Monday, October 7, 2019

Clarence DeMar, 9/29/19, The Battle between Goal Orientations (Ego vs Task) and How to Negative Split a Marathon.




As Kim and I walked to the starting line, I am having a mini-mental crisis because with 8 minutes to go I FINALLY decide to think about my actual game plan.

All week I have been jokingly texting Kim about how I am going to win the race and sending her photos of my Garmin’s predictions for me: “You are peaking!” it told me. “Estimated marathon time 3:15” it proclaimed.  Now that’s funny.

I mutter “Ego vs Task… Ego vs Task”  Kim askes me what the heck am I mumbling. 


“I am in a crisis!” I tell her and I don’t know what to do. If only I knew a Coach who could help me!”

This is my last race before my next surgery (4th surgery now for my GI issues) and I have no idea what will happen once I go under. I am afraid of a setback. I have been feeling good lately but I am not healed. I want to walk away from this race feeling good about my run. This could be the last marathon I run for a while and I want to be happy to be here. 

I explain, “Part of me wants to go out and run 7:50 pace from the gun. I feel like I can run 7:50 pace but I don’t know for how long. Maybe I just need to see how far I go before I blow up? Maybe I hold on?  Maybe I want a chance to shine before I need to stop racing again for however long that is?”

I go on…“The other part of me knows that just ran Sandia Crest Marathon with an 8:45 pace. I have no business going out at 7:50 pace, regardless of what my heart wants. And DeMar is not a goal race. Why do I think I can go out hold sub-8 the whole way? What have I done lately to support that plan? Nothing at all! So I know the plan should be to start about 8:40 pace (just a little faster than my last marathon pace) and try to negative split this thing and finish feeling strong. I should be aiming for an 8:30 per mile average pace. That is what I should be doing!  I should be working on the TASK of pace management and Negative Split Execution right now not dreaming about racing fast, winning anything, getting a BQ, or trying to run like I have actually trained to run a fast marathon.”

Ok, it is settled, seconds before the gun goes Kim an I agree it would be fun to run together again until we decide we need to do our own thing. I remind her that there is a hill around the 14M mark and once I get over that hill if I can pick up the pace that is where I want to start to make a move to negative split. 

I knew the first half would not go smoothly because I still needed to use a bathroom and I just couldn’t get my body to cooperate pre-race.  This better not become a thing.  I never had this issue before.  I can’t stop in the middle of a goal race.  Fortunately, this is not a goal race.

I read my race report last night from the last time I ran Clarence De Mar. It was a glorious experience for me and I have been wanting to get back here ever since.  

Kim and I take off, there is a nice downhill start and we are moving well, faster than 8:40 pace but it is fine, we use the descent and then settle into goal pace as the miles unfold and the terrain rolls. 

The course is net descent but there are hills throughout.

M1 8:24
M2 8:53
M3 8:39
M4 8:41


By Mile 4 I realize I need a bathroom and there are none around. By Mile 7 we start asking people where the next bathrooms would be and are told 1.5M by everyone, for at least 3 miles. ;)  

M5 8:54
M6 8:48
M7 8:49
M8 8:48
M9 8:42

Finally, at Mile 10 we found two. We pick up our pace to get there, knowing we will wait for others to get out. We are as quick as possible but loose about 2 minutes. I feel good enough to finally take my second gel.

M10 8:22
M11 10:45


Over the dam, we go. There is wind. It adds work. It is noticiable. I was hoping for some beautiful fall foliage but the weather has been warm and the trees just barely started to turn. It was still a lovely view.

M12 9:01
M13 9:16

After fighting the wind, Kim says that she wants to slow a little to get her legs back. She is smart. Trying to run even just a few seconds per mile too fast to stick with a friend can destroy the experience. Slowing down, taking a gel, regrouping and getting into the right pace is best. This is TASK-oriented work.  Ego-oriented thinking would have had Kim trying to stick with me even when she knew she wanted to slow down just a little.

The best work we do happens when we are Task-Mastery Focused (i.e. know your specific and personalized job and do only that job regardless of what anyone else around is doing) AND Ego-Focused (having a desire to beat the norm… BUT at the right time). 

I repeat, there is nothing wrong with Ego-Focused work, but it has to be well-timed. We are racing.  Racing is primarily an Ego-Focused activity. This is ok. 

But if we become Ego-Focused too early in a race, we will fail to master our task and that is a recipe for a bad experience.  I believe that Task-Focus pacing should dominate the first 2/3 - 3/4 of a race. The Task-Goal should be set based upon what you have done lately so that the goal is realistic and achievable. Set a task that is too hard and it is really just an Ego-goal in disguise. Set a realistic Task-Goal and this should allow you to shift to Ego-Focused racing in the last chunk of the race and blowing up no longer becomes a threat. 

With the bathroom stop, by the time we got to 12 miles we were averaging about 8:56 pace.  I tell Kim that I can feel that gel I took kicking in and I want to try to push myself. The hill I thought was as 14-15 was really at 12-13 and I just want to power over it. The pace so far was perfect. I felt really strong and I knew I had another gear.  We stay goodbye and I pick it up. 

M14 8:30

I hit the half marathon mark on the course at 1:58:xx.  I realize this is close to a 4:00 hour marathon if I don’t fade but I was hoping for something sub-3:49 (to beat my last marathon time from two weeks ago).  I actually did want to try to go sub-3:40 but with a 2 hour first half, I would have to run a 1:39-1:40 to get that. That was not realistic. I wasn’t even sure I could run a 1:40 half right on its own now outright.  

At this point, I start to run by feel and push myself just hard enough to find something that felt sustainable but strong. I felt like I just ran a 13-mile warm-up and now I was about to race!

My legs feel fresh. I look at my watch and my pace is 7:48!  This felt like 8:30 if I had to guess. It felt sustainable. I think back to the start of the race when I said “I think I can run 7:50s… I just don’t think I can do it the whole way”  Now here I am at mile 15 running 7:48 pace and I tell myself “Well, you don’t need to run 7:50s the whole way, but can you do it for the second half?.”… I am sure as hell gonna try” I reply to myself.

It has been a long time since I felt this good in a race. I was clicking off 7:40-8:00s like I did this all the time. Honestly, I did not run one non-stop run during training over the last 12 weeks and I did a lot of run/walking during the second half of the Sandia Crest marathon after I blew through the first half there in a 1:45:xx.

But here at Clarence DeMar, I felt alive! I felt strong, I felt competent. I felt like I was flying! When you are running 7:50s around people running 9:00s, 10:00s, 11:00s, it makes you feel like you are sprinting.

