At Ironman, a doctor and patient team up to face a different sort of challenge 

Three months after Mike Cleek hurt his hip running, after physical therapy didn’t leave him feeling better and time didn’t ease the pain, he made an appointment with an orthopedist.

He had switched from running to biking, but that had only made the pain worse. There were times when his pain level could shoot up to an 8 or 9 just stepping off a curb. The orthopedist scrutinized the X-ray that his primary care physician had said looked fine. She ordered another X-ray, then an MRI.

When the MRI confirmed an unusual brightness on the left side of his pelvis, Cleek was referred to Jesse Roberts, MD, an orthopedic oncologist at Fred Hutch Cancer Center. 

“It was emotional and hard to walk into that building for the first time,” said Cleek, 40, who lives in Bothell. “I didn’t think it was cancer, but I wanted an assessment from the experts.”

Roberts, director of Sarcoma Multidisciplinary Clinics at Fred Hutch and the Musculoskeletal Oncology Fellowship at the UW School of Medicine, wasn't certain it was cancer either, but he was concerned enough to request a biopsy. When the MyChart result popped up in Cleek’s email, he couldn’t understand the technical terms. But his wife, a nurse, started crying. 

Within days, they found themselves in front of Roberts again, listening as he presented the options for Cleek’s diagnosis of chondrosarcoma, a bone cancer that develops in cells that produce cartilage: take a less complicated approach without reconstruction that would leave Cleek with a short leg and limp requiring use of an orthopedic shoe lift, or an internal hemipelvectomy including reconstruction, a procedure to remove Cleek’s hip joint and half his pelvis and replace it with a custom 3D-printed metal implant to restore greater mobility.

The location of Cleek’s tumor and his level of fitness made Roberts think hemipelvectomy surgery and reconstruction was a good option for Cleek.

Roberts explained both options matter-of-factly.

“When you rattle someone’s world with something like that,” said Roberts, “it’s important that they understand we have a plan.”

Ambitious approach taps 3D technology

For Cleek, the choice was clear. He told Roberts that he had run marathons and hoped to train for a triathlon one day. He chose the more complex and risky approach even though Roberts level-set with Cleek, telling him it was unlikely he could continue pursuing distance running.

Cleek thought of his daughters, ages 3, 5 and 7 at the time. “I thought that’s sad because when my kids grow up, if they run track, I would want to do training runs with them,” said Cleek, director of technology at a software development company.

To give himself a mental boost before surgery, he decided he would take on some sort of physical challenge. He didn’t know exactly what it would be. All he knew was that it had to be lofty enough to power him through his recovery.

“Obviously, I was quite naive about how brutal the post-op and recovery was going to be,” he said. “It was impossible to know, in the way that it’s impossible to know what marriage is like, even when people are telling you, until you are in it yourself.”

The goal of surgery is to remove exactly the right amount of bone to get rid of the tumor while leaving as much bone as possible to allow for successful reconstruction. Roberts worked with a surgical implant company that used Cleek’s CT and MRI scans to create a digital 3D model of his pelvis and design a titanium implant that would fit into Cleek’s pelvis as seamlessly as a puzzle piece, replacing the diseased bone.

Biomedical engineers at the company relied on that 3D model to generate custom nylon templates that were laid on top of Cleek’s pelvis, ensuring that Roberts’ cuts were impeccably precise. Much like an artist using a stencil, Roberts traced the outline of the template, executing his cuts by resting his saw blades against the borders of the cutting guides. Then he attached the implant to the remaining bone using multiple screws with precisely planned trajectories.

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The surgery took place in June 2025. Afterward, Cleek needed a nasogastric tube and had a painful ileus, an intestinal blockage that can occur after pelvic surgery. After a stay of more than two weeks, he was discharged but had to return after passing out at home. “It was rough for a few weeks,” he said.

On June 21, 2025, he finally left the hospital. 

