Thought for the Day

Wednesday, July 29, 2009

S.I.P.E. at Mountain Man?

Anne Findlay, one of my Triabetes teammates, suggested that what happened to me at the Mountain Man Sprint Triathlon may have been SIPE, swimming-induced pulmonary edema. After reading about it on Anne's blog and, I think that's a strong possibility.
The idea that the lack of oxygen would affect me like that just didn't make sense to me. I have run several races in the Flagstaff area, including the Flagstaff Marathon, which tops out at over 8600 feet in elevation, and I never felt anything like I did trying to run that 5K at Lake Mary, about 7000 ft.
However, SIPE would explain what happened in the swim, and my weakness for the rest of the day, especially when trying to run. I didn't have the worst symptoms of SIPE, but mild congestion in my lungs combined with the natural effects of altitude provides a good explanation of what happened.
And if I know what happened, I know some things I can do about it:
I can start taking an ACE inhibitor, which can strengthen my capillaries. These are often prescribed for diabetics as a precautionary measure, to protect the kidneys.
I can get more time practicing swimming in my wet suit which I just purchased.
I can make sure I'm warmed up before I start swimming hard.
I can avoid taking electrolyte tablets and drinking a lot of water until after I finish the swim. This may not be the standard advice, but it can help with this problem of pulmonary edema.

Just one more thing to think about and be prepared for.

Tuesday, July 28, 2009

Mountain Man Sprint Triathlon 2009

This is a long story, so I'll just put the short version here at the top for those who don't need all of the details.
The 700 meter swim was one of the hardest things I've ever done in my life.
Except for wiping out 3 times, the bike ride was uneventful.
I could not run during the "run" portion. I don't know if it was exhaustion, dehydration, lack of food, lack of oxygen, or all of the above.
I finished last, but I'm glad I stuck it out and finished.

Now the long story:

Before the Mountain Man Sprint Triathlon Sunday, July 19th, at Lake Mary outside of Flagstaff, I thought I knew that doing Ironman Arizona was going to be very hard. I've done some pretty hard things.
I didn't have a clue.

