Back at it - 40 miles on the Bike, 10 mile run Sat, 20 mile run Sunday!

Well, I finally broke down and went back out on the bike--I took it easy but managed to squeeze out about 40 miles. So far so good and it was really nice to get back out there. Makes me really appreciate it and I'm hungry for the training again.

T-minus 6 days until my half Ironman Racine 70.3...I cannot believe that race is here already. Gahhh, so nervous.

Flare - Day 8

I went on a walk down to the Bank and Barrique's coffee shop down on Monroe street today to get out of bed. It was nice to get moving around again but I am definitely feeling really strange--I think it is a side effect from the steroids. Kind of a weird feeling to describe but my legs just feel like they have a ton of energy but yet I feel tired so I've been napping on and off all day. My joints also feel really strange-not painful or stiff. My elbows can extend farther than they have been able to in a really really long time so I guess that means the meds are working. I've decided to hold off on working out until Sunday and take a full week off to let my body sort things out. All in all, I can't wait to get back on my bike, or back into the pool, or back with my music on a run.

I also want to give a huge shout out to all my family and loved one who have been so amazing at helping me and making sure I know I have people I can count on. You guys are awesome and I don't know where I'd be without you.

"If you can't stop thinking about it, don't stop working for it"

Arthritis Flare - Day 7

Woke up this morning feeling about the same as yesterday. I'm finally feeling human (and way better than on the worst day of my flare, Monday) but still not back to normal so another day laying around in bed which if you know me at all then you know it is REALLY starting to drive me absolutely insane. The stiffness and pain is pretty much gone away but I still feel crappy and drained.

I also got a cryptic message in my chart last night from my doctor:
"no concern about doing ironman after steroid injection, however I think there is a real risk that exercise might cause the arthritis to worsen"

To be honest, as a patient I was very frustrated especially because during my appointment I point blank asked about my Ironman training and we had made decision about my care so that I could finish my 70.3--was he just warning me that it could get worse? Was he telling me to stop? Was he being like all the other doctors who told me I would never play sports, run a marathon (I've run 4--including qualifying for the 2015 Boston Marathon), do an Ironman. He was just being my doctor, telling me that this is a risk...which of course it is-I have a debilitating disease...BUT that doesn't mean I shouldn't try for something I really want... Mind over matter.

 My newest thought as of this morning is that my goal for Ironman is moving from being competitive/being one of the top finishers in my age group---to just being able to cross that finish line at all. I just want to hear those words... I don't care at this point if it takes me 11 hours or if I barely make the cut off time. I just want to be able to do it, to tell my kids and my patients how I did an Ironman while in medical school despite everything saying I shouldn't. I am confident that I will be able to do the half ironman distance in 11 days at Racine but my confidence level for completing the full Ironman is definitely wavering. Given the recent events, my plan now is to cut back on the intensity of my training...my training program was following a Level 6 of 10 levels which is described as a triathlete who has a goal of qualifying for Kona and crushing your first IM. I will drop back down to a Level 3-4 and just really watch my body and listen to how it responds to the training. If I flare again and thing get worse, well then I think I have my answer but maybe this is just my body's way of telling me that I need to slow down and that I can't do it all. Funny, it has a way of doing that sometimes. I also have to think realistically about all of this occurring as I am about a month away from starting the hardest year of medical school and attempting to do this...yes, I hate to admit it but even I have limitations.

So today, I'm laying in bed thinking about all the things that could go wrong and hoping that they don't---wishing and praying that my body and my arthritis holds up long enough for me to hear those sweet words..."Brock, you are an Ironman" on September 7th in Madison WI. Keep sending me any positive mojo you have.

Arthritis Flare - Day 6 + Rheumatology Apppointment

Well, I had a pretty awful day yesterday and ended up calling my doctor to set up an appointment. I really felt like I was run over by a truck, almost flu like without the fever/chills but just absolute fatigued and in a lot of pain. I have to give a huge shout out to my rheumatologist at the UW, Dr. McKown who is the head of the department. He is an excellent physician who discussed my plan of care and always helps me makes decision that will meet my goals. We ended up deciding to move onto a systemic steroid injection to help me get things under control and feeling back to normal more quickly. He also could tell how awful I was feeling as soon as he walked in the door. As a future physician, I hope I am able to remember my patients as well as he does.

