Surgery for compression-side femoral neck sfx? (Read 84 times)

Hey guys... haven't been here for awhile.  Basically the last 18 months have been an unending cycle of injuries, despite careful and minimal training.  I got a femoral sfx in July 2013, then fractured the femoral neck the following March.  Took 4 months off running and came back, and had just built up to a 10-mile long run and some speedwork last November (2014) when the femoral neck rebroke.  Maybe it had never healed.

During the first break, I did pool running and swimming only. This time I only did swimming and recently began bike and PT.  I tried the elliptical a few times in December, but stopped when it hurt. All of this was with my doctor's permission.  I have also been doing PT and that may have been overly aggressive; the first doctor I saw encouraged me to go saying that the pain I still felt was likely due to muscular weakness.  Turns out it was not, so I'm concerned the PT just made the stress fracture worse, but I was following doctor's orders and thought I was doing the right thing.

Anyway, I recently got a followup MRI and my femoral neck is not yet healed; it looks the same on the MRI as it did in December.

I've gotten a load of blood tests and am seeing Dr. Marci Goolsby (look her up--very experienced with female sfx).  I have diagnosed hypothyroidism, which may be diet-related (eating insufficient carbs in the past, don't anymore), but I treated it with levothyroxine and levels are normal.  I don't yet know if I have any other deficiencies.  I was anorexic in my early/mid teens and then restricted and dropped weight again in my early 20s.  So she says that may play a part, even though my weight and diet have been good for the past year at least--I started to see an RD after my first stress fracture and adjusted my diet.  My weight and body fat are fine now and have been for awhile.

Anyway, for some reason the stress fracture's not healing and I have a couple of options.  One is the drug Forteo. Another is surgery to pin the bone, even though I understand that is rare for a compression-side fracture.

Has anyone had experience with either of these?  Especially curious if anyone has a similar history to me.  I'm very frustrated.

Hi Scap,

I don't have any insight into femoral fx and surgery, but I too was anorexic, and in my experience, your body takes WAAAY longer to bounce back from calorie restriction and what is essentially severe malnutrition than the initial period of restriction.  For perspective, here's my timeline:

2000 - minor "dieting" resulting in 10lb loss

2001 - became disordered eating and pretty serious restriction.  Went from 120ish (?) to 98lbs.  Period of disordered eating/eating disorder/restriction lasted less than 12 months.  I then realized I wanted to run track and kinda got my shit together, but still had disordered eating.

2002 - back to a healthy weight, ran well spring of my junior year (5:17 mile) and XC of senior year (11th at states), but then trained late into fall for Nike/Footlocker regionals and got a sfx in my shin, forget which bone.  No doubt the previous year's severe malnutrition and the continued disordered eating contributed.  I may have been getting enough calories, on paper, but not enough nutrients to build back up the tissue (bone) that I was pounding on a daily basis.

2003 - freshman year running for cornell, started the season with a suspected sfx, couple weeks off, never got into the groove of training and didn't do much.  continued some restriction in the form of avoiding certain foods and minor binges when my resolve weakened.  Was in the habit of trying to use diet sodas and low fat or sugar free snacks (lower cals) to satisfy my sweet tooth.  Backfired.  Ended up gaining weight but with that slightly unhealthy, "soft" look.

2004 - more of the same, enough calories, but still a bit fixated and stressed out about gaining weight, another suspected sfx in the spring.

2005 - quit the team, mostly because of an abusive relationship that made me feel like shit.

2006 - finally started to let go of the need to control food, started running around Ithaca for fun, and actually enjoying what my body could do.

2007-2009 - running for myself became a nice routine, almost completely let go of my food exclusions, but was still particular about trying to control extra oil, cheese, etc.

2009-present - really just stopped giving a shit about what I ate, it was too much time, effort, focus and misery to always be worrying about burning enough calories or feeling like I ate too much in the morning and had to watch what I ate the rest of the day.  Meeting my husband really helped; we cook and eat the same stuff, so no more trying to cook with minimal olive oil, or going light on the cheese.  I just eat real food and enjoy every second of it.  I would say it wasn't until this time that I was completely free of my anorexia.  And now I have been the same weight for the past 5 years.  Was 125+ when I met him, now range between 112-120 depending on season and training.  A legitimate concern I now have is being too light, because I know I don't perform well under 115.  And I STILL look chunkier than most girls on the start line, but this is what works for me.  And I've progressed from 19:00 5k to 17:10 over this time.

