Tuesday, August 7, 2012

Even the Best Laid Plans...............

It has been a long while since I last blogged about sports health issues.  I have spent the last several months performing my own "lab" experiment in training, preparing for, and competing in an Ironman Triathlon.  So, I am blogging this post-Ironman Texas race report and infusing my usual (and hopefully helpful) information of what I learned along the way.

Why Do It?
This is the question that is asked by all who don't.  Any one of the three events of an Ironman is a daunting task.  Many people would relish in specifically training for and completing a century bike ride or complete a marathon.  Who in their right mind would want to do both in the same day and throw in a 2.4 mile open water swim to start for good measure, being allowed a maximum of 17 hours to complete the event?  Surprisingly, more than you think.  There are 30+ WTC sanctioned Ironman races per year worldwide.  With an average of 2,000 people per race, there are nearly 60,000 people who attempt this feat yearly.  Elite level (genetically freakish) professional triathletes complete the race in around 8 hours, but the heart and soul of the sport is the average age-grouper who holds a full-time job and has a family that completes this that fascinated me.  I would watch it every year on TV and see video clips of the ends of these races and see these "average Joe's" accomplish this and say to myself "how is this possible?"  Admittedly, athletically, I am not an endurance athlete by nature.  I have always participated in events that were more anearobic in nature and excel in events that are more high intensity interval based in general (more later on how that affects your training).  However, having enjoyed improved health and fitness by participating in shorter and mid-distance triathlons over the past few years, I decided to embark on a journey of trying to discover exactly how it is possible that this ultra-endurance event was being completed by people like myself.  In essence, I decided to perform my own self-experiment in human exercise physiology, and approached the preparation for the event in this way.

Data, Data, and more Data
I am somewhat of a data geek on tracking issues involving sports health and performance, so I entered this project armed with a heart rate monitor/GPS device (tracking heart rate, pace, etc) for my running and a HR monitor coupled with a power meter on my bike for my training rides.  I downloaded all information into TrainingPeaks.com and was utilizing their performance tracking software.  I used this information only to track my progress and gauge the intensity and of the workouts.  Training for endurance events is more about pacing and maintaining manageable levels of intensity (unless you are one of the aforementioned genetically freakish individuals that can race at a high intensity for 8+ hours).  I thought is was particularly important to monitor my progress of fitness and body response to training to understand what levels of intensity I could work out at and keep my heart rate in a zone that would allow me to perform continuous exercise for 13+ hours. The data helped me to objectively track progress, but I avoided the dreaded "paralysis by analysis" of over-analyzing unnecessary information.

Obstacles Even Before Starting
What made this even more intriguing for me was to have several obstacles to try to overcome in preparation for this event.
1. A job that requires steady 60-80 hour work weeks.  Time management was going to be important.
2. Bone-on-bone arthritis/condition of the knee.  Two previous meniscus surgeries in one knee have left me with no cartilage on the medial side of the knee.  This was also going to be an experiment on utilizing many of the medical therapies that I use on our athletes to see how manageable this was going to be.  My orthopedic surgeon friends shook their heads when I told them what I was going to attempt.
3. Lack of heat acclimitization and opportunities to race.  Winters in Iowa relegate most people to cycling on an indoor trainer and running indoors for the winter months.  Spring weather is unpredictable and very windy in central Iowa. This was honestly my biggest known obstacle.  I am a very heavy sweater even in mild conditions and have had issues with electrolyte imbalances and maintaining proper hydration levels as I have gotten older.  My body has not typically responded well to sudden climate changes and exercise conditions. This was going to be a total crapshoot being that most of the training would be in Iowa and racing in Houston in mid-May could be pretty warm.
4. Never experienced exercising for an ultra-endurance event.  I had no gauge as to how my body was going to respond not only to the environment, but to being exposed to exercise for that long of a time frame.

Most people say that the toughest part of the Ironman is getting to the starting line and surviving all of the training.  I was armed with what I considered an above normal understanding of the above limitations and resources to monitor my progress, and I was convinced that I could come up with a plan to not only survive, but finish my first attempt at an Ironman.

