The Gory Details: from IM to ER to OR

I'm not sure exactly how to start this post - or how to write the middle or end, actually - but I guess I better start where I left off on my last post.

I said I would write a race report about Ironman Texas.

Indeed.. so I did. Unfortunately, it got almost infinitely delayed because all the analysis in the world could not help me with those important "lessons learned" from my race in Texas. It started out so great. In fact, the beginning and the middle went surprisingly well. I just don't know what happened at the end, although I have a possible explanation now which is something I didn't have a month ago.

Ron and me - before swim start.

I really wanted to have a great race in Texas for many reasons. One of the big reasons was that my great friend, Ron, founder of Punk Rock Racing and designer of the new race kit I was wearing here, surprised me by showing up in my hotel room the day before the race. I was therefore super-jazzed to have extra support on the course and at the start that morning.

Ironman Texas started with a 2.4-mile swim in Lake Woodlands. Before the swim, I was told my more than one person that this would be a long swim and do NOT expect a fast time in this particular swim for many reasons. The swim - a rolling start - did a U-turn, then made a right into the waterway channel. I swam wide, as usual, to avoid getting clobbered, and surprisingly had a rather uneventful swim. My stroke felt great and I took it easy until the U-turn, after which I picked up my pace and passed a lot of people before - and even after - we made our way into the channel.

Swim start in Lake Woodlands

Because the swim was "long," I took it very easy, and I hadn't been able to get in the pool more than twice a week during my build-up, I was expecting to see something around 1:10-1:15 (or worse) on my watch when I stepped out of the water. The 1:02 on my watch was a blinding surprise. I tried to keep a lid on my emotions in T1.

We were encouraged to carry our bike shoes through the transition zone because of ankle-deep mud - it was gross, but we were able to rinse our feet before starting the bike leg. I knew I was in good shape when I got to the rack to see most of my age-group was still in the water. When I finally got on the bike, my legs felt great, again surprised with none of the usual fatigue after the swim.

Leaving T1

So I rode relaxed for the first 50 miles (I was told the second half of the bike course is when the hills show up) and made sure to drink at least a bottle and a half of fluids per hour. My new fuel regimen included Skratch Labs hydration drink mix and solid fuel - mostly rice-based recipes from the Feed Zone Portables cookbook.

I took in about 250-300 calories per hour and as the day got hotter (in the high 80s and very humid), I remained relaxed and didn't push too hard, even on the rolling hills in the second half. I did not feel any thirst or hunger during the ride, and much to my surprise, Texas was the first Ironman bike leg during which I had no nausea. Convinced my fueling was perfect, I was actually looking forward to a good - and strong - run.

When I pulled into T2, my time was one of my best 112-milers, my legs still felt good - albeit a little stiff - and I knew I was in the race although my husband Jim and I decided beforehand that he would withhold from me my position in the age group so that I wouldn't chase anyone.

The first mile off the bike was about 7:40 (too fast), but my legs were feeling great and I was trying to run relaxed. The second mile was right around 8 minutes (goal pace). And that was the last moment I felt good.

Inching along

Then everything seemed to fall apart. My legs started to give and I was overwhelmed with a sense of fatigue that I can't explain. It was like every molecule in my leg muscles was screaming at me that they were tired and I needed to stop. It wasn't the heat. It wasn't thirst. It wasn't hunger. It was just .. fatigue. I had no explanation and I could not will myself to go any faster or any slower.

I inched along - running, then walking, then running again - pouring water and ice on myself - and at one of the aid stations around the midpoint, someone stepped right in front of me, and I went down hard, twisting my ankle in the process. I figured that was it, but the volunteers and medical staff helped me get back on my feet, gave me ice on the ankle and I was determined to get back on the course and finish, no matter how slow.

I was angry, confused, hot, and feeling pretty woozy by the time I saw Jim with about 3 miles to go. He kept telling me that everyone in front of my was slowing down, but that did little to help because I had nothing in my legs. I stopped and proceeded to vomit right in front of him. I can't imagine what he was thinking, but I remained on the course and kept going forward. I was never so happy to see a finish line in my life, and - yes, shockingly - I managed to pull out an age-group 4th even with that dismal almost-five-hour marathon.

By that point, I didn't care about anything except getting my medal. I tried to eat and drink after the race but ended up in the med tent with severe nausea and dizziness.

For a couple weeks after the race, I was still very confused about what went wrong. Was it not enough long-distance training? I had only one 100-mile bike ride but several close to 90 - winter training was difficult in Cleveland this year because of extreme cold. And I only ran 18-20 miles a couple times. I had several confidence-boosting long bricks though. Was it my fueling? Maybe solid food doesn't process as quickly as liquid? I really had no clue.

Now I'm starting to rethink it because of a recent illness that has sidelined me. Here come the "gory details" mentioned in the title. And it's really embarrassing to talk about, but hell, it's the truth.

