The (Slow) Return of the Running "Machine"

I wrote an entry a few weeks ago about the breakdown of a running machine and the (unintentionally) self inflicted injuries I've caused myself from running.  After a year of on and off pain, I've set off to try and fix this problem.  But it means navigating the medical system here for the most part in Spanish.  Most likely all my readers have "enjoyed" navigating the medical system in their home countries and see how frustrating it can be ... now try to do it in a language other than your own.

Yes, I know I just wrote an entry on the easiness of using the system here.  And it is actually quite easy.  But once you have the appointment the challenge is then being able to communicate your problem and understand the questions being asked to you in another language.  In the last few weeks I've had to do that for my orthopedist appointment, the emergency room for Liam, the eye doctor for Liam, the emergency room for Aidan, the eye doctor for Aidan and finally, for myself at my bone scan appointment.  

And so far in those past few weeks I've done pretty well with communicating in Spanish.  Only problem is that it's hard to make follow up questions when you don't speak the language fluently.  But I feel like progress is being made and so for now, I'll take that. 

But back to trying to fix the running machine... I had an appointment a few weeks ago with an orthopedist.  A doctor that I was told spoke English, but in fact, did not.  I told him what was wrong with me and how it happened.  He spent less than 30 seconds examining my leg and then said I had tibial periostitis (shin splints).  He ordered a gamagrafia and therapy.  I had no idea what a gamagrafia was and when I google translated it, I still didn't know.  So then I had to google the translation - turns out it was for a bone scan.

I scheduled the appointment for the bone scan which to be honest, seemed a bit extreme since we didn't even do a standard x-ray and now you are going to expose me to radiation equivalent to about 60 x-rays.  But hey, I'm not a doctor and the medical system as I've noted, is different here.  So I'm going with the flow.  My appointment was scheduled 2 weeks ago for 8:45AM to do the bone scan.   

I live less than 2 miles from Quiron Hospital which is where my scan was scheduled - one of only 3 places that has the appropriate equipment in this city.  I left my house at 8 for an 8:45 appt just in case. Good thing I did.  Because Travessera de Dalt and Vallcarca were like Rte 1 at Christmas.  I normally wouldn't mention a parking garage but I'm pretty sure this one went down at least 10 stories like a spiral staircase - no end in sight til you got to the bottom.  I will admit to slight panic of being so far underground.  I went into the hospital and asked where my appt was.  I knew he said bottom of the stairs and to the left but when I got to the bottom I saw the X-ray dept straight ahead, not to the left.  But to be seen I had to pick not just a number but the right department - like going to the DMV and picking licenses, registration, etc.  I took a guess. Turns out that my appointment actually was to the left... Oops!  So slightly late now which totally stresses me, I made my way down to where I had to be. I'm stressed enough already AND I need to do everything in Spanish.  Why can't life just be easy for a moment?  Because stuff like this is tough enough to navigate in your own language.  I checked in and got myself situated in the waiting area. Thankfully there were only 2 other people here.  A friend had once told me that you bring people with you to the doctor - no one should be alone... And yet here I am sitting by myself.  Meanwhile, these other people at least have their significant others with them. 

After 30 mins my name was finally called. The tech asked me a question and I had no idea what he was asking.  The fear set in.  I have no idea what I'm doing.  Thankfully a doctor who spoke English came in and explained.  The tech wanted to know if it was my first time with this type of X-ray.  He then explained the process.  They were going to inject the radioactive dye, take an X-ray, wait two hours and then do the scan again.  I must say, the tech did the injection perfectly - absolutely no pain.  I don't think I've ever had a needle in my arm without at least a pin prick.  And yet I could feel my heart racing while on the table waiting for the giant X-ray machine to take an X-ray of my legs.  The tech had asked if I had a belt on which I didn't.  But he forgot to ask if I had anything in my pockets and part way thru I began think I might have change in my pocket (and yup I did). Hoping that doesn't mess anything up!!!!   

The scan was pretty easy with the only challenge being my ability to lay still.  But I managed.  As soon as the scan was done, I took the change out of my pocket, again hoping this didn't mess anything up.  They told me to come back in 2 hours so I headed up to the cafeteria for a croissant and orange juice.  I basically just hung out for 2 hours reading and playing Candy Crush (I cannot stop playing this stupid game!).  It was kind of nice having no pressure to be anywhere or to be getting anything done - too bad I had to spend that free time hanging out at the hospital.

