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Saturday, December 17, 2016

There is a season and a time to every purpose (a time to heal)


   My last few years have been odd.  2013 was unequivocally the triathlon fairy tale.  2014 was the come down from that, the coming of age-the year where all of those things I spent years worrying about happening during races happened.  The withdrawal due to illness.  The major mechanical.  The crashing out, the broken bones from crashing out.  Each one was a little worse than the last, but the truth of the matter each time was that ones fears came true, I was able to look back and realize that I made it through them all, each time rolling my eyes a bit at my over dramatic self of issues past.  2015 was the year of false starts, where my body morphed into an onion, unraveling to reveal another layer of issue after issue.  Fractures that healed more slowly than planned.  A labral tear, a labral repair.  Fracture sites that started to hurt again.  An overambitious return through it all that left things low-level ambiguously hurting, and my head and heart searching for answers.  My body became the lemon of simple, non-displaced hairline fractures and an uncomplicated labral repair.  This past year, 2016, was, as I had posted after Austin, the year of taking that lemon and turning it into lemonade.  I came to grips with many concepts- healing can't be rushed, the world owes you nothing, and you can still be happy in the face of imperfection.

   At the end of it all, though, I think that the maximum amount of consecutive time I had taken completely off from any swimming, biking, or running from the time I started training again after the fractures (December 2014) through Austin (over 22 months of time) was about 4-5 days after the PRP injections last March.  Sure, I had plenty of stretches in that time where I was doing what seemed like next to nothing to me (and many very long ones of not running), but it wasn't actually, truly nothing.  When I was at a crossroads last spring where I had to make the decision to totally rest or to try to see what happened if I committed more fully and tried to grind through it all, I chose to try to grind through it all, and I had a season.  No regrets.  At the same time, although the peaks and valleys were beginning to shift from mountains to rolling hills, I didn't gain solid footing up at any given point.   I knew that I had things that needed fixing, and I knew that I did truly need a good, clean break before I'd be have a chance at a more steady climb, but mentally I needed to get through a season before I'd be able to wrap my mind around it and successfully execute the healing I needed.  So, that's what I did, it ended on a high note, and seven weeks later, I have no regrets.

   I've started and stopped a bunch of different blog posts since I last updated, having a little bit of writer's block.  Should I review the year?  Write about the surgeries I've had by now (sports hernia repair and laparascopic uterine fibroid removal)?  Throw down a few other ideas rattling around in my brain at the moment?  Being in these post-op time periods, I haven't been hugely busy (obviously), so it wasn't like I had much else going on.  At the end of it all, I figured that I'd go through some of the surgical stuff.  I fully recognize that actually, it's a pretty boring subject, but something that I've found a bit frustrating in going through it all is trying to find specifics as this stuff pertains to triathletes, both in symptoms and recovery.  Plus, the uterine fibroid is a bit outside of the box in terms of "normal" triathlon ailments, but its development has been inextricably linked with some other factors that I think are somewhat important to discuss sometimes.

   The sports hernia repair was fairly straightforward.  Technically, "sports hernia" is a bit of a misnomer, as no true hernia bulging-instead, the obliques become stretched or slightly torn leading to continued pain and functional loss.  In my case, the muscles that attach onto the pubic bone of my pelvis (where I'd had a fracture) had become imbalanced thanks to improper strengthening along the line and overaggressive returns to training.  More specifically, my adductors that I stretched and strengthened the crap out of overpowered my obliques, which had been largely neglected, as I was limited in how much I could strengthen them due to various restrictions after my labral repair.  Throw in the previous trauma, and I was ripe for some chronic groin pain.  I was able to train through it all of this time, managing with a variety of interventions, but after nearly two years of some degree of pain in the area (mostly with running over an hour, faster running, kicking in the pool, flip turns, and higher degree core strengthening), I needed a little extra help.  It wasn't always my main issue, but undergoing the surgery seemed worth it-the surgery itself was a simple procedure with a relatively brief recovery, and addressing one problematic area would knock down compensations and allow me to fully address the others with the strengthening I need.

Visual of the muscle stuff I tried to describe above.  Circle marks the spot.  Lovely.
                                   
I don't really have any pictures that I took that are really relevant to the subject matter that don't look like me documenting a pregnancy with mirror selfies, and I needed to break this boring subject matter up with something visual, so here's not exercising bored Jennie decorating her poor, tolerant dog exhibit A: Ironman flag, and AWA luggage tag.

