Monday, September 23, 2013

Crushed my goal



The US AF Marathon event happened last weekend.  I was supposed to run the 5K, except they canceled the run due to severe weather (lightning).  I was registered to run both the 10K and Marathon on Saturday morning but decided not to run the Marathon because I had not completed my training due multiple surgeries this summer.

The Goal:

As a 22 year-old (25 years ago), I ran a 10K in about 56 minutes.  Since then I have never even come close to beating this time.

After getting the surgeon’s approval to resume training in the last week of August, I’ve been training to beat that time.


Pre-Race:

Over 15,000 people registered for the Air Force Marathon and the organizers lay the course out on Wright-Patterson Air Force Base.  Meaning all 15,000 people must get to the base through just a few gates (I think three gates).  It can sometimes take a long time to funnel that many cars through three access points.

My wife and I decided to arrive at least 1 hour early for the 7:30 am start time.  The 10K and Marathon shared a start time, while the Half Marathon started 1 hour later at 8:30 am.

It rained a lot the night before and continued raining on and off until about 5 minutes before the race.  I went to the race wearing a rain slicker and extra running clothes for warmth.  I elected to strip down to just my tank top and shorts for the race.  I was cool but not cold in the outfit.

Me about 5 minutes before the race


Because this marathon includes pace runners, I found the Marathon pace group that corresponded to my *desired* 10K (the 3:50 hour Marathon / 8:58 min/mile group) and started the race with them

The course:


The first 0.5 - 0.75 miles was very flat (actually part of a runway!).  However, the next mile was up hill - about a 190 feet of climb.  Then the course alternated between down hill (some pretty steep downhill portions) and flat.


My Run:

I found running with the 8:58 min/mile pace group while on the initial flat stretch of the course (we actually ran on an old taxiway).  When we started up the hill (called Loop Rd.), the run became much tougher because on my training runs, I always slow down when climbing hills.

I felt OK at the one mile mark our pace runner called out a 8:56 split (2 seconds faster than intended).  I did not have trouble keeping up with the pace group.  I worried a little about my heart rate because it had already climbed close to what I thought was my maximum.

About 1.5 miles into the race I began having trouble keeping up with the pace group.  I did not have trouble with running at that speed, rather I found myself automatically slowing down to conserve my energy.  I felt like I had burned through 2/3 of my energy after only completing 1/3 of the race. 

Near the two mile mark we crested the long hill and I began to feel *great*.  The pace runner called out an 8:52 pace (6 seconds faster than intended).  I began pulling ahead of the pace group.  After another short uphill stretch we began a steep descent.  Normally on down segments and especially steep downhill segments, I slow down to prevent shredding my quadriceps/thigh muscles.  However, we were approaching the three mile mark and I knew I needed to pick up my pace a little to finish in my desired time.  I felt that I could "tough out" the tired out legs that come from running down hill, so I speed up significantly when going down hill.

During the uphill run, we passed a couple of the wheel chair division Marathon participants.  Once we hit the downhill portion, they rapidly caught us.  Non-wheel chair participants yelled ahead to the runners in front of the wheel chairs "wheel chair on the left!"  All runners yielded to the wheel chair participants and moved over to give them room to pace.  This is a courtesy most runners do not extend to other runners.  I thought it was neat and it made me feel good to see all participants show consideration for others.

At the bottom of this initial steep hill (about mile 3, 26 minutes into the race) the 10K route and Marathon route split.  I got to the split 100 yards or more in front of the pace group.  It seemed to me that there were 10 Marathon runners for every 10K runner.  Since I registered to run this Marathon I felt very sad that I didn't get to continue with them.  On the other hand, my pace was WAY to fast for me to maintain through a Marathon course, so I also felt very glad I only had 3 miles left!

