Marilia’s Powerlifting Blog

The following days were weird, to say the least. In Brazil, we have a pretty different health system – different from all the major models, such as the American or most European systems. Public health is a total disaster, but that is what most of the population has to count on. Besides that, there is a health insurance market, but much smaller and more diversified than the American. Only some companies offer corporate health insurance and then it is the cheap package. Those of us who can afford pay for the packages that offer a better coverage. Coverage, whatever it is, is always 100% of the cost (unlike the US). In this case, we run from companies (such as UNIMED – yes, read your name here, you parasites) who restrict both patient and physician freedom to chose where to go and what lab tests to have. These companies resemble the American system, where the physician is not allowed to request any test he or she considers necessary or prescribe any intervention.
The company I chose (Medial) is a more flexible and obviously more expensive one, where I get to choose any physician and all appointment costs (actually the least of a patient’s problems) are reimbursed up to a limit. Lab tests and interventions are 100% covered. But!… and this I learned now, when we enter the realm of the more sophisticated and expensive tests, they adopt a procedure of systematically trying to obstruct your request. That was the case with the scintigraphy. I was instructed to send the physician’s request by fax (does that still exist??), then check their receipt, and then wait 48 hours for their approval. That sounded funny – I had never handled such a bureaucratic and stupid procedure, but, ok, I really needed the test. I did what I was supposed to and one day later they called. They told me that they needed a “temporality” report. I asked the woman to explain what this was and I immediately understood that these people were trained to handle only the cheap package costumers, who see physicians from the insurance’s list and use the company’s own forms. “Temporality” is the period elapsed from the identification of symptoms related to the disorder being verified. It is supposed to be on “box 50” on a certain form that I obviously have no intention of even getting acquainted with. I called my doctor and we sent a report with this information. Following that we called and they told us we had to re-send the original request. Why in hell? Ah… they had discarded the first one. Discarded??? Although really piss**d off, I did get my poor doctor to send everything again. When I did not hear from the insurance company, I decided that that was GAME OVER for them: I sent an e-mail to all my journalist friends on the major TV channels and told the insurance company to expect the worse. In a couple of hours I received calls from their costumer director promising to investigate this “unacceptable procedure” and apologizing copiously, and another call from the approval department, not only releasing my approval code, but registering me in a special fast line approval service.
Hours and hours of phone calls and e-mails later, this part was done. I was flooded with work and work related problems. My mother had an accident and I had to take her to the hospital to get stitches. A (obviously) tropical storm produced lightening and one hit my house, burning my telephone. And a bunch of other unbelievable and unexpected little tribulations – the unproductivity gnomes were loose.
Basically, I had no time to worry over that part of the discussion at my doctor’s office that read: “you might never be able to lift again”.
When I did have a few moments with myself, that first weird Monday, during my Tai-chi practice, I had a sort of hallucination. We were meditating and focusing on our bellies. Then I felt my abdomen swell with fly worms, which started coming out from my belly-button. I opened my eyes. My tai-chi master led me to the tatami and I slept for about ten minutes. When I woke up, the worms were gone and I had a life to manage. A war to win.
So that was it: a war to win. Was I really prepared to cling to my vows of never leaving the bar and weights? To lift until I die? What was at stake here? Would I submit to surgery, chemotherapy or whatever, if necessary? Did I really believe that my mind was more powerful than anything?
Everybody else seemed to be expecting an answer from me. I feel quite guilty for having lost my patience with my mother and, replying to her constant “what ifs”, I said “then I die, ok? Everybody does! But no – I will not undergo vegetable-transforming treatment, no chemo, no surgery, forget it!”
At night, my daughter looked at me with those wide, scared eyes. Silent “what ifs”. She tried to extract promises from me. To never do this or that again. All I could say was “baby, this DX is probably wrong. Give me one or two days and I’ll show you, ok?”. She went to bed and had nightmares.
I went to bed and woke up with no recollection of whatever nightmares I had. I still had a war to win.
 

Monday, February 11, the little Padawan woke up feeling confident and ready for the big bench (as “big” as big means to a flea-lifter). Being not completely retarded, though, she looked up the lab result on the internet. The medical report was ugly on the elbow issue: ligament tears… bone commitment… and she had lifted aroung 220lbs the week before, talking away the pain (which really works for lifters! This should be studied). She decided to check with her ortho-guru if it was ok to bench heavy that afternoon (she really suspected he would advise her against it). He read the report and told her to drop by immediately, bringing the actual images with her. And, as she thought, he forbid her to lift that Monday. He knows he can never set lifting-free periods longer than six weeks for her, and that is what he negotiated, with special training strategies to accommodate her needs during recovery. 

He then proceeded to examine the shoulder images, whose report was not exactly alarming. However, the images looked scary to him. Usually calm and controlled, Fabiano, the ortho-gury, looked concerned. He told her that he could not be sure, but that the stain on the humerus head looked like an avascular necrosis (AN). If this was so, then other necrotic areas could be spread over the skeleton and she needed an urgent scintigraphy (http://en.wikipedia.org/wiki/Scintigraphy ) to clear this DX. She looked at the image: 

It meant nothing to her. 