   The surgery itself was fairly simple.  I opted to have it done locally, and the actual procedure varied little from an actual hernia repair surgery.  They opened me up (the incision is about a couple of inches long), threw in a piece of mesh along the weakened area where the abdomen meets the thigh, and glued up the incision.  The idea is that my muscles will sort of scar into the mesh, in essence reinforcing the area back together.  Different surgical methods exist that don't use mesh, but I would have had to have traveled to PA and paid a hefty sum out of pocket, so without any overwhelming evidence (I searched) that one surgical method leads to better results than the other, I opted for the open mesh repair.  The first week after surgery was pretty acutely painful.  I needed meds, can't deny that.  Pretty much any activity that required me to contract my abs in the least (bed mobility was the worst!) felt like I was getting stabbed in the incision all over again.  After about 4 days I started taking slow, painstaking walks.  For the first week or so, the mesh just felt odd-like it was poking into my abdomen at its edges and blocking my ability to flex my hip and trunk.  The incision was very tender.  But, at the week mark, things started to come around.  By two weeks, I was able to walk on the treadmill at an incline, bike a bit, and a few days later I began phasing in pulling in the pool-bilateral breathing for the first time ever, because it felt better.  I also began light core strengthening as per the protocol my surgeon's PA gave me. Overall, the area remained sore and I had to be careful, but with my impending fibroid removal, I was less inclined to see any purpose in pushing it.  So, by the time the fibroid removal (finally) rolled around, I was up to 75min rides at out of shape off season aerobic powers, ~3000-3500 pull swims every other day (nothing hard), and perhaps somewhat overaggressive treadmill incline walks.
My dogs normally try to act like they hate each other, but every so often they touch and I get the warm fuzzies.

Poor, poor Bailey.  Seeking out her father, pleading with him to make her mother start exercising again.

As promised, the mirror selfie displaying my hot post-op belly swelling.  At least it was an excuse to wear soft pants all the time.  Not that I don't usually, but I milked it.

Somewhere between the surgeries, Dave made his stupid turkey.  He had to clean it and put it in the oven in the middle of a long ride.  Shirtless man in a HR monitor, bike shorts, and bike shoes in the kitchen scrubbing out a raw turkey=every woman's dream.

   So, that brings me up to the fibroid removal (laparoscopic robotic myomectomy, to give the official name).  I'll admit, it's a little weird to talk freely about my lady parts and hormones and such, but it shouldn't be a secret that high volume, high level training can affect women's health, and it's not like I did something freaky to develop a fibroid.  Fibroids are hugely common, and usually not a problem.  Mine wasn't at first.  Originally, that sucker was nothing more than an incidental finding on my first MRI, a 2cm blip in the midst of a bunch of bigger problems (December 2014).  At the time of my next MRI, it had grown, measuring about 3-5cm in dimension.  That prompted me to finally bite the bullet and actually go to the ob/gyn (I'd been a 3 year delinquent).  Another check that September via US measured in the 3-4cm range again, and I was asymptomatic, so we agreed to wait and watch.  My MRI the following January didn't even note it anymore.  But then, by this fall, as previously mentioned, it measured in the 6-7cm range, and sat on the posterior wall of my posteriorly tipped uterus, making it a potential culprit of my sacral pain, among other symptoms.  The decision was made to undergo the surgery, as it had likely become symptomatic, and was growing quickly enough that waiting might mean that I'd end up needing a more invasive procedure.  This turned out to be a good call-when all was said and done, the 8-9cm (approximately grapefruit or softball sized) fibroid that was pulled out of the back of my uterus was more substantial than anticipated.
Break from awkwardly describing my lady parts because yes, I do have more than one Christmas sweater and Christmas hat for the dog, and she looks forlorn in them all.

  But what was up with that growth?  Fibroids, as I've learned, grow directly in response to the hormones estrogen and progesterone.  During several years of high volume, heavy endurance training while pretty much being in a constant state of trying to get down to a certain weight (which I never quite could, even if it looked realistic on paper), and while racing a ton, it's likely fair to say that my hormone levels weren't exactly prospering (note: I've never had anything formally tested, but...the female body has its ways of cluing one into things).  I raced 5 IMs in 11 months from 11/12-10/13, and nothing, absolutely nothing about training or racing (or body comp) came easily to me the following year.  It wasn't a state of total wellness.  In 2015, as soon as I stopped training after the crash, I gained a bunch of weight alarmingly quickly while the fractures were healing at a snail's pace.  Logically, my body probably remembered how to make hormones in there, and the fibroid grew a bit.  I resumed training heavily that fall/winter, lost the weight, and the fibroid shrunk a bit.  This year, I hung out in the gray area ~5 lbs less than my injured max, but still ~5 lbs more than my previous training/racing normal, and my sustained training volumes were ~50% of my peak years.  Yes, I wanted to weigh less, the extra pounds were a limiter in my running, and I was plenty self-conscious about it all, but I also just didn't have it in me to monitor absolutely everything when I had bigger concerns about my injury status and overall health.  Plus, to be honest, I never really felt like the crypt, and it was nice.  This extended period of time at a higher body weight, not in a constant catabolic, low-energy state proved to fully jump start (or maybe even overcompensate?) everything about being female, almost to an annoying, excessive-seeming level.  The fibroid grew rapidly, especially once the season ended and I had some down time after the hernia repair.  When it measured larger than expected in those last few scans and at removal, I think I was the least surprised of everyone, given how I'd felt.
Another break because I like Christmas decorations.