M15 7:48
M16 7:43
M17 8:04
M18 7:39

At about 19 miles in, I see a sight that says “I love running… I Love Running… I LOVE RUNNING!” I think “I actually DO Love running. God, how I missed this!” I remind myself to smile. This is awesome.

M19 8:08
M20 7:58
M21 7:53
M22 7:47
 

Mile 23-24, in part, roll though the cemetery. They are hard miles. The hills are steep late in the race. My form breaks for the first time. This bothers me. I don’t want to unravel. HOLD IT TOGETHER!  But still, I am passing ladies who look fit but they are power walking. I am shifting to EGO-Focused now. I am starting to look at my competition and aiming to beat them. From here on I am now working on reeling in my competition. I refuse to stop running when the hill keeps going up. I dig in my with my arms to try to create some momentum. It helps.  

Once back downhill, I can breathe. I regain my confidence. I smile again. I make jokes with these nearby. I am having fun!  I needed this.

M23 8:11
M24 8:07

I know my BQ as a 40-44-year-old woman is 3:40. I can’t believe it but I am going to be close to that, much closer than I expected after a 1:58:xx first half.  If I could really push hard and stay sub-8:00, I might get a sub-3:40 and BQ! What a great second half! 

But then I see that my watch is reading almost .2M long so my marathon will be 26.4 by the time I am done and that will make it impossible to go sub-3:40. 

I remember my mental break down at the start. Ego vs Task. I need to stop focusing on the BQ, which is not what I came here to do and it is not realistic. 

What is my job? What is my task? My job today was to run strong, to run a negative split, to not fade, to finish strong, and to walk off this course feeling like marathon runner again before I have my next surgery which may prevent me from doing this again for a long time.

The last few miles start to feel like work, as they should.  They are not overwhelming me. I am still passing runners. Runners are getting slower. I overtake them. I feel faster than I should because of it. I use that energy to keep me moving.

M25 7:52

The last turn brings us to 26M and it is there I start to feel like I can’t hold the sub-8 much longer… but we have only tenths left.  I push for whatever I have left coming through the finish line. 

M26 7:54
Last .2 (.38 on my watch) at 8:15 pace (finally starting to hit the wall ;) ) 

I hear my name announced. I can’t believe I am done!  3:42:40. (8:30 pace!) I missed my BQ by just over 2 minutes. Damn bathroom break! ;) Oh well, that was not the goal. My goal was to negative split and that is what I did. A 14+ minutes negative split!  I ran my second half more than 1 minute per mile faster than the first half. I felt amazing both inside and out. 


As I walked to get my drop bag I realized “OMG, I am not trying to BQ for 2020. I am trying to BQ for 2021 and I will be 45 on race day in 2021…. my BQ now is 3:50!  So technically I BQ'ed at Sandia Crest for 2021 by seconds only…  But here at Clarence De Mar, I managed 7+ minute BQ which secures my spot! I also qualified for Chicago too. Maybe 2021 should be a year of World Majors ;) 

I wonder how Kim is doing. I get my answer soon as I watch Kim fly in through the finish pushing herself to a solid 4:09 marathon as a long run! She looks so happy. She had her own ups and downs out there but she held it together. She overcame obstacles. She did NOT unravel. She faded a little but not really by much and she finished strong. 

What a great day. I missed the marathon so much.  It is a battle of physical and mental challenges. Nutrition and Hydration Challenges. Pace strategy challenges. Ego vs Task.

For me: Next up on Oct 4th is another ACell procedure. But this time I am going into this surgery in the best shape I have been in since this started.  I am ready for a recovery PR and I want to get back to running marathons as soon as possible. 


8:30 average pace. I did my JOB. :) 

Friday, September 27, 2019

Sandia Crest Marathon (9/14/19, Albuquerque, NM), Another Surgery, and Doing Hard Things.

Do easy things and life will seem hard. 
Do hard things and life will seem easy.

I want to do hard things. I want to persevere. I need to endure.  I am not done yet.  I am a marathoner. This is not over! 

My Health Update: 
On September 9th, I had an MRI to determine when my next repair surgery would be. I had been feeling a lot better but I knew was still not completely healed. The next day, my surgeon called to tell me good news! The main infected tracts responded favorably to the ACell regenerative matrix treat and my body was actually healing itself! HOLY CRAP this magical regenerative medicine is working. My body is fixing itself! I had no active infection, no fluid accumulation, and what remains of the tracts has been narrowed down to just slivers.

I have another surgery scheduled for October 4th. Hopefully, if we apply one more round of ACell to what remains of the tracts I can possibly be healed and move on with my life. Fingers crossed.

But here is the thing, over the past 6 weeks or so, I have regained control over my life despite my illness. It doesn’t matter what is wrong now. I have found a way to manage my symptoms so that I can get back to training and work around my obstacles.  I am a long-distance runner and I need to run

Well before this good news, I decided back in June to register for a marathon. I love the mountains and found a race in New Mexico, The Sandia Crest Marathon. It had a generous deferral policy. I have a very good friend who lives out next to the mountain so even if I couldn’t race I was still going to travel out to NM to hike up to 10,000-13,000 feet. I love being up high. 

_____________________


My Training: Three Key Workouts, Using What I Had, Training Deliberately.

It has been a long time since I raced. Once I recovered from surgery and started moving again, I only had 10 solid weeks to train. This is such a ridiculously short time. I can’t even argue that I had a strong base to work from because I did not. I had shut down my training in March after my second surgery and first ACell attempt. I gained 10-15 lbs of extra weight (107 lb was my best racing weight and I was up to 131lbs the week after my last surgery. I am happy racing at 117 or less. I was carrying at least 10 lbs of bona fide extra mass that wasn’t going to help me train or race well.

Knowing I had 10 weeks to get fit enough to endure a marathon, I decided to focus on three key workouts.

(1) Long Runs.  Building from 0-24 miles using a run /walk method starting with 0.15 Run/0.1M walk ratio. Each time I went out to run a long run, I would increase my Run distance by .1M or .15M and keep the walk at .1M.

My long run route was not beautiful. I had to deal with narrow roads, busy intersections, annoyed drivers leaving the MVC all before hit Mile 1 at the Prison and Sex Offender treatment unit. Mile 2 took me under a dirty disgusting bridge, with broken glass, sometimes stray needles, and dead pigeons. I ran past construction sites and down a path behind houses along a river where teenagers loitered to smoke pot. Mile 3 took me through a local park where I had access to water and bathrooms but also grown people who sometimes had trouble behaving themselves. The comments and catcalls get old fast. Mile 4-6 had me navigating narrow shoulders and bad drivers in too much of a hurry. Finally by M7 and beyond I had some peace in a nicer area with bathrooms and water fountains and long traffic-free running paths. At mile 10, I had to turn back and do it all again to get back home.

