Following from Part 1, here is what I have been experiencing. The sudden pains surrounding my left flank, for months October onwards.
It all began when I finished an Extended fasting 40+ hours mid October. Feature meal as PWO (post workout) and breaking the fast ~ pasta meal with tomato paste. Something I haven't had for quite some time.
All of a sudden things slowly turn south. A day or two after I felt radiating, nagging pains, notably on left side of middle quadrant.
First week was mild. But fast forward next two month(s) - quite debilitating that even made walking short distances difficult without short burst of spasms or jolts of pain resembling a disc slip (post trauma / training injury). But here's the strange thing ~ it came out of nowhere. There was no "injury" nor impact trauma per-se.
Yet a day or two after that feature meal, the pains emerged. Out of the blue.
Given my long term condition (AS) ~ I am very well aware of the overall pain distinction. Much less (thankfully) of a "freezing" jolt of shock through the entire spine. However, even though I \remain tense, almost constantly on a daily basis to anticipate its pain whenever I laterally-flex (eg. bending at the hips laterally, pressing on the obliques) .
What I did was the following, from most to least obvious. Immediately upon the first few days of notice:
Within as little as five days I felt relief and even training sessions went unaffected. However came next week, even while maintaining all the above ~ the pain returned. And things got progressively worse.
Sleeping became painful as even a minor torso rotation, back and forth ~ triggered the same burst jolt of pain on the flank. This soon became a daily thing.
I managed to secure both Ultrasound, CT (and later on - MRI) scans about one and quarter month of this pain. And what “they”, the contracted GPs of Updoc® had to say left me feeling mixed.
Ultrasound did not come up with anything unusual. Likewise with the CT scan.
On one hand it is half comforting to hear that my case is not that of typical renal stones. Apparently, the pain should be so overwhelming ~ I’d be immobilized. I suspect it'd be to the level of Dr Eric Berg’s experience - rounds of tylenols, and hours of lying flat on the ground.
There are however interesting cues for me to look up and learn. Though be forewarned ~ these are just for my own speculative insight.
Arguably one of the worst "spending" one ever has to spend during Christmas (next to car breakdowns, or emergency plumbing repairs) is more unwanted health expense.
In my case, by about second month through (being patient with the flank pain) I've already wasted $150 just jumping through hoops in the Updoc® telehealth platform. Just trying to understanding what this flank pain is. The very first and arguably most important step about learning is to identify. EVEN IF WE CANNOT explain it, at the very least, identifying the "what" ~ what type or kind (of pain) is key.
Mine, to this day is still what many would call idiopathic. Meaning ~ we don't know. At least not yet.
So there is one more thing left in my list. My lumbar spine. Considering it was over ten (well technically eleven) years ago since my last MRI then diagnosis on AS, in 2014.
So how did it go after an extra $350 lavish spending? The (next available contracted GP on Updoc) did the usual assurance two weeks later ~ "Everything's normal".
I let you all decide and decipher the results below.
The only next step, according to their opinion ~ was to simply consider physiotherapy.
I clearly stated to them ("everyone"), Doctor(s) x,y,z ~ that this WAS NOT an injury nor muscle "strain". If it were, I'would have known exactly what, where and how it manifests. But my case - it came out of nowhere.
The spasm and mini jolt(s) of pain meanwhile, remains frequent enough I can't ignore it. Even sneezing - is something I had to be very conscious. Likewise even going to sleep ~ brought me some anxiety.
These level of tension never occcured before in my life. Sure, I've gone through L4/5/S1 disc injuries in the past. But confide in comfort knowing and identified what led to it.
This on the other hand, is something else altogether. So many occasions I'm convinced it's nerve impeachment. After all something is pressured somewhere in there. Other times, I still think it's oxalate related. Reintroducing peanut butters and sadly, even gelatin powders for instance, seem to trigger these overall tension.
However few optimism left for me at the very least, I only have questions as the only trail.
Recalling basic theory - the body does generate its own oxalate through Glyoxalate pathway. As protein utilisation and oxidation proceeds, particularly from this specific amino acid hydroxypoline ~ it becomes prone to glycation, if it also happens to interact with another (suspect / culprit) ~ Ascorbic Acid or simply Vitamin C. Glyoxalate is then produced as the end product, then becomes direct precursor to the oxalate crystalization (upon which as it implies) ~ oxalate "crystalizes" by urinary supersaturation (fancy word for dehydration).
There is however mystery in all this. Enter "dumping". This is where the symptoms typically associated with toxicity, immediately becomes apparent soon after 100% elimination of dietary oxalates. Back pain, depression / brain fogs and overall general / unexpected malaise.
