Thursday, February 25, 2010

Oh The Torture – Recovery Week

Maybe my friends are right, maybe I totally bat sh*t crazy and a sadist. I FREAKING HATE RECOVERY WEEKS. Yes by the end of my 70 mile ride and 10 mile run on Sunday my legs were toast, and yes my wind was weary from 40 hours of training over a two week period. But you know what, I love that feeling, I love being run into the ground, I love having my mental fortitude tested, not to prove anything to anyone, just because I love that challenge, it's what I crave. This week however my volume has been cut way down as Coach Orton is giving my legs a week to rest before a huge ramp up before Cali 70.3.

The past few nights I've felt jumpy as I've tried to fall asleep because my energy level is sky high. I've tried to maintain my food intake so that I cover any carbohydrate deficits that built up from the previous two weeks but when you go from 4 hours a day of training to an hour you simply aren't as hungry. Additionally, my blood sugars always get a bit whacky during recovery weeks. Normally I work out in the morning and then again mid-day but with just one workout per day I've been trying to get some extra rest. This has caused my blood sugar from 10am to 2pm to need about 1.3 times the basal rate it normally does. I need to create a new basal profile for recovery weeks and light training days but creating one on my Medtronic pump is way less efficient than it should be. So I've been managing my blood sugars with additional boluses throughout the day.

So yes, it's torturous for me not to have that burning in my legs, the ache in my back and the thrill of an all out crazy workout to look forward to each day. I can't wait for this recovery week to be over and really get after it over the next two weeks. This weekend I'll finish up my Q3 finals then head to Portland for some interviews on Wednesday, out there it's mainly a run camp but upon my return it's training week hell. The second week in March I decided not to go on Spring Break with my friends, some are headed to Egypt, Bahrain and Costa Rica, to train. The decision was two fold, without a firm job offer yet I didn't want to add additional loans and my main focus for the year is on IMCDA; I had an incredible time in Stockholm last year but at this point additional loans would be a tough pill to swallow. So for that second week in March Coach Orton has promised me all the pain I can handle – I can't wait!

Monday, February 22, 2010

Way To Go Kris Freeman

Kris Freeman is America's top Cross-Country skier, he is also a type 1 diabetic. On Saturday Kris was competing in the 30 kilometer mixed-style pursuit race. The race itself takes a heck of a lot of endurance and the athletes who race this distance are in insane shape. However, the race had temperatures reaching into the mid-50s; anything but normal conditions for a Nordic event.

Kris Freeman was well poised to medal in the event, about halfway through the race he was in sixth place, hanging with the pack and looking strong. Then like so many of us have had occur, the blood sugar demons attacked. Kris' pace fell of sharply and he eventually collapsed on the snow, a German coach rushed to his aid giving him some Gatorade and Gu which elevated Kris' blood sugar level so he could continue racing. While I'm sure it is a huge disappointment for him not to have medaled but his 45th place finish after facing the blood sugar demons is more inspiring to me than a gold medal.

Every athlete in the Olympics has faced challenged and adversity. Each athlete is in incredible shape and probably has a resting heart rate in the 30s! On an athletic level they all work tremendously hard, they all have sacrificed so much for sports that they love. But for us type 1 diabetics we can associate with Kris Freeman, how many races or days at work have we had to salvage due to a low blood sugar. How many of us have had a goal time or place be swept away from us because something screwed up the blood sugar management system. Kris' race on Saturday reminded me that each time I toe the starting line I'm racing two battles. I'm racing against my competitors and I'm racing against the demons. While I am 100% mentally past the barriers that my diagnosis presented the blood sugar management challenge is always there. The conditions on Saturday totally screwed up Kris Freeman's blood sugar management system, he may have fallen well past his Olympic goals but Saturday was a huge win for diabetic athletes all over – in the face of adversity we all will preserve.

Friday, February 19, 2010

When It Clicks

On Wednesday I had my hardest training run yet under Coach Orton. The workout had a nice 15 minute warm up then four, eight-minute speed intervals at a 7:30 pace with three minutes of recovery pace between each interval. Five years ago when I had lost my athletic focus, weighed more than 250 lbs. and thought that lifting beers was a good way of training I would have called you crazy had you told me I could have nailed a workout like that. But now three years into my triathlon career I'm starting to shock myself as my heart rate continues to slow and my pace continues to accelerate. Deep down inside I'll always consider myself that overgrown 20 year-old trying to get his forty time down for football; although now I'm quietly starting to admit to myself I've become a triathlete.

