Strength for today and bright hope for tomorrow

Rode my bike to Dr. Kingston's and back.

Today I had my second K-Laser treatment at Dr. Stucky's. So far I haven't observed any benefit, but I'll do a couple more treatments before I pass judgment on the laser. I'm totally off ibuprofen (which I was taking at night to help me sleep), so I should have a completely unfiltered assessment of pain at all times of day. Right now the foot hurts worse in the middle of the night and in the morning. Once I walk on it for a few hours, it is at least "serviceable", in that I am only mildly limping by evening. At no point does it stop hurting though, and it seems to "reset" the pain every evening. Before people start commenting about "plantar fasciitis", the pain I am talking about is all in my toes and in the ball of my foot. It is not PF.

I also got my arthritis blood tests back today. Four of the five tests were negative, but I was positive for the HLA-B27 gene. This is a not a proper diagnostic, but merely means that I am at higher risk of having Ankylosing spondylitis, or "A.S." Over 95% of people with A.S. have the HLA-B27 indicator, but not all people with HLA-B27 have A.S. (less than 5%, I think). So a blood test can only serve as a piece of the puzzle, rather than a full diagnostic. I don't care to describe it, but you can read more about A.S. here:

http://en.wikipedia.org/wiki/Ankylosing_spondylitis

I had already read up on A.S. quite a bit, because several other pieces of the puzzle point to it as well. When I called the dr's office this morning, the tech said that I tested positive for IGG for something like that. I was confused and asked her to double-check what that meant, as I totally expected to hear "HLA-B27" instead. She came back, apologized, and said that she wrote down the wrong one. "Sorry, I meant 'HLA-B27'," she said. "Well, duh," I said. Here's why I already thought I might have A.S.

1. The sports doc I saw a couple weeks ago suggested it as a possibility just from listening to my injury history. No blood test needed for that.
2. It would explain my chronic SI joint pain over the last three years.
3. It would explain why my second toe is swollen a good quarter-inch thicker than its counterpart on the other foot
4. It would explain the joint inflammation on the ball of my foot, and other toe inflammation.
5. It would explain why my neck and upper back hurts, and why it hurts a little bit when I take a very deep breath.
6. It is most common in males in their 20s. I am a male in my 20s. I had no problems of any sort until I was in my mid-20s.
7. It can also cause plantar fasciitis.

But really, I can't know for sure, at least not at this point. I was referred to the local Rheumatologist (Cory Walker), and can't get in for an appointment until June 25th. I'm not sure what else he can do. Perhaps order an MRI, as that's really the only diagnostic tool left. And most likely prescribe lots of prescription drugs, since that's generally what doctors do. sigh. The Pettibon stuff will definitely help my back and neck, but I don't think it can reduce the swelling in my foot. I may consider trying a starch-free diet before drugs, but I need more info first.

Until then, it's back to laser.

Ran to the gym. Not because I felt better, but because I didn't feel like biking or driving. Did 20 minutes on the elliptical and then 2x10 4-way hip @ 90 lbs. Ran home.

Rode my bike to Dr. Kingston's office and back. Fortunately, it stopped raining. My neck continues to improve and feels pretty good these days. Still a ways to go, but so far the treatment is quite effective in that respect.

Last night I had my 3rd K-Laser treatment with Dr. Stucky. This time I could feel some improvement in my foot when I walked out, but I still had the morning pain going on by 3AM. I would say the laser has had some positive benefit, but nothing earth-shattering for me. I have just one more next week. The lady before me yesterday walked out of the treatment room smiling and saying, "Wow, I can walk normally again!" So apparently it works better for some than others.

My latest quack scheme is to try the Three-Day Apple Fast. This one doesn't cost any money though, aside from the cost of apples. In a nutshell it is a detox fast where you only eat apples for three days, along with a tablespoon of olive oil. Hence, the "Three-day apple fast" name. How many apples can you eat? As many as you feel like.

