Rapid Progression

Last night was rather sleepless. I had taken percoset for the pain, which helped tremendously, but percoset makes me feel generally awful and keeps me from sleeping so I was uncomfortable and restless most of the night. When I woke up this morning I still couldn't walk. I used my crutches to get around and had to call a car to take me to work. I was tired and sore all day, but with the boot and crutches, managed to stay completely off my foot.

I noticed mid-day that the pain had lessened significantly and when I finally got home tonight and took off the boot, I was able to stand flat-footed as long as I didn't apply pressure. I'm nowhere near back to normal but I'm really happy to see how fast the recovery from the injection is progressing.

After two days of biking outside in the unseasonably warm weather, I took today as rest due to my foot. I have business travel the rest of the week but should be able to swim before leaving. I've been aiming for consitency. Nothing more, nothing less. I don't need to follow my schedule by the letter, but rather be active on a consistent basis to ease back into the routine of daily training. I've definitely been feeling better since stepping it up and for the first time since before the Ironman, I'm actually looking forward to doing more. That's a huge step.

PRP Experience

Today was my PRP injection and while it wasn't awful, I've certainly had better experiences. I was insanely nervous even though needles don't particularly bother me. I think it's more about the foot being the unfortunate location of the injection than the injection itself. The cortisone shot pre-Ironman really freaked me out so this was exponentially worse.

The procedure was really simple. I had blood drawn, I believe around 10cc, or the equivalent of two teaspoons. That part was fine except the veins in my left arm proved to be elusive so I had the pleasure of being poked on both sides. The blood was then put into the centrifuge for about 15 minutes, during which time I had three shots of local anesthetic in my foot to ease the surface pain of the larger gauge needle used for the injection. These shots surprisingly hurt a lot. The first was back toward my achilles, in a nerve that runs along the length of the foot, the second near the site of the tear and the third an inch or so down in my arch. My podiatrist had me sip an orange juice while I waited for my platelets to be procured and my foot to get tingly. I think he was afraid I'd faint from the blood being drawn or being terrified of the injection. Apparently some patients don't handle it well.

After what felt like forever, the technician came in with a syringe full of a pale pink liquid. It resembled rosè wine but something told me it wouldn't be as pleasant. I started to sweat profusely. I was a little embarrassed I was being such a baby about it. I'm supposed to be tough after all. As the doctor put the needle on the syringe and headed toward my foot I positioned myself so my bent right knee blocked the view. I could not watch. He gave me a quick warning and in the needle went. The initial poke was minimally painful to my surprise and relief. But then he started to slowly inject the PRP, about 4.5cc which is a decent amount, and the pain gradually crept up. He told me I'd feel some "fullness." That was a rather unsettling sensation. There were two areas in the fascia he was aiming to cover with the platelets - the site of the tear in my arch and an area just beneath my heel. I survived the arch and was holding up well, but when he moved the needle to the heel I nearly died. I could tell I was turning a shade of crimson and I felt a wave of heat pass over me. My stomach tightened up. It was an intense shot of pain that at first felt like it might pass once the injection was done, but it instead continued to intensify long after the needle was out. My doctor rubbed the injection site for a minute, bandaged me up and then stayed in the room with me while I composed myself. I was afraid to stand up, afraid to put weight on it. I could barely walk and the limp was way worse than when I was initially injured. But at least it's only temporary.

I'm back in the boot and back on crutches until the swelling and pain subside. I'm really glad I did this despite the discomfort. I need to feel I've done everything possible to get better and this was the final step.

First Race

I registered for my first post-injury race today, a 5K run/walk in Madison on Thanksgiving morning. I'll be walking of course, but not by myself this time. My mom is walking the race with me and I couldn't be more excited. My sister and her husband will be running and we're hoping to have my dad come along and be our official photographer. It will be a family affair.

Even though it's a walk it feels like a big step in my recovery. I feel completely normal about 90% of the time and have really picked up the pace as I walk around daily. For the first time in a long time I feel like I could run, but I know I'm not quite ready. I'm optimistic that the PRP will be the final push I need to get to 100%.

