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Blood flow condition forces Kelly Benefit Strategies’ Ian MacGregor to retire from bike racing

After a year of struggling with the condition, the former U23 champ decides to go back to school

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Macgregor won the Mount Wachusett stage at the Fitchburg-Longsjo Classic in 2008. Photo: Kurt Jambretz

One face missing from U.S. racing this season has been that of Ian MacGregor, the former U23 national road champion and Kelly Benefit Strategies signee. While his new teammates have been on the road since February, MacGregor has been struggling at home with a medical issue that has forced his early retirement from bike racing.

After a year of tests, treatments and frustration, MacGregor was diagnosed with exterior and common iliac endofibrosis in November 2009. The conditions are essentially a kinking in the iliac arteries, which feed blood to the legs. In MacGregor’s case, the adjoining exterior and common arteries in his left leg were impaired, resulting in a significant loss of sustained power. After reviewing his options for months, MacGregor decided to retire in late May.

“Once I finally did get all of the information, I needed to sit on it and at that point in time I wasn’t riding at all and all through that time, Kelly Benefits was supportive,” said MacGregor, who notified team owner Charles Aaron and director Jonas Carney of his decision after the Amgen Tour of California. “For me and my own sanity I really have to say it’s over and I’m done with it.”

First indications

MacGregor rolled down the start ramp for the time trial at the 2009 SRAM Tour of the Gila like so many times before. But within 2km he knew something was wrong.

“In the time trial specifically I had within a couple kilometers complete — I say numbness, but that’s the way you explain it to your dad or people that don’t understand. To people that ride bicycles it feels like that lactic threshold ischemia burn,” said MacGregor. The Team Type 1 rider completed the entire 45-minute TT with his left leg basically dead. His right leg, however, was unaffected.

“The next day there was lingering effect, and now I know it’s because my left leg was doing a 45-minute anaerobic effort,” he said.

That was the first time MacGregor remembered feeling a differentiation between his right and left legs, but a look back at his training journals showed what may have been a building history of similar incidents. Over a handful of days – two in 2006 and four or five in 2007 and 2008 – he had reported feeling differently in his left leg than his right.

Two months after the Gila, MacGregor found himself on the front on a guttered crosswind day at the Tour de Beauce when he felt the familiar pangs for the first time on his road bike.

“At 200 watts, it felt like I was riding 350 watts in the left leg and the rest of my body was fine,” he said. That day was the beginning of a downhill slide. “From then on, not every day was bad, but anytime I spent substantial period in drops, I had problems in my left leg.”

After Beauce, MacGregor sought help for the issue for the first time. He talked with Allen Lim, a friend and former Slipstream physiologist.

“My initial reaction was, ‘Oh shit,’” Lim said of that first conversation. “It’s something I’ve seen in a lot of athletes before.” With Lim’s advice, MacGregor began a systematic exploration of his condition, beginning with chiropractic treatment and physical therapy.

One of Slipstream’s former chiropractors, who diagnosed a nerve problem, prescribed a regiment of supplements and exercises, and told MacGregor that he should be recovered in six weeks. That time — and the Cascade Classic — came and went, and his condition was worsening to the point of affecting MacGregor anytime he was seated for a 10-minute-plus sustained effort, whether on the tops, hoods or drops.

MacGregor saw his primary-care physician after Cascade and she diagnosed a nerve condition as well.

“She gave me a new set of ‘Do this, do that, it’ll get better,’ so I did this, did that, (Tour of) Utah came and it was still worse,” he said. “I found myself not necessarily getting dropped — I didn’t ride horribly — but struggling at power outputs and heart rate levels, specifically, that didn’t correlate with the results.”

Stage 1 at Utah began with a sustained climb up Ogden Canyon and MacGregor began to feel the burning within three minutes of the start.

“It was just this weird disproportionate thing,” he said.