The Preparation
The fall months were spent maintaining fitness in all three disciplines around a hectic college football schedule, but all-in-all, training went relatively well ranging from 7-10 hours per week of training.  Full-on Ironman training started in the end of December (while we were at the Pinstripe Bowl) and I utilized a combination of training programs from various "experts" who are highly published.  I constructed the program to meet and challenge my strengths, build my weaknesses, and timed to avoid injury problems (particularly controlling the amount of damage occuring to my arthritic left knee).  In the end, over 24 weeks of training, I completed 97% of my scheduled workouts and distances.  My swimming was the better than at any point in my nearly 4 years of triathlon.  Biking was certainly different, concentrating on longer rides with less intensity (more on that later), and running was manageable.  I had decided early on that for any runs that were going to be longer than 60 minutes, I was going to train with a popular method of running three minutes and walking 1 minute and did all endurance runs using that method.  I planned on using that method for the entire run of the marathon for as long as I could hold out.  I should mention that my longest competition run ever was 13.1 miles (done in a half-ironman in Kansas two years ago).  It's funny that most people who know me from high school and college would remember my accomplishments as a runner on the track, but running has become my nemesis as I have gotten older.  I admire people who run marathons, but you will never catch me signing up for one unless it is at the end of an Ironman. Typical training weeks were 8-14 hours with most of the endurance training being done on the weekends (too many 4+hour rides on the indoor trainer watching movies for my liking).  In the end, I had dialed in what power levels I could hold on the bike for 6+hour of riding, was comfortable with the pace I could hold on the run for 2 1/2 hours, and was very confident in my swim.  I had carefully monitored what my approximate fluid intake would need to be (measured how much fluids I was losing factoring in fluid intake on all long rides) along with nutritional needs to get to the marathon without "bonking".  The only knowledge I had of the race course was a podcast I listened to by the people from Endurance Nation who had ridden the course and described (in very accurate detail) where the specific challenges of the bike course loomed.  I had no "goal time" for this race.  My one and only goal was to finish, but based on training times, I had a realistic shot at anywhere from 12 1/2 - 13 1/2 hours to complete the event.

The Pre-Race
I drove to Houston from Ames four days prior to the event (thanks to my father for riding along), checked in two days ahead of time at the mandatory check in (highly organized and very friendly people), and attended the athletes banquet.  They say every person in an Ironman has a story, and this was an inspiring evening of speakers and Mike Reilly the voice of Ironman hosting.  The day prior to the race involved checking in the bike and transition bags.  I was able to meet current women's Ironman World Champion Chrissie Wellington (for a 2nd time) and listened to her speak about her new book "Life Without Limits" and had her sign a copy (I highly recommend this to athletes of both genders).  It was the second time for me meeting her, and I will say that professional athletes from all sports could learn something from her.  She is genuinely one of the most endearing people in sport.

Chrissie Wellington IM World Champion
Having stayed at my sister's house about 30 minutes from the starting line, we headed out early (4:30am) checked into transition, put last minute items into the special needs bag, and headed out for the .8 mile hike to the start of the swim.  Temperatures were about 75 degrees, and the water was warm enough that it was not wet-suit legal for participating for awards.  I obviously wasn't going to be in the running for any awards, but chose to participate without a wetsuit to attempt to stay cooler in the water (you get hotter than you think).  I didn't want to risk any more possibilities of dehydration than I needed to. 

I typically get a little nervous before most of my events, but I was strangely calm before the start of this one.  It was unbelievably inspiring to be out there with nearly 2,600 people.  I was anxious to get the day started to see what was going to happen.

