Sunday, April 17, 2016

20 days post surgery

Spirits are stable and mainly up
So here I sit. All in all, my spirits have been pretty even and generally up. I had my post operation visit with the doctors. They said everything seemed to be healing quite well. In fact, I think that worked against me because where my sutures were in, my body was starting to get pissed off to have to deal with them. I had a small spot that a little abscess formed as a result. We quickly got me on some antibiotics and that seems to be working like a charm.

Ditch the crutches
I was expecting at this appointment that they would tell me to start to introduce weight bearing gradually. Instead, they told me to go ahead a lose the crutches and try to have a go with just the boot! I was a bit shocked cause you come in there thinking not to let the foot touch the ground, and leave there with instructions to suck it up. LOL. Kidding of course but only kind of.

I couldn’t do it that first day, it was too painful on the medial and internal side, but was told that was normal. The fat pad at the bottom of my foot wasn’t ready for the weight bearing either so that took a couple days. I do have two pretty big wedges in my boot and I thought I would introduce a familiar feeling to my foot to help it along. So I grabbed an insert from a pair of running shoes and put that in the boot. It actually worked quite well. Within 2 days I was already doing about 90% walking in the boot.

Walking in the book sucks. It makes my one leg a lot longer than the other so I have to be very careful to not let my knee hyper extend while walking in it. I have heard many people need to follow up ankle surgery with knee surgery for this reason. I really don’t want to do that. So I am trying to just take it slow, and when I want to walk fast I grab the crutches.

The boot is heavy, its hot, and I am so thankful I have been cleared to just not have to sleep with it anymore.

Trying to not be a fat ass.

I have been able to go t strength 4 times already. Garrett has been awesome. We come up with complete circuits where I am basically on my knees the entire time. He has been great though as I can actually say I leave there feeling fully challenged.

This week I was able to actually get on the trainer and spin. I leave the fan off so I can actually sweat a little bit but today I was able to ride for 65 min at an average of 165 watts. I have to have the boot on, and a running shoe on the other foot to make it work. I also lower my seat a bit so my calf isn’t put under a lot of stress. I don’t want it to pull on the tendon repair. It makes your ass incredibly sore sitting on a low saddle without any standing breaks at all.

I’m not really working out for a comeback, at least not yet. I still have not decided how and if I’ll do a comeback to competing yet. I have a unique opportunity I believe right now where I can comeback if I want to, but I don’t HAVE to return to the same level of training for myself. This season basically off creates a natural break point for me to decide what it is I want to do. So I am going to take my time with that. For now, I just like moving and staying in touch with fitness. I know I always want to do something.

PT makes all the difference

I have been really lucky to know some of the best PT’s in the world I believe. Three immediately come to mind.

Bryan Hill in California

Wolfgang in Scottsdale

And Gina Pongetti here at home.

Gina works with USA gymnastics athletes, Cirque, and is an Ironman competitor herself. She teaches dry needling, Garston, ART, and many more techniques I’m sure I am leaving out. So I am damn lucky to be able to go to her.  She has been working her magic on it already. We are able to already mobilize the joint, work on the plantar fascia and start to do band work to strengthen my ankle.
It is giving me tremendous confidence that all will be well.

Sick - ugh

I final caught a bit of a cold. So if I can just shake this, I think I’ll be good to go. My next surgery is in 4 weeks. The Dr. was like “you sure?”. I told him, I just want to get through this. If I can be healing two things at once, I’m down for that. I have no doubt that I will be in for a tough May/June. However, my goal is to be able to walk around the 4th of July and be able to work out that morning ding something. 

Sunday, April 10, 2016

2 weeks after surgery

I was able to go off the pain meds after about 3 days. They gave me some powerful stuff, and some not so powerful stuff. I never used the big boy stuff, had a few restless nights but all in all seem to be fine.

My foot swells a bit when I am up and about a lot. That makes it uncomfortable but the stiches seem to be healing quite nicely and Tanya, is dying to take them out here at home. To be fair she is an Orthopedic surgical PA. We are waiting at this point to hear if the Dr. would rather us come in for that.

