Running with Atrial Fibrillation – It’s Okay To Be Slow! Forget The Pearl Izumi Advertisements

I saw some recent Pearl Izumi ads posted on The Trail and UltraRunning group on Facebook and thought I’d comment.

There are a number of Pearl Izumi ads that make fun of slow runners, here are two examples:

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Pearl Izumi – Trying to sell shoes by denigrating slow marathoners

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Divide and Conquer – Pearl Izumi teasing “joggers”

The remaining ads can be found on this excellent blog:

Short, Round, and Fast

One of the nice things about endurance sports, from half marathon and up, is that most participants do not have this type of attitude. It is a live and let live culture. It seems like half marathons in particular are a plce where you generally see conspicuously non-athletic looking athletes – and good for them!

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Half Marathon Participant – Right on!

As for me, I’m in permanent atrial fibrillation, which makes me slow, and now I have to take a beta blocker, which makes me even slower.

But I’m certainly not going to stay home, and I’m going to remain a trail runner, even if I’m slow, and I still plan on signing up for distance events. At my last half marathon I was very surprised to see almost the entire field, including people who would previously never had been in front of me, pass me, get smaller, and disappear from sight. In the first two miles. Not fun. I was thinking, “Whoa, where’d everybody go?”

Contrary to how it might appear to faster runners who are observing slower runners, it’s not always easy being slow. It might actually be more difficult. Yesterday on a four mile trail run, my first run on the beta blockers (more on that later), I rounded a corner and saw another runner behind me. He was an individual who I had seen at the trailhead, who appeared to be a bit older than me, and who was wearing jeans and a long sleeved shirt on a ninety degree day. I thought, “Oh man, I don’t want to get passed!” and I cranked up my speed. I don’t think I was running fast at all, maybe about a ten minute mile, but the burning in my lungs and legs felt like a fast 5K. “This is ridiculous!” I thought, saddened. This is “fast” for me now.

But that is my new reality.

As far as Pearl Izumi is concerned they evidently think that being assholes, and creating some controversy, will make their ads stand out. They may be correct. There are a lot of competitors out there, they have an extremely small market share, and it is said there is no such thing as “bad publicity.” I knew that they made shirts, and jackets; but until now I didn’t even know they sold shoes.

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Pearl Izumi Shoes – so fast you’ll kill your dog!

One of their ads last year, which featured a runner who ran so fast in his new Pearl Izumi shoes that he killed his dog, made quite an impression. Of course they apologized and had their (unfunny) ad featured in news stories and blogs for weeks.

By the way, my main nylon running jacket is made by Pearl Izumi. I like it, it’s a good jacket. I’m not going to boycott them or burn the jacket, or anything like that. I just want to say in this blog that slow runners are probably slow for a reason – and that reason isn’t necessarily poor character or laziness.

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Me – Lazy jogger with atrial fibrillation after a twenty mile training run. I ran so slow that my dog survived!

Or even if the slow runner does have poor character, or is lazy, well, what’s it to you?

And guess what – Pearl Izumi got three of their ads posted in my little blog (and elsewhere) – for free!

Runner’s High – a Gift?

Is distance running therapeutic? Is mountain biking addictive? Is there such thing as a good addiction? If my atrial fibrillation worsens and I could no longer do long runs or bike rides – how hard would it be to kick the habit?

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High Lakes Trail – Southern Oregon

Today in the hospital lounge, while I was eating some potato chips, somebody was telling me how bad potato chips are for me. Whatever – I have given up almost everything in the world that is bad for me. I haven’t drank alcohol in several years, haven’t smoked a cigarette in decades, gave up meat and eggs a couple of years ago, I’m almost dairy free, and I haven’t taken recreational drugs since high school in the seventies. Potato chips, which I feel are good enough to be “worth it,” are about it for me. Well, that and diet soda, which is also an unhealthy habit that I have.

But what about “runner’s high?” Is that my addiction?

And what exactly is runner’s high? Does it even exist? I’ve been hearing about it for a long time, even before I started running in the early 80s.

Allegedly the athlete’s brain is “flooded with endorphins, more powerful than any street drugs!”

