I'm so Vein (Part 1)

Disclaimer:
I am not a doctor or anatomy expert. The following information is presented more or less in layman's terms because that is the terminology I understand. Any misinformation or exaggeration is because I don't know everything about everything yet. But hey, you are here and this is my blog. Jeremy Run's This. Feel free to comment and correct anything I screw up but as far as I understand and am willing to understand currently the following is true. I provide it partially for my own record but also so that those who care will have one (hopefully) consistent account of my vein journey.
 
Anatomy Lesson #1
The human body has miles and miles of blood vessels. (I don't know how much and I'm too lazy to look it up now.) The vessels that take blood from the heart to the body are arteries and the ones that return thee blood to the heart are called veins. In humans the veins in the legs are equipped with one way valves that help keep the blood from falling back down to the feet. If these valves do not close completely or do not close at all gravity takes over and the blood pools in the lower veins. This can be very uncomfortable (achy, burning, itchy) and is often visible in the form of spider veins and vericose veins.Like breast cancer this is more commonly found in women who may "earn" them as part of the birthing process but can also affect men. The main cause of varicose veins and venous insufficiency in general is genetics. However, symptoms can be exacerbated by long periods of inactivity, hours and hours on your feet, or sitting for prolonged periods of time.

Options: 
Temporary solutions to the pain and discomfort include wearing compression sock/stockings and use of Ibuprofen or other NSAIDS to help with the inflammation.When these simple measures are not enough or the discomfort becomes too great, getting rid of the failing veins can be achieved through surgery.Traditionally veins were able to be "stripped" but this is a fairly invasive procedure requiring significant recovery time. One less invasive alternative is ablation. This is a process where a catheter is inserted in the vein and as it is removed sections of the failing veins are cauterized shut. For some reason I used to have the strange idea that new veins would grow in the old veins' place but that is not correct. The ablated vein gets absorbed and the blood is forces to return to the heart through the other healthier veins.


My History:
I have many relatives with varicose veins and that is most likely why I have mine but I didn't always have them. My first recollection of having any strange visible veins in my legs is from shortly after I was hit by a car in 2002. It was a minor hit where I was more concerned about my Discman than my body and no medical or legal attention was given. But during the collision my right shin collided with the car's bumper. Soon after I noticed it was a little purple and was tender. I thought this was a bruise but in the ensuing years it has turned into what I affectionately call my 3D tribal tattoo, my biggest, grossest, most noticeable, and most painful varicose vein.

1/2/2013

Up until 4-5 years ago the veins weren't too bad and weren't achy enough to worry but in the last several years they have become more and more noticeable not just to the eye but also with regards to pain. For the last few years I have begun wearing knee-high compression socks when I would go on a long run, have to be standing for a while, or while traveling. This has helped some but has not completely eliminated the discomfort. About a year ago I went in for a free vein screening with Dr Grover in Logan, UT. He told me a little about the causes and options for my situation. The next step would be an ultrasound to find out which veins were not working properly. I was not ready for this yet so once again this topic was shelved while I continued to use compression socks multiple times a week.

1/2/2013

In the summer of 2012 I finally caved and went in for the ultrasound. Dr Grover took pictures and did and ultrasound on both legs, both upper and lower. I had always thought that the problem was just what I was able to see but we found out that I had venous insufficiency in both legs both upper and lower. In order to test the veins they push on your leg to instigate blood flow and they time how long it take for the valves to close. If it take more than 1/2 second then the veins are bad enough that they are covered by insurance. I had veins that took longer in both my upper and lower legs. The fun thing: the gnarly one in my right lower leg didn't even close for 2 seconds while we watched it. We gave up waiting for it to close. I shared the news with Martha and we made arrangements to do the operations in January to eat up our insurance deductible so that any further problems for the rest of the year would be taken care of.

As we called to make the appointment, it turns out that I would have to undergo 3 separate procedures.

Procedure #1:

Before Procedure #1: Numbing cream in saran wrap

On January 2nd I left work early and went in to have the first set of veins mapped.Dr Grover had a medical student with him. Ammon was the med student's name. He and the nurse? watched as the doctor lubed my leg up with ultrasound jelly to find the veins that were to be treated. This first procedure would close one vein off in each leg going from my crotch down the inside of each leg to the mid to upper calf. The idea behind this is that since these veins were failing they were putting even more pressure on the veins in  the lower leg. After he'd found the veins he drew a line tracing the vein and called in a prescription for a special cream that would numb my skin. I was instructed to apply the cream along the line 2 hours before the procedure and then to wrap my leg with saran wrap to keep the cream from rubbing off. Apparently it takes about 2 hours for the cream to work. But it was a life saver because I didn't feel the stab me with a needle multiple times to numb the area under the skin. I had also be instructed not to eat or drink within 3 hours of the procedure and I obeyed.

