Sue Aquila – FeWoman

Author: Sue Aquila

  • Tools for Success Hip Recovery

    If you read Recliner Hostage on Substack, here is the gear behind it. And remember, no one would let me be a medical professional. Talk to your doctor before you listen to some weirdo on the internet. Seriously.

    What I used to recover from Bilateral Simultaneous Hip Replacement

    • Journavx instead of Opioids. Shout out to endurance athlete and orthopedic surgeon Howard Luks for the suggestion. Not all major hospital systems carry this new pain killer yet. I had to fill the prescription outside our system and bring the unopened pill bottle with the pharmacy handout to the hospital. The hospital pharmacy had to inspect it before giving me the first dose post-surgery. Info here.
    • Wound Vacs. Dr. Buller did a plastic surgery close on my hips. The wound vacs helped prevent scarring and infection. My incisions look amazing. Dumb and dumber were worth it!
    • Hydraulic lift recliner. Purchased used on Facebook marketplace. Used for elevation, sleeping and easier standing.
    • Walker with four wheels, brakes and under seat storage. I started with an inadequate hospital walker. Purchased here.
    • Disabled parking pass. If your MD doesn’t offer it, ask for one. I almost made the mistake of declining it until KT intervened. Walking wasn’t a problem but the pass allowed for greater space between parked cars. I needed to open my car door wide to lift both legs together out of my seat.
    • Grabber reacher tool that is foldable. I dropped everything. The grabber gave me back some independence. Cheap on Amazon.
    • Soft ankle weights. My PT progression needed more inertia.
    • Frozen high protein meals. I focused on 100-125g of protein per day. Having frozen pre-prepped meals helped my family.
    • DoorDash or Grubhub. Impromptu dinners for friends or family were much easier to host.
    • Gym membership. I have a great home gym but lifting and twisting with dumbbells and barbells was replaced with the safety of machine strength training.
    • Robot vacuum. Okay I didn’t purchase this for my surgery but we did get a new one and it saved a ton of cleaning stress.
    • Six large ice packs to rotate in freezer. I used two at a time every few hours.
    • Right spouse. KT was all in on this project and I could not have done it without her. She walked me to every bathroom break, tucked me into bed each night with my legs elevated and swathed in ice packs. She helped me walk and understood my need to do things within my capabilities. She also knew when it was time to make me stop. Having the love of your life be a teammate in the trenches made all the difference.

  • How to Choose an Orthopedic Surgeon: An Insider’s Checklist

    When I decided it was time for hip surgery, I had a secret weapon: KT (she who must be obeyed) is one of the top orthopedic physician recruiters in the country. Vetting surgeons is literally her job. So before I ever sat in Dr. Buller’s exam room, she ran him through the same checklist she uses at work.

    You don’t need a recruiter in the family to do this. Every step below uses free, public information, and most take less than 15 minutes. Here’s KT’s checklist.

    1. Confirm board certification and fellowship training

    Start with the basics: is the surgeon board certified, and did they complete a fellowship in your specific surgery?

    Board certification. You can check this yourself in a minute on the American Board of Orthopaedic Surgery’s Verify Certification page. 

    Fellowship. A fellowship is an extra year of specialized training after residency. For a hip or knee replacement, look for a fellowship in adult reconstruction or joint replacement (arthroplasty). Then research where they trained, because fellowships are not all equal.

    Dr. Buller completed his fellowship at Hospital for Special Surgery (HSS) in New York City. It is one of the top orthopedic fellowships in the country. The surgeons training there do an enormous volume of surgery!

    Your surgeon doesn’t need an HSS pedigree. But you should know where they trained and be able to find out why that program is respected.

    2. Check how many surgeries they do

    Volume matters. Surgeons who do a procedure often tend to get better results, and Medicare publishes free data showing how often each doctor performs it.

    Where to look: the Medicare Physician & Other Practitioner Look-up Tool from the Centers for Medicare & Medicaid Services.

    Medicare’s Care Compare site has also started showing procedure volume right on doctors’ profile pages, a feature it added in January 2024 (CMS). It’s an easier place to start than the full look-up tool.

    3. Read the patient ratings

    Patient reviews on sites like Healthgrades, Vitals and Google, along with the star ratings many health systems post on their own doctor profiles, tell you what it’s like to be this surgeon’s patient. Read for patterns.

