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Now This Is Hard
Sheena Wisler faces the San Juan Solstice 50 following a year of chemo and surgeries
This week’s post is extra long for the sake of sharing an extra meaningful ultra story about health and resilience. Stay tuned for a bonus installment tomorrow about the Western States 100. If you haven’t subscribed to this newsletter, please do!
This is so hard, I thought last Saturday on a section of trail above tree line, midway through the High Lonesome 100 route. The singletrack trail switchbacks up a talus field—which is basically a mountainside that looks like a rockslide—and ascends 500 feet in only half a mile.
With each step, I planted trekking poles in front of my feet and gripped the handles to help my lower body take big upward steps. I breathed as if running a 10K road race even though I was hiking at a pace so slow that I covered only about 2.5 miles in the hour.
When the trail topped out at a ridge line around 12,500 feet elevation, the wind slammed my body as I willed my legs to run the flatter ribbon of trail. The first serious slate-gray clouds of the season gathered overhead, and I heard the rumble of thunder. The mountain rainmaker known as the monsoon was making a comeback, a couple of weeks early.
After a short jog along the alpine tundra of that ridge, surrounded by the mostly bald but snow-streaked Collegiate Peaks poking up in the surrounding Sawatch mountain range, I listened to my gut tell me to turn back in case the sky produced electricity. This was just a training run. I headed back down to run (more like, hike) another segment of the High Lonesome route in preparation for the race, which is slightly less than five weeks away.
I covered 20 miles of the 100-mile route because last year, during the race, I traversed this portion after nightfall, and I wanted to demystify it by experiencing it in the daylight. Instead of building my confidence in the light of day, however, the outing implanted repetitive thoughts, This is so hard, and, I’ve gotten so slow.
It also shook rather than built my confidence about this Saturday’s San Juan Solstice 50. On Friday, I travel to Lake City for the next day’s 5 a.m. start of a notoriously tough 50-miler with strong weather in the forecast. It features three major climbs, two of which top out at 13,000 feet, and a long stretch on the exposed, high-altitude Continental Divide Trail. I need to brace for the challenge.
I had a 3.5-hour drive back home to reconsider what “hard” is and to adjust my perspective.
The fact is, I had chosen to be on the mountains for the day, instead of working, which is a privileged choice. I was not sick or injured. The stakes were not that high—either I kept putting one foot in front of the other, or I rested. The upcoming competitions are personal tests of endurance that are entirely optional.
I suspect that I and others sign up for these ultras in part to add adventure to a cushy life. By contrast, those runners who live truly hard lives probably sign up in part for an escapist or healing day to counter their hardship.
Really, I’ve got it so easy. This coming Saturday, when I’m struggling through the San Juan Solstice 50, I should instead tell myself, This is so easy! It’s all relative.
Thinking about Saturday’s experience and the San Juan Solstice 50 made me think of a woman named Sheena, who’s also getting ready to run this weekend’s San Juan Solstice 50. I reached out to her the next day and asked if I could share her story to help me appreciate what “this is hard” can mean.
It’s a good thing we ultrarunners are used to talking about poop, GI distress, weird bodily functions, and health in general, because the following story contains a lot of that.
I met Sheena in the fall of 2020. I had moved to Colorado year-round and needed to find a gynecologist, so I contacted Alpine Women’s Center in Montrose and got an appointment with their new female OBGYN, Sheena Wisler, because I wanted a female doctor, and she was the only one accepting new patients. Admittedly, however, when I saw her photo, I felt a bit skeptical due to engrained sexist stereotypes. She was so young, blond, and beautiful, barely 30; did she really have the experience and brains to help me with menopause?
I brought with me a printout of my period log—notes of my erratic perimenopausal cycle—and woven into those notes were details on how and when my cycle coincided with ultras.