When dry needle therapy in August failed to return results, MacGregor declined his roster spot at the Tour of Missouri. On his physician’s advice, he took eight weeks off the bike — even his cruiser. In the meantime, after discussing his condition with team management, MacGregor signed a 2010 contract with Kelly Benefit Strategies. He expected to be back to normal after the eight-week hiatus and some position changes.

“The first day I rode, I couldn’t even ride without noticing it,” said MacGregor. “It was an instant reminder and I kind of freaked out at that point.” He trained for three weeks into November, hoping the feeling would go away, but when he experienced problems every day, the former Beauce stage winner widened his net for advice.

That’s when MacGregor remembered a conversation he’d had with Team Type 1 boss Phil Southerland at Redlands in 2007. Southerland was complaining of unbalanced pain in one of his legs and MacGregor suggested that his boss had “iliac garden hose kinkasitis,” a condition that had sidelined his former teammate Stu Gillespie a few years earlier. When Southerland shared his experience with his soon-to-be former rider on the phone, it was clear to MacGregor that his hose was kinked.

The diagnosis

One of the tests for iliac endofibrosis, the Ankle Brachial Index, is basically an advanced blood pressure test. Because his symptoms only developed in a dynamic cycling position, MacGregor needed to mimic that situation in a laboratory. Lim and his physician found a physiologist in Denver that would allow MacGregor to bring a bike and trainer into the facility and Lim to run the exercise portion of the visit.

Riders with iliac endofibrosis

  • Derek Bouchard-Hall
  • Charles Dionne
  • Stuart Gillespie
  • Hayden Godfrey
  • Juan Carlos Guillamon
  • Chad Hartley
  • Mari Holden
  • Bobby Lea

“Essentially I did a lactic threshold test on the trainer, in the drops to aggravate the problem,” said MacGregor. “Allen did the program for that, until the left leg was good and burning, good and numb, and I jumped off and they checked my blood pressure in all my extremities.”

MacGregor in a 2010 team photo

Within hours MacGregor had the results he expected: His garden hose was kinked. “It was pretty clear from the blood pressure and Doppler tests that under load there was significantly less blood flow going to his left leg,” said Lim, whose testing protocol came largely from pro team doctors Prentice Steffen and Max Testa.

Lim had seen the same result years earlier when he put Gillespie through the ABI test. The promising espoir ended up leaving the sport as a result of his condition.

“We walked out of that hospital after the initial testing, the exercise stress test, and I think (Ian) knew that the writing was on the wall and that it was a bad issue,” said Lim. “We didn’t know what the blood flow issue was caused by, so the next step was to determine mechanism.”

Lim and MacGregor sat for a long time outside the downtown Denver facility where they completed the tests, discussing his future.

“One of the things I tried to impress upon Ian is that he is probably the smartest kid I’ve ever met in my time in professional cycling,” said Lim. “What I basically said to him is that ‘I know that you want to be a professional cyclist, a pro athlete. I also understand that you want to be the best in the world at what you do and you don’t want to half-ass anything.’

“What I essentially told him is that no matter what he decided to do, whether it be athletics or beyond, that he is lucky enough to have the brain as well the physiology to be the best in the world, that he is young enough right now, he’s close enough to finishing college, that if he went back today, he would be done in a year or two and he would be as successful if not more successful in whatever career that he chose to pursue and there are not a lot of people in cycling that have the options that Ian has.”

A series of angiograms and CAT scans soon revealed that MacGregor’s case was extreme. Most athletes suffering from IE see constriction in their exterior artery, but he had it in both the exterior and common iliac.

“They both were contributing to about 30 percent decrease in flow, which combined was giving the overall effect,” MacGregor said.

Baste chickens or retire?

The result meant that, at 26 years old, the once-promising climber would have to make the choice between a far-from-certain surgical repair and hanging up his chamois.

