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Philly area people: Recommendations for a doctor who understands athletes
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TL;DR: Does anyone know of a doctor in the Philly area I could go see who might be able to figure out why I lost the ability to train hard? A doctor who understands athletes, won't blow me off, and won't tell me I need to "start exercising".



Background:

Male... 40yrs old. Up until the pandemic, I was crushing it. Went 9:29 at IMTX in 2018. Qualified for Boston 2019 with a 2:59 BQ. Went to 70.3 WC a couple of times. Was chasing a Kona slot...

Then 2020 happened. I never stopped training. The only real difference between my training pre-pandemic and now is that I stopped mostly doing the SUPER long IM training (what would be the point?). But I did do a few century rides (both in Zwift and solo outdoors) in the spring of 2020.

Starting around June-ish last year, I quickly lost my ability to train well. I went from running 7:30 pace for long runs (meaning that was a non-stressful pace) to barely being able to hold on to 9:00/mi for only 5 miles, and having that wreck me for days. I found myself unable to recover from even easy sessions. A short run at what I would call a slow pace would cause me to feel like I had run a marathon the day before. On the bike I used to be able to roll 200 watts average for hours at a time (and still run a strong marathon off of that after 112mi). That kind of power feels like a challenge to me these days. I haven't tested my FTP lately but based on how stuff feels I could say I easily have lost at least 30-40 watts off of my previous 310 FTP.

And just to reiterate, I didn't sit around at all in 2020. I got out every day and did whatever was on my plan. Granted it wasn't a plan to build for a race, but I had a plan laid out and I stuck to it.

I feel like I am constantly in a state of deep fatigue. Getting out of bed is a major chore. Every muscle is stiff and sore all the time. If I am in bed overnight, or even in my chair at work for a few hours, standing up takes a solid minute of stretching and slow movements to get my muscles to loosen up, and even then I have to be careful not to cramp when I stand up. For a while I was laying in bed having to pee, and debating whether it was worth the pain of getting out of bed to empty my bladder.

TMI alert: I also developed some bowel issues. For a while I found myself unable to be too far from a bathroom. I started doing all of my training in my basement on my trainer or treadmill just in case I had an emergency and could be only steps from the bathroom. I regaled what I thought at the time was a humorous story in the "I shit my pants mid-run" thread about my incident on the IMLP run course... but looking back that was the start of this issue. It has gotten better, but isn't completely resolved.

In any case, back around September 2020 I had had enough of this and decided to go see a doctor. I told her this story, and how I am here because I can no longer put down big training weeks of 15+ hours, and now can barely get out of bed. She ordered a bunch of blood work that would test for anything fatigue-related. Thyroid, Lyme, Mono, etc. She also did a normal CBC and such. I asked if she thought I should also get a COVID antibody test, but she said no and that she wouldn't think it would show anything if I thought I might have been infected in June (as it was now September). I don't have reason to believe I had asymptomatic COVID, but it was a thought I had.

The tests came back negative for everything except my cholesterol was "slightly high". Her recommendation, left as a voicemail: I should eat a healthy diet and start exercising 20 minutes a day, 3 days a week. To say I was pissed off was an understatement. I called the office back and asked to speak to her. She gets on the phone, looks at my chart and after I told her what I was used to from an exercise perspective, she simply parroted what she said before. To start exercising.

Anyway...

Long winded story to say... I need help. I never got sick this past year. As far as I can tell I was never infected with COVID (though I accept that asymptomatic cases happen). Yet, here I am with no explanation as to why my body has completely betrayed me. I need to talk to a doctor who understands when I say I used to be able to run sub-3 marathons and now can't get out of bed without pain.

