Merry Statesmas! My WS100 Picks and a Pre-Squaw GUR Top 50 Update

I'm recycling the title of this post from last year.  Let's get into it!

I've been way behind on the Gunksrunner Ultra Rankings this year, mostly due to finishing my exercise physiology coursework, but I finally got caught up in the past two weeks, and have a pre-States GUR Top 50 at the end of this post.  As such, though, I haven't been quite as immersed in results as in previous years, so my picks for this weekend's Big Dance are likely to be even less reliable than usual.  But you get what you pay for.  Which is nothing.  So here goes.

Ladies
Six of last year's top ten return, joined by a very deep field that includes ten of the current GUR top 50 (including six of the top 10), and twelve of the 2016 top 50 (including 10 of the top 20).  The depth of this group is frightening; while both the men's and women's fields have at least twenty solid contenders for those magical top-10 places, the talent and experience on the women's side might outflank the men, especially at the 100-mile distance.

1. Kaci Lickteig
Final 2016 GUR: 1
Current 2017 GUR: 5
2016 WS: 1
Western States does tend to look kindly on defending champions--think Krar, Olsen, Trason, and Jurek, to name just a few.  Whether the Pixie Ninja belongs among the all-time greats is still debatable, but the returning champ has three straight top-5 finishes here, and her buildup to this year's event looks awfully similar to last year.

2. Magdalena Boulet
Final 2016 GUR: 2
Current 2017 GUR: 3
2016 WS: DNF
The 2015 champ and UROY dropped early in last year's race, then gutted out a difficult fifth-place finish at Speedgoat later that summer.  She bounced back, however, with a strong second at North Face in December, and this year has looked very strong, placing second to Camille Herron at Tarawera and earning her ticket to WS with a T2 at Lake Sonoma.  She's got the speed, the experience, and the 100-mile chops to ascend the podium again.

3. Andrea Huser
Final 2016 GUR: NA
Current 2017 GUR: NA
2016 WS: NA
She's got wins or runner-up finishes at a dizzying array of Europe's most competitive trail ultras, including Diagonale des Fous, Lavaredo, Madeira Island, and UTMB.  We don't often see rookies or Euros atop the States podium--usually it takes a couple of tries to get it right--but she's not your average rookie.  Is she too much of a mountain specialist for this course, or does she have the wheels to hang with Magda, Kaci, and Camille when things start heating up on Cal Street?

4. Amanda Basham
Final 2016 GUR: 18
Current 2017 GUR: 9
2016 WS: 4
Speaking of wheels, I like the recent UROC champ to reprise last year's finish.  Undefeated in three ultra starts this year, though has yet to face a field of this caliber in 2017.

5. Camille Herron
Final 2016 GUR: 24
Current 2017 GUR: 2
2016 WS: NA
I gave a lot of serious consideration to picking Camille for the overall win.  Already this year she's beaten Magda at Tarawera, and may have already locked up Performance of the Year with her dominant win at Comrades two weeks ago.  (An honor she won in 2015, her first year in ultrarunning.)  However, she hasn't yet proven to be quite as dominant on the trails as she is on the roads, and this will be her 100-mile debut; besting a field of this caliber under those circumstances may be too much to ask, especially if there's any residuals fatigue from Comrades.  If anyone can pull at Walmsley on the women's side, though, it's definitely her.

6. Maggie Guterl
Final 2016 GUR: 17
Current 2017 GUR: 128
2016 WS: 8
She's lightly raced so far this year, having picked up wins at some smaller, short East Coast trail races, but she smoked a 14:47 at Brazos Bend in December.

7. Jacqueline Merritt
Final 2016 GUR: 69
Current 2017 GUR: 6
2016 WS: NA
Another East Coast stud, she already has four wins this year and a second-place finish at the Georgia Death Race to lock up her Golden Ticket.

8. Amy Sproston
Final 2016 GUR: 6
Current 2017 GUR: 109
2016 WS: 2
I picked Amy seventh last year and commented, "I feel like I actually might be selling her short here."  She went out and crushed a second place finish.  Naturally I've dropped her to eighth this year, so I fully expect her to win and make me look like an idiot.

9. Stephanie Howe Violett
Final 2016 GUR: 133
Current 2017 GUR: 16
2016 WS: NA
The 2014 WS champ missed most of 2016 due to injury but rebounded for ninth at North Face and then bested a solid field, including Camille Herron, to win at Bandera in January.  Definitely selling her short here.