Anyways, I headed back to the waiting room and 2 hours turned out to be 3 but finally it was my turn.  They did the scan again and said my results would be ready to pick up in the morning.  Damn that's fast!  I had been told it takes up to 10 days to get them.  So I rushed home to call the insurance company to set up an appointment for as soon as possible with an orthopedist to review the results.  Since my appointment was on Thursday and my results ready on Friday, the earliest they could do was Tuesday (Monday was a holiday).  The doctor my friends had recommended had nothing available til June and I wasn't willing to wait that long so I took a chance that the doctor would speak English.

I picked up my results with no problem.  On Tuesday morning I decided that in an attempt to prep myself for the doctor saying I couldn't run ever again, I rode my bike to my appointment.  It actually felt good to ride it to get from point A to point B and not just to work out - the ride itself was a workout anyways and it got me to my destination.  Why I didn't start doing this sooner is beyond me.

Sorry, I digress.  I went in and the orthopedists are on the 1st floor.  But when I checked in, the guy told me to go straight ahead and to the right.  It all said traumatology and ophthalmology.   I was like, hmmm, I think he misread where my appointment was.  So I went upstairs anyways.  The woman at reception told me, no I need to go downstairs and I was pretty sure she said ophthalmology.  I started to panic thinking that they set me up with the wrong type of appointment but it turns out this guy is traumatology.  Ok, whew!!!

And bonus, he spoke English.  And it kind of threw me off a bit to be able to explain everything in English.  We didn't talk long but he looked at my x-ray and said that I definitely had tibial periostitis but that if I'm not having any pain right now, I can start to run.  SLOWLY.  And short distances.  And slowly work my way back up.  He told me that if I don't listen to him that I'm at risk for a stress fracture and that, I can do without.  The pain that I've had off and on over the last year felt like a stress fracture and if that pain wasn't a fracture then I don't know want to know what is!  I need to do warm ups before I run - something I'm not used to doing as my run usually is my warm up.  And for the time being I can only run inside as it's less pressure on my leg than running on the hard pavement.

My face just totally lit up.  I could't stop smiling.  He was telling me I could run.  I don't think I realized how much I missed my ability to run until that moment when I thought he might tell me I could never do it again.  But to be told that yes, you can do it, but take it slow... I can manage that.  But it's been a challenge.  I'm competitive, even with myself.  So to take a step back bothers me from a mental standpoint, not a physical one.  The idea of running at a 10'30" pace instead of a 9' or 9'30" pace bothers me.  I know I need to do it, but I'm having trouble with my ego on that one.  To the point where I haven't uploaded any of my runs since I started back again last week.  Stupid I know.  But it bothers me to know I'm not running at my best or trying to beat my best.

However, I know it needs to be slow progress if I'm ever going to be able to run consistently again.  And so I've slowed my pace down and my distance.  I started off last week running at 10'30" and only ran a mile.  The next day I added 2 minutes to my run.  Then I rested for 3 days with no running.  This week I've run every day at least 10-15 minutes.  I'm slowly, slowly increasing my speed.  This morning I ran for 20 minutes and ran at about 10'7" per mile.  It's a start.  I'll get there and I know I will.  Progress is still progress and I'm just happy to be back on track again.

I go back to the doctor in mid June for a check up.  He's hoping I won't need physical therapy (I'm hoping the same) so I plan to do my best to be "good" so I can show him a print out of what I've done in the 3 weeks since our first appointment - that I'm slowly increasing both time and speed.  That I'm doing a warm up before my runs and making sure I stretch after (that part I was actually doing before).  But with any hope and perhaps a bit of luck, I'll be back to my "normal" self within a month or two.  Here's hoping!

Besos,
Julie

Navigating the Medical System

I actually started to think about this post quite a while ago but given that between the kids and I, we've been to the doctors countless times in the last few weeks, I thought it was long overdue.  What's it like to navigate the medical system with socialized medicine???  Well, it's great... overall... if you speak Spanish :)

But wait, that's not just it.  It actually IS great.  But I "think" it's because we have private insurance.  Here, everyone is entitled to medical care and it's free.  You need to have a medical card that is issued from the government to receive this free care.  We don't have these cards but could, if we wanted to, get them.