Week after week, I had to force myself out the door to make this journey to save my soul. I never felt unsafe, but I missed running in the lovely parks of Monmouth county where I could see wildlife that was still alive, smell the clean air, and not get verbally harassed by teenagers or adults who seem to have no idea what it looks like to witness someone doing hard things.

By the end of my training, I was able to run beyond 1 mile non-stop before walking for .1M to recover. My pace was just under 12:00 pace at the start and ended at 9:29 pace for my fastest run/walk long run of 24 miles, which was not actually the last long run I did. I struggled with these runs because most were done late in the day in the summer. I worked hard to make the long runs the focus, increasing my distance at least once but often twice in a week so that I would have the chance to get to 24M with some time to rest. I actually made it 24 miles ahead of schedule and hoped to repeat 24M or even get to 26M at leasts once before I took a week of rest, but I just couldn’t hold on. I managed a second 22M and then a 21M after the 24M, but the last two long runs were much slower than my 24M and I felt like I was just done “cooking” by that time. I was tired.

(2) “Speed work. At least once per week, I worked on trying to get my turnover back and I wanted my legs to get used to the pounding of faster paced running. For this workout, I still used the run/walk method, but the runs were all .45M and walks were 0.5M. The run pace was mid-to-low 8:00 pace with some sub-8 bursts when weather was cooler and I felt strong. These runs were about 8Ms long and by the end, I was able to get one total workout to average sub-9 pace. That was as fast as I could go.

(3) Hills. I used to travel a half-hour to Holmdel Park to run steep repeats of the bowl but with my condition requiring me to say close to home (to deal with the dressing changes and because I did not want to spend any extra time in sweaty clothes with open wounds) I had to find a hill close by. I live at maybe 85 ft elevation. There are no hills here.

The best I could do was a neighbored hill that climbed 46 ft in .15M. I used an "up-over a block-down- turn around and go back up-over a block-down" route to cover .7M with two .15M ups and .15M downs. The grade was about 4.9-5.5%. This is not very steep, but it is not flat either.

The best hill work I did was a 10M run with 7M of hill repeats. I needed to work hard on the downhills so my toes, shins, legs could get used to the pounding descent. But I knew this could never adequately prepare me for 4000 feet of descent down a mountain.

In addition to these runs, I did easy runs with Sidney at whatever pace he wanted  (also run/walk) and I walked the dogs as much as I could. I focused on getting as many steps per day as possible and in August I was very close to 800,000 total steps in the month. 

I did not do one single non-stop run in 10 weeks time and I was about to go try to run a marathon. lol ;) 

As a result of my training, I had lost 8 lbs, got my resting hard rate down to 44 bpm, and felt like I had done as much as I could do in the time I had available. I did not do any lifting, or yoga, or jump rope, but I did what I could. I was ready to give racing a marathon a shot.
_____________

The Race: 




I picked Sandia Crest Marathon because I love the mountains. This race was net descent but if you read the review you will see it is not easy. There are mile-long climbs at altitude that are hard for anyone, especially a runner from sea level. The hours of steep downhill pounding will add up and make it hard for the quads to persevere. The dry air is incredibly dehydrating (and just before I left for my trip, my molar cracked and exposed the root making it really hard for me to drink cold fluids with out shooting pain to my brain. Cups of ice water seems like a great idea when temperatures rose, but I just couldn’t handle the pain from the ice-cold fluids hitting a nerve so I know I drank less than I should.

I loved staring at sun rise on a 10,000 foot high mountain top. But I was a little concerned. This would be the time I have run first thing in the morning since maybe January 2018? I have been up and walking dogs first thing in the morning for months, then doing afternoon or evening training most of the time.

The first mile was blazing fast. The descent was no joke. I managed a sub-7 minute pace for mile 1 and can’t remember running that fast since May 2018 at a race. I tried to settle down but gravity made it more jarring to my quads to hit the breaks than it did to just go with the flow.

As I floated along I felt amazing. I could see myself running a fast time, surprising myself. My expectations were to try to beat 4:15, but if I found that I could actually go for a BQ I wanted it! I did not really believe the 3:39 was possible until right now in this race. Suddenly I could really see it happening. I remember running sub-3’s and how smooth I felt. I felt just like this. Oh wow, I am gong to FLY through this race!

Running a mile uphill at about 8500 feet is demoralizing. I am incredibly proud to have been able to maintain a running stride for that entire mile. I didn’t lose as much time as I expected but I am pretty sure I may have taken a few years off my life trying to hold on. Oxygen debt is no joke. At this point, I wasn’t even sure if I could finish the race. BQ! Ha! Who was that delusional idiot back there at mile 3? Success at this point would be measured by me finding that ability to take a full breath of air that actually circulated some oxygen to my extremities. Oh wow did I feel so unprepared for a marathon! Ok, back to reality… the goal once again is to just finish this thing!

Soon we started to go back down. I regained coherence and I got more pep in my step. These next 3 miles were fantastic. I knew I had a smooth ride ahead of me until about the 12M mark.

This course was fast through 12M and then the hard stuff would happen (expect big and rolling hills throughout the second half as the temperature rose and shade decreased). I expected a faster first half than the second half. Mission Accomplished ;)

But by mile 7, I had started to feel my stomach rebelling a bit. I needed to use a port-o-potty but I didn’t want to stop. I was so proud to have run the furthest non-stop run since maybe January? But I did not have an option. And there was a line. It is really hard to wait on line during a race. I lost a least a minute waiting but the rest break surely helped.

Once I started running again I was still holding around an 8:00 average pace and was shocked by this. I really did not think this was truly possible. 

The next hurdle came at mile 12, just before a huge hill that was about 1 mile long. I had to stop again. A runners just one stride before me jumped into the port-o-potty and took literally 3 minutes in there. I know this. I timed him while cursing and pacing. I knew at this point the chance of me BQing was diminishing greatly despite me still technically being ahead of BQ pace. The 12-mile hill was a beast and I knew it was getting hotter and hillier as I traveled along. I expected to fade a lot in the second half, which I did.

From this point forward, I returned to my run/walk training, walking up the steep hills and running anything I could run. It was getting harder to run because my quads were not prepared for hours of the steep descent. I did no jump rope this training cycle. My “hill” was barely a hill. My quads were in shock and my toes were disowning me.

