Welcome back! Last Friday, on August 14th, I celebrated being one year post-transplant. A milestone that felt a million miles away last August has now come and gone in what feels like the blink of an eye.
I’ll have more to say about that in the coming weeks, specifically in my one-year Field Note update, where, as always, I plan to go into a bit more detail about where I am at mentally, medically, and physically.
By that time, I should have my biopsy results in hand and should be back from my first international trip post-transplant (more to come on that later as well!)
But for now, we are going to just focus on the physical side of things. If you have been following along for a while, you’d know that I was an avid runner before all this and have been doing my best since transplant to work my way back to that.
In the six months we’ve had between these updates, I have made a lot of progress, progress that I am deeply proud of, but I have also had a few setbacks that we’ll be going over today.
Maybe not so much setbacks as reminders that my body went through a traumatic experience last year, and that while I may be firing on a lot of my old cylinders again, my body is still very much healing.
This post will largely follow a similar format to my last Health & Fitness update, starting with cardio-focused exercise before diving into strength training, the limitations I’ve experienced, and ending with my nutritional habits over the past six months and what I have planned coming up.
So, let’s get started.
Disclaimer: I am no expert on any of these topics and am speaking solely from my own personal experience. I can and will reference outside sources whenever possible, but I will always recommend doing your own research whenever possible to determine what is best for you.
Exercise
Cardio
Starting with the largest topic we’ll likely be covering today: cardio. My weekly schedule more or less revolves around work and my weekly mileage goal, and I kind of make everything else just fit around those two things.
Walking
I have talked at length in a lot of my posts about the benefits that I have experienced from incorporating more walking into my routine, especially in the earlier days post-transplant when I didn’t have many other options.
While I absolutely stand by those statements still, I have slacked off in this department quite a bit as my running mileage has increased and the temps have risen here in CT.
To me, it was not something I mourned too hard, as I think I knew that was always going to happen at some point. A trade-off would become necessary as my running volume increased, and walking was the logical area to pull time and energy from.
For context, below is a graph from my Strava account showcasing what my walking mileage has looked like as of late.
As you can see, barring a few exceptions, I have typically been falling somewhere between 3-8 miles a week. I am actually still pretty happy with that, but I recognize that it’s a steep falloff from the miles I was consistently putting on earlier this year.
Biking
Speaking of steep falloffs, I don’t think I have biked since March. That’s okay. It was always going to be a winter training tool to assist in getting me back on my feet, and it helped me do exactly that.
I left it in here because I wanted to make sure that I acknowledged, once again, how good of a tool biking can really be during your recovery. Similar to walking, biking is very low impact and a truly great place to start post-transplant in order to get your muscles moving and start building your aerobic base back up.
If a small walk or a few minutes on the bike is all you can manage, then that will always be better than nothing.
I also left it here as I imagine that it will once again fold back into my rotation as the temps cool later this year. Time will tell either way, but for now I am quite enjoying my bike-free existence.
Running
Progress. That’s the keyword that I would use again if you asked me how the past six months went in regard to my running. I mean that physically, but also mentally, specifically in how I have chosen to listen to my body recently and adapt where necessary.
From roughly March to May, I increased my mileage to regularly fall within the 25-35 mile-per-week range, and it felt great. Natural, even. This eventually culminated in one of my biggest post-transplant highs to date, when I ran my first half-marathon of the year in early June.
I set out at a ~8-minute-per-mile pace, thinking that I might struggle to maintain that for 13.1 miles, but actually increased my speed after a mile or two because it didn’t feel like much of anything. I finished the race in 01:39:39, a ~4-minute course PR in my fourth year of doing that race.
At not even ten full months post-transplant.
I was buzzing, but very quickly learned that there was a price to be paid for that all-out effort. I hadn’t asked anything like that of my body in the ten months since transplant, and my body let me know exactly how it felt about it. For a couple of weeks afterward, I was really struggling with my runs and had to rest a lot more than I could have predicted beforehand.
My original plan was to settle back into the 25-35 mile-per-week range and to keep building, but my body simply didn’t have the reserves for that to be reasonable. Add in the summer heat, and all of a sudden the motto had become more “I’ll do what I can” instead of holding myself to a strict mileage goal every week.
The graph below may depict that in a clearer way than my words can.
As you can see, I have been a bit all over the place mileage-wise these past three months. I still feel very fit, but have been nowhere near as consistent as I was coming into that race in June.
I did manage to stay consistent strictly in terms of getting myself out the door over the past couple of months, though, and I am proud of myself for that because some days it was a lot easier said than done.