Gina has given me a few PT sessions already. I’ve been in a boot so have been able to do some slight movements of the foot and its remarkably tight, but very little pain. At this point I think the PRP felt worse for the first week but the IDEA of what is actually trying to heal makes this recovery more serious by far.

I’m supposed to be able to do slight weight bearing starting Tuesday I guess. For the first time since the surgery I can start to wrap my head around the idea that it would actually be able to be done. I worry how this foot will be able to do all that my good foot has been doing for me in just a few short weeks when I have my other one done. I don’t think it will be able to yet but I still would rather they both heal up simultaneously then to get all the way through this then restart the entire process. We may look into wheel chairs for a couple weeks to help ease the burden of the good foot while it gets strong.

I’ve actually been able to work out with Garrett twice. I’m on my knees the entire time but am able to do sit ups, curls, pushups, band work, etc.

I still put the oils on it 2-3 times a day and I think it is helping things heal up nicely.

I should have more to report in a week when I can actually start to use it. until now, it’s just been hanging off my body. So nothing really to update.

I do feel very satisfied at this point I had this done. I have zero regrets. At least for now. J

Friday, April 1, 2016

3 days post Opt

Once I decided to have the surgery I needed to figure out where and when and who.
Dr. Paul Bishop as an amazing podiatrist who I have been using and I initially scheduled my surgery with him and felt very good about the decision. As Paul and I are such good friends, he refused to do my surgery if I didn’t talk to someone else for a second opinion first. He had a few names he wanted me to go see. I really didn’t want to, I wanted to get on with the procedure. Everyone I respected though Paul, Gina, Tanya, etc. told me to get take the time to get the second opinion.

First I cannot believe the level of support that the endurance community gave me. Julie Dibens found out what I was going through and wrote me. She offered to give me her surgeon’s name. Lindsay Corbin said she would help get me in touch with someone.  I can’t thank everyone enough.

I’m the type of person that when I decide to do something, I just want to put the best people around me and get on with the jo at hand. I finally agreed to go to another person though. Paul told me to go see someone he said if he was having it done, this is who he would use. After meeting with this doctor he said I absolutely need surgery on both sides. He is very good at this, has done several hundred, and he had a technique that he felt would allow him to hopefully not have to graft it. It is called a speed bridge. My understanding is it will help increase recovery time. 

I should add here; these are the question I really wanted answered:

-        How hard is this procedure? How important is the person doing it? Obviously you want a good person but was I searching for a brain surgeon type case, or having my tonsils taken out effectively.

A: It’s a pretty important procedure and the skill level of the surgeon matters a lot. Not only in their technique, but their understanding of what you want to do with your life. For example, if you need a graft; if too much of the tendon is damaged they will need to fill that void with something after they cut it out. If they do a graft, there are several options on what they use. Synthetic, hamstring tendon, or mist common is the HFL, which is a tendon that your big toe uses. I did NOT want to use that tendon. The Dr. I went with does use that often, but we agreed to leave that option off the table. You need to know the person has had a lot of success because the scar tissue left behind could then be an issue, or if the tendon isn’t reassembled at the right tension, that could be an issue. So bottom line. The surgeon and his technique matters. Big time.

Do your research on your doctor. It’s insane what I found online. In some forums doctors were asking other for advice on HOW TO DO The surgery. Don’t pick that one. LOL

-        What was my most probable outcome? What would my recovery outlook be?

A: I had a couple people I talked to initially tell me that my career as an elite racer would be over. The surgeons I narrowed it down to felt that while there would be a LONG recovery. Perhaps a year or more, I could have a great chance to return to normal. Nobody could promise me this of course, but I knew I wasn’t going with anyone who going in, didn’t think that was an option. I have to get BOTH done So my recovery will be a bit longer. They wanted to do them 4 months apart. I got him to let me schedule 6 weeks apart.

He wanted me to make sure I was happy with the outcome of this first one, but I already know I hate how my foot feels now so I want to get on with it.