By Mile 21, I watch my pace fade to slower than BQ pace and for a moment I felt disappointed in myself. Had I BQ’d it would have been on the very last day to possible do it and it would have the potential to qualify me for 2 years of Boston. It would have been a raging success to go from such a low point in my health to achieving something so amazing… and I watched it slip away.

But shortly thereafter I had some clarity. I REFUSED to let my inability to achieve a REACH Goal take away the joy I should feel from doing exactly what I was doing, which was running a marathon after almost a year of debilitation health problems off of 10 weeks of prep and I was going to come in well under 4 hours! This is a victory and if I let this feel like a failure then shame on me for not knowing how to set realistic goals for myself. I should know better and it is what I do.

So I shifted and started repeating the mantra I have been using throughout my training. “You are exactly where you are supposed to be. It doesn’t matter where you have been or where you want to go. Right now You Are Exactly Where You Are Supposed To Be” and then I start looking around my world for object and I repeat “Right now you are supposed to be right here, right next to this telephone pole…. Right now you are supposed to be right here, right at this intersection… Right now you are supposed to here, Right at this water stop with the lady where sunglasses shaped like popsicles…. Right now you are supposed to be here, power walking up this mile-long hill at mile 24 and nowhere else.”

This helped me tremendously. I was doing something amazing and I almost missed the joy of it because I about to feel bad about not qualifying for some other race that won’t happen for months. I refuse to distract myself from experiencing joy just to allow myself to feel bad about something else that was not happening. That is crap and I refused to allow myself to feel bad while doing something well.

I decided that since the BQ was out and my body was very tired that I would make sure that I enjoyed the remainder of the race. I worked hard, power walked when I felt I needed to, and enjoyed the emotional ride to the finish line with no pressure to do anything but have fun!

After all, I was running a MARATHON!  A hard marathon. And this is where I belong!

I am so proud of my effort. I felt like myself again, even when it all unraveled for me in the second half. :)

___________________

Do easy things and life will seem hard. 
Do hard things and life will seem easy.
Expand your comfort zone. 
Persevere. 
Endure.
Appreciate the Moment.

Stats
Time: 3:49.16
OA Place: 39
Gender: 12th
Age 3rd

Sunday, July 28, 2019

7/28/19 Update: Enzo is my Co-pilot. Another Surgery in the future. Never Give Up.

I have been quiet here. I believe that "If you don't have anything good to say, then maybe it's best to say nothing at all."

I have been having some very hard heartbreaking experiences. I am never ever looking for people to feel sorry for me, so I didn't feel posting about all the sadness while I grieved and adapted was necessary.

I am ready to update my blog now.  After all, this is a journal of my life... so here it is.

My Enzo.
The hardest thing that has happened to me since my last post was that Enzo died in my arms while Sidney cradled his face and stroked his head and I will never be the same. We had to put him down because what the vets thought was a spinal stroke or a slipped disc appeared to be a terribly aggressive form of cancer called a Hemangiosarcoma.

By the end of April, Enzo was able to trot again up to a 1/2 mile non-stop at a time. This was amazing progress. He was fighting back! I was getting more hopeful that he was healing.  His stride wasn't great so I bought him a sneaker to protect his toenails from dragging.  He was happy.  I was happy.

It had been months of caring for him when he was completely immobilized and now he could go 1/2 mile on his own. This was a huge improvement in quality of life. But then he had a setback and started to look more uncomfortable. A setback, we were told, meant that it was not a spinal stroke. It was most likely a slipped disc and he could possibly get this fixed. His cardiologist cleared him to have spinal surgery. He was scheduled for an MRI and surgery in early May. But instead of spending an overnight in the hospital, he was kept for 4 days while a team of vets ran a series of test trying to figure out why his symptoms made no sense to them.  Why could he walk sometimes? Why did he have a feeling when he should not.  They found a mass and said they could possibly get to it and remove it. We asked them to please try. But when they operated they discovered he had no mass at all. He has the remains of a hemorrhage but they could not figure out where it came from.  They did see another mass that they could not reach unless they broke his pelvis, which was not happening. They could not even reach it to biopsy it.  However based upon what they did not, they suspected only one problem, a type of highly aggressive and untreatable cancer that ofter results in hemorrhaging called Hemangiosarcoma.  The fact that he hemorrhaged and did not die at that time is a testament to Enzo's Strength and Will to fight through anything.

After the operation, we brought Enzo home and we were told that we could wait a few weeks and then put him through more exploratory surgeries to see if they could get a conclusive diagnosis by trying to biopsy the mass they could not reach during surgery by going in a different way.  If it was Hemangiosarcoma, at this stage there would be no cure. Chemotherapy could be a possible option but it would not heal him if it did anything at all. However, Chemo was not an option because they did not have a conclusive diagnosis. But because the mass was inoperable, we could expect him to experience increasing pain and a potential hemorrhage again at any time.

We took him home and loved him more than I thought I could ever possibly love anyone or anything in my entire life for only a few days. 

And then my heart exploded when it was time to say goodbye. Once the pain medication stopped keeping Enzo comfortable and happy, we knew we had to let him go on May 11th.

Holding him in my arms while we said goodbye was by far the hardest thing I have ever done in my entire life and I will never be the same.  The reality is we had only a few days with him from his cancer diagnosis to the end of his life and it was simply not enough time to process anything.  What made it so much worse for us was that we sent him to the vet with very high hopes that spinal surgery would help him, only to find out that things were much much worse and incredibly aggressive. 

Yet through it all, my boy Enzo never showed us that he was fighting for his life. He improved. He was trotting up to 1/2 mile the week before. He was happy and he loved his life. He fought so hard. He is my inspiration.  He will always be.

I shared this post on FB that felt like a Funeral for Enzo on 5/12 here.  This helped me.

Since Enzo's passing, he is still everywhere. An old man walks past our house now.  We stopped to talk with him one day when he ran up to see our dogs saying "I just want to say Hi to the dogs!" Then he introduced himself "My name is Enzo," he said.  We see him now almost every day.

The book "The Art of Racing in the Rain" has been turned in to a movie. This is a story about a dog's recounting of his life with his person on his last day. The dog's name is Enzo. When I first met Enzo, I was listening to the audiobook and named him after this very dog. The trailer for this movie runs repeatedly, breaking my heart each and every time. 

