Sunday, June 2, 2013

POST EVENT RECOVERY

2 weeks after the event that was TNF100, I've had some time to reflect on what worked and what worked didn't.  But instead of  lamenting over the 'what-ifs',  I've been focusing on how to best facilitate my recovery.  

After having several days of feeling very much below par,  I had some blood tests and a general check up performed five days post race.  At this stage I was concerned about my kidney function as I was still more than 5% above my race starting weight and had notable peripheral oedema. I also had investigations into gastric ulceration as race day nausea and reflux hadn't settled.  As an athlete and a Health Professional, I am acutely aware of the impact of ibuprofen on kidney/renal function and gastric ulceration and refuse to take anything in the NSAID family of pharmaceuticals pre/during/post race or at all.  Another consideration is that paracetamol metabolism is undertaken primarily in the liver, so I also avoid this group of drugs as well.

General systemic check showed normal BP for me (110/50) and HR 55 with normal rhythm.  During the event I had several episodes of SVT (HR: 180) that lasted for around a minute and gradually reduced with a gentle carotid rub, so a normal rate and rhythm was good news.   The results of my blood tests came back with surprising results.  All electrolytes, vitamin D and B6/B12 (specifically), calcium and iron levels were normal (good news considering a near vegan diet!).  Kidney function was normal and in fact, optimal.  No evidence of gastric ulceration either. The outliers were my liver enzymes, with nearly all being elevated above normal.  

I've done some empirical and anecdotal research since being given these results and have found elevated LFT's seem to be present in some athletes following long distance events and also after high intensity events.  The liver seems to be bombarded with toxic by-products of extreme exercise such as skeletal muscle breakdown (rhabdomyolysis) and lactic acid and is unable to process and metabolise these toxins effectively.  Not only is the liver trying to keep processing and suppling energy to the working muscle, it also having to deal with becoming loaded with toxic by-products.  The end result is liver dysfunction. (most notable causes of liver enzyme dysfunction is infection, obstruction, cirrhosis, fatty infiltration, myocardial stress, medication use, alcohol abuse and skeletal muscle trauma).  So, given this, the most likely culprit is racing induced muscle trauma.  
The Liver: time to pay more attention to this vital organ


However, I, along with over 30% of surveyed TNF2013 respondents (www.ultra168.com) used Hammer nutrition as their primary source of race day nutrition.  I was one of those respondents.  These products worked well in training with my GIT tolerating them very well.  Race day was another story though!!  On searching the USA Hammer Nutrition website, a marathon athlete posted having raised LTF's post event and thought that there may have been a link to the products being used.  He ceased the Hammer products, had bloods performed and his LFT's returned to normal levels.  As a trial he recommenced the products and had further blood tests performed and ....voila....a return to elevated LFT levels.  Co-incidence? Maybe.  Admittedly, one case does not mean the results are the same as a double-blind ramdomised controlled trial.  But in my case....definitely food for thought.

Specific recommendations for liver recovery:

  • No alcohol 
  • Review/cessation of  medicines, supplements
  • Nutrition for optimal liver function: broccoli, kale, apples, beets, garlic, cauliflower
  • Specific liver herb: milk thistle
  • Low grade, low level exercise only:  so as to not cause skeletal muscle trauma (I did see that the recommendation by Hammer Nutrition was for 6 weeks complete rest for the above mentioned athlete and then re-test)...that length of rest is probably not going to happen in my case :-P
  • implement the above and see what the repeat bloods show.

Lessons Learned:
  • Listen to what your body is telling you during racing...it won't the same as in training
  • Act early in making changes to hydration, nutrition, pace and nervousness levels
  • Don't persist with what's not working
  • Have more fun with running!!
  • Hindsight is a wonderful thing!!!

Mummy and Maddi being bears in the woods at a local running event!

“Struggling and suffering are the essence of a life worth living. If you're not pushing yourself beyond the comfort zone, if you're not demanding more from yourself - expanding and learning as you go - you're choosing a numb existence. You're denying yourself an extraordinary trip.” 
― Dean KarnazesUltramarathon Man: Confessions of an All-Night Runner





Thursday, May 23, 2013

The North Face 2013: The race that never was

Well, it's been a while since I posted but here is my recent race report

Entering the 2013 event in December 2012 was done whilst recovering from an acute injury to my plantar fascia....my chances of getting to the start line at that stage were rather slim....but I was up for the challenge of just getting to the start line as prepared as I could be.  The road to recovery from this injury proved to be one of the most difficult I've yet to overcome.  For anyone with PF issues, you'll know what I am taking about!  For the better part of two months, I was unable to run more than 5km without pain, let alone run down steep technical descents or stairs or long distances 