The Swim
If you have never seen the start of an Ironman race, it is one of the coolest spectacles in sport.  Being in the mix, however, is even more of a spectacle. Starting a race in the water with 2,600 people at once is a little like trying to get out of a crowded pool if there was a shark attack.....it is chaos......and man, is it fun!   This was taken from the bridge seconds after the start of the swim at the race. The huge group out in the water are those swimming without wetsuits, those using wetsuits started 10 minutes later. The IM Texas swim is kind of strange with an approximate .8 mile swim out into the lake, .8 mile swim returning to near the start, then a .8 mile swim up a canal on the left side of the picture to get to the bike transition area.  The water was warm.  Knowing that I have had trouble with overheating in warm water races in the past two years, I opted to not wear a wetsuit, but did wear a recently purchase Blue Seventy speed suit that was AWESOME!  I started near the back of the pack giving myself a little room and trying to avoid congestion (I hate people swimming up on my legs).  Within the first 800 meters, I had worked my way up to the pack and at the turn to come back felt pretty good.  I was maintaining what I thought was a reasonable pace.  I did have a moment of panic when I looked at my watch at the turnaround and misread the time (I thought I was on pace to finish 30 minute slower that what I anticipated at that point in the race, but didn't panic and just moved on).  At the 1.6 mile mark, we hit the turn to swim up the canal, and by that point in the race, you are typically swimming with people your own speed, but I seemed to be passing quite a few people. The canal is approximately 20 yards wide, so it was destined to be congested with swimmers, and  I tried to swim up the canal (which had several small "s" type curves in it) on the left hand side taking what appeared to be the shortest route.  My hand started striking something that I assumed was another swimmer, but when I slowed up, found that I was actually hitting the bottom of the canal with my hand.  I stood up and was only waist deep in the water and could see other swimmers on the right making good progress.  I learned quickly to make any time in the water I needed to be in an area of the canal that had been dug out for tourist boats and moved over into a traffic line with other swimmers.  The canal swim was very strange.  Because of the huge number of swimmers making waves at once, the turbulence of the water was tremendous.  There were so many side-to-side waves in the canal, it seemed as if we were swimming upstream (which was virtually possible, since there was no current in the canal).  Regardless, I pulled in at the end of the swim only to be very surprised that I had misread my watch earlier, and had actually bettered what I thought would be a reasonable swim time for my first Ironman and got out of the water in a little over 1 hour and 10 minutes.  I was not overly tired, and was thrilled with the start of my day. I decided I didn't need to be in any great hurry to get through transition (I wasn't really competing for a Kona spot) and decided to walk to pick up my transition bag and insure that my heart rate was in a very manageable spot.  As I walked into the transition area, I noted that not many transition bags had been picked up in my age group and was thrilled to find out that I had finished in the top 20% of all swimmers and done very well in my age group.  I picked up my transition bag, put on my cycling shoes, socks, and jersey (opting for a light weight cycling jersey over my traditional tri-racing top to battle effects from long exposure to the sun and remain cooler), grabbed my nutrition, took in a healthy amount of sports drink, and picked up the bike.........time to get my ride on!

The Bike
I was forewarned on a podcast regarding the race that the bike, though it appeared fairly flat, would be challenging due to the last 56 miles of the course likely being into a headwind and a portion of it on chip-seal roads. Over the course of the winter, I had paid particular attention on my longer rides to my fluid loss rate and the average power I was able to maintain during all 4+ hour rides.  My plan was to stay within those limits for the entire ride regardless of the speed of other competitors.  I settled into a comfortable pace early within my limits and averaged over 20mph during the first 40 miles of the race.  Roads were great, and it was apparent that we were being pushed by a slight headwind. Despite my better than expected speed, I was being passed by a lot of competitors, but I was determined to stay in a range of power that I knew I could handle.  At around 40 miles, we entered the Sam Houston State Forest.  The ride was beautiful, but the roads (or dare I say single car asphalt trails) were not.  The temperatures were starting to rise, and there was no wind in the forest and the hills became challenging a few times.  As we exited the forest at around mile 52, we turned back into a now heavier headwind and entered about a 20+ mile stretch of the course where the roads were chip-seal asphalt.  I new the temperatures were starting to get up there, and should have known there were going to be problems when I saw the larger-than-expected number of competitors in the medical tent somewhere between mile 60-70. I witnessed more than one person veer off the road and crash due to disorientation from dehydration.  I believed I had a solid nutrition plan being very concerned with my natural loss of large amounts of sodium when I exercise, and drank a minimum of 24 oz of either water or sports drink every half-hour along with energy chews and about 500mg of sodium per hour. By my best calculations while on the bike I drank roughly 240 oz of fluids and took in about 1600 calories and over 4000mg of sodium over the course of the ride.  At about mile 90, I saw my awesome wife who drove out of town to catch up with me. It was terrific to see her out there, and just the push I needed after riding into the wind for so long.  At that point, I was hot and legs were getting fatigued, but still felt like I had controlled my effort pretty well.  That would all change 5 miles later.  With roughly 17 miles to go in the bike, I started to catch some minor cramps in my hamstrings which I was a little concerned with, but also figured was expected since we had ridden basically 50 miles into a headwind.  True to the podcast's predictions, the chip-seal roads had taken a toll on my legs and I finished the last 15 miles of the bike more fatigued than I would have liked.  Only after returning to Iowa and plugging my bike computer in and downloading data did I discover that the last three hours of the bike, we were riding into a wind with temperatures ranging from 100-104F.  No wonder I was tired?!  Additionally, the computer told me I had hit it exactly on the mark for what heart rate and power I could maintain for 112 miles of biking.  The last 10 miles of the bike were more about me being sick of riding than of overriding fatigue, and I was glad to return back to transition to get off the bike.  My sister, niece, nephew, and brother-in law were near the transition area.  As I passed my bike off to head for the tent to get my running gear, my sister yelled "Are you OK?"  Being tired from biking and hot, I felt pretty good, but after running about 10 yards I was concerned why she was asking and I turned back to ask her why.  She replied "because you don't look too good".  I should have known then that it was going to be a challenging rest of the day.

