Recovery update - GETTING BACK!

I’m finally feeling like I am at the end of recovery (almost). I’m able to run on the alter G now with fairly normal speed up to 80 percent un weighted. Ironically the Achilles on either side isn’t eh part of my legs that gets the most tired or sore, so I take that as a good sign.

I am able to bike almost normally. What is hard is the standing and not letting my ankle drop at the bottom of my pedal stroke because the calf is just not strong enough to push with just the forefoot. At first I thought my saddle was off (too high) but then it occurred to me that if my heel wasn’t able to stay up, it was going to feel high. I flew out to see Mat Steinmetz who was kind enough to do a fit review for me and confirm my suspicions. We decided to leave the bike in the optimal position and then I would just try to work on the strength and or ride other things until I could hold the position. That was 2 weeks ago and already yesterday I rode 92 miles with Tanya in the position, so things are progressing quickly now I hope.

Standing on the bike is tough because all the pressure is on the forefoot again and I end up supporting a lot of weight on my hands over the handlebars. That too is getting better. Finally on the bike, when mountain biking I can’t ride off road very much because I don’t have the strength to hold my ankle tight all the time so when going over bumps etc. it feels “loose” and can be a bit painful. No worries, it too is getting better and I can stick to smoother roads for now.

I went to see the surgeon the other day and was told I had the ALL CLEAR! Said I can run, or do whatever I want at this point. I had asked about waiting until I run until I was able to do 3 x 25 single leg toe raises. He said that due to our procedure we used and the extent at which he cut off my heel that I could start to run now and that I am in no real danger of the injury returning. He did say he would lay off the run until I could have a pretty normal gait, or at least not limp so I didn’t cause other compensation issues.

-        Note: I had a pretty extensive repair. On my left side he said despite having done the procedure hundreds of times, it was in the top 3 worse he had seen. So if you have a lesser surgery I would check on your own return to run protocol. I know if the tendon becomes too tight or weak it can lay down the same injury again, so double check that

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Last week I decided to run 1 min, then walk 2. It was very slow, but I was able to “Shuffle/jog” for much longer periods with no pain and made it 4.5 miles! I have run up to 3 miles 2 more times since then and the pace is around 9:30 pace for the most part. Not blazing, but legit “jogging”. The Achilles has no pain which still blows me away as I can’t remember not having pain, but the peripheral stuff gets weak and fatigued and still have some “nerve” pain which causes me to pause and take some breaks. I also do not have the forefoot strength to really push off so I am definitely more on my heels then before, but the strength will come and I have been using the alter g to remember good fast run form.

I also want to point out even about 3-4 weeks ago I felt like today would never come. Its not an easy road and it I am sure I still have setbacks ahead of me but the healing is not linear. That’s the hardest part. You’ll feel one week like you will never get back, then 4 days later feel remarkably better. So don’t think your progress is limited to a set trajectory. I also would have a few days here and there where I would be pretty pissed off at my situation and angry. I would get discouraged with people trying to encourage me, or try to tell me it would be fine. Go ahead and feel like that sometimes, you deserve it! It does suck to rehab. If It didn’t, more people would go fix stuff. However, you have to snap out of it and figure out something to focus on other than feeling sorry for yourself.

I have a lot of people to thank. My awesome with Tanya has been almost too supportive and positive through all of this. I couldn’t have done it without her. I’m also convinced some of her oil concoctions have made a huge difference. I’m about 8 weeks ahead of recovery schedule right now.
Not only that but her clinic where she works has amazing systems for rehab. They even do PRP now. Pain and Wellness Group out of Plainfield and Villa Park is truly committed to athletes.

Achieve Physical Therapy has been amazing. Gina has been pretty busy with life and helping Olympians but left me in great hands. Taylor and Lindsey have been awesome PTs to work with. They know all the tricks. Dry needling, Graston, massage, exercises, stretching, Alter G, etc. 2 x a week they put me back together. I continue to be so grateful.

Dr. Ginsberg has been on my adjustments for chiropractic since before day one! He was able to keep my hips in line while off center in the boot for almost 3 months. He kept my back and neck feeling fine the entire time as well. I literally had no issue with the crutches, or the boot thanks to him. He even manipulates the ankle now to make sure it stays all lined up.

