Don't be a statistic!

Yesterday, I was perusing articles online, and one grabbed my attention--the subject was that athletes are not immune to hypertension. Without repeating all of the details, the net conclusion was that studies on athletes involving the risk of high blood pressure have been poorly done, and not well documented, but that statistically, it appears that athletes have the possibility of developing unhealthy blood pressure independent of their activity level.  The conclusion makes sense--if you work out all the time, it does not give you carte blanche to eat nothing but fried food and desserts while smoking and drinking a fifth of vodka every day.

What concerned me was some of the comments to this article--and one in particular from a guy who was obviously a medical doctor of some sort.  He stressed that his recommendation was for everyone to take in no more than 2300 mg of sodium per day.

About a decade ago, I was diagnosed with a heart condition, called a patent foramen ovale with atrial septal aneurysm (PFO w/ASA), and was simultaneously misdiagnosed with hypertension. The PFO w/ASA is a topic for another post--but right now, I think it's important to point out the missteps that the medical community made in relation to my misdiagnosis.

First and foremost, blood pressure readings were taken on me that indicated that I had borderline high blood pressure, measuring anywhere from 130/85 to 150/95.  These numbers, standing without context, are enough for pretty much anyone to suspect that there is a problem. But context is something that appears to have lost traction in today's slam-bam-thank-you-mam 5 minute visit with a medical professional.  I was placed on blood pressure medication, and my numbers came down...way down.  Frankly, I think that I could barely move.  I lost the ability to exercise effectively--running become next to impossible, and I wound up having to move down a couple of lanes at masters swimming.  It was my own conclusion that a drug that prevented me from working on things to improve cardiovascular fitness was probably not the right answer, and I stopped taking the blood pressure medication. I did, however, heed the advice of the doctors to watch out for "excessive sodium intake" and began watching my diet for these things while training for and (barely) completing my first marathon.

In the years that would follow, I would successfully complete two ironman triathlons, along with a number of other things, take off a minor amount of weight, and have wildly fluctuating blood pressure readings.  All the while, I would watch for dietary consumption of sodium, but know that to complete an ironman triathlon, supplementing electrolyte intake was important.  People collapse on the course due to sodium depletion routinely--so routinely that seeing someone hooked up to an IV in a medical tent is an expected part of the race.

I developed wicked headaches after most of my long distance training sessions.  Common knowledge was that I must have been dehydrated, and I would talk to people (other athletes, my GP, one of the several cardiologists I saw, and a nephrologist) about this, and explain that my urine was clear, and a universally puzzled look would come across their faces and the conversation would end. It was not until I started working with my current triathlon coach (Joanna Zeiger) that we got to the bottom of this.

I raced a half marathon one day, and did not do as well as I would have liked. My muscles seized on the finish line and I couldn't move for a period of several minutes. This passed--and I went home and somewhere during this process texted Joanna my result, the fact of my headache, and that I seized up on the finish line, and that I was in no condition to talk to her.  She was persistent (not out of the norm for Joanna), and eventually got through to me that she thought that I was low in sodium.  She had no idea at the time what I had been through regarding the whole mess with my heart condition and the recommendations from doctors to limit my sodium intake. In desperation, I conceded to try consuming what would wind up being three cans of V-8, with a little water to wash it down (that's right--36 ounces of the stuff, containing nearly 3 grams of sodium). The effect was rapid--over the course of a couple of hours my headache would disappear, my mood would improve, and I would feel like the adverse affects of the half marathon never occurred in the first place. In the past, once a post workout headache would occur, it would stick with me for the rest of the day, and only relent with the passage of time, generally until the next day.  So, this change was dramatic.

The fact of the matter is that physicians are trained to act based on statistics--the vast majority of patients that they see with a high blood pressure reading are sedentary and they do not exercise at all, let alone to the point that triathletes do.  The recommendation of no more than 2300 mg of sodium per day holds true for a very large percentage of the population, so they're going to be right probably 99% of the time.  The problem is that endurance athletes are the statistical anomaly in their day to day operations.