10. Clare Gallagher
Final 2016 GUR: 13
Current 2017 GUR: 65
2016 WS: NA
Talk about selling short...she won Leadville last year in her 100-mile debut, but has flat speed honed during a stellar collegiate career, backed up with a fifth place finish at TNF in December.  I could easily see her in the top 3.

Hedging my bets
11. Meghan Laws (nee Arbogast)
12. YiOu Wang
13. Kaytlyn Gerbin
14. Nicole Kalogeropolous
15. Alissa St. Laurent

Lads
Eight of last year's top ten return, though unfortunately not defending champ Andrew Miller, recovering from injury.  Eight of the current GUR top 50 are in the field (including three of the top 5), and thirteen of last year's top 50, including eight of the top 20.  Add in several top-flight Europeans and you've got a very solid field of contenders...but absolutely nobody is picking an upset.

1. Jim Walmsley
Final 2016 GUR: 1
Current 2017 GUR: 3
2016 WS: 19
Allow me to become the 457th commentator to observe that the only person who can beat Jim right now is Jim.  His stunning 100 mile debut was one of the most electric performances of the year, notwithstanding the wrong turn at 91 miles that cost him the win and likely the course record.  Did you know that other than that wrong turn, Jim hasn't lost a race in over two years?  I could see him maybe blowing up if he is serious about chasing his stated goal--a sub-14:00 finish, which would better the course record by nearly an hour--but it's not likely.  And short of that, or injury, I don't see anyone in this field who can beat him.

2. Kyle Pietari
Final 2016 GUR: 23
Current 2017 GUR: 1247
2016 WS: 8
OK, I'm going straight chalk with my picks for the winners, but here's a little bit of a dark horse for you.  He backed up last year's top-10 with a second place finish at Leadville.  He's been quiet this year, with only one ultra finish back in March.  Is he ready for a huge breakout?

3. Alex Nichols
Final 2016 GUR: 12
Current 2017 GUR: 46
2016 WS: NA
Alex has a long history of stellar performances at huge ultras and other mountain races, including multiple wins at Pikes Peak, and has represented the US in the World Mountain Running Championships.  He made his long-awaited 100-mile debut last year with a win at Run Rabbit Run, and backed that up with top-five finishes at Speedgoat and North Face.  The WS course sets up well for people with Alex's particular skill set--climbers who have flat speed to burn.

4. Jeff Browning
Final 2016 GUR: 11
Current 2017 GUR: 25
2016 WS: 3
When you've been running ultras for fifteen years, it's hard to have a career year at 45--but that exactly what Jeff did last year, with a win at HURT, third at WS, and fourths at Hardrock and Run Rabbit.  He's undefeated in three low-key 50Ks so far this year.  It may be too much to expect a repeat of 2016, but I feel weird picking against him.

5. Chris Mocko
Final 2016 GUR: 29
Current 2017 GUR: 4
2016 WS: 7
He may have had the best 2017 so far of anyone in the field not named Walmsley: second at Way Too Cool, third at Sonoma, wins at Marin and UROC.  As long as he hasn't cooked himself too early in the season, he'll be heard from this weekend.

6. Jonas Budd
Final 2016 GUR: NA
Current 2017 GUR: NA
2016 WS: NA
I always have trouble picking the Euros (though I did hit Lorblanchet exactly last year, and wasn't too far off on Giblin) so who the hell knows.  But Jonas has the speedster pedigree of the Euros who usually perform well at States, and he was second to Walmsley at Tarawera earlier this season, though not really without shouting distance.

7. Ian Sharman
Final 2016 GUR: 3
Current 2017 GUR: 1528
2016 WS: 6
I'll pick him to finish in the top ten every year.  More dependable than taxes.

8. Thomas Lorblanchet
Final 2016 GUR: NA
Current 2017 GUR: NA
2016 WS: 4
Fourth in 2016, fifth in 2015.  Pretty safe bet he'll be up there again.

9. Brian Rusiecki
Final 2016 GUR: 2
Current 2017 GUR: 5
2016 WS: NA
The perennial UROY contender and 2015 GUR #1 makes his long-awaited WS debut.  Brian usually excels on more technical tracks, and so the WS trail might not quite be in his wheelhouse.  But he's incredibly smart and tough, and he comes in off one of the best stretches of his career, including his recent runner-up finish at Cayuga Trails.

10. Mark Hammond
Final 2016 GUR: 8
Current 2017 GUR: 57
2016 WS: NA
Maybe a little bit of a dark horse here, but I like his form recently, particularly a runner-up finish to Nichols at Run Rabbit (ahead of Browning), and a smoking 14:49 at the Salt Flats 100 in April.

