18point5

Our grandson Henry, an accomplished child, loves to say "Henry did it!" when completing a monumental task like pulling his shirt off or helping his mom organize the pots and pans onto the kitchen floor. When I came through the front door last Sunday "Henry did it!" were the words I found best described my 18.5 mile long run.

First I did 3.5 miles on the treadmill. This gives me time to make sure I can make socket adjustments before heading outside. Depending on what I am watching on TV, sometimes I go a little longer. I much prefer getting my longer runs and speedwork done outside, where I have a better sense of my real effort as opposed to a moving belt under my feet, uh, foot.

I did feel the faint hint that my residual was not entirely happy, so I stopped twice to adjust my prosthetic socks. Finally I hit on a fit that my leg found acceptable, so I finished my indoor run then headed out for another 6 closer to home.

Once again I knew I was going to make the distance even if it would be slow. Fatigue was not weighing me down as I donned my Camelbak for the next 9. I was feeling quite strong but allowed to the thought to enter my mind...yeah, you can be sailing along in a marathon and then BOOM the wheels fall off and you are left dazed and confused in the ditch.

I didn't fall in a ditch, but I was a little dazed around 12.5 miles when I stopped, grabbed my knees, and studied the macadam at length. As I stood up and prepared to go again, I noticed an SUV with "13.1" and "26.2" stickers on the back window had rolled to a stop. I couldn't quite hear what she was saying, but knew as a fellow running she was making sure there would be no memorial where I stood today.

This simple kindness made me smile, cleared my head, and off I went. I would still take a couple of breaks in the later miles, this being my longest run since December 9, but I finished strong and not nearly as bone-tired fatigued as the past few weeks. My residual did not revolt and the swelling wasn't crutch-worthy either. My knee wasn't terribly happy with the extra pressure from the many socks I was wearing; given the ill-fitting socket this is the best I can do with what I have.

*******

Today being Tuesday, January 29, I still do not know the outcome of my appeal with BC/BS. When I see other amputees getting legs for skiing, or swimming, or rock climbing, or weight lifting without problems it is hard to understand why I was denied. I only hope it was an oversight that will be corrected without having to take other time consuming measures. This should be something good for all concerned; indeed, I believe I will be the first amputee from my state to run Boston.

We are very excited making plans for the weekend before the race, meeting new people, and oh yeah, RUNNING THE BOSTON MARATHON!!! This is a lower mileage week for me before I hit another 3 weeks hard which should include two 20 mile efforts if my prosthesis will allow it to happen.

Eight weeks of training, 2 weeks of taper, and then the amazing, this miracle will happen. I cannot grow tired of saying it: what a day it will be.

No News Is...

good news?

No word on my appeal for new prostheses from BC/BS this week. From people who deal with appeals, they thought this might take 3 - 5 days, so mine is just over a business week. I am hoping this is a case of "no news is good news" but I desperately need to hear some good news soon. Pam who handles the insurance paperwork at ProCare has been very supportive during this trying time. None of us understand this denial.

After I posted on Facebook about the problems I was having with my old prosthesis and being denied a new one, there was an outpouring of prayers, thoughts, and support from my friends and family.

And then something happened. I have no other explanation other than another little miracle, or perhaps not so little when I think about it. I changed my running routine to two shorter training runs each day, but I had to keep my long weekend run intact, which was 17 miles last weekend.

I could still feel the sensitivity in my socket at times, but it never exploded into the discomfort that would force me onto crutches. Although I slowed considerably over the last few miles, I got this key workout done. I should already have completed a couple of 20 mile runs according to my training plan, but I am grateful I can run at all right now. I am tweaking my schedule often depending on my physical conditioning and prosthetic issues, and I still hope to get 3 or 4 20 milers in before the race.

Tomorrow I plan on 18.5 miles. Yes, an odd distance but halfway between the 17 I have done and the 20 I need to do. Next weekend I will drop back, maybe even do a half marathon, and then the following week go after 20.

20 miles is a key confidence builder. For me it usually takes at least 2 or 3 of them before I start feeling strong and comfortable at the distance. My confidence was shattered after the first attempt at 20 miles detailed here. I felt like Boston was again dissolving into a waking dream. But now, on the cusp of a 50 mile training week, that confidence is rising.