When I got to the office I laid down on the table and they prepped the room for the procedure. They had hospital gowns on and everything. I got to wear some briefs but other than that I was bare from the waist down. They placed a drape over my lower body but taped it to my skin so that only the inside of each leg was exposed. The doctor cleaned my legs and injected local anesthesia to the area around the veins. An IV was inserted in the vein in my calf and through the IV they inserted the catheter on a long wire. Dr Grover just fed it up the vein until it got to the top of the area to be treated. He used the ultrasound to make sure it was in the right place. Then I learned a little more about human anatomy. Did you know that the veins in your legs are housed within a sheath-like membrane? I didn't. It was cool to hear the doctor explain to the med student what he was doing and I asked a bunch of questions.Anyway, because the catheter gets so hot to cauterize the vein closed, they inject fluid between the vein and the sheath to have a buffer zone to avoid damage to surrounding tissues. This creates pressure and is kind of uncomfortable in a strange way. Once the flluid and catheter are in place, they cauterize a small section at a time as they work their way out of the leg. Then the whole process is repeated on the other leg. I remained alert and awake during the whole procedure and was only a little uncomfortable a couple of times.

The line and punctures from injecting fluid

Irritated thigh skin from the tape

Mummy legs after Procedure #1

The worst parts of the ordeal were after the procedure was complete. When they were done they ripped the drape off that had been taped to my leg and that was painful. Then he had to scrub each leg to clean off the iodine that had colored my legs brownish orange. This was not fun because he had to scrub hard right where they had just ripped the tape off and it was cold.

Once I was all cleaned up, The doctor wrapped my legs from foot to crotch with ace bandages that I had to wear until the next morning. This quickly became uncomfortable as the bandages seemed to bunch up behind my knees and pinch my skin and pull my hairs. I went home and rested but I did go for a 20 minute easy walk later that evening.

The wrappings

The mummy unwrapped

Recovery:

My new thigh high compression Stockings

The doctor told me I should just walk and take it easy for 3-4 days but then I was cleared to run easy. The next morning I was so excited to get the bandages off, I didn't even mind having to wear thigh high compression stockings all day everyday for the next 2 weeks. I stayed home from work Thursday but went back in the next day. I went for a walk on Friday during lunch and felt fine even though Martha says I was waddling like I had just run a hard marathon. I think I was only about 1/2 marathon sore. Saturday I went to a yoga class and felt fine. Sunday I went for an hour walk and felt great.

Monday I went for my first run. To make sure I kept it easy I wore my heart rate monitor. I went 6 miles which was probably a little far but I felt ok. My legs just felt a little off. Monday afternoon I had my post-op checkup and got mapped for my next procedure which we thought would be done Tuesday. We thought wrong and scheduled it for Today (1/10/13).

Finding veins for Procedure #2: (Photo Credit Dillan)

Mapping veins for Procedure #2 (Photo Credit Dillan)

So I got to run Tuesday, Wednesday, and I even got up early enough to sneak one in this morning before we had to apply the cream to the new area to be treated. But I think that is a topic for part 2. Stay tuned.

10 Questions

My friend Christie of www.marathonmama.net/ was challenged to answer these questions and tag her friends. She tagged me so I figure I'll give it a go.

1. Best Run Ever: Its a tie. When I first returned to running and went trail running part way up Ben Lomond I got a super awesome running high and as I yelled out "woo hoo!" I tripped and fell. You'd think that would have ruined my high but watching everyone's faces as I continued down the trail was classic. Then I got to the car and saw what they were really looking at; bloody nipples.

The other one was a little later when I had a chance to go back to Palmer Park in Colorado Springs, CO where we used to run for HS cross country. I got the chance to go for a run and I ran almost all the trails we used to run in high school. It used to take a week to go through all of those. That is a great place to run.

2. Three Words That Describe My Running: playful, experimental, personal

3. My Go-To Running Outfit Is: cheapo walmart shorts, an old race shirt, my Home Depot trucker hat, cheapo compression sleeves and my Altra Lone Peaks.