Not everyone will share an incredibly special bond with their dog, although I would guess most people truly do. Dogs make sure of this. They are the best creatures on this planet. And every once in a while there is a really special dog that changes your world and Enzo did that for me. I am so blessed to have loved him. 


My Health:
Since my last post, I had another ACell Regenerative Medicine application to the open fistula tracts in my lower GI.  For those following this post because they have a fistula and are terrified please know that I have a very high, complex, horseshoe-shaped, trans-sphincteric multiple tract fistula infection.  I am not sure if it gets much more challenging than this. Hopefully, yours is not as complex.

During my last surgery, the surgeon has said if he could actually reach where my abscess was located, he would try to repair me from the inside with what is called a Flap surgery.

When I woke up from surgery, I had learned that my abscess is so deep (high) that he could not reach it to fix it internally. While exploring, he also discovered the tract had branched out, spreading to make a new infected tract that needed to be closed as well. It is not a great sign that he could not reach the abscess site to close it.

He had to make a very large opening in my butt cheek (maybe the size of a half-dollar) and had to use the existing fistula track apply the ACell matrix.  He cannot cut me or I will lose bowel control for life. This surgery has not been comfortable, but I am very proud of how I have been managing.

At one point during a run with Sidney, he turned to me and said "You are the strongest sick person I have ever met" and that, right there, was the best thing anyone has ever said to me. We aren't weak OR strong... we can be both. I am both right now. 

After my surgery, I could not move for 5 days. I needed to take the prescription pain meds to tolerate the early days. I took 10 days to rest and then I was back at work. The truth is I really need another week before I really felt well enough to deal with driving, sitting, working, etc without pain meds.  I was in a lot of discomfort for 17 days but then I felt better.

I saw my surgeon on 7/22 and he confirmed what I already knew, the fistula tracts are not fully healed. The ACell did not work, at least not by 7/22.  He said to give it 3 more weeks to see what happens (but truly if it was going to work, it should have work quickly).  Then we will move on to another MRI and try to assess what surgery I can have next.  I already know he can't reach the internal gland that abscessed.  I don't know what else he can try to do for me, but with every more complicated surgery comes increased risk that I will be in a colostomy bag so we are taking things slow.

He did say I am not infected at this time and my surgical site looks like it is healing well.  He told me to live my life and if I suddenly have signs of a new infection to call him right away. Because my version of this condition is very complicated, too deep to reach, and has multiple branches, at any time I can become infected and possibly septic again.  If I have a fever or pain, I need to stop everything and get treatment. If I have no symptoms I can do what I want, including running as long as I can tolerate it. 

Marathon Training, Running for Enzo... Running WITH Enzo still: 
I have decided that "waiting until I am better" is not working for me anymore.  This illness began in October.  I waited for months, losing almost everything I love about my life during that time.  I am not going to do that anymore.

So over the last month, I have begun training again. If I had to pick one workout to help me get faster and to build endurance as quickly as possible, it is the "Run/Walk."  I still have a large opening from my surgery.  Initially, I was packing that wound with antibiotics covered cotton then covering with a plastic adhesive covering with a gauze pad.  With that in place, I could run as far as I could tolerate.  Right now I don't need to pack the wound anymore. I can just cover it with gauze and plastic adhesive and go on my way.

I am now up to 14-mile long runs and my fastest and most recent 12-mile run was at 9:25 pace walking .10M each mile. I am getting stronger. I am getting faster.  I am not giving up. 

I have a Long Run playlist. Somehow the song "Fix You" by Coldplay ended up saved to my Long Run playlist. "Fix You" was the song I played 2-3 times per day when I did PT exercises with Enzo to try to help him heal his spinal injury (when we thought it was just that). With my playlist on shuffle, "Fix You" will randomly play.  The last few times it came on just as I reached the park where Enzo and I trained most often.  I can't help but feel like Enzo is now trying to fix me.  I can believe anything I want to believe. I choose this.

I can't explain how much I miss having his leash tethered to my wrist when I run. I walk Lapis and Piper with a waist belt.  No one is tethered to my wrist anymore.  Enzo was always a crazy dog and not the type that could be off-leash ever. He just wanted to run. He wanted to run fast and he wanted to run far. He didn't give a crap about what anyone else thought he should do. He was his own boss. That is what you get from living on the street for who knows how long.  He had a lot of issues, but he was happiest when he ran.  He had the ability to run over 50 miles per week with me and could have done more if I didn't get tired.

So now I well enough right now to train again. And I am not just doing this for me. I am carrying my boy Enzo with me in my heart wherever I go. I am letting him do what he always loved to do. 

If I make it through this cycle of marathon training, it is only because of Enzo. I run for him now. I refuse to sit back and wait when I can be out there Fighting like Enzo did every day.  Enzo is the inspiration for everything that happens to me now in my life. Where I go, he goes and I want to take him everywhere. 

Enzo is my Co-pilot. 
He is my inspiration. 
He never gave up. 
I can't either. 
Not now. 

#EnzoIsMyCoPilot, #CreatingMomentum!, #NeverGiveUp

Wednesday, April 10, 2019

4/10/19 Starting over again, after a really hard 4 months.

A lot has happened since December. I am exhausted, truly. But things are getting better in every way.

My Husband and our new dog: In January, my husband Sidney was deployed to Afghanistan. He just got home. It was long 3.5 months.  The most beautiful part of his deployment was him finding Lapis. 
While deployed Sidney befriended a puppy. He found out that in his area of Afghanistan, the culture is not dog-friendly. If this "little" girl was not found a home, she would be either euthanized (most likely shot) or released to the wild (off-base) where she would likely not survive the harm from people or other animals.
  
Lapis  at 3 months old
By February 10, we had coordinated with and help to fundraise for Puppy Rescue Mission to have her shipped to a shelter in Kabul, quarantined, vaccinated, medically cleared, and transported home to us to join our family.  She just got here too.   

Sidney named her Lapis after the blue gemstone found in the mountains of Afghanistan. Sid wanted her to have a name that represented her place of birth but he wanted it to be connected to something beautiful, not the base or the desert. She appears to be all or part "Afghan Kuchi (Shepherd)" which are dogs that follow nomad herders around protecting them from wolves and thieves. I took Lapis for a mile of jogging yesterday and it turns out she LOVES to run, at least right now. (Vet already said I can start running with her)

My Health: On 2/5, I changed surgeons. My old Colorectal surgeon gave me one option for surgery that had a low success rate and too high a risk of incontinence. 