    4. Find out where they have practiced A surgeon’s career path tells a story. Check their bio on the practice or hospital website, and their Care Compare profile, which lists hospital affiliations (CMS).

    5. Do a quick Google search

    Spend 10 minutes searching the surgeon’s full name plus “MD” and “orthopedic.” Then try the name with words like “lawsuit” or “complaint.”

    6. Search for malpractice claims and license discipline

    This is the step most people skip, and in Indiana it’s free. Check three places:

    What to checkWhereWhat you’ll find
    Malpractice claimsIndiana Patient’s Compensation Fund databaseThe provider’s specialty and the number of malpractice complaints filed against them (Indiana Department of Insurance)
    License statusMyLicense.in.govWhether the license is active and in good standing
    Disciplinary actionsIndiana PLA Discipline SearchAny board discipline; updated weekly

    License status and discipline are separate searches in Indiana, so do both. Outside Indiana, start with your state medical board’s license lookup. A claim isn’t proof of malpractice. Many are dismissed, and busy surgeons who take on hard cases may have one or two over a long career. What matters is the pattern: several claims, claims that ended in payments, or any discipline on their license.

    7. Make sure they operate at a top institution

    You’re not just choosing a surgeon. You’re choosing the hospital, its nurses, its anesthesiologists and its physical therapists. Check the hospital’s hip and knee replacement ratings in U.S. News & World Report, and its overall star rating on Medicare’s Care Compare.

    High-volume joint replacement centers tend to have practiced teams and well-oiled recovery routines. Remember that benchmark from step 2: a hospital doing more than 200 joint replacements a year.

    The bottom line

    An hour of homework can change how your surgery and recovery go. Then trust your gut in the exam room: the right surgeon listens to your goals. Finding someone who agrees to a plan together makes all the difference. He had me at unlimited running and simultaneous double hip replacements.

    Read the full story: The Smallest Space, Part 2: Both/And

  • When Pain Isn’t the Price

    When Pain Isn’t the Price

    6 Warning Signs Athletes Shouldn’t Ignore

    Endurance athletes excel at suffering. We train ourselves to hold the pace when our legs burn, to finish the last interval, and to see discomfort as proof that we’re getting stronger. Most of the time, that toughness helps us.

    Sometimes, though, it lets us ignore real warnings for years.

    I know because I did. For almost twenty years, I treated pain as the cost of racing at the pointy end. I added strength work, ate more protein, trained harder, and planned my Advil and Tylenol around my workouts. It turned out I had severe osteoarthritis in my hips. My whole story is on Substack: The Smallest Space, Part 1. This post is the practical side: the warning signs I missed, so you don’t miss them too.

    1. Your recovery doesn’t look like everyone else’s

    Everyone is sore after a race. But if you routinely need help walking, can’t sit comfortably, or feel much worse than your training partners after the same effort, pay attention. Comparing yourself to others is usually a trap. Here it’s useful information.

    2. The pain shows up when you’re not training

    Pain after a hard session is expected. Pain that shows up at rest, wakes you up at night, or shows up on easy days means something has changed. Mine started showing up outside of racing years before I did anything about it.

    3. You need painkillers to train or sleep

    If you have rules for when you can take ibuprofen or acetaminophen so you can get through workouts or sleep, you’re managing symptoms instead of finding the cause. Talk to your doctor about any regular use of pain medication. 

    4. Your world is getting smaller

    This is the sign I most want you to catch, because it creeps up on you. You stop doing strides. You avoid hills. You drop sports that require quick cuts or changes of direction. You slow down and tell yourself it’s age or a training choice. Each change seems reasonable on its own. Together, they’re your body telling you something.

    5. You’re losing range of motion

    If stretching and mobility work stop helping, or a joint feels stuck no matter what you do, something structural may be going on that exercises can’t fix. 

    6. Other people notice before you do

    My friends and family finally had an intervention because I was walking differently. If someone who knows you says you’re limping, guarding, or moving strangely, don’t brush it off. They can see what you’ve gotten used to.

