It ain't all sunshine and rainbows

With all the beautiful/happy pictures and good news (jobs, marriages, babies) inundating social media, many blame rising rates of depression on these unrealistic life snapshots. My blog, chronicling many years of triathlon success, is no exception. Breaking away from this mould, I wanted to share what I’ve been up to since Kona. Spoiler alert: It hasn’t been very much fun.

It’s no secret that part of being a successful endurance athlete is being friends with pain. Sure, the human body was made to move, but the first guy who ran the marathon dropped dead after finishing. The vast majority of our training-related aches and pains subside within 48 hours, only to be replaced by something new. From time to time, however, they linger on. Such has been the case with my hip.

On the bright side, at least I'm not Alex Smith.

One month before Kona (September 15^th, 2018), my good friend and super-fast triathlete, Jordan Bailey and I got together for a big (*excessive*) training weekend in Savannah. We started our Saturday morning with a 4k LCM swim that was closely followed by a 100 mile ride and an eight mile run. Besides some ridiculous crosswinds on the bike courtesy of hurricane Florence, I felt great and was able to descend the run finishing well below ironman goal pace. The next day however was a different story, and although we were able to achieve our 15 mile run goal it was not without ample bitching from yours truly. As may be anticipated after so much volume, towards the end of the run I started to feel what seemed to be some tightness in my left hip and immediately attributed it to a tight IT band.

PSA: when training with very fast athletes, its easy to overdo it.

By the end of the day I had almost completely forgotten about my hip and didn’t feel it the entire next week, even on what felt like a magical 20 mile long run. I can’t quite recall when my hip began to bother me again, but I can tell you that it was giving me some grief the week of Kona. With my anxiety at an all-time high (hard to fathom for those of you who know me) I kept telling myself it was just phantom taper pains and I wouldn’t feel it during the race. I was right until about four hours into the bike when out of nowhere I felt a searing pain in my left hip. I told myself I just needed to get off the bike and it would get better, and I was kind of right. I’m not sure whether I was just suffering too much on the run to notice it, or it actually didn’t hurt that bad, but I don’t remember being overly bothered by it.

Beer cures all woes.

Fast forward two weeks and after many nights spent slaying beers rather than miles the pain still lingered. That’s when I started to worry. One of my best friends and amazing professional runner, Jon Grey, tragically took his life in February after battling back from not one, not two, but three labral surgeries in less than five years. After some online research, WebMD (and slowtwitch) had me convinced, my labrum was destroyed. As I traded stories with other athletes who either currently have or have had labrum injuries (not disclosing their identities for the sake of their privacy, but I REALLY appreciate them speaking with me) the similarities caused my heart to sink.

Bout sums it up.

And so began my journey through the healthcare system. In all honesty, my health insurance is pretty good. Although by no means free, I am fortunate to be without a deductible. The catch of being part of a health maintenance organization (BCBS), however, is everything requires a referral. After a couple days of calling my assigned primary care provider (PCP), you can imagine my surprise when a google search returned his obituary, 3 YEARS AGO! After identifying a living PCP, I was livid when I received a call cancelling my Monday morning appointment at 4:55pm on Friday afternoon (October 27^th). When I finally did get in for my appointment the doctor wanted nothing to do with preventive care (PT or chiropractic) and instead referred me straight to an orthopedist, who I was told would call to schedule my appointment. After waiting about 10 days my patience had worn thin so I decided to give the orthopedist a call. Can you imagine that, they were “just getting around to giving me a call.” I still wonder when, if ever, I would have received that call (appointment scheduled for November 20^th). 

When I finally got into the orthopedist I was pretty disappointed to discover that I had been assigned to a physician’s assistant, who seemed to believe that the pain was coming from my back, rather than my hip. Fortunately the x-rays disproved her hypothesis and she resolved to refer me for a MRI. That’s when my obsessive research practices paid off; an arthrogram (imaging procedure following injection of contrast dye) is frequently necessary to diagnose a torn labrum. When I inquired about this procedure, I was told “we usually don’t recommend those,” which upon further inquiry I learned was to “save money.” Looking sheepish, the PA agreed to include the arthrogram injection (contrast) with the referral.