Ok, let’s drop the tale’s third person for a while: many readers know that I am a researcher and medical information specialist. So you can well imagine that my head was spinning faster than the Intel processor on my ortho’s computer at this point. I could hardly restrain myself from diving into the keyboard and researching all about AN and T2 contrast MRI. The Padawan-lifter asked punctual questions concerning the DX’s implications and the scintigraphy’s contribution. She was not totally relaxed when it sank in that she could have developed a pretty ugly bone degeneration, that her bones could be ready to collapse and that all this could be symptoms of something even uglier. One suggestion from doctors was her previous use of short half-life androgenic steroids and another, cancer. 

She left Fabiano’s office ready for three things: dozens of phone calls to schedule her scintigraphy as fast as possible, finish a work-related report and delving whatever medical evidence she could put her hands on. No time for projections into the future. While she sat down and made phone calls and decisions, everybody else was falling apart. Family and friends were freaking out. Focus. 

Follow the next chapter on “the test”! 

As any tale, this one starts with a mundane fact. So, once upon a time, this powerlifter felt a little sore on the shoulder and sought her dear orthopedist, who promptly identified a acro-myo-clavicular injury, also known as weight-lifter’s osteolysis. That was in June 2007. He asked her to get a MRI, which she avoided as much as she could. For years she had been telling herself that she was extremely claustrophobic and could never handle the MRI tube. She had a couple of MRI’s done under sedation, which is a pain in the a** to schedule. 

So, she never got the image, treated the injury with a very short rest and not much else and kept benching. Eventually, of course, the soreness returned, which she systematically ignored. Her ortho-guru, on the other hand, insisted that this year she had to have the MRI, if only to follow the progress of the chronic degenerative injury. 

At this point, the lifter was a tai-chi and meditation practitioner (very novice and unexperienced, though) and decided that, WTF, claustrophobia was for jellyfish and nerds, and she would get the f* MRI’s as cool as a refrigerator. 

A week later, this Padawan-lifter did the most stupid ever finalization workout and succeeded in screwing her elbow, which felt more than just sore. So, the ortho-guru, with all his patience, required an extra MRI for the elbow (curiously, all on the left side). 

The zen-lifter then scheduled both MRI’s for the same day. She took her meditation CD’s with her, which was useless, since the sound system was broken. They offered her a little ear-stopper to muffle the machine noise, which is weird and sounds like some extra-terrestrial techno or rave party. 

She actually managed to meditate inside the tube during both MRI sessions because the noise is interestingly meditative. They should study that. However, the elbow was so swollen that the lab had her return the following day for two extra sessions with different contrasts. Since all her previous MRI’s were done under sedation and she didn’t really study the images, she was not familiar with MRI contrasts. 

She managed to meditate again, although this time she had to struggle against feeling the elbow pain and the numbing fingers, since the technicians accidently hyper-extended her swollen elbow. 

That was Friday, February the 8^th. She was very happy with herself, since her thesis that “claustrophobia is just a name and WTF I can handle it” had been verified. She was also confident that she would bench 242lb Monday (she is a 123lb category lifter) because she had an “insight” about technique. 

She did not lift Monday, nor the next Monday and for that matter she won’t lift until March the 18^th. Actually, Monday she learned that she might possibly never lift again and that this “never” could be quite a short period, since she may have had developed a pretty serious, possibly lethal, disease. 

Follow the next chapter on “the DX”!!! 

This is a long journey into different levels of ignorance. It starts with our basic ignorance about training details and apparently minor issues, which lead to baffling performance losses or injury. It goes on to medical ignorance concerning the athlete body – it’s physiology, morphological and functional adaptations and responses. It ends, however, on our own ignorance about dealing with permanent losses, changes in identity and, ultimately, death. 

Yes – again! But this time it isn’t the nerve: it is probably the triceps tendon. The injury itself happened about ten days ago, during a lock-out workout. I always feel a little tenderness when I start doing lock-outs. But this time it is more than that.
I don’t have my movement filmed, but I think I know what is going on: hyper-extension of the elbow joint. Either my grip is still wider than it should or it is just that I am hyper-extending the elbow for some other wrong reason. Since obviously there is no epidemiological assessment of this injury among lifters, I don’t know how it is distributed. But I strongly suspect that women benchers would be more prone to having them. First, we are more flexible and our joint softer. Second, the arm muscle volume is smaller.
In any case, I guess I know how to prevent recurrence of this very nasty problem.
I have had many sport related injuries but one thing I am pretty sure of: I learned a lot from each of them. First I had this stupid ulnar nerve injury while playing with widening the grip too wide; then I broke my leg while squatting on a slippery surface; then I almost crushed my skull under the bar while benching with insufficiently instructed assistance.
As long as they don’t turn me into a DEAD lifter, my injuries are quite useful to the community – a real experimental approach to lifting. Oh, how altruistic.