Hobbled: Running, Plantar Fasciitis and My Mom

One of my earliest memories is of my mother instructing me how to propel myself on a swing to soar above the then cement-covered playgrounds of New York City. “Stick your legs out and pump!” she coached three-year-old me. I didn’t know what “pump” meant and she had no understanding of aerodynamics. It didn’t go well.

Like many runners, I did not grow up athletic. In fact, I come from a family of remarkably uncoordinated couch potatoes, particularly on my mother’s side. This did nothing to stop my mother from attempting to teach me physical skills she herself did not possess, such as the afore-mentioned swinging.

One concussion and many skinned knees later, I accepted my lack of athletic prowess. After all, I was in good company. Hardly anyone in my family knew how to swim, let alone skate, ski, or play tennis. You’d think it had to do with lack of money but my father, the lone exception, grew up poorer than anyone, yet knew how to swim and skate. He learned to swim by being thrown by his buddies into New York City’s East River. I know. Amazing he was able to procreate after swimming in that toxic soup.

According to family legend, my mother sank like a stone when thrown into a local pool as a teenager and had to be pulled out ignominiously by the seat of her raggedy bathing suit. I have to assume being thrown into a body of water was a rite of passage back then. Lacking my father’s innate abilities, my mother was unfazed, and determined that I learn how to swim.

When teaching me by the side of the local pool didn’t pan out — “Kick your legs, and alternately stroke with your arms, taking a breath every other stroke!”– my mother scrimped to send me to a day camp specifically to learn to swim. I contracted a bad case of swimmer’s ear on day one and had to sit out pool time for the remaining two weeks.

Cutting her losses, my mother set her sights next on bike riding. Quickly she realized this kind of tutelage required a degree of coordination and strength far beyond her own. This was especially true when the child in question had no sense of balance. Someone was bound to get hurt.

My father finally managed to teach me how to ride without training wheels when I was eight, a feat akin to teaching Koko the gorilla American Sign Language. Soon after, I got bumped by a car when I attempted to cross the street between two parked cars. (Hey that’s how we rolled in the Bronx.) Lacking the self-preserving reflexes possessed by most humans, I failed to put my arms out to break my fall. For weeks I sported a grotesquely fat lip and lost the tooth I hit 10 years later.

Catholic school did not help me improve my athletic skills. The backs of my legs always sported welts from misadventures in jumping rope. Jumping-in eluded me and forget about Double Dutch. The dreaded dodge ball in gym was a little bit “Lord of the Flies” in terms of lax supervision and Piggy, I mean I, knowing neither how to throw nor to dodge, was often the worse for wear.

I found my people when I left the nuns and went to a “special” public high school with a concentration in science. You had to take a test to get in and it had nothing to do with physical fitness. Our most popular team was math team. My dodge ball days were over.

In college, there were two major obstacles for the non-athletic — the dreaded swim test and a gym requirement. The swim test, though well intentioned, was a source of severe anxiety to certain demographics. Namely, the poor, the foreign and the phobic. We had not learned to swim as children and could not believe we had to do so now.

There was no choice but to take the introductory swim class. Yes, it was a bit like that rite of passage my parents endured. But at least it counted toward the mandatory gym credits. I found it was a major advantage not to be phobic and to have English as a first language. I actually learned to swim the required three strokes as well as tread water after jumping off the deep end, a feat never to be repeated.

I’m drawing a blank on how I managed the remaining college gym requirements This might have something to do with repeated head trauma sustained during introductory volleyball — I couldn’t help closing my eyes when the ball was in flight.

I know I tried to be more active during those four years. Inspired by a boyfriend at the time, I even attempted “jogging” for the first time. I barely got to half a mile before I had to sit down on the curb, out of breath and half suspecting I might be having a heart attack.

Fast forward 25 years or so. My daughter joins the cross country team her first year of high school. Inspired by a not well-received wish to show solidarity, I start to run. And I like it. I took it slow and was gratified to find that my prior life of sloth left me pristine knees and hips compared to experienced runners.

I started doing some races. Controverting popular running wisdom, I began with a very hilly 10 K and finished (that alone was my goal) in a little over an hour. The vomiting at mile 3 was just an added bonus. Running became my way to relieve stress, to think, and to keep middle age weight gain under control while still eating (and drinking) what I wanted. This past summer, I toyed with the idea of a half-marathon and upped my distances, getting to 12 miles.