After one week of patiently waiting for my MRI to be scheduled, I can’t say I was surprised to learn that the PA/Orthopedic office had failed to relay the referral to the imaging center. I was told by the orthopedic office that “something had happened to the dictations” that day (appointment scheduled for December 8^th). Fortunately, although they were busy, my experience at the imaging center was long but smooth. Forty-five minutes in the MRI machine, followed by 20 minutes of awkwardly conversing with two nurses as I lay totally naked on the operating table (I’ll revisit this later), waiting for the doctor to stick a large needle in my hip and inject an absurd amount of dye. The second MRI was shorter, maybe 30 minutes, and on my way out the doctor told me that if I came back that evening I could pick-up the interpretation from the front desk.

My situation

As I drove back to the imaging center, I wasn’t really sure what to think. To be honest, by this point I had pretty much already accepted what I felt was the inevitable: “my labrum is torn and I won’t be racing triathlon in 2019”. The report confirmed my suspicion, but I was somewhat relieved to see it described as a “very small” tear, and nothing about the finality of my triathlon career. By this point it will probably come as no surprise that the orthopedist in Savannah was about as useless as a stick of gum “So, do you know what a labrum is?, Because I can’t fix them, I only do hip replacements and you don’t need one.”

I trust him.

After some calling around I scheduled an appointment with Jon Hyman, an orthopedic surgeon in Atlanta who performs hundreds of these surgeries a year. I drove to Atlanta to meet with Dr. Hyman this past week (Wednesday, January 2^nd) and for once I felt like I was finally getting somewhere. I explained how although far from perfect, my hip was certainly bothering me less than a couple months ago. He was very thorough and took the time going over my MRI with Bri and I. He explained to me that although the labrum had a minor tear, this is not an uncommon finding by any means. In fact, nearly ¾ of the population has a labral tear, the vast majority of which are asymptomatic. He also pointed out an extra wide area near the top of my femur, a condition known as a CAM defect (prevalent in about 37% of individuals) that might be causing my pain as is it rotates around my pelvis. He then presented me with 3 options:

1) Lifestyle change – he said almost jokingly

2) Surgery to repair labrum and reshape my femur - dislike.

3) Cortisone injection – a tactic that would not only serve diagnostic purposes, i.e., if pain goes away we can confirm the pain is coming from my hip, but an option that he felt might knock the pain out entirely.

CAM deformity, prevalent in over 1/3 of the population.

Two days ago I went back to the imaging clinic in Savannah for the cortisone injection. While getting a large needle stuck in your hip isn’t exactly a treat, at least this time I was given the dignity of some robes, allowing me to remain at least somewhat concealed as the nurses took x-rays of my pelvis. After one of them commented about remembering me from last time, it took about all my self-restraint to ask if that was because I was the guy laying stark naked and spread eagle on the operating table for 20 minutes.

Not really me, but I am quite pale from sitting inside writing grants.

Although I am still a tad sore from the injection, I very much enjoyed a pain-free, 50 degree, 15 minute jog around Daffin Park this morning. Undoubtedly, the past few months have been some of the most frustrating I’ve experienced. For the past 15 years, training has often been the best part of my day…its what makes me, me. With that gone, I’ve had to focus my energy elsewhere and I’ve had a lot of time for self-reflection. Thank god I have a fulfilling job, loving wife/family, and fantastic friends. While I’m not sure what my endurance escapades have in store for my future, I am choosing to approach the situation as optimistically as possible, something I NEVER would have been able to do until just a little over a week ago. I believe that in conjunction with a smart and conservative return to training, I will be able to get back to full health. I believe that I will run a faster Boston marathon this year than last. I believe that I will have a successful 2019 triathlon season. I believe that the perspective and knowledge gained from this experience will make me a better athlete and coach, both now, and in the future.

Non-triathlon related activities.

Thanks for reading.