Last Run of the Year

1310 miles in 2009.  Not bad.  Although it would have been closer to 1500 if it weren't for this damn butt issue.  And judging from last night's 5-mile test run, I don't think it's going to go away anytime soon.

The run felt OK at first.  I did feel some achy joints, but it was mostly just the result of not running for 27 days.  Initially, I also felt some achiness in my right butt/hip.  I couldn't tell if this was related to my injury or not, but it eventually went away as I warmed up.

The first 3 or 4 miles went really well.  I was running with Mike and John, and although they were running pretty slowly, in retrospect it was probably a little fast for me on my first run back.  The last time I ran in the park, I started getting ankle pains around mile 2, and ended up jogging/walking the rest of a disappointing 4 miler.  So I considered it a success that I did not feel any ankle issue even up until I turned off at the 102nd Street transverse (3 miles).  Just to be safe, though, I slowed down for the last two miles.  Around West 86th Street, I did feel the tendinitis coming back in my ankle.  It wasn't so bad to be debilitating, but it was definitely noticeable.  I slowed down a little bit more, but never felt the need to walk.  Although it's disappointing that the issue is still there, I feel like I just need a few more weeks of taking it easy and my ankle will be back to normal.

The butt, though, is a different story.  My butt has never really bothered me while running; it's always afterwards or the next day that I feel the pain.  Well, after the run, we went to Big Nick's Burger and Pizza Joint (on 75th and Broadway) for dinner.  It was the first time I went to Big Nick's.  They have a massive 28 page menu, which includes everything from Greek food to burgers to pizza and more.  I got a chicken souvlaki pita (pictured below), which was pretty good. 

In contrast to their huge menu, though, the area inside Big Nick's is tiny.  As we were standing in the entryway waiting for our table, some of us had to exit the restaurant whenever someone needed to walk by.  They packed five of us into a table crammed into the back of a narrow room.  Needless to say, I didn't have much legroom.  Halfway through my chicken souvlaki, I was needing to stretch my legs, but felt like I was trapped in this tiny restaurant with nowhere to go.  By the time we paid our check, pain was running from my right butt almost down to my knee.  I was trying to discreetly massage my hamstring during dinner, but I couldn't get in deep enough.  I was glad to get up when we finally left.

As I slept last night, I woke up a few times feeling that the pain in my hamstring was still there.  And at work today, I've had to get up several times to stretch my legs.  It's disheartening, and I know this means I should take it easy.  But I still want to run.

Happy New Year!

"You should start running..."

Saw the foot and ankle specialist today, Dr. Jessica Gallina, and her words were music to my ears.  She looked at the MRI, which had shown a tear in my posterior tibial tendon, and did a clinical exam on my left ankle.  Because I was able to stand on my tiptoes and rotate my foot in and out with no pain, she concluded that I just had some tendonitis.  What showed up as a tear on the MRI was microscopic and could have been just some inflammation, or even an MRI "artifact" (which I think is like the equivalent of a fingerprint on the lens).  She did say, however, that the posterior tibial tendon is very important, as it holds the arch up in place, and that a tear or rupture would have been REALLY bad, possibly ending my running.  But since I have no problems with my arch, it's not really a concern.  I'm very glad.

Dr. Gallina also said that if I wanted, I could get some physical therapy on the ankle, or take some anti-inflammatories.  However, as far as she was concerned, I could start running, a little bit at first, and just build my way back up.  She told me to continue to be sure I wore my custom orthodics, as they will support the arch and therefore relieve stress on my posterior tibial tendon.  If, the pain persists, I'll go back to her and try out some other courses of treatment.  One idea she had was platelet rich plasma therapy (PRP)--a process where a small amount of my blood is drawn, and the growth-promoting platelets are collected and injected into the tendon in order to help with regeneration.  It sounds serious and high-tech, but she said she had the tools to do it right in her office.

In the end, I guess Dr. Gallina's diagnosis is the same as what Dr. Metzl said to me almost two months ago, that the ankle issue is not a big deal.  However, I feel much more comfortable with Dr. Gallina's diagnosis since she had the benefit of an MRI, and really took the time to examine and explain my condition.