What's the benefit to having a medical card if I already have insurance?  Well, as I found out last year when I tried to go to a hospital just down the road from us... if you have insurance you can't go there.  What do you mean you ask?  Well, I went in, showed them my insurance card and they said, oh, you need to go to your insurance's (Sanitas) hospital.  If you come here, we have to charge you.

And so off I went with one more tiny bit of knowledge of how the system here works.  I now understand that there are approved hospitals, like the kids go to - Hospital de Nens (Childrens Hospital) for their appointments.  So while they are not a Sanitas Hospital, they are approved by our insurance company.  And my appointment for my bone scan today - was approved at another hospital because my insurance doesn't have a machine that does this at their hospital.

The fact that our insurance has their own hospitals and clinics is interesting in and of itself, but I also wanted to point out a couple of other things that are interesting here compared to back home.

Ease of Appointments
The kids and I are going home in August for vacation.  I made appointments for them and myself for the dentist and doctors (we go here as well but I like to cover my bases) for August back in February.  No joke, I got the only appointments available - more than 6 MONTHS in advance.  This is just ridiculous.

Last year I went to my gynecologist here for a regular annual exam.  She asked if I had had a baseline mammogram yet.  My response was no.  So she said, well, let's just do it right now.  And 30 minutes later I was getting my mammogram done.  No muss, no fuss.  Easily this would have been months to schedule an appointment at home.

With our Sanitas insurance we also have an English speaking customer service support team.  So when we want an appointment, we call them up and as long as it is within one of their hospitals or clinics, they will actually set the appointment up for you.  Never have I been asked if I have a referral for an orthopedist or an eye doctor from our primary care.  Never.  I called up today to make an appointment to review the results of my bone scan and she just said, what kind of doctor do you need an appointment with?  So easy!!!

On Time Appointments
This one is particularly important to me.  Doctor's offices that run on time!  Now they don't spend the same quality time with you as they might at home but I think other than one time, I have always been taken on time, if not early.  I remember our first dentist appointment for the boys... we arrived early and Aidan ended up needing a cavity filled and a tooth pulled.  All of this was done and completed BEFORE our scheduled appointment was even slated to begin!  Seriously, I kid you not.  Oh and this was before we had local insurance (at the time we only had global insurance where we would get reimbursed for our expenses) - so the whole appointment for a cleaning, tooth pulling and a cavity filling cost me something like 70 euro.  And that was WITHOUT the insurance.

Cost of Appointments
There is no co-pay here.  You make the appointment, go to the appointment, hand them your card and leave the appointment without paying a dime.  That's it.  The only time I have paid is when the kids needed shots that were only needed in the US and the shots cost me all of 60 euros and we only had to do it once.  I submitted it to my other insurance and all was good in the world.

Cost of Prescriptions and General Medication
This one will kill you guys.  First off, a side note that most veterinary medicine is the same as human medicine in different dosages.  Jake takes thyroid meds here that he would use at home but I get it at the regular pharmacy.  Unless it is specifically made for animals, there is no problem with pets using some human drugs here.  Jake's thyroid script used to cost me $80 a month at home.  Here it is 4 euros (no, I didn't forget a zero) per month.  Yes, FOUR EUROS.

The same goes for my birth control.  At home, my co-pay is $15 a month - so let's guess how much it would cost without the co-pay?  Here it is 15 euros without insurance (pharmacies don't take insurance, prescriptions are just paid as anything else would be) and it is considered to be on the expensive side.  I pay about 2 euros for a box of ibuprofen.  I paid less than 2 euros for eye drops for the boys for their upcoming eye appointments.  Rarely do I pay more than 5 euros for any prescription I have ever purchased here.

The point is, medicine here is beyond inexpensive which makes me wonder, if I'm using the same drugs as I was at home... why are they so expensive there and so inexpensive here?  Something to make you go hmmmmm.....

The Downside...
There really hasn't been a downside except I haven't figured out how to get myself a primary care physician.  But then, I do that at home so I haven't needed one.  The kids have one and that's most important to me.  The only other downside is that my Spanish isn't medical lingo fluent.  I've found in the last few weeks that it's much better than it used to be, but of course, when dealing with anything medical, especially with the kids, it's important for me to do it in my native tongue.  For example, the problem with my leg - I was told the doctor spoke English but he didn't.  But let's also remember, we live in Spain, so I can't set any expectations that the doctor would speak English here no more than I can expect every doctor at home to speak Spanish.  But it does certainly make navigating the system a little more difficult.


