2020 – A Pain in the Butt

First the world caught on fire, then COVID-19 showed up, which led to the stock market crashing and burning. About the time it seemed like that all started to straighten itself out along came murder hornets, police brutality allegations, and nationwide protests and riots as a result of systemic racism and bigotry. What a pain in the butt! Well actually, murders hornets and such aside I don’t really think current events had anything to do with my pain in the butt.

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Like most people, we have been at home (with a few brief exceptions) since the middle of March. Fortunately, I’ve been able to continue working all this time and without pesky expenses like gas, tolls, oil changes, eating out, or virtually anything else, we’ve been saving a lot of money. One of the things I’ve saved on is race fees. There have been none. As mentioned in a prior post, most of race season 2020 has been cancelled. When not required or expected to go anywhere, some may go on living in harmonious bliss without missing a beat but I still need some sort of outlet. The gym has been closed as long as I’ve been home so my outlet has been running and cycling. Without the ever-present worry of a dead last finish, some days motivation has lacked but I possess one unique quality. Unlike most of my running and riding friends I love a sweaty, steamy summer run or ride. Lately most runs have been just that. The dew point (whatever that is) has crept higher and higher and outdoor exercise ends in a soaked, sweat fest. I’ll take this any day over winter days of having to pry a frozen hat off my head post-run.

Last week was no different. The end of the week featured two days of class so I anticipated early workouts both days. As class drew to a close on Thursday I squirmed in my seat. My butt was sore presumably from sitting all day. I finally got up and took a walk around the block before dinner. I had put in some good miles that morning and was too mentally tired to tackle a run. My sore butt told me a bike ride was a bad idea but I still assumed it was from too much sitting.

Friday morning I headed out for a few speedy miles on the river trail before class. It was a gloriously sweaty run. Back at the house I sat on the stoop to cool off like I always do. OUCH! Seriously. Why does it hurt to sit!? It was a burning, bad-blemish kind of ouch. When I said “What a pain in the butt” I meant it. Once in the shower I investigated and found a golf-ball sized hard lump on my butt cheek right where you put pressure when sitting. I wasn’t really alarmed until now. Concerned about a potentially serious problem I did what anyone would do and checked with Dr. Google. Results were mixed. The first thing the good Doctor had to suggest was some form of soft tissue sarcoma. That’s comforting.

Bumps that are cancerous are typically large, hard to the touch, and appear spontaneously. 

Dale Shepard, MD, PhD

Another seemingly likely candidate was guinea worms. I’d first heard about guinea worms in a class last year. We had an exercise about the best way to handle a crisis involving guinea worms in a small African village. It seems they are a parasitic worm that live in warm, fresh water lakes and enter the human body through any open cut or sore. The larvae grow, and upon reaching maturity exit the host’s body anywhere potentially causing great damage or death. Prior to exiting they form a painful lump. With impeccable timing, the class exercise about the worms occurred just before I headed off to the local warm fresh water lake for an open water swim. But given that guinea worms are native to a small part of Africa and since I am from Pennsylvania and I haven’t been swimming in so long I’ll probably drown in the bathtub, chances are it wasn’t guinea worm. But still . . . ewwww!

Now I had it down to boil, cyst, or abscess all involving some sort of infection. I stopped reading when I got to MRSA and decided to try some warm compresses throughout the day and see if that improved things. I had also planned to slip back into denial and pretend I hadn’t noticed it but denial is hard when there is the ever-present sensation of sitting on a lit match.

At least one day of most summer weekends are set aside for a long bike ride. When I woke up on Saturday, the very idea of sitting on a bike seat . . . shudder. But walking and running felt fine so off to the river trail it was. The run was so good I started letting myself slip back to denial. Maybe it’s better and I don’t have to do anything. I hopped in the shower to wash off the sweat and checked things out. Not only was it still there, but it had gotten bigger and more painful. Yikes! In an unlikely turn of events, ignoring the problem didn’t appear to be the correct solution.

The next reasonable course of action was to bug my medical friends on social media. ‘Cause it wasn’t like they were trying to have a weekend or anything. And it isn’t like all their other friends and family are bugging them all the time for medical advice. Seriously though, I have awesome friends. You know who you are and I thank you for your advice. I knew I needed to do something I just didn’t know if I could wait until Monday to see my normal doctor (who I’d just seen days ago for a wellness visit) or if I should take a trip to urgent care. I poked a couple different folks hoping for an answer I liked but ultimately all said the same: “Go to urgent care”.

For urgent care I prefer Patient First. I’ve used them a time or two before. Once for the worst back pain I’ve ever encountered and once for some other odd infection probably due to spending too much time in sweaty clothes. Each time they did stellar work to help me right the ship. I wonder if they sponsor triathletes?