I felt strong and fit. Clearly I was overconfident. Ran perhaps more than I should have one weekend with friends who were marathoners. Or maybe it was the neon Easter-egg colored minimalist shoes that didn’t give enough support but were so cute. The next time I ran, I felt this searing pain in my heel about 2 miles in that would not permit me to continue my run. I hobbled home.

Plantar fasciitis (PF). Once thought to be an inflammatory condition, currently the etiology was being debated. There was no consensus on best treatments. It depended somewhat on whether you consulted a podiatrist or sports medicine orthopedist, how far you were willing to go (injections of platelet rich plasma, anyone?), and how much you were willing to pay.

As a health care provider, I tried what the literature suggested and what I in turn had suggested to my patients. Non-steroidal anti-inflammatories and prednisone, an oral steroid, didn’t help, which gave credence to the latest thinking that PF might not be an inflammatory response to injury. I did all the proscribed stretching exercises daily. I took up yoga again. (Downward dog is the perfect stretch for plantar fasciitis.) Decided to eschew steroid injections based on my research and orthotics based on prior bad experience.

I believed the cause in my case was a sprained ankle about six weeks prior that I ran on too soon. The ankle was weak and threw off my gait. So I started cross training at the gym to build up strength. Faithfully stretched, used a foam roller and massaged my foot with a frozen rubber ball daily. Wore the snazzy Strasburg sock at night (https://www.amazon.com/strassburg-sock).  Got fitted for more supportive (albeit slightly less cute) shoes at a running store.

Almost six months later, it is definitely getting better. Some days I have no pain at all. I can run four miles outdoors, five on the treadmill with minimal discomfort. I’m back, baby.

I often wonder what my mother would have made of this newfound running obsession and my recent struggles. She wouldn’t have understood it but she would have put her two cents in. “Propel yourself forward while swinging your arms,” she might have called out, undeterred as always by her lack of personal experience. “Shorten your stride and increase your cadence. And don’t forget to stretch.”

Thanks, Mom. I think I got this.

#plantarfasciitis #RunningInjuries, #unathletic, #HobbledNoMore #RockingThatStrassburg Sock

 

Comfort Zones Part 1: The Night Shift

When I was in my last year of NP school I volunteered at a weeklong sleepaway camp for kids living with HIV. This was in the days when “living with”  was a euphemism for “dying from.” What was I worried about going in?  Not contracting HIV.  Not even seeing kids who were very sick.  I was concerned about the night shift.

Having gone straight through nursing school to graduate school, I hadn’t worked as an RN. Many new RNs start out on the night shift. Somebody has to do it and it’s viewed as paying your dues.  In the camp program I was in, everyone was assigned one night shift, and we were partnered up so noone was alone.

Of course the night shift per se should have been the least of my worries. We were taking care of some very sick kids with j-pegs, and kangaroo feedings and weak lungs susceptible to Pneumocystis pneumonia. My nursing experience was all academic at this point. I could ace a test, but maybe not save a life.

But what I was worried about was staying awake.

In this particular program, there were mostly inner-city kids. HIV knows no demographics – anyone can contract it. But these kids were all born with it. Their only risky behavior was being born. Many of their parents had drug problems at some point. Many of the children were orphans and many whose parents were still living, were in foster care.  This I knew going in. What I did not expect was to see how happy the kids were, getting off the bus. All seemed to be excited to have a week of camp, whether they were six or 16.

The facilities were not impressive, but there was a lake for swimming, basketball courts, and plenty of room to run around. The kids stayed in cabins with a counselor, and while not fancy, accommodations were adequate. The counselors told me the kids were not used to the lack of traffic sounds and were at times frightened of the sounds of the natural world. We were not technically in the country, more like an ex-urb, but to these kids, it was very remote.

We nurses spent our shifts keeping everything stocked, treating bug bites and minor scratches, and of course, giving meds. The kids were all on a lot of meds. There were a number of ICU nurses there who easily took care of the parenteral feedings and med administration. The rest of us took care of the oral meds. The kids were stoic, having grown up taking lots of nasty-tasting stuff and swallowing large pills. They just wanted to get it over with, anxious to get back to the fun.

