Race Report: Cayuga Trails 50

All smiles.
all photos: Joe and Elizabeth Azze

I’ve been having a difficult time starting this recap, both because I'm a little ambivalent about my performance--I'll get to that in a minute--and because I feel like I don’t have anything new to say about this race.  This was my fourth time running the CayugaTrails 50 mile in the race's five-year existence, and I’ve written extensively in thepast about my previous experiences.  It’s a race I keep coming back to year after year, despite the fact that I struggle with the course and I never seem to run it particularly well.  I keep returning because the race is in Ithaca, one of my favorite places; because the course is as beautiful as it is challenging; because as the 50-mile national championships, it’s a great opportunity to run against some really top-flight competition not far from home; because Ian continues to put on amazing events that put the athletes first; and because my MPF/RNR teammates annually put on a show of force that I always want to be a part of.  But my experience with this race has always been a mixture of positives and negatives, and this year was certainly no exception.

Last year I had an ideal buildup for this race ultimately foiled by another bout with Lyme disease, and this time around unfolded much the same.  After Rocky Raccoon it took a bit longer than I anticipated to start feeling back to normal; I didn’t really get into a good flow until early April.  But several strong hill workouts and two solid wins in low-key tuneup races (the XTERRA Northeast 50K at Wawayanda State Park in early May, and the New Paltz Pizza Challenge six days later) had me feeling pretty confident as taper time drew near.  Sixteen days out, I was forced to cut short a low-key track workout (three sets of 800m/400m repeats) with extreme fatigue, upper-body achiness, and dizziness.  I was immediately reminded of last year but tried to convince myself it was heat-related; temps were in the mid-90s, and I thought I might be dehydrated.  But when I had similar symptoms six days later, barely able to gut out 4 x 800m at 2:55 pace (which should have felt barely harder than a jog, given my fitness level) despite reasonably mild temps, I knew the Lyme was back.

At that point, eleven days from race day, my instinct was to pull the plug.  After dropping halfway through last year's race while on antibiotics I had no desire to repeat the experience. That night, however, I spoke with a buddy from med school who specializes in infectious disease, who thought my symptoms and previous lab results pointed more towards anaplasmosis (a Lyme-related, tick-born infection) rather than Lyme. If that was the case, I might be able to get away with ten days of antibiotics--which would finish up the day before Cayuga--and maybe feel well enough to compete.  I decided to wait until Tuesday before the race--my usual day for a final "hard" workout--before I made any decision.  I planned on 2x1mi at a relaxed but hard tempo; after I was able to run a 5:50 mile without feeling like it was the end of the world, I skipped the second rep and decided to go for it.  Cayuga would be my last race anyway before some planned down time; after I couldn't get the weekend off of work to run the Whiteface Skyraces in July, I was already anticipating my first real offseason since last summer.  So either way I figured I'd give Cayuga a shot.

Two old men trying to stay warm.
You know it's cold because Ben's wearing a shirt.

My jog with Phil and Tim the day before the race felt pretty solid, and as we lined up Saturday morning I felt reasonably confident (despite a restless night of sleep) that I could approach my perpetual goals at Cayuga of 8:00-8:15, top 10-15, top-3 masters.  I knew from prior years that even splits on the course were a near impossibility, even for the top elites, and that it would take a 3:50 opening lap to have any chance of running 8:10 or better for the race.  Given my recent illness, I had decided to run completely on feel, and let the time and place take care of themselves.  The goals were the goals, but just getting through this one without feeling like complete garbage was going to be a win.

As planned, Phil and I ran together in the early going; as usual in these circumstances, I set the pace with Phil tucked just behind.  We settled into position in about 30th place, running just over eight minutes for the first mile before easing off as the climbing started in earnest.  At the top of the first climb, about three miles in, Ian had added a mile-long loop of rolling singletrack that, while pretty, was obviously going to be a real slog on the second lap.  This threw off our splits as compared to previous years, but the effort level seemed to be in check as we rolled through AS1 and headed back down the gorge towards the river.

We crossed the river feeling strong and made a relaxed climb out of Lick Brook gorge nearing the top 20, but missed a turn at around mile 10 that cost us about three minutes and four or five places.  We still had a long way to go, though, so tried not to panic as we made our way back onto the course and into rhythm.  The trail was in great shape, for the most part, though there were some very soft sections that were going to get very muddy later on.  We came through Buttermilk Falls (AS3) just over two hours in, grabbed a few supplies out of our shared drop bag, and began the climb back up.  Coming back down Lick Brook we caught the second place female, and we maintained a nice rhythm back up towards Lucifer's Staircase.  Before reaching the stairs, we crossed paths with the marathoners on their way out; seeing many friends and training partners hammering by early in their race gave our spirits a boost as we faced the daunting climb.  We caught the women's leader at the base of the staircase and pulled away at the top.  Coming back down past AS5 to finish the first lap I was feeling very strong and was holding back so as not to put any undue pressure on Phil.  About a mile from the start/finish he caught a root and almost pitched off the side of the trail into the gorge; he was able to pop right up but seemed a bit shaken and had a little trouble maintaining contact the rest of the way down.  (He told me after the race that he felt like he was "in shock," and that it ultimately took him several miles to fully recover.)

We reached the turnaround in 4:04 on a course that was ultimately about two miles longer than previous years--maybe equivalent to a 3:55 previously.  I was feeling great.  Legs felt strong, the weather was cooperating.  After running the first 14 miles without carrying any fluid, and then using a handheld for the subsequent twelve, I switched to my Orange Med Single Barrel HydraQuiver for lap 2.  We were in 17th and 18th place, less than two minutes behind 15th, about 6-10 minutes behind 10th-14th.  I was ready to start hunting.  Phil was dawdling a little bit in the aid station, trying to get himself back on track, and we had planned on splitting up at that point anyway, so I grabbed a banana and took off.  Within fifteen minutes I had caught the two runners ahead of me and pulled away; by AS7 at the top of the gorge I was running solo in 15th place, with a little more than twenty miles to go.

Working my way through lap 2.

