last minute injuries stink

We’re up in Penticton, British Columbia, on the shores of Lake Skaha,  The original plan was that we would be here to support Kris as she competed in Ironman Canada (IMC).  This was to be her second Ironman distance triathlon, that it would not be interrupted by bike crashes, or anything else.  Not to be, unfortunately.

Several weeks back, Kris began experiencing lots of pain in her left calf.  It seemed to be more like muscle pain.  She got some deep tissue work done on it, which made it feel a bit worse.  She also continued training on it too.  Given the timing of the injury, relative to IMC, I can definitely understand doing this.  It actually started just prior to her final long bike and run workouts – she ultimately did at least one half marathon in pain, trying to leave herself in position to compete.  After seeing a couple of doctors, she was diagnosed with a stress fracture in her left tibia two days ago.

She’s a really focused and pragmatic person, and claims that the trips a lot easier, now that she’s not worried about competing.  She’s spoken with the organizers of IMC, and has gotten permission to defer her registration until next year (good to have the option).  It’s nice to be up in BC to cheer our friends on, to see a part of Canada we’ve not seen, and visit with some folks we’ve not seen for a while.  But it’s really tough to pour your heart into something like this for a period of months, and then have to stop at the last minute.

an afternoon run

Yesterday I went for a run up near Snoqualmie Pass in the Cascade Mountains, about an hour from our house.  I’ve been trying to prepare for doing a 50k (an official, unaccidental 50k, that is).

I did a loop that I’d first heard about from a friend of mine several years back.  You run past a series of the lakes, across a number of boulder fields, and then descend down at the rate of about 700 or so feet per mile to another trailhead.  You complete the loop by running an easy 3 miles along a road.

I’d gotten a late start.  Kris had to attend a meeting at R’s school, so I didn’t leave until nearly 2 pm.  This would give me about five hours of daylight, which should have been plenty for a seventeen mile run, right?

The climb up to Melakwa Lake was quite a bit tougher than I remembered.  It was steady, occasionally steeper, and often across rocks, rendering the footing iffy.  You climb a bit over 2000 feet until reaching the lake basin.  I stopped to check out the lake and refill my water bottle from it.  Not a soul in sight, just the sounds of birds and wind.

The turn to Lower Tuscohatchie Lake is takes you to a trail that’s occasionally difficult to follow.  A couple of times I had to reassure myself that I’d be able to survive a night up here if I got lost.  The description from the trail running book I used (50 Trail Runs in Western Washington by Mike McQuaide) told me to follow the sound of the creek, which turned out to be perfect advice.  Soon the trial opened up onto a steep green hillside, with a beautiful view of the mountains to the north, above a valley.  This is one of the reasons I’d rather spend summers in the Northwest than anywhere else.  I ran about a half mile or so along Lower Tuscohatchie Lake, and then found a connector trail that took me to over to Pratt Lake.

I’d run out to Pratt Lake a couple of weeks before, and so was prepared for the challenging climb up out of its basin, and across a couple of boulder fields.  By then, I was feeling pretty tired, and was ready to begin descending.  I was so focused that the crest out of the basin snuck up on me, and suddenly I was heading down.

Several times along the four and a half mile descent, I thought I’d trip over one of the many roots and rocks along the way.  It just felt too good to make the easier progress going down though.  About a mile from the trailhead I did it – caught a rock, and ended up sprawled out across the trail.  I checked myself, and found that I’d only sustained a couple of bumps and scrapes, so kept going. 

The harder part came after exiting the trail and running the steady climb along the three mile road taking me back to the car.  I was so ready to be done, but there was no getting around it.  I guess this is why they usually tell you to start with this part, but I’d left it for the end, in the event I was running out of daylight (better to run a road in the dark than the trail).

I got back to my car about four and a half hours after starting – a bit slower than I’d hoped for.  But that’s the thing about running in the mountains.  It takes as long as it takes, and there aren’t many shortcuts.