I have to say it was a first for me today in terms of treatment haha, but now I can say I know what it is like to get a shot in the good old cheeks (yep, in my @$$). I feel pretty jittery and got a headache shortly after the injection. He said I'd probably have increased energy, appetite (as if my IM appetite wasn't enough) and insomnia. I get insomnia when I just take the pills so I'm sure it'll hit me pretty hard but I should feel better in 48-72 hours. Thank goodness--I am sick and tired of feeling sick and tired. I have to say this is probably the worst flare I've had since high school/beginning of college when my knee was drained the last time and I was on crutches for a week. Yesterday, I was moved to tears I just felt so awful so I am grateful for the medicine today.

The best part of the appointment (and probably the conversation I was the most scared to have) was that he told me I still have the green light to train and compete at Ironman Racine 70.3 in 12 days and Ironman Wisconsin. I'd be lying if I didn't say that I had been starting to lose sight of why I was training so hard day in and day out for this race. This flare up, for whatever reason, is an amazing reminder of how fortunate I am that the medications allow me to be as mobile as I am able to be. I think back to when I was on the Juvenile Arthritis Family Network Panel, listening to a young high schooler discuss her mobility issues and joint replacements... I am a lucky one. I'm not doing Ironman just for myself, but for all those patients who have arthritis or anyone who is physically disabled due to pain and who struggle to complete simple daily activities like brushing your teeth or washing your hair. At the peak of my flare this week, I started to experience some of those devastating limitations....honestly, it doesn't get any more motivating than that.

For now, finally watching the show Dexter on Netflix and lots of rest and relaxing until the injection takes effect. Thank you for all the well wishes, prayers, and positive thoughts. They have been heard.

"Whether you believe you can or believe you can't--you're right."

Arthritis Flare - Day 5

I ended up calling my rheumatologist before the holiday weekend to get some Prednisone just in case and yesterday, I finally caved and started the dose. I am a big supporter of less meds is more but I know that I would not be doing what I am doing without my medication. My right elbow is still giving me a lot of trouble so I  just want to get it under control again. I knew its as bad when I was having trouble reaching out to pick up things or even washing my back in the shower / brushing my teeth. Today I woke up feeling pretty overall just drained and ill so just going to plan on taking it easy. I unfortunately had to cancel a clinic shadowing experience which is always just an added hassle. I hope that the medications start to work and that I am feeling better soon. My plan is to call my doctor tomorrow if I am still not feeling well to see if I should come into the clinic. I forget how frustrating this disease can be when you just want things to be normal. Makes me appreciate everything that I am able to do when I am able to do it. I found this website that made me chuckle and I'm hoping it can help some of my other fellow RA patients as well: http://www.rheumatoidarthritisguy.com/you-know-you-have-rheumatoid-arthritis-when/

I had a pretty successful training weekend (except for the fact that I haven't done any swimming since last week Wednesday) and even managed to get a bike/run preview of the half Ironman Racine course  while Jenny was taking her USMLE Step 1. Shout out to her and so proud that she is finished the biggest exam of her medical career - I know she rocked it. I can't believe Racine is already in 13 days AND that today marks the 2 month point from Ironman Wisconsin so things are getting real. I think a lot of people wonder how I am able to run/bike while flaring and its not that I don't have pain, of course I do, but I have found that the exercise often helps me stretch out and feel better by getting the adrenalin going and joints moving. It is way better than just laying in bed for hours on end. I find my mind wandering to all of the what ifs..what if they have to drain my elbow, what if I need a cortisone shot, what if I can't keep swimming training as much as I want to/need to, what if this is the time the medications stop working for me... but I keep reminding myself that there is no point in worrying about anything I can't control. Just need to take it all in stride. Here's to hoping the flare turns around soon. Sincerely, one frustrated Ironman-with-rheumatoid-arthirits-in-training.

Bike/Run 7/2 and Arthritis this AM

I had easily one of the scariest biking experiences of my training. Yesterday, I was coming back from 1:35 minute ride and I was traveling on Whalen, one of the main straight aways of the IMWI course which has a lot of bikers on it. I attached a map with where it happened outlined in red. Yesterday, there were a lot less bikers on the course because the weather wasn't ideal. Not to mention the road isn't idea, on the sides there are huge chunks of the road that are missing, which makes staying out of the lane of traffic even more difficult.