Many distance runners claim to experience euphoria during or after running, and some claim they’ve never had it happen – not even once.

The endorphin theory is the oldest, but more recently I’ve read about how endocannabinoids (naturally occurring neurochemicals related, in a way, to the active ingredient in cannabis) might be the cause of runner’s high.

Another article I recently read attributes runner’s high to “dopamine, serotonin, and endorphins.”

Whatever the cause, it certainly appears to be real.

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Pacific Crest Trail via Brown Mountain Trail – Klamath County, Oregon

Ultrarunner Dean Karnazes describes the role that running has in his life: “Some seek the comfort of their therapist’s office, other head to the corner pub and dive into a pint, but I chose running as my therapy”

“I’m convinced that a lot of people run ultramarathons for the same reason they take mood-altering drugs. I don’t mean to minimize the gifts of friendship, achievement, and closeness to nature that I’ve received in my running carer. But the longer and farther I ran, the more I realized that what I was often chasing was a state of mind – a place where worries that seemed monumental melted away, where the beauty and timelessness of the universe, of the present moment, came into sharp focus.”
― Scott Jurek, Eat and Run: My Unlikely Journey to Ultramarathon Greatness

Actually, a recent New York Times article states that on good experimental evidence it has been finally determined that exercise does indeed produce a flood of endorphins in the brain. Lucky us!

Researchers in Germany, using advances in neuroscience, report in the current issue of the journal Cerebral Cortex that the folk belief is true: Running does elicit a flood of endorphins in the brain. The endorphins are associated with mood changes, and the more endorphins a runner’s body pumps out, the greater the effect.

I won’t review the article here, but please read it – an elegant experiment, and solid conclusions.

But irrespective of the cause, what is runner’s high and what does it mean to endurance athletes? Can a person become addicted to it?

Personally I feel that the term runner’s “high” is a misnomer. I would describe it better as an altered state of consciousness rather than a high. Maybe I’m splitting hairs but I have never felt intoxicated by endurance sports.

Euphoria might even be too strong of a term – but maybe not. There are times during and after running when everything appears exceptionally crisp and beautiful. That’s why I love trail running, in Oregon, in the wilderness – does that happen to people in health clubs running on treadmills?

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After an hour or so even carb gels seem remarkably delicious!

Also – music becomes intensely enjoyable. I do run with an iPod and sometimes I feel I am going back to the days back in high school when I smoked pot and would listen, chemically enhanced, to suddenly amazing music on headphones. Except now instead of sitting in a darkened basement I’m moving through the woods. It’s funny – a lot of the music that, for me, is most enjoyable on long runs, is the same type of music that I believe would be most enjoyable to a person who is stoned. Sometimes a song sounds so good I’ll repeat play a song two or three times.

But another reason I don’t like the title “runner’s high” is it isn’t all euphoria, beauty, and music joy. I think the exercise induced altered state of consciousness can involve a certain amount of emotional lability. Here’s an example: once I was on a twenty mile trail run, and at mile sixteen an old song I hadn’t heard in years, Careful With That Axe, Eugene, started playing in my random shuffle. This very early, nine minute long Pink Floyd song is sort of a novelty song; a one chord song that slowly builds on a rising and falling bass line with a mellow organ playing over it. At one point a whispering voice says, “Careful with that axe, Eu-zhene.” And then there is this horrific screaming and dissonant guitar, and finally it evolves back to the mellow bass and organ. Back when I was in high school, if we had somebody over who had never heard the song before, we’d put it on and turn down the lights, and of course when the screaming began it would scare the crap out of the first time listener, and we’d all have a good laugh.

Well I knew all about what was going to happen during that song and wondered if I would start laughing when the “axe” section came up. Imagine my surprise when I burst into blubbering tears when the screaming began. I should state that this was shortly after my ex-wife (with whom I was still friendly) and her family had died in a horrible house fire – but honestly I wasn’t even thinking about that until the screaming in the song. I know I wouldn’t have been anywhere near that emotional if I hadn’t just put in sixteen hilly trail miles.

Other times while running something will strike me as funny I will begin laughing giddily – out there all by myself, or in the back of the pack at a marathon. Or an angry song will play and I’ll feel, like, GRRRRRRR!, become angry – quite a catharsis.

