GREELEY — When Andrew Alirez felt a pop in his left knee, it sounded as if someone had snapped their fingers, like a wizard finishing a spell.
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It made sense. It was as if he’d been transformed.
On a mat, he was — as Ric Flair, the iconically macho wrestler (pro variety), was fond of saying — “The Man.” In high school, Alirez won a state title all four years and beat college All-Americans in regional tournaments. He had a realistic shot at the Olympics. But after coming back from an injury-ridden freshman year at the University of Northern Colorado in Greeley, he thought he’d gotten his mojo back, only to tear his knee.
He’d never taken off more than a couple weeks from wrestling. This injury would mean sitting on the sidelines for six months. He was no longer the man. In fact, he didn’t have any idea who he was anymore.
“I thought, well, I’ll never be healthy,” Alirez said. “I lost myself a bit. It gets pretty dark in there sometimes.”
Alirez knows now that he had never been humbled before and didn’t know how to react to the adversity. But he also knows now that for the first time in his life, he was depressed.
Depression is a common and understandable malaise after facing any kind of severe medical diagnosis, and yet, health care providers admit they didn’t really understand how prevalent and serious depression was during recovery until recently.
But hospitals now have experts on hand to help patients, and universities such as UNC and professional sports teams in the last few years have hired counselors to help athletes cope both physically and mentally with serious injuries.
The fact that it seems to hit a wide range of people, many of whom aren’t skilled athletes, means UCHealth and Banner both have a number of support groups filled with others going through similar conditions. There are support groups for breast cancer, bariatric surgery and brain tumors. There’s also behavioral health specialists integrated into most primary care clinics and hospitals. There are men with heart histories who talk to other men after their first cardiac arrest. There are support groups for those such as Alirez healing from a major injury.
Molly Brady, a UCHealth psychologist who sees a number of patients, said doctors have come to expect their patients will be a little down, or worse, during treatment.
“More often than not, that’s the case,” Brady said. “The big consideration is when you don’t want to be over-pathological. It makes sense to some extent that you’d be depressed. But we also don’t want to overlook it.”
Depression, after all, can delay recovery, sometimes by months. It slows healing, given that depression is linked to inflammation. Depression also discourages patients from doing what they’re supposed to do to get better: Recovery can be hard work, and if you’re not eating well, or sleeping, or doing the difficult exercises, well, you don’t recover.
Alirez, for instance, wondered why he bothered watching his diet, forgoing the temptations of life such as alcohol and working out so hard when he couldn’t wrestle as a reward.
“I wanted to just get through it,” he said, “instead of attack it.”
Life-changing events
There are many factors as to why any kind of medical condition, illness or injury can cause depression, Brady said, beyond the obvious reason that, well, it sucks.
Pain can alter dopamine levels, so patients don’t feel as well as they normally would, Brady said. This can make the pain seem even worse.
“Pain affects mood and mood affects pain,” she said. “A patient’s job is to cope with the pain. Pain is not a catastrophe.”
Medical trauma, or even surgeries that are elective, such as a hip replacement, can disrupt life, and that can also cause anxiety and therefore depression, Brady said. Money is usually an issue, both from bills and from the time off work. Parents may not be able to take care of their kids. Recovery can also mean spending all day indoors, isolated from friends, family and the sun.
I wanted to just get through it instead of attack it.
— Andrew Alirez, wrestler
Considering all these factors, it’s almost crazy that more patients’ lives don’t fall apart, Brady said, and it’s OK to remind patients of their fortitude even if they are depressed.
“It’s part of my job to destigmatize depression,” Brady said. “It doesn’t mean you are weak. We need to consider the depression part of your overall management.”
There are several different ways to help patients through their depression, Brady said, and they start with the basics. Patients should push themselves to get into a regular sleep schedule again, eat well and find outlets for their stress.
“These are basic health routines that can go by the wayside when you are worried,” she said, “but in reality, those routines are foundational to your recovery.”