“For a cyclist that’s noticed problems, it’s a 50-50 chance at best and in my case, I had two spots that needed to be fixed,” MacGregor said. “You cross those two and the chances are pretty low.”He spent the winter taking engineering courses at the Colorado School of Mines and talking with vascular specialists and riders like Derek Bouchard-Hall and Gillespie about surgical options. Dr. Ken Cherry, who corrected iliac conditions for Bobby Lea and numerous other cyclists, was a sounding board for MacGregor.

Lim advised his friend to fully consider the ramifications of the surgical route.

“I’m definitely of the opinion that young guys like Ian should not get surgery if they don’t have to,” he said. Ryan Cox of Barloworld died in 2007, weeks after receiving the procedure in Europe.

Death wasn’t the only risk. The long-term ramifications of the surgery are not well known, but according to MacGregor, the potential risks include blood clotting and increased blockage, among others.

“To have kids, you need a syringe and a turkey baster and the chances of that were in the 15-20 percent range, which at the time, were right on par with my chance of success,” said MacGregor.

Spring came and went, with the wiry engineering student hopping into a handful of collegiate races. MacGregor admittedly struggled with the prospect of retirement, but in the end, the decision was easy.

“That to me wasn’t an option,” he said of the surgical risks. “Cycling is wonderful … but for me, I want to be able to go hiking when I’m 40 and run around with my kids in the future, and that kind of stuff, much more than I want to race for another six or seven years.

“If I don’t have surgery, my potential comes down drastically, from what it was to being an OK domestic guy, maybe winning a race or two. I wasn’t willing to be away from home, not be progressing in school, not be in Colorado in the summer, all those sacrifices that every cyclist makes at any level, so that I could be fighting for $20,000 contracts with no job security.”

MacGregor did pull a salary from KBS for a portion of 2010, which he earned in part by handling his teammates’ prize money distributions. But after the team finished the Tour of California, he picked up the phone to tell Aaron and Carney that he would not be walking down the surgery path — or riding professionally — anymore.

“It took some time and ultimately Ian came to his decision that he would retire from cycling. It was disappointing to the team because we felt that he was a great addition to the roster and he would really help us to step up in the mountains and in altitude races,” said Carney. “As disappointing as it was for the team to not have him, I’m sure it was a thousand times more disappointing for him to have to end his career.”

Moving on

Carney was right. As easy as the decision was to retire, the transition to life after racing has been equally challenging for MacGregor. The Golden, Colorado, resident has faced new emotions as he saw his fitness — and the 10-12 hours of sleep he used to get at night — diminish. And he said his wife could see the change.

Lim described the anger his friend showed throughout the spring.

“That’s the hardest thing for me, it has nothing to do necessarily with the injury, it’s just that adjustment that every cyclist who raced for more than a year or two, let alone 15, has to deal with at some point or another is that to walk away and the life adjustment,” he said. “And we see so many guys struggle with it. You can’t just do a pickup game and your shot’s not there.”

Since acknowledging to Carney that his career was done, MacGregor has seen a somewhat smoother road. One thing easing his transition is the work he has been doing with Lim.

“In that parking lot, I wanted to assure Ian that money was not going to be an issue,” said Lim of their conversation at Kaiser. “I told him that if he doesn’t want to do this (surgery), the next step would be to have a conversation about how he can make some money … what that morphed into was Ian taking care of a ton of different projects for me.”

Lim, who moved from his position at Slipstream this year to working with Team RadioShack, is a master of many trades and his new apprentice is responsible for everything from mixing the team’s sports drink on the paint shaker at a local hardware store to building literature reviews on aerodynamics and nutrition. When asked for a job title, Lim called MacGregor the MSH guy — the Make Shit Happen guy.

“It’s initially a bridge to get him through and out of school, but the thing about Ian is that he’s going to punch his own ticket,” said Lim.

MacGregor is even out on the mountain bike. “He can still pull out some whoop ass,” said Lim. And while he won’t be dishing up the pain on the world stage any longer, Lim expects MacGregor to keep pulling the whoop ass out as he pours his efforts into a master’s degree at School of Mines and his own exploration of all things cycling.