The Cayuga course is an unrelenting beast.  While the trails are almost universally runnable, the constant short ups and downs and sharp turns make it difficult to find a rhythm.  Small logs and stream crossings that pass unremarked on in the first lap become major hindrances in lap two.  Avoiding lapped runners, front runners, and marathoners in both directions begins to take its toll, adding in countless small lateral movements that sap momentum.  The staircases that were run up cautiously in the early stages become nearly insurmountable objects; the downhills pound the quads into submission.  Four hundred runners traversing a double out-and-back turns numerous soft patches into ankle-deep, shoe-sucking mud pits.  For me, the second lap of Cayuga is always a mental battle trying to avoid negative self-talk.  The difficulty of the course wears me down; there is a constant sense that the finish line is so far away.  I was running pretty well, making it easier to keep a positive outlook, but there's no getting around the fact that year after year, lap two of this course is a slog.  Ultimately, after my two early passes I was completely solo the rest of the way; I wound up about five minutes behind 14th and about five minutes ahead of Phil in 16th.  Despite a 4:50 second lap--about what I've done in previous years--I wasn't close to getting caught by anyone, which is a first for me at this race and speaks to the length and difficulty of this year's course.  (Times were generally 30-40 minutes slower than previous years among repeat runners in the top 20, with the exception of Scotie and Cole, who had amazing performances; I'd suspect my effort was worth about an 8:20 or so on the old course.  I'll take it.)  I would up fourth master, third in the 40-44 group behind Ben and Scotie--my fifth AG top-3 at a national championship since becoming an old man, but still looking for that first AG win. 

Mostly just relieved.

Much like Sabrina wrote in her fabulous recap of the race, I was somewhat ambivalent about the race in retrospect.  It wasn't my best day, but it wasn't my worst.  I finished about where I should've in the field, but certainly didn't make any great strides or achieve anything beyond my potential.  My time was the slowest of my three previous finishes, but I was closer to the winner and to most of the elite returnees like Ben and Matt than I've been previously.  Ultimately I decided I'm satisfied with the result, if not completely happy with it.  Which, considering the illness coming in, I guess is about all I can ask for.

Gear
Patagonia Strider shorts and top, courtesy of Mountain Peak Fitness/Red Newt Racing
inov-8 Race Ultra 290s
Orange Med Single Barrel HydraQuiver and Handheld
GU Roctane gels and GU Brew

Lab Rat

As I've previously mentioned, I've recently started working with the Heart Center in their new sports cardiology practice, performing exercise physiology testing on athletes and assisting on a research project examining the relationship between distance running and heart disease.  However, though I've become quite familiar with performance testing over the past several months, I'd never undergone any physiologic tests myself.  That changed recently when my friend Beth Glace, a sports nutritionist and exercise scientist at NISMAT, recruited me to take part in a study on the mechanisms of fatigue in endurance athletes.

Ultrasound looking at muscle glycogen stores.
All photos: Charlotte Freer

I took the train into Manhattan and walked uptown to NISMAT, which is an extension of Lenox Hill Hospital that specializes in sports medicine and athletic performance.  I met Beth and her co-investigator, Ian, who showed me around and took me through the various elements of the research protocol.  First, I had my height and weight taken, and I underwent an ultrasound of my quadriceps, as a means of measuring my baseline glycogen stores in the muscle.  (Though I'm still on a low-carb/ketogenic diet, my levels were pretty normal.)  Then, I hopped onto the treadmill for a VO₂max test, the first arm of the protocol.  In this case, it didn't really matter what my max was, as this was just being used to determine the intensity at which I'd need to run during the latter stages of the project.  But surprisingly enough, we ultrarunners can get a bit competitive about some fairly mundane things, so I was pretty fired up to see what kind of numbers I could hit.

The dreadmill, with all kinds of fancy equipment.

The test followed a standard protocol, which includes a very brief warmup followed by progressive increases in intensity, until the subject/athlete can't go any further.  I was placed on a heart rate monitor and affixed a plastic headset that held in place the tube into which I'd have to breathe.  This tube ran into an analyzer that measured the relative volumes, rates, and percentages of the various gases I inhaled and exhaled.  From this, Beth and Ian could see not only my VO₂max, but also my lactate threshold (technically my ventilatory threshold, I'll probably bore you with some details about the difference in a future post), and, via a measurement called the respiratory exchange ratio (RER, or sometimes just R) could also determine whether I was burning carbohydrates, fats, or a mixture of the two, at various intensities.

I began by walking on the treadmill at 3mph (20:00/mile), which increased by 1 mph each minute, until reaching 6mph (10:00/mile) at the four-minute mark.  From that point on, with each passing minute, the incline increased by 2%.  Beth informed me that the treadmill had a max gradient of 20%, after which (if I was still running) the speed would then increase to 7mph (8:30 pace) for a minute.  If I could somehow keep going for that minute, the test would automatically stop.  And so I arrived at my arbitrary goal.

If you've never had a VO₂max test before, it is a very brief, very exquisite sort of torture.  The goal is to push the athlete to run to their maximum effort; thus, the test needs to be difficult enough to induce exhaustion, but short enough that the athlete doesn't end the test prior to reaching their max due to accumulated fatigue.  For the first eight minutes or so, then, the test is rather benign, but as the grade pushes past 12%, it begins to get unpleasant quite rapidly.  After eleven minutes, I reached 16% and was really starting to feel it.  At twelve minutes and 18%, I knew I could at least get to the 20% maximum grade, but I wasn't sure how long I could hold it there.  I fought my way through the entire minute at 20% and briefly entertained the possibility that I could finish an entire minute at 20% and 7mph, but after about 15 seconds I gave a desperate signal to stop.