4. Quirky Habit While Running: I always want to go further than planned. This is not good when I have somewhere I need to be.
 
5. Morning, Midday, Evening:  I'm a morning runner but I don't mind an evening run. I have a hard time balancing eating and running to do in in the middle of the day.

6. I Won’t Run Outside When It’s:  There's not much that I won't run in but when it gets to be about -15F or below I will at least consider a treadmill or a day off.

7. Worst Injury and How I Got Over It: I'm guessing this refers to a running injury. I thought for a long time that I had really bad ITBS but eventually I figured out it was my aching vericose veins. Thank you genetics. I've had PF in both feet (luckily at different times) I pretty much ignored it both times. The first went away on its own, the 2nd I feel like has turned into a migrating imbalance on the back of my left leg. Sometime the PF flares up, then it could be the achilles. On really fast or hard runs, my left hamstring starts to get tight. The achilles was where I was stuck for a long time (over a year) and I think I'm mostly healed now. Some time off, eccentric calf raises, more time out of shoes with a heel, and rolling out the knots in my calf on a softball have all contributed to the little success I've had.

8. I Felt Most Like a Badass Runner When I: Ran my first Ultra. It was what I now look back on as a "baby ultra" as far as distance. It was the 2010 Logan Peak trail run. A 28 mile trail run with 7200' elevation gain and loss that not only goes to the peak and back of a local peak, but it also circumnavigates it.

9. My Next Race Is: I'm pacing a guy from Chicago in the Bear 100 this weekend. Other than that, who knows? Whatever goofy race I feel like jumping into. Probably not a big deal race until next spring.

10. Potential Running Goals for 2013: I want to complete my first 50 miler in 2013. Looking at the Buffalo Run 50M in March. I ran the 25k in 2010, and the 50K in 2011. I was going to run the 50 this year but the aforementioned achilles issue made me choose otherwise. But that was still awesome because I got to meet Christie and pace her for a few miles. I also had a fantastic experience as an aid station volunteer.

The above goal may be a challenge because I have scheduled a surgery on my veins for the beginning of the year.  I don't mind that my legs look gnarly but they just ache when I've been on my feet or butt for more than a couple of hours.

If all goes well, I'd like to do a marathon and/or half marathon where I can actually prepare and race to see what I can do. If I get to do some races for free as a pacer that would just be a bonus. 

Now I get to “tag” other bloggers that I follow! I choose my swim coach who would be an awesome runner if not for a string of injuries, Andrea of and if he'll accept I'll also tag my favorite DM friend from Canadia, Steve.

Pacing the Top of Utah Marathon 2012

First, the background story...

Last year I was chosen to pace the 3:20 pace group for the Top of Utah Marathon. I was confident that I could do it, felt like I trained well for it and it seemed like it would be a stroll down the canyon. It wasn't. I got sick the week before the marathon and felt like I was just getting better by race day... until mile 20 or so where I could no longer hold the pace. I ended up finishing almost 8 minutes behind my scheduled time. (by the way there was also a bit of rain, wind, cold, and hail). I felt horrible! Not as much because I ran slower than planned but because I felt like I let everyone down. If I recall correctly I think I even cried about it.

Ok, fast forward to this year when I was given the opportunity to pace again. I considered just racing for myself rather than dealing with the pressure to run a specific time but ultimately agreed to pace based on the fact that I was returning from an injury (achilles, that I actually was dealing with at the 2011 TOU), I knew that work and family schedules would keep me from training as consistently as I would like, and they had asked me to pace a slightly slower time (3:25).

This summer I spent many of my weekends trying to get to the summits of as many mountains as possible. I think I ended up with about a dozen. While this is great exercise and is closely aligned with my passions, it may not be the best way to train for a predominantly downhill road marathon course. With a few days before the marathon, I started to get nervous. The thoughts of last year's failed pacing attempt and a reminder of the pressure to perform had me post on DailyMile that I'd rather do a 100k than have to run a specific time. Adding to this stress was the fact that my wife was sick and I really didn't want to catch anything and I was told that I could only be at most 2 minutes faster than an even split at the halfway point meaning I could run the first 13.1 no faster than 1:40:30 and the second half no slower than 1:44:30. I had never run anywhere close to that even of splits in my previous 4 attempts at this race. (The first 17-18 miles are mostly downhill, while the last section is flat and winding with several gradual hills that always feel longer and steeper than they are at that point.)

