Matthew “Matt” Q. Miller, MD, should have died on the Blue Ridge Parkway along the Blue Ridge Mountains in Charlottesville, Va. Instead, the Ironman triathlete, otolaryngologist, husband, and father of two is about to become an assistant professor in otolaryngology–head and neck surgery at the University of North Carolina, Chapel Hill this July.
He has come a long way—symbolically, if not geographically—since then.
In 2008, Dr. Miller, then 20 and a college junior, along with two friends from the University of Virginia’s triathlon club, were on an 85-mile bike ride. Dr. Miller lost control of his bike and collided head on with a car traveling 40 miles per hour in the opposite direction. The accident knocked him into the air, and he fell to the pavement, sustaining a traumatic brain injury and panfacial fractures.
Thankfully, an anesthesiologist was in the car behind the one Miller hit; that physician was able to revive Dr. Miller’s breathing and keep him alive until a medical helicopter transported him to the University of Virginia Medical Center. There, Dr. Miller faced a long and, at times, unknown recovery, with the left side of his face completely paralyzed for months. “After the accident, I was told the police shut down the road to perform an investigation in case I became a fatality,” he said.
Ultimately, Dr. Miller recovered. Nearly two years, to the day, after he left the hospital, he trained for, competed in, and finished the Cozumel Ironman triathlon competition in Mexico in 2010 during Thanksgiving break of his first year in medical school at the University of Pennsylvania. The former high school and college swimmer spent 10 to 15 hours a week for six months training to prepare for the 2.4-mile swim, 112-mile bike ride, and 26.2-mile run, wearing a sweatshirt as he ran on a treadmill to get his body used to competing in a warm climate. Ultimately, he finished the race in 10 hours and 30 minutes.
“I had made an unofficial goal for myself to complete an Ironman as a symbol of my recovery,” he said. That day, he said, his main goal was to “race smart and finish the race. I was very happy with my time and performance,” he said.
The mental discipline has helped make me more productive, because to put in the time requirement to train, I have to schedule my day out to the minute. It has helped me become more productive in my academic and clinical roles. —Jim Daniero, MD
For Dr. Miller, now 33, and Jim Daniero, MD, a distance trail runner who competes in ultramarathons—generally 50 kilometers (about 31 miles) and 50 miles—and is also an associate professor in otolaryngology–head and neck surgery at the University of Virginia, such athletic training helps each establish priorities and set both personal and professional goals. “The mental discipline has helped make me more productive, because to put in the time requirement to train, I have to schedule my day out to the minute,” said Dr. Daniero, 42. “It has helped me become more productive in my academic and clinical roles. It would seem like there’s not enough time in the day, but you can manufacture time.”
While Dr. Miller had already decided to pursue medicine before his bike accident, his healing experience helped him to choose otolaryngology–head and neck surgery as his specialty.
His recovery lasted almost two years, and he had complete left-sided facial paralysis for several months. “During my recovery, I experienced firsthand how facial paralysis takes away our ability to express ourselves and our ability to communicate effectively. People often ignore what patients with facial paralysis are saying because they’re left wondering why they cannot make normal facial expressions; it can leave patients depressed and socially isolated. This experience has really motivated me to take care of facial paralysis patients to help restore facial form and function.”
Dr. Miller appreciates how much a skilled facial plastic surgeon can do for patients. “You really have to strive for perfection in facial plastic and reconstructive surgery,” he said. “All the details matter. People are looking at faces all day long—except when we’re wearing masks.”
Dr. Daniero learned about otolaryngology while attending Eastern Virginia Medical School in Norfolk, Va., following a healthcare policy position with the Institute of Medicine and completion of a biotechnology master’s degree at Georgetown University, both in Washington, D.C. The complexity of the head and neck region proved fascinating, in particular the voice box.
Preparing for the Cozumel Ironman was a great journey, as you have to dedicate a minimum of 10 to 15 hours a week training, including two-and-a-half-hour runs and five-hour bike rides. You have to embrace the journey and not just the outcome. —Matthew Q. Miller, MD
“There are various functions of a complex biomechanical nature that we take for granted,” Dr. Daniero said. “It sits inside the throat and lets us talk, allows us to sing, ingest food, play an instrument, and plays an essential role in the need for central breathing,” he said. While he is a classically trained pianist and neither plays a wind instrument nor vocalizes, “I respect the talents of others and I’m happy to be able to help them tune and repair their vocal instrument.”