So, my ever loving and tolerant husband bought me a mountain bike.  I was off and riding! I learned a new skill, had quite a few stacks along the way and even entered a couple of 6hr and 100km events and had a ball in the process.  It took the focus away from running and changed my approach to training whilst allowing my foot the chance to recover. I even podiumed in each of these MTB races; much to my amazement! 
First ever MTB race..first ever time in cleats!
By February, I progressively started to reload my foot on the trails....pain free going up but still painful coming down.  Perseverance paid off and I started to feel more confident and happy in the knowledge that I was more and more likely to toe the start line.  My foot was coping with longer 30-40km runs and was happy doing 'recovery' run of similar distances the following day.  I was able to put in some decent 100km weeks without any significant change in my foot symptoms and even ran a road half for fun! In the past I've struggled with gut issues (nausea, vomiting, bowel frequency) particularly in TNF.  Training was going well with none (or very little) of these issues (I live in the heat and humidity and the coldest we get is 20deg!).  Late March I spent 4 days with my wonderful friend Jaci Richards training in the Blue Mountains.  My foot and gut coped exceptionally well and I put in some big days on the trails and the punishing climbs.  Confidence in starting TNF and performing better than previously was now at an all time high compared to 4months prior. 
Training on Golden Stairs

As with all ultra-runners, juggling the balls of daily life is a constant.  Sometimes the focus on training has to shift, and this occurred in the last month leading up to race day.  My business seemed to be in a tailspin with significant staffing issues that didn't resolve quickly.  My stress levels were particularly high and in normal situations running would alleviate this. But working 12-14hour days and then dedicating time to family and children, didn't leave me with any.  The challenges were certainly coming my way. "You can only do what you can only do" but it seemed that everyone else's needs were coming before mine, right at a time where I should have been prioritizing my needs first. But, like all things, the ebb and flow of life changed and I was finally en route with my family to the Blue Mountains a week before the event.

Arriving in the mountains was a relief...a relief to leave everything behind and to be able to re-group, recover and prepare. Also more importantly, it was a chance to reconnect with my beautiful husband and children.  We walked holding hands, gave each other lots of love and attention and spent that valuable time together that binds us as a watertight unit.
My beautiful little man


Support crew captain! x

Race start with my amazing support daughter xx


Race day arrived. I slept over 7hrs the night before and felt calm and at ease; markedly different to years gone by.  I ate an early breakfast, drank fluids, got ready, dressed the kids and off we went to Leura before daylight! All was going well until the repeated toilet visits....oh no......lucky for gastro-stops!  Race briefing over and before I knew it, it was on the start line in start wave 3.  I had a nice smooth start with minimal bottle necking and made my way long the course.  I was eagerly awaiting my family along the course and was greeted with loud cheers from my kids!  We descended into the Leura forest and made our way around toward the base of the Golden Stairs.  I found a nice easy rhythm. Drank regularly and stayed on top of my calorie and electrolyte input.  I felt good and happy with the early pace.  Once on the Golden stairs, I took it nice and steady and didn't push myself.  I arrived at the top feeling as though I could have run up!  Once on Narrowneck, the cool wind started to make itself known.  I started to get very sore arms/forearms despite still being in my Icebreaker.  My hands were also really cold and started to cramp, so out came the gloves again. I refilled my water at the CP and decided to keep moving so as to not get cold...my nemesis!!  I found a nice pace again but hand cramps became worse.  I started to get quite stiff in my lateral upper calf; quite unusual.  I tried to take in the majestic views.  

I was in a reasonable head space at this time and was just keeping CP2 as my focus and not let the enormity of the task become overwhelming.  I struck up a conversation with a fellow runner who previously used to live near me...there is really only 3 degrees of separation! We had some great conversations along the way and shared similarities with our work. 
Once down the ladders, I started to have further problems with my left calf and the cramps in my hands continued despite gloves.  My hands now were quite swollen and my wrist movement limited.  My belly started to become more of a concern with nausea starting to set in.  I kept moderate electrolyte intake in the form of Endurolyte capsules.  I was also now only able to tolerate Hammer gels (one per 1.0-1.5hrs) alternated with Perpetuum; trying to keep calories to about 180 per hour and not fall behind.  


