Appendicitis & Cycling

First, this blog is NOT about whether cycling increases the likelihood of appendicitis–several doctors told me that there is no causality. This blog is about cycling with and after appendicitis. Here’s the picture that tells the many words below:

Around Thanksgiving Nov 28, 2013, it started quite innocuously: I remember being tired after Thanksgiving meal fest and going to lay down by 7pm but shrugged it off–probably too much champagne and other alcohol, which I am no longer used to. Around that time, my bowl movement went off its typically clockwork regularity. Perhaps I had some constipation; darn, I even took some colon cleansing pills. A friend suggested a laxative (which I didn’t take), but the problem remained: some days no potty, which is abnormal for me. Then I thought I had food poisoning or some type of food-related parasite. Typically that passes after a few days, but symptoms remained.

On Sunday Dec 8, about 10 days after thanksgiving, I had my last cross race of the season (state championships). During warmup (and it was bitter cold, under 20F, or below -5C) recall telling my buddy that my stomach felt weird saying “For the first time, I drank tea this morning; I guess I should have stuck to my coffee.” Race went ok, not great. The next day, we took a candidate to a fancy dinner, part of our faculty recruiting process. During dinner I started feeling unwell, and left the restaurant without touching my rack of lamb and glass of Bordeaux. Uncharacteristic…

The next day I felt completely out of it and stayed in bed. The kids told me this wasn’t normal and that I should see my doctor–I agreed with their rational. On Wed Dec 11, my primary care physician diagnosed me with an infected prostate (“quite likely for a cyclist”) and put me on oral antibiotics (AB). “You should feel better by the weekend, if not, get a CT scan next week.”

That weekend I flew to Miami to teach our executive MBA students. After teaching on Saturday I was so out of it that I went to bed at 8pm. I figured the fatigue was due to my early morning run and attempt to break my record (I didn’t). But coming back to Chicago I did not feel any better. So, after finishing my 7 day AB treatment, I biked to the hospital for my CT scan of my abdomen with contrast on Thursday morning Dec 19. That was super efficient and by 9:30am I rode to work.

Exactly three weeks after Thanksgiving I finally got the correct diagnosis by phone call around 11am: “Your scan results have come in and you should report directly to the emergency room. You appear to have “complicated perforated appendicitis with abscess formation.” Well, the nurse didn’t tell me that much–she thought the appendix may burst, but it actually already had. At the ER I asked the triage nurse whether I could see the radiologist report, so the sentence above is from the report. It also mentioned a large, drainable abscess of 9cmx5cm.

That evening, radiologists tried draining the abscess but only a single syringe worked; they could not install a drain due to “access problems.” Because of the abdominal infection, surgery was not recommended–stitches wouldn’t hold if done in infected milieu. So I was put on IV AB and stayed at the hospital until Christmas Eve. During a follow-up visit with the surgeon, we scheduled the laparoscopic appendectomy for end of Feb. (I got the impression you need about 5-6 weeks to fully heal before surgery but that there was no urgency either and I had my demanding teaching quarter ahead of me..)

After not having been on the bike since Dec 16, I started riding easy on Dec 28. I felt ok and started slowly building the training, culminating with a 20min FTP test on January 23. The test was really disappointing: almost 30% lower 20min watts than usual. Amazing how an infection weakens the body, I thought. But my belly started feeling weird again too, so my sister and brother-in-law, both medical doctors, recommended a blood test to check whether the infection had returned. And it had: white blood cell count was up at same levels as my second day in the hospital (almost 11).

We moved surgery up by a month and on Friday January 31 at noon, after a morning of teaching, I went in for laparoscopic appendectomy. All went well and I was home by 7pm. Rested for 3 days, and then taught MBAs for 4hours on Tuesday morning. (MBA teaching is as draining and tiring as a 4hr tempo ride!) For a week I had to rest about 1hour in bed in the afternoons. Exactly 1 week after surgery I started feeling better–even skied two days. And 12 days after surgery I returned to the bike. Today, 2 weeks and 2 days after surgery I am doing ok, but still weak: regular endurance watts feel like real work and tire me out. Hopefully the body is slowly rebuilding–at least the weight is coming back, hopefully fitness will follow…

Post scriptum: how was I able to keep going with a burst appendix for so long? Probably because my appendix was located behind the colon and away from the peritoneum (the membrane lining the abdominal cavity). Proximity to the peritoneum apparently makes appendicitis that much more painful…