I am told I will be total non-weight bearing for 2-3 weeks. I cannot do any workouts until my sutures heal. Otherwise I risk infection and that’s just simply not worth it. I will start PT next week. This is because I have an amazing PT staff around me. They really know their stuff. You don’t want to activate the tendon but there are other thigs they can do.

I believe your PT the rehab I do will dictate my success at returning to good form. I read stories where some surgeons recommended no PT for follow up and then these people wonder why they haven’t had success with the procedure.

One thing my PT already told me – I need to be able to do 5 single leg calf raises BEFORE I am cleared to really run or the muscles and tendons are not strong enough and while yes I COULD run, it would start laying bone down again because the body has a memory and if it senses that your tendon is not strong enough yet, or the muscles, it will lay down bone again to protect itself.  When you think about that, I am not sure if I could do 5 full calf raises before. Just more proof on the types of “little things” we can all pay attention to get better and make sure we are healthy.

-        How extensive will the surgery be?

A: You don’t get that answer definitively until they get in there and look around. Be prepared for that. You can absolutely get some ideas from an MRI and X-ray but you will not know for sure.

-        How do you know if surgery is the right choice?

A: I tried everything else. PRP, Shock Wave, orthotics, PT, etc. It got to the point that I could run some days with little pain, but then couldn’t walk right the next morning. Or even later that day. For me the pain was bad enough that I was starting to hate training. I wasn’t able to train the way I wanted to in order to be able to do the results I wanted. Then I started to feel terrible just in my everyday life. If I can’t return to the results I used to get, I’ll be bummed, but I can live with that. I don’t want to have pain all day every day like I had been having. That’s when I knew. It just was not fun anymore.

I also wanted to do it at a point it wasn’t so bad that my body couldn’t come back from it. I wanted to be decisive as to give myself the highest probability of success for recovery

So I had surgery on March 29th, 2016.  They did a local nerve block which meant I couldn’t feel my leg and general anesthesia. I had never had this before and I can’t believe how out you are for a surgery. I have to admit it’s one of the craziest things I’ve ever experienced.  

The surgeon said he has done several hundreds of these and I was in the top 3 overall with the extent of the of the bone growth. He was worried that the growth was so bad that the bone would no longer bleed. Essentially your body gives up on the area. He said mine bled very well, the blood looked very healthy and the surrounding Achilles tissue was in good shape! I credit that to the therapy I have been getting and Tanya having me on her essential oil supplements.

The last two days I have been pretty uncomfortable, been managing with pain meds. My foot cramped in the middle of the night on the second night home which made me shriek in pain. I was upset because I thought it hurt, but was afraid I was going to mess up the healing. I was wearing my boot and as long as you do what you are told and wear it, you should be fine.

Tanya has given me all type of oils to apply to the surrounding area (not the incision). They help promote tissue growth, anti-inflammatory, and immune health. I know the two things I want to try to prevent now are infections and scar tissue. So I am doing everything I can think of to do that.

I’m still not ready to go for a run yet, or really anything else, but it is feeling a lot better already on day 3. 

Tuesday, March 29, 2016

Surgery (Achilles Tendonosis / Haglunds deformity)

I had surgery today. I realize that this may be a thing a lot of people have gone through, but I haven’t.
I have been racing competitively for over a decade in triathlon. Been participating in the sport for more than 25 years, have always played other sports growing up and other then a very minor broken bone in my hand once and my foot on another occasion, I have been relatively bullet proof.

Needless to say I was a bit distraught at the idea of this and too make matter worse, I was even more concerned because as a triathlon coach I am used to being out among the athletes racing. What would happen if I wasn’t? I guess for both I still have a bit of time to figure that out but here is what I already do know for certain.

1.      I blog rarely. I have been told so many times correctly that I should tell my story more often. I used to weigh over 240 pounds, I was very out of shape, couldn’t run a mile…etc. I have since been to Kona 9 times, qualified for it closer to a dozen times. I have been 9:16 at Hawaii which I think is important not because I want to brag, but I had to figure out SO MUCH in order to get that. Once I did figure it out I was routinely under 9:30 and qualified dozens of athletes who have never been before and I was able to pass that info on to them.