These past few days and weeks have been really tough.  Online information about tears in the posterior tibial tendon seemed bleak.  Not being able to go to the Wednesday night fun runs left a gaping hole in my weekly routine.  And I gained about 10 pounds since the Chicago Marathon in October.  But I'm glad I've gotten such great support from my friends and I was happy to rediscover yoga.  Just to be safe, I'm going to wait another week or so, until after Christmas, to start running again. Although I still have some trouble sitting for long periods, my butt issue is getting better and hopefully by then I will be just about healed.  Until then, I'm really happy about the news today, and I'm getting excited to get back in my running shoes!

Six weeks off...

I have not run for two weeks now, and I learned this week that it's going to be quite a while longer.

Last Friday, I went back to Dr. Babiy.  The purpose of the visit was to look at the x-rays on my ankle and determine the next steps, as well as to get my electromyogram (EMG) on my butt.  The x-ray came back negative for a fracture.  However, it did show some signs of "cortical thickening," which I guess means that the outer layer of my tibia bone had grown thicker than usual.  She said this was probably the result of my running--as the muscles pull on the bone, they cause stress on it and make the cortex thicker.  She said this was probably not a huge deal, but told me to get an MRI just in case.

The EMG is a test used to record the electrical activity of muscles.  It can be used to detect muscle abnormalities, such as when there is a pinched nerve.  The purpose of the test was to see if I had problems with the sciatic nerve, since I had reported a "pins and needles" sensation to her.

The test was sort of like the rubber mallet reflex test that doctors do, only more high-tech, and much more painful.  The doctor places these electrodes up and down my leg.  She would administer a little shock here and there to basically see how much my leg reacted.  By my foot, where the sciatic nerve is at its smallest, I would feel what amounted to a little electrical pinprick.  But as she moved up my leg, the shocks felt more and more intense, and my reflexive reaction got bigger and bigger.  When she got to my butt, it felt like I got hit with a stun gun, and my leg let out a huge uncontrollable kick.  It was kind of funny and painful at the same time.  The EMG showed that there was nothing wrong with my sciatic nerve, so it turns out that my butt issue is just a muscle problem, like a pulled hamstring or something. 

Later, at physical therapy, my PT Marina (funny, both Dr. Babiy's and my PT's first names are Marina) confirmed that the problem area was not, as I had believed, my piriformis muscle.  She did this by isolating my piriformis muscle: I lay on the table on my left, bent my right leg and raised my right leg up, while her hand applied downward pressure.  This maneuver apparently isolates the piriformis muscle, which ends up flexing out of the butt.  She poked around at that muscle, and I didn't feel anything abnormal.  The area where I felt tenderness was further outside--my glute.  So I guess Dr. Metzl was right, I just have a weak butt. 

So I've been working some exercises to strengthen it, although some of them don't really seem to be butt exercises at all.  One of them is a "pushup" where I lie on the floor and push my chest up while keeping my legs and hips on the floor, kind of like an Upward Facing Dog in yoga.  My favorite part of physical therapy is when she attaches the electrodes to my butt.  The electrodes make a tingling sensation, nothing like the EMG shocks.  She sets the machine for ten minutes, and I usually end up taking a quick nap while it makes my butt feel all warm and fuzzy.  Here's the machine:

The next day, Saturday, I went to get my MRI on my ankle.  I have to say, as great a doctor as Dr. Babiy is, the places she sends me to get imaging done are the worst.  For my x-rays, I went to a place on 17th Street, where I had to sit in the waiting room for an hour and a half!  This was during my lunch break so I thought I was going to get fired.  For my MRI, Dr. Babiy sent me to Union Square Diagnostic Imaging.  I appreciated how this place had evening and weekend appointments.  They were able to fit me in the day after I called them, for a Saturday evening appointment at 7:30 (yes, I was planning to spend Saturday night getting a magnetic image of my ankle).  Around 2:00 they called me and told me they were running ahead of schedule, and asked if I could come in at 5:30.  I gladly obliged.