So the moral of my story is that your anorexia, whether you believe it to be in the past or not, is still very likely contributing to your health woes.  I was cleared to run in 2002, but it wasn't until 2005 that I was injury free, and then not until 2009 was I able to train hard and see results, baring one more sfx in my metatarsal (correlates to switching to soft, neutral shoes).  You dug yourself into a hole and it will take a long time to get out, but it's up to you to do it.  I realized that anorexia was my fault.  I let myself slip over that edge into an eating disorder; yes, at some points it was a disease and felt very much like an addiction, but ultimately it was up to me to cut the crap and get back to normal.  Now that I am, it feels wonderful. With your history, you may still be in a calorie deficit - a year of good eating may not be good enough - and working out while trying to heal is severely retarding the process.  The timeline you describe is much slower than what one would expect of a healthy person and don't jump to the possibility of surgery before you are sure your diet is not a contributing cause.  Of course, I don't know what your cross training routine has been like, but more time off, totally off, may be necessary.  And a bone scan is a good idea, given your multiple bouts of restricting, so see what your baseline density is.  Just my $0.02; I've been through that cycle and it sucked, so I want to help others avoid it.

Hey guys... haven't been here for awhile.  Basically the last 18 months have been an unending cycle of injuries, despite careful and minimal training.  I got a femoral sfx in July 2013, then fractured the femoral neck the following March.  Took 4 months off running and came back, and had just built up to a 10-mile long run and some speedwork last November (2014) when the femoral neck rebroke.  Maybe it had never healed.

 

During the first break, I did pool running and swimming only. This time I only did swimming and recently began bike and PT.  I tried the elliptical a few times in December, but stopped when it hurt. All of this was with my doctor's permission.  I have also been doing PT and that may have been overly aggressive; the first doctor I saw encouraged me to go saying that the pain I still felt was likely due to muscular weakness.  Turns out it was not, so I'm concerned the PT just made the stress fracture worse, but I was following doctor's orders and thought I was doing the right thing.

 

Anyway, I recently got a followup MRI and my femoral neck is not yet healed; it looks the same on the MRI as it did in December.

 

I've gotten a load of blood tests and am seeing Dr. Marci Goolsby (look her up--very experienced with female sfx).  I have diagnosed hypothyroidism, which may be diet-related (eating insufficient carbs in the past, don't anymore), but I treated it with levothyroxine and levels are normal.  I don't yet know if I have any other deficiencies.  I was anorexic in my early/mid teens and then restricted and dropped weight again in my early 20s.  So she says that may play a part, even though my weight and diet have been good for the past year at least--I started to see an RD after my first stress fracture and adjusted my diet.  My weight and body fat are fine now and have been for awhile.

 

Anyway, for some reason the stress fracture's not healing and I have a couple of options.  One is the drug Forteo. Another is surgery to pin the bone, even though I understand that is rare for a compression-side fracture.

 

Has anyone had experience with either of these?  Especially curious if anyone has a similar history to me.  I'm very frustrated.

I see these on occasion. Ask her to prescribe an Exogen ultrasound bone stimulator for you - way more effective than Forteo. www.exogen.com  What is your Vit D level? You may need more.  I see athletes all the time with stress fractures. The sports doc tests their Vit d level and it is usually low. There is a correlation. I recommend getting it tested ASAP. If low, get on 10,000 IU a day for a while. You want your blood level above 50. If she is experienced, both of these topics should have come up.

Hey scappodaqui. Sorry to hear you're still dealing with this. So frustrating. Your question was specifically about bones, but as Kilkee already touched on, I wonder if your mindset toward food and exercise isn't playing a role in the slow healing of your fracture. Not just in terms of calorie restriction and resultant nutritional deficiencies; what about the role of stress and cortisol in healing? Because the whole restricting/stressing about calories/forcing yourself to eat even though you think you don't deserve it...isn't that stressful and anxiety producing? Even if you're technically getting exactly the right nutrients and calories at every meal? And exercising while injured: were you, for instance, doing the leisurely old lady head-above-water breaststroke for 20 minutes and calling it good, or were you ferociously swimming the f*** out of those laps for at least an hour a day, five days a week? I would be doing the latter, in your situation, so no judgment here, just a question...if the latter, perhaps it was counterproductive even if non weight bearing...same with the elliptical and whatever other cross training.