Exercise is especially beneficial, Brady said, even for those who weren’t active before.
“It’s shocking to people in my field at the level it helps,” she said, “even when we knew it was beneficial.”
Finding support is also important, she said, and sometimes that can be more important than prescribing medications.
“Engaging in the community, maybe a job change, or finding purpose and meaning,” Brady said.
Physicians have learned to recognize the signs of depression, and this is why sometimes it’s Banner Health orthopedic surgeon Dr. Kelly Sanderford’s job to be a cheerleader. He will try to educate his patients on the time it takes to recover from a serious injury or joint replacement and refer those more severe depression to a counselor or their family physician. But he will also encourage them to keep working on getting better.
“It’s part of the job, I think,” Sanderford said. “The length of time of recovery is hard on people. You have to encourage them to just push on and get through it. We don’t get a lot of training to speak of that, and a lot of surgeons don’t want to get into that at all. I’m honestly not sure I’m good at it. But if I sense they need a little encouragement I’m all in on that.”
Hiring some help
When he’s not talking to student athletes at the University of Northern Colorado, sometimes Eddie Boyer will make his way down to the training room.
He’s fit, but getting buff isn’t a goal for these trips. He’s looking out for those who don’t seem themselves.
Many times, this can mean athletes recovering from an injury who are pouting, or going at half speed, or don’t even seem to care at all about doing the work to heal.
“You can see the ones who are doing well and the ones who aren’t,” said Boyer, the athletics mental health coordinator for UNC. “Other times coaches typically have a pretty good bead on who is down, and they will send them my way.”
Universities have beefed up their mental health staff across the country, and now that’s true in athletics as well. UNC hired Boyer a couple years ago to counsel athletes going through a tough time. That doesn’t always mean they’re injured. College athletes have as many or more doubts than the rest of us. But many times an injury is a big reason for visiting Boyer.
“Most of them have done sports for 20 years, so their identity is wrapped up in it,” Boyer said. “So they are questioning who they are at this point. It doesn’t have to be a year either. Just six weeks of being hurt can do it.”
Identity can be a huge thing for our well-being, Boyer said, and so even those who graduated from college 20 years ago, or are weekend warriors at best, can use sports to frame who they are as people. People call themselves “runners” or “mountaineers” or “ballers.” When that’s taken away from them, a literal identity crisis can occur. Boyer can relate: He once broke his leg, eventually endinghis own promising athletic career as a pole valuter.
“That changed the trajectory of who I am,” he said.
Not all athletes will see Boyer even if their coaches recommend it, and he can’t force them to come. All he can do is do the job well.
“It’s my job to give them hope,” Boyer said. “When people see hope, it changes their ability to recover.”
When he does, sometimes other athletes will vouch for him.
“I’ve had teammates convince others to come see me,” Boyer said. “When it’s working well, it feeds itself.”
Boyer arrived at UNC just a year ago, too late to help Alirez through his crisis, but Boyer loves talking about him now.
Alirez returned and wrestled his junior year, and he admits today that he didn’t do enough work to get ready.
He struggled through knee pain and doubts. But in the months before his senior year, he came to a realization: He wanted to try his best just to say he did. He worked hard, watched his diet again and, by the start of his senior year, he felt a bounce again.
“I was afraid my junior year, I’ll use that word,” Alirez said. “But my senior year, I was able to get after it.”
That senior year, two years after he tore his knee, he won an 2023 NCAA title in his weight class. He was UNC’s first wrestler in the modern era to win a national title.
“It’s not like I became a way better wrestler,” he said. “It was mindset.”
Once again, he’s thinking about the Olympics: The trials are in April. He’s now learned how to embrace the mental aspect of wrestling, not just the physical part. He talks to himself regularly, filling a once-cynical head with positive mantras that fuel his workouts.
“All those corny sayings you are used to hearing,” Alirez said. “They’re all true.”