I swam today after a two-week hiatus and oh my. Swim fitness dies quickly. I felt like I was swimming through mud and was about as graceful as a fish flopping around out of water. I'm a little averse to swimming these days but clearly will need to force myself to go at least twice a week to maintain a marginal level of fitness. I only covered 1,300 yards and was beat. I wondered how I ever did those 4,500 yard workouts and managed 2.4 miles with over 2,000 people. Then I thought about everyone racing Ironman Florida today. I hope it's the day they dreamed of. There really is nothing like an Ironman.

So Much For Free Cookies

It's now been two months I've been grossly off my pre-Ironman training diet and I continue to feel the toll. I'm about five pounds heavier, my body composition has drastically changed and my energy is inconsistent. If I felt so much better when eating better, why is it so hard to stick to it? My activity is also tremendously low so I blamed the five pounds on going from training 15+ hours a week to 15 minutes. I keep thinking I'll get more active and magically shed the pounds. But then I read this New York Times blog today and am beginning to think otherwise.

A recent study proves that in most people, exercise does not lead to weight loss. Nearly all of us also have to modify our diets in order to drop the unwanted pounds. It also shows no evidence of a miraculously revved metabolism that keeps blasting calories long after the workout has ended. So if you're indulging a little - or a lot as has been the case for me over the last two months - and exercising to compensate for it, you're likely just equaling things out and not ever burning enough to be one of the lucky souls who can eat whatever they want and not gain a pound.

I've been hitting my nutrition goals about 50% of the time. Let's not discuss the other 50%. So now I'm vowing to aim for 80% and ultimately 90% when I'm back into serious training. But as with all other aspects of my life, I'm planning to remain flexible. After all, a little dark chocolate or the occasional cookie can't hurt, right?

PRP: It's On

Thanks to an insurance company denial, I thought the PRP treatment I wanted to try for my foot was no longer an option. However, after an appointment with my doctor today it's back on the horizon and looks likely for early next week. It's still very expensive but much more manageable thanks to his help. I'm also filing an insurance appeal, but coverage is a long shot. I don't care at this point. When I think about other things I willingly spend money on without a thought and then compare it to my well being and long-term enjoyment of this sport, there is no debate. While it's an unproven treatment in general, it has been known to work well for my specific injury, particularly in preventing future re-injury. That's good enough for me.

In other good news, there is a chance I'll be running again in just four weeks. I'm not even sure how I feel about that. On one hand I can't wait to get back to normal, but on the other, I'm terrified of not being 100% ready and risking a setback. Injuries really screw with your mind and I imagine I'll harbor some doubt and fear until I make it successfully through my 2010 season.

A little bad news often accompanies good news. The bad news here is that the boot will be back for a week after the procedure. I thought I was done with my old friend the boot, but it looks like we have unfinished business. I'm just glad I refrained from running over it in a car in celebration of being liberated from it. That ceremonious moment will have to wait for now. But luckily, not for long.

A Walk in the Woods

Since I was heading up to the Adirondacks for the weekend I asked my podiatrist if I could do some easy hiking, and to my surprise he said yes. So today, on a crisp, clear, beautiful fall day in Lake Placid, I went for my first post-injury hike and loved every moment of it. We hiked Mount Jo, just shy of three miles and around 800 feet of elevation. I walked carefully and my foot felt fine. It was such a pleasure to be outside doing something different for a change.


After the hike I finally stopped at Mirror Lake to test the water temperature. Suffice it to say there isn't enough neoprene in the world to make that water swimmable at this time of year. I dipped my hand in and it swiftly went numb. But touching the water definitely made me look forward to being back up there for training and racing in the warmer weather. What a perfect weekend.

From Zero to Fifty-Six

Since Ironman Wisconsin, I've only ridden my bike outside three times. I did a 14-mile ride in Prospect Park, a 25-mile ride a few days later also in the park, and a 45-mile ride on Long Island. I have done a handful of rides on the trainer in between but it's been slim. But yesterday I broke through the no training barrier with a one-loop ride on the Ironman Lake Placid bike course. This ride was incredibly fun but also incredibly challenging. I'm operating on minimal fitness and it's a very difficult course. I climbed more than 3,000 feet over the course of 56 miles and was swiftly reminded of how much making up I have to do after this two-month hiatus.

