"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.