Still gasping

On Friday night, Beat and I started the Fat Pursuit 200-mile snow bike race in Island Park, Idaho. Our intent for this race was to test ourselves and our Nome gear in a more demanding environment than our typical training rides. I'll probably write more as I process my experience, but I ended up pulling the plug at checkpoint one (mile 80) because I'd had difficulty breathing for ten hours, there was no joy or benefit in the hypoxic struggle, and I'd already failed my personal test. For whatever the reasons or causes, I still experience respiratory distress during higher levels of exertion. In an endurance race setting, it's distressing and frustrating. In the Alaska backcountry, it could be extremely dangerous. This is something I need to address immediately, rather than grasp onto the fraying threads of optimism that "this is something I can control" or "this will get better" just to keep my Alaska dream alive.

I DNF'd another race, and I am disappointed about that, but that disappointment is far outshadowed by the idea of giving up the Iditarod. This is the dream I've been fighting for since the first signs of breathing difficulties developed during the 200K version of the Fat Pursuit in January 2015. But I'm not performing remotely well at this level, and the Tour Divide showed me that these issues just go from bad to worse over days and weeks. Also, when I'm experiencing breathing difficulties, every molecule of joy is sucked out of the endeavor. Beyond my personal safety and concerns about my health in the future, I won't abide the gray, disoriented, distressed and joyless state of oxygen deprivation just to prove I'm tougher than myself.

So, what happened? The shorter version — the race started at sunset and I immediately fell off the back of the field of 25 or so. Okay, that's fine, but I was already stressed about what I viewed as a tight cutoff, and realizing that I was starting out so slowly caused some anxiety. As darkness fell the course entered a series of rolling ski trails, and I surged to keep my momentum up short but steep hills. This necessitated hard breathing that soon triggered a feeling of pressure in my chest, and I remained completely winded for the next ten hours. If I pushed too hard, I could hear a chirpy wheezing in my throat after I stopped to catch my breath. I tried using my albuterol inhaler, but it was not spraying adequately in the 15-degree cold, and holding it in my hands for a few minutes didn't warm it up enough to work. Hiking up steeper inclines (and soon all inclines), I needed to stop and rest frequently. Before I reached the checkpoint, I was stopping every five minutes or so even on flat terrain. Trail conditions were relatively slow, with fresh grooming (which churns up the hardpack) and an inch of fresh snow, but I struggled to maintain 4 mph and I saw that as the minimum pace for making the final cutoff — if I could hold it together for another 34 hours. This seemed unlikely, needlessly punishing, and potentially reckless. Beat waited for me at the 80-mile tent checkpoint for nearly two hours, and convinced my still-foggy mind of the futility of pushing this limit. He was concerned enough about it to stop his race and ride the 12 miles back to Island Park with me. He did warm up my inhaler to a point where I could take a puff and feel much better, but the effect was short-lived when I started riding again.

The Fat Pursuit feels like my "Come to Jesus" moment. My problem is probably not just allergies, high-altitude, anxiety, over-exertion, pneumonia, cold weather, or any single-cause incident. It's a complicated pattern. Endurance racing is the constant. Exercise-induced asthma would be one possible explanation. But my pattern doesn't fit the classic profile of asthma or even exercise-induced asthma, since I've only experienced breathing difficulties and congestion in the more extreme situations I put myself in, and during the recovery/aftermath.

I spent some time reading reviews of relevant scientific studies. I'm not trying to diagnose myself via Dr. Google, assume I understand all the factors of these studies, or even assume they relate to me (most of those studied were professional athletes, not amateurs.) But the articles did provide some interesting observations. From what I can gather, in a nutshell: People who spend large amounts of time breathing heavily outdoors — especially when exposed to allergens, pollutants, high altitudes, or cold — appear to have a higher incidence of respiratory disorders than the general population. Among the findings:

"Chronic physical training might arouse a faulty adaptation of the main lung components, at the alveolar–capillary interface or at the airway level, particularly when exertion is carried on in particular environmental locations, as in cold or in hypoxic conditions at even moderately high altitude. The result is that the negative influences of these respiratory system limitations will be greatly intensified during exercise performance, especially in highly fit individuals."