I continued to gradually descend until about mile 4.5 (this is about 38 minutes into the race).  This was my race low point.  I completed 2/3 of the race but felt completely exhausted.  Later I realized this coincided with the lowest elevation of the course and that I had started climbing a low hill again.  Since I don't remember climbing a hill, I think its slope was gradual enough to not notice.  This reinforced a lesson that I keep relearning, when my body feels like its working hard, it is.  It's OK to slow down when your body says it needs it.
The course had a water stop around mile 5.  Up to now, I skipped all hydration stops, however, I felt so exhausted I took a Gatorade and walked for about 100 feet to catch my breath.  Gatorade contains easily digested carbohydrates (aka sugar) for fast energy.  I hoped this would boost my energy levels at the end of the race.  Then I resumed running.

With only about 0.5 miles left, I walked again around mile 5.6 and I walked for a longer time (perhaps 100 yards).  I used this time to rest and catch my breath again.  My heart rate had reached the 186 beats per minute range (the highest heart rate I had recorded during my two years of running was 188) so I felt that I did not have much excess capacity to keep it up.

After the short walk I resumed my run and kept running through the end of the race.  During this last half mile I noticed a large group of runners in front of me, which I could not catch and a large group of runners behind me.  A few of the runners behind me caught me before the end of the race.  However, at the 6 mile mark, I felt I had enough energy left to "sprint" at the end.  Over the last 0.2 miles, I caught almost everyone that had passed me over the prior 0.3 miles.

The results:

My Heart Rate monitor record of the race

My heart rate monitor recorded my highest heart rate ever since I've kept track.  Even higher than the two stress tests I've taken under doctor supervision.  My stress test maximum heart rate was 176.  During this race, I hit 196!  After completing the run my heart rate started recovering from my 196 peak almost immediately, it probably dropped to 185 range before I finished walking through the finisher's chutes (below). 

Looking like I worked really hard but not as spent as I was after the Marathon!


On Saturday, I ran the 10K in 54:30 “crushing” the PR I set as a 22 year-old!  I’ll attach some pictures of the event as I get them from my wife.

 Official race results for the US AF Marathon 10K

Probably my best results at a "big race".




A colonel (shown) or higher ranked officer awards every medal!  My first year a three star general awarded my medal. 



Despite doing much better than my goal and placing very well (for me), it felt like I finished near the tail end of runners.  I think that was because I finished perhaps 0.1 miles behind a large group of runner and didn't really pay attention to the large group of runners behind me.

The aftermath

Day 1: 

My legs, butt, and abdomen are tired and a little sore.  Other than that I feel great and am able to do all my normal daily activities.

Day 2: 

I am almost as sore as I was after some of my early couch to 5K (C25K) training runs.  I am not used to feeling sore after runs, even after races.  My thighs are sore from running fast down-hill.  My butt is sore from running fast up-hill.  Various other muscles are also sore, even my abdomen (from breathing so hard?).

Sitting still makes the soreness worse.  Moving around reduces the soreness.

I ran 2 miles to loosen up my legs.  The first mile felt great but my legs burned by the end of the run.

Day 3:

I feel less sore than Day 1.  I ran a short 2 mile "easy" run.  I felt really good for the first mile but my legs burned and felt tired by the end of the second run.


Day 4:


I felt very little muscle soreness.  I ran a 3 mile trail run to continue giving my body time to recover.  I felt good for the first two miles but began to get that familiar muscle burning and tiredness by the end of the run.


Day 5:


I felt no muscle soreness.  I ran a 4 mile trail run and had the same experience as the previous two days, I felt great for the majority of the run but felt really tired by the end.  My body is still recuperating from the strain of the race.


Day 6:

Rest


Day 7:

Rest


Day 8:

I'm ready to resume my training again.

Summary:

It was really worth it, I kicked my 22 year-old ass!