Anyways, those were just a few tidbits I thought I would throw out there since the medical system is on my mind...

Besos,
Julie

The Break Down of a Running "Machine"

I've never considered myself to be a runner.  I will never forget when Josh and I lived in Waltham, back in 1999 and my friend, Ursula (a marathon runner) asked me to go running with her.  I hadn't run in years.  Hell, at that point, I don't even remember the last time I had done much exercise of any kind.  I was 23 and still my young, perky self with no concern for the future.  But I went with her and she literally ran in circles around me - and talked to me the WHOLE TIME.  I was hating her just a tiny bit for her abilities and thought, that will never be me.  I gave up.  And didn't run again until after Liam was born.

But I didn't start running right after he was born.  It was only after I couldn't get rid of those last pesky 10 lbs almost a year after he was born that I started to go to the gym.  And I didn't start to run right away or very well when I started to work out - I didn't think I had it in me.  So let's call it about 4 years that I've been "consistently" running.  Then we moved to Barcelona and I had Liam home with me full time and so couldn't take him to the gym with me (I'm a morning gym person and they don't have daycares at the gyms here) so there went 9 months where I ran on the occasional weekend but not consistently.  

After Liam started school in September 2010, I started to go to the gym a few days a week.  I was a bit intimidated by my new surroundings even though I had worked out regularly at a similar type of gym in the US.  But it was still new to me.  So I stuck to the all familiar treadmill and ran.  

Over time I found my distance getting a little further and a little faster.  Before I knew it, I was running between 3 and 5 times a week with a minimum of 5k per run.  I started to increase my distance little by little and found that I had more endurance than I had ever realized.  I'll never be the fastest, nor will I ever be the one who goes the furthest, but I have always enjoyed competing with myself and trying to continually improve my personal best. 

I don't just compete with myself though.  It's like a special little clique - runners.  And so when I see a friend on my Facebook has just completed a run, I have to click "like" because I know what it means to have people behind you, cheering you on to go for that next run.  To see your progress and note such.  It's kept me in touch with my friends at home as we virtually run together - I might not be there but we can still be together in alternative ways.  

Running relaxes me.  Which is odd because most of my run I'm wondering when it will be over.  But without a good run, I feel out of sorts.  It's the runners high that I get when my run is done - that's what I live for.  And I need it... it's like a drug for me.  No other cardio does this the same way for me as running.  

But like most runners, I've been faced with constant injury.  Specifically my knees, arches and my lower legs.  The knees improved with new sneakers which I've learned need to be replaced more often. But my legs, my legs have been a consistent problem for the last year and it's only gotten progressively worse.  The worst part about it; I know it's self inflicted.  My trainer is constantly telling me to stop and rest for a few days or weeks but I push on... 

Why do this to myself?  I think like other things, it's an addiction.  If I felt well enough to run, then I would.  Even if my legs hurt - the pain would go away after a mile or so and I'd feel great.  On top of the world.  Until after the run.  It would only be when the pain became debilitating that I would stop and do something else, sometimes breaking for a few days, other times for a few weeks.  

But what I noticed is that the recovery time was getting longer and longer in between runs.  That more often than not I would run and I'd have some discomfort, if not pain, throughout the run.  That even walking was becoming uncomfortable.  But I would push on, because that's what I do.  And I don't give up.  And I'm uber competitive, with myself and others.  Josh would run 4 miles on a given morning, then I would also need to run at least 4 miles.  By the way, Josh is not competing with me - this is my own self made insanity that pushes me to do this.  He doesn't care if I run 1 or run 100 - it's about us staying in good physical shape.

I've seen doctors about my leg in the last year.  All in Spanish.  Which is frustrating for me because yes, I live in Spain and yes, I speak the language (well enough to function and a bit more) but I don't speak medical jargon.  I can describe what is wrong with me, how it happened and that I love to run.  But to understand what they are telling me in response is my challenge and missing just a little bit makes a big difference. 