    What to do instead

    • See a sports medicine doctor, not just a therapist. Physical therapy is valuable, but if you aren’t improving, ask about a diagnosis and imaging.
    • Tell the whole story. Be honest about how long it’s been going on, how much medication you’re taking, and everything you’ve quietly given up.
    • Don’t wait for a breaking point. Getting answers earlier gives you more options.
    • Remember that a diagnosis isn’t an ending. My surgeon told me it was a new beginning. Knowing what’s wrong is what lets you get back to the sport you love.

    Toughness is one of an athlete’s best traits. But being tough isn’t the same as ignoring warnings, and the strongest thing you can do is get help.

    I’m a coach, not a doctor. This post shares my experience and is not medical advice. If something on this list sounds familiar, please talk to a qualified healthcare provider.

    Read the full story: The Smallest Space, Part 1: The Cost of the Pointy End

  • Training Now

    What is it like to train as a 58 year old woman?

    I have been in menopause just over a year. I take HRT and am experimenting with low dose Testosterone for a short block. HRT has been incredible at stopping my hot flashes which were occurring every 1-1.5 hours in my sleep. Testosterone is an attempt to help with joint and muscle pain. I haven’t felt much of a difference on it and may discontinue it in the New Year.

    My training now:

    • 90 to 120 minutes of aerobic training a day
    • 60′ of heavy strength training 3-4 days per week

    Typical week:

    • Monday: 90′ Zone 1-2 Cycling/60′ Heavy Upper body
    • Tuesday: 80′ run am/15′ SkiErg pm and either will contain some intensity
    • Wednesday: 90′ – 120′ Easy Run/60′ Heavy Upper body
    • Thursday: 80′ run/15′ SkiErg pm and either will contain some intensity/Heavy Lower Body with some mobility
    • Friday: 90′ Zone 1-2 Cycling/60′ Heavy Upper body
    • Saturday: Long run up to 120′
    • Sunday: 75′-90′ run/Optional afternoon cycling

    My running mileage is 35-50 miles a week depending upon the time of year. I walk 7-10K per day in addition to the steps I get running. Easy to do when your spouse loves to walk.

    My blood tests and blood pressure are excellent. My heart calcium scan was zero and my bone density is off the charts for a woman my age.

    I do take rest days as needed. Rest days happen with travel or if I notice my resting heart rate 5+bpm above normal. I do use HRV as part of the equation but only if there is a trend showing a decline.

    My nutrition includes a lot of protein (at least 100g per day) and almost no alcohol. I focus on eating veggies, fruits, meat and rice. There isn’t anything I will not eat but I tend to avoid anything fried.

    I prioritize sleep but am not obsessive. My sweet spot seems to be 7 hours with a natural wake up. I take a <45′ nap every day around lunch time.

    I was diagnosed a month ago with moderate to severe osteoarthritis and impingement in my hips. It may seem like I buried the lead but this hasn’t made a dramatic difference in my life. Pain is intermittent and low level. If the pain is noticeable, I may take a couple of Tylenol before a run. On days I don’t lift, I will take two Advil to help with sleep if I notice some muscle and joint pain. I am very careful with Advil and I don’t make it a habit.

    My surgeon who is an orthopedic hip preservation specialist was clear that without my training, I would be in a much worse position. I may need a hip replacement at some point but it is also possible that I may not. His advice was to keep doing what I am doing.

    And I am doing! I had a great time running a 13.1 mile race with my daughter in November. Winning may no longer be an option but my love of participation continues. And I plan on participating as long as I can.

    I am already making plans for what my life might look like if I can no longer run. More cycling, Pickleball, SkiErg, ElliptiGO and adding an ARC trainer to my home gym. Motion continues to be lotion.

    No Easy Way!

  • A 401(k) for Young Adults

    She who must be obeyed (aka KT) had her life changed by a colleague at her first Division I head coaching job. He directed KT (22 years old at the time) to sign up for maximum contributions to the University’s retirement plan. KT was smart and listened to her elder. This trivial amount, at the time, has ballooned into part of her terrific foundation for her retirement.

    This story inspired me to ask young people with new jobs three questions:

    1. Does your job provide you with a retirement plan?
    2. Are you contributing the maximum amount?
    3. What mutual funds have you chosen?

    Too many young adults contribute to their retirement plan without realizing they must also choose how the money is invested. If they don’t select any funds, the money can sit in the account earning almost nothing.

    Once they understand the compound interest they’re missing out on, I point them toward a low-cost Vanguard index fund.