Garrett Krug, my strength trainer has continued to look for ways to bridge the PT/ strength training gap. To say he is just a strength trainer is not enough. He not only has a 4-year degree in this stuff, but is CONSTANTLY educating himself on new techniques. He went so far as to come to some of my rehab sessions to talk to the PTs to make sure what he was doing lined up with what they wanted.

Dr. Vora, my surgeon. I can’t believe how good this guy is. Not only is he good but he has a system for closing surgeries that I swear I barely even have a scar. If we are being honest, I was worried I would have Frankenstein looking calves and ankles. Not even close. He is blunt, to the point, but effective!

Paul Bishop has not only found my surgeon for my case but has made me the best running orthotics I have ever had. They were so good I got Tanya a pair and combined with some new coaching methods will be the first year she has made 12 months’ injury free!

I write this and seems like I am thanking a lot of people, but that’s what it takes. Don’t do things half way. If you want to get better, go all in. Invest in yourself. 

One reason for a bad race

Look let’s be honest. Call it what you want, but it SUCKS when you have had a BAD RACE. Nobody plans for or hopes for that outcome.

I wanted to share some of my thoughts on one of the main reasons it happens and how to avoid it.

The most heard story in an Ironman debacle story is a nutrition one, or lack thereof. Here is what I think most people screw up. They are simply too regimented or narrow minded in their thinking when it comes to race day nutrition.

I don’t want to get into what you should or shouldn’t eat for race nutrition right here, that’s an entirely different subject. However, whatever you do decide to use, use it properly. What I mean by that is most of the time in training people have their very best days. They think “Wow, if I can feel like that on race day, I will have an awesome race!” The thing is, in training they aren’t so deliberate or strict in most cases with their nutrition if they are honest.

Without making this too long, I think in training when you are thirsty, you tend to drink, and when you are hungry you tend to eat. Simple enough. In a race however they have stop watches and mile markers that they force nutrition down no matter how they feel – DON’T!

The human body is pretty sophisticated. It does a good job for the most part letting us know what it needs and when. We just have to listen to it. In the race though we know at baseline we need to get 200-300 calories an hour in on the bike give or take, but that’s not hard to do. You need to be regimented in when you do need food, you need to know what agrees with you, and when you need to drink, what that is you can drink and so on. That’s critical and I don’t disagree with practicing and having a plan for that. But I think you should have a general idea what you want to eat and when, but then listen to what’s going on inside you and decide when you need it exactly.

Here is another tip – GUESS LIGHT. It’s so easy to add calories. It’s very uncomfortable to take them away.

I am much better at speaking then typing so will cover this in more detail in our podcast tomorrow.

Update

I have been bad keeping this updated but honestly it’s because things have moved slowly, or maybe they haven’t, it just seems that way when it’s all you seem to think about every day.  I did want to catch you all up though on where I am with the heels so if anyone wants to know for themselves.

-        I had a lot f ups and downs over the past month. Its tough to be this long into recovery because while there is discomfort and some pain, it really isn’t that bad anymore. Well, that is unless you are trying to do something. Then it becomes limiting. What I mean by that is for me, the inside portion of my ankle has a nerve that when I put pressure on my big toe to do work, say like a heel raise, it gets pissed and won’t let me. It gets better every week though so I can see the end in sight.

-        I have very minimal pain walking around and while I can go upstairs with no issues, the bottom part of my calf (even around to my shin) still isn’t flexible enough to let me dorsiflex to go down the stairs straight on. I have to side step still but it’s getting better.

-        BTW, I’m at 19 and 13 weeks respectively.

-        In the pool I am swimming normal. I think I am biking a touch too aggressively, so I am going to take a week to back off that. The hard part is I can’t seem to stand as my calf isn’t strong enough to hold me so I end up “tip toeing” for just a few sec to give my ass a break.

-        The 13 week one is still a touch inflamed but nothing major. I’m able to elliptical, and Stairmaster. I was even able to run on the alter G at 60% the other day with no pain. I’m pretty out of shape though.

