Pacific Northwest guidebook author Craig Romano takes PMR diagnosis in stride

The pain started in June 2020, a curious ache in a busy man’s right shoulder.

“I didn’t think too much about it,” says Craig Romano, the author of more than two dozen Pacific Northwest trail guides and a seemingly tireless hiker and runner who logs 20-mile days in the mountains as routinely as most of us take laps in supermarket produce sections.

“Due to the [coronavirus-caused] lockdown, I had been on the computer a lot, so I thought the pain was maybe due to overuse from typing,” Romano says. “I started going to physical therapy, and I felt some improvement. But it never really went away.”

Still, last summer Romano, 59 at the time, maintained a typically ambitious hiking and trail running schedule, covering 325 miles in August alone as part of his annual Hike-a-Thon fundraiser for the Washington Trails Association. He devoted much of last summer to gathering fresh data, mile by mile, for future book updates. The second edition of his “Backpacking Washington” guidebook was published this spring by Mountaineers Books.

“The pain was always there, but I could wear a pack,” says Romano. “I was still feeling good, but I couldn’t lift with my right arm. I was losing my range of motion as fall progressed. One morning in October, I couldn’t even turn my neck.

“I was moving slower by November. I had trouble bending over to put my socks on, and I couldn’t lift my arms up over my head. I couldn’t sleep on my side. It was excruciating.”

Romano has run more than 30 marathons, including the 1991 Boston Marathon, and multiple ultradistance races, such as the White River 50 Mile endurance run at Crystal Mountain (conquered on his 50th birthday). Coping with discomfort was nothing new to him.

Yet this was different. When your life’s work revolves around high-energy activity, what do you do when your body turns on you?

“It frightened me,” says Romano, who searched medical websites for clues. “I was actually afraid to start looking things up because I was terrified of what I might find. I thought, ‘Oh my God, this might be the end for me.’”

And then there’s his 6-year-old son.

“When I decided to be a dad late in life, I never thought my age was going to be a barrier to anything,” Romano says. “I planned to live an incredible life doing things with him.

“We play ball and kick and run. I’m 60 and I’m taking him on 12-mile hikes. He’ll be a teenager when I’m in my 70s, and I thought we were going to do all this great trail running and biking. But what if his father becomes debilitated? How horrible. That all went through my head. It hit me hard.” 

The last straw came when a 15-mile run with some running club friends proved too much. “Normally that’s easy, but I dropped out after a couple of miles,” he says. “I thought, ‘What the heck is going on here?’ That’s when I went to my doctor.”

Two weeks of antibiotics (to counter a possible infection) did nothing. But a prescribed anti-inflammatory corticosteroid called prednisone did.

“I took the pill that morning, and by the afternoon I was feeling better. After a couple of days, the pain was gone,” he says. “I headed down to the Columbia River Gorge a few days later for a four-day hiking trip, and I was running up hills again. After not being able to run or even sleep, I felt like I was born again.”

Romano, whose Rainier-sized calves bear evidence of the 40,000-plus trail miles his legs have covered, has a disorder known as polymyalgia rheumatica (PMR). “I just thought it was some muscle pain,” he says. “Nobody at first thinks some inflammatory autoimmune disease is creeping up on them.”

PMR is an inflammatory disease that causes pain and stiffness in the shoulders and upper back, or around the hips, per the Arthritis Foundation. It is a common ailment, with about 50 cases per 100,000 persons ages 50 and older annually.

Stress, from COVID-19 to political rancor to the death of his beloved cat, may have triggered the condition, Romano speculates. PMR has no cure, so taking medication (in gradually smaller doses) may be a long-haul necessity. For Romano, one of prednisone’s most concerning potential side effects is weight gain.

“To me, that’s one of the worst things that could happen, because I’ve been physically active my entire life,” he says. (He made his first of three coast-to-coast bike rides at age 18). “I’m more worried now about the medication than I am about the condition.”

Romano overhauled his diet, ditching processed foods, and has actually lost 11 pounds since starting the medication. “In past summers I’d have a shake after my long runs,” he says. “I just had one for the first time in six months. I had to cut a lot of stuff out.”

The health scare changed Romano on other levels, too.

“It was a revelation,” he says. “Once I took the medication and got my life back, I realized I’m not going to wait for anything anymore. Time is running out to do things at my peak physical performance. 

“I knew I’d be slowing down at some point in my life. I just didn’t think it would come so abruptly. The fact I can go out now and run 30 miles on a trail and feel great is liberating. It’s what I live for. To lose that, and then gain it back with medication, helps me realize every day is a blessing. Now I’m going to make things happen.”

One goal: commemorating his 60th birthday in May by returning to his home state of New Hampshire and, in the White Mountains (where he once spent a summer as a backcountry ranger), completing the demanding Presidential Traverse — 19.5 miles, 8,600 vertical feet, seven summits and two sub-summits. All in 14 hours.

“The family and I were going to hang out for three days at Cape Cod,” Romano says. “The more I thought about it, I thought, ‘That’s not me. I don’t do passive vacations.’ That’s when [Romano, his two brothers, his nephew and another friend] came up with the Presidential Traverse. That would be incredible. And because we got an amazing day of good spring weather, it was.”

In August, as part of his 2021 Hike-a-Thon campaign, Romano one-upped himself with a 41-mile, one-day run around Mount Hood on the Timberline Trail (with 10,000 cumulative vertical feet). He and friend Peter Clitherow left Timberline Lodge at 5 a.m., traveling counterclockwise. 

“When we started, I was thinking this would be like the Wonderland Trail, nice and maintained with bridges over all the creeks,” he says. “Then I found a big section of downed trees, and no bridges, and because it was 80 degrees, the crossings would be up to my waist. I thought, ‘What did I just agree to do?’”

Despite wading through three deep, fast-flowing creeks (a tough task for the 5-foot-7 Romano), the pair finished at twilight after 15 hours and 42 minutes. “Midway through I told Peter we were not going to finish in the dark,” he says.

Romano’s chief take-aways from all this: Stay positive (“I better realize a lot of people are dealing with emotional and physical suffering that others can’t see, and it’s forced me to cut people slack and not be as judgmental”); cherish your time (“This has made me so much more appreciative of really living for the moment”); and value your health.

“Because I’ve been active and healthy my whole life, that made a big difference when I got hit with something like this,” he says. “You can’t feel sorry for yourself or get angry because none of that is going to matter. You have to say, ‘OK, this is the reality. What can I do to live well?’

“If you’re young, be proactive. Don’t wait. You need to move. Overeating and being inactive is going to catch up with you one way or the other. There are so many factors in life that you can’t control,” Romano explains. “But what you eat, being active, being positive and getting good sleep; these are all things you can control. They make a huge difference for healthy living, whether you’re 20 or 70.”

The prolific guidebook author and hiker proclaims that “motion is lotion to the body,” and hopes that his story, and others like it, will inspire folks to get out and get moving, regardless of their age or condition.

“Through an online PMR forum, I connected with a guy in the U.K. who’s in his 70s with PMR, and he’s running 100-mile road races. That was inspiring to me. So I want to do the same thing for people.

“I didn’t ask for this, but I’m staying positive. I have no choice. It’s part of my journey.”