The Cortisone Cowboy

Sometimes it takes reaching a low point to try a different tactic. The Twin Cities marathon was such a catalyst; not finishing the race due to ongoing rib pain and the continued pain in the days afterward spurred me into action. Last year I underwent a series of cortisone injections with minimal success. I decided, though, to visit my good friend the Cortisone Cowboy (the physical medicine doctor who administered the injections last year) and try another series of injections. I had nothing to lose and potentially a lot to gain.

The first order of business was to try and diagnose a particular area of swelling on top of and below my 12th rib that has been hanging around for 18 months. Due to the protruding nature of this malady and its unknown make-up, I affectionately call it “the alien”. The Cortisone Cowboy did a diagnostic ultrasound of the alien and while the ultrasound did not reveal anything conclusive, he deemed it a pocket of swelling and scar tissue.

The next order of business was to determine where the injections would be most beneficial. Last year the Cortisone Cowboy injected the intercostals at ribs 9 and 10, so this time he decided to inject the intercostals at ribs 11 and 12 as well as the most sensitive spot in the alien.

The injections are comprised of lidocaine, a numbing agent, and cortisone, an anti-inflammatory. The lidocaine is short acting, 8 hours max, while the cortisone is long acting and can work for weeks. If you inject the proper location, the relief from the lidocaine can be revolutionary, and for me, this was the case. I had a lidocaine buzz for the rest of the day -- the reduction in pain was a magnificent feeling that made me giddy. This also confirmed that the issue was stemming from these two ribs. It was huge bummer when the lidocaine wore off.

The cortisone has reduced some swelling allowing for more aggressive and much deeper soft tissue work. An entrapped nerve has been identified behind the 12th rib, presumably the root of all evil. It is hard work trying to free this nerve, but so far the results have been encouraging in terms of pain reduction, easier breathing, and feeling stronger on my right side.

In the meantime I have spoken with two surgeons who are not only familiar with this injury but have performed surgery to help correct some of the problems caused by the injury. Mainly, the ribs are shaved several inches so when they move they do not rub the nerve. The intrinsic problem, the hypermobility, is not actually repaired. Thus, there could still be potential soft tissue problems in the long run. I also had a conversation with a woman who recently underwent surgery for this injury. Her post-operative recovery has been incredibly slow and not without its pitfalls. She couldn’t get out of bed for two weeks and after six weeks she was just beginning to walk. Yes, she scared me a little.

I have decided to hold off on surgery for the time being. I want to allow time for the cortisone to kick in even further. As well, I want to address the soft tissue and nerve issues since they need to be resolved regardless of whether I have surgery. I have also stepped up my gym work from 3 days a week to 5 days a week in an effort to rebuild muscle that has atrophied from the nerve impingement.

That leaves me in a bit of a limbo. Will I be able to run another marathon? I am realistically optimistic. Only time will tell.