Tuesday, August 28, 2012

It's about time

Competitive swimming is steeped in time standards. As a novice, the goal is to move from C times to B times and then on to A, AA, and AAA. From there, junior Olympics, Junior Nationals and Senior Nationals loom large. The ultimate time standard is an Olympic trials qualifier. Swimming websites are fraught with local and national age group top-16 times, not only from this year, but for every year dating back to the Pleistocene era. And let’s not forget about the pace clock, every swimmers best friend or worst enemy. There is rarely a day a swimmer jumps in the pool and just swims around aimlessly. We are slaves to the pace clock, always and forever.

It is no wonder then, that after being immersed in a culture that places so much emphasis on time, I am still time obsessed in training and racing.

As a triathlete, as surely as I was racing my competitors, I raced the clock. Every race was an opportunity to set a new PR in any of the three disciplines or for the whole event. One of the reasons I often frequented the same event year after year was to obtain a direct comparison of my progress – could I go faster than I did in the past? It is hard to compare a time at St. Croix 70.3 to Eagleman 70.3, but the task of comparing St. Croix 70.3 over a 5 year span makes more sense. I realize that conditions change from one year to the next, giving me a perfect excuse when slow times emerged, but there is still an overall sense of comparison that let me know if I was improving, stalling or even, yikes, sliding backwards. The bottom line: triathlon is place focused and not time focused. A top placing will get you to Kona, but you can set a PR and still not make the cut. This makes perfect sense given the inaccuracies of course measurement, course difficulty and weather patterns.

I have spent the last two years running. All of the time conscious habits of my swimming days have reappeared in flagrant fashion. My place in races is far less important to me than how fast I run. I am continually in pursuit of PR’s in the half and full marathon. I pick and choose courses than are amenable to running satisfactory times. In training I push myself on a weekly basis in an effort to eke out a few less seconds per mile than the week before.

And that brings me to the last few months of 2012. With the rib surgery behind me and endless opportunity in front of me, I have chosen some races to close out the season. I plan on racing a half marathon in Colorado in September (I cannot decide which one), the Columbus half marathon in October, a local 10k in November and the California International Marathon (CIM) in December. My goals? To run fast! Most importantly, I hope to run sub-1:18 in Columbus which will set me up for my assault on breaking 2:40 at CIM in December. Heady aspirations, yes, but not entirely impossible. With so many years of injury and despair in the rearview mirror, it feels right to think big. Whether or not these goals come to fruition is secondary to the fact that I even have a chance to dream about them.

Monday, August 13, 2012

Recovery Mode

Any athlete will tell you, the first question on their mind after an injury/illness/surgery is how long it will take to recover. Athletes are movers. Sitting around “getting better” is not compatible with the agenda of training. I am no different than anyone else; one of my priorities has been to start training again. And why shouldn’t it be? I am a self professed exercise addict.

Prior to traveling to Minneapolis for surgery, I emailed the surgeon on a few occasions to get a better understanding of what my recovery would entail. The gist of his responses was, “It depends on what I find during surgery.” How vague is that? After surgery, when he presumably gathered all of the information he could possibly need to answer my whine, “When can I swim and run?” all he could muster was “You can probably start working out next week. Let pain be your guide,” and then he set me free.

My immediate thought was, how can you give that much latitude to a person who was running 80-90 miles a week with a 2 inch neuroma on an intercostal nerve? Clearly, my perception of pain is skewed and I need something more concrete than “let pain be your guide.”  I think the bottom line is that he really had no clue. First, he has never worked on an OCD athlete and second, he has only performed this surgery on one other occasion. He just had no reference based on prior experience and rather than admit that he didn’t know he gave me the standard pain as your guide answer.

If this Weeble had curlier hair and blue eyes, it could be me!
I experienced several unpleasant after effects to the surgery. I was bloated and swollen to the point of feeling like a Weeble. I sent a picture of my surgical wound to a friend. He texted, “Holy shit…You look fat, lol.” Thanks, buddy, that’s a real pick me up. I most assuredly did not LOL when I could barely button up my pants. The rib pain felt very similar to a broken rib. I had intense pain upon laughing, coughing, sneezing and trying to get out of bed. These sensations have dissipated much more quickly than a broken rib, though. And, of course, there was the discomfort from being cut open. The nerve pain that ailed me for almost three years is noticeably absent.

Notice the post-surgical muffin top
Here’s the thing. On the one hand, my desire to recover and let this surgery work is paramount. On the other hand, I detest sitting around. After a certain amount of time doing nothing I feel like I am going to spontaneously combust. I tried to compromise by integrating moving with sleeping. I offset taking a walk with taking a nap. And, there is no question, movement has aided in my recovery by increasing my range of motion and helping prevent the accumulation of scar tissue. And, as an aside, I just happened to read an article this morning that showed exercise helps with wound healing in mice by upregulating blood flow which delivers more oxygen to the wound (this is probably true in humans too, but it is really hard to find volunteers that are willing to participate in a study that requires them to get deep slices all over their body).