What a day for a run!

braces

Over the past several weeks, I’ve started wearing braces.  This has happened in three increments.  Three weeks back, I had some spacers put in.  Some brackets went in last week.  And then yesterday, I got more brackets and some bands.

This whole adventure is due to breakage of my upper and lower jawbones during my bike accident.  As a result of this, my jaw hurts when I open my mouth semi-wide.  My upper and lower teeth are misaligned.  And it’s possible that nerve compression near my mandible joints are to blame for the chronic tinnitus I’ve had since after the accident.  The point is, I require the orthodontic work for reasons beyond the simply cosmetic ones.

I will need to wear the braces for about two years.  About a year from now I will need to have my upper jaw rebroken (during surgery) with the upper and lower teeth being realigned as a result.  Lots of fun.

It hurts too.  Enough to put me off food.  Those that know me will find this shocking – there’s very little capable of putting me off food.  But making eating hurt is enough.  I’ll not dwell much on the impact to my vanity that this has had.  I looked in the mirror the other day and could have sworn I saw an adolescent with touches of gray and lines on his face.  Humbling.

My eldest daughter has been great to me during this adventure.  She’s worn braces, and has shared a number of coping tips with me (advil, yogurt, and watch out when you get them tightened).  It’s actually kind of a fun and interesting experience for me to have KK comforting her aching dad.

Now let’s talk a bit about medical coverage for this condition.  I’d had nicely aligned teeth prior to the accident – this whole thing is due to the (uninsured) guy running me over last July.  And although my medical coverage is excellent, my dental and orthodontic coverage is not nearly as excellent.  Less than a fifth of the cost is covered.  That means by default we would be thousands of dollars out of pocket for this work, even though there are bona-fide medical complaints associated with this, and that it’s due to this accident. 

I first consulted an orthodontist last October.  The usual story was that we’d need to pay for the work up front, and argue with the insurance company on our own.  The orthodontist that I’ve chosen agreed to try to work this out with the insurance company.  After six months, and much documentation, they agreed to cover it as a medical expense.  So in June, I received a notice from them that they would cover any work done prior to a year from the date of the accident as medical.  The good news is that this would give me about 100% coverage as long as I got two years worth of work done in just three weeks.

I called them up to request an extension.  The guy on the phone essentially told me to go ahead with the work, but to understand that they might say no.  At that point, voice raised, I told him about the truck wheel running over my head last July.  I cited the dates of my initial consultation, when they began considering my case, and pointed out that they’d taken a full six months to approve it.  Within five minutes I had assurances that they would extend the deadline for the work.  About a week later I received a notice telling me that I had an additional three months to complete the two years of work.  And so it goes.

The point is that the insurance gets complicated and contentious quickly.  And as I mentioned, on the whole, my medical coverage is quite good (and reliable).  Adds perspective to some of the opposition to the health coverage reform movement.  It would be nice, particularly for those who are not as fortunate to have any coverage.

brain power and recovery from TBI

This past Sunday, there was a very interesting article in the New York Times about recovery from a Traumatic Brain Injury (TBI).  This is the latest in a series of articles titled Brain Power.

The focus was a 19 year old guy named Adam Lepak, who survived a serious motorcycle accident in late 2007.  Adam spent about six months in a near-vegetative state, only minimally responsive.  His diagnosis was Diffuse Axonal Injury (DAI).  This is a condition in which the connections between the “white matter” (axonal tracts in the brain appear white due to myelination) and the “gray matter” of the brain are disrupted due to the traumatic shearing forces that occur when areas of varying density in the brain are subject to very sudden acceleration through the less dense brain tissue.

Over 90% of patients with DAI never wake up.  I believe that my friend Peter Ostertag, who died as a result of brain injuries received in a bicycle accident in 2005 had DAI, owing to the description we received from the neurologist who worked with him.  The axonal injury can be widespread over many areas of the brain, governing executive function, personality, and logic.  In Peter’s case, the diagnosis was that in the unlikely event that he were to awake from his coma, the damage was widespread enough that he would never be able to live independently or even interact with those around him.