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GRRRRRRRR!

So is exercise induced altered state of consciousness addictive? I’m thinking: yes.

A CAGE questionnaire is commonly used to assess alcoholism.

Try applying it to your running:

C – Have you ever felt you needed to cut down on your running?
A – Has anybody ever annoyed you or criticized your running?
G – Have you ever felt guilty about your running?
E – Have you ever felt you needed a run first thing in the morning (Eye-opener) to steady your nerves?

Well – I can honestly say I’ve never felt guilty about my running, but the rest of those questions, well . . . .

And I can state for the record that with my atrial fibrillation, and the likely progression of my a fib, including my upcoming need to be on a beta-blocker, I have been dreading the day when I am no longer able to run. Very depressing.

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Biking in A Fib – like riding through mud

Aside from that I have a theory. I think it is obvious that not everybody will experience anything like a runner’s high. Clearly many people hate the way running makes them feel, and they are the people who think distance runners are completely nuts. And why wouldn’t they? Based on the time they ran two miles and felt nothing but fatigue and pain, and interpolating that up to, say, thirty-one miles, their obvious conclusion would be “WTF?” to use the parlance of our times.

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Lyon’s Trail – Lava Beds National Monument

But as for myself, and I’m guessing most of the people who would be interested in this blog, the so-called runners high can be generally considered to be a gift.

Diversion: How to talk to your children about distance running:

Emergency Pack for Trail Running or Mountain Biking While on Anticoagulants (Coumadin, Xarelto, Pradaxa, Plavix)

This article is a work in progress and is only a description of my strategy for the time being. I hope to learn from readers of this blog about how to better plan for a trail debacle.

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Heading out for a trail run on the Pacific Crest Trail

What kinds of things should a person like me, who is dealing with atrial fibrillation and is taking an anticoagulant (I take Pradaxa), carry on a long run in the wilderness? Or during a long mountain bike ride in remote areas?

When the high country in our local wildernesses is not covered with snow, I will generally do runs, nearly every weekend, of anywhere between six to twenty miles. I almost always run alone (except for my trail buddy – Ringo).

Dangerous and a bad idea? Possibly. But this is what I enjoy in life so I don’t plan on stopping any time soon.

The most important piece of equipment is a phone. People complain that everybody is always on their smartphone, and they should NOT be talking on their phones on mountain summits when everybody else is trying to get all Zen-like and self-actualized, and whatever – that’s a different discussion. You certainly don’t even need to have your phone on; but you absolutely should take it with you, and it should be fully charged. The days of getting hopelessly lost and spelling out SOS with rocks hoping a search plane will find you are fading into the past. A smartphone is a GPS and a direct link to help.

I always carry my iPhone in a baggie with my ID and a sheet of paper towel (which I use for unrelated toilet purposes).

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Fully charged and protected from water

Even if there is poor cell phone coverage in your local high mountain or deep canyon wilderness, and a phone call isn’t always possible, I find that a text message can often still be sent. It might take a while but it eventually will be sent, especially if I am moving along a trail.

There is the standard emergency gear that most people take, often called the “ten essentials” which most people carry while in the wilderness. Of course there is truly no such thing as a standard ten essentials and the list of things you carry will vary depending on the season, your skill set, your location, and your past experience.

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My generic survival gear

I got out my little survival kit that I typically carry in the wilderness, and of course not everything is pictured here, and I might not even have all of this stuff with me on any given trip. Naturally I will also have other things like food, gels, electrolytes, a jacket, and plenty of water.

What I found in my default wilderness pack is:

Two knives – a mini-leatherman tool and a standard knife. I will only actually carry one of these.

Two lights – a headlamp and a tiny LED flashlight (one is plenty).

Fire starter – a cigarette lighter, birthday candles, a tampon, and hand sanitizer (which I discovered has completely evaporated).

A space blanket, a compass.

Repair gear (Shoe laces, tenacious tape, dental floss)

Pain pills: Vicoprofen samples – okay they expired in 2000 but I’m guessing they are still good (at least for a placebo effect). Missing: Benadryl for allergies or yellow jacket stings, and I probably should have some of my Pradaxa in case I end up unexpectedly staying out overnight. Also missing: small roll of duct tape, safety pins, and my whistle!