The day after surgery, my parents and I walked a little bit. By the fourth day after surgery, I got on the elliptical (without using the arms) for 20 minutes and took a lovely walk around Lake Calhoun (about 3 miles). Eight days after surgery I ran 30 minutes on the Alter G at 70% of body weight and a very easy pace. I have taken several hikes on terrain of varying difficulty. Today I did my first swim, 1000 meters at a snail’s pace. Most importantly, I started back doing rehabilitative stretching and exercises to regain flexibility, muscle balance and strength.

Each step of the way, I have asked myself two questions. 1. How much does this hurt? 2. Is the pain level increasing during a given “workout.” If the pain level topped out at a 3 and never increased beyond that then I felt that I was in no danger of damaging myself. Before each workout, I set parameters in terms of time or distance and speed. No matter how good I have felt, and no matter how tremendous my desire to push beyond my preset limits, I have stopped as planned which is no easy task for somebody who is used to pushing the envelope.

Tuesday, August 7, 2012

Surgery Recap

Instead of a race report, I am writing a surgery report. It’s almost the same thing.

I met my parents in Minneapolis last Monday. On Tuesday, we went to clinic to meet the surgeon for the first time. His easy going demeanor instantly relaxed us. And let me tell you, I was feeling far from relaxed. Despite the knowledge that this surgery was imperative, and despite the knowledge that I was in capable hands, I was profusely nervous, as evidenced by my incredibly high blood pressure readings and racing heart rate.

The appointment was a meet and greet coupled with a hands on evaluation of my rib area. He poked and prodded and then injected some lidocaine in an effort to numb it which would allow him to pinpoint where the pain was occurring. If the pain was gone after the numbing agent was injected, then that would be the point where he would make the incision and look for the problem.

After the exam, Dr. Grail explained that the surgery would have two components. The first phase of the surgery would be exploratory where he would attempt to find and diagnose the problem. The second phase would be to correct the problem. He estimated the procedure would take 30 minutes. I nearly dropped off the exam table; three years of pain reversed in 30 minutes? It seemed impossible. I said, “Whoa, there cowboy. No need to rush. Let’s do this right.”

I can only compare the surgery to an Ironman. The similarities are just uncanny. The clinic visit was analogous to packet pick-up. I had a sleepless night before the surgery. There was an unusually early wake-up call. I had the jitters. There was a check in procedure in the morning before I could do anything else. I got a nifty bracelet that I could not take off until after I was done. I had to get body marked (my body marking consisted of the surgeon inking my rib cage where he wanted to make his incision), but they did not put my age on my calf. There was a lot of hustle and bustle followed by a lot of waiting around before the whole thing started. I had to put all of my clothes in a plastic bag which had my name on it; the bag was moved to another location, and I could not retrieve the bag until afterwards.  Instead of a canon blowing to mark the beginning I got an IV filled with magical medicine that knocked me out.

The aftermath was not too dissimilar from the end of an Ironman. I had an IV going, I was disoriented and I was incredibly swollen and bloated. My hair was a mess. My eyes looked glazed. And the soreness and fatigue lasted for days. I did ask for photos for posterity (and this blog), but was emphatically turned down. Where is ASI when you need them? Sure they would have charged $1,000 for a 1x1 photo, but how can you put a price tag on a once in a lifetime experience? In case you were wondering, I will not get the hospital logo tattooed on my ass.

I always knew Ironman prepared me for something other than just another Ironman.

This nasty red thing is an intercostal neuroma.  Not mine though, since they denied me photos.
The surgery itself was very productive. Rather than the ambitious 30 minutes that was predicted, it lasted an hour. In the exploratory phase, Dr. Grail found fractured cartilage at the end of the 11th rib. The cartilage was so damaged it basically crumbled under his touch. This cartilage was fractured in the 2009 accident and due to the lack of blood flow to cartilage it could not heal. The damaged cartilage caused instability in the rib making it rub the nerve that sits behind it. The continued rubbing over so much time led to the development of an almost 2 inch neuroma on the nerve (i.e. an intercostal neuroma). A neuroma is a tumor-like growth of nerve tissue and this is what was causing the pain. Correcting the problem included:  getting rid of the damaged cartilage and excising the neuroma and the nerve. Just to be clear on why this was so difficult to diagnose in the first place, Dr. Grail has only seen an intercostal neuroma on one other occasion and he has done more corrective rib surgeries than anyone else.

I spent the rest of the week in Minneapolis recovering. I slept a lot, went for walks and watched the Olympics like I was going to be quizzed on it later. We met some family friends for dinner, explored an art fair, and cleaned out Trader Joe’s.  I even challenged my mom to a reading contest; we would both start the same book at the same time and see who finished first. I won by default. I was the only one who started (FYI, the book is called Emily and Einstein by Linda Francis Lee and was quite a good read).

My parents were excellent care takers and made the recovery process as comfortable and easy as possible. A few days before we left for Minneapolis, my mom said to me. “You better be fun while we are there.”  I think she was ribbing me (get the pun?), but I do believe we made the most of our time in Minneapolis.

I am unsure of what my recovery will bring. Dr. Grail did not set out a time line to follow. Of course, I would love to get back to triathlon, but before I start riding again after a 2 year hiatus, I want to be pain free running and swimming. While I am still feeling the effects of the surgery, there is a noticeable absence of nerve pain. I am hesitantly optimistic that once I have healed I will be pain free.