The amazing thing about the run on Wednesday was how unbelievably happy I was during it. I've been pretty stressed recently as I try and lock down my post-MBA employment or figure out which part of my body I'll need to sell to science to pay back my loans. It will never cease to amaze me how a great workout can wash everything away and just make me smile. Back in the day the second I stepped on the field it didn't matter what went on during my day, those few hours at practice were always awesome – swimming, biking and running has quickly provided that same solace for me. When I got to Sugar Hollow, saw the trees covered in snow, drove past a flock of wild turkeys and heard the rushing water of the thawed creek I had about as big a smile on my face as possible.

I think at first hard triathlon work outs thrilled me because it was in those moments I felt like I was still the same person I had always been, that diabetes didn't fundamentally change me. I mean I know I signed up for my first Ironman to prove that my illness wouldn't limit what I could accomplish, a lot of that was to inspire others but a part of it was also my way of dealing with my diagnosis. Now, I've mentally moved past proving that this disease hasn't changed me, I'm confident in my blood sugar management skills and know 100% that this disease will never limit me, I've learned what I need to do to control it so I can challenge myself. Sport has returned to what sport has always been to me – the most pure, amazing and thrilling experience I can fathom. When I'm out training in any of the disciplines I don't think about anything but what my body can accomplish, I focus on my breathing, my senses are heightened and my mind is as sharp as it ever is. When I'm out there it's about nothing other than the enjoyment I derive from training and how beautiful the world looks to me in those moments. It's kind of weird that I can think the world looks beautiful when I have snots running down my face, am covered in sweat and about to throw up but hey we all have our quirks.

So back to the training, the thing that shocked me most was that I got faster during each of the 8 minute intervals. And the great thing is I don't care that I'm getting faster, I just care that I'm enjoying each workout more and more. I never would have thought that on my fourth speed interval I'd have a smile on my face, laugh at the end of it and say "I wish Eric had given me one more." Who knows if it was my performance at SC that gave me the confidence to push the envelope again, or if something else just clicked. But right now I feel like I'm as good or better shape than I have been at any point in my life and am ridiculously excited to get this tri season underway.

On a side note is anyone else obsessed with Curling? I'm mesmerized by that sport! The Olympics are just so freaking cool.


Monday, February 15, 2010

Even With Snow The South Is Still Paradise

Friday morning I finished up a great swim before class and could hardly contain my excitement for my training weekend down in Rocky Mount, NC. My swim on Friday set the tone for what would be a flat out awesome weekend, I finally felt fast and confident in the water again. Some guy even asked the lifeguard if it was the "swim team and if the pool was open, because that guy is really moving." I laughed quietly on that one, the UVA swim team is smoking fast and I can't hold those dude's Speedos!

After class I finished cooking my shredded chicken with black beans, ground buffalo and whole wheat pasta – packed my cooler and was off. I arrived at my hotel in Rocky Mount around 7pm, threw my chicken and beans in the microwave to eat while watching the opening ceremony of the Olympics. I ate the chicken a bit too fast and actually started feeling a little sick after I ate. I also didn't use the dual wave function on my pump well enough and wound up going low so I had to eat a few clif bars and other treats. I then also started to feel really really sick and wound up puiking my guts up as my blood sugar started to rise. This wasn't the best start to the weekend and I felt up feeling not so great on Saturday but hey part of triathlon is fighting through some adversity so I wasn't too worried.

Unfortunately, it snowed across all of eastern North Carolina on Friday night, channeling my days in Mahopac; I gave myself a 2 hour delay. Instead of starting my ride at 8am I started my ride at 10am so the sun had a chance to come out and the roads had a chance to dry. I loaded the ride I picked out from onto my Garmin and set out on my 100 mile journey. The first 50 miles of my ride were MISERABLE! The temperature when I started my ride was 32 degrees; there were still some flurries and the roads were still kind of wet. About 20 miles into the ride my blood sugar dropped to 92; because of the two hour delay I gave myself two units of insulin for the clif mojo bar I had at 7am and 1.5 units of insulin for the 2 pieces of whole wheat toast with almond butter I ate an hour and ½ prior to my ride. I think I had too much IOB (insulin on board) causing my blood sugar to drop quickly over those first 20 miles. However, the worst part my zipper on my winter cycling jacket broke! I rode about 10 miles from the time my zipper broke until I found a gas station where I bought some safety pins to at least keep my jacket somewhat together.