Here's a blurb about it: This Apple Fast provides not only the benefits of the malic acid in apples, but also gives you large amounts of natural pectin fiber to cleanse the intestinal tract. The pectin leeches toxins from the blood stream and intestines and will leech anything with food value so do not eat anything else and do not take vitamins at this time. (Edgar Cayce suggests 3 week breaks from vitamins anyway so that your body doesn't become dependent on them and stop making it's own vitamins)

It's called a fast because, by eating only apples, the body is fooled into a fasting mode, where it starts dumping toxins from the liver, kidneys, and other internal organs, into the bloodstream, where they can be leeched by the pectin.

http://www.astrodreamadvisor.com/Body_Apple_Fast.html

http://www.ehow.com/how_12675_apple-cleansing-fast.html

Many people with AS have said doing an apple fast every few months can get rid of flares. Nothing to lose (other than hating apples as a result), so I'll give it a shot. 

Apple fast update:

Day 1 went fine. Got pretty sick up apples by noon, and was hungry for the rest of the day. Ended up eating 10 apples total for the day. Only other thing consumed was water. No change in how I felt by the end the day, but none expect.

Currently halfway through Day 2. Still sick of apples, but feel over the mental hump of fasting. Supposedly the second day is the worst, as all the toxins being released causes headaches and generally grouchiness. I do indeed have a headache, but am in a fairly good mood. The headache could actually be from no coffee in two days, but probably a combination of both. Apple hangover.

Some improvement in how I feel. My foot didn't hurt as bad when I got out of bed this morning, and I noticed around 11AM that my hip/SI pain has magically disappeared. This is a good sign. Neck is about the same. I look forward to more apples.

Postedit: just did Pettibon exercises, and it's very noticeable how much looser my lower and mid back are. I mean, I haven't had this much range of motion in months. The only thing that could be throwing up my assessment is that I've been lifting things all morning for our yard sale, plus pulling some weeks, so perhaps my back is just extra "warmed up". But I doubt it.

Sunday, Day 3: More apples. Apples apples apples. Lots of water. Headache from Saturday went away though. No much change in how I feel. Capped off the day with a healthy dose of olive oil (almost half a cup). Yuck!! Woke up at about 1AM, and had greater range of motion and less pain in my toe since the whole thing started.  Got very excited. Woke up again at 4AM, and foot was back to hurting like normal. Oh well, easy come, easy go.

Broke fast this morning with a glass of orange juice, three slices of cantaloupe, and a slice of flax bread. In all, the apple fast was a positive experience. I learned that a mono-food fast/detox is quite doable, and remained in good spirits the whole weekend. Also, the fast did succeed in releasing my back and SI quite a bit. But the foot is only minimally better.

This week I am starting the Low Starch Diet (LSD), which will hopefully transition into No Starch Diet (NSD). Many people with AS have had success controlling symptoms with NSD, and no or minimal meds. Personally, I would rather give up pizza, pasta, rice, nachos, and bread than take meds the rest of my life and fry my liver. So I'll give it a fair shot. Plus, it gives me something to do before I see the rheumatologist later this month. See links below for theory on NSD.

http://www.kickas.org/londondiet.shtml 

http://www.kickas.org/as_dietary_primer.shtml

Biked to Dr. Kingston's this morning. Then biked to the pharmacy to pick up some iodine (for testing foods for starch).

**************

breakfast: see above

snack: mixed almonds, walnuts, and raisens; pear

lunch:

Had my last laser treatment at Dr. Stucky's, then had Stacy drop me off at the gym. Did 20 minutes elliptical, 10 minutes arc trainer, and ran home.

Rode my bike to Dr. Kingston's and back.

Biked to gym. 20 minutes elliptical, 10 minutes arc trainer.

I decided to go for a run before I get put on the Lost Sheep list. The swelling in my foot has gone down a bit, thanks to a short course of ibuprofen, and I was feeling inspired after driving for the Wasatch Back Relay. Plus I had new shoes to try (won at the St. George Marathon last year). Did the Planet Walk, nice and easy, 3.5 miles. The foot didn't feel too bad (but not great either), and pace was certainly slow, although I'll never know since I didn't time it. What I do know was that it was a beautiful day, and it felt good to run a few miles. Maybe I'll do it again sometime.

