Monday, June 21, 2010

Why RAAM 2010 almost didn't happen for me

** in the spirit of RAAM, this post is a little long because A LOT happened.  There were quite a few times where I thought I wasn't even going to get to the start line.  But, I persevered, and all the chaos set me up for a great mindset going into this **

So, when I developed that injury during Ironman St. George that was diagnosed as ITBS (with an emphasis on BS), I was told:

    * Cycling is fine and shouldn't bother the injury
    * It should take 3 weeks of treatments to heal it
    * Doing RAAM would be fine

Well, things didn't really work out that way.  Here's what went down.

One month from the race

After a very easy 2 weeks post IMSG, I joined my teammates Larry and Kevin for a 90 mile ride up to Dana Point and back.  It was a hard ride, but certainly within my capabilities.  At about mile 80, the pain on the lateral side of the knee came back, so I took it easy on my way back home. I ended up canceling my Sunday ride, and was NOT a happy camper.

I gave my knee a few days rest, and did 8 hard hill repeats on Wednesday, followed by 6 on Thursday.  Everything with the knee seemed to be fine, and life was good!  Back on schedule...

2 weeks from the race

I did a four hour ride the next Saturday morning, with the slightest of irritation, and an easy 45 minute spin in the afternoon.  Sunday morning, I did an hours worth of intervals on the trainer, and then Michelle and I headed out for an easy spin up to Carlsbad and back.  About 30 minutes in, my knee started getting a little annoyed, and by about an hour in, it was more than "noticeable".  75 minutes in, I had to make the call to get off my bike because I was in so much pain and had to ask Michelle to finish the ride by herself so that she could come pick me up.  I hung out on a bus stop bench for 90 minutes, reading the paper, working on my tan, and being really pissed off.  I was 13 days away from riding my bike across the country at full throttle, and I couldn't even pedal it 12mph on a flat.  Frustrated is a light way of describing how I felt.  By the time Michelle arrived, I had already come to the conclusion that I wasn't going to be able to do RAAM, and was preparing for how I would approach our alternate rider to take my place.

Later that day, I emailed my PT, and his response, despite 3.5 weeks of PT, was that my ITBS "was acting as expected".  WTF!  As expected?  As in, "normal"?  I thought cycling was fine, doctor?

I spoke with Chuckie and then Angela about this, and they had some ideas.  It was helpful to hear people who have dealt with these types of issues, but at the same point, there was conflicting evidence, and now I had more questions, so I decided to get an MRI to try and get some real answers.  I spoke with my primary care physician that Tuesday, and he thought I had bursitis, so he prescribed me prednisone, which is a strong steroid and anti-inflammatory.  I told my roommate Graham about it (who knows a thing or two about endurance sports and who happens to work for a pharmaceutical company), and he said I shouldn't take prednisone because it could "really mess me up", and that I should wait to get the MRI results and get a proper diagnosis.  At this point, I had spoken to 3 people whom I trust, most of whom had different perspectives and opinions on the matter. 

The next day, I met with an orthopedist, a guy who has done Kona 5 times (that was cool), and he said I probably have ITBS, but that an MRI would be the best bet to give the best answer, despite it not being 100% accurate.  He recommended that I do just easy spinning until the race, and not push it all.  I was able to get an MRI 8 days (Friday) before the race, but, because it takes 48 hours to process the images, I couldn't meet with him on Monday, and with him being in surgery on Tuesday, I couldn't meet with him until Wednesday - 3 days before the race start!!  F!! I was a mess this an entire week and a half, coming to the conclusion 2 more times that I would, then wouldn't, be able to do RAAM.

7 days before

As the weekend approached, I still felt uneasy.  The last time I biked, I couldn't pedal at 12mph, but when I thrashed myself up hills at LT time and time again, I felt fine.  I realized that I needed to test the knee before the race.  If I couldn't handle a weekend of training, there was no way I would be able to pedal 375+ miles violently for a week.  So, saturday morning, I did TEN repeats up Torrey pines at LT.  No issues with the knee before, during or after.  I reviewed the power data after, and my avg output was no more than 1.5% less than it was 2 weeks before IMSG. "Hmm, cool"

The next day, I did it again - TEN more repeats up TP.  Again, no issues with the knee before, during or after, nor was there any power decrease more than 1.5%.  I was surprised, and cautiously optimistic at best.