• Endurance athletes sweat (a lot).  It's not uncommon for me to lose, and subsequently replace, 5 pounds of water weight a day while training.  Each pound of sweat lost contains, on average 1.5 grams of sodium.  Simple math reveals that 7.5 grams of sodium lost is much more than the 2.3 grams of dietary sodium recommended as a maximum.
• Athletes tend to have more muscular arms.  It turns out that most nurses, and some doctors, are unaware how much the wrong size blood pressure cuff can affect a blood pressure reading.  Switching to the "fat-people cuff" revealed that my blood pressure is within the norm for the population.  Too small of a cuff crushes the blood vessels in the arm, creating a situation where an accurate reading is impossible.
• Athletes tend to get workouts in all the time...and those workouts can cause increases in blood pressure that last for hours, often spiking that blood pressure reading during your office visit.
• Some doctors have a problem with a god complex.  One cardiologist I saw would not even let me finish a question about how much I sweat and how to deal with that while limiting sodium intake.  In retrospect, it would have been best if I had never gone back to see this guy again.
• Low blood sodium is much more dangerous than high blood sodium is, with risks including hyponatremia, brain swelling, loss of muscle coordination, and potentially the risk of fatal fluid buildup in the pericardium.  It is possible that the heart palpitations I have experienced in the past are the result of insufficient sodium in my bloodstream.
• A lot of pills sold as electrolyte supplements do not contain enough sodium to be effective.  Before my collapse at that half marathon, I was using Endurolytes (80 mg of sodium per pill) and not taking enough of them.  Since then, I have switched to SaltStick (215 mg of sodium per pill) and now take 4 per hour while running (or more if very hot).

The simple fact of the matter is that today's medical industry does not adequately address the needs of the athlete, and it does so for very good reason.  The endurance athlete is the 1% of the clients that they see, and they're going to be right much more often by ignoring them.  I have to remind my doctor during my annual physical to use the large blood pressure cuff, that I worked out a couple of hours beforehand, and that in the past week I've sweat out approximately 15 liters of fluid. Nobody is going to fix this problem with modern medicine, but with the right knowledge at your disposal, you can probably avoid becoming a victim of it.

The stages of a triathlon

Last Sunday, I was smacked in the face with how far I have come in the sport of triathlon.  To summarize the race, I was 3rd out of the water, fell back to 10th place during the bike, and then had my knee seize up on me during the run and had to walk the last 3 miles into the finish line.   The swim and bike are likely my best performances ever in a triathlon, and gave me the opportunity to hang with the upper echelon of that day's race competition--it was enthralling!  A few years back, I could have never hoped to be in this position.   And my run falling apart was much more about the fact that I've had difficult times at work and haven't been able to get in the training required to go the distance with those guys.  I'm not concerned about it at all.

Though, what did happen was that I had a chance to witness all the different varieties of attitudes that are present at a race.

1.  The race leaders:  the guy I was running with initially showed concern that I dropped off the pace and gave me a simple "Come on, you got this..." and then remained steadfastly focused on his own performance.  The other people who passed me could not care less--I was just one less person to threaten their spots on the podium.

2.  The concerned crowd:  The people passing me quickly morphed into a group that was concerned for my well being--"Are you ok?" (with the implication being "medically").  I assured them I was--just having issues with my IT band, and everyone kept running on their merry way.

3.  The motivators:  Somewhere, the middle of the pack transitions to this group of people that are super-motivators.  Every single person, for what seemed an eternity, was determined to get me running again--by this point, I knew my knee would not function again for that day, and I was doomed to a long walk into the finish line.  This peaked with a guy coming up from behind me, grabbing my left arm, and screaming "You can do it--You've only got 2 miles to go!!!"  I nearly crapped my pants from the shock.

4.  The experienced finishers:  After the supermotivators, I encountered several people that offered words of encouragement, but clearly had seen my situation before.  They knew that I knew that they knew that whatever they said was appreciated but wasn't going to do a damn bit of a good.   I know this from the telepathic bond formed that was predominantly "Not your day today?"

5.  The walking/jogging/running dead:  There's a group at the end of a triathlon that is simply trying

to survive to the finish line--and while they're completely motivated and concerned about you, they don't have the energy to outwardly offer encouragement.  None of them appeared to be at the point of needing to eat flesh straight off the bone yet, though.  So I got to save that visual for the Walking Dead premiere later that night.

Looking forward to next season--for now, my focus is on a the SPMS Champs swim meet in December!

No further comment

Some people just totally suck ass.

The lone cyclist

Something I came to terms with a few years ago was making a decision between training and riding, and when it comes down to it, it's a decision I've continued to have to make on a very frequent basis.  When I started working with my coach, Joanna Zeiger (racereadycoaching.com), the way I approached cycling workouts didn't just change--it was upended, torn apart, and put back together again all over the course of that first year that she coached me.  I got a power meter, and I struggled with it.  At first, I struggled to even grasp what I was supposed to be accomplishing with the numbers that seemed to be only tangentially related to what I thought was going on with me on the bike.