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Saint Christopher Medal

Oh, and there is a Saint Christopher medal. This one belonged to my grandfather. Well it probably won’t change anything, but it certainly couldn’t hurt. Feel free to substitute your own personal good luck charm.

But what about specific items for the runner on an anticoagulant? Is there anything else beyond the “ten essentials”?

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Other stuff: Map with reading glasses (if needed) and some rope

Obviously having a major bleed while running alone in the wilderness would be a disaster. Death is certainly a possibility. How can a trail runner prepare to increase the odds of a good outcome?

I always make sure to let somebody know (usually my wife) where I’m going and I also send her a text (I text “OOTW” short for “out of the woods”) when I get back to my vehicle.

I also wear a Road ID. This way if somebody finds me they will know I am on an anticoagulant. Maybe this won’t help, but it certainly is worth wearing. At least they will be able to figure out why I bled out so quickly (I know – not funny).

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My Road ID

Another item I always carry is a bandanna. This can be used for a number of purposes, such as making a field dressing; but I want to have it in case I need a tourniquet. Plus – I have an extra one because my trail dog always has one draped around his neck.

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Bandanna

My bandanna came in handy a week ago when my wife Margo (not on an anticoagulant) crashed her mountain bike and punctured her left thigh with her brake lever. I used it to make a compressive dressing before we road our bikes back to where we could get a ride to the hospital.

One item I do not currently have but definitely need to obtain is a Quickclot field dressing. Evidently these things really work and are routinely used in combat situations. It is a topical coagulant (an anti-anti-coagulant?) which helps clot blood and also serves as a physical barrier to bleeding. I’ve been meaning to obtain one of these for a long time. They are available online via amazon.com, and I just ordered one.

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Quickclot

Question: Will the Quickclot sponge even work on bleeding in an individual who is on a direct thrombin inhibitor like Pradaxa? Answer: I have no idea. I’ll let you know if I ever get a chance to find out.

In case of bleeding the most important first step is to apply direct pressure. As a surgeon I have a lot of experience with this. Usually sixty seconds of direct thumb pressure will stop or slow most bleeding, but of course if you take an anticoagulant it will take longer. Apply direct pressure as long as necessary. Elevate the wound if possible. Don’t try to clean out major wounds as this will restart bleeding – that can be done later at the hospital.

A tourniquet is a last resort, but the bandanna can be used as a compressive dressing if needed.

Please understand that an anticoagulant doesn’t completely stop clotting of blood, it just makes it take longer. Eventually bleeding will stop. Hopefully before all the blood leaves your body!

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Ringo always has a spare bandanna for me

Bonus – How to stop a nosebleed:

I have been plagued by frequent nosebleeds since I was a child but, oddly enough, I haven’t had a single nosebleed since I started Pradaxa a couple of years ago. The best method I have found is to pinch the nose, fairly tightly, just above the nostrils, and lean forward. Don’t lie with your head back – that doesn’t work. Hold for a full sixty seconds. Repeat as necessary.

If you are, like me, a trail runner or mountain biker on an anticoagulant, I would love to hear from you. Please leave comments and suggestions in the comments area below.

Thanks.

Mountain Bike Injury – Thigh Impaled by Brake Lever

Not me – my wife, Margo.

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Before Crashing

While I have been trail riding and trail running on technical trails since 1988, my wife Margo, although fit, generally stays off of steep, rocky stuff. She likes rail trails, or the easy trails near Lake of the Woods (Oregon) – but she only gets on single track about once per year.

I was delighted, of course, last Sunday when she agreed to do a “real” mountain bike ride with me. We headed out from home and rode to Moore Park via the Link River Trail, then up the Ridgeview, Blueberry and Linda’s Trails then we descended via the Half Gallon and Big Sky Trails.

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Note small hole in tights

As we rode I tried to let her know when various hazards were coming, and we both walked through most of the rock gardens. We were almost to the bottom of Big Sky Trail, and ready to finish up on a couple of easy trails, when I (foolishly) commented, “Well, you made it. No crashes. Great job.”