-        Two weeks ago in the h pool (about 4 ft deep) I was able to do 3 x 25 heel raises no problem except calf fatigue on the 19, and only 10 painful ones on the 13). I stick with it though and in the last few days have worked up to 3 x 25 on both although the right calf (13) is still pretty smoked half way through

-        I go to PT 2 x a week and do a lot of self-therapy at home. It takes a lot of time.

I am to the point I feel I will have a pretty normal life here soon, but it does take a while. I think I will beat the 6 months return to run, I even considered doing IMFL, but then I was like “What’s the point?

I signed up for a 70.3 next April, and Lake Placid and am optimistic. The tough part is I have put on 8-10 lbs. It’s tough to battel that but if I’m honest, I don’t think it’s the lack of working out, it’s the fact that you snack more J

Update - sorry its been awhile.

I haven’t written a blog with an update for some time for a few reasons. In an attempt at full disclosure here are the reasons:

1.      I’ve been super busy. I’ve really poured myself into some new clients this summer and it is exciting to see them having awesome results.

2.      I’m not trying as much but I am doing a TON of PT. I try to seek out the best help and advice on things when I need it and Gina is awesome but almost an hour away. So by the time I drive there, get work down and drive home, its usually 3-4 hours round trip in the middle of the day. So I try to cram in a few things in the am, then off to PT, then home to fit in a few things before the evening comes around.

3.      I’ve been frustrated with the process lately. If you are reading this and wondering if you should do it then here are my thoughts as of now. If you have to wonder, you probably need it. So get it done. I can tell it will be worth it. I have less pain walking around in my heels already. I can tell that as of now. I do get stronger every day but it’s a slow process.

I lack the strength to really toe off even while walking right now, so running is a no go for sure. I can elliptical as of now. I should note I am like 13 and 7 weeks post op on the two feet. I can do stair master actually pretty good but I can tell it gets pissed a few times so I am reluctantly going to give up that work to make sure I am being conservative.

Therein lies the issue for me. It’s confusing for sure what is the “good” pain, the “bad” pain, and the “pain need to work through” pain. Add to that I have had this done twice within three months and both healing processes feel a bit different. So while I can learn from one, I can’t really.

I’m afraid to ask or talk to anymore doctors about the issue because every time I do I find out someone has a harder standard to which I should meet before running again. That becomes super frustrating.

First I was told: I have to do 5 single leg calf raises. I thought, that was tough but manageable.

Then I was told: no, 10 is the best number… Damn… I thought. (keep in mind I can’t do 1 when I heard this).

Then I was told 25! WTF……

No, no… its actually 3 sets of 25 with 15 seconds rest between…. You’ve got to be killing me! In fact, give that a shot.

So I have stopped asking. LOL

Its dawning on me how long the actual road to recovery is. It sucks. I feel pretty out of shape. I’m 10-12 lbs. up. I’m barely back to where I was swimming. BARELY. I can’t hold the efforts for a complete set yet but I am starting to see signs of life. I can’t really push off the walls normal yet although close, I have to think this is part of the slower times.

The Bike… this one is interesting. I have been riding a lot of rides in tennis shoes on my pedals. It kind of sucks so I invested like 20 bucks in some platform pedals and have that on my MTB. Tanya asked me to do a 100 mile organized ride with her and some friends. I told her I didn’t feel like it because I only feel OK on my MTB and I don’t even have clips yet.

She convinced me to come and then basically dropped me… ugh. I made it 64 miles into the ride with eh group but had to do the last 3 on my own. It’s been a LONG time since I was owned like that on the bike. That wasn’t a good feeling and although I finished in like 5:30 on my MTB I was ready to retire for good.

I was able to ride in clips a few times but it was a lot of strain on my claves. Interestingly making me rethink moving to the mid sole cleat position as you can really feel how hard the regular shoes make your calves work. That being said I think while in the midfoot position it would be a bit tougher to stand and accelerate or sprint. Remember though, I’m not clipped in right now so hard to say definitively but I will re look at this. The doctor told me though I am getting a bit too far out over the front of my skies with the regular shoes though and has told me to go back to the running shoes on the bike. I hate going backwards.