The numbers were pretty cool; it's amazing how much data is generated from these tests and what it can be used for.  I was able to reach a VO₂max of 4.59 L/min, or 70.1 ml/kg/min, which is a pretty solid value for an old man.  My ventilatory/lactate threshold occurred at 88% of my VO₂max, which is near the upper end of normal.  (Higher is better: beyond the LT, lactate accumulation occurs faster than lactate clearance, and the steady accumulation of lactate will lead to fatigue; thus, being able to exercise as close to max effort as possible before reaching that point is obviously beneficial.)  Most interesting to me were the RER values.  I didn't start burning carbs at all until I was nearly halfway through the test, and I didn't hit an RER of 0.85 (metabolizing 50% carbs and 50% fat) until the ten-minute mark, running at at 14% grade with a heart rate of 171.  (My max HR came in at 184, slightly above predicted.)  Beth described this as very unusual, but consistent with the theory behind the ketogenic diet.  Nice to see that it's working.

Torture device.  I mean, the Biodex.

So that took care of the baseline testing.  I returned to the lab a week later for the main part of the protocol.  I began on a virtually empty stomach, having been instructed by Beth only to drink 13 oz. of Ensure about an hour prior to arrival.  After re-weighing and rechecking my ultrasound, I was seated on the Biodex, which was used to measure muscle contraction strength in my right quadricep.  Ian explained that first, they would measure a voluntary contraction, as I tried to extend my leg as forcefully as possible against resistance.  Then, they would provide stimulation with a magnetic field over my femoral nerve, which would induce an involuntary contraction.  Measuring the difference in the amount of force between these two, before and after exercise, would suggest whether fatigue was mediated by central (nervous) or peripheral (muscle) mechanisms.

Probably before I knew what was coming.

After strapping in to the seat, I pushed as hard as I could for about five seconds, and the force was measured.  Ian then positioned the magnet over the femoral nerve in my right thigh and induced a few isolated contractions.  It was forceful enough to make my body jump, but not painful.  Then came the payoff: I again gave a maximal voluntary contraction; after about three seconds, Ian introduced a continuous magnetic field, stimulating a sustained involuntary contraction as I continued to apply voluntary force.  As soon as he hit the button, I screamed; it wasn't painful exactly, but was one of the weirdest and most uncomfortable feelings I've ever experienced.  We did that twice more.  Then the real testing could start.

Waiting with dread...

The meat of the test was a two-hour continuous run on the treadmill, at 70% of my VO₂max.  Beth attached the breathing apparatus every fifteen minutes to ensure that I was maintaining the appropriate work rate.  My blood sugar and blood lactate levels were checked every hour.  When the two hours were up, the ultrasound measurements were repeated, and I was once again subjected to the Biodex, which remained just as unpleasant.  Then, back on the treadmill for a 2km time trial, as hard as I could push myself.  Then weighed again, ultrasounded again, and--you guessed it--the Biodex again.

Either really tired, or just anticipating getting back on the Biodex.

I'm not gonna lie, it was a pretty exhausting day.  But it was really interesting to see some of these processes in action, and I got a great feel for the different types of data that a treadmill test can generate.  I'll talk a little more about some of this stuff as the sports cardiology program starts to launch and I start seeing patients in the real world.

Running and Your Heart, Part II: The Athlete's Heart

Last week, inspired by some recent schoolwork and research, and mildly prompted by my collapse at Rocky Raccoon,  I started a series of posts on distance running and cardiac health.  The first post used my last twenty miles at Rocky as a jumping-off point to talk a little bit about pulmonary edema, and rather obliquely about cardiac illness.  I'd like to delve a little bit more into the relationship between endurance exercise, heart health, and heart disease.  In light of some of the recent media coverage of these issues, we're going to discuss some facts and address some common misconceptions and/or misinterpretations of some of the data out there, with the goal of all of us becoming better informed regarding this topic and better able to make rational decisions about our athletic future.

Before we can get into dysfunction, though, we have to talk about normal function, and about the physiologic adaptations that the heart makes to long-term endurance exercise.  Many of these adaptations are beneficial, but they're not without problems, either.

The normal heart

Chambers (and valves) of the heart

I don't think there's any need to get into a bunch of esoteric facts about the heart (It pumps six liters of blood per minute! It weighs 300 grams!) but we should first go through a few basics.  I'm sure you can remember from ninth grade biology that the heart is a muscle that pumps blood through the body.  You might also remember that the heart is split into two sides (left and right), each of which has two chambers (an atrium and a ventricle).  The right side of the heart pumps de-oxygenated blood to the lungs, where the red blood cells bind to oxygen.  Blood from the lungs then returns to the left side of the heart, from where (whence?) it is pumped out to the rest of the body so that the various tissues and organs can use that oxygen.  Having delivered oxygen to the tissues, the blood then returns to the right side of the heart to begin the cycle again.  Blood flows throughout the circulatory system in what is essentially a series of tubes; veins carry blood to the heart, while arteries carry blood from the heart.

OK, simple enough.  From a basic standpoint, that's all we need the heart to do: pump oxygen-poor blood to the lungs, deliver oxygen-rich blood to the rest of the body.  So when we talk about cardiac disease, we're most generally talking about a failure of the heart to fulfill that function.  But there are a bunch of different ways in which this basic function can be compromised.  For our purposes, there are three systems inherent to normal heart function that we want to be familiar with in order to understand possible dysfunction: the coronary arteries, the conduction system, and the heart muscle itself.

Coronary arteries

We spoke briefly about the heart muscle last week; simply put, the muscle squeezes, increasing the pressure within the chambers of the heart, and forces blood out into the circulation.  The muscle is the heart's engine.  The coronary arteries are responsible for delivering oxygen to the heart muscle.  Wait a minute, you're saying, didn't you just say that arteries carry blood AWAY from the heart?  Yes, I did!  Thanks for paying attention!  Arteries do indeed carry blood away from the ventricles, but in this case they don't have to go very far.  The coronary arteries arise from the aorta immediately after the blood leaves the left ventricle, and they surround the heart, supplying oxygen-rich blood to the muscle.  When you hear the term "heart attack," this is usually used to mean an interruption of blood flow to the heart muscle, usually due to a narrowing of, or blockage within, the coronary arteries. We're going to do an entire post about the coronary arteries next week, so for now, just think of them as the heart's plumbing system.