Arrival at CP2 was uneventful other than the cramping and sore toes.  At least no vomiting in front of medics like last year!  Once the random gear check was done, water topped up, I was off at a slow but stead pace.  I knew Iron put climb was coming up, so I wanted to have some reserves before the ascent.  Once at the top, the calf cramping worsened; the nausea kicked in like a vengeance and I felt like I was developing contractures in my hands from the cramping in my little fingers!!  But, smile and move along!  Down the other side of Ironpot and then a little creek to traverse.  Some stepping stones in place and as I'm about to balance, the most breath-taking adductor cramps set in!  No more smiling now......no more happy happy joy joy.....none at all....holy crap...WTH??   I've never had cramping issues ever....gut problems...Yes!  But not cramps.  I must have looked like I was doing the dipping downward dog on the creek stepping stones.....or giving birth!  After what seemed like an eternity, I walked on....sort of.  This process continued until CP3. 
Not feeling too good :(

Arrival into CP3


I have never been so grateful to see my husband and children.  By this time, I was not thinking clearly, unable to make decisions about what to do.  I am so lucky that the Rusty Ironman took charge and sorted me out.  "No more of that Hammer Crap!" ......"Stop the electrolytes"....."water only with some Sustagen for calories". With that said, he picked me up and pushed my through the out gate with instructions to walk and drink water only until I pee'd.   I stopped before Nellies and did my first pee the entire day.....not a pretty sight.  I was now really concerned about my kidney function or significant lack thereof.  My hands were still swollen and cramping and so were my legs.  Things were not right, but CP4 was not far away.


I arrived at CP4 with significant nausea and on entering the hot stadium, I had the most overwhelming desire to eject my stomach contents.  I have never needed to use such focus and willpower to not do so.  Team Woodward went to work on mummy.  Coke, Sustagen, water, gear ready to go for the next leg.  I needed 30mins to get sorted, mentally and physically.  I still had not done a pee so there were many doubts about continuing at this point.


Not Happy Jan!
The 4 colours of green!


 I took a cup of warm Sustagen and off I went into the darkness.  Miracles of miracles, the urinary urge returned!  Thanks the bladder gods for that!  Legs and belly were still not happy but down the Giant stairs I went and then into the Jamison valley.  I ran/walked the descents as the nausea worsened with too much bounce.  On the Kedumba ascent I struggled.  Although my legs were better and I was now peeing, it seemed my mental state was now providing me with my biggest challenge.  My km calculations were out. On arrival at the Kedumba gear check, I thought I was at 87km and to be told I was at 84km, with 5km until the next CP, was like telling me I had to turn around and go the entire way back.  I crumbled. My strong facade slipped away.  This is the point at which you have all your layers removed, you are completely exposed and raw; nothing covering your inner self, nothing for protection. This is the point at which you start to discover what you are made of, how resilient you really are.  You have to face the unknown and forge ahead, be brave and courageous.  My focus narrowed, all I could see was my feet on the ground.  My race had just begun at 84km.  I put one foot in front of the other and kept moving, because the alternative was to sit down and cry.  My plans, my preparations, were destroyed, my hopes were gone. I was reduced to just getting to the next CP.....over 50 minutes away!  I had many messages from friends along the way and if could have seen my phone, I would have read and them again....just to keep me going. 


I did arrive....not in a very good place.....in fact the worst place I've ever been.  Lights, people, noise....I was dazed, confused and unable to find my husband....the only thing that had kept me going was knowing that he was going to be there....and I couldn't find him.  I. Felt like a deer in the headlights. My eyes full of tears  A volunteer took pity on me and helped and another went around trying to find him. What seemed like an eternity, he was found and I went to pieces.....an entire day of feeling like crap, an entire day of second guessing myself, an entire day of suppressing and trying to override negative self talk had gotten the better of me.  The tears rolled and the negative self believe came flowing out.  His arms around me was all that I needed. He put all his love and self believe into me. He kissed me and wiped away my tears of self disbelief. He put my thermal pants on, put the extra buff on my head, plugged in my earphones, handed me a hot Sustagen and sent me on my way.  
CP 5. My husband, My saviour!
Off I went. That last 11km may as well have been 110kms.  When I crossed that finish line, I felt numb. I felt relief. I felt disappointed that I completely failed to live up to my own expectations. 17hrs36mins of tough going. There was no elation, no euphoria and no fist pumping.  All I wanted was to be in the arms of my family, and there they were.....waiting for me, arms open, hearts wide. It is at these moments of being stripped completely bare and exposed that you realize the important things in life, and there they were waiting for me. 
My welcoming team!

Couldn't even eat the soup
Trashed feet...but no plantar fascia problems!!!


In the past few days since TNF2013, I've had some time to reflect and think things through.  My physical recovery has taken a few days. My weight has been nearly 8-10% above normal.  it's only now, 4 days later, that my metabolic system is starting to normalize with additional fluid being excreted and my appetite starting to begin once again.  Emotionally, I'm still a bit numb and blunted.  Time will hopefully heal all.  Thank you my wonderful family.  I love you more than anything. 

It's not how hard you fall but how quickly you get back up.  Onto the next event!