Well, I got to the waiting room, and ended up waiting for an hour and forty-five minutes.  I was like, ripsh-t.  I mean, like, they f-cking tell me to get to my appointment two hours early only to wait in the f-cking waiting room for two f-cking hours to watch f-cking Animal Planet on the f-cking TV?!?!  I went like apesh-t at the poor receptionist there, who was the one who told me to come early.  Not one of my proudest moments.

The MRI itself went off without much incident.  Despite the completely unnecessary noise (like an ambulance siren combined with a tractor truck's backup beeps), I managed to fall asleep during the half hour long process.

Wednesday, I had another physical therapy appointment.  And although I did not have a separate appointment that day with Dr. Babiy, she agreed to see me after my PT to discuss my MRI results with me.  It's things like this that make Dr. Babiy such a remarkable sports medicine doc.  I can't imagine another doctor taking time out of their busy day to have an unscheduled meeting with me.  So here's another plug for her.

Well, the MRI results were not good.  I have a partial tear in my tibial tendon.  On top of that, a bone bruise cannot be ruled out.  Though she's not able to say for sure at this point, Dr. Babiy said that these types of injuries usually require about six weeks off from running.  I've already taken two, so four more to go...  Dr. Babiy also referred me to a foot and ankle specialist, Dr. Jessica Gallina, who will further evaluate and treat the condition.  She mentioned the possibility of wearing a boot.

What little information is available online about posterior tibial tendon tears does not give me great confidence.  It is also somewhat confusing.  This injury does not appear to be a common one in runners.  Instead, it usually occurs in sports that require a lot of lateral movement, such as basketball or tennis.  It could also result from a sprained ankle.  I vaguely remember twisting my ankle at some point after the NYC marathon.  But there's a possibility that I'm imagining it, or it could have been my other ankle, and I certainly don't remember it being particularly major.  My appointment with Dr. Gallina is on Monday, so I guess at this point, there's no real point to stressing over it.  It's worth mentioning that while all this is certainly bumming me out, I am glad I sought out Dr. Babiy for a second opinion after Dr. Metzl told me there was nothing wrong with my ankle.  I'll let you know what happens after my Monday exam.

Last week I went to yoga five times.  Yesterday, I realized that I need to get back to doing cardio, lest I continue to balloon up.  I went swimming for the first time in months.  Hopefully, by the end of six weeks, I'll at least be able to develop my stroke.

*                *                *

I made a couple of chicken dinners over the past week.  The first one was a five-spice braised chicken and daikon that I made in my pressure cooker.  I just threw the chicken and daikon in the pot, along with some scallions, ginger, garlic, soy sauce, rice wine, Manischewitz, five spice powder, star anise, and sugar.  In the picture below, the daikon looks a little like scallops.  I recently discovered that I can make brown rice in my rice cooker, so I'm making an effort to eat more brown rice instead of white rice.  And I've been on a collard greens kick of late, so that made a nice pairing.

The next night, I made pan-barbecued chicken.  For the barbecue sauce, I used ketchup, soy sauce, sesame oil, grated ginger, sugar and Worcestershire sauce.  My cast-iron skillet did a great job at giving the chicken a tasty caramelized crust.  I served it with a vinegar-based nappa cabbage coleslaw (I was excited to use, for the first time in my life, coriander seeds in this), and some not-so-homemade Bush's Baked Beans.  Oh, and some leftover brown rice and collard greens.  Dessert was a delicious Betty Crocker carrot cake with cream cheese frosting.  Mmmmm......

Gone Fishing

My butt is still hurting.  I've decided that Dr. Metzl's diagnosis of a "weak butt" is not completely accurate.  My symptoms appear to be a textbook case of sciatica (minus the loss of bladder or bowel control).  I have a numbness / pins-and-needles sensation from the lower part of my back to right above the knee.  Sciatica is commonly caused by a herniated disk or piriformis syndrome.  I'm not completely sure what a herniated disk is, but it has something to do the the cartilage in the spine, and it can occur when engaging in heavy lifting with your back.