The conduction system, then, is the wiring.  This system is comprised of electrical fibers that coordinate the heartbeat.  The depolarization of these electrical cells causes the atria, and then the ventricles, to contract synchronously.  The contraction of the atria forces blood into the ventricles, and the contraction of the ventricles forces blood out into the circulation.  When you see that familiar tracing that we all know represents a beating heart:

what you're looking at is a graphic representation of the heart's electrical activity.  (I'm not going to go into what each of those little squiggles means, but if you're interested, read this.)  Without the orderly input of the electrical/conduction system, these contractions may lose their synchronicity, robbing the heart muscle of its ability to pump blood effectively--or contractions can cease altogether.

The athlete's heart

Note the enlarged (dilated) cardiac chambers
in the athlete's vs. non-athlete's heart.
Photo: cyclingtips.com

Like any other muscle, the heart responds to exercise by adapting to stress.  Weight lifting, for example, places the skeletal muscles under stress, ultimately causing the muscles to adapt by increasing muscle mass and size (hypertrophy).  Similarly, aerobic exercise means that the muscles requires more oxygen, necessitating increased cardiac output (the amount of blood the heart pumps).  Over time, the heart muscle adapts by increasing the mass and thickness of the muscular wall of the left ventricle.  Other adaptations include dilation (or enlargement) of the various heart chambers, and dilation of the coronary arteries (which I'll discuss more in next week's post).   In the absence of a history of vigorous exercise, many of these structural changes--hypertrophic ventricular walls, atrial dilation--would be considered pathologic.  That is to say, when we see these sorts of things in the population at large, they are usually the result of chronic high blood pressure or underlying cardiac disease, are usually associated with a loss of the heart's pump function, and can lead to congestive heart failure, pulmonary edema, and other general badness.  But in endurance athletes, who demonstrate these changes in the setting of preserved pump function, they are usually considered normal adaptations to long-term vigorous exercise that we term the athlete's heart.

What's the big deal? Aren't adaptations good?

So, in general, we think of the chronic adaptations associated with the athlete's heart to be beneficial, or at the very least neutral.  They allow for us to increase our cardiac output to meet the demands of intense aerobic activity, and do not appear to be associated with the sort of pathology we would otherwise expect from these kinds of changes in heart morphology.  However, there is some evidence that suggests that there may be some downside to some of the adaptations of the athlete's heart.

For example, take the dilation seen in the heart's chambers, particularly the left atrium and right ventricle.  There is a hereditary disease called arrhythmogenic right ventricular cardiomyopathy, a rare condition that causes dilation of the right ventricle and fibrous deposition or "scarring" within the myocardium (the muscular layer of the heart wall).  This fibrous tissue can interrupt the electrical pathways of the heart (remember that conduction system stuff?), serving as an origination point for life-threatening ventricular arrhythmias (abnormal heart rhythms).  The dilated RV seen in long term athletes can be accompanied by similar fibrous deposition, leading to some speculation that there may be an "exercise-induced arrhythmogenic right ventricle" that may mimic the inherited condition.  (Some have posited this as the theoretical framework for the death of Ryan Shay at the US Olympic Trials marathon in 2007, though that--in fact, all of this--remains unproven.)  Dilation of the left atrium also seems to place athletes at increased risk of atrial fibrillation or atrial flutter, two abnormal heart rhythms that, while not as dangerous as ventricular arrhythmias, can still cause significant cardiovascular complications.

No bueno.

Another interesting cardiac finding associated with ultra-endurance exercise relates to cardiac enzymes.  Many of you are probably familiar with rhabdomyolysis, a fun little problem in which repeated skeletal muscle trauma (as seen in, say, a 100-mile run) causes breakdown of muscle tissue and the release of enzymes called myoglobin and creating phosphokinase into the bloodstream.  Just like skeletal muscles, heart muscle contains these enzymes; but there are also enzymes that are specific to cardiac muscle, notably troponin.  Troponin is generally only minimally detectable in the bloodstream; elevated troponin levels generally imply damage to the heart muscle, usually from ischemia (lack of blood flow)-- a "heart attack."  Now, several studies have detected significant elevations in troponin levels following prolonged exercise.  Does this mean that we're giving ourselves small heart attacks during every ultra we run?  Probably not; while troponin elevations following heart attacks tend to peak many hours after the event, and persist for several days to weeks, post-exercise troponin elevations typically appear, and resolve, very rapidly.  Furthermore, while there have been studies showing reduction in LV and RV function following ultra endurance events, in almost every case function has been demonstrated to return to normal within one week, unlike what we would see in a "heart attack."  It appears possible that the transient elevation in troponin following extreme exercise is related to increased permeability (leakiness) of the cardiac cell membranes rather than ischemia, cell death, or permanent heart damage.

What does all this mean?

I know, I hit you with a lot of information, and right now you might be freaking out a little bit.  Freaking you out is not the objective of this post.  We're going to talk big picture in a couple of weeks, and hopefully when we're done you'll feel pretty comfortable with the whole deal.  For now, here's the take-home points:

• there are several adaptations that the heart makes to accommodate long-term, vigorous aerobic exercise
• most of these adaptations are generally beneficial
• there are some morphologic changes (that is, the the size/shape of the heart) that may increase the risk of arrhythmias in athletes
• most of the evidence we have at this time shows correlation, not causation, and much of the framework surrounding this remains theoretical/speculative

Again, we'll go big picture in a couple of weeks, and I'll be able to draw things together a little bit more.  The point of all this is just to make you a little more aware and informed about some of the interesting stuff that's out there, and maybe to generate some fodder for a discussion with your doctor if you have questions or concerns.  

If you want some really detailed reading on this stuff, check our these highly scientific articles:

George K, Whyte GP, Green DJ, Oxborough D, Shave RE, Gaze D, and Somauroo J. (2012). The endurance athletes heart: acute stress and chronic adaptation. British Journal of Sports Medicine, 46(S1), i29-i36.

O'Keefe JH, Patil HR, Lavie CJ, Magalski A, Vogel RA, and McCullough PA. (2012). Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise. Mayo Clinic Proceedings, 87(6), 587-595.