The night before the race I laid out everything I was going to need for the race on the extra bed in my room in the Budget Host Motel. I made lists of what I needed in each transition:
Transition 0, at the start, Triabetes tri-shorts and top, sunscreen BodyGlide, wet suit, goggles, swim cap, ankle strap chip, gel...
Transition 1, swim to bike, gels, water bottles, bike shoes, helmet, gloves, sunglasses, more BodyGlide, ...
Transition 2, bike to run, gels, running shoes, hat, more BodyGlide, ...
I get kind of nervous before races that I'm... well, nervous about. And I was pretty stressed out about the 700 meter open water swim I was going to have to do. Swimming is a very weak area for me, and I had dropped out of the Tempe International Triathlon Sprint just a few meters into the 400 meter swim in that event.
I had so little concern about the bike ride and the run portion of this triathlon that when my son asked me how long those portions were, I had to admit that I didn't know. I hadn't given any attention to them until he asked. It turns it's a 700 meter swim, an 18K bike ride, and a 5K run.
I set the alarm for 4 AM, but I wasn't able to sleep very well. I finally got up at 3 and didn't go back to sleep. My blood sugar was 145 mg/dl when I checked, and I took a 0.8 unit correction bolus with my insulin pump.
I had a PureFit bar and some coffee at 4 AM and took the bolus wizard recommended 1.8 units to cover it. I took care of some biological necessities and at about 4:45 I loaded my stuff back into my car, dropped my key off at the motel office, and hit the road out to Lake Mary just as the sky was starting to get light.
There had been a few drops of rain the day before, but it didn't look like there would be any of that on race morning.
I got lucky with parking and took a spot across the road and just a few yards north of the entrance to the parking lot where the transition and finish areas were. With no concern for speedy transitions, I set up in a fairly clear area at the back of one row. It hardly mattered how much space I had when I got there, though, because it all filled up quickly.
The bustling pre-race atmosphere had a special Mountain Man touch added by the presence of actual Mountain Men on horseback. They were riding and walking around, getting their pictures taken, talking to athletes and supporters, and lightening the mood. The horses contributed by leaving a couple of large, steaming piles in the walkway through the transition area.
Adding even more rustic, frontier charm, outside of the fencing and on the uphill side of the transition area, just a few feet away from where I had carefully laid all of my gear out on a towel, one of the horses stopped to urinate. He went buckets. The Mountain Man atmosphere almost took my breath away.
Fortunately for me, the slope of the parking lot had the flood flowing away from my bike, but toward others. From what I could see, most people were able to move their belongings in time, but the flow continued on out of my sight. I don't know if everyone was spared. And of course, the already crowded conditions got worse over that way.
At about 6:15 my blood sugar was 143. I set my basal rate to a lower level, not so much in anticipation of the swim as to be where I wanted it to be for the bike and run. I was going to have to disconnect from my pump, getting no basal insulin, before leaving transition for the swim.
At about 6:30, I had a juice box and took half a unit bolus, disconnected, pulled on my rented wet suit up to my waist, and walked barefoot over to the swim start, about a quarter mile. The pavement had been shoveled clean, but I tried to watch out for where those horse piles had been.
The last wave of swimmers scheduled to go out was mine, all of the males in the sprint competition, about 140 of us, at 7:17 AM. I listened to the swim instructions to the women in the sprint race, then hung around nervously on the boat launch ramp for about twenty minutes to hear them again for my group.
I suppose I should have gotten into the water and tried to get used to the temperature and the feel of it before the start. This was my first time swimming in a wet suit. A couple of minutes splashing around with no pressure might have helped.
The thing is, I didn't feel like I had any pressure to do well. I just wanted to finish. Speed was not an issue. So I didn't want to waste any energy.
When it was our turn to start, I walked into the water up to my knees and stopped, in the last row. Some men were out up to their chests. The starter warned some of them, up to their necks, to back up a little, telling them the steps they were trying to save wouldn't matter, unless they got disqualified for it.
I was content to be way in the back, maybe the last person, in any wave, to start swimming.