   Moving forward, it's probably going to take a little work and a little tweaking to find a happy medium between my extremes of the past several years.  I'm not happy or performing well when I'm in a state of having zero reserves, but I'm also not satisfied with having body comp be a performance limiter, and with being in enough of an overdrive state to grow a freaking softball in my bits.  I've been through this enough to have a fair idea of where the line is, and I feel as if trying to force myself below that just ended up pushing me way above it.  Women are all different in what represents their personal health.  I know where I can be more careful (which might be in a lot of places right now...but, surgeries and holidays and off season, right?), but I also know where it starts being too much to support what I'm asking out of myself.  But anyways, enough about that.  As for the fibroid surgery itself, I had a few moments in the first week post-op where I thought about how they should actually let the people going through it write those flowery "what to expect" articles, full of euphemisms designed to deflect that actually, you're probably going to be more uncomfortable than you can remember being in your life.  The surgery itself, unlike my other ones done in an outpatient place, was done in the actual hospital.  After laying there starving (because obviously I'd gotten up at 5am to swim and bike for a couple of hours on coffee and apple juice) until 3:30, I woke up sometime around 6:30 and heard something about how my fibroid had been bigger than expected, blood loss, and that I'd have to stay overnight.  The overnight hospital stay basically sucked, and I think I would have been better off ultimately at home, but I was finally released the next morning feeling decent.

   That didn't last.  First, I developed right shoulder pain.  During the surgery, my abdomen had been inflated with CO2 gas to better visualize things, and afterwards, some of that gas remained lodged against my diaphragm, which referred pain into the shoulder.  The pain was pretty severe, and the only way I could get any relief was from the pain meds and Dave rubbing the area to gate it a bit.  I couldn't really take deep breaths.  As the day progressed, my GI system went into lock down, and I started to run a low fever.  I normally consider myself pretty hardy, but when my attempts to walk it off around the house left me doubled over and in tears, we ended up back in the ER (my first experience in the US...definitely a bit different than Mexico).  I ended up (after testing) being diagnosed with a simple case of ileus and a UTI, and was given the green light to head home that night.  Thankfully, life started to come around after that, for the most part.  A couple of nights later, I did go through one final round of stomach and back pain with a fairly significant fever (102), but that broke within a few hours, and from then on improvement was fairly linear.  The actual physical pain from the surgery was never nearly as bad as the hernia had been, and once the surgical symptoms (the fever, shoulder pain, stomach pain) subsided, I felt decent.  I was able to go back to work last week without issues, Christmas shop, walk the dogs daily, etc.  I started with a VERY easy ride today (just under two weeks post-op), and found that my main issue was that I'm now a little bit behind in the hernia rehab-that area's a bit tight after the time spent down.  But, I was able to pick up that protocol again without issue.  I'm still feeling just a little more short of breath and drained than usual with activity, but my RBC/hematocrit/hemoglobin values all took a modest hit with the surgery.  How much pain relief I'm going to get from the fibroid removal has yet to be seen, I think.  The whole area is still only 11 days post-op, so still in need of some time to normalize.

Another picture break, because the woods were a winter wonderland yesterday and it made me happy.

   Still, I've felt surprisingly chill throughout this entire process when it comes to exercise, training, etc.  When it comes down to it, this is my time to get things right.  This is the break that I never took.  I'm actually more concerned right now about giving all of the unspecified stuff that wasn't surgically addressed (namely, that still irritating ischial tuberosity fx site) enough time to settle while I can than I am about the surgical areas.  It shouldn't be any secret that I want to get back to IM racing, and that I want to be able to do it well.  I tried to roll through and give it a go last year, and as it turned out, I couldn't obtain this goal as was.  I've held onto the belief that there is a route that's going to take me there, but the short route I tried proved to be a bunch of neighborhood streets that went around in a bunch of little circles with no outlet.  I had to turn around, make the amends that I could, find my way back to the start, and get myself on the long, but better proven route.  The start is rest.  I've done zero swimming, biking, or running for almost four out of the past six weeks.  Meandering in the woods with my dogs has been my main source of exercise this late fall.  I'm not worried about losing fitness, because pressing for that before the body is sound is putting the cart before the horse, something I've done far, far too many times in my life.  What does the long road look like?  There are slow increases, and there's listening.  I'll find gratitude to be moving forward on it, no matter the pace out there, and the road map includes being as structured and progressive about my own rehab as I am with my patient's programs.  I don't expect it to be without setback and frustration, and I don't expect that I'm going to exist in zero pain, but I have faith that my healed pelvis, stitched up labrum, repaired sports hernia, and cleaned out uterus, along with what I've learned and the guidance and support I'll be continuing to receive can get me through.  And for now, that's enough.

If you have to go back to move forward, do it with gusto.  (Also, proof that Bailey's forays into sweater humiliation are short, and normally she gets to do fun stuff.)

And finally, a tunnel in the woods, just because I thought it looked awesome.

1 comment:

  1. I am with this and you! Love the dogs and sweaters❤️

    ReplyDelete