Friday, July 30, 2010

More Abnormalities!

Recently I went to see Dr. Jordan Metzl, sports doctor for the stars, about the chronic back pain I've been having during cycling.  Dr. Metzl is a contributor to Triathlete magazine, Ironman finisher and all around awesome advocate and supporter of athletic pursuits.  I knew him from my days with Terrier Tri in Manhattan and had visited after him IMLP to talk about the stress fractures that I developed in each shin during that race.  This time around the situation was a bit more serious as my chronic back issue has seriously been affecting race day performance.

On my flight back from Seattle a week or two ago after having made my appointment with Jordan, I came across one of his articles in Triathlete magazine.  The stars were aligned as his most recent article was on pain in the sacroiliac joint; the article described the issue I was having perfectly!

The great thing about Dr. Metzl is that during my appointment prior to asking me any medical questions or rushing me out of his office he took the time to ask me how triathlon was going, talk to me about my latest races and tell me about his pending plans to compete in IMLP.  Then after a quick examination (his article made it pretty easy to tell him my problem) he triumphantly shouted - I can fix you!  Gave me a fist pump and was off to get me the info for the physical therapist who would put me through pain towards health.

I've now been to Chris and Ali at Vitaris Rehabilitation a couple of times.  They diagnosed the cause of my problem as a leg length difference!  Currently we're working through determining if the leg length difference is an anatomical or functional problem.  The functional issue of a pelvic tilt needs to be addressed first this requires a ton of stretching that has me sweat like a pig and put my abs into spasms but all that is an effort to level off my pelvis.  After a few weeks of torture Chris and Ali will re-valuate the problem to determine if there is an anatomical difference between the bone structure in my legs.  If so I'll need to wear a lift in my left shoe while running and biking so that I'm on a level surface.

The leg length discrepancy has caused my right side to basically compress on itself to artificially level off my pelvis during exercise.  This compression is causing my sacroiliac joint to spasm which starts as an ache in my    lower right back, turns into a shooting pain and then eventually the pain radiates from my back to my right hip.  When that happens I loose the ability to generate power with my right leg on the bike and it kills my speed.  The off season is time to fix stuff so hopefully I can get this leg length issue taken care of and then really get after cycling!

Tuesday, July 27, 2010

Huge Shout Out - Jon Paladini

For the past year or so I have been helping out my younger sister's best friend's younger brother, Jon, prepare for Ironman Lake Placid.  Jon was diagnosed with Chron's Disease when he was just a kid and really struggled to get the disease under control as a youth.  Over the years he became really interested in fitness and nutrition and will soon graduate from SUNY Cortland with a degree in nutrition and physiology (or something close to that).  Anyway, just over a year ago I received an e-mail from him on Facebook asking me about Ironman Lake Placid and telling me he was thinking about signing up for the race.

I had warned Jon about the time commitment training for an Ironman takes and that the Ironman won't go anywhere but you're only in college for a finite period of time.  He was fully prepared for the commitment and seemed hell bent on crossing the finish line so I told him I'd help with whatever he needed during his preparation for the race.  With that he drove up to IMLP last year to sign up for the long journey to the starting line.

Over the course of the year Jon prepared for the race all on his own.  From training to nutrition he read books, found outlets online and asked questions to develop his own training plan and nutrition protocol.  I was a bit worried when he told me his main source of nutrition on the bike would be Fig Newtons, but hey if it worked for Dave Scott in the 80s' I guess it was "ok" to break out the history books and try it again.  We went on a couple rides together, I talked to him about cadence, gave him a set of my old clip on aero bars and discussed how the Ironman is way more mental than physical.

Leading up to the race we continued to exchange e-mails, he told me about sleeping on an air mattress in his friend's apartment on weekends because there were too many parties on his floor, asked me what the worst long training ride I went on was, and picked my brain about running form and things like that.  All in all I think I was just a resource for him not to feel like he was the only person who had thought "what the hell did I get myself into."

