Marilia’s Powerlifting Blog

For some reason I am sure will never be understood, I developed a horrible pain in the ear during the hours I spent at the lab. I even asked the doctor if there was any possibility that I might be having a weird allergic reaction to the contrast fluid. He said no. You iron brothers well know how low our pain sensibility is – we just don’t feel pain. But – wow – that was some ear ache. Besides, I was tired. It was a stressful week. So I allowed myself one tylox and some ear drops and went to bed quite early.
Saturday, February 16^th, I woke up at 6:30AM and went to my tai-chi practice. I knew I wouldn’t hallucinate on dead body worms that day. I felt good and relaxed (a little deaf, though, which took about a week to go away). From there I went to my dermatologist for my skin treatment session and then downtown to have lunch with a friend. The friend is a biochemist and we chatted about my case over a couple of beers. I was in a very good mood.
I planned to get home and check the medical report on the net. As I logged in, I was notified that it was not available: I had to pick up both the image and the report at the facility. Something clicked inside me. The little “doubt devil” woke up with its “what if’s”. I decided to leave immediately and pick up the result. That was about 2:30PM – the lab closes at 6PM.
My daughter was around and asked me to go along. She wanted a ride to the subway station and she wanted to see the result with me. We had some stupid argument on the way and I just left her at the station.
“Why are you stopping here? Weren’t we picking up the result?” she asked
“I want to be alone. I’d rather read that stuff by myself”
She looked at me anxiously. She apologized for the argument and made me promise to call her with the result. I did and left. I turned off my cell phone to avoid the many calls from friends.
The subway station is close to the lab facility, but it took me hours (not true: 25 minutes at the most) to get there. I made all sorts of stupid mistakes and took wrong turns, until finally I got there. The building was almost empty. Just a couple of workers and myself. I handed one of them my ticket and he gave me a small, white envelope.
I felt hot, specially on the throat and eyes.
I asked the worker if that was all. I think I was disappointed with the size of the envelope.
I also asked for the CD and there was none.
When I had no more questions left to ask, I faced the envelope, sat down at a small table and opened it. Tough as I think I am, I have to admit my heart frequency increased. And there it was:

(if you can’t see the picture, click at http://www.bodystuff.org/cintilografiafev2008.jpg

The report expressed the physician’s perplexity. There were hot spots all over, osteogenic activity in all joints plus some “weird” extra locations, all of which make sense to a powerlifter: they are the sites of tension incidence during the lifts.
No cold spots – no AN. Just more and more medical puzzles, but I just looked at the image and smiled. I knew what those hot spots meant.
I breathed deeply and felt a sudden head-ache. I turned on my cell phone to keep Mel (my daughter) my promise. There were three calls from her. The girl was freaking out. I told her the news and went home, straight to bed.
 

The following days were an attempt to make sense of the only evidence I had: a series of hard-do-interpret MRI images. I began by collecting publications about AN in general, AN and steroid use, AN and athletes and concluded that if that was actually what I had developed, then it was both idiopathic (with no evident cause) and asymptomatic (since I felt no pain). I searched AN MRI images wherever I could. Most were hips and femur head images. I found no shoulder AN image on the net. However, all AN MRI images I found were quite different from what I saw in my own shoulder image.
Next I decided to understand T2 contrast MRI imaging. I read something about the technique and started collecting images. I found one specific shoulder image that called my attention: http://www.mr-tip.com/serv1.php?type=img&img=Shoulder%20Sagittal%20T2%20FatSat%20FRFSE
On this image, the dark area was lighter than mine and the bone cortex thinner, but the overall pattern did not look much different. Fabiano had mentioned that strength athletes’ bone cortex was supposed to be thicker. It occurred to me that maybe the darker area on my MRI would be an analogous adaptation to function that could result in an increased absorption of contrast. Thus, a darker medular area.
I remembered that the previous week I had played with 200lb benching. If that dark area was an AN, then it was enormous and my humerus head would have collapsed under the weight.
I showed all this both to Fabiano (Rebouças), my orthopedist, and César (Fernandes), my obgyn. I trust very few physicians, especially concerning their lack of flexibility concerning the concept of “normality” and its application to clinics. For some reason, present medical education fails to get students to understand that “normality” is a statistical concept, not a physiological reality. That is why they must stay technically updated on advances in their field and use information as a tool to understand individual situations where billions of variables create uniqueness – not “normality”. Fabiano and Cesar are exceptions to this rule: they are both knowledgeable and critical.
Both tended to agree that we were looking at something on the line I was arguing, but Fabiano felt he needed to discuss this with other colleagues. We still had the scintigraphy to help clearing the case.
Friday, February 15, I checked in Delboni’s Sumaré unit. Delboni is a huge clinical laboratory facility in Brazil with many units scattered over the country. I have a special VIP treatment there because of my sports records, which is really cool: considering you must spend hours with nothing to do, having some nice treats makes all the difference. We get internet access, a nice living-room and (the best part) very nice snacks. If your tests do not require fasting, then you can spend the whole time eating and drinking, if you want (ok, you can disregard this comment, but I am permanently hungry and this is a salient feature for me).
Scintigraphy consists of the intra-venous administration of a radioisotope indicator which binds to bone tissue. The images recorded in different times reflect bone physiological activity. Images are recorded at zero time, five minutes and two hours.
I know I am good at what I do (retrive technical information) and I was confident that I was right concerning the MRI image interpretation. But “confident” is one thing, “certain” is quite another.
I must admit I was anxious to see the result, which would be ready the following day.
Don’t miss the next chapter on “the envelope”!