Hedging my bets
11. Tofol Castanyer
12. Paul Giblin
13. Jared Burdick
14. Dominick Layfield
15. Zach Szablewski

Pre-Western States GUR Top 50 (as of 6/16)

	Men	State	Points	Women	State	Points
1	Sage Canaday	CO	126.4	YiOu Wang	CA	191.5
2	Max King	OR	125.5	Camille Herron	OK	178.1
3	Jim Walmsley	AZ	118.5	Magdalena Boulet	CA	95.3
4	Chris Mocko	CA	107.1	Ladia Albertson-Junkans	WA	74.5
5	Brian Rusiecki	MA	96.3	Kaci Lickteig	KS	71.8
6	Tim Freriks	AZ	71.75	Jacqueline Merritt	GA	61.7
7	Hayden Hawks	UT	68.5	Sabrina Little	TX	59.25
8	Cody Reed	AZ	63.6	Courtney Dauwalter	CO	58
9	Chris Raulli	NY	55	Amanda Basham	UT	48.5
10	Tim Tollefson	CA	52.5	Marianne Hogan	CO	48
11	Dakota Jones	CO	45	Kaytlyn Gerbin	WA	46.8
12	Chikara Omine	CA	43.9	Hillary Allen	CO	46.7
13	Michael Owen	OH	43.5	Kathleen Cusick	FL	46.5
14	Matt Flaherty	IN	40.75	Camille Shiflett	WI	45
15	Justin Ricks	UT	40	Cassie Scallon	CA	43.7
16	Zachary Szablewski	WA	38.5	Stephanie Howe Violett	OR	40
17	Franz van der Goen	CA	38.2	Nicole Kalogeropoulos	TX	38.5
18	Masazumi Fujioka	WA	38.2	Megan Roche	CA	35
19	Ed Ettinghausen	CA	38.05	Rachel Drake	OR	34.5
20	Ryan Kaiser	OR	35.8	Ashley Nordell	OR	33.75
21	Dylan Bowman	CA	35	Devon Yanko	CA	33.6
22	Scott Trummer	CA	35	Dani Filipek	MI	32.5
23	Ronnie Delzer	TX	33.9	Janessa Taylor	OE	31
24	Matthew Thompson	VA	33.5	Gina Slaby	WA	30.6
25	Paul Terranova	TX	32.3	Shandra Moore	TX	30.2
26	Jean Pommier	CA	31.65	Julie Koepke	TX	29.9
27	Dominick Layfield	CA	31.2	Rachel Jaten	WA	28.9
28	Anthony Jacobs	TX	31	Sheila Vibert	VA	28.9
29	Travis Morrison	UT	29.9	Penny McPhail	CA	28.3
30	Ben Koss	CA	29.75	Caroline Boller	CAN	28
31	Cole Watson	OR	29.5	Meghan Arbogast	CA	28
32	Bob Shebest	CA	29.4	Molly Schmelzle	OR	26.9
33	Olivier Leblond	VA	28.6	Kirsten Hite	FL	26.3
34	Avery Collins	CO	28	Amy Macintire	TN	25
35	Ryan Bak	OR	27.25	Julia Stamps	CA	25
36	Jesse Haynes	CA	26.9	Rachel Entrekin	AL	25
37	Mario Martinez	CA	26.1	Bree Lambert	CA	24.9
38	Joe McConaughy	MA	25.025	Katalin Nagy	FL	24.9
39	Tyler Jermann	AZ	25	Jenny Hoffman	MA	24
40	Michael Daigeaun	PA	23.4	Alicia Hudelson	GA	23.9
41	Jason Schlarb	CO	23.05	Shawn McTaggert	AK	23.5
42	Ryan Ghelfi	OR	23.05	Meg Landymore	MD	23
43	Jean-Bernard Flanagan	IL	23	Chavet Breslin	CO	22.5
44	Matt Smith	TX	23	Karen Holland	CAN	22.5
45	Alex Nichols	CO	22.5	Amy Rusiecki	MA	22
46	Rob Krar	AZ	22.5	Camelia Mayfield	OR	21.9
47	Tyler Green	OR	22.5	Michelle McLellan	TN	21.5
48	Drew Macomber	CA	21.7	Addie Bracy	CO	21
49	Noah Brautigam	UT	21.7	Katrin Silva	NM	21
50	Patrick Caron	MA	21.5	Keely Henninger	OR	21

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.