Knowing how much work he had put into the race there was no way I was going to miss cheering Jon on at IMLP this year. The Friday before the race I sent some text messages to people who were going to be at the race to see if I could find some floor space to crash on.  Of course Jon's sister came through and away I was from my parent's house to Lake Placid to watch the race as spectator for the second time.

Heading into the race I was worried for Jon.  Like I said he had the 1984 nutrition plan and he had only done two sprint triathlons prior to the big day.  I knew he would cross the finish line but wondered if the Fig Newtons would give him the energy needed to perform well.  Holly Cow did he SHOCK ME!!!!

Although he had won his age group in his last sprint triathlon I never expected him to lay down a 12:31 FOR HIS FIRST IRONMAN!!!!!!  On a training plan all his own, dealing with the stresses and weird schedules of college life, on a nutrition plan to fit a college budget Jon freaking crushed the Ironman Lake Placid course; 12:31 is a great time for any Ironman, but freaking incredible for a first one!  Congratulations Jon, you've come a really long way since you started to win your fight against Crohn's disease!  I'm incredibly honored that you let me be a small part of your journey to the finish line - you are an Ironman!

Tuesday, July 20, 2010

IM Aftermath on Basal Rates

For the past few weeks I've been traveling between the East & West coast interviewing for jobs that will be the first step in my post-MBA career.  Over that time I've had to pay extra special attention to my blood sugars as breaking out in a full sweat while interviewing with a Senior VP at a multi-billion dollar company isn't the best way to make a first impression!  That's given me the opportunity to really see what effect recovery from an Ironman has on blood sugars and basal rates.

In the week following IMCDA my basal rates slowly climbed from the 11ish units per day my basal was set at on race day.  Towards the end of the week my blood sugars were consistently in the mid 200s to low 300s.  As my muscles recovered from a brutal training year and arduous race alot of insulin was needed to transport glucose from my blood to my muscles for the recovery.  8 to 10 days after the race my basal rate had jumped about 5 points to 16 units per day.

As I began to do some unstructured workouts and my sleep schedule returned to normal my basal rate started to slowly fall.  Last Monday, some 2 weeks after the race I started to encounter low after low.  My Dexcom would wake me up several times a night with a low alarm, and during the day I'd constantly be fighting my way out of the 70s.  Finally my metabolic rate had returned to normal, my body finished it's aggressive recovery and I have reduced my basal rate to about 13 units of insulin per day.

The variation of blood sugars and basal rates has all sorts of short-term consequences on one's mood and energy.  All the lows I encountered as my basal rates returned to normal forced interrupted sleep and had me exhausted in the mornings.  Additionally, the high blood sugars after the race increase irritability and really just made me feel kind of "icky."  Active management of my blood sugars with a focus on basal rate patterns was necessary to get back to feeling like myself as quickly as possible.

Monday, July 5, 2010

Compete Each Mile: IMCDA Race Report

Determined not to have to borrow just about every piece of triathlon gear imaginable like I did for California 70.3 I flew out to Coeur d'Alene the Wednesday before the Ironman with a death grip on my triathlon back pack.  I figured I had built up enough goodwill points with the airlines by always stowing my carry on under the seat in front of me to have one flight where I could jam a big backpack into the overhead bins without feeling guilty.  With my triathlon gear in hand I arrived at my beautiful lake front condo on June 23rd feeling amazingly confident and calm.

As the week progressed I was shocked at the contrast in my attitude and demeanor towards my second Ironman than at IMLP in 2008.  It's not that I didn't feel nervous, it was more that I felt like an athlete and less like someone to prove.  I was excited to take on the distance, to strut my stuff for 140.6 miles and was determined to give the race everything I had.  In speaking with Coach Orton in the days leading up to the race my only goal was to compete for every mile.