    Like KT’s colleague, each of us can be a positive ripple in the future financial success of our children.

    *I have helped at least two young people who had no idea that they weren’t invested in anything!

  • Diary of the Treatment of a Calf Strain

    Since a few people have asked, I thought I would detail how I overcame my calf strain a few weeks before my A race (to end up winning my age group at Ironman Louisville). First and foremost, I STOPPED RUNNING when the strain happened during my last long run. I could have kept going but I decided the “walk of shame” was worth recovering in time for my big race.

    Immediately (please note, I am not a medical professional. I highly suggest you connect with your own physicians regarding your treatment plan):

    • Ibuprofen (800mg) around the clock for the first 48 hours
    • ART (Active Release Technique) within 24 hours for calf and posterior chain. Continued treatments Monday, Wednesday and Friday.
    • Ice cups (fill paper cups with water, freeze, and then rub over calf for fifteen minutes). Alternate ice and heat (hot tub) after 48 hours.
    • Stick for self massage (focus on whole calf, not just acute injury area)
    • Calf sleeve for compression
    • Wore my highest drop (heel height much higher than forefoot height) running shoes for walking and moving. This provided less stress on the calf and achilles.

    As soon as the acute pain was reduced, we (Coach, Physician and ART Chiropractor) slowly introduced a very limited amount of easy running on a treadmill with no incline. We also implemented a focused program on various exercises for my calf as well as everything two joints above my calf (hamstrings, hip flexors, glutes, knee, hip/lower back etc.).

    Here is the list of exercises. It looks overwhelming but really takes 20-30 minutes at most. I started each exercise with minimum time or reps. I executed daily and increased time and reps accordingly.

    • Monster walks for time
    • Side monster walks for time
    • Foam roll glutes
    • Foam roll hamstrings
    • Foam roll calves
    • Eccentric hamstring raises (up on a two count/down on a six count)
    • Clam shells
    • Single knee pull up while lying down on the floor
    • Hip flexor stretch
    • Piriformis stretch
    • Eccentric heel focused raises (up on two feet, down on one) on a step. Very gently!
    • Gentle angles ankle board stretches
    • Big toe pulls with band. Feet should be angled out.
    • Towel scrunches. With bare feet, pull a towel towards you by scrunching.
    • Alphabet. Write the alphabet with your feet while seated on a couch. Forwards and backwards.
    • Stick to massage hamstrings
    • Stick to massage calves

    We continued Ibuprofen only at bedtime for approximately a week. I had a therapeutic massage focusing on my back once per week and added a core program 3x per week.

    The good part about an injury is that it reminded me how lucky I am to be able to do the sport I love. I do not take this journey for granted.

    Reader Questions

    When your calf was strained, what did you do instead of running? Elliptical?
    No, I did not elliptical. After a few days we added very short, very easy runs on the treadmill. I would stop if there was any sharp pain. I was amazed how well I was able to run at Louisville despite the limited running before the race. Trust the process. Your run will be there on race day.

    How did you manage your bike workouts?
    Bike I would do as tolerated but avoided big gear or lots of climbing. I would make sure your cleats are new and properly positioned on your shoes. It can be very helpful to your calf and achilles to push the cleat as far towards your heel as possible.

    Did you just swim with a pull buoy all the time?
    With swimming, I either just swam or used the pull buoy. No kicking drills and no using that leg to push off the wall. Fortunately, I have a 50 meter outdoor pool near my house which reduces the number of flip turns.

  • The Power of the Loop: How a Small Team Built a Lasting Business

    Building a business is about building a community. When I started my business, my focus at first was only about building a community of customers. And it was easy. On the third day of business, we blew out the third year projections of my business plan.

    Success can destroy an unprepared business and owner. I was in trouble and I knew it. I didn’t have enough staff and I was young and untested. I had to learn through trial and error, to “win” I needed to create a team. In my previous post, “Coaching, Building a Team, and the Beauty of the Loop,” I outlined what it took to build a running team. Similar principles apply in business.

    The hardest part was finding my first follower. I made it harder because I was young enough that I hadn’t found myself yet. I kept trying to fit round pegs in square holes. Finding myself meant acknowledging the talents I lacked. As I did, I opened my eyes to the people that had those talents.