About 4 weeks ago, shortly after Ironman Texas, I started to get a strange pain in my butt, kind of up near my tailbone and to the right. I was also feeling extremely fatigued - so much that Jim kept insisting something was wrong because I was sleeping so much. I sloughed off the pain as being muscular in nature - maybe from riding my road bike for the first time in a while. I thought nothing of it.

A week later, when the pain did not subside, I started poking around and felt what can only be termed a "lump" - or hardness. Still thinking it was muscular, I went to Google (yep, I Googled "pain in the ass"). Googling is not something I recommend to anyone contemplating a lump of any sort in their body. GO TO THE DOCTOR.

In the second week of butt pain, there were also other symptoms - ones I did not associate with my butt. I had a headache that wouldn't go away, I lost my appetite and was constantly feeling nauseous, and I had pain in my skin (the kind of pain you might associate with a fever but my temperature was only 99ish). When I did a training ride or run, I would get fatigued and be dragging after about 20 minutes. I told Jim I would call the doctor if it didn't go away, but it felt like it was subsiding by that Thursday, so I put off the call.

BAD IDEA. By Monday, I was in severe pain with all the other symptoms and now a larger elongated lump. Scared sh*tless about what it might be, I called and begged my doctor's office for an appointment, which they couldn't provide until Thursday. Tuesday, I called our health insurance "nurse on call" for advice - which was, duh - SEE A DOCTOR WITHIN 24 HOURS. The Cleveland Clinic has same-day appointments, so I took one Tuesday afternoon with a nurse practitioner. I didn't care. I was in severe pain.

The diagnosis? The first diagnosis was that I had a pilonidal cyst - this is basically an infection/abscess located near your tailbone usually caused by a plugged up hair follicle. She gave me antibiotics and sent me home. Two days later, I saw my family doctor. There was still pain. Some fever. Major fatigue. The lump was unchanged -- maybe bigger, it was hard to tell.

She had a different diagnosis: I had a peri-anal abscess. She gave me a different antibiotic in case the first one didn't work and referred me to a colorectal surgeon, just in case - if it needed to be "lanced and drained" it would be a simple office procedure for him. Ok, now I was freaked out - I've failed to mention in this post that eleven days from then I had a trip to Sweden to race in the ITU Long-course Age Group World Championship. My doctor reassured me that the surgical consult was "only for the worst case scenario."

Yep, I went home and Googled the hell out of this one.

My Google findings turned up the following: this type of abscess will not respond to antibiotics. It must be drained, either on its own or by lancing by a doctor.

My surgical consult was Tuesday. By Monday, I was almost comatose with an ever-expanding lump (this thing was now covering about a third of my butt cheek), pain, headache, fatigue, nausea, dizziness, and now a 100-degree fever. I called Jim, he called the surgeon's office -- they sent us to the emergency room "where it could be lanced and drained if necessary." In the ER, I was pumped full of a DIFFERENT antibiotic, pain killers, anti-nausea drugs and given a CAT scan for more information. The ER doc said no way was he touching this thing because of its location - better leave that to the colorectal guy.

(JUST A QUICK ASIDE: while we were chatting with the emergency room doctor, we found out that he was in attendance at my first Ironman, Ironman Utah in 2002 - his brother raced - and he happened to be one of the medical personnel trying to revive the man who drowned in Utah Lake that morning. Talk about bizarre coincidences!)

So... after reading the scan, he gave me the third diagnosis. I had an ischio-rectal abscess that was no longer full of fluid but now had blossomed into a case of cellulitis. It "had not become gangrenous" (yeah, i know, WTF!?!?). I was sent home from the ER with more instructions and info to deliver to my colorectal surgeon. When I got home, my fever went up to 101 degrees.

I had the worst night of fitful sleep ever.

Tuesday morning, I saw the surgeon and found myself in tears just telling him how bad I felt. He took one look, checked the CAT scans, and sent me to the hospital to prep for surgery in the OR at 2pm. No problem, he even said I'd be able to race in Sweden the next week. REALLY?

When I woke up from surgery, the overall feeling of illness was gone. Seriously. The drugs were not masking it.. my headache and nausea and fever were all gone. I still had pain, but now it was from three incisions and drainage tubes sticking out of my butt cheeks.

Jim gave me the lowdown - the abscess was much worse than even the surgeon expected - hence it wasn't a simple lance-and-drain kind of thing. It was deep and extended to my left side (they call it a horseshoe abscess). No, I wouldn't be racing in Sweden - no lake swimming with open wounds.

I didn't care. I was so happy to be free of this thing - and I spent the next three days in bed. We contemplated still taking the trip to Sweden, but I couldn't envision sitting on that plane for many hours and spending the entire trip worrying about gauze and drainage and - omg - what if there were complications?

So, it was a drag to do, but we canceled the whole trip, and I've been recovering from this surgery for one week as of today. I saw the surgeon this morning and - yay! - my drainage tubes have been removed and he hopes it will heal up in 4-6 weeks. But no swimming (Boo!)

I can't help but wonder if my fatigue in Texas might have been the beginning of this illness. Either way, and true to my nickname, I seem to have picked a great way to start out a new age group.