After I got through the first 50 miles with a broken jacket, a blustery head wind and some sketch towns the second half of the loop was like Shangri-la. The tax bracket of the second half of the loop was considerably higher than the first half of the loop. I was also sheltered from some of the wind so I was actually able to ride and wasn't half as miserable as I was during the first 50 miles. However, my back did start to bother me on the second half of the loop and I had major problems getting into the aero position. Normally I remove the arms from my cycling jacket to turn it into a vest but because of the cold I kept them on for this ride – big mistake. The zippers that keep the arms in place put a tremendous amount of pressure on my mid back and biceps so that I felt like I was in a straight jacket anytime I went aero. Regardless I made it through my ride averaging 18mph. I finished with a blood sugar of 152 and went for a 10 minute brick just to get my legs used to feeling like two lead bricks.

When I finished I drove over to McDonalds for french fries and coffee, then hit up Sonic for a shake. Once I got back to my hotel room I showered up, flipped on the Olympics and around 7:30 pm ate my dinner. My whole wheat pasta and ground buffalo was deeelicious! However, I was fighting off lows the entire night and wound up eating at least 3 clif bars of different varieties, a snickers bar and drinking a whole lot of odawala super food. I woke on Sunday reminded of how I felt during 2-a-days during college football: dreary eyed, sore legs, a tired mind and dreading just getting out of bed. I learned my lesson from the day before and was happy to see the temperature had warmed up. I jerry-rigged my zipper so that it would hold my jacket together, took the arms off and wore my merino wool jersey with warmers for more flexibility and comfort. More importantly I took in half the amount of Insulin from the prior day for the same amount of food and encountered no lows during my ride!

This ride started off with temperatures in the low 40s and reached the upper 40s by the end of the ride. My legs were tired but as soon as I started my 51 mile loop I felt fresh; the lactic acid started to leave my legs, my mind became clearer and my intensity increased. I stayed in zone 2 for most of my ride because really pushing it had my back screaming but I was able to stay aero for almost the entire ride. The biggest limiting factor to my speed was the pain in my back and legs, Coach Orton and I need to determine if that pain is from a lack of muscle fitness and fatigue or if there is something out of whack with my position. I may go into UVA's "Speed Lab," to have them test out the biomechanics in my position. If I can figure out how to quiet the pain in my back I can post some seriously fast times on my bike. I finished my 51 mile ride with an average pace of 17.8 mph, fueled up a bit with coffee, water and a clif builder bar and set out on a 2 hour run 20 minutes later.

My run was fantastic! During my ride I had found a great 6 mile stretch that had some great hills to run and beautiful scenery. I crushed the first 10 miles of my run, my pace was between 8:40 and 9:05 the entire first 10 miles and I only walked for about 30 seconds to adjust my fuel belt bottles. At mile 10ish my blood sugar started to go a bit low but I knew I had enough in the tank to power through. With my quads screaming I trucked it back to my car and finished my run with an average pace of 9:03; not bad after 150 miles of riding! From there I stopped at Wendy's on my drive back to Charlottesville and had 5 slices of pizza for dinner - ahh the benefits of 14 hours of training!

For nutrition during my rides I followed my usual protocol; on the bike I had a water bottle every 1.5 hours, each bottle had 2 scoops carbo-pro, 2 scoops EFS first endurance, 4 thermolyte salt tablets and a ½ scoop of cytomax pre-formance. For the 100 mile ride I also had 2 clif shot gels and a clif bar; that wasn't necessary for the 50 mile ride though. For my run, each 2 hours I have the same nutrition mix as my bike bottles but also run with a Nathan back pack for all the water I can drink – that has made a HUGE difference in my training. Recovery from this weekend will be tough because all in I need close to 5,000 grams of carbohydrates to cover my nutrition needs over those 2 days. There's no way I can take that in during a short period of time so I'll be eating extra in a healthy way all week to avoid a big carbohydrate deficit. I'll also have to carefully monitor my blood sugars for the next couple days because the chance of a low after that much training is greatly enhanced.