 "With all of the preceding discussion relating to exercise triggering, can exercise really cause asthma? The answer turns out to be yes: there does appear to be an asthma variant caused by extremes of exercise and cold air exposure. In this syndrome, elite athletes, especially those who train in cold climates, may experience non-atopic airway inflammation and subsequent airway hyperactivity. The best understanding of this process has come from studies on Alaskan sled dogs competing in the Iditarod race. Compared with nontrekking dogs, race participants demonstrated a dehydration injury of their airways leading to an inflammatory process associated with airway hyperactivity."

 "The available literature indicates that participation in high-intensity exercise in certain environmental situations is implicated in the development of airway pathophysiology. Thus, whilst the benefit of regular physical activity for health and well-being is widely recognized, there is legitimate concern that the intensity of hyperpnoea necessitated by elite-level exercise may be detrimental for respiratory health."

"Possible mechanisms involved in the development of asthma in athletes are still uncertain; however, the content and physical characteristics of the inhaled air seem to be important factors, while immune and neurohumoral influences could play a modulatory role."

I intend to see a pulmonary specialist as soon as possible, in hopes there may be some physical evidence that I can address and treat. But I recognize I might not find readily available answers, and that I may need to take a prolonged period away from endurance activities to improve, and that it may never get better.

A number of people have reached out to share their own experiences with respiratory distress. Some manage their exercise-induced asthma with medications, some had to readjust their training or move to a different location. One woman who had breathing difficulties and multiple bouts of pneumonia for years finally got a CT scan, which revealed a cyst that, once removed, cleared up all her issues. So ... there's hope, too. But this is where I'm at right now. Uncertain, disappointed, but grateful I still have good overall health that I intend to maintain. 

Comments

  1. Bummer, Jill. Have you made any decisions about the ITI yet? It seems to me that all or most of the time you are having these problems are when you are at high altitudes. Trying to do the ITI, even just to McGrath, might help sort that out.

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    1. I haven't made the decision yet. I am leaning heavily toward dropping down to the 350 to McGrath, possibly on foot. Breathing difficulties continued for several weeks after the Tour Divide, and I found it was a lot easier to control my breathing when I was running. Biking tends to have burst of power followed by rests, and this seems to trigger the attacks. But I'm still mulling it over.

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  2. I'm so sorry to hear that! Dealing with asthma sucks. I had pretty severe exercise induced asthma throughout junior high and high school, which almost completely disappeared when I moved for college. Due to that, I assumed it was mainly caused by environmental factors. Unfortunately, my asthma returned with a vengeance about when I turned 30. I've been keeping it semi-under control with an emergency inhaler, but I really need to go see an asthma doctor to see if there are any underlying causes I could potentially treat.

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  3. My problem is probably not just allergies, high-altitude, anxiety, over-exertion, pneumonia, cold weather, or any single-cause incident. It's a complicated pattern. Endurance racing is the constant.

    Jill, your only constant is your allergies. I relate to your issues, since my middle ear inflames exactly 3 days after a strenuous bike ride. BUT IT IS NOT biking, it's allergies. Or allergy related sensitivity. The triggers are multiple. Let's talk about this on a bike ride. It can ( and must) be managed!

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  4. Best wishes. Hopefully you can figure this out once and for all.

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  5. I can only imagine your frustration.

    I hope the move to Colorado will help. You have such a strong endurance background with no similar issues until the previous year or so that it makes me think some of it could be related to the Bay area, whether that's climate, pollutants, greater exposure to allergens, whatever. Best wishes to you in finding a doctor who can get this figured out!

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    1. I'll be honest ... I'm excited but a bit scared about moving to Colorado. Combination of high altitude and grass pollen is going to make for a rough spring, regardless of any treatments I might find. Still ... hopefully I'll adapt!

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    2. OK, here's a random idea. Don't move into the mountains west of Boulder, you'll be 2 or 3 thousand feet higher than in town which might exacerbate your asthma. Look at some wonderful neighborhoods right in town at 5,400 ft elevation with trail access right out the door. Neighborhoods just west of North Boulder Park (3rd thru 7th St.) or west of the Hill nestled underneath the slopes of Flagstaff Mtn. Some really cool places, less driving and commuting, plus you get to live in the vibrant, always fascinating experience that is Boulder. In town you can park your car for weeks at a time and do everything by bike.