From 0 to 55 hours of training

A month later, before he was even cleared to walk, Cleek started exercising with a paltry three minutes of stationary biking on July 26. It was all he could manage. He built up a little each day, and in October, once he was cleared to ditch his crutches, he walked unassisted for the first time.

In early December, he saw Sarah Niles, PA-C, who works with Roberts, and nervously asked if he could train for a race. 

After that visit, Cleek started running and dreaming big. He registered for the Ironman 70.3 Coeur d’Alene, which plunges participants into Lake Coeur d’Alene for a 1.2-mile swim in 68-degree water, followed by a 56-mile bike ride that gains 3,400 feet of elevation, capped off with a 13.1-mile run to the finish line.

At the end of January, he began swimming laps. Cleek had never done any distance swimming before surgery, and now he had to learn to open-water swim with a titanium implant that was three times heavier than his bone had been.

To keep himself motivated, he tracked his activity level. “I went from essentially 0 minutes of exercise in July to about 55 hours in May prepping for the race,” he said.

In April at his last checkup before heading to Coeur d’Alene, he told Niles about the upcoming race. “I was scared, so I debated whether to tell them,” he said. "I knew they hadn’t explicitly said don’t do it, but with a prosthetic, the more you pound on it, the quicker it will degrade."

Her response took him by surprise. “I think Dr. Roberts signed up for a half Ironman too,” she said.

Niles called Roberts into the room, and he and Cleek burst out laughing as they realized they had signed up for the same race. Roberts hadn’t been training enough and had been toying with the idea of pulling out. But hearing that his patient was determined to participate made him lock in.

“He said if I was going to do it, he had to do it,” recalled Cleek. "He had no excuse.” 

Success stories

At the same time, Roberts was conflicted about Cleek’s participation.

“This is not normal,” he said. “This is not our promise to patients. But especially with young people, we are treating their cancer so they can live their lives. This was a hugely important life milestone for Mike, but we also need to think about how to preserve the long-term viability of the implant.”

Roberts doesn’t tend to tell his patients certain activities are explicitly off limits. But if someone is intent on being a runner, he advises them to spend most of the time on an elliptical machine so it’s low impact. An Ironman is the opposite of low impact.

Roberts cautioned Cleek. “There is a limit to the impact this implant can take,” he said. “If this thing fails, we really don’t have good options depending on how it fails and what bone it takes with it, if it were to fracture or loosen and destroy adjacent bone.”

Cleek understood the risks, but he was determined. It was a mental challenge as much as it was physical, a testament that he had survived cancer. He was so committed to his training that he and Roberts joked that Cleek might have to drag Roberts across the finish line.

“My job does not make it easy to train for this event,” said Roberts, “but hearing how great he was doing preparing for this really motivated me.”

Days before the race, Roberts and Cleek had made plans to meet up to introduce their families. The night before the competition, Cleek told Roberts’ wife that part of the reason he had signed up for the Ironman was for Roberts “and every patient of his who will come after me because I want him to have better success stories than the ones he shared with me.” 

The day of the race dawned sunny and hot. It was June 21, exactly one year since Cleek had been wheeled out of the hospital.

The race was hard for Cleek. Making it through the lake’s choppy water was tough, but the run was even tougher.

“I knew running was going to be the most difficult part because I can’t run like I did before surgery,” he said. But he got a boost during the transitions from swim to bike and bike to run, when he caught a glimpse of Roberts. “He is a folk hero, a total celebrity in our house,” he said. “To see how he wanted to meet my family, how much he cares about us, was super special.”

As Cleek crossed the finish line, Roberts was waiting to congratulate him. The official Ironman photographer captured the two of them, arms around each other’s shoulders, smiling big.

“Mike had said he was going to break down, but I was the one fighting back the tears,” said Roberts. “As a cancer surgeon, I am always paranoid, mindfully prepared for anything that can go wrong. But when the plan goes well and everything works out to the absolute utmost, it’s pretty wonderful to sit back and see that.”