“Everybody’s at war with different things, I’m at war with my own heart sometimes.” - Tupac
The Genesis
“It’s going to be very hard for you to see him” - my physical therapist commented.
I asked if she had any tips on meeting this famous doctor, and she shook her head in response. My therapist has become familiar with me enough to know I will go to any lengths to crack the mysterious injury’s code. She wished me luck and, with a diplomatic grace, added:
“But you know, Bavaria is different. They like rules over there, and your Californian enthusiasm will not work”.
Without losing a beat, I responded from a message table:
“Okey, I want to try anyway. If they ask me to play tambourine, I’ll do it.”
Fabienne smiled and broke - the typical for Swiss - professional self-restraint and opened up slightly:
“I don’t know where you end up, but I like your unusual motivation.”
The truth is that I was running on fumes. It was the midpoint of the three-month-long medical sabbatical I took from my work in San Francisco, and nothing was going according to plan.
I’ve read once that to write well, you need to pick a good story. A good story will serve as a guide and a backup - even if your writing falls short of high aspirations, a good story still will be there to save the reader. Undoubtedly, my recovery from a rare and daunting medical condition is the best story I can tell. On the one hand, my whole endeavor is a two-and-a-half-year-long Marshmallow test. There were so many times when I thought I was wasting my life chasing a hopeless goal. On the other hand, this is a tale of trekking the very edge of sports medicine and a relentless search for a hidden pass.
Upon moving to San Francisco over three years ago, I was immediately struck by the life-advice culture, especially in the work setting. Only closer inspection lifted the lid on the little secret - the advice is aspirational. It often expresses more the intent of how the world should work than reveals its mechanics. For example, beware of any management book that doesn’t talk about emotions. Ben Horowitz said once that people management’s basic motions are easy, and emotions are the hard part of the job. I agree and would expand this to health struggles and going through a long recovery. The basic motions of discipline and exercise regime are comparatively easy; trusting them when they seemingly lead nowhere is the hard part. Building a top-notch business and dealing with a complex medical issue share a trait: both are highly dimensional, and there’s no recipe.
Being wary of thin advice, I’m writing an account first and a collection of the lessons learned second. I greatly benefit from hindsight - my extremely unusual choices worked out. However, I fully recognize that a downright failure was as likely of an outcome. I could have as easily burned an enormous amount of money and people’s goodwill and have nothing to show for it.
I’m writing from a somewhat privileged position of a member of one of the most high-flying industries of our time. Even if it felt anything but a privilege in the depths of the struggle. So it’s a story about how not to screw up your advantage. It’s a story of how not to punk out.
My intention is not to be brief. I’m writing how I wish somebody else had told me everything I know now when I was running around looking for a solution or just a sliver of hope. A rich backstory would help me believe that this person I’m talking to truly knows what a health struggle is about. I would cherish every word if I found a series like this - I searched wide and deep - as you’ll see.
The Basel rewind
We need to roll back to 2018. I moved to Basel to fix my semimembranosus (one of the hamstring muscles) injury.
The recap of my injury I wrote back in 2018:
Semimembranosus injuries are rare, and my pull is in the lower part of the muscle, which is even rarer. I’m two years into this injury, and I haven’t recovered despite a dedicated commitment to physical therapy. Typically, muscle pulls take 2–3 months of physical therapy to treat, but my injury wants to stand out.
I moved to Basel for the summer of 2018 by taking a sabbatical from my job at Stripe. The plan was to entirely focus on the injury, spend three months working out the underlying puzzle, and fix my problem. I would come back to San Francisco, recovered, ecstatic, and back to kicking. I bet on the original sports clinic of Europe, and it felt like a good plan.
I took detailed notes of my first eight weeks of recovery. You can check them out if you’re really curious. Notes from previous weeks: week 1, week 2, week 3, week 4, week 5, week 6, week 7 and week 8.
Why did I stop at week 8, given I had planned 12 weeks of stay? The last four weeks were too painful to write about. By week 8, it was clear that my bet on Basel clinic didn’t work out. I came with hamstring tension that we made significant progress on, but a lingering adductor tension developed into a major problem. By week 8, I felt worse than before I started the Basel treatment. People have warned me at Rehnbahnklinik that my issue is in the all-bets-are-off territory, and my move doesn’t guarantee anything. The warning didn’t say my condition might get even worse, though.
Last month I spent feverishly looking for a solution. I had developed a muscle tension in my adductor that would turn itself on and off, seemingly at random. The switch was so fast that both the people at the clinic and myself become convinced it had a neurological origin. We tried a whole palette of local interventions that I described in my notes. None of them seemed to address the root cause of the problem. My doctor at the clinic declared he is out of ideas. I had a month left in Basel. I decided to follow one more clue: Luca (one of my therapists) discovered that I had a condition called visual suppression caused by convergence insufficiency. In a nutshell, we suspected that my ski accident might have left small residual damage in my brain’s perceptual regions linked with the sense of balance. Adductor is one of the muscles that stabilize hips and balance maintenance.
One of the challenges you face when dealing with a mysterious condition is that there’s a lot of guesswork and false hopes involved. The trick is to stay open to any possibility and, at the same time, kill the wrong hypothesis quickly.
How do you go about killing the hypothesis on a connection between insufficient converge, a hidden brain injury, and stubborn tension in an adductor? I started off researching the strength of the first link. After searching online forone whole afternoon, I came across research by Dr. Uzma Samadani, who worked on detecting hidden brain injuries. I sent her an email describing my condition, and she responded promptly (thank you!) with one sentence: look for an optometrist.
