Showing posts with label physical therapy. Show all posts
Showing posts with label physical therapy. Show all posts

Tuesday, July 21, 2020

Why COVID? Why?

So I've been away from triathlon a while now; a long while. The last time I raced was October 8th., 2016. In July of that year a low speed bike crash left me with a torn labrum in both shoulders. After five shoulder surgeries over the course of two and a half years the shoulders are back in working order. By the way, two and a half years of shoulder surgeries, accompanied by three years of PT left me longing for normality. Or what I perceived as my normal anyway.

Then I was handed a game changer.

One Sunday in late February of 2018 as I dressed for a morning run I began to have chest pain. As I bent down to tie my shoes I began to have what I would call significant chest pain. I wandered around the house for a few moments convinced it would clear. Now Bootsy had left a little earlier for her run so this gave me time to do what boys do, time to think it's a good idea to head out on a run to "shake it off". To rub a little dirt on it if you will. I ran the sum total of about three blocks before images of Bootsy finding me face down in a ditch started playing in my head. So I turned around, took my chest pain and went home.

Of course I didn't say anything to Bootsy about what was truly going on. Again this is what boys do, or in this case what boys don't do. The next morning I had an appointment with my PT. After spending huge volumes of time in my PT's office Mike had figured out when things other then my shoulders are ailing. I told him I had chest pain. He immediately asked me to get up off the table and head to Urgent Care. I of course balked so he then told me of a very fit local runner who had recently gone out for a run when sudden onset of chest pain during the run had him in heart surgery within the hour. I took heed and headed to Urgent Care. I of course made a few phone calls along the way.

After a few tests at Urgent Care I was sent to E.R. Now Bootsy was working out and away from her phone so as I sat in my car I text her "On the way to E.R. Please call". Full disclosure: I was scared! Like shaking scared. Can I/should I even drive myself to E.R. kind of scared. My mind was racing. When the Urgent Care doc said I needed to go to E.R. and to do it NOW, it left me in a bit of a fog and the only thing I could think was "What about Bootsy?" There was so much I needed to say. And if this thing would have gone south it could have become, so much I should have said. That's the part that shook me most, the should have's.

Tests, tests and more tests. Cardiologists, nurses, and support staff all working for a diagnoses. And I couldn't work because we didn't know.

Now it takes time for a new patient to get in to see a cardiologist and we were not willing to wait for test results for what in my opinion was way to long to see the cardiologist so we took an appointment with the physician assistant.

Bootsy and I both went for what we thought would be a meeting with physician assistant but when the cardiologist walked through the door I knew he was not there to deliver the news we were hoping for. The diagnoses was a thoracic aortic aneurysm in what is the worst possible place and it's sizable. Thank goodness Bootsy was there. My mind was immediately overwhelmed as I drifted away from the all to many details to ponder what my new normal may now look like.

My head was swimming. I wanted to get to the car so Bootsy could breakdown for me what just happened. I was on overload. As we left the cardiologists office he said "Please stop by the front. You will need to make an appointment to see a thoracic surgeon." I had no idea what this meant in that moment other then I was just told I needed to be prepared for open heart surgery.

So today I'm walking around with this thing, this thoracic aortic aneurysm. We monitor it closely but it's a large aneurism and I have been told that one day it will grow to the point where it will need to be fixed. But until then there are restriction. No contact sports of any kind and no short course racing are just a few don'ts. The stress of short course racing causes an increase in blood pressure during the period of elevated heart rate. But I can race 70.3 as long as I keep a close eye on heart rate during activity, training and racing. One of the frustrating things about the condition is the professionals will tell you what you can't do but they won't necessarily tell you what you can do. So no one is willing to say if I can get back to full iron distance training and racing. I feel that I have races left in me and multiple race venues I want to either race for the first time or return to.

So why this long winded "poor me"? Why now with all that is going on in the world? Or in this time of COVID, what is not going on? With all racing and so many other activities being cancelled across the globe it's simple, I am missing the community.

Recently in my memories on a social media platform the following video popped up. Which is how this post got started. So I watched and well....