I am once again as excited about the race as I ever was. I just wrote on FB that I feel like a kid waiting on Christmas; as a kid we think that day will never arrive, yet for Boston I know it will be here before we know it. Indeed, it is just over 11 weeks. That leaves 9 weeks of training as I will only do a 2 week taper.

Then there was more good news. Kelly Luckett asked that my wife Jennifer run as one of her guides for half of the race. We're not certain which half (or a little more) at this point as plans are still being formulated. Still, I am so happy Jennifer will get to participate in the race, as I know she, like me, thought she would never be on this most famous of marathon race courses.

This day just grows more special. Family as well as new and old friends will be there to support us as spectators. Ashley will be there. My stepson and his wife Kristen will be there. Kim, a dear friend of Jay's, will be there. Grit and Jodi will be there. And of course the runners and guides and someone who we will all be thinking about on the greatest day in distance running: we will be running with The Greatest.

A place for remembering The Greatest
Jason Pisano

I am going to be out of my mind that weekend. The one thing we can always expect from the marathon is the unexpected. I have never run this distance without a huge struggle in the last miles no matter how high my fitness level was. This will be my second marathon as an amputee. I do know this, as long as I finish the race it will be the most rewarding. Not for any time I may finish that day, but for all the friends we have made along the way. Be they there or not there, we will run with them every step of the way.

One day Ashley may be on this very course in her racing chair, teaming with someone to show the world what it means to have the heart of a champion, of someone who has faced adversity like few others, to see that the legacy of Jay, Impossible Is Nothing, is more than wordplay. It is the very nature of this miracle of life we share.

Dum spiro spero

Sunday Stroll

After 2 miles on the treadmill I suited up and head out for the remainder of my ad hoc 15 mile run. My plan was to go as slow as I needed while not putting any extra stress on my residual. As I got my Camelbak ready, put on my i.d. and FOP bracelets, I could feel the first signs of discomfort in my prosthesis. I entered the church of denial.

Swelling nearly 6 hours post run

With my ill-fitting prosthesis, I have found whenever I stop my residual often gets very sensitive. So today there would be as few of these as I could manage, which I did until the last 3 miles. The day would be a warm one which I received with mixed blessings. At my speed it would more welcomed than if I was running faster and generating more body heat.

It wasn't a great run, but it was one I needed to get done. After mile 12 I stopped at every mile to take a break, not walking but standing still while taking long drinks. The first few steps running were extremely uncomfortable, but once I got underway the worst of the pain disappeared and allowed me to manage my, why yes let's call it what it was, jog.

My total run time was over 3 hours. I jogged all the way to the front door to avoid my residual going into revolt, which it did once I walked into the house. I grabbed the crutches to ease my pain and headed to the shower.

Last Sunday I was on crutches all night after the 8 measly miles, but after my shower this afternoon I was able to squeeze my swollen leg into my prosthesis and walk without the sticks. I still have intense sensations in the residual, just short of pain but the feeling remains that I would love to put that missing doggie in a cool, mountain stream like the Little Pigeon River.

*******

I am keeping my fingers crossed that I will get Dr. Ohlson's notes tomorrow so I can continue my appeal with BC/BS. In the meantime, I will continue to do all I can to run without being further disabled by my ill-fitting prosthesis. Jato has been a great companion to me and once reconstituted, just like me, will be ready for the battle that is Boston.

It will not be the time I know I can do, but it will be a time that is all I can do. And I won't settle for less.

Crunch Time

Next week will be a decisive one for me. I should be able to submit Dr. Ohlson's notes to the health insurance company as part of my appeal to their denying me new prostheses. I am hopeful I will not be rejected again. If so I will have to continue to fight through other avenues, but those would take longer and possibly no resolution would come before the Boston Marathon.

Assuming I can get the good doctor's notes to BC/BS on Monday, the insurance medical director will have to review and then if approved, I will have to schedule an appointment with my prosthetist at ProCare to be fitted for the new prostheses. This could take an additional 2 - 3 weeks to be fitted and get all the parts needed to complete the work. At that point I would have about 8 weeks of training left before the taper for the marathon.

With these setbacks, I have had to adjust my goal times for the race upward. I believe I can still have a decent race with consistent training. One thing I have learned in my amputee running experience is there are just too many variables to assume you can have consistent training, especially at higher mileage and longer race distances. I can control getting my butt out of bed for a 4 am training run, but I cannot control the issues like I had last year that caused my residual limb to get smaller.