(Yes, that's 20 repeats up the pines for the weekend.  Trust me, I was happy just to be doing it.  That, and I owned the hill those mornings).

I spoke to the team captain and told him that with my variable condition, if the team wanted to move forward with someone less "risky", then I wouldn't be offended.  There was more at stake here than just me - I didn't want to let an entire team of 19, including crew, down.  Kevin assured me that the team had my back, and I couldn't be more relieved.

3 days before

The orthopedist and I reviewed the MRI, and it was evident that I had ITBS, and bursitis.  What I also learned was that ITBS is a general, all encompassing term that could include bursitis, but not necessarily (Side note: always ask lots of questions to doctors to get the real story, because you may not get what you need to hear the first or second time).

He said that if I do the race (and he recommended that I do it), there is little to no chance that I wouldn't do any long term damage, which was the biggest relief.  Sweet!!!  He prescribed some strong ibuprofen, told me to ice and stretch it, but that there is a greater than 50% chance of it flaring up during the race, and that I shouldn't get an anti-inflammatory injection (commonly known as cortisone, but he said depomedrol is better).  He also recommended that I bring my MRI images with me on CD in case it does flare up, so that I could get an injection during the race. He wished me good luck, shook my hand, and like that, he was gone.

Here I was, 3 days before the race, and I finally felt somewhat, but not completely, confident that I could do RAAM.

2 days before

After thinking about it, something wasn't sitting well with me.  I called him back the next day, and basically said "If you think there is greater than 50% chance of it flaring up, then wouldn't I be stupid NOT to get the damn shot before the race?  Wouldn't that be better rather than being uneasy about it until it flares up, and then hoping that there would be a orthopedist somewhere in the middle of Kansas?" I thought my logic was so clear, and yet just couldn't understand why him and other medical professionals were saying NOT to get it.  Yes, they know more than me, but none could give me a straight answer as to why I shouldn't.

There was a part of me that was scared to do the race because of what (bad things) might happen, but at the same point, I didn't want to NOT do the race.  What might be even worse is watching the race from my desk at work the entire week, wondering "what if".  Major cognitive dissonance.

I thought about it some more, and my perspective was that I needed to do EVERYTHING in my power to minimize the risk of something bad happening. I didn't want to be in the middle of nowhere with the closest orthopedist being 200 miles in the wrong direction letting myself and MY TEAM down.  No way.

I called another doctor friend of mine and discussed this with him, and he basically said that it was already too late to get an injection, and not to bother.  I thought my sails just lost their wind for the last time.

The day before (!!!)

I called the Orthopedist and said that I made my decision to get an injection for the exact reasons I laid out above.  After bike inspection, I drove down, got it, and immediately felt more at ease (despite my knee feeling a little numb).  He was totally cool with it, and I gave him our web address so that he could follow along.  FINALLY, 24 hours from race start, I knew that I had done anything and everything to ensure that I could do this race (and tru$t me, I paid for it).


The last 13 days before the race were an absolute roller coaster.  This was the type of stuff NO ONE should have to go through before such an event.  I almost felt like getting to the start line was going to be harder than the race.  When I was just about convinced that I wasn't going to be able to do it, I would tell myself that if I actually was able to do it - that no matter how much it sucked (because I knew there were going to be a really tough parts) that I should just be happy to be there.

So, that was my perspective going into the race: be happy to be there and to make the absolute most of it, because there may not be another RAAM, and that this one almost slipped away a few times.  This was supposed to be the fastest team in our history, and the time has come to kick some ass and have some fun.  Let's hope for the best!

So, I hope you enjoy my stories as I Race Across America with one fresh perspective...


Tawnee said...

Wow. wow. wow. As someone who's battling similar issues right now, thanks for sharing all this in such great detail! Glad RAAM worked out for you!

We should have an "ITBS is BS" party! haha

jameson said...

wow that's some gnarly stuff dude... way to take things into your own hands.

can't wait to hear about the race.

Frank Pucher said...

Ryan. Congrats my man. I followed via my limited web access while on vacation w/ the Mrs.
Awesome accomplishment for you and TEAM.
Thought: Endurance activity is a metaphor for life. Sometimes you feel good, Sometimes you don't. Either way - 'Winners' Keep Moving Forward.
Congrats again. Look forward to connecting again down the road.