In a word this weekend was INCREDIBLE. Eric sent me a quick note on Friday night instructing me to "just have a blast," over my training weekend and a blast I had. Outside of talking to a few people at stores I stopped in to pick up supplies I hardly spoke with anyone over the course of the weekend. After near constant networking over the past couple months as I continue to pursue my post-MBA dreams this was totally refreshing. Additionally, I had the opportunity to just focus on my training, test myself to see where Eric and I stand in my preparation for Cali 70.3 and IMCDA and find out if all the work I've been putting in has had tangible improvements. As I drove home Sunday from North Carolina I let out a "woohooo" in my car over the excitement from my weekend. As I said on Thursday I wasn't worried about covering the distance, I just thought I'd be a whole lot more miserable covering that distance than what I was. My blood sugars were a bit more variable than I would have liked but I performed way better on my run than I ever would have thought – without any recovery or rest I basically equaled the time from South Carolina in October; this weekend set the table for what looks to be a flat out amazing 2010.

Friday, February 12, 2010

My Own Private Training He.. err Camp

I alluded to the absolutely awful road conditions in the Charlottesville area during my last post. Between the snow banks left in the middle of the road, the additional ice that forms each morning from the melted snow during the prior day and the fact that the roads are about ¾ of their usual width because of the snow on the sides of the road, it just isn't safe to run or ride outside. Due to my frustrations with the road conditions I suggested to Coach Orton that I drive a little South this weekend so I can actually get in my training. Of course my sometimes sadistic Coach was totally on board with this and decided to turn the weekend into Ed's Personal Training Camp: Where The South Is Anything But Paradise.

This afternoon I'll hop in my car and head to Rocky Mount, North Carolina. The eastern part of NC has gotten far less snow than the western part so I should have no problem getting on the roads to get in some insane workouts. Saturday I have my first century of 2010, followed by a quick 15 minute run to get used to bricks again. Sunday will be another killer day with a 50 mile ride followed by a 2 hour run. The goal is to start building up my endurance for California 70.3 but more importantly IMCDA. I feel like my running and swimming are right on schedule but having done only one outside ride this year has me a bit worried about my endurance on the bike. Eric assures me that the work I've done on the trainer has prepared me for anything I'll encounter on the road but we'll see. Also, I think I finally figured out my back issues on the bike – my saddle was warped, I demoed the same kind and in a 2.5 hour trainer ride I had no back issues to speak of, this weekend will be the big test for that hypothesis.

The crazy part about this weekend is how much food I had to schedule into my routine. This will be the first time since the summer of 2008 where I'm going on my own training weekend and am tremendously excited for it. Prior to IMLP I took a few solo weekend trips Lake Placid to get in hardcore training. I always loved heading up there to just focus on what I needed to get done. Last night I cooked up some shredded chicken in my crock pot and rinsed some black beans which I'll cook during class today. After class I'll brown up some ground buffalo, boil my pasta and pack my cooler. I have snacks, dinner and nutrition all ready to go; Saturday I'll need about 2,000 grams of carbs and then Sunday I'll need an additional 700 – 1,000 grams of carbs; that's a whole lot of food in one weekend!

Contrary to my training weekends at Lake Placid, I don't view this weekend as a learning experience. I'm confident I can get in the miles, confident that my blood sugars will hold up and am really just enthusiastic about enjoying the experience. It's nice to go train where I'm not worried about having a "breakthrough," or freaking out about being able to cover the distance, really I'm just ready to get after it and have some fun. When not working out my weekend will be filled with academic research on wellness and productivity and reading two new books Slaughterhouse-Five (which surprisingly I've never read) and The Master & Margarita, my two passions will be accomplished, total nerdom and athletic pursuits! Plus is there a better way to spend Valentine's Day than with my true love, El Bastardo!

Wednesday, February 10, 2010

Transitions & The Arctic South

In case you haven't heard the Mid-Atlantic is the new North Pole as we have received about 400 feet of snow in the past couple of weeks. Having grown up in the Northeast, snow normally doesn't bother me but since the Charlottesville plowers like to leave snow banks in the middle of the road it is a considerably less enjoyable experience here than it was up North. Last weekend the Darden folks headed out to Snowshoe, West Virginia for a weekend of skiing, I had planned to return home on Saturday to get my weekend workouts in but opted to leave Friday since I thought dealing with the start of the blizzard would be better than dealing with the aftermath. Six hours and 200 miles later I finally got back to my apartment and was set for my weekend workouts – well the ones I could control.

Last weekend I had a 70 mile bike ride and a little self-directed indoor triathlon with a 2,500 yard swim, 45 minute bike and 1.5 hour run with tempo intervals. Due to the weather the 70 mile ride was changed to a wonderful 2.5 hour trainer ride that totally kicked my butt, at least I could control what happened inside my apartment; a different experience than I would have the following day. On Sunday I woke up and headed to the pool at 10:30 am (it doesn't open till 10am on the weekends), got in a solid swim and then came home for my 45 minute trainer ride, then the fun started. I realized that the roads were in no condition to run on Sunday so I decided to go to the gym to try and get in the 1.5 hour run. There was only 1 treadmill open at the AFC and when the speed got above 4 mph it squeaked uncontrollably, so I opted to get off of that one and wait. 5 minutes of waiting had my blood sugar soar to above 350 and at that point I realized it was time to head home.