For instance, last year I went to the walk in clinic and saw a doctor.  He started to tell me something and then kept moving his hands from my waist down to my ankle.  I swear he told me he was going to put my leg in a full cast - this is terrible!!!  Turns out... he wanted to take an x-ray from my hip down to my foot.  Yeah, I missed something in the translation there.  He told me it was tendonitis - an inflammation of the tendon that runs along my calf.  The best treatment - rest, ice and ibuprofen.

I did that.  It got better... for a little while.  But not for good.  As I said, it's been getting progressively worse.  I'd like to think that if I were in the US that I would have seen a doctor to find out why it's getting worse and not better.  But then in the US, I would need to get several referrals to see a specialist and then wait months to see said specialist.  So I can't be sure that I would have taken care of it.  But then, I hadn't done anything since last spring here so it's no one's fault but my own.

In an effort to feel better about the Boston Marathon bombings last month, I ran my longest run ever - just over 8 miles.  My first 4 kilometers (about 2 miles) were painful - almost to the point where I wanted to quit.  But my desire to run and my desire to put the pain of what happened at home behind me and to do just one little thing to show my Boston pride, won out.  And I ran.  And I ran hard.  And I ran far.  And I was stupid.  Because my leg became worse... again.

Now a year into this injury, I had an ah ha moment one day at the gym when I remembered that our insurance now has English speaking customer service.  As soon as I got home I called them up and scheduled an appointment with an English speaking orthopedist.  I was disappointed to have to wait something like 4 days for my appointment as I was actually excited about the idea of finding a solution to my problem.  

I got to the doctor on May 3rd... the first appointment of the day.  I was excited, I was nervous - what was he going to say?  I was going to be able to describe my problems in my native language - a feat that I haven't been able to do to date.  And I was going to understand what the doctor had to say in response.  Was I finally going to figure out what's wrong and how to fix it?  Could I actually think of a time where I might run without pain?  

Ahh but I got my hopes up.  Because while my insurance claimed this doctor spoke English, he actually spoke NONE.  I almost cried out of frustration.  Just another bad Spain day for me.  I understood the gist of what he was saying but he literally spent less than 5 minutes with me. I explained that I run... a lot.  And that I have pain... a lot.  And that the time between my runs has gotten longer and longer and the pain sticks around and never really goes away.  It was what he said in response that was hard for me.  I have no idea how long he told me not to run.  He felt my leg for less than 10 seconds.  He ordered up some kind of treatment and I think physical therapy  At least that was what I came out of the appointment thinking.  

He wrote both things down on prescription paper so I was able to actually read it after.  I made one appointment right away - turns out it was for therapy. I have no idea what the therapy entails, just that I have an appointment.  The other paper was for an xray of some sort which turns out to be a gamagrafia - or a bone scan.  Straight to the big stuff.  No standard x ray or MRI... a bone scan (which for those who don't know, has radiation equivalent to about 60 x rays - like I can't be around kids or pregnant women for at least 12 hours).  

But they couldn't make the appointment for the bone scan because they don't do them at that hospital.  Apparently only 3 places in Barcelona have this type of machine that can do this scan.  I called my insurance company to have them make the appointment (perk of my insurance company) but they couldn't because it wasn't one of their hospitals (insurance companies here have their own hospitals and clinics - often you are covered at other locations but they cannot schedule you for appointments at places other than their own).  Near tears, the customer service rep walked me thru it - something I normally wouldn't have needed but was just so frustrated by not being able to communicate that I couldn't take one more thing.  But I did it... I managed to make the appointment and go this Thursday for my bone scan.

So while I didn't get all the information I was hoping for, I did find out this - I have tibial periostitis.  Basically chronic shin splits.  At least that is what this doctor is now saying (with his 10 seconds of feeling my leg).  I also made an appointment for the bone scan.  I am making progress towards a solution.  And bonus, friends of mine have been seeing an orthopedist in the same hospital that I went to and have an English speaking doctor - so when I get the results of the bone scan, I will make an appointment with him to review them and come up with a plan.  So while none of this has gone smoothly, it is progress and that's more than I've had in the last year.  

It's time to find a solution - a long term solution.   Being a runner doesn't mean that you have to run marathons.  I've finally realized - I'm a runner.  Because I WANT TO RUN. 

Besos,

Julie