Before we move on, I did have one other race fall within this training window. A special one, if I am honest, as it fell just two days after my one-year anniversary.
The Falmouth Road Race is a pretty famous summer race here on the East Coast, and it wasn’t initially on my radar this year, mainly because I didn’t know there was a general lottery that you could enter to get into the race until the very last minute.
My brother, soon-to-be sister-in-law, and I all got in, so we got to spend last weekend on the Cape enjoying the nice weather, racing, and, on a personal level, celebrating my health one year removed from transplant.
My health that I once again put on the line by trying to run an all-out 7-mile road race in the August heat for no good reason.
That’s just me being dramatic. Sort of. Stats from the race can be found below (don’t mind the average heart rate, not too proud of that)!
As you can see, things went very well. The first two miles were way faster than I had planned, and by the time those miles were behind me, I wanted to see if I could just hang on for the rest of the race, and I largely managed to do that.
I crossed the finish line exhausted, but proud and honestly a bit shocked by how much I enjoyed the race. Our bibs had our names plastered on them in fairly large font, so over the course of the 7 miles, we heard dozens of strangers calling our names and pushing us all onward. It was electric.
Somewhere between mile 2 and 3, one of the roadside announcers called out my name and gave me a one-year-post-transplant-specific shoutout. I grinned and kept pushing on, sort of like how I managed this past year.
Overall, it was just a truly special race that helped cap off what had been a very sentimental week for me, and I won’t be forgetting it anytime soon.
Recovery-wise, it will be hard to differentiate the recovery timeline from this race from all the one-year testing that we did two days after the race, but I will hopefully be able to speak to both of those topics a little more in the next Field Note.
Strength Training
Similar to my walking habit over the past six months, my strength training routine also took a bit of a hit during this time.
I chalk that up to my energy being spread out over more and more activities, not all of them purely exercise-related either. I just have been participating fully in my life more, and I love it, but it leaves me a little more tired on a day-to-day basis than earlier this year, when I really didn’t have much else to focus on outside of my exercise habits.
If that sounds like an excuse, it kind of is, but it’s just how the past few months have gone, and it’s something that I think will change in the coming months as I readjust my overall routine a little bit.
As far as what my strength training looks like, I mainly focus on calisthenics and dumbbell-related exercises here at home. I don’t currently have a gym membership, and I don’t foresee myself changing that anytime soon.
My adjustable dumbbells range from 10-55 pounds, which is more than enough for me to challenge myself when combined with a healthy mix of bodyweight-focused exercises.
For more specifics about my exact routine and split, I’d recommend checking out my previous Health & Fitness update, as I go into a bit more detail there, and things haven’t really changed all that much since then.
Limitations & Setbacks
As with most setbacks, some are self-inflicted and some are outside of your control. I think there was a balance between both over the past six months, with one overarching issue that very likely was the root cause behind the other issues that we’ll be discussing.
Heat
It’s been hot. No other way to really put it. When I was getting back on my feet late last year and earlier this year, I had the privilege of being able to do so in the colder weather. Sure, some of the walks and runs that I did were freezing, but that actually went a long way in helping me keep my heart rate down and helping me not sweat all that much. That changed in June.
When the temps started to really climb, so did my heart rate on all my runs. The amount that I sweated also increased dramatically, which I think came as a bit of a shock to my system, as it now had to really relearn how to handle fluid loss in a way that was not really required in the months before when the temps were low.
I had run in the summer heat in previous years without any problems, but post-transplant, my body is still trying to figure out what the heck is going on in a lot of ways.
What endurance training in the heat feels like was not on its list of knowns until June rolled around, and even a few months on now, I still noticeably struggle on warmer days more than I had in years past.
Energy Level
The natural remedy to training in the summer heat is to try and not train in it as often as possible, and for me that has meant attempting (and largely failing) to fully transition back to morning workouts.
I have spoken a bit about my desire to do this before, but the reality is that I am still tired most days between everything that I have been trying to do lately. Running, working, planning trips, concerts, time with family, etc.
Not so much excuses this time as reasons why I try and take my rest when I can get it, and sometimes clawing myself out of bed first thing in the morning is the absolute last thing I want to do.
If I had to guess, I am shooting about 40% from the field in terms of actually getting up and doing my workouts in the morning lately. It’s a vicious cycle, as the evening workouts in the heat only serve to compound the underlying issue.
Will I break this cycle soon? Not likely, as my schedule is as hectic as they come these next few months (all good things, mostly).