Wednesday, September 18, 2013

Running with Crohn’s: Diet 2

This is a continuation of my previous entry on diet for patients with bowel strictures.  I’ve thought of several other foods with fiber that never caused me bowel obstruction issues.  These foods include





Food
Fiber g / serving
Notes
Honeydew melon
1.1
Avoid seeds!
Cantaloupe
5
Avoid seeds!
Watermelon
1.1
Avoid seeds!
Sweet potato
4
No skin!
Potato
4.7
No skin!
Spaghetti sauce
3.7

Whole wheat bread
1.9

Rice
3.5

Banana
3.1

Avocado
10

Pumpkin pie
1.8

Pumpkin bread
2

peanut butter
6
smooth only
Baked apple
5
avoid skins
Mashed potato
1.3



If you experience bowel obstructions and have other suggestions, please let me know.  I'm always looking for ways to improve my diet.

Running with Crohn’s: GERD


If I haven’t mentioned it in prior entries, let me state now that IBD suffers are far more likely to experience many of the conditions I’ve mentioned in my entries.  Things like eye problems, kidney stones, GERD, and many others afflict Crohn’s suffers in much higher percentages than non-IBD suffers.  As I experience these things or think about them, I am trying to write entries about them.



A GERD episode I experienced last night inspired this entry.  Normally my GERD episodes feel like normal heartburn and I treat them by taking 1-2 Rolaids/Tums.  Last night I experienced a feeling of intense pressure and pain in the center of my chest.  Because I had gone to a hospital with these symptoms on a prior occasion, I highly suspected this was GERD and not a heart attack.  Therefore, I took 6 Tums, which had exactly zero effect on the symptoms.  Drinking 2 teaspoons of baking soda mixed in a glass of water finally alleviate the symptoms.


What is GERD


GERD stands for Gastro Esophageal Reflux Disease.  When people suffer from frequent heartburn (stomach acid moving back through the gastro esophageal sphincter into the esophagus), stomach acids begin to damage the sphincter and esophagus.  Over long periods, this damage can lead to ulcers in the esophagus and/or cancer.


This is another, of the many, conditions that affects people with IBD more frequently than the general population.  If you suffer from IBD, you may not develop GERD but you should watch for the symptoms of GERD




Mayo clinic on GERD



X-ray with barium contrast of GERD reflux moving up through the esophageal sphincter


GERD Symptoms




The Mayo Clinic published a list of GERD symptoms.  I most often experience simple heartburn.  I occasionally suffer from pressure and a dull but powerful pain in the center of my chest.  This chest pain caused enough distress on one occasion that I went to an emergency room for a heart attack.


My GERD symptoms:

  1. Burning sensation in and above my stomach
  2. Burning sensation in my throat
  3. (rarely) pain and pressure in my chest feeling like it emanating from my heart
  4. (rarely) feeling like a weight pressing on my chest
  5. (rarely) intense nausea

WARNING: if you experience chest pressure and pain, especially with shortness of breath and/or arm or jaw pain, get to a hospital immediately.  These symptoms can indicate a heart attack!



If you experience GERD symptoms frequently (more than twice a week), then you need to speak to your doctor about treating it.  Frequent heartburn can cause severe long-term health consequences.  Treating GERD in its early stages can be easy.

Diagnosis

If your doctor suspects GERD, he may recommend performing an endoscopy.  This involves an outpatient procedure in which he will sedate you, insert a flexible scope down your throat, inspect your esophagus, and probably inspect your stomach and duodenum (first chamber of your small bowel).

If you suffer from bowel issues and get colonoscopies on regular basis, then your doctor will perform the endoscopy during your colonoscopy.







Picture of GERD damage to esophagus (erosion, scarring, and stricture)




During the endoscopy your doctor may take biopsies of the esophageal tissues to look for abnormalities.  If you get a chance to read the biopsy results, Normal == good and Abnormal == bad.

Medications

Over the years, my GI doctor treated my GERD with different medications.  These include Nexium (esomeprazole magnesium), OTC Zantac (Ranitidine), prescription strength Zantac, and prescription strength Prilosec (Omeprazole).  I also treat myself with Tums (calcium carbonate), bicarbonate of soda, and Pepto-Bismol when I suffer acute symptoms of GERD.

If you think you have GERD, speak to your doctor about treating it.