I found a doctor in NYC from Columbia. He provided me with a second opinion about my fistula.  So far this tunnel of infection of my lower GI tract threatened to leave me incontinent once a surgeon would attempt to close the hole. Because this hole was left open,  I was living on months of antibiotics with drains in place to prevent me from becoming septic again.  This new doc explained that he wanted to try a minimally invasive new procedure that used ACell, regenerative medicine, to stimulate my body to heal itself.  When the Acell matrix comes into contact with injured tissue, it triggers the cells to turn back on and regrow.  This has a good chance of repairing me completely or in part. If only partially successful, it should make my situation so much better so that if I did need another operation, that next operation would be simple not leave me incontinent.  

I was able to find some promising research on this procedure.  It seemed hopeful and involved no cutting, minimal pain, and an uncomplicated and speedy recovery process. https://www.ncbi.nlm.nih.gov/pubmed/25975335



Enzo needed 6 weeks of crate rest 
to help initial his healing.
Enzo (my boy, my family): On 2/18 Enzo had what was most likely a spinal stroke and became completely paralyzed
in his back left leg.  While on a walk, not even .5 miles into the walk, he suffered some incident that caused him to lose functioning over 12 hours and eventually he could no longer walk.  I think knowing Enzo is an older dog, both Sid and I were both afraid something might happen to him while Sid is deployed and it did.  

It was the most heart-breaking situation I have even been in with a pet, watching them suffer from sudden immobility.  I learned how to do PT for him, I took him to 5 vet appointments for help, including a neurologist.  For the first 9 days, life was miserable and recovery seemed hopeless. By day 11, Enzo was starting to get around better and used his leg more. All I wanted was for Enzo to be basically OK by the time Sid returned.  With a lot of work, Enzo was able to walk a little by the time Sid saw him again. This was good but not great. Enzo may never run again. He may never fully regain the use of his left back leg.  But, we are going to keep trying to rehab him to the best of our collective ability.

My Surgery: On 3/8, I had my ACell surgery. I haven’t run much since. I was told to try to move very little for the first 5 days just to give the matrix the best chance to trigger regeneration. I could not lift anything. I was not supposed to be on my feet much.  With a paralyzed dog at home who needs to be carried everywhere, I was terrified I would not be able to care for myself or for Enzo well at that same time. But Enzo rose to the occasion. The day of my surgery, Enzo started to use the dog ramp and dog door on his own. I did not have to lift him at all during my recovery. After 5 days, I was told to exercise lightly at first and to take things easy until I saw my surgeon again for my 4-week follow up.  Today was that day. 


It has been so exhausting trying to take care of Enzo and myself post-surgery while attending to Piper and the birds' needs without any paid time off to use and without Sidney around to help me. But it all got done and everyone made it.  My training fell off my plate which was likely the best thing I could have done, since training could have messed up my healing process. 

Sidney's Return and then Lapis's arrival:  On March 27, Sidney finally returned from Afghanistan. It was nice to have him back. We had two full days together before we had to drive to DC from NJ to pick up Lapis on 3/30.  We quarantined Lapis further from our other dogs, which meant Sid and I taking turns sleeping on an air mattress with her until the vet checked her.  She did come back positive for Giardia and all dogs got 7 days of meds twice per day.  I felt like a nurse for the last week. LOL.  They are finally all healthy but they all need time to become friends.

Today, 4/10, I was able to see my surgeon to find out if I needed another surgery.  I knew I wasn’t 100% healed but I was trying to not get my hopes up either.  I was afraid he would tell me that I needed a new surgery but instead, he told me that the ACell matrix seems to have worked. He reported that he can’t see any evidence that I have a fistula anymore, but I am not 100% healed at that time. I was told to go live my life and come back to see him either (1) only if I have any pain suggesting infection, or (2) if I want peace of mind, I could see him again in 4 weeks.  I opted to return in 4 weeks. 

ACell is  an ECM that trigger regeneration of tissue
  
So now I am ready to start over. There is still a lot of work to do but we are on the upswing. 

First, I have to train all the dogs to get along safely. I have to train Lapis to run more than a mile with me. I have to train Piper to not be fearful of this giant puppy (40 lbs at 5 months old). 

I have to keep working with Enzo to see if I can get him walking better on his bad leg. I worry about him. 

And now I have to wait 4 more weeks to find out if this nightmare is over while praying I do not become septic again. I can start lifting again and I can start running again. For now, I feel like I have experienced a small miracle with this ACell regenerative treatment.

I feel both happy and terrified at the same time.  I get to move on with my life while hoping nothing bad happens along the way.  The more time that passes, the less fear I will have about this. So for now, I get to start training to rebuild my fitness again. <3 


And for the record, this is Lapis at 5 months only 2 months after that first photo was taken. She is going to be huge! 


Friday, December 28, 2018

The Day My Asshole Tried to Kill Me and Why I May Never Race Again...

If you are easily offended by foul language, unmentionable body parts, bodily functions, and details about surgeries, then you are dismissed. This post is not for you.   

If you are curious as to what happened to me and would like to offer some understanding, support, and encouragement during my attempt to find myself again, then you may proceed. 

This post, actually, is for me (and for others newly diagnosed who need some help making sense of WTF is happening). My blog. My journal. My body. I write about the good. I will write about the bad too. 

****
Why am I sharing all this personal stuff?  
First, because I train a lot of athletes who are wondering what the heck happened to their coach. I care about my runners and I want them to know what is happening to me. I want to be a role model of perseverance and I want to show them that when I tell them to never give up on themselves, I also practice what I preach. 

Second, I am really sharing it publically because for the last three weeks all I have seen are horror stories. There seems to be no hope for people in my situation, just problem-focused misery. I have been desperately seeking examples of people who are managing this condition well. I want to read about people who are living life. I want to see athletes succeeding despite this condition. But I have not found one post, not one comment, no blogs from anyone who racing marathons or playing sports competitively in my condition. (I am sure they are out there but they just may not want to talk about their asshole). The people who are sharing their stories are the people who have seemed to give up. I don’t want to give up!  

If I can’t find a success story, then I want to be that success story. I want people, like me, who are desperate for hope to find my blog. I want them to read about the hard reality that I am facing (this is bad and I can't pretend it isn't). But I want people to also see that I have found my way and they can to. This is not pretty and it is not problem-free, but I am managing it. If I can manage, others can manage.     

***** 
What happened? It has been just over 3 weeks since my asshole tried to kill me.  Jeez, make one too many self-deprecating jokes about trying to not poop your pants on a long run and the universe decides to blow up your anus. Not cool. I didn’t even know this was a thing. 

