It was like watching Baryshnikov dance ballet, Yo-Yo Ma play the cello, or Michelangelo paint. That probably sounds like an exaggeration, but to me, watching him was truly a work of art. He made 5 minute mile pace seem effortless. He was in perfect form. Watching him, I knew he could be one of the best marathoners in the world.
Suddenly, without warning, Nate tripped. At first I thought he must have tripped on something, and then I saw his right leg flopping. This wasn’t loss of coordination. This was as if his bones no longer existed and the only thing holding his leg onto his body was the soft tissue. It flopped around like it was a rag doll in a stiff breeze. When Nate describes his leg “going” he often says he’s peg-legging it until he completes his run. This was not peg-legging, this was Nate hopping on his left leg while the right one flopped.
I started to cry. I cried because seeing this happen to him was just as shocking and hard as seeing him get shot. He was being cut down in his prime, and it was inexplicable. I also cried because I knew this was not a problem that I personally could fix. This problem was so much bigger than me. But I promised myself I would never give up. It might take all the brain power that God gave me, but I would research and find someone or something that could fix this.
If you take a step back and think about what was happening to Nate, the answer is very clear: the motor nerves, the nerves that cause the muscles to fire, were essentially shut off. They were shut off from the hip, which meant the most likely place for the pinched nerve was the spine.
The next step was to obtain an MRI of Nate’s spine. I remember sitting in a friend’s kitchen holding the films up to the light while on the phone with Nate’s chiropractor (the amazing Mika Tapanainen in Wellesley-Hills) explaining what I saw. What was very clear to me was that Nate had a herniated disc in his lumbar spine. Mika had been expecting this as well, given the lack of improvement with all the other treatments.
It was amazing to see such a frank disc herniation on film and to know in my gut, “that’s the problem”. I figured the herniated disc must be pushing on the motor nerves going to Nate’s right leg, and that was the cause of his problem. Nate actually had arthritis throughout his spine, and several other herniated discs as well, but these were higher up in the spine, up in the thoracic spine. I could clearly see the problem in the lumbar spine. Now we just had to address that particular herniated disc. I thought for sure in a year Nate would be competing at the highest level in marathons.
With my background in chiropractic I knew the statistics for failed back surgery so I researched spine surgeons very carefully. I asked to meet with some of the higher ups at the hospital I work for to ask their honest opinion about spine surgeons in the Boston and greater Boston area. I am still shocked these people made time for me and I’m so appreciative that they were willing to give me their honest opinions.
Two doctors were mentioned as the best of the best. One older, seasoned spine surgeon with thirty years of experience, and a new up and comer who showed great promise. I chose the seasoned professional, who promptly referred Nate to the up and comer, honestly telling him that the up and comer had “the best hands he’d ever seen.” I am thankful that the seasoned professional was humble enough to refer Nate to the person he felt was the best man for the job. That’s something that’s not always easy to do, especially with the egos that can form in medicine. It’s also the mark of a good surgeon when they know when not to cut.
The seasoned professional may have also realized that Nate’s case was a can of worms. He may have been saving himself from that. Most people who have a herniated disc have a lot of neuropathic pain. They complain of sciatica, they have numbness and tingling that radiates from their glute into their toes, and the pain is persistent. These people struggle to do even basic daily activities because they are in so much pain. Nate had some sciatica, but he did not have severe pain symptoms. In fact, his sensory symptoms were rather mild. The disc wasn’t affecting the sensory nerve, it was affecting the motor nerve, but in the vast majority of cases it’s the sensory nerves that are impacted. The up and coming surgeon was hesitant to perform any surgical intervention because he was initially not convinced that Nate’s problem was caused by the herniated disc. Without classic symptoms, this surgeon could potentially open Nate up and Nate would be no better off than he was before the surgery. No surgeon wants that on their record.
Moreover, traditional spine surgeries often result in spinal fusion, where metal rods are screwed into the spine to hold various segments in place. If Nate wanted to continue running at a high level, he would not be able to have a spinal fusion. There are also newer, inter-spinous devices, used to hold open the space where the disc was herniated, thereby relieving pressure from the nerves. However, these devices are fairly new and the up and comer surgeon was not confident in their performance in someone with Nate’s mileage.
That left a third option: remove the disc and lamina (bone) and don’t fuse, don’t put anything else in the spine. Just leave it. This would never be recommended for your average patient, but it was the only solution that would allow Nate to continue running competitively. It would mean that his core strength would become paramount. His upper and lower body would effectively be held together by his muscles alone. If, years down the road, he neglected his core strength he would need to return for a spinal fusion.
This is the first part of a three-part blog. Just like the Lord of the Rings trilogy, you have to wade through two more long stories before you get to the end! Remember, it took Nate seven years to “fix” the coordination in his leg. Thankfully, it shouldn’t take you that long to read the three blogs. Next one is scheduled to be posted on Tuesday!
Part 2 here http://nateruns.blogspot.com/2015/03/fix-you-part-ii-guest-blog-by-melissa.html