Maybe it's time to step back from the exercise and really have a chat with your body about what it needs. Your head really, really wants your body to exercise hard but it seems like your body is telling you that what you've been doing isn't sustainable. People get "out of shape" and back in shape all the time (just ask any female runner who had a baby) and a layoff from hard exercise, scary as it sounds, may be more productive in the long run than doing the same thing over and over again re: injury/hard cross training/reinjury.  Bone stimulation and forteo sound like amazing options, but unless done in conjunction with a period of relaxation and learning to be kind to yourself, I'd be afraid that all that time and money investment wouldn't lead to long term running health.

...all this for whatever it's worth from a random internet stranger I'm not a doctor or in any way medically trained, but I do have 38 years of experience with anxiety, food issues, and generally being my own worst enemy to draw on! Wishing you tons of luck as you sort this out.

Perhaps simply the intensity is hampering recovery?  

 

Yes.  You are burning calories that your body could otherwise use to heal.  With your history, you probably still are motoring along with a calorie and nutrient deficit.  Be careful not to get hung up on forteo as a solution while your diet and behaviours are still not great.  I admittedly don't know all the details of your diet and training, but I think it's safe to guess that they are still contributing to your bone woes.  Had you not had any experience with restricting, over training, etc, then maybe you just unfortunately have freakishly strange bones and healing patterns, but I don't think this is the case.  Hope things improve quickly and you find a good, healthy balance.  Less really can be more

Scapp

 

What is your Vit D blood level?

56 ng/ml!  It's apparently really high.  HA.  Like I said, I do take 1000 iu a day (plus I think a little more with my daily calcium supp).  So that's not the culprit.  In fact, everything in my blood work is perfect (thyroid only because I take levothyroxine, but still).  The only very slight abnormality is creatinine (BUN/creatinine ratio is fine, but creatinine itself is 1.01-1.02, which is .... .01ish above normal? I doubt it's worth worry).

The only thing is that I have, and I know it, been eating at a slight deficit.  For about 8-10 weeks now, have lost maybe 3-5 lbs.  I guess that's bad.  I'm talking to my nutritionist today since she'd said it was OK (I really am above my happy body fat levels but obviously the timing for losing fat is poor; I started when I thought I was basically healed).  Sooo kilkee may have a point there.  But it's tough--I feel like part of the reason I GOT the sfx is because I weighed more than I used to when running.  That's crazy, right?  It's not like I'm overweight.  But perhaps my bones weren't used to some extra pounds.

It is also hard for me to scale back on swimming since I'm improving very rapidly. I swam 500 yards in 7:28 today, which I consider fairly good, given that I didn't know how to swim at all 2 1/2 years ago.

Ha, I'm not trying to sound harsh, but I remember what it was like to lie to myself about my habits, even when deep down I knew I wasn't helping my situation, so I'm just trying to cut to the chase and be blunt.  All I can really offer is the assurance that letting go of obsessive habits (be it restricting calories, overly-picky tastes, avoiding entire food groups, needing to work out hard all the time...etc) WILL benefit you physically and mentally in the long run (no pun intended).

I think basically kilkee is right here, and thanks for sharing your experiences.  I hope I can get to where you are.  Just so you know, I see a GREAT dietitian every week and as of this week she has had me increase my calorie intake, which frankly comes as a relief... I've been pretty hungry and tired.  The good part is I don't really restrict any food groups--I eat protein, fat, carbs, meat, bread, white bread, pizza, whatever.  My thing is I just stick too tightly to calorie limits instead of listening to my hunger.

Tchuck, fyi, as I mentioned above, I DON'T live down south. I live in New York City.  I walk a lot outside, though.  But I'm also surprised by my D levels, especially since I have Sicilian heritage and am quite dark-skinned.

Also, in terms of my diet, I think I'm good on K2, as I regularly eat grass-fed butter and meats, along with a lot of vegetables.  I take a magnesium supplement daily along with my calcium and vitamin D. I'm pretty up on the research on all this, I think.  I've also been doing a LOT of reading on stress fracture etiology, and it's so interesting how many causes there can be.  So many people are getting them, it's crazy!  I have many running friends (frankly almost all) who've suffered--most of them serious competitors, but not all.

In my case I'm pretty sure it was an intensity thing, not volume. Camille Herron would support this, I think.  The thing is, I'm a decent sprinter (not to brag) and so when I run, I throw in sprints far too often and go too hard, though Ialso think long runs tax my body far more than they apparently should.  I guess I'll revisit training plan issues far in the future, when/if I can run again.  Frankly, I'm quite afraid to run again, even thinking about it; I can't go through another injury like this, but I don't trust myself not to go hard.