So this is where I am. I’ve invested too much in getting this solved so I am not going to do anything that goes against it healing, but I realize it’s going to be a long road back. The reality is I couldn’t do the things I wanted to do before the surgery anyway so it’s not like had I don’t nothing I would have otherwise been racing well this year.

If you’re scared to get it done though, I wouldn’t be. Just go to a doctor who is good and gets what you are trying to come back to.

I’ve also been really trying to think about controlling my weight with diet instead of workouts. That’s going to prove to be pretty liberating I hope in the end.

If I had to guess, I would say the end of July I can start to think about going for a jog.

BTW, I searched everywhere for what the scar would look like, I couldn’t find one so here you go. I had what’s called a “mattress” suture. Looks freaky with the stiches in but when they take them out its ok. My surgeon I guess has a good way of closing so it really looks good for what went down there. 

We have some exciting news!

Training Bible is the backbone of the company. The book will be released in its 4^th Edition this fall!  As we continue to grow with new books, knowledge base, and experience, we have decided to rename some of our offerings to allow us to represent all of them. We are very excited! 

Nothing will change for this season. We are still team TBC!  As we move through the end of the season, our coaching division will be renamed to “SuperFly”!

A toast to Ben Kanute!

Ben, you did not earn your spot on the Olympic Team last night. Yes, you received your spot last night, but you made the team with all your years of hard work and amazing team of people around you.

It’s impossible to say when it started exactly, perhaps with the Geneva River Rats even!

Keith Dickson pouring his heart and resources into the youth development here in our area was awesome.

Bill Schalz played a huge role laying the ground work of your amazing swim which remains a weapon to this day.

Our group rides and people like Rob Kelley helping us get you around the group ride course. I can still remember being able to drop you, not anymore!

Eric Ott and other local business supporting you and still standing behind you through thick and thin.

Brian Grasky and the Tri Cats at U of A helping yo through a crazy college schedule. The friendships of people like Stephen Pedone Pedone from places like this continue to be amazing!

Getting Trek bikes to believe in us and our vision for you and what we can accomplish has been nothing short of unbelievable and second to none.

TJ Tollakson taking you under his wing when you first moved to Arizona – Such a class act.

I know you have an amazing support staff in Tucson. 

Jim Vance who is willing to always lend advice and info. Jumping at any chance to do whatever is needed.

Ryan Bolton stepping up to the plate to help us get over the hump with your running and confidence in it, and his willingness to help ongoing and giving you chance to run with great runners – unbelievable.

Bobby McGee and USA Triathlon has always been there to help with run form, technique, advice, support.

People even like Joe Lotus who lends advice and encouragement and perspective, is something I know I am personally thankful for. Your parents Mike and Eileen Rassin Kanute and family.

I watch with continued amazement at the support structure and values that you are brought up in. Words cannot describe the level of devotion and enthusiasm, and TRUE UNCONDITIONAL love and support I have seen them give you over the years.

Ben, you took all of these things not just last night, but over the last 10 years or so I have gotten to personally witness and have always given honor to them by who you are as an athlete, but more importantly who you are as a person.

So you got your spot last night, CONGRATULATIONS! But I have seen you earn it for years. We all have. Enjoy this!!!

We are all behind you Ben!

Getting through things

One week after my second surgery and here I sit on the couch. I knew when I set out on this journey this would be the worst week, and it has been. Don’t get me wrong, my spirits OK. I’m just as out of shape as I have been literally in 15 years, and as immobile as I think I have ever been in my life. Add to that it’s my right foot right now and I cannot drive.

You know what though, I already have 1 week done! 5 to go.

As I tell my athletes when things look overwhelming, just take things one thing at a time. Here are some simple tricks I have used to do just that:

-        Marine Corps. Boot camp: I would try to make it to each meal. The weeks were too much, sometimes even the days. But I could make it from breakfast to lunch, then luck to dinner. Then soon I would wake up and have breakfast again. And so on. They add up pretty quickly.

-        With huge blocks of training: I would have weekly hours over 20 when I was working 2 full time jobs years ago. It was quite tough. Even when I was working less I would see some weeks I would think “how the hell am I going to do this?”. One workout at a time. Even on days you think you’ll have no time. If you just get one done, then try to find a window for the next. You’ll be surprised what you can do.