I rode solo and can't believe how quickly the time flew by. This is a magical place to ride, I think I could do the course over and over again and never get bored. The roads have been largely repaved and it was dry so I was able to ride rather comfortably. After the famous Keene descent and my favorite part of the course, a relatively flat and super fast stretch on 9N, my average was 18mph. At the halfway point I was on track to do the ride in 3:15, which would have been my best yet on this course. But the punishing climbs on 86 coming off 9, the Hazleton out-and-back and the final long climb back to town made my average plumet to 15.7. I finished the ride in just over 3.5 hours. Not bad when you consider where I was coming from. And most importantly, I really enjoyed it.

The rest of the day was fantastic. I love being here and wish it weren't such a long drive. I'm really looking forward to racing here next summer and having an excuse to make a few training trips this spring.

Lake Placid

I arrived in Lake Placid around 10:30 last night and was immediately happy to be here. This is such a special place. There is a huge high school hockey team at the hotel so they upgraded our room to the top floor where we'd get some peace and quiet. It also came with a beautiful view of Mirror Lake. I sat in the window last night looking out at the lake, thinking about being there nine months from now at the start of my second Ironman. Very exciting.


It's sunny and 47, heading into the lower 50s. Today is a perfect day to ride the Ironman loop. It will be my longest and most challenging ride since Wisconsin so I'll take it easy and just enjoy being on my bike in a beautiful place.

Watching My Ironman

My brother had a video camera on race day but I never had a chance to see the footage until a DVD arrived in the mail today. I cannot describe the emotional weight of an Ironman. It's been eight weeks and I've barely trained and barely thought about the race, but the moment I saw the video I was filled with a variety of emotions ranging from happiness to pride to awe. I still can't believe I did it, especially given the injury I was dealing with. When I see myself on video I have a hard time believing it was such a struggle. I looked so happy. So I guess I really had the best Ironman experience of all: one filled with joy from beginning to end. I wouldn't trade it for the world.

If I can figure out how to compress the video I'll post it here. In the meantime, I got an update from the doctor today. He is filing an appeal for the PRP but I won't hold my breath. The more promising update is that he offered to discount the treatment significantly so it's back on the table. I have an appointment next Wednesday. We'll see.

I'm off to Lake Placid tomorrow!

Denied

I received a letter from my insurance company today confirming that my doctor had requested coverage for my PRP injection, what they referred to as "Removal of tissue for graft, Autologous blood process." The decision? The medical director reviewed the request and determined it was "Denied - Not Medically Necessary." The letter went on to explain that tissue grafts are not approved for my specific condition and there is insufficient medical evidence to support the procedure.

I hope they enjoy paying for the months and months of physical therapy, follow up MRIs, regular appointments with my podiatrist and likely someday the surgery or other treatment that will be needed to correct my chronic condition and resulting scar tissue. Medical insurance companies absolutely infuriate me with their short-sightedness.

So my recovery will continue as massive waiting game. I realized today it's been two months since it all began. Just two months out of the four to six I need to be recovered. I've lost so much in that two months that will take me an additional two months to regain. But on the bright side, I am getting better and now that PRP is out for sure, I'll likely start PT and hope for the best. Hope and waiting seem to be the only things my costly monthly premium covers.

Happiness is an Outdoor Pool

I had the chance to swim in an outdoor pool this summer while visiting my sister in DC. I loved feeling the sun on my back and getting glimpses of trees and green when rotating to breathe. It was such a nice change from the basement pool I swim in. I'm back in DC for the weekend and much to my surprise, the outdoor pool is still open and the only thing better than swimming outdoors in the summer is swimming outdoors in the fall. It was a crisp, perfect day, right around 60 degrees and incredibly sunny with light wind. The water didn't feel particular warm, but was just the right temperature. There were fall leaves on the surface and I had to keep my eyes closed because the sun was so bright. It was absolutely wonderful. For the first time since Ironman I actually enjoyed swimming.

I have a short week and long weekend coming up. I'm heading up to Lake Placid on Thursday for what was originally meant to be a big biking weekend. However, due to lack of training I'll be taking it easy and attempting only one full loop at what I'm sure will be a leisurely pace. I'm also looking into other activities I can do that won't bother my foot, but will allow me to enjoy the area. It is so beautiful up there. The weather is looking decent with highs in the upper 40 and only one day of rain so far, but it's the Adirondacks so I won't trust the forecast until I wake up each morning. Regardless of the weather and the time I'm able to spend on the bike, I know it will be a really great weekend.

