Iron Man John Dermengian

2.4 miles in the water, 112 on the bike, and 26.2 pounding the pavement. And some might say, for John Dermengian, that was just the victory lap.

As John Dermengian crossed the finish line of his first Ironman race in 2003, after 16 hours, 26 minutes, and two seconds of intense effort, he patted his side and thought "good job." Something of an understatement, no doubt. Sure, the crowd wasn't what it was a few hours earlier, the cheers not as frenzied, but why would a man with such boundless energy and exuberance celebrate such an amazing accomplishment in such a way? It really only makes sense when you know just how far he traveled to get there.

Yes, it was 2.4 miles in the water, 112 miles on the bike, and 26.2 on the pavement. But John's Ironman, the journey on which he proved that anything is possible, began a few years earlier -- and there was nobody cheering.

In January of 1999, John began to experience some of the hallmark symptoms of inflammatory bowel disease. He noticed spots of blood in his stool, and was suffering regularly from abdominal cramping. A couple of weeks passed, John's internist said it "could be several things -- most likely an intestinal infection," and put him on Cipro for one week. During that week his bleeding increased, he experienced dramatic tiredness, and was referred to a gastroenterologist (GI). John's subsequent colonoscopy revealed inflamation "everywhere," suggesting a more serious problem. With the results of his biopsy came a diagnosis of ulcerative colitis.

Moving from the onset of symptoms to a diagnosis in just over a month is not a story that will elicit a ton of sympathy from many IBD patients. Recent surveys have shown that most IBD patients wait 38 months and see an average of five physicians before receiving an accurate diagnosis. But, for the moment, John was lucky.

Is this serious?

Like most IBD patients, John didn't immediately "own" his disease. He listened to what the doctors were telling him, and took his pills per their instruction -- but John was looking to get past this. Despite adhering to that initial regimen, he quickly found himself in the hospital being fed through a tube. John could tell by his GI's face that things weren't going well. "Is this serious, or just something I have to live with," John remembers asking. The silence that followed was more revealing than John could possibly know.

Not long after, John got a call from his GI's office telling him to come pick up his file. John learned that his doctor had given up his practice and was being treated for stress-related anxiety, because several of his patients weren't doing well. Not exactly what a new chronic disease patient wants to hear.

Newly diagnosed and now set adrift, John quickly sought treatment elsewhere. And, worried as he was about his new chronic condition, he was also carrying with him a ticking time bomb that he knew little about. A few years prior, John's mom had battled colon cancer, as had her father. John's dad also had polyps, and some GI-related issues in his lineage. "I was on a collision course with my family history," John says.

His fears about his UC cresting, John met with a colonic oncologist at Stanford, and was put on an aggressive drug regime. Weeks and months passed, but John's tests never looked any better. Soon his case became refractory, meaning it no longer showed any response whatsoever to the drugs. His colitis spread from his left side throughout his entire colon and another test revealed displasia all the way through the wall of the colon.

The Only Thing to Do

"The only thing to do was remove everything," John said. And in June 2000, a surgeon removed John's entire colon, rectum and anus leaving him with a permanent end-ileostomy and an external prosthesis to collect bodily waste. In that one dramatic action, a painful existence of frequent bloody stools, weight loss, fatigue, abdominal cramping, and inability to eat ended for John.

The following February, John and his wife moved to Hawaii and began to build a relatively normal life. Living in the host city, John volunteered at the 2001 Ironman triathlon championships later that year. After the race, a friend handed John the flag -- a symbolic gesture in Ironman culture. "You should think about doing this," the friend said. John, who used to run to keep himself in shape, started to toy with the idea. He bought running shoes and took a two-mile run along beautiful Alii Drive, which stretches along the water and comprises, coincidentally, the first ten miles of the running portion of the Kona Ironman. Little by little, John's runs got longer.

At six miles he had a setback. "Stress fracture," a doctor said. "Probably a byproduct of the Prednisone." Prednisone, for the uninitiated, is a steroid many Crohn's and colitis patients must use to get their disease into remission. Its side effects include osteoporosis, high blood pressure, insomnia, acne, psychosis, and a swelling or filling out of the face.

John realized that if he was really going to do this, he needed a well-devised plan. Luckily, this doctor was an 18-time Ironman finisher and knew a few things about training. He helped John to develop his plan, and soon John was working out regularly in a gym with a trainer.