Joanna was very patient with me, and took me through several of my power files over time, and explained what the issues were.  In retrospect, it really wasn't surprising.  Cycling, in general, does not lend itself to encourage you to do what you should actually do to get better.  When you ride in a group, you really have no control of what kind of effort level you're putting into the pedals, and more than likely, you wind up riding too hard on uphills, and way too easy when sitting in the draft zone of even a single cyclist.  Your workout tends to look like a mess of random garbage that doesn't really train your muscles or the energy systems that supply them in order to make you go faster. Over the course of years, I've discovered that most cyclists tend to double, if not triple, their power output when going up a small hill.  As an example--you're pedaling along at something close to your long distance aerobic pace--let's say 150 watts, and when you reach a hill, you feel the need to maintain your speed, and testosterone kicks in, because who wants to be the one to slow up the pack going up a hill?  It's not uncommon for me to sit in the back of the pack when this occurs and watch how I have to break 300 watts and approach 400 watts or even more just to stay on someone's wheel. So, you've gone from something you can probably maintain for 5 or 6 hours, to something you wouldn't be able to maintain for 5 or 6 minutes, all based on the randomness of the road.  There simply isn't another sport that this happens in.

An example of a pretty decent power file, with a 20 minute long interval in the middle of it

I don't crank through workouts that way anymore--if I ride with a group, which is rare, I tend to hang in the back, and drop off the pack going up a hill.  I'll catch them on the downhill or a flat that follows.  When I do ride with a group, it's usually for a workout that I'm not trying to accomplish something specific, or it's for a portion of the workout that my effort level can change--the warm-up is usually an ok place/time for me to do that.  The simple fact of the matter is that I watched myself take an hour and a half off of my ironman bike split when I trained correctly, and that's what I was after all along.  I've found that most people in triathlon don't actually want to ride like that--they're there for the group ride--and to have fun, which is perfectly ok.  I just decided a long time ago that triathlon was about setting and achieving goals for me, and doing what I need to do to make that happen.  So I wind up riding alone--a lot.  Occasionally, someone rides with me, and does one of my workouts with me, but it never seems to stick--while I can guess as to the reasons why, I don't actually know in a lot of cases, because we're all out there for a different reason.

So, it's time for me to get out of my head and get on my bike, for a long ride with some long intervals at half-iron pace.  Ride on and be safe everyone!

 

"Hi, my name's Drew and I'm a recovering swimmer from the '90s"

I grew up in the age of "You will swim 17,000 meters a day, and if you don't get good from it, that's your problem."  This has left a lasting impression on my life that is flawed to its very core. On one hand, the work ethic that swimming taught me was unparalleled to anything I probably could have gotten as a child, and that's saying a lot, given that I grew up in a military household where sitting around and relaxing was viewed as a cardinal sin.  On the other hand, it mistakenly taught me that more is always better, and it has taken me decades to unlearn, and something that I still struggle with on a daily basis.

I was lucky going through school because it was easy for me--people used to get really pissed at me when I explained to them that the amount of time I spent studying for exams was on the order of minutes, as opposed to hours or days in some cases.  It was simply very straightforward for me to identify what I didn't know, review that, and be done with it. My test scores, grades, and acheivements all reflected that, and I carried this into my professional life.  The only difference was that time became measured in hours worked, rather than in tasks accomplished, and I set out at a very early time in my career to fill my days with the most productive time I could, rarely exceeding a 40 hour workweek and often outperforming my peers in the process of doing so.  I'm only saying this to point out that somehow I was lucky in not letting the lessons that were ingrained in me as a swimmer carry through to my career.

I am, however, extraordinarily hard on myself in my activities outside of work.  Joanna, my triathlon coach, has pointed this out to me, and she has been dead on.  If I am not exceeding the bounds of reality of what my body can handle, I am not happy with the results of my workouts.  If I am not constantly achieving new PRs, I am not satisfied with my race results.  If I'm not doing all of this while I'm holding down a job as an aerospace engineer, where I am routinely faced with the realities of a contracting industry laying off workers left and right, then I have failed.

I think that the lesson that I had to learn, and still have more to learn about, is that sometimes non-perfection is good enough.  Beating myself up for ending my workout yesterday after a wasp sting is not productive, and given the black-and-blue mark I have on it today, I probably didn't need to finish my hard intervals while riding home.

I'm not going to the Olympics, and given that I'm about 3 hours out of contention for a Kona slot, I'm not going there either.  The daily struggles that I have with performance have to be more about enjoying the process, rather than focusing on the result, and I think I've lost touch with a lot of that--so I was all too happy this morning when a brief bout of runner's high kicked in during my 10 miler, and I could remember what it's all about.

It's time to just enjoy the day.

Work/Life/Triathlon Balance

Notice how "work" has a higher point value...