Anyway, several of my DM friends commented on my post with words of confidence and encouragement and I didn't feel nervous again until Friday night at the check-in and expo. We had a pacer booth to answer questions and get people set up with pacers and people have a way of asking questions that make you question yourself. In addition to this, the guy that was supposed to pace with me didn't show up that night, so we couldn't talk strategy or coordinate at all. It was great to meet all the runners and I even met Isela from DM and encouraged her to join my pace group. She didn't think she was ready for it. I think she is.

I came home from the expo, laid out all my stuff, put my son to bed and tried to go to sleep. It took me a while to fall asleep and I woke up several times through the night worried that I might sleep through my alarm. I didn't. I actually got out of bed about a minute before the alarm went off at 4:45am.

I got up and got dressed and ready to go and walked down to the bus pick up which was about 1/2 mile from my house. I got on the bus and had some great conversations with several people and we talked for a good portion of the bus ride to the start. The bus ride always seems so long you question whether it will take you that long to run that distance.

At the start it was pretty cold but not too unbearable. I questioned whether to wear arm sleeves and/or gloves but ultimately opted for neither.  I found my spot in the starting herd and those in my group started to gather. I never did find the other guy who was supposed to help me pace. I was worried but quickly dismissed it because there was nothing I could do about it.

Just before the race start I saw Heather from DailyMile and wished her good luck. The race started late and I was wishing for the first mile that I had stepped off the road at the start to pee. The guy who was in charge of the pacers came up and ran with my group for a while. I ditched off behind the first port-a-potties I could see (they were occupied) and relieved myself. Before I was finished I noticed 2 others doing the same thing next to me. That would have pissed me off except it was during a race and who really cares?

I quickly found my group and realized that we had actually gone out the first mile slower than our average pace should be so we picked it up slightly. It was pretty smooth sailing down most of the canyon. We chatted, told jokes, and talked about who we wanted to win the rivalry football game. Good times. There were probably about 10 or so in the group with one that would fall off and then catch us every now and then. Over the miles, unfortunately the talking and joking started to die down. I tried to talk but when I would be the only one talking it tended to slow me down a bit so I backed off.

It was pretty apparent by a couple of miles down the road that my Garmin was not on the same page as the race course. It was consistently telling me I hit a mile marker before we were there on the course. I thought that would work itself out so I didn't worry about it much at first and just kept trying to keep our average pace around 7:40 going down the canyon. We ended up hitting the halfway point in right around 1:42 (my watch had it as almost 13.3) and I got a little worried. I told the group that when we came out of the canyon to the more gradual downhill we were going to try to keep the pace for as long as possible before slowing so we didn't lose much time.

When we came out of the canyon around mile 14-15 I could feel my body want to just pound it in. You see, I did most of my long training runs on the last half of the course and on my longest run of 26.2 my halfway/turn around point was the forest sign at the mouth of Blacksmith Fork Canyon. This, I felt, was now my "home turf". The group had thinned a little by this point but it was probably still 6-8 of us. We kept the pace really well along Hollow road and onto the highway. This is where things really started to thin out. We were almost to the 18 mile mark and I started to lose people. I told them to just hang on to me as long as they could and I kept going.

I still felt pretty strong at this point. It was basically me and the guy in the VFF Komodosports who'd been with us since about mile 2 or 3. He was running strong (despite the foot slapping sound all the way). We ran side by side most of the rest of the race. We were starting to pick people off left and right. This is the section that has some uphill and it gets difficult to maintain the pace. I had a few miles that I wasn't sub 7 min on and I think most were this section. According to the average pace on my watch we should have been fine running 8's all the way in but I was suspicious that the course would be long (at least according to my Garmin) so I ditched the idea of allowing me to let the average slip to a 7:49 and tried to slow down the slowing down. This way if the course was long I'd be ok and if the course was correct according to my Garmin I would have a cushion.

Waiting for Daddy

A couple miles out I pointed out the finish line to the VFF guy (it was 2 blocks away) and we briefly mentioned how uncool that was. (see the map) About a mile out I could feel him wanting to go and told him to just go for it. He did and I didn't see him again.

Now that I was getting super close to the finish I did a quick calculation of the number of block until the finish. It was 5. I had just under 5 minutes until I was supposed to finish. I know that in general, in Logan you can do about a block a minute at around 8 minute pace. I was worried about the time and started to push harder. I could feel the time slipping away. As I made my way down the home stretch I knew I'd missed my time but I heard my wife and son yelling "We love you!" and finished.