Also... I am now two-weeks (as of today) past my second Pfizer shot... so I doubt there is any way to test if I had COVID in the past now since I have been fully vaccinated
Last edited by: g_lev: May 7, 21 7:16
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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Penn has an antibody test that won't give false positive from vaccine. I had it myself.
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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When you had the checkup, did they check vitamin B12 levels? (I'm assuming when they did bloodwork they checked iron, RBC, and all that stuff.)
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Re: Philly area people: Recommendations for a doctor who understands athletes [Dilbert] [ In reply to ]
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Dilbert wrote:
When you had the checkup, did they check vitamin B12 levels? (I'm assuming when they did bloodwork they checked iron, RBC, and all that stuff.)

They did... after I got annoyed at the doc a second time she called me back to say my B12 was "a little bit low" and that I could try supplementing. I did. It hasn't helped anything
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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I sit here in a doctors office reading your post and sympathize. I had flu like symptoms back in January followed by fatigue and muscle aches. I’ve had negative Covid tests and seen 7 doctors. I’ve had dozens of blood tests. Nobody has a clue. Which is all to say these things can be hard to diagnose sometimes.

I don’t have a good answer regarding docs other than the people I saw at Penn Medicine Perelman were generally more understanding of endurance training than those I saw elsewhere in Philly.
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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When you find one, let me know. I can give them two more patients.

I've concluded that while we hold the medical community in the highest regard, there's little absolutism in general health practice. We tend to think of our bodies as cars: The car can be running fine, but when a "noise" appears we go to the shop, they replace a belt, and the car is back to 100%. Noise gone.

In contrast in general medicine, I think of treatment on a bell curve. On one end, we know exactly what to do on either tail with the perfectly healthy on one side and those with a diagnosis (i.e. cancer, the flu, etc.) on the other.

In between, we like to think it's black and white, but it's not and I'm not sure there's anyone who really cares to find out. There's no one out there who specializes in replacing that noisy belt.

I love my primary care and he's treated my "sicknesses" expertly since high school. But when I went to him and told him something felt "off" with my health, he was useless. From his perspective I'm:
  • Late 40's
  • My sugars, cholesterol, BP, etc are all fantastic
  • 140 pounds with 30-in waist
  • More flexible than 99% of his patients
  • I still do triathlon and keep a workout schedule that would put most of my peers in the hospital.
  • Etc, etc, etc...no bragging here. I'm just like the rest of us.

So why exactly should he be alarmed that my mile time is now 5:45 instead of 5:15?

He has no idea and frankly doesn't really care. Nor does he even know where to begin. I've just accepted this.

One thing I would advise against is wasting any money on either Athlete Blood Test or InsideTracker. I did InsideTracker and my wife did Athlete Blood Test with the idea we would make a long-term commitment to the one we liked most. Turns out for all the promises they make, both really just send you for a blood test and then cut-and-paste stuff you'd find on the internet to make your "personal report".

For example, for everything in my blood results that were outside the recommended range, InsideTracker's recommendation was to either consider a supplement after consulting with my primary care or they stated they didn't have an opinion because the science isn't clear on whether the range really even matters. $500 later and it turns out if you have a Vitamin D deficiency you should take a supplement and get in the sun more. Perfect. They also recommended I exercise "at least 3-4 times per week" (yes, there is a questionnaire where you tell them what you eat, how much you sleep, and what your exercise program is.)

My wife's Athlete Blood Test report was littered with typos like it was written by a high-school student the night before the term paper was due. Their advice to her was similarly unimpressive.

So, yeah, if you find a doctor in the Philly area who can help us really understand how to correct when we feel "off" and replace that noisy belt, let us know.
Last edited by: JFHJR: May 7, 21 15:19
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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g_lev wrote:
Dilbert wrote:
When you had the checkup, did they check vitamin B12 levels? (I'm assuming when they did bloodwork they checked iron, RBC, and all that stuff.)


