The physiatrist

You might remember that my orthopedist ordered a second MRI of my pelvis, since I continued to have nagging pain at the exact same place as the fracture. I didn't know what the pain was, only that it was at the same spot. Since I managed to ignore everything my body tried to tell me until I couldn't walk any more, I was mostly nervous that I might do that again, only perhaps with worse results.

The MRI showed that the fracture is healed, and that I have some mild hamstring tendonosis in both legs, which I knew about and do feel. But that's not where the nagging pain is. So he referred me to a physiatrist because, as he said, the issue was no longer bone so I was out of his area of expertise. I'm really grateful to have had a good orthopedist who's also pleasant but I still hope I never need to see him again.

I'd never heard of a physiatrist before, so I checked with Dr. Google and here's what I found:

First, it's pronounced fizz-EYE-a-trist. I have a hard time remembering how to pronounce it, and Kent just gives up and calls it pianist, and then we both laugh.

Second, they look at the big picture and focus on the entire body rather than just one organ. To put it in more dictionary-like terms, this is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities.  They use a head to toe approach, which they believe is especially good for hard-to-diagnose problems like spine pain, which may be caused by anything from muscle strain to osteoarthritis. Or my case, nagging pain at the fracture site.

Third, they use a team approach and I can validate that. At one point, I had the physiatrist, plus a med student, plus an intern and two others who were part of the team only I didn't catch what they did, plus the PA was supposed to be in there but was with another patient. But I loved that Dr. Khadavi used my situation to help train his interns etc. How else will they learn if they don't see patients with all sorts of different issues?

During the exam, he would ask them what they would do next as they assessed me. I had to touch my toes, and then while lying on my back, they manipulated my legs in different positions while asking me when and how this pain occurred (all the time? only during the day? during what kinds of activities?). 

Finally he did a physical exam. Keep in mind, the inferior pubic ramus (what I broke) is in a very personal spot, right by my crotch. Really close, in fact there's just no way to show where it hurts without things getting up close and personal. Which is fine, I was there for his diagnosis, but I think it was a good learning experience for his team. And yes, he found the spot and the nagging pain got more nagging.

Here's what he told me:

• This kind of a break is fairly rare. He sees just a couple a year.
• Fractures like mine really don't heal any faster than 9 months, they just don't. I'm not at 9 months yet, got the month of February to get through.
• I have a callus on the bone and that's what the pain is from.
• In fact, I will probably always have this pain.
• The good news is that I'm not damaging myself by running with this pain.
• My flexibility is great (I laughed at that, and he told me me no, he was serious, I've got good flexibility).
• I should cross train like crazy.
• I should run shorter distances more frequently. So aim for a 2 mile run 4 to 5 times a week, rather than trying to knock out a 6 mile run.

A year ago
I'll be back!

He also got an x-ray for baseline, and I'll see him again in two months. He thoroughly approved of my physical therapist (and she equally approved of me seeing him, said he was the best in the city). That's always nice when your health care providers at two different practices approve and are glad you're seeing them.

I'm relieved, to be honest. I was so afraid that I was hurting myself again or that somehow I'd turned into a big whiny baby in the last few months. Knowing that the recovery time is much longer than I realized helps so much. I'm focused on my long-term goal of full recovery and ability to run races again. I still want to get just one marathon done and in the books. It may take a little longer than I realized.