I called the local vision research clinic and explained my predicament. I said, “I have this big muscle control puzzle, and there’s this eye-related hypothesis”. A few emails later, I convinced them to take me almost the next day despite the holiday season peak. I learned how to play a “mystery card” by that point. I would get people excited that they are part of breaking an enigma. Especially in Switzerland, trying to go around the rules (e.g., skipping the line) won’t get you far. Taking people on a quest is what worked much better for me.
A week later, a diagnosis came back: a doctor didn’t find any vision issues, and the convergence insufficiency is within the norm. Some people have it naturally. I aced every other vision test (good news), and I’m back to square one (bad news).
Deeply resigned, I reported the findings to Fabienne. I asked her one more time if she could think of anything else she might suggest. The next day she brought a book with her and said, “I have an idea for you. There’s this famous doctor in Germany that treats soccer players and specializes in muscle injuries. I learned from his textbook.”. I was all fired up about this idea, and then she continued, “but it’s going to be very hard to see him”. By now, you can recognize this as the conversation with Fabienne I opened my post with. So what happened next that day? I told Fabien that I would figure out how to get there and see the famous doctor.
Once my physical therapy finished, I headed to a library. I looked up the clinic online, and it was indeed famous. It was enormously controversial too. I saw articles claiming miracles done for an impressive lineup of celebrities, and questions raised whether the methods can still be called medicine. I discovered that Bono was a patient there not so long time ago. Then, I saw Usain Bolt and other Olympic athletes on the list. Two questions were popping into my mind: 1. what’s so special about this famous doctor that’s attracting all these top-notch people? 2. how can I become part of the list?
I didn’t belong to that list, but that didn’t matter. Beating my injury is all I cared about. To give you a sense of how much I cared, let me highlight some of the things I did before my conversation about the Munich clinic Fabienne recommended. I was taking detailed, everyday notes on changes to my muscle tension in hopes of working out a pattern. I sat in a library and read sports medicine research papers on hamstring injuries in the hope of finding a connection to the adductor tension. A few weeks into my Basel stay, I knew that “glutes” is a complex of three muscles: gluteus maximus, gluteus medius, and gluteus minimus meticulously arranged behind your hips. I learned about muscles such as piriformis - a small muscle right below the glutes and more inside your body - important stabilizer of your hip and leg. During my library sessions, the Human Anatomy Atlas iPad app became my most faithful companion.
Why did I learn all of this? Partly, it was a way for me to do something with my time. I went all-in with my recovery: it was a full-time proposition. Partly, it was my response to the despair I felt. I bet a lot on Basel and was trying to save my gamble. Partly, I hoped I would find something others have missed. Lastly, I wanted every ounce of effort and creativity from people that were taking care of me. I deeply believe motivation is contagious. What’s a better way to show you’re motivated than come to a doctor’s appointment, say, “Doc, I’ve read about piriformis muscle and have some questions,” and watch his eyebrows rise?
Sing For The Moment
The other thing I strongly believe in is that one shouldn’t be a downer. You shouldn’t suck the energy out of the room you enter. I understood it well, having observed how physical therapist reacted to other patients that were consistently outpouring their ills on their surroundings. The therapist I watched would be professional, but deep inside count minutes until the end of their time slot with a mood-sucker. And to be clear, I’m talking about embittered people, not the ones truly suffering in the moment. Anyway, I didn’t want to be one of the whiners, yet my mental health wasn’t excellent to say the least, and I suspected everyone could tell. I reached out to the great Slimshady for consolation. Each morning, as I biked to the clinic or the training, I would snug my Airpods in and blast ‘Till I Collapse by Eminem:
‘Cause sometimes you just feel tired, feel weak
And when you feel weak, you feel like you wanna just give up
But you got to search within you, and try to find that inner strength
And just pull that shit out of you
have chills run through my back, and bike faster. ‘Till I Collapse would become my anthem for the rest of the year 2018.
A few weeks into my frantic study, I felt like I’m learning lots of low-level details (and retaining a fraction of what I read), but I missed the big picture. And more importantly, nothing was turning up in the “hamstring injuries lead to adductor issues” category. I decided to continue sitting in the library, but my reading list expanded with books on elite athletes. I was interested in athlete’s medical teams in the hope of finding leads to other doctors. I researched and called clinics in Dubai, Abu Dabi, Tokyo, Quebec, and Toronto. To no avail. Once I got over front desk workers - to the actual doctors - the conversation always ended either of two ways. One way was “we don’t think we have anything to add on top of what you have done already”. The other was, “we don’t know what this is, but we could see you, and maybe we can look more closely; by the way, we’re fully booked for the next three months.” I’ve tried many things already, and the prospect of traveling across the world on a very thin backing didn’t sound like a good bet to me.
Fabienne was one of the best physical therapists I’ve met. She had this fantastic feel for the body and what I like to call kinesthetic intelligence. She could instantly pin down my muscle issues just as I was walking in. She was unusually observant and curious. Her earnest recommendation of a mysterious clinic in Munich was a strong signal for me. I thought it was worth giving it a chance. After all, Munich wasn’t that far from Basel.
The hard part was getting an appointment. In my scattershot attempts, I’d find myself posting on Hacker News (programmer’s news and community website), chasing down people in Florida, and a whole lot more.