They did... after I got annoyed at the doc a second time she called me back to say my B12 was "a little bit low" and that I could try supplementing. I did. It hasn't helped anything

first off, I really sympathize with your story here.....I've been in situations of banging my head against the wall with doctors and the disregard for athletic people's needs in general. It is really really hard to find a doctor that understands the demands of an athlete verses a couch potato that smokes, drinks, and never exercises (and not just doctors - also physical therapists!) They see far more of those types of people than ironman athletes, so that's what they know. One way to find a doctor who might be more receptive to your needs is one that is a runner, cyclist, or triathlete themselves....ask around about such a person from your local triathlon friends or club members.

Also, I agree about getting your iron levels checked as well as Vitamin D....besides the regular iron test that most doctors know of, also ask for ferritin and Total Iron Binding Capacity tests and compare those numbers to what they should be for athletes *not sedentary folks*....for example, ferritin should be higher for an athlete. I have heard of strikingly much better performances and feeling for athletes who correct an iron deficiency.

much luck - as I understand how frustrating doctors can be - I hope you find a good practitioner!
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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No specific recs, but there are enough running groups, tri groups etc in the Philly area that if no one chimes in here you should check with them. There were various running-friendly PTs when I was still living there but that's getting to be a while ago.

That said, given your description of your various ailments, sure sounds like you could use a doctor who can give you a definitive Dx. Getting back to full speed is important but that bowel thing sounds rough.

Stay strong, hope this all gets better soon.
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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Slightly out of the box thinking, but check out SteadyMD, specifically Dr. Leah Roberts, who is a multiple-time Kona qualifier and excellent IM athlete herself. It's remote/ tele-medicine, a bit like a concierge service, but very reasonably priced and in my experience, well worth the price. Working with Dr. Roberts was almost life-changing for me after a long time of similarly seeking answers for unexplained fatigue and inability to recover. She took the time to listen and dig in a bit deeper, absolutely looks at test values and symptoms from an athlete's perspective, and won't give up on trying to find answers. I was on the verge of walking away from the sport before I found Dr. Roberts because I was so exhausted and frustrated with a lack of answers -- I coudn't be more thankful for her in helping me get my health (and performance) back on track.
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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sorry to hear about your changes...
there are a number of things that can cause a change in performance and fatigue. I am sure the basic labs were done (CBC, CMP, Thyroid, etc..) but there are some autoimmune things that could pop up. Also there is a spike protein antibody test to confirm vaccine. Along with the "labs" what about the mental aspect. Psychologically can have a major impact if things have changes (work, family, $$, etc...).

I am PA that has worked in Internal Medicine / Primary care and now in ER and Urgent Care (better hours for my family / life). But when in primary care, I have taken care of a number of different patients (the couch potato to runners, etc..). The body doesn't change but we change. And we check the same basic labs for everyone. Now the percentages / values may be different in regards to genetic history and body shape/ diet/ etc.. So I agree with you to an extent about long distance athletes vs non long distance athletes. And how your body will handle the load of training and recovery.
So.. unless you share all the results.. hard to give advise without knowing all the data...

With Covid telemedicine has changed for the good. There are plenty of options available to get to the bottom of this.

Best of luck!!!
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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I don't know why I didn't think about this when we were riding on Saturday.

I know this may not seem like where any issues are sitting but I have heard great things about Rothman Institute and working with athletes.

https://rothmanortho.com/...ties/sports-medicine

Maybe this guy?
Last edited by: LifeTri: May 10, 21 7:44
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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g_lev wrote:
TMI alert: I also developed some bowel issues. For a while I found myself unable to be too far from a bathroom. I started doing all of my training in my basement on my trainer or treadmill just in case I had an emergency and could be only steps from the bathroom. I regaled what I thought at the time was a humorous story in the "I shit my pants mid-run" thread about my incident on the IMLP run course... but looking back that was the start of this issue. It has gotten better, but isn't completely resolved.

Have you seen a GI Doctor? I would visit one and get checked out, which would most likely include a colonoscopy.