The days leading up to the race had my blood sugars doing some really funky things.  E had warned me that I might become extremely hungry during my taper as my body recovered from a years worth of the training hell he created for me.  In the 10 preceding days to IMCDA it almost seemed like I didn't need any insulin to cover the food I was eating.  Of course this would be a welcome gift to any Type 1 but..... in the week leading up to an Ironman I'd rather have business as usual with the blood sugars.  Even though my training volumes had dropped way down my basal rate went from about 13.5 units per day the Monday before the race to 11 units per day the Saturday before the race.  Just something I was going to have to deal with, no freak outs were allowed.

Race Day

After a week of doing pretty much nothing I was itching to go on Sunday morning.  I woke up at 4am, had my fruit shake, hopped on a boat with my flippy floppys (Arrowhead resort made my race day commute the easiest I've ever had!) and headed over to transition.  At transition I popped on my race day Ipod play mix and got deeper into my own world.  Calm, confident and anxious were the 3 words that described me best in the hours before the race.  I knew I had put in the work, now it was time to have some fun.

I unfortunately was not able to drop the kids off at the pool prior to the race.  As hard as I tried nothing would happen.  As much as I try and practice race day bathroom habits I just can't seem to get it right.  So after 20 minutes in a port-a-potty and nothing happening I figured I'd have to take a quick break at some point during the race.  After my trip to the plastic throne I stripped out of my morning clothes, donned the Triabetes jersey, lubed up with some body glide and was off to the beach.

The Swim

My only complaint about the race organization was that the path to the swim start was not sectioned off from the spectators like it is at IMLP.  2,700 athletes had to fight their way through friends and family to make it to the one entry way that activated our timing chips; nothing like adding a rush hour bottleneck to the high stress environment of a IM swim start.  The first time I made it through to the timing mat pretty easily; I made my way from transition to the entry way at 6:15 am; but much to my surprise I couldn't find a medical needs table at the swim start or finish so I had to return to transition to put my blood sugar meter and Dexcom in my swim to bike transition bag.  God however was smiling down me, threw the throngs of people and faceless crowd I spotted a "Ring The Bolus," t-shirt on my walk back to the transition area.  Serendipity was in full effect as I ran into my parents and friends on my hectic fight to find refuge for my diabetes gear; with a bear hug for my Mom and high-five for my Dad I smiled at this awesome stroke of luck.

I returned to the beach, got into the water for a quick warm up and was kind of surprised at how cold my back was.  After a 10 minute warm up I got out of the water and realized that the zipper on my wet suit had fallen down, no wonder I was so cold!  However, the open zipper caused the gel I had planned to take between lap 1 and 2 of the swim to fall out of my wet suit so I had to adapt my race day plan.  I wasn't too worried about the short fall in carbohydrates.  Prior to leaving my bs meter in my transition bag my blood sugar was 285 and that was prior to my final liquid fuel up so I was pretty sure my bs would be in the 300s at the swim start; high but I'd rather be high than low during a swim.

Coach Orton wanted me to start in the front 1/3 of the field for the swim.  I stupidly took this to mean to start in the second row.  As Mike Riley got the athletes and crowd pumped up with his unreal enthusiasm and energy I wondered if I should move back just a bit.  Too late!  Before I knew it the gun went off and I was charging into the water ready to get the day underway.  For the first 500 meters I totally got my a** kicked in the water; even though I'm a strong swimmer I'm not one of the fishes so for a brief moment thought of bowing out of the race before my day ever really started.  I slowed my breathing, cleared my head, remembered that I had started way too far up in the field, found some open space and regained my composure.  Freak out # 1 of the day was under control and I was settling into my race.

The IMCDA course has 2 turns during the swim in pretty close proximity.  If you want to know what the turns feel like, cram yourself into your washing machine and have someone hit you over the head with a rubber spatula.  50 at a time we bobbed water around the turns and laughed together that this was more like a pinball machine than a swim.  Finally able to get horizontal again I finished my first lap right around the 35 minute mark - perfect, just where I wanted to be!