Thus I found myself in the waiting room at Patient First Wyomissing along with a dozen or so other mask-clad patients. This was the first time I noticed that their chairs aren’t the softest. Still, it wasn’t a terribly long wait before I was taken back to a room. The nurse did a quick vitals check, along with the requisite COVID-19 survey, provided me one of those awesome examination gowns and then left me to wait for the doctor. Happily, it wasn’t a long wait. Irene Sileski (PA-C) entered the exam room and introduced herself. We talked over the situation and she quickly determined the offending lump was an abscess. I decided it was best not to influence the diagnosis so kept the guinea worm theory to myself. The treatment for an abscess is straightforward: Pierce that sucker and squeeze out all the bad. “By the way, it’s going to be a bit painful.” Good to know.

I’m not going to compare myself to the mothers out there who have suffered through childbirth but I will say Irene and the nurse both thought I must have a high tolerance for pain and wished all their patients were like me. I explained that I was a runner and triathlete and was used to some degree of self-torture. Truthfully, the initial shot of lidocaine or whatever numbing agent they used really burned but it was short lived. After that, I really didn’t feel much. I can only imagine how much “fun” the procedure would have been without the drug.

Irene did explain that it was good to come in early and not wait. Apparently there was a lot of infectious material, or in layman’s terms, icky stuff in the abscess. Apparently even waiting just a day or two too long can lead to life-threatening sepsis (also a non-Google . . trust me) and much more serious consequences. I sort of knew the answer but but asked anyway “I know riding a bike is out, but can I run?”. NO! “Just take it easy for a couple days.”

Ultimately, I left Patient First with a new hole in my butt cheek packed with gauze (or something), a bandage taped over it, and a prescription for an antibiotic. Instructions were to return to Patient First or my primary cary provider in two days to get the packing removed and re-examined. Meanwhile, the Patient First labs would perform a culture to verify the nature of the infection and results would determine if any further action had to be taken.

The first thing I noticed when I got in the car to drive home was immediate relief. Granted I think my butt was still a little numb from the local anesthesia but clearly the giant lump was no more. As the lidocaine wore off, there was a small amount of tingling and burning but I don’t think the butt cheeks are exactly a nerve center. Still, relief was immense.

Fast forward to Monday: Rather than return to the good-but-random care of Patient First I decided I’d rather followup with my primary care provider. I called the office early and learned Dr. Strohl was not in the office on Mondays but they could get me in with one of the other Docs. Fine with me. All the doctors and PAs at the office are capable and good providers and I felt good about them being able to talk directly to Dr. Strohl just in case further followup was needed.

Here is an idea for all you entrepreneurial types out there. How come after all this time, nobody has invented a better examination gown? This thought occurred to me while sitting in said gown waiting for the doctor. The particular model I was sporting had a very feminine, blue pattern with little colored flecks throughout, and the familiar opening up the back with a couple gratuitous ties that the patient can’t reach to tie and don’t really do much. I think the main requirement specified for these gowns was “Make sure the patient feels really humiliated”. Given the reason for my visit, in this particular application the gown was well suited. But you get the same gown if needing to disrobe for any part of the body. The thing covers the patient from neck to knees in so access to the front of the body can only be gained with almost complete disrobing but thank goodness we put that gown on. Maybe they could at least invest in some masculine colors or patterns for men. Perhaps camouflage or little fishing or hunting scenes. We are building electric cars and 5G data networks. Certainly with all that great science and engineering at our disposal someone could find the time to craft a better solution.

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Shortly after donning my pretty blue gown there was a knock on the door and Dr. Jillian Ventuzelo entered. We reviewed the problem and procedures to date and got down to business. Dr. Ventuzelo removed the packing, washed the wound with sterile water and determined that it looked pretty good. There was no sign of continued infection and, other than still being a little red, appeared to be healing. “Stay on the antibiotics and let us know if you have any new symptoms. It should heal from the inside out.” Again the big question. What about Swim, Bike, Run? “Not until it heals completely”. I had sort of braced myself for this answer but it still sounded a little like a death sentence. We camp in Lancaster County over July 4th and I look forward to riding among the Amish and sharing a bowl of ice cream with the cats at the dairy. Not to mention that 10 days (or more) of no running or riding equals several pounds of added weight courtesy of my awesome metabolism. Sawdust and water it is then. Oh well. First world problems as they say and I’ve been injury free for 20+ months at this point. That isn’t too shabby for a 54 year old athlete. At least I don’t have to worry about losing training for any upcoming races. I suppose 2020 is a good year to be injured or have weird medical problems.