Sheena took one look at my notes and said, “You’re an ultrarunner!” And that’s when I first glimpsed her spark, realness, and toughness. She works full time as a doctor delivering babies and helping women like me, but her rival passion is running mountains. We spent the first two-thirds of our appointment talking about training and races. She shared her disappointment that Run Rabbit Run 100 had been canceled because of the pandemic, since she had trained so hard for that to be her first 100-miler, and I told her about my experience racing it in 2017. We clicked and could have talked endlessly about ultra training but eventually had to talk about hormones instead.
I connected with Sheena through Facebook and realized we have a mutual runner friend, so I continued to hear about Sheena through her. And that’s why and how I got caught up in following Sheena’s life-changing year that began just a little over a year ago.
She was diagnosed with stage 3B rectal cancer May 10, 2021, at age 31.
I asked Sheena about what she’s been through and what her prognosis is. She wrote me, “I’m happy to share so that people are aware small symptoms may be something serious.”
Side note: I am writing this in part to raise awareness about colorectal cancer because my brother-in-law (my husband’s only sibling), who was half a year younger than I, died of it in September of last year. We learned through him what it’s like to have your lower “plumbing” removed and to get used to a colostomy, and then to have the cancer spread to other organs.
I got my first colonoscopy a little over a year ago, right before I turned 52. Given my good health, I expected to reassure my husband and myself that I have no risk. I was shocked to learn I had several aggressive pre-cancerous (“adenomatous”) polyps that were removed, and I was told my kids should start their screenings at age 40 due to genetic risk. I now need to get checked every three years. So, folks, the risk is real, even if you’re in good health—so get a colonoscopy, now recommended at age 45!
A Q&A with Sheena
As a runner and as an OBGYN, you are probably very in-tune with your body. What were the first signs that something was wrong? Did you ignore and run through them for a while, or did you take action right away?
Sheena: “I’ve always had IBS [Irritable Bowel Symptom]-type symptoms since a young girl, loose stools when I get nervous (before all of those exams, haha) for instance. When I had a small amount of bright red blood to my stool intermittently about a year prior, I had little concern, because I see it all the time with young women and hemorrhoids. I only began to have pain with bowel movements in January-February of 2021 and got a GI referral right away. It took me several months to get in for a diagnostic colonoscopy. I never developed ‘red flag’ symptoms such as decreased appetite, weight loss, fatigue, etc. I ran 40 miles and took calls the week before I was diagnosed, and I operated the evening before. I was convinced I had inflammatory bowel disease the morning I went in for my scope.
“I woke up and Ryan [her husband, also a doctor] was in the room with me. I made a joke about there being bad news because he was not supposed to be there with covid restrictions. Sure enough, the GI said there was a tumor so large, he could not even pass the scope. Our lives had changed in an instant.”
Tell me about the milestones in your treatment.
“I made the decision to delay treatment slightly, which was nerve racking, for an IVF cycle, because Ryan and I had sadly not started our family. The necessary radiation would likely make me infertile in addition to not being able to carry a future pregnancy, which was a difficult and heartbreaking reality to face. Fortunately, the fertility specialist I trained under [in medical school in Louisiana] took care of us, and I had an egg retrieval in New Orleans completed by May 31. I flew home the next day, had a port placed the next, and started chemo the very next.
“Over the next 10 months, I received 11 total rounds of chemo, a course of pelvic radiation, and five surgeries not counting two scopes! That’s general anesthesia seven times in 10 months. One of my surgeries was actually an ovarian transposition in which the ovaries are moved out of the pelvis and into the abdomen in an effort to prevent menopause. So far, it has worked! I finished what I thought was my last cycle of chemo late October and had a Low Anterior Resection—tumor resected, most of my rectum and part of my colon is gone—with a temporary ileostomy placed December 7.
“Unfortunately, I had not had a complete response to chemo and radiation and had several lymph nodes that came back with cancer. I would start chemo again on January 11 for three additional rounds and finish up mid-February. I finally had my ileostomy reversed on March 17 with clear scans the day prior. I officially have no evidence of disease, and my plan is to stay that way!”
I was shocked to learn of your diagnosis because you are so young and healthy. Was it random or did you have risk factors?