In playing back the last month or so in my head, and spending way too much time on mayoclinic.com, I had an "a-ha" moment.  The day before the Chicago Marathon, I had some pretty bad back pain.  I believe it came from lugging my carry-on bag from my house, on the subway and a bus to La Guardia, into the overhead compartment of the plane, and then onto another subway and bus to the hotel in Chicago.  The next day (Saturday), the back pain was so intense that I wondered if I'd be able to run on Sunday.  Fortunately, the pain subsided for the marathon.  But immediately after the marathon was when I started to feel the butt pain.  And now I wonder if that pain stems from a herniated disk that occurred when I was lifting my carry-on bag.  Damn me for being a cheapskate and taking public transportation everywhere that day.  The good news is that herniated disk/sciatica gets better on its own with some rest.  But still, I think an MRI would ease my mind a bit.  Can anyone recommend a doctor that I can go to for a quick MRI?

In addition, my left ankle is still giving me problems.  I don't think it's serious--probably a tendon issue.  But, while the butt issue is not debilitating, the ankle problem has really limited my running.  In the two weeks post-NYC marathon, I've run a total of 10 miles.  One upshot of this, though, is that I've gotten a chance to return to yoga, which has allowed me to both build up my butt muscles and stretch the problem areas.

Last Thursday, FaTai and Roberto came over for dinner.  I never really cook whole fish, but FaTai does frequently, and I love to eat it.  I stopped by Hong Kong Supermarket in Chinatown on the way home and I saw that they had live tilapia swimming in a tank, so I decided to get one.  Believe it or not, it was my first time ever buying a live fish, and the fishmonger's technique was a bit of a shock: first he scooped my fish out of the water with a net and put it into a plastic bag, then he took the bag with the flailing fish and hurled it against the wall.  The fish stopped flailing.  I think it was pretty much knocked out at this point, but just to be sure, he took the side of a cleaver and smacked it against the fish's head.  I have a feeling that fish had seen better days.

I also ended up buying some pork rib tips, tofu and a mystery leafy green vegetable.

Once home, I cooked up a batch of mapo tofu.  Mapo tofu is a traditional Sichuan dish with tofu and pork and lots of hot chili-bean sauce.  Literally translated, it means "pockmarked grandmother's tofu."  I always thought it was so named because the beans/chilis/pork resembled a grandmother's pockmarked face, but the references online appear to universally state that it was named after an old woman during the Qing dynasty who served this dish in her restaurant.  I guess it's more appetizing to have a dish served by a pockmarked old woman than to be eating her face.

The the leafy greens, which I just sauteed with garlic, came out pretty well.  I'm not sure what kind of greens they were, but the stems were a lot more tender than Chinese broccoli.

The pork rib tips were a bit of a mystery.  I didn't really know what I was going to do with them.  Fatai doubted me, saying that I would need 30-40 minutes to cook them well enough.   That immediately lit a lightbulb in my head, prompting me to pull out my new pressure cooker.  I first seared the pork a bit with some garlic, ginger and scallions, and then added some seasonings (soy sauce, fish sauce, sesame oil, Franzia), and sealed up the pressure cooker.  Eight minutes later, I ended up with delicious, tender, fall off the bone ribs.  A little Korean bulgogi sauce added some sweetness.  Yum.

The fish presented the biggest challenge.  I decided to "red cook" it, which means to braise it in a seasoned soy sauce base.  Fish is usually fried a little before braising to give it a moist but non-slimy texture.  I didn't feel like using a gallon of oil to fry it properly, so I kind of just pan-fried it a little in my wok.

After frying, I added some soy sauce, rice wine, star anise and of course Franzia, plus some leftover pot-roast juice for braising.  To make the most out of my braising liquid, I also added some shitake mushrooms, Chinese wood's ear mushrooms, dried lily flowers and tofu skin.  Here's the final product:

The fish itself came out really well.  I think pan frying it first helped it to develop its flavor.  The other stuff that I added to the braise (mushrooms, etc) could have used some extra time braising.  (The next day, I put it back in the pressure cooker for about three minutes, and it came out perfect).