-        Workouts: this one is key and can be used for any sport. I would look at sets and start to anticipate how I would feel at the end. Then I could easily let that make me feel defeated before I even started. DON’T DO THAT. Take the next interval and so the best you can per the instructions for that interval. Then about 90 percent through your rest interval evaluate the next interval. Do the best you can at each one.

-        Races: Same as workouts. Evaluate how you feel right now and make choices based on that. For long course you have to obviously have to think about how you feel right now relative to the plan so you can finish strong. However, if you are at mile 10 of a 70.3, worry about the next 15 min. manage that. Then work on the next 15 min.

-        Injuries: For this one, I’m learning a lot on the job. What has been working for me is to try to get through weeks. I get through the weeks by trying to get to PT sessions. I know I have 2 of those a week most of the time. So if I can get to Tuesday I get a progress report. Then I only have one free day before I am back. Then I am only one day away from the weekend and those always fly! Then its Monday again and I into another week and 1 day away from PT. 

Here we go again… We got this.

Here is a recap of how it has gone so far

It should be noted- I did a lot of research on the subject. I had previously tried PRP as well as low shockwave therapy. Both did help reduce the pain initially but I could tell I was quickly on my way back to a lot of pain. I had a structural issue in my heels that needed to be removed in my case. I am the type of person that when I know what needs to happen to get the true result, I like to just do it. In my case I felt in my core this was the ultimate decision for me to make to actually give me the best chance at a full recovery and life.

Things that went into my choice

-        Non-surgical vs. surgical. Addressed above.

-        Was I ok with the outcome if it “worked” but I wasn’t able to run like I had before? Yes. I was and remain hopeful it will be my choice to return to normal triathlon activity. However just like I talk to my athletes who want to set a big PR, sometimes you have to be willing to take risks. Yes, they can be calculated but you need to back yourself at some point. If you don’t, who will? I knew I wasn’t happy with how I felt now. Something needed to change.

-        What was the technique I felt the most comfortable with? I chose a technique that used something called a speed bridge. http://www.arthrex.com/foot-ankle/achilles-speedbridge. I chose this because I was told it was knotless, I was told it was strong enough that I could put weight on it in 2 weeks, and the procedure made sense to me.

-        Who. This was a big one for me. I have use Dr. Paul Bishop for all my foot issues and continue to do so. He made my orthotics. They are the best orthotics I have ever had for running hands down. He fixed my forefoot issue which used to derail me. He diagnosed the issue I am dealing with now. He is amazing. He and I have become very good friends over the past couple years and I initially chose him to do my surgery.

After further discussion, he had recommended I speak to another surgeon he trusts implicitly. We thought due to our friendship it may make sense for me to have a different surgeon. I sometimes think about how honorable that was. The mark of a person who REALLY knows their stuff in my opinion, is the ability to practice humility. He obviously puts his patients first.

Even though he told me to consider someone else I was very reluctant to change from someone I have been having so much success and trust in. At the end of the day, Tanya and I decided to take him up on his offer to get us in with Dr.Vora.

Dr. Vora is equally as amazing. He cut right to the chase. He told me exactly what he thought I needed. He said I could mess around with PRP, and shockwave, as well as other non-surgical things but it would just be something that he would do to satisfy my curiosities. He said based on the structures in my Achilles and the extent of the Haglund’s deformity on my heels I will ultimately need surgery.

-        What was the expected outcome? He of course could not guarantee any outcome, but he was 99.99% sure I would have very close to 100% recovery. He said he had done hundreds of my procedures with great results and one athlete had just done a 100-mile trail run after. Each case is different though he warned and until he got inside to see the actually situation needed me to know nothing is a guarantee.