I miss it. I miss iron distance training and racing. I miss everything that goes along with it. I miss just being out there, the fitness, and the camaraderie. In this time of COVID-19 I hardly think I'm alone in the missing it part.

Riding around our neighborhood and through Riverside State Park is both respite and torture. I love seeing people out and about, training, walking the dog or just talking to a neighbor over the fence in the back yard; it reminds me what life was like before COVID-19. But I can only imagine there are plenty of people for whom, seeing families playing in their yards, folks going for a jog or walking their dogs can send them plunging into a spiral of loneliness.

There is a bit of irony in the fact that I may have not been happy with my fitness level or lack there of before the pandemic hit, but I was enjoying things away from my fitness lifestyle and new found distractions from health concerns. But with the changes in community due to the pandemic, I too have felt some emptiness and loss of my home acutely.

Unfortunately, I am one of those who are driven by the race calendar. I need a point on the calendar to focus on, something to drive me. Without it I flounder, to say the least. It's been hard to or it has been easy not to get out. I have days where I sit on the couch in lieu of getting out and enjoying all the beauty the Pacific Northwest has to offer. As I sit I wonder how much longer can this go on? Can this continue for months - a year? No one knows.

Bootsy has been very careful in pushing me to do things that I myself would consider constructive. She continues to make suggestions almost daily but she also understands that I can sometimes step into my "walled city" so she treads lightly, as do I. When I get "the look" from her I begrudgingly realize I should "stop in my tracks for fear of walking on the minds I'd laid."

When might there be a return to normal? Who knows. Or if you do know might I suggest a trip to Vegas? Or to a virtual Vegas in this case I guess.

From battles on the front lines to social distancing from friends and family, to which in my case include my parents who lets just say aren't as young as they used to be, COVID-19 has caused a massive shake-up of our daily lives.

After second-guessing everything from hugging our loved ones to delaying travel, there is one big question that everyone is likely to think about: will we ever get back to the status quo? The answer currently is not very clear-cut.

(And no, because I did not mention "wearing a mask" it does not mean I do not believe in wearing a mask. I wear a mask. Let's just leave it at that.)

So what's next? Bootsy and I are signed up for IMCDA 70.3 rescheduled for September 6th. but honestly I don't see a path where it could be held this year. Also we have received communication from someone who works in conjunction with Ironman and he has cautioned against signing up for any Ironman races on this years schedule. Stating that in his opinion "IRONMAN is done for 2020 and possibly 2021."

If IMCDA 70.3 is a go this year, I have strong doubts I would be comfortable enough to toe the line with the current COVID trends around the nation and in North Idaho.

Bootsy and I have had discussions as to whether or not next years IMCDA is something we should take a look at. But will it even be staged next year? If Ironman St. George is canceled this year will that push IMCDA back a year? The purpose for the rotating race venues, amongst other reasons, is to serve as the North America Championship race.

Lots of "I don't knows" which may mean we are hesitant to throw down a bunch of cash on a 2021 race in hopes that things return to "normal" and we would be delivered a race day experience that is worth the price of admission.

I also would need to address health concerns. As a proud member of Team Ironheart there are avenues available to put me in touch with one of the worlds leading cardiologists as it pertains to long course racing. When I feel travel is a good option I will seek her opinion on any and all risks involved with the stress of training and racing long course at this time.

So for now everyone is forced to look at this in a different way. We can't ignore it.

Sunday, January 14, 2018

"The Best Way to Get Something Done is to Begin".

When training and/or racing have been removed, what could be left to write about on a blog designed for adventures in and around triathlon? Maybe things such as weight gain, sleep loss, blood pressure, loss of fitness, alcohol consumption or middle of night reality checks of always changing mental strengths. Maybe the consideration of never getting back to racing at all or at least to a level that would be considered a success. These are the things I'm left with as I sit typing with one hand only because over the past year, in large part, one or the other arms have been in a sling and under rehabilitation. Currently my dominate hand is affected and because of this a one finger hunt and peck with what I might call my "Dumb Hand", much like almost everything in life right now because of it, takes twice as long.

