Breathing easier

Beat at the semi-sunny start of the Crystal Springs 50K
On Wednesday I checked in with the asthma doctor who I first visited in October. We had a very long conversation (I was surprised she was willing to spend so much time with me. I'm used to medical professionals being in more of a rush) and she conducted a few tests. My resting lung function is now significantly better than it was in October, but the doctor said she could detect possible inflammation. She started me on a once-a-day cordicosteroid inhaler, along with advice to use my albuterol inhaler before every workout. She's of the opinion that I do experience exercise-induced asthma, and this condition was possibly first "activated" by engaging in intense activity while ill (this could be the case in both the 2015 Fat Pursuit and the Tour Divide), or a condition of my allergies that have worsened over the years. I have both genetic (my dad has adult-onset) and environmental (endurance/outdoor enthusiast with allergies) connections with asthma.

The doctor thinks stress and cold temperatures are a likely trigger, and urged me to engage in at least one more difficult cold-weather workout before I go to Alaska. I am supposed to check back in one month from now to see whether I've made any progress with the medication. Exercise-induced asthma can be a nebulous illness to diagnose and monitor, and I can't rule out other possibilities such as vocal cord dysfunction (which asthma medications do nothing for.) So ... there are still many question marks. But I feel optimistic. I'm glad to have found a doctor who's willing to listen and seems genuinely invested in finding a solution. She works with researchers at Stanford and has treated a number of elite athletes, but when I waved off my "little hobby" compared to the Olympians she's worked with, she responded, "it does matter!"

She seemed excited about the ITI, and told me there's no reason I can't participate if I feel my asthma is under control. I still see some glaring issues. First of all, I'm not sure how I can develop this confidence in one month. My breathing incidents are still limited and have only been triggered in more extreme cases that I probably won't be able to effectively test before Feb. 28. Also, it's difficult for anyone who hasn't been there (myself included) to really understand the isolation one is under on some sections of the Iditarod Trail. I'm thinking specifically of the 180-mile section between Takotna and the Yukon River that is truly a no-man's land, where Beat and others were effectively stranded for more than 10 days following a major snowstorm last year.

It is entirely possible to be all alone out there for 10 days (if the Iditarod Dog Sled Race moves to Fairbanks again. But even if it doesn't, mushers and volunteers are not in a position to provide assistance except in extreme emergencies.) If I start experiencing Tour Divide-level breathing difficulties, I will have nowhere to recover and may find myself in a state of becoming weaker until I need to curl up on the side of the trail for 10 or more minutes every hour, which is exactly how I hauled myself into Silverthorne during the Tour Divide.

It's one thing to risk this when it's 90 degrees outside and I can stick out my thumb if I truly feel desperate. It's quite another when it's potentially 40 below and I am a hundred miles from the nearest village. If I have any doubts about my fitness, I should *not* venture out there. I feel strongly about this. That won't necessarily stop me from trying if I've created assurances for myself, and that's something I also lie awake at night thinking about. The 350-mile effort to McGrath is, I think, doable. At least I'll probably know early in the race whether it's not. But I want — so much  — to go to Nome. I really need to draw that line, but it's hard.

So I am proceeding with my training with an admittedly disappointed eye on the 350-mile ride to McGrath ... still planning to ride, but keeping my running legs fit in case it's a huge push-fest, or in case the Iditarod Dog Sled Race does move north and I opt to bring a sled in order to hedge my bets on a big storm with nobody breaking trails behind it. On Wednesday and Thursday I did two tough bike rides, intentionally seeking out the steepest hills nearby. I did this because my "central governor" — that quiet, semi-subconscious switch in your brain that keeps you from pushing your body too hard — has been extremely conservative since the Fat Pursuit. I've been proudly clinging to this idea of self-restraint when it came to keeping my heart rate in zone 3, but during a Monday run, I realized I couldn't boost myself into zone 4 if I tried. I was too scared. Scared of losing my breath, and not getting it back.

 Zone 3 or lower is fine for multi-day endurance efforts — but now is the time to test my breathing capacity and potential asthma triggers. Situations during the Iditarod will certainly boost my heart rate to the top of the charts. It's unavoidable. Here, roads like Redwood Gulch and Bohlman Road with their 20-percent + grades will force me into the red zone — I can't pedal slow enough to stay out of it. Still, I didn't feel all that fantastic on these steep sections. My breathing was cautious and a little shallow, with my less-quiet central governor begging me to get off the bike and walk. I was perplexed. Here's a new mental limitation I need to address — is my lung capacity really that limited, or is it all in my head?