“All of my genetic testing has been negative, but I am convinced it plays a big role. My maternal grandfather had colon cancer in his 40s and my mother has always had a large number of polyps on her colonoscopies. Aside from him, no other family members have had cancer. I don’t have the typical risk factors of obesity, high alcohol intake, a diet high in red meat, smoking, etc.”
I can’t fathom how hard it must have been to have so many dreams all at once jeopardized—of becoming a mother, of being an ultrarunner, of leading a normal life. You had to put both your running and professional life on hold, right? What was that like and how did you cope?
“Yes, the diagnosis is absolutely awful and life changing for anyone, but, for a full-time physician who spends all her free time in the mountains, well, it ripped away all of my sources of happiness all at once. I had plans to keep working and running throughout treatment, but I wasn’t as tough as I’d thought I was! After my first day of chemo, I ran Sutton mine. My second day, I did the via ferrata. After a few more days, I was down for the count. I decided to take off work after walking out of a patient’s room and vomiting into the garbage can.
“After just three rounds of chemo, I’d lost about 25 pounds and couldn’t force myself to eat a few hundred calories most days. Sadly, I had no energy to even walk for about three months. The worst days were the weeks after radiation, I would only move from the bed to the bathroom (granted it was about 30 times) and to the cancer center to get fluids in order to stay out of the hospital. It was the worst time of my life. I realized how much joy I draw from being outside, in the mountains and just being active in general. The lack of control was a tough pill to swallow (not as tough as my chemo pills, which I would eventually ditch). I would listen to meditation music, journal, and watch TV—the Olympics! I watched every event, including the 50K speed walking event, haha. I also had an excellent support system of family, friends and coworkers that kept my mindset overall positive. My healthcare team changed my chemo regimen due to my weight loss and side effects, and I began to slowly do better. I was able to force myself to eat at least, even though it still tasted awful. As soon as I gained enough energy, I was outside for a walk even if only down the driveway.”
Before you became sick, how much were you running and what were your accomplishments and goals as a runner?
“We [Ryan and her] started about four to five years ago as training for a trip I’d booked to Rainier. Soon, the challenge became enjoyable and we ran our first half, followed by a full marathon, followed by—why not?—a 50 miler! We were totally hooked once we got on trails. My ultimate goal is to attempt the 100-mile distance, it’s magical to me! In 2020, I had signed up for Run Rabbit Run. I ran about 2000 miles that year. Sadly, it was canceled just weeks before, but I had some other big adventures in the San Juans and got to do the Grand Canyon Rim to Rim to Rim to finish out an awesome year.”
Your husband, also a doctor, is also a serious runner too, right? Didn’t he run an ultra while you were in treatment? What was it like supporting him?
“Yes, Ryan is actually the real deal, I’m a wannabe! He definitely used running as his main coping mechanism and actually got stronger during the time. He was able to complete his first 100 miler, The Bear, last September. It was pretty wild crewing him all day and night while I was still on chemo and weak. We were a sight to see, but we got him through to the finish line. It was emotional watching him finish, I was incredibly proud!”
When did you return to hiking and running, and how did it feel? How did you cope with your bag and chemo port?
“By late September of 2021, I was determined to go on my first trail run at Lower Spring Creek [near Montrose]. I was still getting chemo, but it was my week off. My body had never been weaker, and I was very unstable, and I knew I couldn’t fall because I had very low platelets! (Meaning, I shouldn’t fall because I would bleed and bruise easily.) It was three miles, and I had to stop every half mile to rest! It was like that for some time—very frequent breaks, lots of water and extra supplies, before I could trust my body. That was a tough part for me, not being able to trust my body.
“I made Ryan bring me up Sneffels in early October because I had not been able to do a 14er that year yet. It was winter conditions by then. I had to keep my face and extremities covered in addition to heating my water due to the cold sensitivity that my chemo causes, which would cause a lot of pain and spasms in your airway making you feel like you could not breath with any cold exposure.
