Monday, August 25, 2008

Perspective and a Race Report

Hoorah! I finished! I told Rob last night that I think this race was the hardest one to finish. I hear people talk about those "low times" in Ironman but I really haven't experienced it before now. But I'm getting a little ahead of myself so here goes the race report.

The swim start was great. Everyone around me swam so politely and worked together from the beginning. I sat in the back of a small pack of 8-10 swimmers and we were off. The water was cool but not uncomfortable. The swim went by quickly and I was out in just over an hour. I grabbed my bag and ran into the changing tent, quickly got ready to ride, and passed about 15 women in the tent. I don't know what they were doing in there for so long!

The bike went well. I love this bike course. I think the reason I keep coming back to do this race is because of the bike course. It is as beautiful as a postcard, and it has a little bit of everything. Long grinding climbs, challenging rollers, fast flats, and superfast descents. Oh, and I successfully peed on the bike! On my sixth Ironman, I finally got it!! Ok, TMI, I know.

Coming into T2, I was ready to start running. In my previous two Ironman runs, I have been getting a little bit faster, so I was excited about this one. I had just over 4 hours left before an 11:00 finish, so I made my goal to finish under 11 hours. I thought that would be easy. Silly me, nothing is easy in ironman!

Heading toward OK Falls, we had a terrible headwind. It was difficult to not get discouraged but I kept the heart rate in check and kept plugging along. Then I started experiencing some stomach troubles. I made many trips to the little blue penalty boxes every mile or so on the run course. I really had to "gut it out" from there, in more ways than one! It was so hard to keep it together and keep plugging along. I said all kinds of terrible things in my head -- I wanted walk, I wanted to quit today, I wanted to quit Ironman, I wouldn't take a Kona slot if they gave it to me on a silver platter(shame on me!)etc.

At this point I was past the turn around, and my perspective changed. I was watching all the people that were heading to the turn around, and I started thinking that they probably wanted to be where I was. So the marathon was not going as wished. Suck it up, buttercup. At least you are out here and you better give it your best. It began raining at this point, and as I came back into Penticton, the streets were still lined with spectators. They were cold and wet, but they were still watching and cheering. From their perspective, each one of the racers is amazing, and worth their time, even if it meant standing in the rain, to cheer us on. That gave me the motivation to give my best.

So I finished in 11:04. I didn't make my goal of sub 11 but it could have been a lot worse! I finished 6th in my age group. The Kona slot rolled down to the 5th place woman, who went 10:59. But, I sincerely mean this, it is totally OK. I know this woman has barely missed a Kona slot several times, and I am super happy for her. Keeping it in perspective.

Here is a picture of my three kids on the first day of school.

From their perspective they couldn't care less if I finished first, last, or anywhere inbetween. They just are happy I can tie a cute bow in their hair or help build a LEGO scene.

And here is where I am going now, world famous Tickleberry's ice cream. Oh yeah, I deserve that!

Friday, August 22, 2008

A Funny Thing Happened On The Way....

Today is Friday, a big rest day for me except for a short 20 minute swim. I was looking forward to the swim today because I have heard that the water is much warmer, already. Down at the swim start there were quite a few people with the same idea.

When I first got in, my feet were cold, but after a few minutes the water was PERFECT. Seriously, it is quite a bit warmer than it was two days ago. I was really enjoying my swim, feeling smooth and fast in my new Xterra Vendetta wetsuit, thinking how clear the water is ("hello fishies down there!") and what a great swim it will be on Sunday, then BAM!!! Head on collision with a rather large guy in a bright pink cap. OUCH! The first thing I thought of was the sound -- I was suprised how loud two skulls sounded when they hit head on. Then I tasted blood in my mouth and thought "that wasn't very fun". So I popped up, Big Pink Man popped up, and we both apologized. He was very nice, and it was all good. Really, it could have been my fault just as much as it was his. I finished swimming to the Sycamous then turned around and came back.

My friend Michal was waiting at the shore. When I finished swimming, my noggin still hurt a bit, and I told her what happened. She started laughing hysterically and said that not too long ago a Big Man in a Pink Cap exited the water and said "I ran into three people on my way back in". She thought it was so funny that I happen to be one of those people! Maybe it wasn't as much my fault as I thought it was! Well, luckily, on race day we will all be heading the same way, so that won't happen again.