Defensive biking is mandatory because just by probability with how long I spend on the bike an accident may happen. I heard a dump trunk coming behind me, when I looked back I could see that he was traveling very fast with no intention of slowing down. As I turned my head forward, I could also hear another car coming over the hill and I knew that they were going to meet at the crest of the hill and I was going to be caught between them. The dump truck didn't slow down, in fact I think he sped up and before I knew it I was caught between them with two options 1) get plowed over by dump truck or 2) head for the ditch. I veered off to the right down into the ditch and unclipped. I managed to keep my bike in control and stay upright. Moral of the story: Please be aware of other cyclists/bikers on the road. We are 1,000x more vulnerable out there, especially when we are clipped in. I was definitely a little shaken up but I had nothing left to do but press on and finish the bike. I was grateful to be running with both feet on the group after that for about an hour.

Arthritis: Today my right elbow is giving me trouble. Interesting that it is asymmetrical but I have a feeling it was from the way I slept last night. Lots of stretching to hopefully get it feel better and increase my range of motion. I also took some NSAIDs to help. I feel like most people who hear that I am doing an IM and I have arthritis don't understand how that is possible. To them I say, arthritis is a part of who I am and it's something I live with every day. I feel like most people don't know what arthritis actually looks like and that is what's tricky. To someone who has never had it, you can't really see it unless my joints are actually swollen. My elbow is a little tender and it does have some fluid in it but that is my training as a medical student that allows me to see it. For patients like me with RA, we feel some sort of pain or fatigue almost every, single, day. I attached pictures showing the limit in my range of motion on my right side of almost 25 degrees this morning. I also have pain with movement, particularly flexion/extension or any type of exertion (e.g., carrying groceries, washing my back in the shower). Arthritis sucks sometimes and there is no and if or buts about it. Hopefully it clears before the holiday weekend!



I leave with my motivational quote for this week: "Pain is weakness leaving the body"

ITU World Triathlon Recap - PR 2:21

This past Saturday I competed at the ITU World Triathlon in Chicago. It was an amazingly fun, fast, and flat race that helped me to shave off 11 minutes from my previous time. The race was extremely spectator friendly and the back drop of the Chicago skyline couldn't have been any better. I also loved watching Gwen Jorgensen dominate the women's elite field (Go Badgers!) I had to deal with some of rain especially during checking in my bike and setting up my transition. Luckily, it was beautiful by race time.

Finish Line

The swim was right in front of Grant Park in Lake Michigan. The water was crystal clear and very calm because it was in a breaker area. Starting race waves were separated by about 20 minutes to prevent congestion on the bike course. My age group 25-30 was the largest one of the Olympic distance with 118 people and man were there some great athletes. Compared to previous races, there was a lot more congestion. I got kicked in the face and also had someone grab my ankle and kind of pull me under. I also had to body roll some people mid stroke when they started to swim completely sideways to stay above water. All in all, it was great practice for Ironman races and have everyone start at the same time. Again while I was in the water I realized this is my weakest sport out of the three and that I like it the least. Just kind of need to grin and bare it.

Swim Area

The bike was absolutely the fastest and flattest course I've ever done, I averaged 25-26 mph over 4 loops! My favorite part was when we went on Lower Wacker into the tunnels. It was like a vacuum that seemed to suck you in it and make you go even faster. By the time you turned round, you had to go up a little bit of an incline but nothing compared to IMWI. Once you exited the tunnel, we had a pretty strong head wind that slowed the entire field down around the U-turns and long straight aways. The other factor was just dealing with the size of the transition areas and trying to find your bike. At one point, I ran right past it.

Transition Zone

The run was hot and centered around Buckinham Fountain and included 3.5 loops. Compared to marathons that normally don't loop, run portions of triathlons frequently loop or overlap and make you run the same area so that is something I am having to train my brain into doing...it takes a lot of will power to keep pushing yourself knowing that you are doing the same thing over and over again. My best tactic so far has been to focus on the positive so instead of saying oh man 2.5 loops to go, I say 1 loop down. Sometimes its the little things. I still managed to have a pretty great run split but had to deal with cramping that I think was caused by gatorade during the bike so it is definitely something I need to figure out nutrition wise for the longer 70.3 & 140.6 distances because it can be a   deal breaker. Overall I ended up 33rd in my age group and 251 overall at a big race.

Finisher Certificate