Running and Your Heart, Part I

So...it's been an interesting couple of months.  I think I've mentioned this before, but since late last year I've been involved with the Heart Center, the preeminent cardiology group in the Hudson Valley, in establishing a new sports cardiology practice.  I'm not a cardiologist (which will become eminently obvious over the course of the next couple of posts) but I have more than a layman's understanding of the athlete's heart and many of the cardiac issues that endurance athletes deal with.  Plus, I've always had a major interest in exercise physiology, and have been looking for an opportunity to break into that field for some time.  Starting within the next couple of months, we'll be opening the doors on our new sports cardiology practice (spiffy title pending) and I'll be working part-time as the group's exercise physiologist.  So exercise science and the athlete's heart have been on my mind quite a bit recently.

This was obviously at the forefront of my thoughts during and after Rocky Raccoon.  As a brief recap, I was running very well at Rocky through 60 miles (9:12) and, despite a nosebleed and some other minor issues, was still on pace for a top-6, sub-16 hour finish through 80 miles (12:45).  In the last twenty miles, however, I developed some rather scary breathing issues, including some rattling breath sounds starting around mile 88 that had me concerned I might be developing pulmonary edema.  Pulmonary edema is basically fluid buildup in the lungs; it can occur for a variety of reasons in sick or elderly individuals, but is much less common in young, healthy folks.  (I'm referring to fluid within the lungs; this is different from a pleural effusion, or fluid around the lungs, which is an entirely different issue I'm not going to address here.)  Mountain climbers can experience high-altitude pulmonary edema (HAPE), which is basically a failure of the pulmonary (lung) vasculature (blood vessels) in response to the physiologic demands of altitude--obviously not an issue in Huntsville, TX.

The most common reasons for a buildup of fluid in the lungs are basically an inability to remove fluid (kidney failure) or an inability to circulate fluid (heart failure).  Reports of kidney failure following extreme endurance events, due to a condition called rhabdomyolysis, are not uncommon.  Rhabdomyolysis occurs as a result of extreme muscle breakdown, when large amounts of a muscle-based proteins myoglobin and creatine phosphokinase (CPK) are released into the bloodstream.  Without proper fluid intake, these proteins can accumulate in the renal tubular system, causing kidney failure.  Kidney failure can lead to anuria (inability to urinate) and pulmonary edema, as the body cannot excrete excess fluid and hydrostatic pressure causes fluid to leak into the lungs and other tissues.  In a 100-mile race, this is certainly a possibility (though remote).  However, I wasn't terribly concerned; I had urinated several times during the race, without any blood (a telltale sign of muscle breakdown called myoglobinuria), I had been taking in adequate fluids, and it was not an overly warm day.  Also, rhabdo-induced renal failure is usually a later finding; it was hard to believe that my kidneys could have already failed to the point where I was going into pulmonary edema less that fourteen hours into the event.  My real fear was my heart.

The most common cause of pulmonary edema is heart failure.  Basically, if the heart muscle is weakened (by any of a variety of mechanisms; most commonly, a heart attack), its ability to pump blood adequately can be compromised.  This can lead to a backup of blood flow throughout the body. When the blood does not flow adequately through the venous system, that can cause an increase in the amount of pressure within the veins.  That increased pressure can cause fluid to leak out of the veins, where it doesn't belong--including into the lungs.

Fortunately, not my chest X-ray
photo: wikipedia.org

Now, I had no real reason to be concerned about my heart.  Other than some mild hypertension, I have no personal history of heart disease, and no other significant risk factors; I had even undergone a recent CT angiogram of the coronary vessels (more on this in subsequent postings), which was normal.  But as I mentioned, I've been rather immersed in sports cardiology and the athlete's heart recently, and as I'll talk about in the next few posts, there are a lot of unlikely but unpleasant possibilities that can befall those of us who take this running thing a bit too seriously.  At its essence, the heart is a rather simple pump, but the underlying components of the organ are a bit more complex, and therein lies a lot of potential problems.  The relationship between exercise, heart health, and heart pathology is actually quite fascinating, and I'll explore that a little more as promised in coming posts. But certainly in real time I was less fascinated and more, well, freaked out.

Anyway, I finished the race by walking the vast majority of the last 18 miles or so, and since then have recovered more or less normally.  I had the usual post-race leg swelling, which in this case brought on some additional anxiety but ultimately resolved as expected.  For a few days afterwards I felt as though I was getting short of breath just walking around or climbing stairs, but I think that may have all been in my head.  A week later I went for an echocardiogram, which is an ultrasound of the heart.  This test shows the activity of the heart muscle in real time; it can show if there are areas of the muscle which are not functioning normally (wall motion abnormalities), if there are problems with leaky heart valves, and how much blood the heart pumps with each beat (ejection fraction).  My cardiologist said my heart was very photogenic:



He also told me that, other than some normal findings associated with the athlete's heart, everything looked good, and that my ejection fraction was normal.  And after a two-week break, I started running slowly again.  It's been a longish recovery period, but now five weeks post-Rocky I'm running more or less normal mileage and feeling just about ready to get back to some harder training again.  (Though the estimated 24" of snow coming our way tomorrow may preclude that for a little while.)

So, apparently this has all been much ado about nothing, fortunately, though it's forced me to think a bit about the role of the sport in my life.  It's a silly pursuit, of course, for those of us who are not making a living at it; sure, it's better than plenty of other bad habits we could have, but there probably isn't anything in our lives that needs to be taken to the extremes that we ultrarunners face regularly.  I did have some fleeting thoughts about what life would look like without 110-mile training weeks.  Unfortunately I don't think I'm mature enough to make any difficult decisions about it at this point, though with a clean bill of health it doesn't seem I'll be forced to do so for awhile.  So for now I'll keep plugging away and trying to slay whatever dragons strike my fancy in the coming months.  (Plus there's always the Western States lottery to look forward to.)