Friends and acquaintances alike have asked: "How's your training? What's your next race?" To which I refuse clarifications, telling them that I'm focusing on other things in life right now, which is technically true despite a few serious omissions. Watching their confusion is selfishly far easier then hearing the insidious answer that lies between my ears. "I have been injured. It is unclear at this point but I am hoping to get back to training and racing again soon. So I don't know, maybe I will get back to racing at some point this year."

The competitive void has left me moody, frustrated and at times down right surly. Just ask Bootsy, she always speaks in honest truths instead of my oft-chosen convenient or half truths.

I am, of course, one who has decided to devote myself to a lifestyle that involves semi-regular bouts with injury. A place where you could be asked to pay dearly for the answers of your day. So being laid up as a result of multiple surgeries to both shoulders and forced by the sports gods into a bit of self-reflection could seem almost - natural, all in the effort to move past in any type of timely matter.

Training and racing provide me with more then simple fitness, they have taught me to better maintain focus on long term goals while finding safety in a world of constant risk and uncertainty. They have taught me to be mentally quiet. Training and racing have been my chosen avenue to mute emotion, while removing stimuli. They have taught me to simplify. Physical exhaustion can muffle doubt as well as certain types of fear. Whereas injury can muffle joy, inspiration and honest inward reflection. After years of finding protection from certain aspects of ones self as well as the outside world, living this lifestyle, it has felt safe. It at times has felt, what I would consider beautiful. But once removed I have felt somewhat bare. The feeling of lost in a lifestyle where the compass has been removed or at minimum distorted, is something I long to step beyond.

I long to be fit again. Fitness can provide a feeling of joy in my life that without has left me with the feeling of an unfulfilled journey. There have been times where I have felt as though I am merely a spectator in my own life. The frustration isn't in the fact that I can't achieve goals and dreams, it lies in the fact that I can't start chasing them. So maybe this is just part of my given journey, but it's a journey I must once again - guide.


I was struck by the contrast when comparing the heaviness expressed in the above portion with the lighter more goal focused arena where growth is the resounding theme, replacing suppression by circumstance.

There came a point when I realized I wanted a comeback to an iron distance start line - in the past. But how can this happen? There is only one way to do this and that would be to simply begin. Begin what I would consider a return to what was once my normalcy. 

-

While running the 2004 addition of the Portland Marathon, our first marathon, Bootsy and I were passed by a man juggling. That's right we were passed by a juggler - juggling - while running a marathon. Now juggling is impressive in an of itself but this guy ran past us at the 18th mile all while holding a conversation with a young lady which I could only surmise was his girlfriend. I hope I’m painting the picture for you here. If I were juggling while walking within the comfort of my own home, trust that all my mental faculties would be focused on not falling over something. But for this guy, the most difficult thing he was doing, was the thing he was taking for granted. I doubt I could walk and talk with the grace he exhibited while running and juggling. And the great thing is that he wasn’t trying to impress anyone. He was just trying to get to the same place as the rest of us that October day - the finish line. Perhaps he had run many marathons in the past and was looking for a new challenge. Or maybe he had lost a bet during an adult beverage fueled stop on the way home from a training run with his local running group. Or maybe it was a penitence to be payed for a girlfriend mess up. I don't know. Does it really matter?

Imagine being stressed. Now imagine being stressed while on a balance beam. See, suddenly you’re forced to put your stress aside and concentrate on keeping your teeth.

Sometimes the spectacular is cloaked in normalcy. For instance, the women I love and continue to date (I love the fact we still date) is the cutest and most adorable in the times when she isn’t trying to be. There’s something about someone just being that is fun to watch. Endearing even. 

So if normalcy is what I seek, then let us begin today, but I must remind myself that NOBODY gets through life unscathed. Nobody. Everyone has or will have a condition, disease, accident, injury or event in their lives that knocks them around a bit and sends their life spinning. It’s one of the prices we pay for the gift of living.