Our team was led by an ER doc who had done this a number of years. His mantra was to just keep all the kids well enough to continue camp. Cellulitis? Medicate and cover up to avoid transmission. Toothache? He just injected procaine as often as needed so the little boy could enjoy camp. I felt so sad that he could get this kind of a toothache at this age, but of course, he was one of the ones in and out of homeless centers without regular dental care.

My scheduled night shift was in the middle of the week. I polled the experienced nurses to see if they recommended napping that day in the afternoon. No consensus.  I tried, but it was very noisy and I wasn’t able to sleep.   Finally it was time for my 7 o’clock shift. I had coffee with my dinner but was already feeling tired. The other nurse had just gotten off the night shift at her job in a small community hospital a few months ago so she was an old hand.  We chatted. Listened to music.  Played tic tack toe.  This was in the days before smart phones.

Around 2 am we heard the crunch of footsteps on the graveled path leading to the door of our makeshift clinic. The screen door slammed as one of the male counselors came in, carrying a boy who looked about six, piggy-back style. He informed us the boy had fallen out of his bunk bed. We both knew Victor (not his real name). He was kind of like the camp mascot. He always seemed to be having fun and giggling. He had skin the color of tea with a drop of milk, blondish, nappy hair, and the sweetish smile imaginable. He melted hearts wherever he went and that was before you heard his story. Both his parents were addicts. His father had died of HIV when Victor was two. His mother had been living with the disease until last year, when she relapsed and died of a heroin overdose. Now he was in the foster care system and had had some bad placements.  You would never know it from interacting with him.

Victor looked like he had been crying but was smiling and cooperative as I examined him. His counselor told us he had not lost consciousness. He had woken from a bad dream and had been in the act of trying to climb out of bed when he fell.  Luckily, there had been s pile of rolled-up sleeping bags on the floor which had broken his fall. He had not hit his head and now he denied any pain. Nevertheless, I gave him a thorough neuro exam, checked his joints for swelling, his abdomen for possible internal injuries. Gave a good listen to his heart and lungs. His vital signs were all normal. We instructed the counselor on what warning signs to look for and they got ready to go, with Victor fully expecting — and getting — another piggy-back ride.  The other nurse told them to “hold on” as she rustled around in the bag of stuffed animals we had and gave him a large plush snake to take back to the cabin.  He was delighted.

The remaining time of our shift went rather quickly and then it was over. I had survived the night shift. My cohort and I were glad to see the day shift, chatted a bit and went to raid the camp kitchen before heading for a long nap. We had the whole day off.

Thankfully, there were no major calamities that week, but as can probably be expected, interacting with the campers was bittersweet.  Whenever I saw Victor, he was clutching the stuffed snake, seemingly none the worse for wear from his early morning fall.

On our last night, a talent show was scheduled and the kids were very into this, even taking time from swimming and games to practice. The karaoke machine was enormously popular.  The campers all seemed to know the latest music and could lip sync songs and dance like the original artists. It was impressive but heartbreaking when one of our older campers, a cachectic 16 year old girl on oxygen, gave an amazing rendition of a Selena song. The kids did enjoy the little number we nurses put together, dancing (after a fashion) and swinging our stethoscopes like feathered boas.

The next morning was a rush of packing up supplies. We had been told repeatedly at orientation not to give gifts to the kids to avoid favoritism and hurt feelings, but some nurses drove into town on their time off and did just that. I was assigned to gather up the toys to pack away for the next camp session. I went from cabin to cabin driving a golf cart and collected them. The kids had been told to deposit them in a box in their cabin. My last stop turned out to be Victor’s cabin.  As I went to drag the box out, I spotted the plush snake’s nose peeking out from beneath a bare pillow. I reached for it and Victor came running in and hugged me. “Please nurse, can’t I keep him?” he asked.

And here’s what haunts me to this day.  I said no. I explained we had to have all the toys back for the new campers next week.  Victor didn’t cry or make a fuss.  He just looked sad and nodded that he understood.  This was what I should have been worrying about instead of the night shift: how I was going to feel about those children. Was my heart already hardening out of self-preservation? I had been relying on the rules to get me through this week, a week that took me way out of my comfort zone.  Victor was dying, all the kids at that camp were.  Why was I depriving him of remaining in his comfort zone, for just a little while longer?

#patientstories, #comfortzone, #HIVcamp