The Transition
After talking to my sister briefly while I was moving through transition to get my running gear, I started to get pretty dizzy and didn't feel well.  I had this happen on another occasion when I raced in temperatures over 100 degrees at the finish and ended up with an IV to recover.  So, needless to say, I was concerned.  Having not known exactly what the temperatures we were racing in, and considering I had tried to hydrate adequately throughout the bike, I was confused as to why I would be having these symptoms.  At this point, I was only about 7 1/2 hours into the race and knew I had 9 1/2 hours to complete the marathon, so I decided to stay in transition until I started to feel better.  I found a small area next to the changing tent in the shade, but was having a hard time cooling down and getting rid of my dizziness.  There was virtually no breeze in the area and even in the shade I was having a hard time recovering.  I normally am in transition about 3 minutes, but on this day, I camped out in there for about 45 minutes!  After several bottles of water and cooling down, I started to feel better and headed out for the running course.  Prior to leaving, I stopped by the medical tent and got a bottle of sports drink to try to replenish some calories and electrolytes, and was ready to take on the rest of what I knew would be a long run........

The Run
As I headed off on the run, I was planning on using my run 3 minutes, walk a minute strategy, but could only muster a 1 min run 1 min walk strategy due to some nagging cramping of the hamstrings.  The IM Texas run course is an approximate 8 1/2 mile loop that is done three times.  After walking/jogging (mostly walking) for the first 3-4 miles, I started to feel better and jogged until I started to have problems, then return to walking. This pattern continued for about the first 15 miles of the run.  Since the loop ran through the woodlands canal area, I was able to see my wife and other relatives who were in the area on the run course several times.  My wife had cut across the course and walked with me on a couple of occasions and she will never understand how important her support was at those points.  I was very frustrated with my inability to sustain a run, but kept in mind the ultimate goal was the finish line.  At about mile 15, I ran past a restaurant where another couple from Iowa who were there to do the race were (he had dropped out of the race due to heat earlier in the day) and I was encourage by them (they were both previous finishers and said I was looking great and only had one more lap to go).  I really appreciated them at that point and moved on.  At the end of the second loop I saw my wife and asked her to meet me at about mile 22 to do some walking.  It was getting close to sundown and it was starting to finally cool off.  I felt pretty good physically, but just felt exhausted and wanted to get through the last 8 miles. I still had about four hours to finish the race and felt it was well within my reach, I just needed to continue to be patient.  The run course gets a little "curvy" when it heads out of the Woodlands, and with it now getting dark and with fewer competitors out there racing, I ended up getting a little confused and frustrated on the trails in the trees.  At some point around mile 20, I decided I needed to take on more sports drink (I had only been drinking water and cola for the past 10 miles since my stomach was upset).  As I entered the aid station, I asked a volunteer if I could take an entire bottle of sports drink to carry instead of a small cup that is normally used.  The said "no problem" and I bent over the tub of ice where they were stored to get it.  As I stood up, I knew I was in trouble.  I became instantly dizzy and heart rate started to climb quickly (if you have ever stood up too quickly after lying down, think that x 10).  I walked to the end of the aid station and felt it would be best to stop and sit for minute until things normalized. Unfortunately they didn't.  In a strange set of circumstances in 90+ deg heat, I finally started to cool, but this time started cooling too much.  What started as shivering advanced in to full fledge shaking which I couldn't control.  Still having my senses, I was trying to determine if I was having a potassium problem or if I was suffering from further dehydration.  I was prepared to deal with the dehydration, but was also growing concerned that a legitimate potassium problem was potentially dangerous.  I still had over three hours to complete the last 6 miles and the medical personnel who had come by were leaving the decision of whether to continue to race up to me (they had learned what I do for a job and that made it pretty easy to communicate).  After sitting there for roughly 20 minutes and symptoms worsening (rather than improving), I looked at my arm where I had written three key things for the race.....(1) only worry about things I could control, (2) be patient, it is a long day, and (3) family is my inspiration.