    Once I found that person, I needed her to find her first follower (or my second). And she did.

    I applied the rule of loops by keeping our “loop” small. I had too many people that wanted to join the team. Some in exchange for equity (don’t get me started on that red flag!). I said no a lot. And I did everything possible to keep our loop small even as I expanded our physical footprint.

    I kept the loop small by using technology. Everything, and I mean everything, went into Basecamp (a cloud based project manager). Anyone could add anything; contracts, after action reports, holiday notes. Creating institutional knowledge empowers the team to make the right choices. It also creates accountability and trust in the organization. We supported each other and our purpose.

    I also invested in our relationships long term. I worked with our COO for 25 years and was proud to sell the business to her. I kept vendors in place for 28 years. I used the business to make Bloomington a better community by making a difference.

    I am proud of what I created and even prouder that the values and team we created lives on. Team work does make the dream work.

    No easy way!

  • Coaching, Building a Team, and the Beauty of the Loop

    I run in circles. When I was competing in triathlon, I ran the half mile loop around our collegiate football stadium – sometimes for hours. When construction started, I moved my running to another half mile loop that had a bit more variety.

    I started to invite others to join me. I got my first follower, soon followed by my second follower. Today, fourteen people showed up despite it being 22 degrees with a windchill in the lower teens.

    The team is free and our participants vary. We have walkers to elite runners. People in their 20’s to people approaching retirement. Beginner to someone that qualified for the Olympic Marathon trials. I start our program at 6:10am but most of the team warms up earlier. We gather at the start and I attempt to impart some training wisdom and a bit of humor. After those nuggets, I present the training session. Each session is specific for different goals and abilities.

    This team has made me a better coach. A handful of the athletes pay me for individual coaching (discounted for local folks). I love having the opportunity to look each of these athletes in the eye before our training sessions. If any red flags pop up, I change their session.

    Believe it or not, high achievers in life and sport, will fake it until they make it. In person coaching allows me to see where they are on a given day.

    I am so grateful to coach in person. It is a privilege to share the joys, the struggles, the failures and the triumphs together. I get to experience years of athletes development rather than a season. And I love it.

    I *often* get my training done at the same time. The exceptions are key interval sessions when I know the observer effect makes a difference.

    One of the things that has been remarkable to me is that we have developed a very strong men’s team. They are Dads first. They love training together while forming lifetime friendships. They push each other during practice and support each other off of it.

    If you need some motivation and/or some people time consider starting a team. Pick a short half mile loop! I know it seems redundant but no one gets lost and everyone is supported regardless of their speed. Find something lit and safe for the women on the team. And be patient. Find your first follower. Then your second. In time you will have a community.

    No easy way!

  • Cancer

    Like most of us, cancer has touched my life in innumerable ways. Fear of it, treatment for it and death. I have been a caretaker, a supportive family member and the grieving.

    Cancer is the reminder that we all die. Sometimes well and often horribly. What amazes me in these many journeys are the physicians. They are very smart, kind and willing to serve you on the journey where you are. And with some prodding, on the journey you should consider to be on.

    I reflect on there doctors do they meet our mortality every day and do their damn jobs in the best way possible. And sometimes, the best way is to help a patient acknowledge the end. I have sat in those conversations multiple times, and it is the most intimate interaction one has with another person. A moment of humanity and finality. We should all be privileged to have those moments.

    I don’t know if I will get cancer and I don’t know that I won’t get cancer. I do know that I will die. Maybe well but probably horribly. I remind myself frequently that today may be my last day. And in doing so, I remind myself to make the most of it. No easy way.

  • Choosing Well

    I start every day with a win by completing a training session. I don’t win or lose based on how the session went. My success depends upon FOLLOWING THE PLAN – including a rest day if required.

    And the days I wake up feeling sub-optimal? I remind myself that I have an opportunity to be great today. I know if I still feel like crap after 10′, I can call it for the day. It never happens, but I know I have a choice.

    Choosing well is a muscle. Strengthening the choice muscle takes practice. And eventually the practice of choice will become a habit. Habits are much harder to break. Opportunities to practice choosing well are everywhere – your marriage, your work, your health, etc.

    Surround yourself with others that have proven that they have chosen well over and over. Choices and habits are contagious.

    No easy way.