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The Coach(ed) Corner: Any way you slice it, surgery sucks

  • By Jason Sumner
  • Published Jun. 23, 2008
  • Updated Dec. 18, 2012 at 7:15 PM EDT

Two words you never want to hear from your doctor: hernia surgery.

Alas, that was the crux of a conversation I had with my physician about two months ago. The diagnosis was an inguinal hernia, meaning a small portion of my intestine was bulging through a hole in my abdominal wall. Or in laymen’s terms, every time I coughed or clenched, it looked like I’d swallowed a ping-pong ball, which was now lodged in my nether region.

In the grand scheme of ailments this wasn’t a big deal (Mr. Hernia was causing minimal physical pain and posed no immediate health risk). But until you get it dealt with, you run the small risk of a little problem known as strangulation, where the whole mess gets trapped in the aforementioned hole requiring a quick trip back to doc’s office for emergency surgery.

After putting it off for a while, I decided that emergency surgery was not something I wanted to deal with, especially during an upcoming trip to British Columbia, where I’ll be taking on the B.C. Bike Race, a seven-stage mountain biking adventure that starts on Vancouver Island and concludes a week later in Whistler on the Fourth of July. So last Thursday, I rolled in to the Boulder Medical Center and went under the knife.

The good news is that because of the size and location of my unwanted friend, I was able to chose laparoscopic hernia surgery, meaning it was a small knife. Basically, doc makes three half-inch-long incisions below my bellybutton, providing openings for an air hose, tools and a laparoscope. Then he pumps me full of air so he has room to work, before affixing a mesh patch over my problem area. Start to finish, the whole procedure took about two hours, though I don’t remember much since I was out cold.

As simple as it all sounds, there was still a fair bit of post-op pain (everything is irritated, doc explained) and not surprisingly the ensuing week included very little training time. I spent the first few post-surgery days in a Vicodin-induced haze, cringing at even the thought of sneezing, coughing or doing anything that put stress on my abdomen. It was only after five full off days that I ambled over to the gym to attempt riding a trainer. That lasted exactly 17 minutes; average watts, 25.

Fortunately, each ensuing day has gotten a little better. And while I had to postpone a previously scheduled long weekend group ride with some friends from Pactimo Elite Custom Cycling Apparel, I actually managed to ride outside on Thursday. Got to admit I felt like crap, but my coach Neal Henderson assured me that five, six or even seven days off the bike was not the end of the world.

“It’s not to say that nothing happened,” Henderson explained during our weekly chat at his Boulder Center for Sports Medicine office. “Top-end enzyme activity usually starts to come down some within the muscles, so initially your ability to do really hard efforts will be impaired some. Also, plasma volume drops, so your heart rate at a given level of effort will be a little higher than it was before. But the bottom line is that you’ve got the fitness. You put in the work and five days off isn’t going to change that. You may not be able to access it today or tomorrow. But when you start the race on the 28th, you’re going to be just fine.”

This was very encouraging news. I’ve put in a fair amount of work for the BC adventure, so it was good to hear it wasn’t going for naught.

My doc concurred with this assessment, asking only that I take it easy for four or five days after surgery and then be prepared for some occasional pain.

“You can’t mess up any of the work I did,” he said. “The patch is not going anywhere. But that doesn’t mean you’re not going to feel it. Surgery is surgery. It’s not something the body is really happy about.”

The plan between now and stage 1 – which has applications for anyone coming back from injury – is pretty basic: Take it slow and build gradually.

“In the beginning, you’ve got to start really easy, not really training, just moving your legs,” Henderson said. “Keep it under 100 watts. It’s just moving the legs in circles, reacquainting with that feeling. Then in the next 10 days before the race, we’ll shoot for one longer day and one more day of hard intensity. That will be the last real training type effort.”

Coach also stressed that you’ve got to avoid starving yourself just because you’re not riding as much as usual.

“Sometimes athletes get a little twisted, thinking ‘I’m not riding so I don’t have to eat,’” he said. “In fact, certain illnesses can actually increase metabolic rate dramatically. I talked to one physician that had a patient with mono who was actually going through an extra 1000 calories a day while fighting the illness and creating new cells. Your body is recovering and rebuilding, and that takes energy even if you’re just sitting on the couch for a few days. Taking in adequate protein and not cutting back because you’re not riding your bike is key to helping the recovery process.”

This was more good news, considering the bulk of my recent physical activity consisted of walking from the couch to the fridge and back.

Now on to this week’s Q&A. If you’d like to ask coach Neal Henderson a question, please send e-mail to CoachNealQandA@gmail.com. Please include your name and hometown. Questions may be edited for content and clarity.