Inflammatory bowel diseases like Crohns Disease and Ulcerative Colitis can result in many of the issues that you are describing. And the bowel issues you describe are certainly consistent with UC.
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Re: Philly area people: Recommendations for a doctor who understands athletes [LifeTri] [ In reply to ]
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LifeTri wrote:
I don't know why I didn't think about this when we were riding on Saturday.

I know this may not seem like where any issues are sitting but I have heard great things about Rothman Institute and working with athletes.

https://rothmanortho.com/...ties/sports-medicine

Maybe this guy?

I always thought of Rothman as the guys to go to for physical injuries. I've gone there before to see doctors about knee and ankle injuries. I'm not sure the problem I am having is something the Rothman people can help me with. I could give them a call and ask though,.
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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What was the outcome as we wrap up 2021? Back to training like before or are things still different?
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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g_lev wrote:
TL;DR: Does anyone know of a doctor in the Philly area I could go see who might be able to figure out why I lost the ability to train hard?

Ben Simmons may be a good person to ask for this. I think he's working with a psychiatrist at the moment for the same issues.
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Re: Philly area people: Recommendations for a doctor who understands athletes [Diabolo] [ In reply to ]
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Ouch!!!


Remember there are significant differences between Psychiatrist, Psychologist, and Therapist

"What's your claim?" - Ben Gravy
"Your best work is the work you're excited about" - Rick Rubin
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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my BIL is a colorectal surgeon in philly... DM me if you want me to hook you two up

daved

http://www.theundergroundcoach.com
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Re: Philly area people: Recommendations for a doctor who understands athletes [g_lev] [ In reply to ]
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So sorry to hear what you are going through. The big piece to the puzzle that hasn't seemed to get much attention is the bowl issues. I think that could be the red flag. Two pieces to that - 1. some sort of GI pathology. or 2. a symptom of stress/psychological type issues. Just to be real frank with you, although I'm a bit older than you I have had some of the same sort of physical/performance type issues during this crazy Covid period. I am perfectly "healthy" and all tests come back fine;. but there is no doubt that covid has put more stress on me, and maybe even some mild depression . . . and I'm a super energetic positive guy. This past 20 months has just been tough. I have continued all of my workouts, etc and my fitness seems fine, but my current performance is subpar for me. Hopefully there is light at the end of the tunnel and my spark will come back. In the meantime I am trying to just relax a bit more and get myself through this period. Wish you the best.

David
* Ironman for Life! (Blog) * IM Everyday Hero Video * Daggett Shuler Law *
Disclaimer: I have personal and professional relationships with many athletes, vendors, and organizations in the triathlon world.
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Re: Philly area people: Recommendations for a doctor who understands athletes [qngo01] [ In reply to ]
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qngo01 wrote:
What was the outcome as we wrap up 2021? Back to training like before or are things still different?

I'm still dealing with it for the most part. My endurance and speed haven't returned although I have been working at it. I deferred all the fulls I had planned for 2021. I race 70.3 Maine though, and I managed to go around 5:20 (my previous PR on that course was in the 4:20-ish range, so an hour off my best time from 2018). I haven't tried to run more than 10 miles or so in a while, that seems to be around where my body stops wanting to run. My speed is gone. I used to casually run 7:30/mi all day long as my long run pace. I just ran a turkey trot 5k at 7:30/mi and that was all I had in me. So my 5k race pace now is what I used to run my long runs at. I lost easily 30-40 watts off my FTP and I haven't gotten it back.

But I keep trying... I'm still at it, but I feel like my fitness just entirely disappeared. I am hoping I can figure it out and regain that old edge I had. Thanks to deferrals and such I am now scheduled for 3 140.6s in 2022 (StG, Lake Placid and MD), so it would be helpful if I can get back to something that looks like fitness.


My bowel issues have mostly resolved. I can go for a run without too much worry about crapping my pants. However what I noticed I still can't do is get up at like 4am and get in the car for a road trip. That is a sure fire way to set my guts off.
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