I think that one of the hardest things I deal with is what I've come to call work/life/triathlon balance.  As someone working in corporate America, I have, like most people, been given the standard lip-service of "work-life balance" through various modes of communication at work over the course of a couple of decades.  It's something everybody struggles with, because we all lead very complicated lives in very complicated and often, quite-demanding jobs. I don't think my problems are unique or different than anyone else's when it comes to this issue.


I just complicate the issues by adding in an on-going pursuit of triathlon. There have been times in my life when everything to do with this sport clicks together with my personal life--I have wound up with friends training with me--the workouts have been enjoyable--triathlon becomes a path of life that seems to fit and fill in a part of my life that helps to achieve that balance without taking anything away.

There have also been times when nothing seems to work.  I wind up plagued with injury--my friends have disbanded, so I'm training on my own--my workouts become a source of stress and anxiety instead of stress relief and a near meditative state. All of this goes on while my career does what it does, which is to go through the cycles of stress and reward that it does--as everybody's career does.

I think all of this kills me when the three major things in my life all go into a synodic intersection of a spiral of death at the same time.  My career has become a source of stress again--I just had a series of workouts that kicked my ass following a series of subpar performances at Gay Games--and I did them all on my own...mainly because no one I know wants to do a four hour long brick workout if they don't have a half ironman sitting on their schedule in the very near future.  Today, some of my friends headed out for drinks at the Faultline, and I decided against going because I'd lost seven pounds of bodyweight during my run this morning, and couldn't get my shit together to get my swim done in time to be able to meet them.  I'm insane--I realize that...it's just possible there's a reason why this guy that I dated many years ago had friends that told him "Gay rocket scientist triathlete?  Does not exist."  But there are probably many of us, actually--and we're all equally insane.  And frankly, I just don't understand how anyone with children does any of this--some people are simply superheroes.

But I'm not that strong--I cannot keep my shit together at a time such as this.  So I just have to cope day by day.  And search for a light at the end of the tunnel.  Find some new people to train with, wait for the aerospace cycle of death to turn around, and hope that the climb out of this quagmire is imminent. Besides, I've got an appointment with a new therapist on Thursday.  By Friday, I should be completely fixed.


Visualize puppies and rainbows.

Gay Games 9 Triathlon--A New Beginning

It's been a long time since I've written in my blog--I can name countless reasons why I haven't.  Brian and I sold our old house and moved to a new one, work stress has grown, we've had way too many issues going on with our dogs, Josie and Max, and frankly, I've just been a little overwhelmed with things.  And I would be lying if I didn't say that my issues with depression have played a role in dealing with things.

I'm currently at Gay Games 9 in Cleveland, Ohio, and yesterday competed in the Olympic Distance Triathlon.  My performance was excellent, but the outcome of the race was not--to sum it up, the race course was not clearly marked on the run, and I didn't know beforehand (as I should have) where the double-back loop was supposed to occur.  It turns out that the loop was supposed to be doubled over the 2 miles of the beginning of the run course, so by the time I'd identified something was wrong (within half a mile of the finish line) there was nothing I could do.  Following the finish, I waited to find someone else who had done the Olympic distance race and figured out where my mistake was.  I immediately knew that I had to ask the officials to disqualify me--the finish time that I was given would likely have been the fastest overall and robbed people of the medals they rightfully deserved.

Given my long term issues with injury over the past couple of years, this is disappointing, but there are some things that make this race a very big positive.  I had a swim split right around the 22 minute mark, which was the fastest of the day--in order to disqualify my results, the officials destroyed my swim split time, so I won't know for sure my exact time, but the next fastest time in the results was 22:47.   Given that I pulled away from my wave in the first 200 meters and never saw them again, I can be happy with my return to decent swimming shape.

My bike split was an average of 213 watts over a hilly course, and lacked the characteristic peaks and valleys in power that I have typically had problems with on this kind of course--it was a better ride than anything I have done in years.   And my run was going extraordinarily well--I ran 8:30s for the first four miles, and was prepared to finish strong for the last 2.2.  If I take a look at where 8:30s would have placed me in the final standings, I would have wound up second in my age group--but 2nd and 3rd in my age group go to the people who actually took the time to know the course beforehand, as they should.

Bike power--The dips under 100 watts are the turnarounds at the far ends of each of the 3 loops

So, I'm back in the shape I was before my injuries and probably even much faster than that. My injuries are under control, and well on their way to being completely non-factors in my performance.  In the past couple of months, the path that Joanna and I have taken is to address the muscular imbalances and weaknesses in my glutes, hamstrings, and core that so many triathletes have from excessive overuse in biking and running.  These new exercises seem to not only be fixing my problems with injury but also unlocking new speeds I have not seen before.

I'm excited to keep on racing--Up next is 5 events plus 3 relays in Gay Games Swimming!