I promised my family that I wouldn't do anything stupid to try to complete this race (I have been known to be pretty stubborn when it comes to finishing physical activities) and as I sat there contemplating the cause of my significant inability to control my body temperature and the constant shaking that was occurring and worsening, I decided that I should withdraw from the race and truly live to race another day.  It was painstakingly one of the most difficult and disappointing decisions I have ever had to make.  I had signed up for this race, made a well-thought out program to complete this test and was planning on it being my only Ironman.  The time sacrifices by both myself and my family over the course of the previous 10 months was pretty significant.  However, without knowing the cause of my problems, I didn't think it was worth the risk to continue.  Frustration and disappointment do not describe the moments following that decision.  There I sat, 6 miles from the finish (only about 2 miles as the crow flies), able to hear Mike Reilly announcing the names of the finishers, and had to give in.  I knew I was in need of medical attention.  The outstanding medical personnel at the race attended to me right where I sat.One of the medical volunteers was a combat medic and inserted an IV into my arm right then and there.

Going to Medical 
My biggest concern as I was being attended to was getting word to my wife and sister who would be waiting about two miles down the path for me to come through a final time.  It was dark and I hate to worry her.  She couldn't be reached on her cell phone (drained the battery doing race updates to all our friends and family), and I was worried that she would be worried.  Regardless, they put me on a makeshift cot and onto a medical Gator and transported me to the medical tent.  As I lay there crushed from disappointment I was simultaneously freezing from the open air wind in my sweaty clothes on the medical cart.  Once in the medical area, I was attended to by a highly organized group of medical personnel involved with the race (only I could appreciate that fact in this moment).  In the end, after having blood work done in the medical tent and after 3+ liters of IV did we discover that I had been dehydrated and suffering from a huge sodium deficiency.  Unbelievable, that I had taken nearly 4000 mg of sodium on the bike and used snacks with sodium on the run and still was out!  I knew that I was a heavy sweater and did need to monitor my electrolytes, but my gosh........sometimes the best laid plans don't even work.

The Conclusion
It has taken me awhile to put this together after thinking about this for most of the summer.  Coming up short has affected me more than I would like to admit.  However, in the end, Ironman is one of the most inspiring events you could ever attend or participate in.  Though incredibly disappointed that I had to pull out, I am still grateful for what I learned in the process of preparing for and participating in this race. I was able to raise money for the I Will Foundation during my quest for the finish line and enjoyed representing them during the race. As I've told others, the race is not necessarily about total fitness.  It is about knowing your limits, putting time into preparation, mentally preparing yourself for things that might go wrong over the course of a 12+hour race, and knowing the pacing you can handle. Even sitting in medical tent, I was inspired by others who I had raced beside throughout the day, whether they finished, or not.  The commitment of the individuals participating, and the volunteers working the race are unbelievable.  It is a test of preparation and will.  Ironman Texas was going to be my only Ironman.  But, for those that know me, I can never leave unfinished business.  I will give it a go again in July 2013 in Lake Placid, NY.......this time, hopefully it will be cooler!

Until then, I will get back to my regular blogging.....many exciting topics on tap for 2012-2013!

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