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.

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.

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.

Triathlon rewards the patient

 I had a very interesting conversation with an athlete the other day. He made a very astute observation, a concept that I try to impress upon my mentees, but often is ignored or forgotten. He said, “You know, I have a question. It seems that triathlon rewards those that wait. A lot of guys I know have made really big gains over the last 5 years. What are your thoughts?” I thought, “Gee, I better write a blog about this!”

Excelling in three different sports at one time is no easy task. Each discipline of triathlon has its own nuances in technique, training, and recovery. It is no wonder, then, that I view training for triathlon as a long term project. That is not to say an athlete won’t or can’t make incremental improvements, but, often the biggest gains take place over years. It is not feasible, for example, to drop one hour in an Ironman in a period of 3 months and qualify for Kona, unless previous races were contested with one leg tied up. Yet, I still have athletes ask me if that is a possibility.

Meteoric improvements are rare and are reserved for those with a phenomenal athletic background. This is true both in the professional and amateur ranks. For most of us, reaching our potential, whether it is an 8 hour or 12 hour Ironman time, requires precision in training. It is a matter of learning how to swim faster and more efficiently. Athletes need to hone their skills on the bike so they execute the fastest ride possible without damaging their ability to run well. This means a steady, controlled, leave the ego at the start line kind of ride. And, perhaps the hardest part of all is discovering how to run off the bike without melting down. Plus, there is the nutritional component which if not resolved can undermine even the best prepared athlete. Putting all of these pieces together takes a Herculean effort that can only be achieved over time.

Athletes want to take shortcuts. There is the faulty notion that training more or harder will get one to their goals more quickly. In reality, anybody can train hard. It takes a special someone to delay the gratification of short term glory in an effort to achieve their long term goals. Just think about the training monsters who kill it during workouts yet fail to produce on race day? Why does this happen? Because the body only has a finite ability to produce and to suffer and if one chooses to use this up during training there is nothing left on race day physically or mentally. Trying to bypass the laws of triathlon will not work.

My theory is that consistency is the key. It sounds obvious and simple. But, I still see people ignoring this simple principle all the time. There are the “weekend warriors” that train HARD all weekend and spend the rest of the week recovering. There are the “cyclers” who train HARD for a few weeks and then limp into a rest week or two. And then there are those who know how to mete out efforts over time so that they can train well for an extended period, taper and then go HARD on race day.

Improvements come from good ‘ole fashioned training day in and day out, week after week. It is not any one workout that makes an athlete better. It is the conglomeration of workouts over time. It may be months or years, but it is having a long term plan and realizing that triathlon does reward the patient. And the athlete who precipitated this very post? He was very patient in his training (and on race day) and set a massive PR at Ironman Lake Placid.

Let's get physical

There should be a requirement that doctors must have a sense of humor. It really makes the doctor/patient interaction so much more comfortable when you can share a laugh. This morning I paid a visit to my internist whom I will heretofore refer to as Dr. Drab, for a pre-op physical; his stoicism really reinforced my need to lighten up a situation with some sarcasm. In fact, I almost felt as if I was being challenged. Can I make this guy laugh?

Dr. Drab is a stodgy, older gentleman who is nice enough. I have only been to visit him on one other occasion, so we have never established any kind of rapport. For all intents and purposes, I am a complete stranger to him.

The first order of business was getting weighed. I don’t care who you are, getting weighed at the doctor’s office sucks. I made sure to wear my lightest clothes and removed my shoes. Somehow I was still 2 pounds heavier than I was on the scale at the gym and one pound heavier than the one at home, both of which I tried out this morning, wearing the same outfit, just for comparison. I am a scientist, so I like reproducibility. Somehow, there is a major fail going on here. Three scales, three different weights. It is like how all of the clocks in my house tell a different time.

Next up was blood pressure (100/62), heart rate (42) and temperature (96.4). Those look the vitals of a nearly dead person.

I was then queried about the nature of my injury. I gave Dr. Drab the abridged version, explaining how my 12th rib has been impinging a nerve. Of course, he had to put in his two cents; it seems everyone has an opinion, but no right answers.

Dr. Drab: Well, have you tried Neurontin or Lyrica (medications that help with nerve pain)?

JZ: I looked into those drugs, but they have nasty side effects. And, it doesn’t make sense to go on a systemic medication for a localized problem.

Dr. Drab: How about lidocaine patches?

JZ: I tried those. They didn’t work. In fact, I have tried everything. I’ve had nerve blocks, cortisone injections, and physical therapy. I even danced around a totem pole. Nothing worked.

Then he asked a barrage of questions about my family history. When I told him, yes, my sister is healthy, unless you count insanity Dr. Drab didn’t even crack a smile. What does a person have to do to get a laugh?

The physical exam was almost innocuous. He was palpating my abdomen and suddenly, without warning, he jabbed a finger in my side, directly into the pain epicenter. I was so startled by the intrusion that I jumped up quickly nearly causing us to knock heads. “Oh, did that hurt?”, was all he could muster.  No shit!

Then, to make matters worse, he started poking around the area, each time asking if it hurt. I wanted to ask him, “Would it hurt if I slowly pulled out each hair in your mustache, one by one?” What I did say was, “I think you have sufficiently found the offending spot.” He took the hint and stopped prodding.

Finally, it was done. Even though I passed my physical, I failed in my mission to get Dr. Drab to loosen up. I just hope I do not need Dr. Drab’s services any time soon, but if I do, I will be certain to bring along a sense of humor and gift it to him. 