****
For those people hate "vague-booking" here you go. Careful what you wish for! 
On 12/4, I was rushed into emergency surgery because a crypt gland several inches inside my anal canal became very infected. Why? No reason. The gland, whose job is to lubricate the anal canal malfunctioned. It became impacted or maybe succumbed to bacteria. This type of infection is most often linked to Crohn's disease, Ulcerative Colitis, Diverticulitis, Diabetes, Obesity, etc… none of which I have. I have Bad Luck. Sometimes Really Bad Luck.

The mounting pressure from the pus needed a place to go. Rather than take the path of least resistance and discharge through my anal canal, the raging river of infection decided to go on a seek-and-destroy mission to find a new exit out of my body through my left butt cheek. On its way, it bore a tunnel through my both my voluntary and involuntary sphincter muscles. This tunnel is called a Fistula.

On its way out, my river of infection decided to divide and conquer splitting into two branches to make what is called a horseshoe fistula. This is bad. My fistula never actually busted through the surface of my skin but rather created two huge pockets of infection, one inside my body and the other near the surface of my left butt cheek. When sitting, could feel a large hard mass in my butt cheek. After many days of this (it took two visits to get this diagnosed correctly), I became septic. A few moments into my second doctors visit, my doctor realized that I was septic and ran from the exam room to book an Operating Room ASAP! I had surgery a few hours later. 

Here is a short cartoon that shows what happened (there is no sound): https://www.youtube.com/watch?v=aA0wqcoeI_g


******

When I woke up from surgery, I was not prepared. I was told I have a very large complex fistula that was incredibly infected and it passed through both my sphincter muscles. This meant it could not be repaired. Instead, my surgeon inserted two seton drains and a larger tube drain. The setons will stay in place for 4 months. The tube was removed 10 days after surgery.

The setons look like large blue rubber bands that are threaded through the fistula tunnel and looped out my anus and then tied and sutured in a knot outside of my body. Not comfy. 

The setons keep the fistula tract open so that the infection can continue to drain as needed for months. The setons help “mature” the fistulas by irritating the tunnel causing scar tissue to form inside the walls of the tunnel. 

The third tube-like drain was inserted to keep the large fistula exit hole the surgeon cut into my butt cheek open so that it could continue to drain the infection and so I would not have to repack the wound each day. The doc stuffed a huge wad of gauze packing inside the tunnel during surgery. I got to pull that all out 24 hours later. I needed to wait 48 hours before trying to walk. I was told to wait a week before trying to do any exercise. And I was told to wait 2 weeks before lifting anything heavy.  

The setons stay for 4 months to provide an escape route for any new infections that will (likely) form in the future. 

*****
Then I went home. And cried. A lot. For three days.

WTF just happened to me? Here is an excellent video that very clearly explains the different types of fistulas and the different types of treatment.  https://www.youtube.com/watch?v=LM4qGZ88McM Mine is one of the complex types. I do nothing half-assed.  #OverAchiever.

First please know that any type of anal fistula is incredibly rare and they all suck. The majority of those who have fistulas have a “simple” fistula. These are very close to the anus and do not cross any muscle. These simple fistulas are easy (but very painful) to fix with one surgery that “lays open” the track by cutting through the skin, opening the tunnel, sewing it open to lay it flat. It heals slowly and painfully over time. Without muscle involvement, there is no risk of losing one’s ability to control bowel movements.

A minority of people with fistulas will experience “complex” fistulas. These are the type that have burrowed through one or both sphincter muscles, which control our continence. We have two sphincters, a voluntary and involuntary sphincter.  Once these muscles are cut too deeply (like during surgery), they will stop working forever. However, the fistula doesn’t damage them enough to impact bowel control. Surgical intervention will leave a person incontinent if too much muscle is cut. 

The first type of complex fistula is called an intra-sphincter fistula. It crosses through only the internal involuntary sphincter but does not touch the voluntary sphincter. There is some hope for bowel control. If this type of fistula involves less than 30% of the one sphincter muscle, this fistula may also be “laid open” as well with low risk of incontinence since most of the sphincter muscles will not be cut. 

The second type of complex fistula is called a trans-sphincter fistula, which crosses through both the voluntary and involuntary sphincters. Surgery to repair trans-sphincter fistulas are more likely to fail and more likely to leave a person incontinent because both sphincter muscles are involved. This is my type. 

The only thing that can make a trans-sphincter fistula more challenging to treat is the presence of multiple or horse-shoe tracts. This means the fistula split and took more than one route and is now longer than those that took more direct routes. The longer the fistula the harder it is to close. The more tracts, the harder to treat.

What do I have:  A complex, high, horseshoe-shaped, trans-sphincter fistula.  This is not going to be an easy fix. 

*****
What is next:  Complete Cure vs Colostomy Bag? Only time will tell. 

Because the sphincter muscles cannot be cut, the seton drains are put in place and they remain for months. As I explained, this is supposed to scar the walls of the fistula tract to seal closed the inside and lower the risk of re-infection along the tunnel. However, this tunnel is directly connected to the inside of my anal canal. Anal canals are not germ-free places. Infections of fistula are to be expected while the seton is in place because fecal matter can still get in the fistula opening from the inside and there is nothing I can do to stop it. This is bad news.

At the present time, I can do what I need to do to keep the outside of my body clean and healthy. This means I take Sitz Baths every single time I use the bathroom at home. I try to not use the bathroom when not at home. I need to keep my new extra butt cheek hole covered with clean gauze since it drains (not a lot) all day and night. I get to wear menstrual pads every single day now to catch any drainage. This is fun. I feel bad for men with this condition.

In about 3-3.5 months from now, my surgeon plans to attempt to close the internal hole from the inside. There are a handful of methods, all with not very good odds. Some options are to pull a flap of skin over the opening from the inside, but that usually fails as the flap pops off. Another method is to try to stitch the tunnel closed, which also tends to fail.  Some doctors tried to create plugs, but those pop out. Some doctors try to use glue to fill the fistula, but that is not very effective. There are some promising results with laser cauterization, but this is still considered experimental and not available to the public unless you live in the UK. Some go to India for some special magical thread treatment that is not approved here in the US. Some have the seton drain rigged to be a "cutting-seton" and it is pulled tighter and tighter overtime to cut through the muscle slowly, but that has problems too. 
Some people do decide to leave the loose seton drains in for life. But over time, a risk of anal cancer can possibly increase because the drains are foreign bodies that are constantly being rejected.  