Timing is a key component to training with type 1 diabetes. If I wait too long to take in carbohydrates during a training session or race, or take in my nutrition too close to exercise I'll have a low blood sugar event. Conversely, if I take in nutrition too far out from exercise or take in too much during a training session or race my blood sugar will shoot too high. Normally the turnover time for a training session with a brick is 5 to 10 minutes, however the lag time between riding and running on Sunday bordered on 25 minutes. The extra 15 minutes of down time caused my blood sugar to spike to a level not safe to workout with. A quick bolus brought it right back into line but missing the workout was still frustrating.

And it's snowed again last night – hopefully I'll be able to get a run in on the roads today as I really can't deal with the dreadmill.

Monday, February 1, 2010

My MBA & Diabetes Meet!

This quarter I am taking a phenomenal course titled "Health Care Management," taught by one of the leading experts in the field, Elizabeth Teisberg. Professor Teisberg wrote the book on value based health care. Literally, she authored a more than 700 page book on the faults and solutions for the health care system with Michael Porter, arguably the greatest strategic mind in the history of business. The course examines why competition in the health care industry does not add value and simply spreads costs instead of developing more profitable, innovative ways to treat diseases. Last week our case was on The Joslin Diabetes Center!

Some of the interesting business aspects of The Joslin are that the Joslin operates at a loss per patient while their affiliate programs operate at a positive cash flow. Additionally I found out from some of my classmates who are MDs that for non-compliant patients it's a lot better to get them to take care of all their appointments in one day rather than have them schedule several different appointments. That was a bit counter to my experience, when I was a patient at a diabetic center I hated having to spend hours there to meet with several different doctors and also didn't like that I was forced to use who they had on staff. I've been a lot happier putting my own team of experts together who fit my personality and goals but the class all agreed that I'm kind of "weird."

As the conversation progressed we discussed what was optimally needed to treat both type 1 and type 2 diabetics; although the conversation mainly focused on type 2 which requires a different type of management. I believe that since type 1s basically face immediate death if their disease is not kept somewhat in check forces us to be more compliant than type 2s whose symptoms progress at a slower more prolonged pace. While advances in medical technology and blood sugar management ideology have now allowed juvenile diabetics to do everything from playing professional football to competing in the Olympics more can be done to help educate all diabetics alike.

Most of my classmates had the idea that for better integrated health care diabetes centers should include more doctors, cardiologists, podiatrists and any other person that can treat symptoms. My take was in a business symptoms are treated as errors and our goal should be to reduce the number of errors that we have. If a diabetic maintains their A1c below 7 the chance that they will ever need to see a specialist for complications is dramatically reduced. My goal is to never have to see a cardiologist or other doctor to treat me for a complication, my goal is to only see my endo for when I need my A1c tested and to get prescriptions for my own management. So I suggested that diabetes centers should have a mock grocery store, a test kitchen and a gym – that the centers should be focused on preventing the symptoms, not screening for the symptoms. My question was, what if diabetic centers taught patients how to live healthy lifestyles through hands on experience and classes, rather than a ½ hour meeting with a CDE; focus on simple recipes, smart decisions in the grocery store and work outs that aren't intimidating – that is what health care needs to prevent the consequences of chronic disease, not better screening techniques. At that Professor Teisberg was pretty excited and said, that's health care from the patient perspective; I personally would be pretty psyched to find a diabetic center set up like a marriage between the Food Network and ESPN.

That conversation got me pretty motivated and as I went to the grocery store in Charlottesville snow storm last weekend I really focused on healthy choices. I had originally planned to make pork or chicken fajitas for dinner that night, but Kroger only had grass fed beef, not chicken or pork. So I quickly changed the protein and switched to steak fajitas; everything else I purchased was organic and I remained on the outside aisles; the only time I entered the middle of the store was to pick up some diet pepsi, my coffee grinds and 2 cans of tomato soup. Granted, I pursue my blood sugar management a lot more neurotically and aggressively than most would ever want to but the principles are the same, learning how to make smart choices prevents complications, screening for them is when it's too late.