When the start went off, I put my head down and started swimming, the way I've been training, as smoothly and efficiently as I could. I kept telling myself not to get too excited, keep cool. It fascinated me the way it seemed like the crowd of swimmers around were pulling me along, like I was in a strong current flowing away from shore. Perhaps it's the way a school of fish help each other swim together faster than one can alone.
After about seven strokes I realized I wasn't breathing. I took one breath, two strokes, another breath, and raised my head to look around. I was still doing all right, and I put my head down and swam for another few strokes and breaths.
Then I had that feeling like I had to see where I was again. I was still in the rush of the crowd then, but as I breast-stroked a little, they got away from me. There were others around me, also not sticking to a freestyle stroke.
I tried to get back at it, but it was somehow terribly uncomfortable, head down, nothing but green water and bubbles, and the breast stroke was easy and comfortable, and I could always see where I was going, and that I was making progress.
So I gave up on freestyle.
There was already one guy hanging onto a kayak a few yards away from me. In another minute, as I was calmly, more or less, stroking toward the first buoy, a kayaker out ahead of me raised his paddle in the air signaling that he had a swimmer who wanted out of the water.
Another kayaker looked directly at me and raised his head as if to say, "How you doin'?" I gave him a thumbs up and kept going. The breast stroke felt easy, and I could see I was approaching the first buoy.
The swim course for the sprint was very simple, about 150 meters straight out to the first buoy, a big, red, inflated tetrahedron, about six feet on each edge, then turn left, parallel to shore for about 400 meters to the second big, red, tetrahedron, then left back to shore.
The first buoy was collecting swimmers, first one, then another... I think at one time there were five guys hanging on there. I imagined for a few seconds that all of those guys might actually be pulling the buoy away from me, making me swim farther, but the feeling passed when I saw I was getting close.
I felt no need to rest at this point, and I set it as a goal not to get any help or hang onto anything. I wasn't moving fast, but i was making steady progress.
On the long swim between the buoys, it became pretty clear that I was in last place. Others would stop and float on their backs, or hang onto kayaks, and I would almost catch up, but there was no one behind me. I was bringing up the rear.
After a while, one guy in a yellow kayak, the one who had looked at me for a high sign early on, cruised along within a few feet of me.
Somewhere about two thirds of the distance between the buoys I started to think I had made a mistake. I was trying and trying to do it without any help, but I saw others hanging onto the kayaks and the buoys, then swimming on. My energy was fading fast, and I started to think maybe if I just rested a moment...
My friend in the yellow kayak asked me how I was doing. I call him "my friend" even though he didn't know me because it would be weird, even though appropriate, to call him "my guardian angel." I finally told my angel that I could use a rest, and he let me grab onto the nose of his kayak.
Once I wasn't trying to swim, I noticed something strange going on with my breath. It had a reedy sound to it I had never heard before. The word "asthmatic" came to mind, but I don't have asthma. I didn't want to think about it.
After a minute or so, I swam on toward the buoy. There were other swimmers there, hanging on, but they were gone by the time I was almost there, and I was begging for another chance to hang onto the kayak.
I took another break just before reaching the buoy and, thinking maybe I was so beat because my blood sugar was low, I pulled out the gel I had shoved into the sleeve of my wet suit, tore off the top, and slurped it down. The guy in the kayak took the litter off my hands.
After that, I swam around the buoy, and a little farther on. Another swimmer near me, the last swimmer near me, got pulled out of the water onto a motor boat. There were about four or five drop outs in wet suits on the boat.
I could see other swimmers in the water, the last of them, approaching the boat ramp where they could exit the water, finishing the swim. I knew I was only a few pool-lengths away, but I just couldn't swim it. The breathing noise was getting louder. Hanging onto the kayak again, I asked the angel, who had a goatee and was wearing a ball cap, if he could hear my breath. He said yes, and I told him it wasn't right.
We talked a little, and he was convinced I had just let too much water down my gullet. I knew that I had been swimming with my head out of the water, but I didn't want to use that word I was thinking of, asthma.
I coughed and spat, and tried to clear my throat, but it didn't help.
I kept swimming and stopping, the swims getting shorter, the stops getting longer. I kept trying to clear my throat. I started breathing more forcefully, inhaling and exhaling harder because it seemed to work for a little while. All the while I was getting closer to shore, but it always seemed like it was still too far for me to make it, because I was more and more exhausted.
Finally it was just so close that I could not give up. And for what seemed like hours I kept stroking for those last few yards, seeming to advance only inches at a time... and suddenly... my feet were on concrete and I stood up.
The few volunteers who were there waiting for me applauded, and one guy in a cowboy hat came toward me, held up his hands and said, "Now take a full breath. Take a few deep breaths."
Apparently some people faint when they reach the shore and try to walk out. Fortunately that didn't happen.
I walked slowly out of the water and tried to grab the strap on the back of my wet suit. The volunteer said, "I'll get that," and unzipped me. I pulled down the front of my suit, then could not pull my arms out. I just kind of stood there looking at my arms as I tried to move them. It wasn't that there was too much friction. I had lubed up with BodyGlide before putting the suit on. My arms were just too weak to move.
Finally the volunteer realized what was going on and yanked my right arm most of the way free. I just didn't have the energy. My left arm stayed stuck as I walked away.
I was halfway up the ramp when the guy who helped me with my right arm finally ran up and helped me with the left.
My friends Erica and Lara, there to cheer others and to race on a relay team, had been watching and waiting for me. They congratulated me for finishing what was obviously a difficult swim.

