Friedman recovering from iliac artery surgery

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Kelly Benefit Strategies/OptumHealth rider Mike Friedman is recovering from surgery he hopes will put him back to full strength for the next season. Earlier this year doctors discovered a kink in his iliac artery, the main line for oxygenated blood traveling to the source of power on the bike: the legs.

The problem built up slowly over the years, robbing his pedal stroke of power and his mind of the self-confidence he had built up as a multi-time national champion and Olympian. Finally, at the Amgen Tour of California and US Professional road championships this year, his issues became so pronounced that he could hardly pedal at times.

"I can remember having slow, incremental deficiencies with my left leg versus my right until it was so bad I literally couldn't pedal correctly with it," Friedman told Cyclingnews. "At first it was intermittent, sometimes it was good, sometimes it was significantly more sore. It would feel heavy like I had to think about kicking it over and pulling up, it would cramp first, it would fatigue almost immediately at Tour of California, especially in the drops or aero bars, basically I couldn't do what I used to be able to."

The severity of the issue was a blessing in disguise, because Friedman was finally able to get a solid diagnosis: he had a 90-degree bend in the artery heading into his left leg which, in the riding position, would kink and "restrict blood flow to a trickle".

It's a problem the cycling world has seen before: Australian Stuart O'Grady had the defect corrected in 2002 and went on to win Paris-Roubaix five years later. Other riders affected by the issue are Travis Meyer (Garmin-Cervélo) who had surgery earlier this year, Tony Gallopin (Cofidis - 2010), René Mandri and Hayden Roulston (2007) to name a few.

Friedman explained that cyclists are prone to the issue because of the position they force themselves into on the bike. "'Endofibrosis', which is a narrowing of the artery, can be caused by an artery that is being functionally kinked through the pedaling motion... the body's natural response is to strengthen this weakened area by adding an almost fibrous tissue to the inside of the area of artery which greatly narrows, thus restricting blood flow," he said.

The body can respond in one of three ways, or so doctors thought. Up until Friedman's diagnosis, the thickening of the artery, a flap of tissue tearing loose through damage to the artery wall and a too-long artery bending like a garden hose, causing a kink, were the three ways that the blood flow to the legs could be blocked in this way.

What doctors discovered to their surprise was that Friedman had a kink higher up in his abdomen that was being caused by a smaller artery growing off of the larger common iliac artery - it was basically pulling on the major vessel and holding it at a 90-degree angle whether or not Friedman was bent over pedaling or standing up straight.

"Upon riding the angle of the kink would diminish further and restrict flow to a trickle. Because I had an artery kinking the main artery this has been a life long thing," Friedman said. "It wasn't caused by cycling. Cycling caused the symptoms to be further exacerbated. So there are four things so far that are now known to cause a restriction of blood flow to the lower extremities, and undoubtedly more."

The latest health scare for the 28-year-old Superior, Colorado resident is just the latest stumbling block in his young career. In 2006, a blood clot lodged in his lung leading to a diagnosis of Factor 5 Leiden, a genetic blood disorder that leads to quicker clotting than normal.

Friedman said he had to stay completely immobile while on the blood thinners. "If I moved abruptly or somehow tore the arterial sutures or incisions I was going to bleed, and I don't mean like bleed for a few minutes, I mean gushing out on area of high blood pressure, very slow to clot blood (thin), and inside my body's cavity. I was told that I would either be severely disabled by this or die, emphasis on the latter because its unknown if they could stop it or if I could reach help in time."

The result was a week-long stay in the Memorial Hospital in Colorado Springs, where doctors kept an eye on him until they could manage the delicate balance between healing the sutures and preventing clots.

"Scary shit to be quit blunt."

Luckily, the surgery performed by Dr. Thomas Crepps and post-operative treatment was a success, and while he has two scars: one six-inch long gash where they fixed his artery and another on the other side of his groin where they removed part of a vein to use as a patch, his prognosis looks good and he hopes to be back on the bike in September.

"September 1st I will be able to start riding, slowly at first using the trainer, but once I start doing that I bet I will be outdoors quickly after."

With the support of his Kelly Benefit Strategies/Optum Health team, Friedman will now look to regain his form and let the talent he has shown so frequently in the past shine through once more. But the pain of what it has caused to his self esteem and his career is still present in his mind.

"It was extremely difficult to deal with because I learned self defeat. I would take heat from management saying I needed to train more, I was too fat, I didn't do things right, eventually leading me down a road of over training, depressed, and an eating disorder.

"Eventually I just thought I was no longer any good, or not good enough, and eventually let go. Still a good bike rider I was able to push through a lot of pain and suffering and win a couple races or finish well, but as it progressed I just could not do it anymore.

"If it weren't for the Garmin Doc. Prentice Steffen, and UHC Doc Mike Roshan I wouldn't have found Dr. Crepps as easily. They were willing and able to help me out and it means the world to me. That's the 'Family' in cycling, things just like that.

"As I approach September 1st I am motivated more and more each day. If all works out with this surgery and I'm 'fixed', I will be the only guy in the Pro Peloton actually stoked to start doing base miles this fall," he joked.

"I'm excited for next season with Kelly Benefits/Optum Health. They have stood by me 100% in this gave me their word for next year and I won't let them down. I should be a different and better rider. On top of the anguish I felt, I learned how to cope with it, how to mentally push past it, how to race more efficiently and still race, so if both legs are good I hope for a significant difference in performance."