Unthinkable? Amazing

I haven't posted for a few days because nothing has caught my attention... until today. I get the Ironman.com daily news feed and they shared that Scott Rigsby, the first double amputee to complete an Ironman, has released a book about his experience titled, "UnThinkable." The book documents Scott's journey from losing his legs to becoming an Ironman. I've always been incredibly inspired by Scott for so many reasons. He competed in the 2007 Ironman World Championships, the race that made me take the leap into this sport and changed my life. His story was incredibly moving. I was dealing with personal challenges and didn't know how to swim, but none of it seemed that daunting in comparison to what he faced to achieve the Ironman dream. When I completed my first big triathlon six months later, Scott was competing in the same race. It was really incredible to get a chance to see him compete. I'll definitely add this book to my reading list for the offseason.

This has been a very good week. I've been busy but in a positive and productive way. I've done a little bit of training and have worked to get back on my pre-race diet. But it all still remains very unstructured and I do it as life permits. My foot is still as is, but I can't rush it. I'm hoping to take some steps forward with treatment next week, be it the PRP injection or just old fashioned physical therapy. And I'm preparing for a long weekend in Lake Placid, the site of my next Ironman. More on that to come soon!

Baby It's Cold Outside

I love fall and in particular, I love October. That is until this October. We went from picture-perfect crisp fall days to 30s, rainy and miserable seemingly overnight. This shift in weather directly coincided with one of the most brutal weeks I've had schedule-wise in quite some time. All of it left me feeling pretty drained by the end of the week. I've been loading up on the sleep - 10 hours Thursday night, 9 hours Friday night and 8 hours last night. I almost feel human again, but I'm still bundled up, looking out the window at the freezing rain and wondering if I'll ever get to enjoy being outside again.

The frigid weather pushed me to start loading up on my winter cycling gear. I'm attempting to create a no excuses situation where I'll be forced to ride outside unless it's (A) Snowing; (B) Icy; (C) Pouring rain; or (D) Below 25 (ok, maybe 30) degrees. With the right gear, one should be able to enjoy our fair sport nearly year-round, right? Given I've never attempted to ride in less than 45 degrees, it remains to be seen but I'm up for the challenge. Yesterday, I invested in:

Gloves

Tights

Balaclava

The last item makes me look like I'm headed to a Monty Python themed costume party, but it will allegedly help me stay warm on chilly days. The thing on my must-have list is a good pair of neoprene booties to keep my feet from turning into blocks of ice in my breezy tri shoes. I'm planning to invest in either road shoes or winter cycling shoes eventually, but for now will rely on wool socks and booties for survival.

I ended up just taking it easy yesterday, and clearly doing some shopping, and in the end was glad I did. I was still feeling the effects of the week so any effort would have been forced and minimal. I got back into the pool today and also did my first strength training in months. Since I can't do much else I decided to make that a priority for the next few months. Hopefully I won't wake up tomorrow and feel like a bus hit me.

Barefoot Running - Hype or Help?

Barefoot running is suddenly the hottest topic in the sport. Everyone is reading Born to Run and more than half the athletes I know spend a portion of their running time in Nike Free or similar minimalist shoes. When I first read about crazy people doing marathons barefoot I thought it was ridiculous. How can that possibly be safe? Or comfortable?

Prior to my injury I had considered doing one short run per week in the Frees in an effort to strengthen my feet and beat my chronic PF. But now it looks like I'll have to keep running in my "little foot coffins" as referenced in this New York Times article, "Wiggling Their Toes at the Shoe Giants." It's an interesting article, recently sent to me by my dad after getting it from a friend of his who runs in the Vibram FiveFingers. Perhaps after my recovery I can give one of these alternative shoes a try and see for myself.

PRP - Maybe Not For Me

I finally got the call today I've been waiting for - my podiatrist's office letting me know if I could move forward with the PRP treatment. Similar to an MRI, the procedure requires pre-authorization that can take a few business days. It sounded fine to me, but then the office called and explained the process: I pay a deposit and have the procedure; they submit the claim to my insurance company; they reimburse me when the claim is paid. The catch? The deposit is $1,200 and the timing of the claim can be three months or more. Even more troubling is that the insurance company could reject the claim.

I've already paid out of pocket for my orthotics and am really not in the mood to do the same for an interesting, but definitely unproven treatment. Here is an article. What would you do?

NY Times