Still I have never felt totally at ease talking about myself. I see some people blogs talk about how awesome they are, and good for them! To me though, it’s always felt a bit strange. I concentrated a lot on my own results, and they matter to me greatly but I have always cared MORE about my athletes and their performances. So to just write about me, felt strange.

2.      I had no time because I was helping athletes. Those who are coached by me know that RARELY are the times they do not get a response immediately. If not right away, within hours. My days were so busy. By the time I have been finished doing everything I needed to do for the day, I wanted to veg at night and typing has never been my thing. Hell, I still look at the keys when I type. LOL. I even tried to get a speech recognition software! That didn’t work well. I had to spend more time going back retyping my words to make sure it wasn’t putting down something like “I started to peel pretty fuzzies” when I was really trying to say “I started to feel pretty funny”.

3.      Some of my partners like Joe Friel, and Jim Vance write so eloquently, it can be humbling to write an article when you see some of the stuff these guys produce as well.

4.      I started a podcast! So I host a podcast semi regularly- Training Bible Coaching Podcast, This gave me a great medium I still enjoy using to get my thoughts out there.

When I started to look for information on my surgery and more importantly outcomes, the information was VERY hard to find. It would bring me to blogs where people mainly had bad things to say. This did nothing but freaked me out. My wife, Tanya who does orthopedic surgeries, and an athlete herself, would tell me not to read that stuff, but it was addictive!

So anyway here is what I am going to try to do because I think a lot of people deal with what I am going through. I am going to try my best to give a weekly update to let people know what the scoop is and hopefully give anyone searching for info a bit of a glimpse into what this is like.

My issue:

Haglunds deformity on BOTH heels along with calcification in my Achilles tendons caused by tendinosis and the actual rubbing against the Haglunds which is much like a bone spur.

My symptoms:

Chronic pain. Sharp, dull, aching, you name it and I had the pain. I would walk down the stairs especially in the morning sideways for years because it hurt so much to put stress on my Achilles. I had insertional tendonitis / tendinosis so any type of pressure at all to my forefoot and I would be in pain.

How did I let it get so bad?

Without addressing what CAUSES it yet, I’ll tell you how it got to this point. When I first had this pain, maybe 8 years ago, I went to an ortho who took an x ray and told me what was forming. He told me what caused it. He suggested ways to try to avoid it, and that for now, just let pain be my guide. So I did. Well, let’s be honest, once it would start to feel better I wouldn’t do the prehab work I was suggested to do. I would just work until it felt bad and then would do the therapies/ massage/ rolfing, etc. until it felt better. It always would feel better, than I would get lax on it again. Well what happens is that while I was ignoring the root cause, what would happen was it would be laying down more deformity. That was starting to add up so the therapies were getting closer and closer together until they were constant. Last March after Oceanside it hurt during the run, and really never stopped. It hurt me all year and I was beside myself trying to figure out what was the next “therapy” to get me through the next interval that would help me feel better.

I went to an amazing podiatrist who set me up with some orthotics. He sent me to a doctor that did a low frequency shockwave therapy. this effectively would create trauma in the area to help the body re recognize it needed to heal itself and I tried this first because I was allowed to train through the therapy. It was incredibly painful to go through. It definitely helped in the short term. It felt like a mallet was repetitively hitting my heel to create the trauma.

Another reason I was willing to try this is because it was May and I still wanted to race for the season. I mean, that was what I did in the summer and I couldn’t imagine not. Plus, I was doing Kona for my 9th time and I was close to my internal goal of doing it 10 times.

By July I was already in pretty good pain again. Paul, my podiatrist who at this point was just doing damage control, helped me a lot with some orthotics. They got me through to where I could train OK, but I could never do the training I was used to. I was in constant pain all year. My races went like crap to be honest, I started to resent the training, but I thought if I could get through Kona and possibly qualify at Florida or Arizona then I could address this in the off season.
I don’t want to make this about my races, so briefly the season went belly up. I had a crappy run in Kona, and while I was second overall off the bike in Florida, I walked the entire run. Hence, no qualification.