However, there's an awful lot of information out there regarding distance running and long-term health, and a lot of it can be very confusing.  So in the next few weeks I thought I'd try to demystify some of that information, in case anyone else is struggling with some of these decisions regarding their future in the sport.  Next post we'll talk a little bit about the athlete's heart and some of the various changes related to distance running, and whether or not we need to worry about those things.  After that we'll go into the association between ultrarunning and coronary artery disease.  And I'd like to spend a post on the relationship between strenuous exercise and overall mortality, which has been in the news quite a bit recently.  So, check back soon for more possibly accurate, semi-scientific information.

Race Report: Rocky Raccoon 100

It's been almost two weeks since Rocky Raccoon, my first real 100 miler (not counting last year's 24-hour at North Coast, though maybe I should).  I've been struggling with various, conflicting emotions since I crossed the finish line in Texas.  Relief at being finished.  Disappointment at not having achieved most of my goals.  Frustration that, despite excellent preparation and race execution, I was left with a sub-par result, largely due to circumstances outside my control.  Pride at having actually accomplished the task of running 100 miles, still in a relatively respectable time.  Concern and fear over what I might be doing to my body.  Uncertainty as to where I go from here.

I came into Rocky about as prepared as I could've hoped.  I'd had four months of basically uninterrupted training since North Coast, averaging over 100 mi/week for the previous 13 weeks (including recovery weeks!) with a nice mix of track work, hills, tempo, and marathon-pace efforts.  Greg had almost fixed my chronic Achilles tendinosis.  Scott had basically tortured my muscles into balance.  My weight was perfect, right in the 137-lb. range.  Four weeks earlier, I had run a solo 50K in 3:39, feeling completely relaxed; my last 10 miles were easily the fastest of the run.  I had no excuses.  I flew to Houston on the Thursday before the Super Bowl with my great friends Phil and Laura (and Francis Ford Coppola, who was on our plane); Phil would be running his second 100 (after an epic battle with the Grindstone course last year) and Laura would be crewing me and pacing my last 25 miles.

All smiles at the start, with Phil.
photo: Laura Kline

The opening pace was about as fast as I expected.  My pre-race goal was 15 hours (I didn't know exactly how realistic that was, but I knew I could run 16 hours, and I wanted to be mentally prepared to try to run faster than that), and based on previous years I figured that a 15-16 hour performance would have me comfortably in the top 5.  I was anticipating a quick start, though, so I lined up several rows back and let folks go crazy in the early stages.  I stopped to pee around four miles in and was very pleased to find that Phil had been running right behind me (why he hadn't said anything for the first half hour is beyond me).  He was planning on running in the 17-18 hour range, so this pace was a bit faster than he needed to be, but he was happy to run comfortably with me and plan on slowing down later, so we settled in to 9:00 pace and wiled away the miles chatting and making sure not to go too fast.

With Phil at mile 23, cruising along.
photo: Laura Kline

We finished the first 20-mile circuit in 2:58, right on pace (if not place; we were easily outside the top-20, already over 30 minutes behind the leaders; but I knew there weren't about to be twenty sub-15:00 100s out there) and resolved to slow down just a tad over the next lap, so as not to overdo it.  Phil was the pacemaker for most of lap 2, and did a masterful job in guiding us through a 3:02 lap for a 6-flat split at 40 miles.  The course was fun--a mix of singletrack and doubletrack, with a few more rolling hills than I had anticipated, but mostly excellent footing and eminently runnable.  The aid stations were well-stocked and staffed with hilarious, enthusiastic volunteers.  All in all we were having a blast.  I stopped briefly at 40 miles to eat a little peanut butter and chat with Laura for a few seconds while Phil ran through the aid station and opened up a little gap on me, but I had been moving just a touch better over the last several miles and was not concerned about catching back up; by 42 miles were running together again.  I was a few seconds in front when we came to an intersection that had clearly had the markings tampered with; it took us a minute or two to sort out where the signs had been switched around and get back on the right path.  (Where does this compulsion come from, to fuck around with course markings?  How is this fun for whoever is doing this?  I could almost understand it if you were sitting there and laughing at stupid runners getting confused and running in different directions, but why are you switching markings and then just walking away?  What pleasure does that bring you?)

End of lap 2, 40 miles in.
photo: Laura Kline

I kept the pace steady throughout lap 3; I still felt very good, but did not want to go overboard yet, and focused on trying to run the same splits between aid stations as I had on the first two laps.  Phil fell back and I was on my own; I could track my progress to some of the leaders, though it became obvious that a lot of people had dropped out already and I didn't have a clear sense of where I stood.  My splits were not far off, especially accounting for the few minutes we'd lost at the tampered intersection.  The seven-mile Damnation loop between the second and third AS on each lap did become a bit of a slog.  This was the longest stretch between aid stations, and also the longest segment that didn't involve an out-and-back section, so it was rather isolating; it was a good hour of basically solo running, with few landmarks, and by the third time through it was starting to feel like a chore.  But I maintained through 50 miles in 7:34 and finished up lap 3 in 9:12, now in sixth place.  Fifth was a good 20-30 minutes ahead and looking strong; seventh was about 8-10 minutes back (Phil was about 10-15 back, in around 10th).  I knew by know that I wasn't going to break 15:00--negative splits are almost impossible in a race this long--but I told Laura that I'd be at the 75-mile mark in 11:45-12:00, and that 16 hours was easily doable.

I pressed on through lap 4.  After running through every aid station for the first 30 miles or so, I had developed a nice AS rhythm: two cups of Coke, half a banana, a few bites of PBJ, grilled cheese, or a quesadilla, and some pickles.  A minute or so, in and out.  I'd been running the whole way with my Orange Mud Hydraquiver Single Barrel, so I had 26-ounces of fluid with me, which I was generally drinking twice per lap starting with lap 2--one time with GU Brew, then refilling with water for the second half of each lap.  My fueling and energy systems felt pretty good.  I'd taken a few salt tablets, but not many.  I had peed probably four times in the first 70 miles or so; it was a little concentrated, but certainly not brown or anything concerning.  The Damnation loop on lap 4 was interminable; even though it was only about 4-5 minutes slower than I'd been running on the previous laps, it felt like it would never end.  Still, I maintained a nice pace through mile 72, on target to meet Laura at 75.5 in about 11:50.