I crossed the timing mat into the transition area with a touch of doubt about the rest of the race.
But my breathing had already returned to normal. By the time I got to my bike, I felt like I could at least go out and coast for a while.
So I checked my blood sugar. 310! So I wasn't low in the water. Dang. Talking with Erika, David Bourdon's wife, who was there at the edge of the transition enclosure, she told me that David has the same attitude I do sometimes. Sometimes you look at that glucose meter hoping it will give you an excuse.
Not today... at least, low blood sugar was not going to be an excuse.
The guy who had helped me with my wet suit came by and said, "There you go! There you go!" He could see that I wasn't going to drop out, and he seemed pretty happy about it.
I took a 3.5 unit bolus and headed out on the bike. If I wasn't in the middle of a triathlon, I would have given myself at least twice as much insulin.
The ride was going pretty well. The lake and the shore, tall green grass with a few wildflowers, piny woods, it was all beautiful, and a welcome change from the desert around Chandler, where I live.
I felt no need for speed. My race was all about finishing after that swim, but once I was out on the road, in the race, it seemed silly to just coast through it.
My shoulders and arms were very sore, and I didn't feel like staying in the aero position, but I tried to keep spinning as much as I could. It felt fine. I was about halfway back after the turnaround when, for no reason I can explain, I went off the road.
I was looking down at the edge of the blacktop thinking I was getting too close, and I guess I was just so out of it, and my arms were so weak, I just drifted over the edge. I rolled along into the ditch, full of high grass, for a surprisingly long time before I flew off the bike, rolled onto my back, and had the bike land on top of me.
I wasn't hurt at all. It was very comfortable lying on my back looking up past my bike frame at the sky. Without the road and countryside whizzing by, I became aware of my breathing. I hadn't realized how hard and loud I was breathing until I was lying there otherwise still.
After a decent rest, I got myself out of the ditch, thanked a couple in a station wagon who had stopped to see if I needed help, and set off down the road again. In a little while, I became worried about a little wiggle I felt in my rear wheel. I was thinking maybe I had a puncture and the tire was going flat, but I wasn't sure.
I tried to stop to check this, and for the first time in months, I fell while trying to get my cleats off the pedals. I scraped my calf on the front gears right over the spot where I still have a scar from the last time this happened.
My tire was fine, though, so I just reassured the motorcyclist who asked if I was OK, got back on the bike and headed toward my next transition, for the "run."
To make it into transition, I had to make a left turn across the road in the last few yards. Volunteers had momentarily stopped traffic on the road for a couple of us to cross, so there were lots of spectators and people in their cars watching at this point.
As soon as I started to turn, my back wheel popped loose and got wedged into place in my frame. It had been loosened up when I went off-roading, and that's what caused the unsteadiness I had felt. As soon as I tried to turn, there was enough torque to pop the wheel out.
My tire scraped across the ground unable to turn and my tube blew out.
I was able to dismount without incident this time, and after a moment of hesitation in the middle of the road, I picked up the bike and carried it into transition.

In transition, my blood sugar was 284, still way too high. In hindsight, I probably should have bolused more and eaten something, but at the time, I was just thinking it was coming down and it would be all right.
I tried to run out of transition, but the first few yards were uphill, from the parking lot onto the road, and I was feeling faint. So I walked until I was up on the road, then I jogged across the road and tried to keep jogging.
But I could only do this slow, plodding pace for about 50 feet before I felt like I was going to pass out. I could have been starved for oxygen, dehydrated, or just weak from lack of nutrition. I hadn't eaten anything since the gel I had out on the lake. I had done a lot of swimming after that.
There was no way to hydrate during the swim, and I hadn't thought very much about drinking while on the bike.
And even though I didn't have that noise in my breath any more, I still felt like I was constantly in oxygen debt.
So I just walked the 5K. Walking felt OK. I could actually do it fairly easily, with no worries. But when I tried to run a few times, I felt light-headed, dizzy, and like I might pass out.
I was amazed that it took me over an hour to walk this 5K. It didn't feel that slow. But it doesn't matter. I was just trying to finish.
Finishing was the best I could do, and I did it.

My blood sugar was 267 after the finish, and I finally bolused enough so that it would come down and I could eat something in a little while.