Thursday, August 21, 2008

3rd Time's A Charm?

This will be my 3rd annual trip to Ironman Canada. This year, for a change, I decided to fly into Spokane then drive from there to Penticton.

It worked out great. The flight to Spokane was easy, and the airport there is pretty small and getting in and out was quick.

I shipped my bike to a local shop in Spokane, because I though it would be important that my bike went with me on my drive to Canada. Uh, yeah. What a nightmare it would have been if I had to wait around in Spokane for my bike to arrive on some later flight.

Here is a picture of my bike waiting for me to come get it outside of Two Wheel Transit. It is a really cute bike shop but my bike didn't want to get left behind. She heard there was a party in Penticton and she didn't want to be late.

This is the coffee shop in Spokane where we had lunch. It is just about as cute as the bike shop.

We drove past the Grand Coulee Dam on the Columbia River.
Did you know there is enough concrete in the Grand Coulee Dam to build a 60 foot wide highway four inches thick, from Los Angeles to New York City! ~ That is a 4 lane Highway 3,000 miles long!

Here is a picture at the US and Canada border. Not a very good picture, but I didn't want to stop and get out. It was raining, plus I don't think the border patrol would appreciate any horsing around at their border.

We drove past the Husky Station that marks the turn up to Richter Pass. My bike wanted to get out but I told her she had to wait until Sunday. See ya on Sunday, Richter, my old friend.

Finally, we made it to Penticton in the afternoon.

Driving into this city is a welcome site. I love this race and this place!

Here I am standing by "the peach" -- the most well know landmark in all of Penticton. Well, maybe not, but it ranks way up there. I registered and have my hands full of my race "stuff". The swim start is behind me. The water looks like glass. It really is a fine sheet of ice that is over the lake that makes it look that way! And look out there in the water -- a poor soul is stuck in there, frozen, and can't get out.

Just kidding. The water feels VERY COLD to me, below 60 degrees. But I can't find too many Canadians that will show me any sympathy. Obviously.. that dude is out there without a wetsuit!!

Tuesday, August 19, 2008

New Motivation

1972 was a simpler time. Technology was still in its infancy. Digital Watches were just being introduced. The first scientific hand-held calculator (HP-35) introduced (price $395), and Atari kicked off the first generation of video game with the release of "PONG". HBO was just launched in US as the first subscription cable service. There were just a few fast food restaurants in our community.

Most kids then played outside all day. When school was released, I ran home with the motivation of beating the bus riders. I rode my bike all over the neighborhood and throughout the town. We played football in the vacant lot. There were only three TV stations and cartoons played on Saturday mornings. Besides that, nothing else was that interesting, so TV was a less important part of my life.
I grew up in the Kansas City area. My mother put me in a lot of different sports as I grew up, but at 10 years old, in the summer of 72, I preferred the refreshing cool swim practices versus standing in the hot sun in the outfield.

1972 was also the first time I remember watching the Olympics. What caught my attention at that time was a swimmer named Mark Spitz. It was a big story and the family gathered around the TV to watch his events. I was new to the sport and his achievements were both inspiring and motivating to me. This was the first time I had seen medals awarded and learned the significance of each color.

I had a poster of Mark with his seven medals on my closet. (above) I can remember below it said "7 gold medals, 7 world records" and it listed each one. I examined the medals closely on the poster and can remember that I wanted one.

The last swim meet of the summer was an invitational, and I had heard that they were awarding medals to the top three in each event, just like the Olympics. My best event was breaststroke. I was in one of the slower heats so I knew that I would have to swim fast to beat the kids in the later, faster heats. I was a boy on a mission. I wanted a gold medal.

I still remember that race vividly. It was only 25 yards and I stood on the blocks gazing at the end of that pool. I knew I had to swim fast. When the gun went off, I hit the water and stroked as fast as my gangly 10 year old body would take me. I won the heat. I remember, after finishing, looking around and the rest of the kids were still swimming a quarter of a pool length behind me. I had given my best effort.