Understanding how or why the “dumping” happens, is still a confusing part in all of this.
There are those who believe the dumping symptoms appear greater in those who exclude all oxalate intakes too fast, versus those who gradually slows them. As to how and why this occur is not known (at least to me).
Retrospecting my prior years (on/off dietary oxalate intakes in short periods of time) ~ I can definitely re-create classic symptoms typically associated with oxalate-sensitivity. Occasional lower back (nagging) pains ~ that usually resolves within a day or two of dietary exclusions.
Then there is another thing in my list of suspect(s). "Mast cell activation syndrome". My early understanding suggests it is something to do with over accumulation of white blood cells that have tendencies to “get stuck” longer than it has to within actual tissues ~ both organs and connective. Excessive inflammatory responses then potentiates, which also reportedly contribute towards oxalate synthesis. I suspect that my ongoing AS may have some associations with it. But so far it's quite nuanced and heavy reading for me at the moment.
(Updated 29th December)
Not all, thankfully, is "doom and gloom". Towards end of December, I find there have been few variable(s) I recently find that, despite how unintuitive some of these were ~ nonetheless helped contribut some way shape or form at relieving the flank pain tensions.
Although these, I shall write with a large asterisk, with degrees of uncertainties. Your milleage of course remains yours. I do not know that simply adhering to these continuously will fully absolve the problem. Hence just a disclaimer much of this is still mystery to me.
...Not Livers. For many years Livers have always been my go to source as "multi-vitamin", in whole food form. Given also it is widely and well-though, that Retinoic Acid, as opposed to precursors such as caretonoids / beta carotenes, are superiro and more bioavailable form of Vitamin A.
However in just space of two weeks I tried mega dosing Vitamin A; drawing comparisons from either livers (chicken liver pate DIY as usual) or carrots (as dessert and feature meals).
Recalling my journalling - Carrots but NOT chicken livers ~ somehow brought me more ease and pain relief next day. I can confide / attribute to these simply through comparing through my notes among days where I consumed ONLY AND EXCLUSIVELY ~ carrots VS chicken livers.
I know and came to accept this, for me at least ~ having experimented and compared with days that I only eat ONE OR THE OTHER.
In general I have been somewhat hesitant of taking multi vitamins (MVs). UNLESS, as per my last year's write up - that if it is specially formulated with premethylated components, then I may be compelled to stock up one or two. This year thanks to iherb's occasional heavily discounted promotions I was able to secure discounted trials of these premethylated vitamins.
Once again in retrospect to my own self-journalling - comparing between days where I took these MVs versus those I did not ~ clearly there were improvements in overall mobility.
I speculate there might be the pre-methylated versions of certain B vitamins at play here. Which, as I am aware from my nutrigenomics recommendations to take certain pre-methylated supplementations ~ B6 as P5P, methyl folate (B9), methylcobalamins (B12), just to name a few. Perhaps there is some sort of nerve health at a compromise here? Certainly more reading is warranted for me here.
Saving the surprise for last and counterintuitive to 99% of people, including experts.
I shall caution that this is still early days / speculation for me.
What I have gone through throughout first month (since the pain started) was copiously taking in Magnesium Oxide (the "cheap" over the counters, with cofactors B6).
Back then - I thought the magnesium oxide was all that I needed. Confusingly ~ things didn't turn out the way I anticipated. Neither improvements nor relieff on the overall flank pains (and/or the "tension").
Once I've ran out of Magnesium Oxide supplement. I thought to myself (okay), let's try going through several weeks WITHOUT it. And that was when I found out the above first two (2) helpers. that 1). more carrots and that 2). the mutivitamins somewhat did contribute to pain relief.
So I went back to my journalling again and see what else I could find a pattern.
And what I found ~ was magnesium. If I knew something odd happened as soon as I introduced a variable, then I would've written it down. And magnesium, appears to be a strange suspect here.
Specifically magnesium chelated. Despite what everyone thought it is the better version- this appeared to triggered more tension and stiffness. Thus - more flank pain episodal burst(s) and spasms. As to how or why this is happening is beyond me.
Sleeping do get disrupted from time to time. Some anxiety still lingers where I had to pay some attention on how I should position my sleep.
On matters of training (more in next part), I have to be mindful on pull-down exercises that involves compressing the laterals and obliques. Lat pull downs and assisted pull ups for example, are no go. I would say lateral flexions (eg. side bends / lateral hip bends) would not be safe for me.
Let's wrap things up in the next part.
Live-It-Forward,
AW.