His first goal was ambitious -- he wanted to do the Lavaman, an Olympic distance triathlon (1.5 km swim, 40 km bike, 10 km run). He only wanted to complete the race under his own power, but doing that was more than even those closest to John, those most familiar with his impressive drive, could reasonably expect.

But, sure enough, after three grueling hours and 40 torturous minutes, John crossed the finish line of the Lavaman to the joy and tears of his wife and his enteral stoma nurse. The rest of the crowd was quiet, unaware of the magnitude of this achievement for a man who had been so desperately sick. But in John, a fire had been lit, and he knew it wouldn't be long before he'd be crossing his next finish line.

The Running Man

Since that 2002 Lavaman, John has completed over 100 races including biathlons, marathons, half-marathons, 10K runs, cycle time trials, open-ocean rough water swims, and triathlons from sprint to full Ironman distance. "Simply put," John says, "the sport of triathlon has given me the journey to regain my life."

Along the way John has met and overcome many challenges not faced by other typical triathletes. When competing, John needs to fuel up more than other competitors -- "Food goes through me in 20 minutes" --  but he can't take in any solids -- "I can't have output into the pouch during a race." He needs to drink tons of fluids during races for the same reason. His ostomy also makes it more challenging to get into a low, aerodynamic position on his bike. He also faces another challenge that might not occur to even another ostomate -- his lack of a colon makes him considerably less buoyant than your average triathlete, meaning he has to work much harder during the swim.

But these are not problems to John, they're just challenges. And there's nothing John likes better than a challenge. He's perfected a method of waterproof taping that protects the integrity of his ostomy while competing. This is an absolute must, as you can imagine what the digestive enzymes able to break down a steak dinner can do to the tender skin of your abdomen. He even must be more careful with his breathing, as any extra air he takes in by mouth during the swim will end up in his pouch. "I had to stop seven times to let out air during the 112-mile (Ironman) ride," John recalls.

Unexpectedly, a second surgery was needed in September 2005 to remove a portion of remaining small intestine due to a narrowing passage and blockage. This meant John had new ostomy and had to come up with new solutions to fit. But by now you can probably guess how John dealt with that -- head on and full speed ahead. "It just added challenges in my training and gave me an even stronger will to set a new Ironman goal," John says.

Triumphant Return

This past October, John -- with his new ostomy, his new challenges, and his new solutions -- competed in Kona again. But this time it was for us, and for you. As the sponsored competitor of the Crohn's & Colitis Foundation of America, John raced to raise awareness of these devastating diseases and to show that anything is possible.

Since his diagnosis of ulcerative colitis, John has lived his life by three principles, shaped in no small part by his Ironman experience:

1. Anything is possible
2. Opportunity comes from adversity
3. Decisions for change and success are ultimately your own responsibility

In addition to competing, John shares these principles with other Crohn's and colitis patients, and other ostomates, at every opportunity. He knows not every person is going to complete the Ironman. But he also knows that there's an Ironman waiting inside each and every one of us.

Maybe your Ironman is getting a part-time job. Maybe it's taking your kid to a ballgame. Maybe your Ironman is just facing a family history of Crohn's, colitis, and/or colon cancer and taking the necessary steps to try to get ahead of it. Whatever it is, your Ironman is a goal that will take careful planning, passion, and determination to achieve. And, chances are, it will open a whole new world to you. It did for John.

It's important to note that the last five years of John's life have not simply been a string of huge victories. There have been races John hasn't finished and training sessions he just couldn't face. But setbacks are a necessary part of worthwhile achievement and building to a goal is the only way to get there. Even having achieved his goal of completing the Kona Ironman race once before, John still had to start again -- making a new plan, addressing new challenges, suffering new struggles, training harder than he had ever before -- and find the motivation to see it through. John will tell you, "Life is like that."

Having finished his second Ironman race, in a grueling 16 hours of constant motion, John is working to inspire other people like him. He's been a keynote speaker for the American Cancer Society, the United Ostomy Association (now the United Ostomy Associations of America), and for the Crohn's & Colitis Foundation of America. You can find articles by him and about him all over the internet. He also serves as a training coach for Get Your Guts in Gear, a 210-mile bike ride for awareness supported by CCFA.

He's doing a tremendous amount to raise awareness of Crohn's and colitis, and an equally tremendous amount to inspire those who suffer from them. He's using his intelligence, passion, and determination to cross more lines and push more boundaries. And, though there are plenty of us cheering now, he's nowhere near finished yet.

Date Posted: December 1, 2006