EIA Syndrome

“Being relentless means having the courage to say ‘I’m going for this, and if I’m wrong, I’ll make a change and I’ll still be fine.’ You can’t control or anticipate every obstacle that might block your path. You can only control your response, and your ability to navigate the unpredictable. Whatever happens, you have the smarts and skills to figure it out and arrive at the outcome you wanted in the first place.” –Tim S. Grover

I came across this quote last year when dealing with a navicular stress fracture that barred me from competition for the majority of the 2018 season. It reminded me to keep going, to keep showing up. And that obstacles will present themselves and ultimately be overcome with a little gumption and grit. Once I was healed and caught the tail-end of the race season World Cups, I envisioned an upward trajectory, this epic personal comeback in 2019.

Last fall through the start of the New Year, I plugged away in training and recovery, having made some major adjustments that aligned more-so with the ‘train smarter, not harder’ and ‘less is more’ philosophies. Unfortunately, however, in mid-March after a solid race in Australia where I placed 2nd, my body didn’t quite recover in the pattern I was used to. At the time, I misinterpreted some of the red-flags that popped up, chalking them up to some extra post-race inflammation. In a state of hyper-awareness, that week I started to notice a discrepancy between my right and left legs, where the right would fatigue quicker than the left when running or cycling at a higher intensity. It could be very subtle or very acute, making it challenging to decipher and to communicate back to my support team. In retrospect, operating with this discrepancy resulted in compensation (mainly on the run), creating other issues of inflammation in my ankle and a slight strain in my calf. Initially, that’s what I was paying more attention to instead of the elusive ‘weakness’ in my right leg under load. This experience back in March marked the beginning of a messy, tangled situation: I was fit and generally healthy, with a mix of success in racing and training, but I knew something wasn’t quite right. It’s fairly standard as an athlete to deal with discomforts or small injuries, so even though I knew something wasn’t quite right, there wasn’t anything glaringly quite wrong.

Upon returning to my home in Colorado Springs, the Sports Medicine team addressed the compensation issues as well as checked for muscle imbalances or nerve impingements. I passed all the tests, indicating there was nothing that stood out muscularly nor neurologically. I started to think the leg discrepancy was a bad-habit I picked up from the previous year’s stress fracture, or that I was just fatigued, or that I was just being crazy or the issue was in my head. Although the symptoms weren’t always triggered, when they were, they were generally consistent. Once induced, my right leg felt comparatively weaker, slow, constricted, numb. My rate of perceived effort would be very high relative to the output. But once I backed off the intensity, I felt completely normal and there were no symptoms at rest whatsoever.

After a couple of tough race experiences post-Australia, I was able to put myself together for a World Cup in China in May. I executed another podium performance; however, in the race itself I could feel that discrepancy transitioning from swim to bike. I remember getting on my bike and thinking: ‘I have to take this first section as efficiently as possible; no sudden, powerful moves or I’ll trigger that dead-leg sensation.’ Fortunately, that moment eased off and my body allowed me to pursue a performance I’m proud of. It wasn’t until mid-June after an extremely challenging race experience in the Nottingham MTR when I recognized this issue was bigger than poor form or general fatigue. That day on the race course was one of the roughest athletic experiences I’ve endured, but at the same time, I’ve come to view as a blessing in disguise. The symptoms were so extreme and debilitating that they could no longer be ignored. Not to mention, the resulting stress of underperforming for my teammates and my country on the relay prompted a larger re-evaluation.

I decided to call-off the races planned thereafter and return to the US in order to pursue a concrete diagnosis. This became an 8-week process of doctor appointments, scanning, testing, and waiting. Those were some of the most challenging weeks mentally and emotionally—I’m so thankful for close friends, family and the Sports Medicine team that helped keep me laughing between tears throughout this gray period. This was a time when Taylor Swift’s You Need To Calm Down took on additional meaning.

Eventually, the medical staff out at the University of Utah identified the problem as a vasospasm—likely a precursor to endofibrosis—causing claudication in my external iliac artery and explained that surgery was likely the only solution to alleviate the problem. This was a lot to swallow as the diagnosis itself is fairly rare and vascular surgery is a major procedure. Ankle-brachial index (Doppler) testing combined with ultrasound imaging at rest and post-exercise indicated that I was getting 30% or less blood flow and oxygen to my right leg, causing the symptoms that I experienced. In short, my artery was constricting instead of dilating under higher intensity exercise, but normal at rest.

To be 100% certain, and with the encouragement from a couple of mentors, I decided to get a 2nd opinion before moving forward with surgery. In the timeframe of organizing the logistics around these next appointments, I trialed a calcium channel blocker as the non-invasive approach to resolving symptoms. This approach can sometimes work for those who have claudication in their external iliac artery; however, it rarely works for younger athletes who push themselves at a higher level.

About three weeks ago at the Mayo Clinic in Rochester, I underwent another bout of testing to confirm the diagnosis from the University of Utah. Their findings were essentially consistent to what had been identified, and after consultation with the vascular surgeon, I opted to move forward with surgery the following day in order to optimize my recovery timeline. As the first Olympic Test Event was underway in Tokyo, I was in the hospital undergoing vascular surgery: I light-heartedly call it the Rochester Test Event. The procedure involved about a 7cm incision from my oblique diagonally down the lower abdomen as well as a smaller incision in my groin. Upon locating the external iliac artery, a cut was made from one end of the artery to the other and a bovine pericardium patch was sutured and secured over the widened artery. I am now half-way through the 6-week recovery period, in which walking is the only exercise I’m permitted to complete to-date. I couldn’t be more relieved to have this procedure behind me and to be on the upswing with the confidence that I’ll have 100% blood flow moving forward.

Dealing with health or injury issues—especially ones difficult to diagnose—are always challenging. They can make an athlete feel isolated, vulnerable, embarrassed, confused and weak. I certainly felt a range of those emotions throughout this entire process. I had a difficult time communicating what was unfolding, adjusting, and accepting that I had to postpone going after goals I had set for myself at the beginning of an important, pre-Olympic year. I encourage anyone who is dealing with health or injury issues to acknowledge these feelings, share them with mentors and/or loved ones in your support system instead of internalizing them. Challenge yourself to remain steadfast and relentless in your pursuit of a medical answer. Trust your experience, your body’s objective feedback and your decision-making skills; only you are your best advocate. Be open to and accepting of changes and periods of gray when assessing health issues and next-steps. Remind yourself that progression and goal attainment—whether athletic or work-related—are rarely linear. Instead, challenges and obstacles build re-evaluation and problem solving skills, re-appropriate measures of success, and ultimately strengthen character and self-understanding.

So here’s to blood flow, deeper self-awareness and the next unwritten chapter. Thanks to sponsors, mentors, friends and family both near and far—as well as Taylor Swift—for the continued support. Bring it on, 2020.

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