Biked to Dr. Kingston's and back. Note that I counted the 6-mile ride as only 2 cross training miles in order to avoid a long, pointless thread of polite comments.

Went to the gym and did 20 minutes on the elliptical. Then jogged for about a mile and a half.

Finally had my rheumatologist appointment today. Got the official diagnoses of Ankylosing Spondylitis. No big surprise, but I supposed it's nice to get a dx in some ways.

No, ankylosing spondylitis (A.S.) is not the name of a dinosaur. "Ankylosing" means stiff or rigid. "Spodylitis" means inflammation of the spine. So ankylosing spondylitis is a chronic arthritic disease that causes the joints and ligaments along the spine to become inflamed. If left untreated, the spine can completely fuse, causing the person to lose mobility (hence, the "Ankylosing" part of it). A.S. is most common in men in their 20s. The cause is not quite known, but it appears to be genetics (HLA-B27 gene) combined with a trigger event (probably some sort of gut infection). Most people with A.S. have HLA-B27, but only about 10% of people with HLA-B27 have A.S. So the environmental trigger factor is a large role.

Their is no cure for A.S., but it can be treated into remission. Exercise, NSAIDs, DMARDs, and anti-TNF meds seem to be all there is at this point. The exercise is important to keep the joints mobile. Move it or lose it. Swimming is best for obvious reasons, and running is often frowned upon because of the jarring (but for the record my doc said that running is okay if it doesn't hurt). NSAIDs treat the symptoms by killing the inflammation, but does not stop progression of the disease. They also tend to tear apart the stomach and fry the liver if taken for a long time. DMARDs (Disease-modifying anti-rheumatic drugs) can slow down disease progression, but haven't been shown to be terribly effective with A.S. Kind of a hand-me-down from big brother rheumatoid arthritis. Anti-TNFs (tumor necrosis factor, biologics) suppress the part of the immune system that is attacking the body. Biologics can repress or completely halt the disease, and seem to be the most promising for A.S. However, they also increase the chance of infection, and perhaps even some types of cancer.

Diet has also helped a small percentage of people deal with A.S. to varying degrees. Low-starch and No-starch diets are definitely on the fringe of the treatment, mostly (IMO) because there is no money for doing non-drug research, plus pharmaceuticals can't make any money if people just stop eating bread. But the diet has a small but fanatical cult-like following among lay-people. In any case, it is proven that some foods cause inflammation, and some foods reduce it, so it is a safe bet to pursue that kind of diet just for general health and to help things along.

Anyway, this is long, but it's as much for my therapeutic benefit as for anything. My symptoms aren't too terribly severe on the grand scale. Judging by x-rays and flexibility tests, I have suffered no joint damage or no beginnings to fusion either. This is good. Since A.S. isn't terribly well-known, most people can go over a decade without getting it diagnosed, and by that time they may have already started to fuse (once you fuse, you can't go back). In my case, I think my hyper-sensitivity to what is going on in my body due to being a runner helped get me into a series of doctors and start asking the right questions and getting the right tests. I can track my A.S. timeline back to June of 2005, so it's been going on for three years at the longest, which is pretty quick for a dx.

And it turns out that my clusters of "running injuries" may not be entirely from running, and are better explained as A.S. flares. It also turns out that A.S. often affects muscles and tendons near insertion points, so my plantar fasciits and hamstring tendinitis would also be common A.S. symptoms. Of course, running didn't help most of these things either. And A.S. also commonly causes "sausage toe", which is what it sounds like, and is what I have going on with my feet (currently preventing me from running). Timeline:

• 1994 - June 2005: No injuries whatsoever. Nothing, nada. No back pain.
  