After the last race we had decided to try PRP. At this point Gina Pongetti, my PT who is the most amazing PT I have been able to work with ongoing, and Paul Bishop my podiatrist had been keeping me together with duct tape and sticks. They both suggested to try to least invasive procedure first and I went with PRP. They warned me I had a structural issue that would eventually need to be dealt with, but this could buy me time. I had that don’t to both heels at the same time and to be honest thought it may have worked! As soon as I started to really try to run again though I realized I was staring down the barrel of another season like the one previously and I knew I didn’t want to do that again.

This time though, I was thinking March/May (they can’t do them both at the same time) would obviously take me out for the season. I have a faint goal of potentially being able to do the swim and bike at Ironman Florida this November but I have no clue if that’s possible, or if Ill want to, or how I would feel about going into a race I knew I wouldn’t finish. Another blog for another day.  But doing it now, yes would take me out for the year BUT I give me an awesome chance to race again next year if that’s what I choose to do. It would also relieve me of all timelines to have to get better by a certain date because now I can really let things heal and be smart with nothing hanging over my head.

What CASUSES this?!

While some of my research indicated it could be related to some genetics, basically this is caused from tight calves. Yup. Stupid huh? It’s not so simple to just say your calves are tight, WHY they are tight can be just as important.

I was not engaging my glutes when I was running which was making me run with more hips which cause my calves to tighten up under increased load. So when I say I wasn’t doing my prehab work, it goes way beyond just stretching. This is why now; all the athletes I coach I have included a strength professional to work with them to give them the work they needed. Even our Athlete Membership Program athletes get this included. Like all the other stuff I have learned along the way to make me better, this is one of those lessons and it’s critical! The problem is, it’s doing things like lying face down and lifting your heels towards the ceiling. Not fun, in fact boring, and it doesn’t even feel like a workout. So I used to skip that stuff. LOL… oops. L

It’s so important to do the little things right. Its also so easy to blow off the little things. Opt to always go for the hard ride, or run, or whatever your friends are doing. Please don’t make that mistake.

So here I am. Literally 8 hours post op. I’ll post to you the pictures of my x rays. I’ll show you in a link what they did and I promise to try to keep my blog current on my recovery.

This is getting very long so I will write later about the surgical experience. Please email me any time if you have any questions regarding this. 

As for my other concern. I have more time than ever now to focus on the athletes I coach! 

Sunday, March 20, 2016

Just an example of the topics we have in our AMP forum

I was wondering if anyone out there has any tips or experience with dropping weight while race training.  By way of background...

I am 38 years old, 6 foot 4 inches and at 225lbs right now.  I have dropped 10 in the last month but was hoping to get down to around 200.  My diet is actually not bad and I try to hit around 1800 calories a day.  I track meals with myfitnesspal to keep me honest and use a fitbit charge hr to get an idea of health/activity level outside of training.  I have a desk job so during the day I am pretty sedentary.  I have two young kids so schedule can get hectic.  This is my second season doing triathlon.  Last year I did two sprints and one olympic.  This year I have a sprint in May and a 70.3 in July.  Aside from health I want to drop the weight because hauling 20 less pounds around the course would clearly help performance.  If I have a weakness diet wise is salty snacks.  I avoid the chip aisle in the grocery store like the plague because I have no self control.  (Who can avoid bacon mac and cheese flavored chips?)  As I said I have lost 10 in the last month but when I ramp up intensity and training hours that is when the hunger comes on stronger and I am worried I hit a wall weight wise.

One last thing.  While I don't have a need to attend weekly meetings where they serve stale donuts and bad coffee I like beer.  The occasional weekend trip to the brewery with a growler to go home is sometimes as important as those long runs and rides.  It helps the mental health when you have 6 year old twin girls.

So with that background in mind here are a few questions and if anyone out there have some of their own to add or are trying to do something similar feel free to chime in.

How much intensity should you have in your workouts vs. low heart rate so you can spend more time working out?