In a race this long, things are going to go wrong at some point; how you deal with them is what separates a good race from a bad one.  At 73 miles, things that didn't need to go wrong started to go wrong.  I started feeling pretty tired and was struggling a little bit, when I started bleeding from my right nostril.  This isn't unheard of for me, especially when conditions are as dry as they were in Texas, but it certainly was an issue I didn't want to deal with at that point.  I slowed down a little and managed as best I could, and came in to the aid station to pick up Laura right around 11:53 or so.  (For comparison, my 12-hour split at North Coast was about 76 miles, so I was right there, if not a couple of minutes faster.)  Laura was ready to rock (and freezing cold, having been waiting for about 30 minutes as sunset approached) but I had to sit and manage my issues.  A volunteer pulled up a folding chair and brought me some tissues to pack my nose; Laura brought some Ramen and refilled my bottle.

"What else do you need?" asked the volunteer.  "I've got some whoppies.  You want some whoppies?"

Did I want whoppies?  I didn't know.

"I'm sorry, what?"

"Whoppies?  You need some whoppies?"

Shit, I didn't know what he was talking about.  I racked my brain, trying to think of what I was forgetting.  I'd been reminding myself for the past few miles that I wanted to tell Laura to give me a Zofran tablet (for nausea) when we got to mile 80...more as a precaution than anything else, though my stomach had felt mildly queasy...I knew I wanted to drop my vest pack and just use a handheld on the last lap...I couldn't remember what I had decided about whoppies.  Did I want whoppies?  Would they bother my stomach?  Wait, what the fuck was a whoppy?  Why couldn't I remember what a whoppy was?  Laura was back with my bottle, but she didn't seem to know about whoppies either.

"I'm sorry...what are you saying?"

"Whoppies."

"What...oh. Wipies."

Texas accents, man.

Once I had cleaned the blood off my hands and face with some wet wipes (aka wipies/whoppies), we started off at an easy jog.  I led most of the way back to the start/finish, not running the 9-10 minute pace I had been doing earlier, but holding a steady 11:00 pace for the next four miles or so, coming through 80 miles in 12:46.  I needed to run only 10:30 pace to break 16 hours.  Fifth place was over thirty minutes in front, but seventh place was about twenty minutes behind.  Sixth was mine, barring disaster.  I dropped my vest and grabbed my handheld, took the Zofran and, at Laura's suggestion, a caffeine tablet, as my energy levels were starting to sag a bit, and we started off, headlamps blazing, Laura in the lead, running ten-minute miles.

I struggled to keep up as we started off, though my legs felt alright, and tried to keep suffering through what seemed to be a bad patch.  But after a mile or so, I could tell it wasn't simply a bad patch.  My breathing didn't feel right.  I was fatigued, to be sure, but beyond that, I was struggling to keep my breathing under control.  I was hyperventilating on every uphill.  After about two miles, I told Laura I needed to slow down to try to catch my breath.  I wasn't sure what the problem was.  Maybe the caffeine, I thought; though I'm pretty habituated to caffeine, and had been drinking Coke and taking caffeinated gels for the past several hours, maybe the tablet had been too much, and it was causing my heart to race.  We stopped at AS 1 (83 miles) and I sat again to check my pulse.  120 beats/minute.  Nothing out of the ordinary; certainly nothing to cause unusual shortness of breath.  I rested a few minutes, drank some hot broth, and we walked on.

Over the next few miles, I tried to run on the flat and downhill sections whenever I could.  Uphills left me gasping for air and were not runnable.  We decided we'd have to try to just wait out whatever was happening.  I had no chest pain and was still urinating.  My legs actually felt fine; on the sections were I could run, I was holding sub-10:00 pace with any real soreness or achiness.  And maybe the breathing was getting a little better.  I'd just walk the uphills until it went away.

It was on the final Damnation loop where everything went to shit.  I started feeling a rattling in my chest when I was running; I tried to cough up phlegm but nothing would come up.  At first, it was only on uphills; by about 88 miles I could hear a rattling sound even on flat segments.  By now I was starting to freak out a little bit.  I doubted it was my kidneys, as I had peed only a few miles earlier.  Was my heart OK?  All the reading I'd been doing for work and school about ultrarunning and heart disease started playing with my mind.

"Laura, I think my lungs are filling up with fluid.  I think I just have to walk."

So, we walked.  Every so often I'd try running for a bit, but the rattling came back after fifteen seconds or so and I was too freaked out to keep going.  Walking seemed OK, and my legs felt fine, and I was still going to be able to finish, so we just walked.  I felt bad for Laura, who had given up an entire weekend and flown all this way and supported me all day to basically be reduced to walking for 18 of the 25 miles she was pacing, but I couldn't do anything about it.  I was still in sixth, somehow, through ninety miles, but by about 91 folks started straggling by.  Phil and his pacer Mike came past at about 93; he looked so strong I wanted to cry, but I put on a brave face and we just trudged through.  I was able to run for about fifteen of the final 25 minutes or so, and finished the last lap with Laura in 5:01, for a 17:48, 12th-place finish.

I went straight to the medical tent, although I felt generally OK, and had one of the docs listen to my lungs, which he pronounced as clear; my heart rate was about 140 when I first sat down, but came down to 90 within the first couple of minutes.  I was still having a hard time taking a full, deep breath without coughing, which would persist for the next couple of days, but otherwise things seemed to be fine.  I'm still not sure what the issue was/is.  My best supposition is that the dry, dusty air caused some bronchospasm and a bit of an asthma-like reaction; several folks, including Phil, commented on how dusty it had been, and I had my nosebleed as evidence.  But I'm scheduled for a chest X-ray and an echocardiogram tomorrow, so we'll make sure everything is ok.  (I'll try to post a bit on the echo, and some various ultrarunning/heart-related issues, next week.)

My favorite existential sign.
This is the next morning.  No, I don't look good.