Athletic Training and Medical Professionalism
Dr. Daniero had been a casual runner and was never a high school varsity athlete. Nonetheless, in his late 30s, he chose to transition from competing in sprint triathlons (with a half-mile swim, a 12-mile bike ride, and a 3.1-mile run) and half marathons (about 13 miles) to focus on longer races. The scientific possibility of what the body could do appealed to him.
“It’s more of a mind game: the discipline of training, and knowing the nutritional science and the scientific approach of trying to push the limits of human endurance, that really resonated with me,” he said. “It requires certain commitments and understanding of how to run that far and how to recover from it. Some of the training seems counterintuitive, such as not necessarily going all out when leading up to a long race to avoid injury on race day, making sure not to overtrain, and knowing how to go back to a healthy base from where you can extend into another race or training session during the year,” he said. “That really captured me.”
Dr. Daniero, who is chair-elect of the American Academy of Otolaryngology–Head and Neck Surgery’s Voice Committee and chair of the American Laryngological Association Post-Graduate Member Steering Committee, will think through work issues while out on his long runs, which he frequently does on familiar trails with a GPS watch and a headlamp to see at night or in the pre-dawn morning. He has especially appreciated being able to run solo outside in the woods without a mask during the COVID-19 pandemic. “I’ve found that a lot of my ‘aha!’ moments, both in research and on the clinical side, come when I’m doing long runs—just me in my own head for two hours,” he said.
Dr. Miller believes that engaging in team sports—he played baseball, swam in high school, and was a swim team captain for two years—helped make him into a better doctor. “When you function as a team, you need to learn how to work with others—when to take control and when to step back,” he said. “In medicine today, the same principles apply: You’re always functioning as part of a group, each person with his or her own expertise. When managing a complex head and neck patient requiring facial nerve reconstruction, you need to work alongside the cancer surgeon, oncologist, radiation oncologist, and so many others to provide the patient with the best possible outcome. At the end of the day, that’s what matters.”
Family Support and Dream Races
Although Dr. Miller and Dr. Daniero compete as individual athletes, they both cite their family’s support, which enables them to spend many hours training for the events they love. Dr. Miller is married to his high school girlfriend, Emily Privette, MD, a dermatologist at the Beth Israel Deaconess Medical Center in Boston, and they have two children: Anderson, age 3, and Clifford, age 5 months. The family has lived in the Boston area since 2019, when Dr. Miller began a fellowship in facial plastic and reconstructive surgery at Massachusetts Eye and Ear; they will relocate to North Carolina this July.
Dr. Miller calls the training he did in preparation for the Cozumel Ironman “a great journey, as you have to dedicate a minimum of 10 to 15 hours a week training, including two-and-a-half-hour runs and five-hour bike rides. You have to embrace the journey and not just the outcome.” He said that while he wants to compete in another Ironman in the future, right now he is focused on his family and work.
Dr. Miller, an undergraduate history major at the University of Pennsylvania, said he respects the storied history of the Kona Ironman, the first Ironman race that took place in Hawaii, starting in 1978. “Just qualifying for that race is quite the accomplishment,” he said. He had also hoped to run the Boston Marathon, the nation’s oldest marathon event, while living in Massachusetts, but the 2020 and 2021 live races were cancelled due to the COVID-19 pandemic.
Dr. Daniero is married to Amanda Daniero, a former special education teacher. Together they parent Sophia, age 14, Lucas, age 13, and Aubrey, age 8, and live in Charlottesville. “I wouldn’t be able to do what I do without my family’s support,” he said “They realize how much endurance running supports me and allows me to be a better husband and father. Just as my running has made me more focused on what I do for work, it has been the same for my focus on my relationships.”
His dream event is the Wasatch 100-mile run, held in Utah each year, or an Ironman triathlon. “What would sway me is if I start to have knee injuries,” he said. He has signed up for a 50-kilometer (31.2-mile) race this spring (the Grayson Highlands in Wilson, Va.) and a 50-mile race (the JFK 50 Mile in Boonsboro, Md.) for November. If his knees feel good, he said, he plans to sign up for the Wasatch 100 race in 2022.
Being aware of physical limits is something that concerns Dr. Miller too. “I ride in a full-face helmet, because I think my reconstructive surgeon would be quite upset with me if I ruined his work,” he said. “There’s a lot of hardware in my face, and I had two years of dental work as part of my facial reconstruction. All of my teeth are implants and crowns—I almost literally have a million-dollar smile.”
Cheryl Alkon is a freelance medical writer based in Massachusetts.