(Edit: When asked for research to support this of increased risk of anal cancer from long term use of draining, I cannot immediately find the resource at this time so I am adding this note for now to say this is not a common concern and many people do choose to leave setons in a long time, rather than undergo surgery. There is NOT strong evidence that long-term use of setons increases the risk of eventually developing anal cancer.  Balancing risks is important. As a cancer survivor, I am more worried about cancer recurrence than others may be so this detail struck me as relevant for my personal journey.)

Many people have multiple surgeries. Every time a surgical intervention is attempted, there is a risk of damaging the sphincter. The patchwork can fail at any time, days after surgery or months or years later. Reinfection rate for those with complex fistulas is very high, especially once the setons are removed. Multiple attempts to repair the fistula to stop the infections can lead to incontinence. As a result, some patients who are not able to fix the fistula are fitted with a colostomy or ileostomy bag. Usually, by the time someone needs a colostomy bag they seem to actually want it because the battle against repeated infections will finally be over.

Here is a link to some research about how hard it is to close fistulas. The more complex the fistula the lower the success rate for closure
. Mine is very complex.

When a fistula is horseshoe-shaped the failure rate is closer to 60%. 


*****
Here is a flowchart that tells me what I can expect. I am in the Draining Seton Stage of the Complex side of this flowchart.  I can heal or I won’t. We shall see. What should follow after "Follow-up" if we loop back to recurrence is "Nothing is working, infections persist, colostomy bag needed..." 


*****
So what is happening to me now?  

I am an ultra-runner at heart. Ultra-runners are solution-focused athletes. We endure.  We have a high pain tolerance. Meditation taught me focused on the "here and now" and to focus on what I can control. Acceptance is liberating.  

At first, I felt like the universe literally ripped my heart and soul out my asshole. I am a runner. I own and operate my own coaching business. My social life revolves around racing. I was a sub-3 marathoner. I ran 43 miles in 6 hours as a 40-year-old woman. Running is where I belong. It is who I am. I have one more class to complete in order to earn my Masters of Science (M.S.) degree in Kinesiology (Science of Human Movement). It was hard to focus on school after this. My entire life revolves around being athletic. I had almost completed 7 years running daily with an average of just under 8 miles per day. That streak ended on 12/4. My soul was crushed. My heart was broken. I took a few days to feel sorry for myself.

Then, I started searching for success stories. I found none. Not one. People shared about needing 15 surgeries over several years. People sounded hopeless. The stories of raging random infections were terrifying. They shared about getting colostomy bags and being grateful to finally be infection free.

****
Trying to become a Success Story (at least at Stage 1): 

So I decided to try to become my own success story! And for the last 3 weeks, I have figured out how to be myself again. For me, this is a small victory. Just one battle. Not yet the war. 

I needed a week before I could run again. So I walked. For the first week of running, I would only run on my treadmill or from my house so I could stop when I needed to. As my runs got longer I had Sidney ride a bike next to me in case I needed to stop. Then I met Kim at a park, but late in the day so I could use my own bathroom. And finally, I met Rich early for 10M and actually had to use the port-o-potty out in the world. And finally, that day, I felt like myself again. Yes the measure of success for me was being able to use a public trail-side port-o-potty.  I set the bar high. 

But truly this means I can run anywhere and for as far as I want now. I am not limited anymore! At least not for the next 3-3.5 months unless I get an infection (which could happen at any time).

The specific obstacles (TMI, but I don’t care. Others who have this issue may want to know this stuff). 

I had to:
(1) To figure out how to manage any chafing from the knots from seton bands (so far this is not a problem but I have not run more than 10.2 miles). I have an arsenal of lube to test when/if needed. Not needed yet and I don't want the lube to mess up the Tegaderm patches which are sticking well now.

(2) To figure out how to get comfortable running with rubber bands irritating my asshole, making me feel like I had to take an urgent shit with every stride…. but I got used to that and the sensation stopped happening.  Phew!

(3) To figure out how to run comfortably with gauze padding in my pants and (4) To figure out how to use the bathroom out in the world when I can’t immediately get into a Sitz Bath to make sure the open incision that I will have for months stays clean and dry as well as to make sure the rubber bands hanging out of my ass are clean. Fun stuff. 


My solution to 3 and 4 above: Tegaderm patches with gauze included. I am so happy to have discovered that I can cover the setons and open incision with a 4x4 inch plastic Tegaderm patches that have a square of gauze in the center. The adherent patch holds down the majority of the seton drains so that I don’t feel them move and they don't chafe me too badly. Sure, I feel them. The gauze collects any drainage completely so I don't need to use a big wad of gauze or menstrual pads when I run. And because the incision site and most of the lenght of setons are covered with plastic, if need to use the bathroom when on a run, some wet wipes are all I need to keep the area and setons completely clean. 

Based upon what I had read online from others with setons, running was not supposed to be possible! Reports of pain, chafing, repeated infections from just walking around or being out and about too long made running seem impossible. Not True.

So far I have made it up to 10.2 miles at 9:30 pace without any debilitating chafing or any significant pain. I have also run 5 miles at 8:10 pace, but that was hard and uncomfortable. The irritation level is not enough to stop me from running and I was even able to use the bathroom during my run and nothing bad happened. The Tegaderm stays put for the entire run.  Finally, I feel like myself again! 


I am in more pain, actual pain, when sitting and when trying to get comfortable to sleep. Running and walking is less painful than being sedentary.

****
The Plan: Train for a race, maybe
  
I have 3-3.5 more months before my next and first surgery to attempt to close the fistula (See flowchart above. This may be a long journey). My surgeon wants to try the LIFT procedure, where he will try to sew closed the fistula by cutting through my butt cheek, between the two sphincter muscles and stitch the fistula closed. I don't believe I can run for at least a month after that. The LIFT will likely fail. I know this.  Then I start over with another infected abscess, get new setons and wait again for the next surgery.  Based upon the research, for someone with my specific type of fistula (high, complex, horse-shoe shaped, trans-sphincter), the success rate is 40% (so it is most likely to fail) and the risk of some type of incontinence is 30%. So I am not sure yet this is the surgery I want to do. But most have those same odds. 

For now, each day I am infection-free is a day I can train. Each day I can run is a small victory!

My aim now is to find a race to run by the end of March, before I start the next stage of this journey. I may be cured with the first surgery (fingers crossed) or I may end up eventually in a colostomy bag at the worst if nothing works. I really don’t know what will happen.

But what I do know is that today, nothing bad is happening to me. Today I can run.  
Today I can dream about running at least one more goal race and maybe some other races just for fun along the way. I want to do what I can to make this time I can run count.