• June 2005 - November 2005: SI pain, lower back pain, patellofemoral pain (runners knee). Ran through most of it, then took a couple months off after St. George.
  
• December 2005 - February 2006: perfectly healthy, resumed running
• Feb/March 2006 - August 2006: SI pain, lower back pain, patellofemoral pain (other knee), groin strain, plantar fasciitis. No running for 5 months.
  
• September 2006 - December 2007: pain-free, blissful running
• January 2008 - June 2008 (ongoing): hamstring tendinitis, SI pain, sore/stiff lower back, stiff mid-back, neck pain, swollen toes, swollen forefoot.

So it's been alternating healthy - flare - healthy - flare. I am now in my third flare, by my count. This is definitely the longest, although I don't know that it is more severe than what I went through in 2006. So the A.S. may be ramping up each (bad thing), but I am not sure. It would sure be nice if I left this flare and had another 15 months of quiet.

My rheumie thought it would be best to start with a prescription NSAID to wick out the inflammation. Everyone's version of A.S. if a little bit different. If mine follows the pattern of flare - healthy - flare, then I can probably get by with taking NSAIDs as needed. However, if things don't ever get better, and it seems to be progressing, then he will want me do go on an anti-TNF, such as Remicade or Embrel. I'd rather not do this, as it is very expensive (~$20,000/year). With insurance it is something like $100-$200/month, depending on the drug.

So now I am taking diclofenac. Ibuprofen is quite effective on me, so hopefully this will be too, and shrink my foot down to a normal size. My next appt is in 3 months, so until then it will just be the NSAID (as needed), exercise, and a healthy diet.

Will I run competitively again? Maybe. If I can, I probably will, but if I can't life will go on. I know I can be happy and fulfilled without running, and it is not my identity, but I do enjoy it, so I would obviously like to be able to at least go out and run 6 miles pain-free with myself or with my friends. But this whole ordeal has served to remind me that my hope is not in the present with this broken body, but my hope lies in God and in His promise of a future and an eternal life.

19"Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal. 20But store up for yourselves treasures in heaven, where moth and rust do not destroy, and where thieves do not break in and steal. 21For where your treasure is, there your heart will be also. -Matt 6:19-21

And the great hymn, "Be Still My Soul":

Be still, my soul: the Lord is on thy side.

Bear patiently the cross of grief or pain.

Leave to thy God to order and provide;

In eve - ry change, He faithful will remain.

Be still, my soul: thy best, thy heavenly Friend

Through thor - ny ways leads to a joyful end.

Be still, my soul: your God doth undertake

To guide the future, as He has the past.

Thy hope, thy confidence let nothing shake;

All now mysterious shall be bright at last.

Be still, my soul: the waves and winds shall know

His voice Who ruled them while He dwelt below.

Be still, my soul: the hour is hastening on

When we shall be forever with the Lord.

When disappointment, grief and fear are gone,

Sorrow forgot, love's purest joys restored.

Be still, my soul: when change and tears are past

All safe and blessed we shall meet at last.

Ran the Planet Walk today (4 miles). Averaged 7:23/mile. It's amazing how easy it is to run 7-minute pace without hamstring tendinitis, despite being completely and totally out of shape. Foot felt pretty good. It's still swollen, but doesn't hurt nearly as much. I can stand on my tip-toes, which I couldn't do a few weeks ago.

(Pegasus: 10 miles) 

Biked to the gym, did 20 minutes elliptical, adn 2x10 4-way hip. Biked home.

Ran to the end of the single-track and back on the River Trail with Cody. Foot is sore, but the rest of my body feels good, and stride feels good.

Biked to Dr. Kingston's and back.

I've posted a YouTube video of the Wasatch Back Relay for blue van 1 on my personal blog. It's nothing great (I don't bother with transitions or music or anything), but some of you might get a kick out of it. Sorry the video is so grainy, but that is YouTube's doing. The original is quite crisp.

PM - felt like running, so I met Cody and ran the River Trail. 3.5 miles total, averaging 7:20/mile. Very hot.