Afterwards, heading out of town, I turned on my radio and hit the seek button to find a station. It stopped at "The Magic 106.1" and I left it there because they were playing the kind of "classic rock" I usually listen to. Then the DJ said he was about to play a Mily Cyrus song, from the "Hannah Montana" movie soundtrack. I've heard of Mily Cyrus, but I don't remember ever listening to her sing, and I wasn't sure I wanted to. I was thinking about changing the station, but I gave it a chance, and they played "The Climb," by Jessi Alexander and Jon Mabe.

The struggles I'm facing
The chances I'm taking
Sometimes might knock me down
But no, I'm not breaking

I may not know it
But these are the moments
I'm gonna remember most
Just gotta keep going
And I gotta be strong
Just keep pushing on

'Cause there's always gonna be another mountain
I'm always gonna wanna make it move
Always gonna be an uphill battle
Sometimes I'm gonna have to lose

Ain't about how fast I get there
Ain't about what's waiting on the other side
It's the climb

It broke me up pretty much. I was cruising south down Highway 17 with tears streaming down my face. It caught me in a weakened state.
Anyway, as I said earlier, I thought I had some idea how hard Ironman Arizona was going to be. I don't think I really had a clue. I may still have no idea.
But this is going to be hard.

Friday, July 10, 2009

Last Sunday's Ride

On paper, there was nothing difficult about this ride. It would be flat and not very long, just over to my Mom's house and back home. Going the "long" way, it would be 17 miles.
But it turned out to be good experience. The ride out was uneventful. It was hot out, since I was starting in the middle of the day, over 100, I'm sure, but I had plenty of water, and I wasn't working too hard.
I stopped at Mom's and had a nice, cool drink in the air conditioned house, talked about stuff, and started back.
About a mile and a half later, as I was starting out from a standstill at a traffic light, my right foot came off the pedal. I thought my cleat had come off the pedal, that I had improperly popped it on, but when I tried to put it back, I saw that my cleat was still stuck on the pedal. It had come off my shoe.
There were only two of the four screws still in the cleat. Who knows when or where I lost the other two. There was a rock stuck in the cleat where one of the screws should have been. I wondered how this happened for a second. I had one shoe, the left one, with no problems, and the other shoe was all messed up.
Then I realized that I always unclip on the right side when I stop, and I usually leave my left shoe on the pedal. The right shoe gets the extra stress of getting popped on and off the pedal, and also keeps getting put to the ground, sometimes kind of forcefully as I stop or push off for a start.
Fortunately, I was only about a hundred yards from Curbside Cyclery when this happened. I went in and asked to borrow a screwdriver, but they took my shoe, got the rock out of the cleat, replaced the missing screws, and put it all together for me.
Meanwhile, while I was waiting, they had Tour de France coverage on a big screen TV, with free drinks and cookies set out for anyone who wanted to stop by. I felt pretty lucky.
I got my shoe back on and hit the road, and did all right for two more miles, when my ride suddenly got noisy and rough. My rear tire had gone flat.
I've changed the tube in the front tire several times, but I was a little scared to mess around in the back, where the derailleur and gears are. But now I had to do it.
I got the wheel off the bike, and was looking for a way to lay the bike down or prop it up without scratching it. I leaned it on a low bush in the landscaping off the road. It was only later, as I was about to leave, that I realized this bush was covered with thorns. It was just luck I didn't flatten another tire.
I got the tube off the tire and put a new one in without much trouble. It's much easier to change inner tubes when its over 100 out and you've softened everything up by heating it up on the blacktop.
I took out my CO2 inflater and put a cartridge in it. When I tried to tighten the top down I couldn't get it to go on straight, and I partially punctured the cartridge, so I was struggling to get the top on while I was losing the pressure I had hoped to fill the tire with. There was a maddening and frustrating minute or two before I had to give up.
Then I was sitting there with one last cartridge to try the same thing again. Somehow, miraculously, this second time I did it perfectly. Glad I brought two cartridges.
It took me a minute to figure out how to get the wheel back on with the chain around the gears, and I was back on the road.
So all in all, it was a great ride. I had some hardships, but I got through them. I'm sure that the next time I have a flat, and it will happen, I'll be able to deal with it. That was something I couldn't be sure of before.