I am doing what I can to be okay with this, though, for the time being. To have a little grace with myself in the energy department and not immediately think something is wrong just because I feel extra tired some days. There are valid reasons for me to be tired, regardless of what my anxiety has to say about the matter.
Urology Issues
Let the record state that I like talking about my urology issues as much as you all probably like hearing about them. That said, it’s a part of this. A part of my recovery post-transplant, and I would be deviating from the entire purpose of this blog if I wasn’t forthright about the issues that crop up.
I’ll save the full lowdown for the Field Note update that will be coming out soon, but for now, I will just say that I am not experiencing anything all that concerning in terms of symptoms. Nothing that requires any treatment or anything like that, just continued irritation.
It belongs here, though, because I was doing very well in that department up until around May, when it started to get a little warmer out.
The bladder is a very sensitive area of your body, and while mine had been healing well from the Cytoxan, I started to have some increased irritation that showcased itself in a few different ways as my body started to struggle with the increased sweat loss and my inability to maintain an adequate level of hydration for the amount of exercise I was doing.
I drink a ton of water as a principle, but with that area being as sensitive as it is, it does not take much of anything for it to get irritated, especially with prior exposure to certain chemotherapy agents.
My urinalysis results have looked great, same goes for my kidney numbers, but the day-to-day reality is that on hotter days, if I choose to run, I know I’ll pay the price of mild discomfort in the few days that follow that effort.
I met with my urologist earlier this month to go over all this, and it’s something that we will continue to monitor. From our conversations, though, we believe the heat, continued high-volume exercise, and prior Cytoxan exposure are the three main contributing factors.
In other words, I just need to be more reasonable with my exercise and a bit more on top of my hydration in this heat.
Nutrition
Exercise without proper nutrition is doable but not smart. That’s no secret. As my schedule got busier and busier as spring turned to summer, I found myself sticking to a handful of meals that I knew I could meal prep and enjoy.
Because of that, I don’t really have much to say in this section that wasn’t already said six months ago in my previous Health & Fitness update.
I’ve found that meal prepping and keeping things as simple as possible is what works best for me at this current moment in time. I would love to be more adventurous with my nutrition, but I am also in no hurry to make that happen.
Maybe come fall or winter, once my life slows down a little again, I can start to experiment a little more. But for now, here is a collage of the meals and snacks that I find myself enjoying more often than not (the exact same one that was shared in the previous update!)
You’ll see that I try to focus a lot on lean protein, whole grains, fruits and vegetables, healthy fats, etc. I’d be lying if I said any of these meals really excite me, but keeping things simple allows me to kind of go on autopilot each week and know that I am giving my body what it needs in order to live the kind of active lifestyle that I enjoy most. That makes boredom seem like a fair price to pay occasionally.
Looking Ahead
As always, I like to look forward a bit and give you all a little insight into what is coming down the pipeline and how I am loosely planning to tackle the next few months. What sort of goals I have for myself and how I plan to get there, really.
General Exercise, Nutrition, & Health Plan
Starting off a bit broad with my strength training, nutrition, and just the general day-to-day things that I do to maintain my health.
When it comes to strength training, consistency is gonna be the main focus. When my energy levels drop, strength training is usually the first thing to get cut from my daily routine, and I don’t love that I have that habit.
Something that I think will aid in getting back on track is shifting some of my running mileage back to walking each week, like I was earlier this year. At least until the summer heat starts to pass.
Walking will help alleviate some of the stress that I have been putting on my body while still allowing me to stay active, as well as free up some energy to really lock back in with my strength training.
Essentially, I am going to try and focus on rebalancing my daily movement-focused activities so nothing is being neglected.
Nutritionally, not much will change. Meals may shift in and out of my meal prep schedule, but the underlying nutritional focus will remain the same. Real food as often as possible. That’s it.
Running
Like I hinted at throughout this post, I am going to try and settle into what I would call a maintenance zone, at least through the rest of the summer, when it comes to my running. That will likely involve me running roughly 20-25 miles a week. Enough to maintain the fitness that I have built so far this year, but not necessarily enough to get fitter than I already am.
That mileage range is very reasonable for me, and if I mix in a healthy amount of hills like I am known to do, I am not too worried about losing much, if any, fitness over this time.
This will also allow me to show up fit and ready for the races I have planned for the rest of the year. I am excited for all of them equally, so I’ll just list them out below but likely won’t dive into any one race specifically.