And while we rode the last bit of trail I was hoping that she would suddenly start to love “real” mountain biking, and was thinking how if she did like it she would really need a newer, better bike than the super heavy ten year old hard tail she rides – I heard her crash behind me.

It was sort of a freak accident on a slightly rocky downhill section approaching the last switchback on Big Sky Trail. I turned back to see her prone on top of her bike – she had evidently done an endo.

“Are you alright?”

“I don’t don’t know which way to move my leg,” she said. She couldn’t get her left leg off of her bike. She was stuck.

I dismounted and ran back to her, and immediately lifted her, by her hips, straight up off of the bike, rotated her to a supine position, and placed her on the ground next to her bike.

“Are you hurt?”

“I don’t think so.”

She stood up and I noticed she had a little hole in the front of her (brand new) tights. The upper, inner left thigh.

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“We better check that.” She pulled down her tights and there was a small wound about one square centimeter with some subcutaneous fat bulging out and a small trickle of blood. It looked just like an incision for a laparoscopic port. “Shit! It went in. We need to get you to the emergency department to deal with this.”

Surprisingly, she seemed fine. No pain. Very little bleeding. She did not appear to be in distress other than being understandably freaked out. It’s fortunate that Margo didn’t realize what had actually happened until much later.

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Before Treatment

I made a makeshift bandage out of a bandanna I carry with me for this exact purpose, we pulled her tights back up, and began to ride out. I didn’t want to have to ride all the way home so I called a friend to meet us at Moore Park to take Margo to the hospital. It turns out she was 100 miles away on a kayak trip. We then called our son Terry and he loaded up his three small children and met us at the gingerbread house at Moore Park.

I don’t recall ever seeing Margo pedal a mountain bike so quickly on a trail as that last mile or so back to the gingerbread house! I trailed behind her marinating in “survivor guilt.”

Terry dropped us off at the Emergency Department and brought our bikes home. This was our first ED visit in twenty plus years. I’m sorry to admit that I “pulled the doctor card” and asked them to tell the ER doc on call that I was there (we’re personal friends) and we got right in. So much for hours of waiting in the ED reception area.

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“She’s a rock.”

From there it was uneventful. This was a very blunt trauma; but it was clear from the bruise on the back of her thigh that when she crashed the brake lever handle went all the way through her and hit the back of her thigh. Luckily, because the end was so blunt (it actually had a bulb-like tip) it didn’t cut anything and surely went right around any nerves or blood vessels.

Treatment consisted of a tetanus booster, a gram of Ancef (antibiotic), flushing the wound out with sterile saline, and then trimming the rough areas and bulging subcutaneous fat. She was also given a prescription for ten days on an oral antibiotic. No sutures (so it could drain if need be).

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After Debridement

Margo was a rock. It reminded me of the line in Repo Man where Bud lies to Otto that his wife is pregnant and he needed Otto to take her car (actually getting Otto to repo a car for him). Later Otto asks, “What happened to your old lady?” Otto replies, “My old lady? Oh, shit, I forgot all about her. Well, she’ll take the bus. She’s a rock.”

After it was all over and she finally realized what had happened, and how far that stupid brake lever handle penetrated her thigh, well, she started getting a bit dizzy. Every time we got up to leave she had to lie down again; but we eventually went home. Poor Margo.

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Relaxing after a bike ride

At this point, four days later, she’s doing fine and still only has minimal pain. But “it’s creepy pain” she says – because it is only in the back of her leg, not where it went in.

Doing an internet search on this injury I find that it really isn’t an uncommon injury, although I hope to never see it again. In some cases the brake lever had become stuck in the injured rider. And the thigh is the most common site, but not the only site. There are some pretty gruesome descriptions of this injury if you want to check them out.

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She didn’t want to put the tights back on

I’m happy I just pulled her up off of the brake lever immediately. Some of these poor people were clowning around for hours with a person stuck to the bicycle. That sounds unpleasant and might be an example of people making things more complicated than they need to be. See the video below for an example of a brake lever that actually became stuck in a young woman’s thigh.