I should probably consider the word "normal" - "Don’t be normal. Be better than normal!" I haven’t been put into a box because of this; I just broken out of it. Armed with a unique perspective on how quickly life can change and how blessed we are to still be alive, the survivors of injury and like conditions/situations get to learn what many don’t learn until far later in life.

Monday, May 29, 2017

"Have I Earned the Right to Feel Blue?"

So June is rapidly approaching and the question has become....what now? Well for the most part, shoulder surgeries. My bike crash and challenges to get to and through Kona have been well documented but where does one go from there? Any other year the plan would have been to get right back on the horse, back to training. But this has not been any other year.

Bootsy and I had decided not to go long this year prior to the end of last season. We would take a break from full iron distance training and focus on just enjoying the training and the shorter 2 to 3 hour workouts instead of the 4 to 7 hour workouts that iron distance training demands. Bootsy had decided to make a run at a B.Q. (Boston marathon qualifier) but outside of that we would do what we enjoy most and that's training for mid distance events. Unfortunately Bootsy spent the better part of the spring injured, so an attempt at a B.Q. will have to wait.

This February 14th. I had surgery to repair a 100% tear of the post labrum in my left shoulder. Yep, happy Valentines Day Honey, you get a drooling, drowsy, narcotic laced bozo for a Valentine this year.

Fast forward six weeks as I'm sitting in my surgeons office receiving the news that I now have a frozen shoulder.

Frozen shoulder, or adhesive capsulitis, causes pain and stiffness in the shoulder. With time, the shoulder's mobility becomes limited and very hard to move.

Frozen shoulder occurs in about 2% of the general population. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. So I am beating the odds per say and not in a good way.

Dr. Tycho Kersten has been great to work with through out this process. We worked through the details of a frozen joint as he put it in terms I could grasp. Basically no one knows why joints freeze or as he explained it "Frozen joints are like a big black box. We are not sure what makes up the box but we do know a few pieces that are in there." One of which is heredity.

Mike at B&B Physical Therapy is, in my opinion, one of the best therapists in the region. As we worked to rehab the shoulder post surgery I began to wonder how it was going. In hindsight Mike had begun to foreshadow the possibility of a frozen shoulder. It's not his place to make a diagnosis but it was becoming clear that he had begun to wonder if (or believe) we were headed down that road as he started to introduced me to the concept, explaining what others had gone through when afflicted with the issue.

One of the problems with a frozen joint and PT is you're making the joint mad by stretching it. Because of the discomfort or pain this creates I couldn't get off the narcotics. Six weeks on narcotics is no picnic especially for someone who doesn't like to be on them....at all! I don't like the narcotics. Outside of masking the pain, I don't like how they make me feel. And I most definitely do not like the side affects.

After about 10 days on the narcotic I wanted to be done. I tried to ween myself away from them, going to just Tylenol but I had next to no success. Because of the continued aggravation of the shoulder, my pain levels grew through the weekend and when I walked into Mikes office on Monday at 7:30 a.m. he took one look at me and knew something was wrong.

Chasing pain is a funny game. Once behind on the pain it takes a bit to catch up. And because I wasn't sleeping, my sleep pattern already a bit of a mess do to the fact with this type of surgery you are required to sleep in a recliner (not my favorite) I was on a very slippery slope.

Mike recommended a couple days off from work to try to get the shoulder to calm down and try to get some sleep. He would strongly suggested (or flat out tell me) if I didn't get back on the pain meds and get some sleep he would "suggest" sleeping aids, explaining in no uncertain terms that I simply could not heal without sleep and managing the pain was the only way to do so.

The entire process right out of the gate has been a challenge. The pain and discomfort along with trying to sleep in a recliner have led to a disrupted sleep pattern. Being monumentally tired for extended periods of time can lead to problems with perspective. Perspective is the area in which I have struggled the most.