After a short beach jog I returned to the water for my second lap.  The water was pretty rough for the second lap and on the way out I had to fight swells and waves to make it to the turn around.  Although it wasn't overly windy the water still felt pretty angry, so I shortened my stroke and kicked a bit more to combat Poseidon.  This time around the 2 turns had a bit more space but were still crowded.  I took two good kicks to the chin around the turns, one of which had me seeing some stars.  Eric had told me to embrace the physical nature of an IM swim rather than getting pissed off about it, so rather than bite the dude's ankle who kicked me in the face I decided to blow by him and beat him out of the water.

I finished the swim in 1:14, 7 minutes off my dream goal but more than 5 minutes faster than my IMLP time; the day was off to a great start.

The Bike

After a T1 which took an eternity; taking my pump out of its water proof case, reattaching my pump clip, drying my hands to test, attaching my Dexcom, and taking in a gel, I grabbed El Bastardo and was off.

Coach E had laid out an awesome bike plan for me; take the first 8 miles to settle into the race at zone 2, don't get caught up with people hammering past me, spin up the hills, elevate my heart rate on the flats and stay within myself.  I stuck to this plan as closely as possible and felt outstanding.  I was in my own world on the bike, I was having fun, smiling and treated it just like another training day.  When I had driven the course prior to the race I was pretty uninspired, but driving and riding the course were 2 totally different worlds.  CDA is an AWESOME bike course, it doesn't have a consistent personality and you need some serious handling skills to attack some of the descents so the course requires a ton of focus but is fun enough to keep your mind fresh - it's alot of fun.

I started on the bike well out side of zone 2, the adrenaline from my swim and normal race day jitters had my hr elevated.  About 2 miles into the bike I settled in, got my heart rate into the 130s and just cruised.  My cadence was high, my back felt great and I was having fun.  I easily spun up the first hill towards Higgins Point, and the second felt even easier.  On the downhill I started to dig into my aero position, tucked a little tighter and opened my legs up just a little bit.  At that point I started to reel in some people but continued my somewhat casual effort.

Finally, I reached mile 10 and was thrilled to up my effort to zone 3.  Now, it was time to race!  I felt freaking awesome, my heart rate was below 145 and I was actually passing people on the up hills.  Apparently all those rides that almost made me throw up on the Blue Ridge Parkway paid off.  I would spin up hills only to have 3/4 of the people who I had passed on the uphill bomb past me on the downhills.  I knew by the second lap their strategy would take a toll on their legs so I continued to stay the course and stick to the plan.

Around mile 35 my back started to tighten up.  I wasn't super worried about my back at this point but am a little aggravated that no matter what I do to try and solve my back issues on the bike I just can't seem to get it right.  Since the off season is all about fixing things I'm seeing an orthopedist on July 19th to figure out what the heck is going on.  I finished the first 56 miles of the bike in just under 3 hours and made it to the special needs area of the bike in 3:06 - 60 miles in 3:06, not too shabby!

At special needs I made my first major mistake of the day.  My blood sugar was 256 and I knew I needed to get it down so I took in .3 units of insulin.   For me exercise essentially makes a bolus 2X stronger than normal so I figured the .3 units would bring my blood sugars down to the 170s.  In my special needs bag I also had a Snickers Bar.  During all my century training rides I have a Snickers bar around the half way point. However, during training I normally take a break, and sit in the shade for a few while I chomp on the nuget and caramel.  I took in .6 units of insulin for the chocolate but then forgot to continue with my regular scheduled feed intervals.  Around mile 70 or 75 I started to feel really sick and my effort dropped way off.  At that point I realized I was trending low as I checked out the pattern on my Dexcom and started to take in nutrition like a mad man.  To combat the adversity I made a promise to myself to work as hard as I could to get to the bathroom at mile 90.  My bowels finally decided they wanted to make a move around the same time I was trending low so I thought I'd play the 2 against each other to save me from a really painful and dark period of the race.

Finally I reached the porta-potty, got off my bike and dropped the spandex.  Stomach relief at last!  I tested and had a blood sugar of 160 and then started to feel alot more stable.  10 minute later (literally, I timed it) I was back on my bike and off to finish up the final 22 miles of the bike course.  At this point my back really started to act up.  The only way I could get relief going up hill was to pedal with my hands on top of the pads on my aerobars.  This took some of the power out of my legs but I was able to climb the hills pretty effectevley.  Headed back into town the wind had picked up a bit so the stretch along 4th St. and Gov't  Way was a bit slower than in the first lap.