This young woman had an injury similar to Margo’s injury

After this injury I doubt that I will get Margo back out on the single track any time soon – but I truly do think it is important that she at least get back on her bike again soon; otherwise she may have difficulty enjoying riding her mountain bike again.

As for me, I already rode that some trail again. Here is a photo of my bike placed at the spot (and position) where she crashed:

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This is my bike at the site of Margo’s crash

If anybody has any experience with this type of injury, or if you have any comments at all, please reply below.

Sorry about the lack of atrial fibrillation content in this post. Scroll down for plenty of a fib content.

Race Report – Vernonia Half Marathon & Marathon

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Starting line – Vernonia Marathon

My most recent event (last Sunday) was the Vernonia Half Marathon & Marathon near Portland, Oregon. The race is held on the Banks-Vernonia State Trail, Oregon’s first Rails to Trails project. I’ve been interested in the Banks-Vernonia Trail for the past twenty years – ever since becoming involved in the OC&E and Woods Line State Trail in Klamath Falls, Oregon (Oregon’s second Rails to Trails project).

It was nice to final get in a run on this trail.

As I stated earlier I had originally signed up for the full marathon but I decided to switch to the half marathon because although my training was going fairly well, I was having problems with my longer long runs. Anything up to twelve or thirteen miles was okay but for some reason I was really getting fatigued one longer runs like sixteen, seventeen, or eighteen milers. Eighteen was my longest run – and thought, “If I feel like this after just eighteen miles I don’t want to know what twenty-six feels like.”

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Pre-Race Motel

I didn’t think it’d be a good idea to proceed with a marathon without a few twenty mile runs under my belt. (Keep in mind I’ve done about twenty marathons previously so I didn’t feel too bad about the downgrade).

In the past I’ve always tolerated my longer runs well – and even though they were taking my forever I enjoyed them. This time something has changed. Is it attributable to aging or is my atrial fibrillation becoming less stable? I dunno. I have an routine appointment with my cardiologist coming up so I guess I’ll find out.

Anyway – as far as the race was concerned overall it was a nice event.

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Packet Pick-up Chaos

The packet pick-up was in Banks, the runners were bussed to Vernonia and ran either to Banks (full marathon) or half way to Banks (1/2 marathon) and were bussed to Banks.

There were a few problems. They had packet pick-up the night before but also the morning of the race. Since there are no motels near the packet pick-up most people decided to pick up the packets right before the race. Evidently there were problems with the busses as well so we got started a little late – like at 1000AM instead of 930AM. That’s the latest starting marathon I’ve ever been involved with and I imagine it became a little hot for the slow people running the full marathon. The half marathon was nearly all in the shade – but the full marathon had several miles near the end with full sun. The race director sent a great email accepting responsibility for the late start and promising to fix the problem for next year’s event.

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Back of the Pack Starters – Vernonia Marathon

The early start people started on time (830AM) and in retrospect I think I should’ve opted for the early start – I’m certainly slow enough to have been early start eligible!

But honestly . . . I hate doing early starts – it’s discouraging to me to be passed by all those fast people – I’d rather start in the back and stay in the back.

The trail was delightful – it is a paved rail trail that primarily goes through verdant forests. Green trees, moss, ferns – nothing like the OC&E Trail (Klamath Falls) or the Bizz Johnson Trail (Susanville, California) which are both in much drier, browner ecosystems.

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Early Along the Course

As far as the course was concerned the last four miles or so of the half marathon were a consistent uphill grind – relentless. Not steep but relentless. At the half way point of the full marathon the course changes to downhill for most of the return to Banks.

I knew it was a bad sign when for the last three miles of the race I encountered a steady flow of bicyclists whizzing by in the opposite direction – none of whom were pedaling.

The race director emailed that he was considering starting the half marathon at the current half marathon finish and having a common finish line for both races. Yes – sign me up – that would be a lot more fun!

I had a slow day and felt poor during the final three or four miles of climbing. I have been finding that if I take a carb gel every 45-60 minutes during a long run I do well but if I try to run without calories I bonk. I read the pre-race instructions the night before the race and saw that there was going to be carb gels at the water stations so I FOOLISHLY decided not to carry and carb gels with me. That was a huge mistake. There were zero carb gels at any of the water stations. The last water station wasn’t even manned! I think there may have been carb gels for the faster people – I saw several empty Hammergels packets along the course – but I should know better. Never count on there being any gels left by the time the back of the pack runners like me arrive. Actually I would bet that if there were carb gels the early start people got all of them – one more reason to choose the early start.