In order, I am signed up for the Surf-Town Half-Marathon in early September, the Bosco-Fowler 5K in late September, the Hartford Half-Marathon in mid-October, the B.A.A. Half-Marathon in early November, and the famous Manchester Road Race on Thanksgiving Day in November.
What I like the most about this lineup is that I get plenty of chances to test my half-marathon fitness, while also doing a few shorter and faster races like the 5K in September and the Thanksgiving Day race, which is roughly 4.75 miles.
I enjoyed the Falmouth race a lot for that very same reason, as in the past few years I have focused a lot on the half-marathon distance and haven’t done a lot of shorter-distance races. They are fun but also painful in the sense that you arrive at the pain cave relatively quickly in those sorts of races due to the speed at which I ask my body to move compared to what I usually do.
They are a different sort of challenge that breaks up the monotony of back-to-back-to-back half-marathons really well. I like that.
Mindset
I have lots of work to do when it comes to getting to a healthy place with my mindset, especially when it comes to exercise.
These past few months have been tough in that respect, as I had a plan in February for how I wanted things to go and, for a few different reasons, I wasn’t able to stick to that plan entirely and I’ll be the first to admit that I was not always kind to myself about that.
It made me realize that I had shifted a lot of my anxiety about my health towards running, and while running helps me with that in so many ways, it also made it really hard to accept the fact that I needed to scale back a bit over the past month or two.
I started to use progress in my running as a metric for my overall health, and once I was forced to slow down, I found myself more anxious about everything else.
That’s not a fun place to be in, and I am very much still in that space right now. I am not sure exactly how that changes moving forward, but I am going to try and figure that out over these next few months.
I have a feeling that at least some of the anxiety can be attributed to my one-year biopsy, which will have likely already taken place by the time you read this. I have more markers pointing towards things going well than not, and for that I am so grateful, but there is a lot riding on the results this time around.
It’s the difference between continued uncertainty and a little breathing room to continue living and planning for my future.
I am just scared that the footing I have found over the past year, especially the past six months, will be pulled out from underneath me. That I can feel good and be back to fully participating in my life, only to be pulled back down into the foggy grey area that I was in before transplant.
Regardless of the results, though, I know I need to get to a healthier place mentally when it comes to how I speak to myself and my possible over-reliance on running for the state of my mental health.
Long-Term
On a lighter note, my long-term goal still remains very much intact. When the applications for the DFMC team open up in another month or two, barring any unforeseen circumstances, I still plan on putting my name in to run the 2027 Boston Marathon for them and fundraise.
The downshift of sorts these next few months may actually help when it comes time to dive into a full marathon block early next year should I get accepted onto the team. I’ll have more energy, be a bit stronger, and have lower temps to work with. All ideal.
Whether I get accepted or not, you all will be amongst the first to know, I can promise you that.
Closing Thoughts
As I have been writing this update, it occurred to me that I am not entirely sure what the future of this mini-series will be. As always, I want to make sure that what I share is actually providing some sort of value to those of you who take the time to read.
The setbacks that I have experienced in terms of my fitness this summer made me realize that endless forward momentum in this field is not always possible. I think I already knew that, really, but I guess it took the reminder this summer to acknowledge how it might impact what I write about and share with you all.
I have my habits when it comes to my health and fitness that I enjoy and that I am very proud of, and I am at the point where it’s less about recovering and more about fine-tuning and optimizing, which I am fully aware is not always the most interesting thing to read about.
The goal of the three posts in this series so far was to sort of showcase a potential timeline for you all, should you ever find yourself in a similar position to where I was.
I know every transplant experience will be different, and the setbacks you deal with may not look anything like the ones that I did, but I believe that through these three updates, I have, to the best of my ability, provided you all with a look at what my specific timeline has looked like so far in terms of getting back to an active lifestyle as a mid-twenty-year-old post-transplant.
So, while the future may be a bit uncertain for this series, I can promise you that the Field Note updates will continue, and if I end up running the Boston Marathon next spring, there will absolutely be a specific post or two that dives into my training for that and how the experience unfolds.
As always, thank you for reading, and you’ll hear from me in another few weeks once I have my biopsy results in hand and am able to share what the roadmap looks like moving forward.
Talk soon,
Ethan
Resources
External links directly referenced in this article:
- Strava
- Falmouth Road Race
- Cytoxan
- Urinalysis
- Surf-Town Half-Marathon
- Bosco-Fowler Memorial 5k
- Hartford Half-Marathon
- B.A.A. Half-Marathon
- Manchester Road Race
- Dana-Farber Marathon Challenge (DFMC)
- Boston Marathon
Long Way From Home 
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