We did a pretty good job on the fish, although none of us were brave enough for the head.  Good thing my parents weren't there...they would have been disappointed that we wasted a perfectly good fish face.

Running to Duke's

I am not 100% sure whether I'm running the ING New York City Marathon next Sunday. I really want to do it, even if I don't race it.  I would love to do it as a complete fun run, without any pressure to get a time; that was what I did for the Big Sur Marathon in April, and it turned out to be one of my most enjoyable marathons.

However, after Chicago, I feel like my body has been beseiged with a number of aches and pains.  For one thing, my right butt/hip area has been bothering me since my 20-mile trail run over Labor Day weekend.  It doesn't really bother me when I run, but I can definitely feel it when I'm sitting or walking.  For the first week after the Chicago Marathon, I could not sit for long periods at my desk at work, and was convinced that I had a stress fracture in my butt--the pain felt like it was radiating up and down my thigh.  Last Thursday (10/15), I made an appointment with Dr. Jordan Metzl, my sports medicine doctor, but I couldn't get an appointment until next Monday (10/26).  In the interim, I no longer feel like I have a stress fracture, but I think I may still keep the appointment just to have him check things out.

In addition to my butt issue, I have tendon issues on the tops of both of my feet.  This is more of an annoyance than anything else; I'm thinking my shoes were probably tied to tight when I ran Chicago.  I've been massaging the areas, and applying ice when I remember to, but the inflammation doesn't seem to be going away. 

I pretty much took the week after Chicago off, running 3 miles on Friday 10/15 and 4 on Saturday 10/16.  Sadly, I decided to just cheer instead of run at the Asbury Park Relay Marathon, where the two FRNY teams came in first and second overall. 

My plan for this week was to run 6 miles at the Wednesday night fun run, and if that felt good, to do 10 on Saturday or Sunday, and if that felt good, I would do the marathon.  Well, Wednesday was a great run for me.  I was keeping pace with Mike Terry during most of the run (although he outkicked me over the last half mile), and I felt like I was flying up the hills.  I think taking those extra rest days really helped strengthen my legs. 

Yesterday, still on a runner's high from the day before, I headed out for an easy 4 miles along the West Side Highway.  This time it didn't go quite as well as the night before.  The Wednesday run definitely took a toll on my legs, and I felt this new thing developing in my right calf.  I ended up turning around and heading back after only 1.5 miles, figuring that it was better to rest up than to overdo it.  I still want to do a 10-miler this weekend; hopefully it will be a good run I'll end up deciding to do NYC next week.  Not sure if I'm going to do said ten-miler tomorrow or on Sunday, though--I got a long night of drinking ahead of me tonight, haha.

Speaking of drinking, I ended up using my $40 gift certificate to Duke's BBQ yesterday.  I got the gift certificate through Groupon, this collective buying service that emails you every day with a ridiculous deal that you can get if enough other people also sign up for the deal.  Most of the deals are restaurant gift certificates with a bunch of random other stuff thrown in.  Anyways, it was my first time at Duke's and I was in for quite a shock.  I think the place normally caters to a pretty fratboy-heavy crowd, but because of the baseball playoffs and a football game yesterday, it was ridiculous.  The good thing was, on football nights, they have $5 margaritas and $2 bud lights.  Oh, and $5 wings.

The runner in me is embarrasesed to say how much food was ordered.  But since this is a food blog...   we ordered the wings, the fried calamari and the full rack of ribs (with baked beans and cole slaw) to be split between two of us.  They were out of the calamari, so we ended up getting the "Smokin' Stack" instead.  OMG, that was ridiculous, but so good.  Onion rings, piled on top of a plate of pulled pork, with cheddar cheese and chipotle sour cream on top.  Seriously, not good for the arteries.  In case you're wondering: no, we did not finish everything.  In fact, I had one single rib and took the entire rest of the rack home.  I'll be working on that over the next few days, I think.