Positive Splitting

20 Friday May 2016

The metaphorical road to the River Bank run was a long one; The literal road of the River Bank felt even longer. I signed up 11/2/16 at 5:33 AM, so I got the number 301. The first 300 must be reserved for elite runners because I do not know how anybody could have signed up before me. Todd Chassee, my original River Bank partner, wore number 302 (and broke the 1:50 this year). I was quietly hoping that if my race crashed and burned, he would just give me a head nod and run right by. No sympathy needed for this brain cancer patient.

I can’t say I ‘enjoyed’ the run. Far from it. It felt terrible, but a good terrible. There was no runners high at any point. I was running injury free for the last 3 months, mostly on a treadmill. I went through House of Cards season 4 with an average heart rate of 160 bpm. As the race approach, I eased up for about 10 days and felt ready for a good taper. The theory is that you stress your muscles and cardiovascular system repeatedly for a few months and let them rebound with higher performance. Taper too much, and you will slide from peak fitness. Taper too little, and you will just be tired at the race.

This training went way beyond what would be considered helpful for cardiovascular risk reduction. I was going slightly faster than previous years, but I may have already maxed out on my personal capabilities (my times were all within 20 seconds from 2013 – 2015 at 1:33). I do not really follow the published River Bank training guide since I believe the weekly miles are too much. I max out at 25 miles a week or so with interval training. I complement this with swimming at EGR Masters, Fzique spin, and light lifting.

Figure: Left, pre-race picture with Todd Chassee. Middle, a taper run with Mia and Miley. Right, Uncle Pat found me at the start of the race.

After 10 days of putting the brakes on, I was ready. That was until I opened the fridge Friday morning and fell to my hands and knees with a back spasm. That’s what did it: opening the fridge. Once you near 40, apparently you need to be really careful opening a fridge.

After all this, almost derailed by normal middle aged low back pain. So I told as many people as I could on Friday that my back hurt, even a few patients.

“Your prior heart attack reminds me of my back pain this morning…”

I needed to set up a pre-race excuse. I mean, I was featured on Wood TV8 as a River Bank runner despite cancer therapy. There were soccer families that got their kids up for the 7AM 5K (Vances, Vanden Bergs). Janelle Coffey, an old friend from Grand Haven swimming, even got her running shoes on. Several colleagues and staff were present from the hospital. Relatives from Pittsburgh and Philadelphia. Friends and a mentor from Ann Arbor. I needed to be well enough to finish or have a convincing injury story.

I grabbed two ibuprofen and went to the pool Friday morning, my version of Yoga, but I could barely kick. Instead, I hopped out and hit the showers with burning hot water on my back. I also stopped at home to grab another 400 mg of ibuprofen prior to work.
“You don’t understand, this back pain is worse than delivering a baby,” I informed Staci later on Friday. Although I only got a “P” for Pass on ObGyn as an M3, I had seen way more baby deliveries than my wife and her mere 4. I am a doctor afterall. “And I can’t get an epidural.”

“Yes, dear,” she said, understanding my suffering once again eclipsed hers.

Allison, quoting my oldest sister Amy, just said “suck it up, Dad” after she heard me repeat my story to the Waves coaches on Friday night.

“Valium,” my PCP suggested, “It’s a good muscle relaxant.” Who gets calls from their PCPs on the Friday night with offers to write benzodiazepine scripts? I’ve never had a benzo (well, probably during surgery), so trying one right before a 25K may have been too much for this lightweight. They are not exactly performance enhancing, but more of a lubricant for procedures and life. And running fast includes running in a straight line from point to point. I’m not sure that could be accomplished on Valium.

“Decadron,” my local oncology consultant suggested. I have been fortunate not to need this steroid since November, so I have a leftovers in the medicine drawer for a rainy day (which also includes bottles of Zofran, Norco, Keppra, Trileptal, Namenda, and Temodar, but nothing to enhance performance). But then we remembered I was also taking immunotherapy, and this seemed like one too many drugs working on my immune system. Anyway, Decadron would have helped my first mile time, but I would have stopped at each station for several snacks, probably gaining 10 lb over the 25K.

So, another Motrin 800 mg on Friday at 2PM, 9PM, and 6AM with Tylenol and application of BenGay. I even filled out paperwork to see a chiropractor at the River Bank expo, but I had too many packets to pick up to wait around for a free massage and assessment (mainly counting on the free massage). There is just nothing you can do for acute back pain except analgesics and light activity (compared to the 50K David Chandler ran the same day, a 25K is ‘light activity’). After my personal cocktail of Motrin / Tylenol / BenGay, I felt okay Saturday morning at the start of the River Bank. I briefly considered the hole in my left frontal lobe, combined with Motrin’s effects on platelet inhibition and blood pressure, but my back felt okay. That was more important.

I tried to go out at my usual pace on that appropriately gray and cool day, trying to catch some taper magic. At mile 1, I thought I may still find a grove, but was breathing pretty hard. Miles 2 – 4 were just 5 – 10 seconds off my goal pace, but it did not feel right. I was holding on to a pace, but not comfortably, and nothing that would last for another hour. In previous years, I would need to restrain myself from pushing miles 2 – 4 too fast. Now, I was thinking this would be a nice place to stop. Despite dropping my pace for miles 10 – 15 for self preservation, I still managed to hold the last few miles under 7s. It was a good thing I did not stop until crossing the finish line, because I am not sure I could’ve started again. My leg and back muscles tensed up once not continuously in motion, and I limped past the finish. Done.