“After my big surgery and a new ileostomy bag, the new challenge became figuring out nutrition and how to run with it. I ordered a special belt called the stealth belt, which helped secure it during activities. A real challenge was it would leak pretty acidic liquid onto the skin just around the stoma and strip my skin away. I remember telling the wound care nurse that I had only taken one pain pill after I had my entire rectum cut out, and now I was in tears because of this little stoma. I eventually learned how to better deal with it in time for the reversal.
“Since then, it’s been very unpredictable. Some days, I feel normal; some days, I have terrible GI function. It has definitely progressed towards getting better overall. And yes, I still have my [chemo] port today.”
When did you get the idea to run the San Juan Solstice 50, and how has training for it been? What are the greatest challenges or setbacks, and how do you handle them?
I’ve been interested in SJS for several years now. I knew I wanted a big goal for the following summer [this summer, following her treatment], something in the mountains, a beautiful course and nearby. It fit that bill.
“As for the specific challenges—since the ultrarunning community enjoys talking about poop—I have a lot of GI dysfunction. I essentially have no rectum, so my body cannot store stool normally. A lot of times, it’s actually fine while I’m active, I suspect due to blood flow being shunted away. It’s very unpredictable though, and at any point, I may be running into a bush and dealing with a lot of urgency and pain.
“There have been a lot of random setbacks throughout the process. I would run with my 5FU (type of chemo) pump while it was connected. That was funny trying to tuck it into my pants with my bag as well. I called it ‘double baggin’ but no peaks involved’!
“When my platelets were still low, I would cut myself on a rock or stick and have blood running down my leg, or I’d fall and have multiple bruises! And as for the surgeries, just the recovery process each time was challenging.
“Technically, I shouldn’t run for six to eight weeks following each surgery, and as a surgeon, I would not advise patients to do quite what I did, but at the same time it has to be taken individually, and I needed to be active. I needed it physically, mentally, spiritually. It was part of surviving by that point. If I could problem solve and still get out, I was happy. If I had to stay inactive, I would and still do get pretty upset about what cancer has taken from me and the lack of control that I have.”
How is your health and prognosis now, and also, what is your hope and plan for starting a family?
“I still have a lot of ups and downs, including residual side effects from chemo, such as taste distortion, peripheral neuropathy in my feet, and in general lower energy levels. I deal with the new GI function brought on by both radiation and surgeries on a daily basis. I’m going to pelvic floor physical therapy. With all of this, I’m still overwhelmingly thankful to be here and be able to be active. I do my best to focus on living in the moment and not worry about the very real risk of recurrence. Let’s say I’ve gained six or seven tickets in the veteran category now if we were comparing my recurrence rate to Hardrock chances.
“We got eight good embryos [from IVF] and so much hope for a future family. We plan on pursuing with a surrogate in the next couple of years, and I hope to deliver our own baby. That would be an amazing story that will hopefully play out, but still a lot is up in the air.”
What do you want people to know about colorectal cancer?
“It can happen in young and healthy people. It’s best to get checked if you have any types of symptoms, even if your symptoms are mild and have been longstanding. Know your family history and take it seriously. There is genetic testing that may reveal an increased risk to several different types of cancers that you could modify with increased screening or intervention. Any first-degree relative should get a screening colonoscopy ten years prior to that family member’s diagnosis, and the age for [recommended screening for] everyone was lowered to 45!”
How has your relationship with running changed from cancer?
“I appreciate it more for sure. I’ve had to be patient and accept that the process to getting back has not been linear. It’s sometimes difficult to say, ‘It’s not going to happen today.’ It’s impossible not to compare yourself to where you were previously. At the same time, I realize all my body has been through and I try to be patient and thankful for what it can give me.”
I am deeply grateful to Sheena for sharing her story and for giving me a healthier perspective about my relationship to running, including deeper gratitude for my health. When we are on the trail together at the San Juan Solstice 50 this Saturday, I’ll draw strength from her courageous and positive example. I’ll share the race outcome on my social media on Sunday (I’m @sarahrunning on Instagram) and you can check the results here. Please subscribe for future posts, including a brief one tomorrow about the Western States Endurance Run.
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