So, I've given Ortho some grief on my blog, and I think it's time to give them their due. That's largely because of my innate sense of fair play, and also because they recently saved me from serious injury.
I've never been much of a runner, but I decided to take it up in earnest about six weeks ago. My decision was made partly to trim a little from my waistline, partly for cardiovascular fitness, partly for bragging rights ("my 5k time is better than yours"), and partly because I was on an out-of-town rotation and staying in an apartment complex with an air-conditioned workout center with treadmills. I started fairly slow -- just 1.5 miles on each of my first few runs, building up over the course of a couple weeks to a bit past 2 miles. Nothing out of the ordinary -- not even that long of a run.
My mistake was to run too frequently from the beginning. My previous attempts to become a runner involved a MWF jogging schedule, adjusted as necessary based on my work schedule, but never with more than three runs per week. While I was out of town, however, I had lots of free time and none of my normal distractions (family, video games, my movie collection, etc.) so I adopted a M-F running schedule with rest on Saturday and Sunday.
About two weeks into this schedule, I began to develop some left knee pain, particularly at the beginning of my run and after it was finished. I foolishly rationalized that it was simply muscular soreness that would resolve with time in my new routine, so I continued my aggressive running schedule and used Motrin 800 mg tid to control my discomfort. To an extent, it worked, and I was able to keep pushing myself more than I should have done.
My away rotation was four weeks long, and by the time it was over I realized something more than simple muscular soreness was at work. I backed off to two runs per week, but those had become very painful, especially for the first half mile. After each run, my wife was treated to my best Vanilla Ice impression as I collapsed into a chair ("Ice, ice, baby!"). My knee pain had quickly progressed from something associated with my runs to constant discomfort, hurting me even on my run-less days. I was loathe to stop running, since I had come to enjoy it apart from my knee pain, but something was clearly wrong with my knee and I knew I needed to back off or risk serious injury.
At this point, I had a quandary: should I use my own medical knowledge to manage my injury conservatively, or should I involve an orthopedist? It's not always easy for doctors to get time away from their clinical responsibilities, especially if they're residents. Fortunately, one of the perks of medicine is the ability to informally ask for medical advice from colleagues in many specialties, and I approached an orthopedist in the OR two weeks ago to ask his recommendation. He replied that he'd be happy to examine my knee in between cases, and when he did he became a bit concerned.
"You have a clear medial collateral ligament strain," he told me, "but you've also got pain too anterior to be explained by that. I'm worried you may have a small medial meniscal tear."
The orthopedist (I'll call him Dr. Thompson) ordered x-rays and an MRI to further evaluate my injury, asking that I call him when the scans were done so he could check them. I was able to get the x-rays done the same day, but MRIs must be scheduled and it took a week before I was able to have that study completed.
On the appointed day, I went downstairs for my MRI scan. It was completed in about 30 minutes, and afterward the technician returned me to the waiting room while the radiologist checked the images to confirm their adequacy before I left the MRI clinic. Five minutes later, the technician came back and informed me that the radiologist was on the phone and wanted to speak to me.
"Hi, this is Dr. Wong," he said.
"Hi, I'm Matt, one of the anesthesia residents," I replied.
"Matt, I'm looking at your MRI right now and you have a grade 4 stress fracture of your medial tibial plateau. I want to get you on crutches. This fracture looks pretty impressive."
I had a sinking feeling, knowing how crutches would complicate my job, which includes pushing patients around the OR suite and spending a lot of time on my feet. But two things the radiologist said caught my attention. First, he said the fracture was grade 4. I was unfamiliar with the criteria for grading stress fractures by MRI, but lots of things in medicine are graded on a scale of 0 to 4 with 4 being the worst. Second, he said the fracture looked "impressive." That's generally doctor-speak for, "damn, that looks bad!"
Just to be sure, though, I asked him what a grade 4 fracture was. He said it meant you could actually see a fracture line on the MRI instead of just bone marrow inflammation and edema.
So off to the radiologist I went. He showed me my MRI (the picture at the top of this post is a screen capture from my MRI, and all the white crap in my tibial plateau is edema and angry inflammatory cells that shouldn't be there) and wrote me a prescription for crutches, which I could pick up from Physical Therapy.
A few minutes after I picked up my crutches, my cell phone rang. It was Dr. Thompson, who had already looked up my MRI. He had taken the time to look up my home number from the hospital computer system, then had my wife give him my cell so he could touch base with me.
"Matt, this stress fracture isn't pretty," he said. "You need crutches."
"Just picked them up, sir. Dr. Wong from radiology said the fracture looked ugly."
"Yeah, it's impressive. In addition to crutches, I want you in a full-length knee brace. It should be unlocked because I want you to be able to move your knee, but you need to wear the brace at all times. And you can toe-touch, but no weight-bearing at all on that leg."
That gave me another indication of just how much damage I had done to my knee. Total non-weight-bearing? For an active resident who has to walk around the OR suite and the hospital all day long? That's serious business.
I asked about the other MRI findings and Dr. Thompson told me that the MRI confirmed the MCL strain he'd diagnosed, but my meniscus looked good. He told me where to go for the brace and said he'd follow up with me on his next operating day.
And that's pretty much where we are now. I'm hobbling around on crutches because I broke my leg by advancing my running schedule too aggressively. But for now, I seem to have avoided more serious injury (like the fracture extending all the way through my tibial epiphysis). I know the extent of my injury and I now know exactly why my knee was hurting me so much, which knowledge is empowering since it allows me to undertake the appropriate management to promote healing. And it's all because a good, attentive orthopedist was willing to increase his own workload by examining me between his cases, then take an active role in my follow-up and intervention. And a good radiologist was willing to stick his neck out, too, instead of just dictating his findings and closing the MRI.
So here's a big "thank you" to Drs. Thompson and Wong (whose names have been changed, as always) for their excellent work in diagnosing and treating my fracture. I'm deeply grateful for their willingness to go beyond the call of duty to follow up with me and ensure that I received the information and equipment required to prevent further injury.
And I learned a lesson from all this: when you decide to take up running, it is important, as with so many things in life, to pace yourself.
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