So where do I go from here?  I won't make any long-term decisions until after the echo results are in. If everything is OK, I assume I'll get back to training in another week or so, and I'll put together a race schedule for the summer/fall in the coming weeks.  I'm glad to have finished, and to have my buckle, and my WS qualifier, and yes, a 17:48 is not anything to sneeze at.  But everything pointed to a sub-16, and my legs were certainly up for it, and my fueling and everything else seemed to be on point.  I'm equal parts frustrated and concerned, combined with the usual apathy/ennui after a major race is over.  It's not a great headspace to be in right now.

I learned that I can prepare for and execute a 100-mile race plan.  I confirmed, after Bandera and North Coast, that I can compete among the second tier of US ultrarunners at long national championship races--I'm not going to win, but after the true elites beat the shit out of each other, I'm certainly in the next wave of guys that are picking up the pieces.  And I learned that bad patches are just bad patches, and that I should recognize them for what they are, and not panic and try to force myself out of them by taking caffeine pills or whatnot; they just need to be endured until they end.  What all this means for me going forward, though, is still a bit of a mystery.

Gear
Patagonia Strider shorts and top, courtesy of Mountain Peak Fitness/Red Newt Racing
inov-8 Race Ultra 290s (discontinued, unfortunately, but really looking forward to the new Roclites)
Orange Med Single Barrel HydraQuiver, Handheld, and trucker cap
GU Roctane gels and GU Brew

Nerve Gliding

I'm currently in the Best Western Inn & Suites in Huntsville (home of Sam Houston, the patron saint of Texas), about 16 hours ahead of the start of Rocky Raccoon, my first official attempt at the 100-mile distance (notwithstanding last year's 24-hour effort at North Coast).  Right now I've literally got my feet up, propped on a pile of pillows, and I'm watching a Law & Order marathon, so I'm about as happy as I could possibly be.  In about an hour we'll head out for a little shakeout jog before dinner.  I feel pretty good.  The last few months of training have gone great.  I'm a man without an alibi.

I've talked before about how much I hate tapering, and this time around hasn't been all that different.  But I've added a new element to the pre-race routine that seems very promising that may give me a bit of an edge come tomorrow afternoon.  Prior to my last effort at Recover from the Holidays, I visited Greg at Momentum PT for a routine called nerve gliding.  Basically, the brain and the nervous system are in control of pretty much everything that happens to you during a long race...and if we can fool the nervous system into thinking we don't feel quite as bad as we think we do, we can actually run faster and longer than our brain would otherwise allow.  I'll let Greg explain it better:

Common issues and complaints related to physical/athletic performance are fatigue, cramps, decreased muscle activation/strength, diminished coordination and good ol' fashioned bonking just to name a few.  This is especially the case when talking about events that significantly test one's endurance or during long periods of exertion.  There is a complex interplay between many systems in the body to cause these issues but it is impossible not to implicate the nervous system with each one since it is still the CEO making final decisions based on the information it receives.

Most, if not all, runners have experienced these issues at some point during training or a race.  One of the main factors is when the nervous system has had enough,  the rest of the body will follow suit pretty quickly making it very difficult to reverse course.  Even if everything else like nutrition, training and rest went according to plan, nothing can defy the limits of your nervous system.  So those muscle cramps at mile 22 in a marathon are probably not a salt or nutrition issue anymore; it's more likely to be exertion-related fatigue of the neuromuscular system resulting in those muscle cramps.  The good news is that the nervous system is not static, but is actually quite adaptable and something that can be trained leading to an elevation in performance.  Who doesn't want that?

Before going any further, a quick (simplified) physiology lesson is in order.  The nervous system runs on a baseline level of sensitivity but this is something that can change.  It can become more sensitized which means it is more easily triggered causing it to fatigue and run out of fuel faster or less sensitized which means it is less trigger happy and runs more efficiently (read: less fatigue).  In essence, a less sensitized nervous system is able to provide a more accurate picture of any sensory information coming in to the brain since it's not being triggered over every little and insignificant type of stimuli.  An accurate picture going into the brain results in a better, more consistent output to your neuromuscular system.  You can probably see where this is going: good info in + good info out = improved performance.

The question, then, is how to accomplish this?  The short answer is through what are known as nerve mobilizations or nerve glides.  In the case of runners, the posterior nerve bundle of the leg, the sciatic nerve, is important to target because it innervates the hamstring and calf muscles which tend to be susceptible to cramps.  You can think of them as very specific and repetitive short duration stretches which  can be done in a variety of ways.  Just like many systems in the body, when exposed to some kind of stress, the nervous system will adapt and become "stronger" and more efficient.  Nerve mobilizations are a way to expose the nervous system to new stimuli and gently push its boundaries so that it becomes more comfortable with more stress.  This can be combined with other desensitization and calming/relaxation techniques to compound the effects of nerve mobilizations.  The end result is a robust and fatigue-resistant operating system that allows you to push yourself physically with fewer issues.  A nice bonus is that recovery tends to be quicker after your race or training session as well. 

Get it?  Just like the musculoskeletal system and the cardiovascular system, the nervous system is adaptable.  Placing it under some gentle stress shortly before the race teaches it that the stress it will experience a day or two later is manageable.  Our perception of the stress, and of fatigue, changes.

The routine takes about thirty minutes and is pretty painless.  Greg does some static stretching of the hamstrings, placing some strain on the sciatic nerve; it's mildly uncomfortable but not bad at all.  Then he places some gentle traction on the legs and moves them back and forth (abducting and adducting them, if you're anatomically inclined) while kind of shaking them around.  It's actually pretty relaxing.

Does it work?  I only have the one anecdotal experience to report from last month...which was awesome.  I ran a very relaxed 3:39 solo 50K, feeling much less leg strain and fatigue than I usually would for an effort like that.  And the next day, when I would normally be pretty sore from a long, hard road effort, I was able to cruise an easy sixteen miles, definitely fatigued but without any significant soreness or discomfort.  Maybe it's a placebo.  But if it's even a 1% advantage, that's at least ten minutes in 100 miles.  Tomorrow, I'll need every ten-minute advantage I can get.