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Vernonia Finish Line (1/2 Marathon)

But seriously – that is completely my own fault. I should know by now – I’ve only done about thirty or forty of these things. I brought plenty of gels with me and was just too lazy or cheap to stick them in my pocket.

Never again will I make this mistake – the slow runner needs to be more self reliant than the fast runner – that’s the truth. Once Margo and I finished the Pear Blossom ten miler at the very back of the pack (not because we were slow – we had locked our keys in the car and gotten to the race a half hour late) and they were completely out of finish line water by then – ouch!

If anybody is reading this race report scoping out the race for future consideration I would like to go on record as highly recommending this event. Yes – there were frustrating issues for the 2014 race but I think they will be corrected by 2015. The course is lovely and the people are terrific.

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SOB Trail Run – Ashland, Oregon

By the way – my next event is the SOB Trail Run at Mount Ashland near Ashland, Oregon. I’m already signed up for the 15K. There is also a 50K and a 50M. SOB stands for “Siskiyou Outback” and the race follows the Pacific Crest Trail at certain points. More later.

More Photos From Vernonia Marathon

Too Much Water? Not Enough Salt? Hyponatremia in Marathon Runners

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Hyponatremia (low sodium, or “water intoxication”) is a risk for runners with atrial fibrillation. It is certainly a risk for me and I believe I have experienced it a number of times in the past. Personally, I am much bigger than most marathoners (6’3” 205 lbs), and because of that and the atrial fibrillation, much slower – so I’m out there twice as long and sweating twice as much. Plus – over the years it has been drilled into all of us to make sure we drink enough water.

Ironman athletes, ultrarunners, and bigger runners are all at increased risk because we are simply out there for much longer periods of time. Women athletes tend to be at higher risk for hyponatremia – it has been found that women hydrate more during a race.

Drinking enough water is a good idea – but it needs to be accompanied by increasing salt intake.

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Normal levels of sodium are about 135-145 mEq/L. Symptoms are likely to begin at 130 or lower and if you get below 120 the condition may become fatal. While there are a number of medical causes for hyponatremia marathon runners fall into the category of consuming too much water and not enough sodium, and sweating out valuable sodium. Think of the white dried salt on your temple or on your hydration pack straps after a long run.

Symptoms include bloating, headache, swelling (check to see if your ring or wristwatch seems to be getting tight), nausea, vomiting and eventually weakness, restlessness, confusion, and well . . . it just gets worse from there. It is particularly problematic for runners because some of the symptoms (headache, nausea, cramps, and dizziness) are the same symptoms for dehydration so the impulse is to drink more water – which of course makes it worse.

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There is currently an ongoing study at the Houston Marathon involving volunteers who are followed closely, weighed, fluid intake measured, lab studies obtained, etc. The study found that runners with lowered sodium levels drank more water, retained more water than normal volunteers, and they lost more total sodium and had saltier sweat.

Runners who were dehydrated but not hyponatremic had higher heart and respiratory rates, felt worse, and had lower blood pressure than hyponatremic runners. The hyponatremic runners felt better, but had more nausea and bloating.

What can be done?

Drinking less water is sometimes recommended but it is difficult to do when you are used to drinking a lot of water while running. I’ve tried drinking less water during a marathon and frankly I think it made things worse. Also some runners can become hyponatremic without over-doing the water consumption.

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Weighing yourself frequently along the course and looking for weight gain (water retention) has been recommended – YEAH RIGHT! How is this going to happen?

Personally I try to drink water with sodium supplemented (NUUN, GU Brew), and try grabbing some little pretzels at aid stations (if available); but some research suggests this might not always be helpful.

“Watch out for feelings of confusion, nausea, fatigue, and particularly vomiting and swollen hands and feet. If you experience these, seek medical help.”

Fatigue? Really? Fatigue during a marathon – you don’t say? Isn’t that generally a part of the experience?