Daily treatment

After my doctor diagnosed me with chronic GERD, he recommended a treatment plan.  Since he caught my GERD early, this plan included daily medications to control the symptoms.  The drugs I’ve used over the years include Nexium, Zantac, and Prilosec.

Nexium

I consider Nexium the “gold standard” for treating GERD.  Taking one pill daily completely eliminated all GERD symptoms for me.  My doctor’s endoscopy showed that the damage my GERD had caused had healed.  However, my prescription insurance removed Nexium from its formulary.  This made Nexium a very expensive treatment for me (~ $120 / month), so I asked my doctor to prescribe a different medication.

You must take Nexium daily and regularly for it to work.  It will not stop heartburn if you are already experiencing symptoms.

Zantac

Zantac (especially generic Zantac covered by my health insurance), was very inexpensive (~ $3 / month).  Initially it worked well for me.  However, I sometimes I experienced “breakthrough” heartburn.  Over time, the breakthrough heartburn increased in frequency.  Eventually, my doctor had to change my prescription.

Zantac will reduce current heartburn symptoms; however, it takes a long time to feel its effects.  I recommend taking another medication (like Tums/Rolaids) for more immediate relief of heartburn symptoms.

Prilosec

I’ve found Prilosec to work better than Zantac but not as well as Nexium.  Using prescription insurance, I’ve found the costs for the generic higher than generic Zantac too but still quite affordable.  Usually, if I forget to take a dose, I do not suffer GERD.  However, if I forget two consecutive doses I usually experience GERD.  Rarely when I do not forget any doses, I get breakthrough heartburn anyway.

You must take Prilosec daily and regularly for it to work.  It will not stop heartburn if you are already experiencing symptoms.


Breakthrough heartburn

When I get heartburn despite my GERD medications, then I use a variety of different heartburn medications.  These include calcium carbonate (e.g. Tums), bicarbonate of soda, and Pepto-Bismol.  These remedies do not stop the reflux (fluids moving from the stomach back into the esophagus), however, they do reduce the damage that reflux causes by reducing the acidity of stomach acids (using antacids for GERD).

Calcium carbonate

Most OTC antacids (Tums, et al) use calcium carbonate to neutralize stomach acids.  For occasional use in most people, this works fine.  However, taking too much calcium carbonate can cause constipation in some people.  Since I suffer from almost constant diarrhea from my IBD, this does not bother me at all. 

However, taking a lot of calcium carbonate can also cause kidney stones.  I have had kidney stones before (calcium oxalate – but I discuss that in another blog) so this does concern me.  Because these tablets are terribly convenient, I do still use them.  However, I try to use Pepto-Bismol, whenever possible to give my kidneys a break.

Bicarbonate of soda (aka baking soda)

I have not found any OTC medications that use baking soda as an active ingredient.  However, you can take this remedy by putting one or two teaspoons of baking soda into a glass of water and then drink it.  It will taste terrible (it tastes very VERY bitter to me but some people don’t mind the taste as much as I do).

This home remedy works MUCH faster than any other treatment I’ve ever tried.  I start to feel better in seconds and it can eliminate my symptoms in just a few minutes.  It doesn’t cause kidney stone or constipation problems.  Other than taste and convenience, I’ve found this to be the best remedy.

Pepto-Bismol

In my opinion, it tastes better than baking soda but worse than calcium carbonate.  It works slower than calcium carbonate and it can cause constipation.  However, as far as I know, it does cause kidney stones.  If you suffer from kidney stones, use this as a replacement for Tums/Rolaids when you can.


Summary


  • Regular heartburn will lead to more serious medical issues
  • In its early stages, doctors can treat your GERD with daily medication and prevent those issues
  • More serious GERD or long-term damage from it may require surgery.
  • Treat breakthrough heartburn with OTC remedies; choose your remedy carefully depending upon your underlying issues
  • Some GERD symptoms mimic heart attack symptoms.  If you have any doubt about them, get to an emergency room.