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    3. Plus if you stroke out, you're near Boulder Memorial. :-)

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  6. "...grateful I still have good overall health.." Yeah, there's more to life than winning races. Ever try an inhaler? I use one rarely, but when I need it, it is somewhat effective in getting rid of that tightness.

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    1. Inhaler does work, but it seems short lived. I'm convinced there's an underlying issue I need to get a handle on.

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  7. I have asthma when I exercise in cold weather. I do my best to keep my mouth shut and allow my nose to warm and moisten the air, but this is not possible at high exertion levels. Albuterol and decongestants help. I wonder if there is some external way to aid this process, short of an oxygen mask? A damp (unfrozen) bandana? I'd also make sure I was very hydrated, so as not to give the lung surfaces something else to complain about. (I hope this makes some sense...mostly thinking out loud). FYI: Dave Thompson just had his entry accepted for the Leadville 100!

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    1. The airway tightening can be a physiological reaction to dehydration. I should try riding with a buff at all times to see if it helps, but that really obstructs my breathing. It's a hard balance to strike.

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    2. I'm sure everyone is different, but personally I've found that after spending some time practicing, I can breath in through my nose even at reasonably high exertion levels. I was starting to develop some very mild respiratory problems when exercising in cold weather and this has fixed the issue for me.

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  8. Anonymous8:50 AM

    racing is tough, I've seen the best of racers succumb to illness which ended their career. Most notably, Marg Fedyna ( http://cyclingmagazine.ca/sections/news/canadian-marg-fedyna-wins-taiwan-kom-will-routley-finishes-15th/ ) as she had to take a year off and rest after winning La Ruta. There are many plagued with illness after 2-3 years of racing. Hence, many stop after year 4-5... what Lance did after 7 times is amazing really, even if he was doping. To put the body through that must stress is amazing, yet he focused on that one race only. Maybe that's the key? to focus on one race and put all the eggs into one basket. Then comes Tinker Juarez, after 30+ years of racing he's still going. He finished La ruta this year under 10th place. An amazing character and athlete he is. Racing is tough without much long term ROI. Unlike other sports like hockey and football where players make hundreds and thousands a years... most in cycling are in debt. Its like a good-bad addiction. When I was racing, I'd give up a lot for the sport, spend 20k a year and spend upwards of 650km a week (25000km a year) on the bike... many sacrifices. Like Chris Eatough once put it, yah really gotta like the sport www.cyclingnews.com/features/too-tough-chris-eatough-wraps-up-storied-career/
    its tough... kicks the crap out of yah... like a good-bad addiction.

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  9. So sorry to hear of your troubles, and at the risk of adding another "googlesque " idea, I'll let you know my experience. I always had hay fever and allergies (grasses, mold, dust mites), but never had asthma symptoms until age 37 (sound familiar?). After 2 years of progressively worsening symptoms and upper respiratory infections culminating in a horrible bronchitis after a race, I ordered some tests on myself. I was looking for any sight of immune deficiency, but added tests for common food allergies, as well. It turns out that I am not only allergic to grasses when inhaled or on contact, I'm allergic to wheat as a food. After cutting out grains, I slowly got better and have ditched all asthma meds. I slowly got healthier for about 4 months, then started the adventures again (began with some hike training at home, the packrafting in AK). Though I'm not the ultra racer that you are, I did PR a half marathon on New Year's Eve and then PR'ed again the next day for a half. i hope you find the root of your issues - don't be afraid to ask all the weird questions! For your sake, I hope it is as simple a solution as mine seems to have been!

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    1. Thanks for sharing your experience. That's something I've considered as well and thought about asking for further tests. I appreciate the insight.

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  10. Anonymous3:16 PM

    With your travels to Asia and Africa, you might consider seeing an "exotic" disease specialist. It's not too unusual that after seeing lots of regular specialists, chronic fatigue syndrome patients eventually discover something rarely seen by the regular guys. I don't know how likely it could be the case with you.

    Tom
    Fairbanks

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