When the results were published, my name was at the top of the list. I had won the gold. It was only about the size of a quarter on a red, white, and blue ribbon, but I was so proud of it. I was probably just as talented as the rest of the kids there but I guess I just wanted it more. I learned early, that motivation plays such a big part in success. I willed myself to win that medal. I have won many medals since then but none of those wins were as special as that one.

Since that time I have continued with some form of a fitness program and it has just become a part of my life. One of my former training partners called me a "Lifer."That poster, and what Mark Spitz did in the Olympics in 1972 were instrumental to my development and current lifestyle.

Fast forward to today, 2008. There are over a 100-cable television channels. I don’t see any kids today outside playing or riding bikes. I suppose, now, they are inside playing Madden football rather than playing it in the vacant lot. I heard the other day that based on the current trends, everyone in the US will be obese in 30 years. I don’t see that happening.

I have my kids in athletics, and it is a requirement in our family. I don’t care if they win or lose. I don’t push them. If they want to win, it has to be self driven. I just want them to develop the "fitness" lifestyle. I want them to be healthy and be "Lifers"

Michael Phelps did something special in Beijing by winning eight gold medals. Mark Spitz described his 100 fly win as "epic." I don’t remember an age group swimmer in my local meets being as dominant as Phelps was in these Olympics. It was truly amazing. Talent combined with motivation is an awesome thing.

I wonder if it is possible today, with the current trends, to motivate today’s youth to swim and develop lifetime fitness habits. I hope Phelps efforts have motivated today’s youngsters away from their virtual sports worlds and into real world sports and a quest for their own medals.

Sunday, August 10, 2008

Dealing with the Damage

In 2005, I made a comeback into the sport of triathlon. I had yet to do an Ironman or half Ironman for that matter and before I got too old, I wanted to be able to check this event off my “to do” list. I took it much further than I had dreamed, and that one Ironman turned into three including two World Championships in Hawaii. In 2007, I was top 10 in my age group there. If I never do a triathlon again, I would be satisfied. It’s been a good run.

I have been training consistently for three and a half years without illness or injury but this year things have not gone so well. Multiple aches and pains have caught up with me. For the past year and a half, I have been dealing with discomfort in my right knee, which, in the past, I was able to endure and train through.

After the Buffalo Springs triathlon last month, the pain in my knee became too much to bear and I was unable to run without an abnormal gait. When the pain became constant, I put the running on hold and started swimming exclusively to see if it would go away, it didn’t, and I feel it actually worsened. I sought orthopedic attention and underwent arthroscopic surgery this week on Thursday 8/7.

I had my surgery done at a local outpatient surgery center here in Tulsa. I used to supervise the nurse anesthetists here so I was familiar with the staff and the routine there. I worked until 10:30pm the previous night and the last case of the evening I did was an emergent incision and drainage of a large back abscess on an obese diabetic man. It was disgusting. We sucked two liters of pus out of it. Needless to say, I was happy that I had chosen to have my surgery done at a clean new outpatient center. The last thing I needed was a nocicomial (hospital acquired) infection.

I arrived at the surgery center at 9:30 am the next day, and filled out the last set of paperwork including living will forms. I planned to have this surgery done under local anesthetic and MAC (monitored anesthesia care)…awake, so this seemed to be a little much. Tim Davis, a friend of mine, texted me on my phone and claimed my bike if I died. I texted him back and told him that bike was his if I didn’t survive.

I was quickly escorted back to the holding area where I received the standard issue a gown, hat, booties, and was placed in bed number 4. There, I got my IV and passed the time by watching my own personal TV where I caught up on details regarding the Brett Farve trade. I hope it works out for him in New York.

I had many visitors by old friends and folks that I used to work with. A surgery center like this is a great place to work. There is no call or weekend duties and the patients are healthy, unlike the major tertiary center where I work. Many nurses move on to places like this, it’s a much better lifestyle.

Pat Case is a nurse anesthetist that I used to supervise and she arrived there early and signed up for the room that my case was to be assigned. Pat is an avid cyclist and is fluent in Italian. She has a second home in Italy, and has ridden most of Italy’s major mountain passes. Pat has even been to the Tour de France. She would always have a copy of Velo News in her bag that I could read when I was working with her. I was pleased that she would be taking care of me.