Until I stopped, the 25K did not feel like a big accomplishment. It certainly did not feel ‘epic’ running it. I was just acutely aware of every muscle for the last 7-8 miles, counting each mile off as I passed each marker. As I crossed through the finish, I had a bunch of family waiting and a few friends. This was a bit different from previous, since I would usually run through the finish and straight to my car and get to a swim meet or soccer game. This year, I went to my own after party.

After the finish, Todd reminded me early registration for next year starts in 6 months. We have had a tendency to form grand plans in the immediate afterglow of River Bank: New York Marathon, qualify for Boston, an Oregon race to the coast, etc, but that usually fades back to just running the River Bank. But, I’ll be at my computer in early November at 5:30 AM again. If I sign up, I’ll just have to do it. Too much Dutch influence around here to pay for a race and not show up. I wish I could also sign up for 2018, 2019 and beyond.

————————————————————————————————————-

The imwithcraig after party and fundraiser

The after party started in the exit shoot on Ottawa Ave The 5K community walkers mostly beat me to the line, and so I met my family, the Deckers, Mike McNamara (not to be confused with the more senior Rick McNamara who ran the 10K).

“I got a runner’s high just watching you,” little McNamara said.

“I am glad somebody did,” with a fist bump through the fence.

There were also a few wearing Team Craig / imwithcraig gear that I did not recognize in the delirium post race, but happy to give out hugs. Funny thing, the people I did not know often gave me the strongest emotional reaction. I have bottled up my emotions for a few months, not really needing them, but sometimes they were let loose at random times.

I get a lot of credit for things nowadays, sometimes not even partially deserved. For example, I recently received from the Spectrum ER with “Consultant of the Second Quarter” even though I did not do a single ER Consult in the Second Quarter. The same can be said about the fundraiser.

Figure: left, my undeserved ER consultant award. Right, my sisters doing things for which I get the credit.

“Should we make the after party a fundraiser?” one of my sisters asked months ago.

“Sure,” I said.

And there you have it.

The fundraiser required a lot of time, effort, and money, mostly behind the scenes. I just needed to run enough on the treadmill in preparation. We had a great event planner who was considerate enough to not deliver Lily Carrigan Sisk until Monday (Krissy). Courtney Kerry supplied graphic design, social media support, and photography. My sisters did a little bit of everything. Lifestyle Kitchen offered a location, others had to order (and pay for) food, buy and serve drinks. Many people purchased T-shirts over the last 6 months, all which contributed. A few people even rounded up auction items by just walking into stores and asking (Mary Springer and Lucia Steinlage). The team is in place if you need to plan an event.

Race day, I just limped from my car to Lifestyle Kitchen Studio to find an awesome set up by some of the best friends, relatives and babysitters (the Hansons!) around. If I had to pay everybody minimum wage and buy the items at cost, we would have lost money.

“Northwestern? We had a fundraiser, and we lost $2,000, so here’s your bill.”

We were able to raise over $7,000 for the Northwestern Brain Tumor Institute. There were multiple generous individuals and businesses in West Michigan that contributed. Here is a poster that is certainly incomplete, but captures a bulk of them.

Figure: our sponsors, surely to be updated when we remember somebody else…

Figure: upper left, Nurse Jane and me. Upper right, Connor and me. Middle left, med school friends. Middle right and bottom, scenes from imwithcraig.

Figure: left, Nurses Dee, Jodi and me. Upper right, Ann Arbor docs with Peter Hagan and Sara Saberi. Bottom right: My high school girlfriend and me.

With that, I promise not to mention the River Bank for a while…

6 Months

01 Sunday May 2016

Posted by alguirec in Uncategorized

≈ 3 Comments

River Bank Update

The River Bank is less than 2 weeks away. Couch to River Bank plans are getting tight, but very manageable for the 5k Run / Walk. Most people walk 3 miles over the course of the day, so just consider housework, employment, or shopping part of training if necessary.

We have decided to use the imwithcraig River Bank after party as a fundraiser for the Northwestern Brain Tumor Institute. We are going to donate all the money raised from T-shirt sales and the imwithcraig River Bank party to the Institute. Now, I do have some reservations about supporting the Wildcats. I went to MSU and then UM. I had my surgery at UM and radiation and follow-up at Spectrum’s Lemmon Holten. Heck, I’m back to work at Spectrum Health. However, the best clinical research trial available to me at the time was in Chicago. Research generates new therapies, and glioblastoma multiforme certainly needs advancements. And those trials are expensive. If things go well, this therapy will be standard front line therapy for patients from Rutgers (why are they in the Big Ten?) to the University of Nebraska (that receiver wasn’t pushed out on the last drive). Of course, Grand Rapids patients will benefit as well (even if the prefer Ohio State).