*******

Tomorrow I am planning a 15 mile long run. I will not be running a step today when I usually go 3 - 6 miles easy. I am hoping to let the swelling go down in my leg, which seems mostly to be concentrated at the distal end of my fibula.

If I can't make the 15 I will not run the planned half marathon next weekend at the Charleston Marathon. I have been considering not running it anyway as I need to increase my long runs, so we'll see. We could even switch to the 5k and I could run long on Sunday, but no final decision will be made until later in the week. In the best possible scenario I will be at ProCare getting fitted for my new running prosthesis. This would make me happy. Very, very happy!

*******

The track is not a playground

This past week I backed off my training to help minimize the swelling and other skin issues I am having with my current running prosthesis. I was able to complete shorter training runs with less discomfort and did not have to use the crutches again. On Friday I was able to complete my scheduled workout on the track, albeit slower in some unusually warm temps and having to deal with kids on the track once again.

I should mention although the teachers make an effort to keep the kids to the outside lanes; being kids, they do what kids do as you can see in the photo. I now believe my meniscectomy was caused by my trying to avoid a little girl who walked in front of me last year. I had to twist off to my right to avoid knocking her down; this was the incident when the "teacher" was at fault for not doing his job. He said something like: "I yelled at them to get out of the way." Yep, that is how the kids were taught that day.

When that happened I called the Town of Mt. Pleasant Recreation Director, Mr. Ken Ayoub, with a message that I am certain conveyed my frustration over the then complete lack of oversight at the track. After this call I did notice the teachers made a better effort to keep the inside lanes cleared for runners. However, the kids still stray into the lanes whether through inattention or intentional testing of the rules.

The past Friday was more of the same as you can see in the pic. The teachers simply cannot control the children on the track. I will not injury myself again or the kids because I am unable to stop quickly with my prosthesis. I have been making an effort to avoid this situation entirely by running early in the morning and late evening (which has usages problems too), and probably will just do so to keep my calm so I can do a workout without this nonsense.

It sucks. But I am tired of fighting this battle for now, I need to concentrate on my training without hearing kids screaming and wondering if I will have to call out to them to get out of my way while busting my guts running. Sucks. Sucks. Sucks. It is not right I can't run safely at this town track. I am simply asking to use the facility as a track, a running facility, the very thing it was designed and paid for at a cost of around one million dollars. I need just one lane, about 30" wide, on an oval meant for an athlete to run on.

Mr. Ayoub, I know you and many teachers are trying, but these kids should go play on one of the many other athletic fields and leave the track to citizen runners. The track is a running facility, not a playground, and it is irresponsible for the way it is currently being misused. 

I have older post I have not published about the town's incredible mismanagement of the old town track I suppose I should drag up and finish. Perhaps if someone else gets injured they will choose a more direct legal path to change. Unfortunate, but entirely one needed to fix this problem since nothing else is working. Sad.

Frustration City

This will be as short as my long run yesterday.

I was scheduled to run 20 miles - my first at that distance in over a year - and made 8 before my residual limb hurt so much in my socket that I had to quit. I tried to bull my way through the run, having to stop every few minutes to try a difference prosthetic sock fit that would ease my pain. Nothing worked.

After my shower I had to force my swollen leg into my old plastic "convenience" prosthesis. This prosthesis was made about 3 years ago when my residual was far larger and my leg usually slips right into it.

The swelling at the distal end of my fibula made it nearly as large and was longer than the tibia. Jennifer had to retrieve my crutches from out in the garage so I could walk. Yes, I cursed a bit and it wasn't about fiddlesticks either.

The thing is, detailed here, I knew I needed a new prosthesis and had been fitted with a test socket while awaiting insurance approval. I was denied. So now I am experiencing swelling, skin breakdown, and an inability to run and now walk without pain not because of anything I did but because my insurance claim was denied.

I am very shocked this has happened, particularly since my insurance has been so good up to this point. We will be moving through the appeals process and I hope this can be dealt with quickly, because as I write this there is a mere 97 days until Boston. There is a good chance I will miss the Charleston half marathon either due to lack of training or, best case, I will be getting fitted for a new socket if the insurance comes through.