Dr Ron Hood was my surgeon. He trained in San Francisco with Eric Heiden, the former uber Olympic speed skater and professional cyclist, who is now an orthopedic surgeon. Ron is an expert on knees and sports medicine. I liked the way that he was able to do a good local block to allow the patient to stay awake and watch the surgery. It was what I wanted. The post op pictures just don’t show the knee as well as a dynamic live view.

I was taken into the room and hooked up to all the monitors. I requested not to get any Versed (Midazolam). It is a potent fast acting benzodiazapine, which causes amnesia. I usually give this as my pre-anesthetic and can quickly convert a stressed person into a laughing jokester. It is known as truth serum and is often used illegally as a date rape drug. It has a half-life of 2 hours but I had no idea how I would be affected by the drug. I wanted to remember the procedure so I opted not to have it.

When the scrub tech pulled up some local anesthetic in a 60 ml syringe with a long 18-gauge needle, I asked Pat “I think I’ll take that Fentanyl now“. Fentanyl is a fast acting powerful opioid, which is ten times the potency of morphine. I observe patient’s reactions daily as I administer it, and often wonder what it feels like. It is a frequently abused drug in our profession. I soon found out why.

I felt a lightheaded and a warm euphoric feeling came over me soon after I got it. It was smooth. The next drug I asked for was Diprivan (Propofol). It facilitates inhibitory neurotransmission in the brain mediated by a transmitter known in short as GABA. It often burns as it flows into the vein then it renders immediate unconsciousness. I was commenting on the lack of the burn when the next thing I knew; Pat was quietly speaking my name and waking me up. I opened my eyes, I looked up to the screen, the scope was in my knee, and the surgery was already in progress. “Wow, how long was I asleep?” It’s been a while since I have had anesthetic and each time I marvel at the power of these drugs.

Ron quickly went over his findings. Immediately, he said they found cartilage loose bodies floating around in the joint. There was a tight plica stretched across my lateral femoral condyle digging a groove into it. He demonstrated the damage with instruments. I had a torn lateral meniscus and my lateral capsule demonstrated some tight bands causing my patella to track laterally. The photo shown below is the synovial plica which was removed and causing the problems.

Loose cartilage body

Lateral Meniscus tear

Femoral cartilage groove

I had no pain during the procedure and I asked questions just as I would have if I was sitting back there administering the anesthesia.

The lateral plica is a rare finding. Most plicas are medial. The most likely cause of lateral plicas is trauma or overuse. He said he had never seen anything like it. After he pulled it out, I looked at it. It had the consistency of ligament and I knew that it was the source of my pain. It had gradually gotten thicker, tighter and tougher and had begun to wear a groove into my femoral cartilage as a steel cable would if it were rubbed repetitively across a piece of wood.

He trimmed up my lateral meniscus and did a lateral release of the tight capsular bands and I was done. Here is the trim job ----->

I was taken to the recovery room where I was greeted by recovery nurses, Lacy and Kelly. They were familiar faces that I usually drop patients to in the hospital after they awake from anesthetics. They had moved to outpatient too. Dana eventually was allowed back into recovery to be with me. I am normally reserved guy but the Fentanyl made me euphoric and I wouldn’t shut up. Dana had to tell me to put a lid on it. The cardiac alarm above my bed was going off because my heart rate was extremely bradycardic at 38-39 bpm and it was causing a racket. I’m sure that they wanted to get me out of there.

Lateral capsular tight bands

I was discharged quickly with crutches, a large portable ice cooler attached to a knee wrap, which was great. I didn’t need to take any pain medication and my knee felt better after surgery than it had before. This was a good sign. The referred pain, which radiated into my calf, had also disappeared.

I was able to go to work the next day on crutches. I arranged a long room where I could prop my leg up and ice my knee. I brought my knee cooler with me.

Recovery is going well. I might start swimming again on Monday and then in two weeks or so, I will be able to get back to cycling. Meanwhile, I think I will take a break and watch the Olympics. It’s a good time to be laid up. It’s nice to have some motivating TV to keep me off my feet and keep me entertained.

I am so glad that I made the right decision to go through with taking care of this issue now. It’s a relief to know that the source of my discomfort is resolved. Maybe it isn’t all over for me. I plan on a smart recovery and focus on next season. I look forward to the journey back.