I finished the bike course in 6:09, slower than I know I'm capable of but still pretty solid.  I averaged 18.2 mph on the bike, the goal was 19 but with the blood sugar mistake and bathroom break I couldn't be happier with how the bike went.

The Run

T2 went much more smoothly than T1 and I was off to the races.  I came off the bike with a blood sugar of 158, took in a gel to start my run, tossed on my fuel belt and was ready to rock n' roll.

The goal for the run was to get my legs back over the first 4 miles, run at a steady pace from mile 4 to 20 and then empty the tank for the last 10k.  Mile 1 and 2 were run exactly to plan.  I opened up in an easy zone 2 at a 9:30ish pace.  But as I passed by the 2 mile mark my legs started to feel like they were stuck in mud and my mind became fuzzy - I knew what that meant.  I took in a gel, stopped for a quick bathroom break and tested.  My blood sugar had dropped 70 points in the first 2 miles of the run, but I caught the low before any real damage was done.  I grabbed a gatorade, polished off a fuel belt bottle, had a quick stretch and walked for the next mile.  After a mile I tested again and had a blood sugar of 170 - I upped the pace but just couldn't get my mind into it.  I tested and had a blood sugar of 295 - the more than 300 point yo-yo had me feeling awful but I was determined to keep moving forward.

For the next 8 or so miles I ran at a 10 minute pace and walked each aid station to take in as much water as possible.  It also didn't hurt that CDA has some of the best looking aid station volunteers of any race I've done!  I was a particular fan of the aid station captain right before the uphill at the mid-point of the run; even gave her a high-five which during an Ironman is pretty much as good as getting her number, right?

Slowing my pace over that 8 mile stretch worked, my form returned and my blood sugars became stable.  From mile 14 to 22 I was able to run at a 9:30 pace; Coach Orton had me prepared for this race, all that training, all that work was paying off.  Around mile 23 my tank was pretty empty, as hard as I tried to crush the last 3 miles my legs couldn't muster up much more than a 9 or 10 minute pace.  It didn't matter though - when I turned the corner into downtown CDA I can't remember a time that I was happier.

The Finish

Running down the crowd lined blocks was flat out awesome.  I entered the finishing shoot, flapped my arms to the crowd, gave some kids a high five and nearly had my muscles pop out of my arms as I crossed the finish line.  My only goal for the race was to compete within myself for every mile and I did just that.  I took an hour and 16 minutes off my Placid time and while my ultimate time goal was to break 12 hours, finishing in 12:42, 916th overall is just plain awesome for me.  I'm not sure after Placid I had the respect for the Ironman distance the race deserves.  I knew that covering the distance was an incredible feat but I didn't know what it meant to be able to compete for the entire distance.  I had, had so many blood sugar issues during Placid and was so new to the sport I didn't know what it all meant.  At CDA I wanted to really see what I was capable of, I wanted to test myself and just get after it.  I left everything I had on that course and know I have a ton of work left to do to get to where I want to be in triathlon.

Coach E wanted me to have a mantra on race day; I had 4 quotes written on an index card in my tri jersey:

"Success is not final, failure is not fatal, it is the courage to continue that counts."  ~ Winston Churchill
"He is able who thinks he is able."  Buddha
"You can't cross the sea merely by standing & staring at the water."  ~ Rabindranath Tagore

and my personal favorite from the day that I repeated every mile of the run:

"What lies behind you & what lies before you pales in comparison to what lies inside of you."  ~ Ralph Waldo Emerson

I have some long conversations to have with Coach E in the next couple weeks to determine what direction we'll take my endurance sport career.  I might try my hand at track cycling but at this moment I still can't stop smiling because for each mile of that race I competed the way I wanted to and gave it everything that I had.