Of course in my traditional style I did a somersault over the finish mat (wife didn't catch it). My legs didn't like getting up after it. The chip time was 3:25:15 although I had it on my watch at 3:25:20. Here's my Garmin track.

Walking around at the finish I bumped into several from my group that thanked me for pulling them along. Several of them even PR'ed and at least one guy qualified for Boston. Woo Hoo!

I'm not very good at names but I'll see who I can list/ describe who was with me for significant portions of the race:

• guy with pink headband/ wristbands, and shirt and his friend
• two girls wearing pink who stayed just ahead for most of the race
• The girl in the plaid skirt that looked like a kilt
• The VFF guy
• The Umstead 100 guy and his friend (Umstead BQ'ed)
• The marathon virgin (dropped back towards the end but thanked me for pulling him along. 3:45ish)
• Guy from Orem in red shirt
• BYU guy who we learned went to BYU after talking about how we wanted them to lose
• Isela (friend on DM) didn't really run with me but I was just behind her for quite a while until we passed her on the more difficult end. And her husband for a while.

This was a much better experience overall compared to last year. Weather, people, and performance. If you think I needed redemption for last year (I did), I think I achieved it. I'm really glad I did this. It wasn't quite as fun as the half I paced in the spring but I feel great that I was able to come so close to hitting my time.

RANDOM THOUGHTS AND FACTS:

• My bib number was 185 which was pretty close to my weight that morning. I had gained a few pounds during the taper but that and more was gone with this. Not worried. Just interesting.
• One girl in the group described me as a linebacker (she probably meant fullback) that was making the way for them and keeping them out of the wind. She also joked about jumping on for a piggy back.
• As a pacer I got to carry two big red balloons tied to the end of a stick with 3:25 written on it. That thing became more of a pain than expected. I kept trying to get my runners to carry it but no one would. The sign I carried last year was easier to deal with. Oh, well. 
• I need to run the tangents better.
• If I depend on a Garmin next year I need to plan on 26.4 to be safe.
• I consumed 5 gels and 3-4 salt tabs. I walked to drink at almost every aid station and felt like I couldn't get enough water. I would usually swallow the gel or salt tab right before the aid stations. I realized that trying to swallow a pill without water makes me gag.
• I got 6 low fives from spectators. 
• This was a bit more difficult than I wanted but that was part of the reason I decided to pace instead of race it. I know my training wouldn't be that great. 
• Although I am sore, I haven't had to go down any stairs backwards and I can move mostly normal.
• My left hamstring is the worst area. It has been barking at me off and on for a while. Gotta take care of that.
• Other than being a little chilly at the start I loved the weather. It was as perfect as could be without being overcast on the 2nd half. No rain, hail, and the only wind of significance was a tailwind.

After the race we hit a local pizza place and then I laid around for a couple hours before going grocery shopping with the family, got some ice cream, mowed the lawn, cleaned out the basement, took my son to the park, and watched some football.  A great day overall.

Official results:
Chip time: 03:25:15.9
Overall Place: 146/ 1541
Gender Place:  124/ 799 finishers
Division place: 14/ 87 finishers
 

July in Review

I am way behind on posting so the last 2 months are being summarized mostly in pictures. Here we go for July 2012.

I took my son camping. We went for a hike that evening and it got dark on us. Luckily we had some lights with us. Unfortunately they weren't very bright.

 The next morning we went up the windcave trail again.

 

We had to check out this cave on the way back down.

 

There's a rattlesnake in the crevice. My first sighting in "the wild"

 I had a business trip to Indianapolis, Richmond, and Orlando. These are from my humid, muggy run in Orlando.

 Later, I ran the Crimson Trail...

Got a sweet raspberry on my nose and above my eye from a fall. It was even worse looking the next day.

 I took my nephew for his longest run so far. We went up Ben Lomond and over to Willard Peak.

Starting up the "hill"

Are we there yet? Why are you taking pictures?

The goal

Porter on Ben Lomond

Me on Ben Lomond

The summit log on Ben Lomond.

There's a mountain goat up on the cliffs looking at us.

goats grazing

The view of Ben Lomond from my parents' house.

 We went to Alpine, WY to go rafting. I snuck out for a couple of attempted runs in bear country.

Did I mention I got thrown out of the raft on Big Kahuna on our way down the snake river? We did 4 runs over 2 days. I fell out 1 time the first run down on the biggest rapid before they told me what I should be doing.

First Run

First Run

2nd Run

3rd Run

3rd Run