When Nathan Gafuik was diagnosed with Addison's disease at 15, his athletic career had been in a bewildering downward spiral. Despite gruelling training as one of Canada's top young gymnasts, he looked like an 11-year-old boy. He vomited during competitions, and came home to Calgary so exhausted he couldn't get out of bed. To curb extreme salt cravings, he devoured pickles sprinkled with salt. Midway through a prairie winter, he developed a mysterious tan.
The diagnosis clashed with his passion for gymnastics. Addison's disease is a complex medical condition that occurs when adrenal glands don't produce the daily cocktail of hormones that keep people alive. Significantly for Gafuik, his body wasn't producing cortisol, a life-sustaining steroid commonly known as "stress hormone," which helps to regulate blood-sugar levels. Cortisol also floods the body in response to injury, illness, stress and fear.
Gafuik had a major dilemma. If he wanted to continue in a daredevil sport where he routinely twisted and flipped through the air at break-neck heights and speeds, he would have to be on a hormone replacement regime that would not only sustain him but allow him to compete at his best.
There was no road map to follow. Addison's is so rare (about one in 100,000 people have it) that no other elite athletes could provide a model for treatment. Doctors weren't even sure if competing would be possible. Gafuik, with the help of his parents, coach and endocrinologists, forged blindly ahead. "There were definitely hiccups," Gafuik said.
Gafuik's gymnastics career got back on track. But with mounting success came the kind of stresses his body wasn't built to handle: time zone changes, gruelling training camps, and the biggest stressor of all: the Olympics.
In London, Gafuik will be the only Canadian competing in men's artistic gymnastics. It's a remarkable achievement: Unlike in 2004 and 2008 when Canada sent a seven-man team to the Olympics, the Canadians qualified for just one spot in London. Gafuik, at 5 foot 3 and 27 years old, earned a ticket to his third Games.
At his Calgary condo, he'll pack his bags with the usual staples: uniform, headphones, camera. But he's also taking along medications no other athlete needs to consider.
They include two categories of pills. The first is a daily steroid supplement to make up for his body's lack of aldosterone, a steroid that helps with salt absorption and regulating blood pressure. Without the pill, Gafuik can't retain salt or electrolytes – key for any athlete.
He'll also stuff his suitcase with food to keep his blood sugar on an even keel. For salt and electrolytes, that means nuts and Powerade; it also means protein bars and drinks such as Glucema which are formulated for diabetics who need things that are low in fat, and low on the glycemic index.
"Through trial and error" he's found that when he eats these things through out competitions, he's less likely to become sick, explained his mother, Jo-Ann Munn Gafuik, who's played a major role helping her son, the third of four children, manage his disease.
The second, more tricky medication are his cortisol supplements. For most people, cortisol rise and fall according to their circadian rhythm, increasing early in the morning, then tapering off at night. But they also flood the person in stressful events.
For Gafuik, the trick is to use his medication to replicate the way a healthy person's body would behave. The circadian rhythm aspect gets tricky when he crosses time zones.
But predicting stressful events is easier said than done.
At 16, Gafuik flipped into the air on the high bar, his best event, but his neck clipped the bar and he landed on his face. For most people, cortisol would have flooded the body to help with the shock. Without that, Gafuik's blood pressure was in danger of plummeting, sending him into a coma. He was rushed to hospital.
Two years later at a competition in Russia, the combination of general fatigue and a long flight triggered a terrifying and life-threatening event called an Addisonian crisis. He was eventually flown home, but not before a terrifying ordeal that involved Gafuik passing out in an emergency room, arguments with foreign doctors who didn't understand his condition and many calls to the Canadian embassy. "I think that was the worst night of my life," Munn Gafuik said.
Gafuik was 18 when he travelled to the Athens Games as an alternate for the men's Olympic gymnastics team. His routine involved taking cortisol in the morning and at night, doubling his dose on stressful competition days. The problem was that that could cause him to "spike" and feel jittery from the sudden boost.
In London, Gafuik will be using a routine that he nailed down for Beijing, where he placed 17th overall. A lot had to do with his endocrinologist, Stuart Ross, who began working with Gafuik a year before the 2008 Games.
There was something special about Ross, a former world-class distance runner from New Zealand. On a gut level, Ross understood the stress of competition.
"We spent probably more time talking about him, and …concepts of nervousness than we did about cortisol levels," Ross said.
"I shared with Nathan: I was petrified before a race. And he's a bit like that, too. The feeling is the same whether you're an amateur athlete, or a musician …
"For other people, cortisol is just pouring out to deal with that. So how do you deal with that for him?
Gafuik's case has a lot of moving targets, Ross said. "If you give too much [cortisol], the muscles get weaker. If you don't give enough, he wouldn't be able to cope. On top of that, Nathan, when he gets very nervous, he will become quite nauseated. All of these things were in play as we looked at the dosage of the steroids."
(Gafuik has received special exemption from the International Olympic Committee for his medications. Ross said they are not the type of steroids that could be considered performance enhancers.)
Before Beijing, they scrutinized his schedule and tried to anticipate when he would be feeling the most stressed. They mapped out flights, time zones, training days and the time of day he would be competing. With those in mind, they planned his cortisol doses. On competition days, they had him take a higher does, but spread the doses out over the day to keep him on an even keel.
Gafuik's mother remembers watching her son compete in China and recognizing that, finally, his disease was not standing in his way.
"I had never seen him compete as comfortably and with as much joy on his face," she recalled.
Twelve years after his diagnosis, managing his disease remains a daily chore. At times, it can be frustrating, exhausting, and confusing. There are still times when Gafuik wonders: Where does the disease end and he begin?
"It's hard to figure out what is just a characteristic of myself, and if it's my condition that is having issues. Or if normal people would feel the same way. It's hard," he said.
London will be his last Olympics. He has put off thinking much about life after competitive gymnastics. The added stress might prove too much. But in a way, the Addison's can also help, Gafuik said.
"I've had to deal with a lot in this career, not only being at the level I've competed at, but I've had to deal with a lot managing the Addison's. It made me a fighter, I guess. I'm not willing to give up on a lot of situations. I hope that I can carry that on into my next life."