I don’t have a good answer. I know I’ve had problems with this – I’m clearly in the high risk category for hyponatremia. I also generally have particularly poor races if it is a warm day.

My interventions include

1.) Drinking enough water
2.) Electrolyte supplements in my water (NUUN, Gu Brew)
3.) Additional electrolyte supplementation (SaltStick caps, Endurolytes caps, little pretzels)
4.) Making sure I have a salty snack or meal after a race or long run
5.) Trying to dress so I’m a little cool rather than a little warm

I’d love to read your suggestions – please leave a comment if you have any experience with hyponatremia and suggestions as to how to avoid it.

Update (March 13, 2014):

I found this terrific article posted on Twitter by Dr. Larry Creswell. The key points are quoted below.

KEY POINTS

Most medical scientific organizations recommend low or moderate sodium diets to the general population in order to reduce the risk of high
blood pressure (hypertension).

Regular physical activity reduces the risk of hypertension.

Athletes lose sodium in sweat during exercise. The amount of sodium that is lost during endurance exercise depends on the sweating rate and
the concentration of sodium in the sweat. In turn, sodium loss during exercise depends on individual factors, such as genetics, fitness and heat
acclimatization, as well as the type, intensity and duration of exercise and the external environment.

Sodium ingestion by endurance athletes does not typically increase blood pressure, so low sodium diets are not recommended for individuals
who participate in long-term aerobic exercise.

Sodium ingestion during or following endurance exercise will help to stimulate thirst and drinking as well as stimulate fluid retention by the kidney.

No athletes are immune to hypertension, so athletes should monitor their blood pressure as they do their general health. This is particularly
important for older athletes, athletes with a genetic predisposition to hypertension, stroke or other cardiovascular disease.

Next Event – Vernonia Marathon Sunday, April 13, 2014

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Training on the OC&E near Sprague River, Oregon

I’ve signed up for a Spring marathon – specifically the Vernonia Marathon. It is in Northern Oregon – North and West of Portland – a part of the state that I have never visited. I think this might be my 18th or 19th marathon but I’m not sure.

I just did my first true long run and I feel pretty good. I informally classify runs like this: two to six miles are shorter runs, like mid-week type runs. Medium long runs are nine to twelve miles. I’ll usually try to do a nine to twelve mile run every weekend even if I’m not training for anything. In fact, if I’m not training for anything at all sometimes that’s my only run of the week (with mountain biking or hiking on other days). I think of a true long run as being fourteen miles and up. There’s something about that distance that, for me, seems pretty serious. Anything over thirteen requires more fortitude.

I didn’t just start training for an April marathon this weekend – I’ve been training for weeks – but my weekend long runs have only been eleven to twelve miles.

As far as my atrial fibrillation is concerned nothing has changed – I remain in atrial fibrillation all the time, my running has slowed, and I need to make sure I drink enough water and eat something salty afterwards. After the fourteen miler I went through the drive through at Burger King and bought each of the dogs a cheap burger from the value menu (the dogs aren’t vegan), and just an order of fries (with salt) for me. This way I avoid the dizziness I sometimes get from standing up after a long run.

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Sophie Tired After a Long Run

The Vernonia Marathon course is on a paved bike trail. This is the first Rails to Trails project in Oregon – the OC&E Woods Line State Trail being the second. I chose it because I like to train on the OC&E and have completed the Bizz Johnson Marathon (on an un-paved rail trail) seven times.

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Sophie on Paved Portion of the OC&E Trail

I dislike running on pavement so hopefully there will be a dirt trail off to the side of the paved part. If not – well, a paved trail seems a lot softer because it is simply pavement on top of gravel as opposed to pavement on top of concrete (which is what our local streets are.)

I expect the Vernonia Marathon should be a small, informal, fun race and I won’t know anybody there except for my friend Claude who is also going to run it.

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Winter Training

My race strategy is to start out slow and then take it easy. The course profile looks hilly – but how steep can a rail trail be? Trains can’t go up more than a one or two percent grade, right? I think the hills will be gradual – like the Bizz Johnson course.

Funny – I always enjoy the training much more than the actual races.

If anybody has any experience with this event please comment below. See you there.