Living in Frustration City is not where I want to be. I will be stepping up my personal involvement soon as I just don't have a single day to waste as the starting line looms in Hopkinton. Far worse than denying me the prosthesis is denying me this race. It cannot happen.

Will not.

Bump in the Road

MI Athletes Start First at Boston (click for music link)

I am always amazed at how quickly atrophy occurs when muscles are not used in the manner for which they were designed. My right leg lost quite a bit of volume and tone when I could no longer run back in 2007 and especially after my surgeries when I could not use it at all. Once I started running again this process was mostly reversed, with my right thigh nearly returning to the same size as before all this unpleasantness began.

In 2012 I experienced two significant events that caused far more atrophy than would have normally occurred, the meniscectomy of my left knee and then cellulitis on my residual limb. Although my right calf muscle does not function as it once did, when I run it does fire and maintains some tone. With all the time off last year my amped leg got smaller.

Swelling along fibula (right side)

Early in November I visited ProCare to be fitted for new prostheses. My residual limb had changed in shape and volume to the point I was wearing 9 -10 plies of prosthetic socks in my sockets. I was having pain when running until I could get my sock fit just right, which means running on the treadmill until I felt discomfort, getting off and adjusting socks, then trying it again. Usually after a couple of miles I could get the fit good enough to venture outside for a longer run.

This isn't like any issues able-bodied runners face. Closest example I can think of is this: imagine having a size 6 foot and only having size 12 shoes to wear. The only way to keep the shoe on your foot is by adding socks. Sure you can put on 6 or more pairs of socks and keep the shoe from falling off, but you'll find it very awkward to walk. Running - especially what it takes to train for a marathon - would be extremely difficult.

*******

Skin breakdown on end of tibia

My insurance company denied my new legs. Best I can tell it is because I already have prostheses. Doesn't matter if my body has changed or not, too bad. So now I am facing additional injuries from a prosthesis that does not fit. Already I have swelling along my fibula that is worse the more I am on my feet, my patella is swollen from the number of socks I have to wear to keep the pressure off the distal end of my fibula, and from time to time I get skin breakdown. The fibula head has all the hair rubbed off from friction.

The last time I ran I used 14 plies of socks. I have to get my residual limb tight within the confines of my socket to minimize the pain I get on the distal end of my fibula, which manifests itself as a very sharp stab or as a world class friction burn. It is a bit odd that it is worse when walking than running.

*******

I had an office visit with my surgeon, Dr. Ohlson, and we are going to appeal the insurance denial. My life is different from most amputees in that I enjoy running and my activity level is the highest K4.

Dr. Ohlson understands everything I have been through to get where I am, he is one of the most caring, competent, and compassionate physicians I have known. Having performed my two surgeries, no one can possibly know my situation better than he. We are asking for nothing that I am not needing for living my life. Prosthetics are not a luxury item but a medical necessity.

********

With the Boston Marathon a little over 3 months from now, I cannot afford weeks of downtime nor do I intend to let the present discomfort deter my training. What will happen will happen.

My fitness level is not what it was a year ago. Then I was running over 60 mi/week; now I am in the mid 40s. My times are far below what I could do then, in fact slower than almost 2 years ago. I cannot do shorter training runs very well because the number of socks restricts my knee movement so much so that I have to change my gait to avoid toppling over. For now I am doing what I can do; if not faster miles then I will do as many as my body will allow.

These are not excuses, just the facts I have to work with. It is frustrating knowing I am being held back not by desire but by things external. My current running prosthesis is extraordinary technology; however it has to fit my changed anatomy to work near optimal levels. It is now over 2 years old and can no longer function like it once did.

Short of my fibula breaking from the additional stress I am now experiencing, or a piano falling from the sky onto my head, nothing is going to keep me from Boston this year. I am training for all types of weather we may experience, and I hope by race day my times will be coming back closer to my ability. It is also my hope that I will be running in a new prosthesis as well.

I have money to raise for Ashley and the IFOPA. I have a date with my destiny. This is meant to be. I need to be on that starting line with my fellow runners Kelly and Shariff. My guides Randy and Mike will be ready to go. My wife Jennifer will be my rock when I am losing my race day mind. And we will run with the spirit of Jason Pisano in our hearts.

This is meant to be. Let it.

*******

Wings wings who gave you your wings

Who made you lighter than air?

- Wendy Waldman