Power plateau

Dear Neal,
I’m a 34-year-old Cat. 3 cyclist who has been racing for a number of years but just this year started training with power. I have been progressing steadily in my fitness with good gains in functional threshold power (FTP) until the last six weeks. I seem to have hit a plateau of 4.0 watts/kg. I have recently added some 5-minute 110-percent of FTP intervals and one minute at 150 percent and two minutes at 135 percent intervals to pull my FTP further up and better prepare for criteriums. I feel I need a little bit higher FTP so that I will have a better chance in breakaways. Right now when in breaks I feel that I am way over threshold and never get a chance to really settle in and get the break established. My training right now consists of about 6-9 hours a week. What do you normally suggest to your athletes when hitting a plateau like this?
—Neal S.

Neal,
For starters your overall composition looks good. The one thing I’d need to know is how much sub-threshold aerobic riding you are doing and if you are recovering adequately. Many times when someone starts feeling good they take that positive feedback and ramp up their training faster than they should. Then when things flatten out, most people will turn up the heat instead of backing off. But if you are already running near your limit, you’ll likely go overboard if you add more intensity. That said, I’d make sure you were adding enough aerobic training and getting enough recovery between sessions.

With the high-intensity intervals, I’d recommend that you keep it to 4-5 at 110 percent. Anything beyond that will probably overcook things. You’re doing some really hard efforts, so you need to make sure you’re getting adequate recovery and not overdoing it. The intensity makes sense, but I’d also not be afraid to mix in some longer sub-threshold intervals, 10-15-20 minutes at 95 percent, accumulating 30-40 minutes of that type of work. Another thing to consider when you’ve hit a plateau is a mini-training camp just to break things up. If possible take a three-day weekend and do some bigger volume — say 12-15 hours. Just make sure to cut down on other life stressors.
—Neal

Lowland training for big mountains

Dear Neal,
I’m planning to do Colorado’s Mount Evans Hill Climb (peak elevation 14,264 feet) in July and will be coming from the “lowlands” of Madison, Wisconsin. Any advice on how many days one needs to acclimate to race at elevation? I am trying to figure out how many days early to go.
—Eric Knuth
Madison, Wisconsin

Eric
Full acclimation would literally take months, which isn’t an option any more since the race is in mid-July. But some initial adptation will occur in about 10 days. You’ll get an increase in respiratory function. But you’re not going to get increased hematocrit or hemoglobin, which is what you’re looking for in the longer term. If you have a week or 10 days, I’d start by coming to the Front Range, Boulder (5430 feet) or Denver (5280 feet) for the first 3-4 days, and then head a little higher, say Summit County, which is around 9000-10000 feet.

If you don’t have a week or more, I’d go with the old school method of coming in at the last minute, the day before in this case if you were only doing a race at elevations below 10000 feet. For Mt. Evans, or any other race above 10000 feet, I would suggest you spend at least 2-3 days sleeping at 5000-8000 feet at a minimum. Be careful and look for signs of altitude sickness, as well as high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE). One other thing to consider are the simulated altitude exposure products. There are things that allow you to breath low amounts of oxygen, but you just do those at rest so there’s not a lot of good evidence to show that they actually improve exercise performance. You can also read more in this article that I wrote a couple of years ago.
—Neal

Dear Neal,
We are looking at setting up a power training system for my brother who will be at the worlds masters track championship in Australia in October 2008. I’m an exercise physiologist, and have used power training for running but not for track cycling. We would like your recommendation of equipment for training for track events from 200m, 500m, 1000m, 2000m. There is a wide range in prices for each component and I don’t have the experience in selecting any of these and don’t know what group would be the absolute best.
—Andrew Carvalho
Athens, Georgia

Andrew,
We’re not in the business of making specific product recommendations here, but here are some general guidelines to follow. For power meters, you want to be able evaluate power output during training and races. That means you need to find a product that will work on a fixed-gear disc wheel. With trainers, it depends on what you want to do. Some allow you to program certain workouts; others leave it up to you. All of them can provide resistance. With bikes there are two things to consider – fit and affordability. You can take it from there.
—Neal

Editor’s Note: Jason Sumner is a 37-year-old, 168-pound freelance writer and Cat. 4 bike racer who is working with a cycling coach for the first time in his life. Sumner underwent a full battery of lab tests at the beginning of the season, producing a 250-watt lactate threshold, a 3.2 watts per kilogram score and a VO2 max of 51.5. His 2008 goals include improving on his usual mid-pack finishes, not getting dropped on the weekend group rides, and learning something along the way. He’ll be documenting his experiences for VeloNews.com in this twice-monthly column.

Neal Henderson is sports science manager at the Boulder Center for Sports Medicine and a well-regarded elite-level coach. Henderson’s clients include Slipstream-Chipotle’s Taylor Phinney, Jelly Belly’s Scott Tietzel and Trish Downing, a nationally ranked paraplegic athlete. Henderson is also the winter triathlon coach for the U.S. national triathlon team, and was recently named USA Cycling National Development Coach of the Year. He is working with Jason Sumner on a pro bono basis.

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