After the River Bank race, we are going to have a party in the parking lot of Lifestyle Kitchen Studio at 222 East Fulton. You can park across the street in the First United Methodist Church parking structure. There will be a raffle and silent auction for a ridiculous amount of donated items. I’m always surprised by the generosity out there, and there are a few items I may not choose to part with :). I will have a mostly complete list in a week on this blog, but examples include swim lessons, autographed copies of a new book by cancer writer by Mary Elizabeth Williams, gift certificates, and assorted things I like. Or, you can just come for the food, company, and drink. The party will start at about 10:30 or 11AM (the 25K doesn’t start until 8:30AM, so there will be plenty of stragglers).

——————————————————————————————————————-

4/29/16 marked my 6 month date from diagnosis, a 6 month survivor if you will. Am I obligated to say time flies? It has, but on the other hand, those early days seem forever ago. I am truly grateful to be doing as well as I am, and still try to appreciate the little things despite getting into a stable routine. I am unlucky (brain cancer) and lucky (my current health, support) at the same time. I am more aware that my health (or anybody’s health) can change in a moment, even in the middle of a sentence. Sure, I do not feel great with the temozolomide pulses, and certainly have fatigue if I “did too much,” but I am feeling better than I could have hoped for. I signed up for the River Bank 11/2/15 not knowing what sort of shape I would be in 5/14/16. At this point, I’m thinking pretty good, thank you.

After my last stable MRI in April, I knew I would stay the course on my current therapy through the River Bank. With two weeks left, I am not looking for some victory over cancer: I’m looking forward to making it hurt a little bit. I am actually worried I will get carried away, take it out too fast, and that will be my downfall. Even if so, I’ve seen t-shirts that say ‘better to burn out then never be on fire at all.’ Well, that will be my excuse if you see me walking up Fulton toward the finish. My pulse of temozolimide was supposed to start 4 days prior to the River Bank. Working with my study coordinator at Northwestern (yes, I got permission for a study deviation), I am taking my temozolimide a few days late this cycle, and starting the pulse 5/14/16 (the evening after the River Bank Run). Who knows, maybe it works better that way.

I think about my diagnosis all the time, but not like I used to. After 6 months, I only rarely wrestle with it emotionally. It is just a fact. I drop kids off at school and watch them walk away with dry eyes. I go to soccer games and swim meets, and don’t think about how many more I will watch since I’m counting on a lot more. I have been back to work long enough that it is not a novelty. At work, colleagues and staff no longer seem surprised to see me, or feel obligated to say, ‘you look great.’ It is just the normal pleasantries of work, comments on Michigan weather, and help others with their health issues. Me? Oh, I’m fine. And Staci. We have our 15th anniversary this June 23rd, but that was after nearly double digit years of dating in 3 different towns. I don’t know what we will do to celebrate, but best keep it low key. I’m planning on a few more now.

I usually have a full day on Mondays at Spectrum Butterworth, and I quickly got back into my old routine of a the 2 – 4 PM special in the cafeteria where if you spend $2, you get a free drink (coffee). That is a $2 ice cream and a free coffee, perfect for the last push on Mondays. The ice cream is soft serve, so you can’t skimp on any toppings to get to $2. It needs to be a full cup. At home, my kids observe me just having a ‘little ice cream’ on those Monday nights after dinner, setting a good example I suppose, not knowing that this dessert was actually seconds.

I am slowly increasing my work schedule after each stable appearing MRI. I am getting MRIs every 9 weeks as part of this research protocol. Therefore, I get an 8 week vacation from serious cancer thoughts, followed by a few days of concern and denial, and then 45 minutes of labile emotions as I lay in the MRI scanner. To ease the stress, I make conversation with the MRI tech.

“I’m sure there are a lot of people who get claustrophobia in this MRI,” I said to make conversation.

“Not that much,” my MRI tech said, “they are just scared of the results.”

Can this MRI read my mind?

But fortunately, individuals can still make the whole health care experience comfortable. Shaun, a nurse working in MRI prep, recognized me on the second MRI. I am just one of many hundreds of IVs he puts in each week. He is a middle aged African American man. He wears scrubs, a loose Northwestern hoodie, and has all the mannerisms and language of smooth Chicago male nurse. And like the best nurses, he can make a scary procedure seem small and personal. With casual talk, I told him the reason for my repeat MRIs.

“Every 9 weeks while I am in the study,” I explained.

“Next time, you just come on back. If anybody gives you any hassle, tell them it’s cool with Shaun,” he replied.

First off, I wouldn’t be so presumptuous to just walk into the prep area without being called back. It would not even do me any good since the rate limiting step in MRI imaging is magnet time, not IV placement. And I am not sure what he meant by hassle. But he made me feel like an individual and an insider in a large building where you have to leave family in the waiting area. #imwithshaun.

————————————————————————————————————-

I’m headed to Northwestern this Tuesday for one last injection of my performance enhancing drug Pembro. It should be a quick visit, just labs, seeing my nurse practitioner, and infusion. I’ll update this site again with the final details of the River Bank imwithcraig party and list of all the donations. Good night.

Figure: Left, hanging out with friends and family. Right, after 25 total years, probably good to get it in writing.