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Wednesday, September 25, 2019

Chronic Pain Changed the Way I Think About Sufferfests

This spring, a friend half my age moved to my adopted state of Colorado and asked if we could meet for a hike. Seeing her Instagram posts about postholing for eight miles to glaciers and climbing trees during geocache scrambles, I had to bow out. “Maybe we could meet for coffee,” I wrote. Half my lifetime ago, an eight-mile hike wasn’t a daunting goal, it was more like a warm-up. Today that distance is unthinkable.

In April, a few weeks after my friend texted, I visited a spine clinic, peering at an X-ray after a sudden onset of severe lower-back pain. No position brought relief from the searing agony, and it took a few days of steroids and crying and panting as if in labor for it to finally go away. The physician assistant ticked off a list of things she saw on the X-ray: arthritis at the base of both sacroiliac joints, a difference in leg lengths—one hip is higher than the other—and enough curvature of the spine to earn a scoliosis diagnosis.

“I wouldn’t worry about that one,” she said.

“Done,” I said, grasping at optimism.

Next she pointed at what looked like blocks from Minecraft—my vertebrae. She explained that the thick dark rectangles between them were the cartilage between my spinal discs, which cushion each vertebra against wear and tear. “Pretty cool,” I said. Traveling down my spine, the rectangles became lines drawn with a thin Sharpie—disc compression was happening there. Not cool, I thought, my sense of wonder collapsing like a faulty camp chair. She said an MRI would offer more answers.

A couple of weeks later, I sat in the parking lot of the imaging center and eagerly unfolded the report enclosed with the MRI disk. Both sides of the page were covered in single-spaced type, with words like synovial and stenosis. I did recognize one term: degenerative. Apparently, the internal map of my midlife body reads like a craggy ridge of compensatory pain, dotted with an unfortunate mix of congenital abnormalities and multiple prior injuries.

Pain had already been my copilot for many years, after a catastrophic ankle injury left me with bone-on-bone arthritis. I’d reluctantly given up running a few years ago but managed to keep hiking, cycling, and snowshoeing. Even then, due to my badly damaged ankle, the distances I could cover without grinding pain shortened year by year. I gradually lost the deep peace imparted by hours of repetitive stress in the sunshine. Well-meaning suggestions that I take up swimming at a local gym were uniformly met with feral growls; I needed to be outside. The possibility of even more chronic issues felt suffocating.

I texted my friend, my phone screen blurring through tears, to tell her about the MRI results. She reminded me that no matter what happened, I would figure out how to thrive, because that’s simply what we do. I took comfort in that and drove home, wishing I could do what I used to as a coping mechanism—run and run and run until I couldn’t anymore.

“It’s easy for people to fetishize discomfort—the good pain of hard work outdoors—when they don’t live with the chronic suffering and discouragement that comes from having a sick body,” Outside’s Blair Braverman once wrote in her Tough Love column. Even if you don’t buy into our cultural obsession with youth, it’s easy enough to assume that if you stay active, good health will persist even as you age. This calculated optimism makes it tough to go from effortlessly strong and healthy to settling for the crumbs of endurance that chronic pain allows you on any given day. I wasn’t sure how I could manage this decline in such a big part of my identity—hiking with the ghost of the adventurer I once was.

The orthopedic spine specialist I consulted a couple of weeks later about my newly diagnosed degenerative disc disease was much more sanguine about my situation than I expected. While there’s evidence that genetics play a role in disc degeneration, some scientists theorize that humans screwed up royally by becoming bipedal, and one downside to that evolutionary offshoot is that about a third of people have some form of spinal disc degeneration by midlife. The surgeon said that about half of his patients with this condition are in pain all the time. The other half are like me—oblivious to their crumbling infrastructure until they have a severe pain episode like I did. While I felt lucky that the excruciating back pain I’d experienced a few weeks earlier went away, it seemed there was no way to predict whether it might happen again. 

Instead of ordering more tests or treatments or forecasting gloom and doom about my hopes for continued mobility, the surgeon’s recommendation was simple: “Strengthen your abs, and go on with your life,” he said. Good life advice in general. I asked him what would happen if the pain in my back returned, and he said we’d address it if and when it did.

I took his advice and have made friends with my yoga mat again. But on every hike, I still wonder if my spine holds another ticking time bomb of agony, ready to explode at random. And while I do now have some residual nerve pain in one leg, the back pain hasn’t returned.

Pain forced me to rethink my own obsession with metrics and the drive to suffer in service of one-upping myself. It’s been frustrating to recalibrate my expectations, but slowing down and doing less gave me the unexpected gift of learning to be fully present in the wild places I love so much. Hiking shorter trails I used to dismiss as a waste of time, my senses can more fully open up to my surroundings. A patch of moss here, an unfamiliar birdcall there, the spring of loamy earth under a body still able to move under its own power. 

from Outside Magazine: All

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