Five days ago, the Canadian men's hockey team headed to the beaches of Puri to take a bit of a break after their second league match of the tournament. There was one part of the recess that midfielder John Smythe wasn't looking forward to. On the morning of the first day in Puri, the 29-year-old would roll his T-shirt up above his waist. He'd then pinch the skin around his abdomen, stick a thick needle into a thin layer of subcutaneous fat and squeeze out 40 milligrams of adalimumab, a powerful immunosuppressant. "It painful, oh yeah," he says. "I have to do it slow. Because when the injection goes in, that's the painful part."
The injection though is necessary to control Crohn's disease -- the chronic illness Smythe has to deal with every day. The gastrointestinal condition, which is reported to affect about one in every 500 in Canada, causes inflamed bowels, fatigue, weight loss, stomach cramps, diarrhoea and a host of other debilitating symptoms that can prevent those who suffer from it from having a functional lifestyle -- let alone competing at a hockey World Cup.
Smythe first knew something was wrong with his body when he was 17. He was an active field hockey player just like his elder brothers Iain (also a member of the senior team) and Geoff. He was talented enough to be a part of the developmental squad for the junior national team. So when he started suffering an unrelenting sickness, doctors thought it might just be a persistent infection of some sort.
The symptoms steadily worsened to the point that he was admitted to the emergency ward where after two-and-a-half weeks in which he says he lost half his blood and 30 pounds (about 14kg) of weight. Doctors finally thought they knew what was wrong -- it was either colitis or Crohn's disease.
After the usual medications failed to work, drastic measures were taken. "They finally decided to remove 90 per cent of my colon [large intestine]," he says. 'That was a major surgery but even after that I was still getting symptoms for three years. Eventually it turns out I had been diagnosed with colitis when I was actually suffering from Crohn's. Of course, that changed the dynamics of how we could treat it."
There were still tripwires. He took a drug -- Imuran -- only to realise he was part of the three per cent of the population that was allergic to it. "Lucky me," he jokes. "Because of that I got pancreatitis." Eventually though he settled on his current regimen of the adalimumab injections and predisnone steroids to manage his condition.
"I was in a life-or-death situation in 2007 and I was just in and out of hospital for three years and hockey was just never a part of the picture," he says. "I would never have thought I would be part of the national hockey team at that point. I was out of the junior cycle and I wasn't in the senior cycle moving out of the junior cycle." Once he got his illness under some control though he decided to head straight back to the field. "It was just the love of the game that brought me back. I couldn't have quit."
As he learned to manage his condition better, he was eventually able to force his way into the national team, making his debut in the senior team in 2013. Smythe is a regular member of the team now, although he can't train the way his teammates do. "It's not a very flattering illness," he says. "The big difference is that I have to use the washroom a lot more than they have to. And I also dehydrate very fast, so I have to constantly be taking in liquids." He also can't eat anything before training sessions in the morning. "If I eat something so early, I'm just going to be digesting it in the middle of training. So I don't have a lot of energy to go on."
Eating has to be carefully plotted out. It isn't just a matter of calories and protein intake for Smythe. "There's a lot of weight manipulation for me," he says. "I'm always flexing with my weight. There are days when I know I have to eat more and on others I know I won't be able to digest as much. You have to get your body down to a science. You have to know which medications affect your body how much and how much I can eat this day and how much you can have tomorrow."
Smythe also can't make any decisions on the fly. "When I go on tour, I need to take a lot of precautions," he says. "I always have a backup plan in case something goes wrong. In India, my digestive system takes a bit more of a beating so I need to make sure I always have the right medication with me."
Then there are also the side effects of the medications he has to take. The anti-inflammatory steroid prednisolone requires him to get a TUE (therapeutic use exemption) in order to compete, while the adalimumab can cause nausea, fatigue and weakness -- not the best situation to play a match in.
"I kind of manipulate one or two days here and there when I take it," he says. "If I know I have a big match like the one against the Netherlands [on Tuesday], I won't take it until after the match is done because I know I will likely have a rest day after that." That's why Smythe was particularly grateful for the five-day break his side had between its league games. "If a tournament has a game every two days, it's really hard to plan for the side effects on those days."
These aren't issues other athletes in his field have to deal with. Which is why Smythe keeps his direct messages open for youngsters who might have been diagnosed and need someone to talk to. "I want kids to know they aren't alone and that there is still a way to live your dreams despite a diagnosis," he says.
And that's what Smythe is doing. Canada's prequarter match against the Netherlands is likely to be an uphill battle but Smythe is grateful simply to be playing at all. "My disease has made me the man and the hockey player I am today," he says. "There was a point where I didn't think I would play at all and now I've got 80 and I'm about to play in a knockout match in the World Cup."