The effects of sleep on negative mood. - Both correlational and experimental (yes, I work in a building with one of the premier sleep centers in the world. Here researchers actually bring people into a lab setting and keep them up all night for days on end… any volunteers?) evidence suggest that when people are sleep deprived, they feel more irritable, angry and hostile. Sleep loss is also associated with feeling more depressed. In addition, sleep deprivation seems to be associated with greater emotional reactivity, people who suffer from sleep loss are especially likely to react negatively when something doesn’t go well for them. Sleep loss leads to increased negative mood, and decreased ability to regulate anger. From my perspective, anger wasn't my primary issue but negative mood, that's certainly has been.

So what do the folks in the sleep center suggest other then the obvious? Try not to take on frustrating tasks, interact with irritating people, or generally engage in too much social interaction when you are very short on sleep. i.e., NOT a good time to argue with Bootsy about counter tops, style of range or tile color! Oh yeah, we had a major home remodel start February 20th. Not our choice in timing, it just played out that way.

The weight of this entire process has skewed my perspective from time to time. Not in a continues fashion, I have good day mixed with bad. Some of the bad days can be pretty dark, as shown in a following text with Bootsy from that point in time.

Bootsy - "How are you doing?"

My response - "I'm tired. I'm tired of the pain. I'm tired of the house. I'm tired of work. I'm tired of it all. I just feel like I don't want to do this anymore. I'm tired."

This representing what was hopefully one of the darkest days.

A diagnosis of a frozen shoulder sent me home to do nothing, no PT, no nothing. Just wait for the 3 month marker post surgery.

It's been so hard to be still. As an endurance athlete it's exceptionally hard to do so. Endurance athletes have trained themselves to want to go, go, go. But to be still in the fact that I was to go home and do nothing for an additional 6 weeks, except for watching the calendar, this was very challenging.

M.U.A. or Manipulation Under Anesthesia - When the progress in rehabilitation is slow, manipulation under anesthesia can be recommended. This means you are put to sleep with general anesthesia and a nerve block is administered. The doctor then stretches the shoulder joint. The manipulation stretches the shoulder joint capsule and breaks up the scar tissue. In most cases, the manipulation improves motion in the joint faster than allowing nature to take it's course.

This procedure has risks. There is a very slight chance the stretching can injure the network of nerves running to the arm. And there is a risk of fracturing the humerus.

"Family history and racial predilection as markers for genetic association, both of which indicate the presence of a genetic predisposition to frozen shoulder." In other words - it hereditary. So when one falls straight forward off his mountain bike and lands squarely on his chest with both arms outstretched, one not only tears the labrum in his left shoulder, he tears the labrum in his right shoulder as well.

The plan last February was to move forward with the labral repair in the right shoulder as soon as possible. An outline if all went well would have put me in a position to be having that surgery about now. In a perfect world I would have been recovered enough from both shoulders to maybe do Coeur d'Fondo this fall and/or Spokane's half marathon but that's all out the window now.

I asked Dr. Kersten how mentally prepared I should be for the second shoulder to freeze. He said "very". A loose outline for recovery could be three months for the M.U.A. before moving on to the right shoulder. If we were to head back down the same road with the right shoulder as we did with the left then it could be next March before moving past the right shoulder and next September before a return to the pool.

Bootsy and I have booked a trip to Tempe AZ for IMAZ this November. We will volunteer at one of our favorite venues. I had originally planned to sign up for IMAZ 2018 but that race for me is now in question. We will make a game day decision but my mental focus may need to shift to a return to iron distance racing at the 2019 edition of IMAZ instead. Maybe the 2018 IMAZ 70.3? Who knows and in lies the issue.

So have I earned the right to feel blue? Absolutely not! But the fact of the matter is I can get that way from time to times. Ultimately, I am learning to deal with the (chronic) pain and sleep loss with all the things that go along with them. The thing I haven't learned to do is to deal with the affect all of this is having on Bootsy. To watch her suffer in this too, that's what brings me tears. She has been asked to pick up all the slack and to deal with me in my current form, yet through it all she has never mentioned what is going on with her, not once. She has remained focused on my needs, our needs I guess and recovery. But I can see it in her and that's what hurts - a lot.