What things should you look to snack on when the hunger hits between meals?  (please don't say a handful of broccoli)

Are late evening meals deadly for progress?  (Sometimes due to schedule I don't sit down to eat until 8 pm or so after I workout)

Rather than take a rest day should you incorporate something like very light spinning just to burn off some more calories?

Is 1800 calories a reasonable target and how should you distribute them throughout the day?  I usually have something very light for breakfast decent sized lunch and a little larger dinner.

Your comment...

Tanya would be a bit better for these but let me take a crack at what helped me:

In general you cant manage your weight just through working out. don't fall into this trap. Its an easy one to get caught in for sure. I still struggle with that too. Your weight will be mainly managed through your diet. 

intensity is key to helping you burn calories. that doesn't make you fat burning efficient though, those are two different things. when you work out harder, you burn less percentage of fat but the overall calories burnt are a lot more. so its like getting 50% of a dollar or 30 percent of 10. percentage is lower but the caloric burn is a lot more. you also get an EPOC effect with things like high intensity or weight lifting. that basically means that when you do high end type stuff, your body continues to burn after you stop.

TO be successful at long course triathlon though, you have to get your body efficient at burning fat for a fuel source. You have to accomplish that by working out at the right intensity, not taking on any calories (in my opinion) for the first 60 -120 min depending on you, your experience, and activity level. They when you DO take on calories you do something to help limit your blood sugar spikes. One thing that I would try to take on my long rides were the individual made nut and raisin pouches from Trader Joes. Easy to carry and you don't have to finish it all at once.

- BTW I would use those as snacks too. 

I also like mojo bars as they are easy to carry, taste good and low on the glycemic index   

I am not qualified to tell you how much you should eat but good rules of thumb:
- never eat a carb by itself. Always try to eat a fat or protein with it. 
- only eat if you are biologically hungry
- try to eat real food when you can
- don't change too many things at once. 
- if I was hungry at night I would have a snack. but not a large one. after a few bites, you are probably not hungry anymore. 
- chew gum :)

Oh and drink a lot of water. 

Tuesday, March 15, 2016

Have you done what you NEED to do so you can do what you WANT to do?

This time of year it can be a wonder if how you feel in training is actually going to translate to better results this season. Most people train in doors through the winter months and do not get a chance to test themselves against their competition, or the clock in a race like situation.

I remember going into most of my early season races. I would be constantly searching for objective feedback to make sure I had done what I needed to do in order to do what I wanted to do. Until you can get out there and race, or do a hard training session with your friends, you won’t REALLY know. However, there are some pretty cool things you and your coaches can look at to make sure the training you did this season has had positive changes. If it hasn’t, that’s OK! It’s still MARCH and plenty of time to course correct for this season.

A lot of winter months I will try new workouts with my clients, or new programs such as Trainerroad, or Zwift. It is based in science and experience, but at the end of the day there needs to be a leap of faith to see if the new changes are working.

I also like to use testing but like to test my athletes at times when then don’t even know it. J These charts give us an ongoing look at what things look like at any given duration. They take your best effort no matter what the date, what the workout, etc. It looks through all your efforts and takes your best results and charts it.

One of the things I do is look at how we are doing relative to the entire last season. In March, that means we are normally off on a lot of the duration's. This is the case because we are measuring your current winter fitness against all your races from the previous year. Not a fair comparison. So we do another look to see how we are doing relative to the same date range a year prior.  

Sunday, March 6, 2016

Getting the right results can be key

Wanted to take a min to show you what some of the tweaks you can make in training can do to effect results.

This is an athlete that is performing at a high level in both bike and run but the principals could be applied for many levels. Too often athletes train every zone too hard. It’s easy to understand the reason and logic behind why they do that. They assume if they work really hard they should get results, and they do! Sometimes though results that they didn’t want.

Last year with this athlete we spent a lot of time building strength and really pushing their ability to hold higher wattage for longer periods of time. The issue though is we wanted to raise high end output this year to a new level. We decided to take a risk and significantly back off the intensity on the longer days trying to save energy for the shorter days. It seems to be working perfectly!

Check out these charts below to see the progress graphically