Now this doctor has a sense of humor!

Preparing for Surgery

A little surgery humor. 

 Who knew that getting ready for surgery would be so difficult? I figured I would fly to Minneapolis, get my rib fixed, and jet right home. It is not quite so simple. It turns out that I have to stay in Minneapolis for a week so I can go to a post-op visit. What a nerve, the surgeon, the aforementioned Dr. Grail, wants to see me after surgery.

A mad search was initiated by my parents (who are accompanying me) and me to locate an appropriate post-surgical abode. A quick look on VRBO, a vacation rental site, brought up some interesting finds.

Here is a complaint from one reviewer on what looked like a perfectly reasonable condo:

"When we walked down in the basement to the 3rd bedroom, it was quite disgusting to see dog poop on the bedroom floor! When I told owner of this the next morning, she acted as though that could not be. We had no pets with us so it did not come from us."

Can you imagine walking into a rental condo and finding a pile of crap on the floor? That does not sound like a very sanitary way to convalesce from surgery!

Another rental met our criteria and we were about jump on it until we received a cautionary email from the listing site:

"As part of our quality control procedures, we have suspended this listing until we can obtain more information from the advertiser. If we do not receive information that is sufficient to reinstate the listing, it will no longer appear on our site."

If you are like me, than your curiosity is brewing over, wondering what heinous act the people who listed this property committed. Obviously it is much worse than dog poop on the floor. Dead body, maybe?

We decided, ultimately, to stay in a hotel about 20 minutes away from the hospital. It is near a lake and a bike path that you can run, bike or rollerblade on. It sounds perfect... for the one run I will be able to do the day before surgery.

Speaking of the hospital, did I mention that I am seeing a pediatric surgeon and that I am having the surgery done at a Children’s hospital? I have images of going to clinic and sitting in an itty-bitty chair reading Highlights magazine. I think I am required to bring a stuffed animal with me.

As a registered patient at a Children’s Hospital, I am receiving mail addressed to “the parents of Joanna Zeiger.” One of the letters from the clinic informed the parents of Joanna Zeiger, “your child needs to have a physical within 30 days of the surgery”.

I cannot remember the last time I had a routine physical, but I am thinking it might be the mandatory athletes’ physical I had my sophomore year of college. At that time, all I had to do was touch my toes, which I could easily do, impressing the doctor who had just seen the football team. I heard from another athlete those guys couldn’t even see their toes. In this instance, I need an EKG, a chest x-ray, and to answer a host of probing questions. I hope I pass; otherwise the house hunt was for naught.

I really want to run to the hospital the morning of the operation, but I have to be there at 5:30am making this an untenable option. I just think that would be so cool. I would say to Dr. Grail “Sorry I am a little stinky, but I ran here this morning. Hopefully, you slept in, though. You have a big day.”

JZ and Dr. Grail: A Tale of a Quest

I have been dealing with this rib injury for 2 years and 8 months. At some point during that time frame it became evident there was dysfunction in the rib and it would not heal without surgical intervention. I hunkered down with my father and began a quest to find a surgeon who was willing and able to fix my rib.

And, who doesn’t love a good quest? One of my favorite films in high school was Monty Python and The Holy Grail. The Indiana Jones and Lord of the Rings movies have made a killing at the box office. The common theme in these movies, and what makes a quest so enthralling, is that there is adversity, good guys, villains, moments of comedy, uncertainty and ultimately, a satisfactory conclusion. Quests often drag on and on and on and on, exemplified by the Lord of the Rings trilogy which lasts an astounding 682 minutes on 15 DVDs.

My quest has been no different. There has been a huge cast of characters, with heroes (those who have bent over backwards to help) and more nefarious types (those who have brushed me off with the wave of a hand or even worse, told me this was all in my head). There have been incredible highs, such as qualifying for the Olympic trials in the marathon, and incredible lows, such as not being able to ride a bike. I have laughed and cried. I have moved forward and backward and in circles. But, I have never lost sight of the quest, even if sometimes the quest was put on hold due to lack of information or decreased motivation.

And, now, my quest is hopefully coming to its terminus. On August 1, I will have surgery to repair my rib. After speaking with no less than a dozen surgeons, I have found a very capable one in Minneapolis. I affectionately call him Dr. Grail in homage to my favorite questing movie. I spoke with him 2 weeks ago and his kindness and compassion over the phone brought tears to my eyes. He is the chief of pediatric surgery at the University of Minnesota Children's Hospital. In the midst of our conversation Dr. Grail said to me, “You know, I generally work on kids.” I replied, “I am a kid at heart. And, I am not very big.” We had a good laugh, and I knew instantly that we clicked.

Upon describing my symptoms and the treatments I have undergone, Dr. Grail believes I have an unhealed fracture in my 12th rib, or in doctor speak a pseudoarthrosis. This has caused instability in that rib making it move around like a loose tooth causing an impingement on the T12 intercostal nerve that sits behind it. Insertion of a titanium plate into the rib should stabilize it thereby taking away the impingement on the nerve or he may even need to shave off part of the rib. The exact procedure will not be known until the surgery itself when Dr. Grail can assess the exact problem. Nothing like making a game day decision!

I have no idea what the recovery time is, or how long the procedure will last, or any other information for that matter. You see, Dr. Grail said this to me, “I can make you pain free.” After he uttered those glorious words, my brain shut down and I was rendered mute. It seems like an unbelievable end to this grueling quest.