-        Grafting. VERY IMPORTANT – In my opinion, this was one of the most important choices. A lot of people I spoke to said they would use my FHL (the tendon that helps connect the big toe). To ME, it didn’t pass the smell test for returning to running at a high level again. While I have no qualifications to say what is best, like training I need to have confidence in the plan I choose.  What I really liked about Dr. Vora, and was one of the things that pushed me over the top with him; he said he has done so many of these and could almost promise he would not need a graft of any kind. His confidence in this was huge to me. Had he needed one, he recommended the FHL, but we agreed to use something else. (HE WAS ABLE TO DO THE REPAIRS ON BOTH SIDES WITHOUT A GRAFT)

-        My biggest advice – Once you decide, stay off google. It’s insane what you find on there. I found people saying terrible things, it freaked me out. I found DOCTORS asking other doctors how to treat is because they never had…. WTF??? So it goes back to: do your research, google, ask friends, interview doctors, whatever. Once decided, STOP. Trust the process. It’s like walking around an expo asking everyone else how they trained for the event and when their last long run was. You’re never going to get an answer that makes you feel affirmed. Trust your coach and your process.

-        Timeline. No doctor would do both at once. Understandably. Most suggested a 4-month spread. I convinced Dr. Vora to let me schedule my second one 6 weeks out. He agreed to let me schedule it if I would promise to cancel it if I had any doubts at all.

-        The second biggest choice, which I am lucky to have secured is PT. It can be as important as the surgeon. Gina Pongetti, and her team Taylor Millican and Lindsey Rose at Achieve are amazing. Literally every tool at their disposal I could need. Dry needling, Garston, ART, Alter G, etc.  Rob Duncan helps me with the PT exercises and Garrett Krug coming up with awesome ways to keep me fit even from week 2.

Dr. Ginsberg at Ginsberg Chiropractic in Geneva has helped my hips, neck and back stand up to the constant beating my body has taken from the crutches, and having the boot on. This is a huge point as a lot of people have back trouble for months after walking in such an uneven boot. It can be 2+ inches higher then then other leg with it on. Have a plan for this!

-         

RECAP

Left Achilles first. Last week of March 2016.

Week 1 – lots of laying around and pain meds. All non-weight bearing. A lot of swelling and discomfort however the pain was quite manageable with the meds. The worst is having to rely on others. Not because I am someone who won’t ask for help, but I appreciate they have their own stuff going on.

Week 2- Still non weight bearing. Still a lot of swelling when I wasn’t elevated. I was able to use my personal trainer, start PT and get Chiropractic care. At the end of this time I was able to get my stiches out which helped a lot. I was told to let the holes close then I could swim!

Week 3- At the end of this time I was able to get my stiches out which helped a lot. I was told to let the holes close then I could swim! A day after the stiches came out, I got a small infection starting in the lower part of my incision. Taya caught it immediately. She got me on some antibiotics to clear it up but it delayed my being able to swim till the end of the week. I was also told to start to walk in the boot (with a lot of heel lifts). It was very painful at first. I wasn’t sure how I was going to be able to do it at first and took my crutches with me a lot of places.

Week 4- What is becoming a reoccurring theme is things I can’t wrap my head around start to become possible pretty soon after. Walking in the two heel lifts at day 20 was almost impossible. After a few days, I could do it. Now I was down to 1!  I was able to start swimming in week 4 and I was SOOOOO out of shape. If I’m honest I was pretty discouraged with the times I was seeing. I started to ride the bike in the boot. Just on the trainer. This is good but I can only tolerate an hour before my ass hurts so bad (I can’t stand so I just sit there and push about 150 watts which means a lot of time on the saddle)

Week 5- I was able to take out my final wedge. I was able to feel more normal and do thigs like stand up without the boot and even shuffle around the house a touch barefoot. I wasn’t using the foot at all. Just was able to sustain some weight on it enough to slide to bathroom in the middle of the night etc. I started out the week not sure how my repaired foot was going to be able to sustain me when the other couldn’t, but I just had to trust that it would when the time came.

Week 6 – I got to take off the boot! This was huge because the last 4 days in the boot I was starting to get a lot of pain in my plantar fascia – A lot. It still hurts today. It’s the hardest thing about using my repaired foot actually. I got the boot off on Monday

Tuesday was Right foot surgery time.

Dr. Paul Bishop will be doing my post op follow up care. 

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.

THE BOOT SUCKS

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 4^th of July and be able to work out that morning ding something. 

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

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.

https://vimeo.com/92840257 

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 29^th, 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. 

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 9^th 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! 

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. 

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.  

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