Today Beat and I ran the Crystal Springs 50K in Woodside. The sun peeked out for a very brief few minutes at the start, and it occurred to me I haven't seen all that much sun in 2016. El Nino is really cranking out some precipitation so far this year, and it's fantastic for the drought. But for Saturday, it meant another wet, slimy, slippery, and chilly run through the foggy mist. I wrote last week about basically floating on clouds through the Steep Ravine 50K, and that definitely did not happen this week. I worked for it, and I didn't feel great. All of my moving parts were fine, but I was low on energy and general oomph even after I gave myself permission to go at the hills a little harder. I guess there was a part of me that hoped I could run "fast" even though I have no reason to believe I could be fast right now (my once-a-week tempo run that I haven't really done since 2015 isn't going to cut it.)

We had several cloudbursts throughout the race, but around mile 20 the rain really started to come down. It was pouring, windy, and there were icy pellets falling from the sky. I was in a better mood at this point, as I'd given up my "run fast" dream and finally eaten a packet of fruit snacks (I'd been skipping snacks at the aid stations because the food was so soggy. I'm not kidding. The Oreos were practically floating in the standing water that collected in the paper bowl.) When I passed an acquaintance, Marissa, and asked how it was going, she replied, "oh, you know, just trying to get through this nightmare."

"What's the matter?" I said with genuine inquisitiveness. "It's only hailing!" (It was hailing.)

Marissa and another woman burst out laughing. "You can talk, you're used to the cold." After she said this, I realized that my fingers were actually quite numb, but it didn't really bother me before because it was 45 degrees and there was no real danger. But I did struggle to open the next packet of fruit snacks three miles later.

I tried for a little leg-pop to the finish, even risking a bit of slippery sliding in the slimy mud, but it wasn't enough to slide under six hours. I finished in 6:02. I was first in my age group, and actually the second woman to finish — just missed that mug! (Actually, I probably missed it by an insurmountable number of minutes, but the winner was still hanging around at the soggy finish area when I got there.)

Overall it went well, especially because I didn't place nearly the focus on my breathing that I did last week (I admittedly did not have the energy for this kind of fixed thinking. I was just tired.) Which is good to know, since I can't exactly meditate my way through a whole Iditarod. Optimism continues to regroup. 

Comments

  1. I'm glad you are feeling better. You are still completing some challenging activities even if you are not at the level of fitness, performance and health you'd like to be.

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  2. Nome is not going anywhere. It will still be there next year.

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  3. I think she hit the nail on the head about the asthma being activated by racing sick. The more we learn, the more it looks like the best thing to do when sick is take some time off. It would seem that toughing it out, powering thru it, can lead to negative long term consequences. Of course try telling that to an obsessive endurance athlete (not referring to anyone in particular, just aerobic animals as a group)!

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  4. I'm glad you've got this Doctor and more light is being shed on your issue. Given how severe the symptoms are and the nature of the ITI, I hope you don't take any chances this year. If you still have questions in a few weeks, then a change expectations for this year to having a good time, support Beat, visit friends and solo day trips, would not be the end of the world. And you've got a proper year to prepare for Nome.

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  5. I was treated unsuccessfully for a couple of years for exercise-induced asthma when I actually had/have VCD. I did not have any changes in resting lung function while I was being treated for asthma. My symptoms have always very localized to my vocal chords. I stopped all asthma medication once I got the diagnosis. I went to a couple of speech therapy sessions to work on my breathing and now take 75mg of ranitidine before hard workouts, since my VCD is triggered by acid reflux that only happens when I'm going hard.

    tl;dr I think you can rule out VCD.

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    Replies
    1. Thanks for your input. I actually received a few breathing exercises from my doctor and am working on those for good measure. VCD is unlikely for me, but I haven't been able to rule anything out yet. I had pneumonia back in June, and this can have a lasting effect on lung function that may or may not be connected to the high-effort breathing difficulties I'm experiencing. But most signs do point to allergies/asthma.

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