The young man whose injury was detailed in the article was quite a bit more fortunate.  Despite having extensive injury, Adam Lepak did awake from his coma.  He has made much progress, although the injury has affected him significantly.  He is able to interact with friends and family, and recalls some of the circumstances of his injury (“I think I was in a motorcycle accident”).

One of the more intriguing aftereffects has been that Adam sometimes becomes suspicious of his closest relationships – believing that the people close to him are “imposters”.  Apparently, this is also common in schizophrenic patients as well as some trauma patients.  Doctors have hypothesized that this may be due to the nature and location of the damage to the brain. 

In Adam’s case, he sustained damage to his cortical midline structures.  This is a thick trunk of neural pathways that traverse the brain from the frontal lobes to a number of other regions, some of which are the “identity centers”.  These are the diffuse areas that piece together different bits of information that permit us to associate the beings and objects in front of us with the aspects of memory that help us identify them. 

Delusions of identity suggest that the conduit between acquisition of the raw information (in this case the cortical midline structures) and the regions of the brain that interpret them has been disrupted.  The medical data suggests that this is also related to disruption of connection between the logical, linear reasoning areas (left hemisphere) and holistic judgment and emotional processing areas (right hemisphere).  Often the patients have sustained more damage to their right hemisphere, affecting their ability to associate the images with what those images mean to them personally.

The delusions seem to result from the absence or incompleteness of true holistic judgment (“this is my mother”) with the resultant logical judgment (“she looks familiar, but she must be an impostor”).

One key to recovery is to facilitate remapping of the neural function ordinarily occurring between the cortical midline structures and the areas governing holistic judgment.  The brain is definitely capable of doing this.  Naturally it requires concerted effort and therapy.

The most important theme in the article with respect to this therapy is that the patient needs to be surrounded by familiar people and images.  They also need to be continually cued to and reminded of the associations between them.  In Adam’s case, being constantly around family and friends who sound very loving and supportive is exactly what the doctors ordered.  And while it can’t always be easy when the patient accuses his loved ones of “being fake people”, I’d posit that remaining close and working through the problems together feels a lot better than giving up.

While not directly relevant to my specific form of TBI, I find articles like this to be illuminating and somewhat inspiring.  They teach us what’s possible with respect to recovery from profound injury.

an unofficial 50k – and plans for the ms ride

The folks behind last week’s Pacific Crest Trail FA event have issued the results, and they tell us that we completed 31 miles, rather than 28.  If I factor in the half to full mile that I inadvertently tacked onto the distance with a missed turn, I’ve unofficially completed a 50k.  Not a bad day’s run.  This makes it more tempting to target a 50k as my September event. 

One nice wrinkle to the planning is that Kayla has committed to doing the MS Ride with me up in the Skagit Valley in mid-September.  With both of us obliged to ride 22 miles, and to raise $250, it’s time to start training and fundraising, isn’t it?

fresh inspiration from matt long

Some months back I wrote an entry here about Matthew Long, a NYC Firefighter and Ironman athlete.  In December of 2005, Matt was struck by a bus while riding his bicycle in Manhattan.  Matt survived very serious injuries, then trained for and completed the NYC Marathon this past November.  There was a very inspirational article in the March issue of Runners World Magazine, which detailed Matt’s determination, focus and incredibly hard work.  I read this shortly after completing my first half marathon following my serious bike accident in July of 2008.

I could definitely identify with some of the feelings identified in the article.  I could also identify with his desire to prove to himself that he could do these things again, post-accident.  Matt’s climb was longer and more difficult than my own though.  Because of the injuries he sustained, he needed to train and perform differently than he had before.  To be very clear, Matt was a very accomplished athlete, completing the 2005 NYC Marathon in 3:13, and completing Ironman Lake Placid in just over 11 hours prior to his accident.  Recasting how you do things that you love can’t be easy.  Keeping your mind and heart open to things that are possible, but more difficult than before is a struggle.  On my own path, I’ve drawn inspiration from people who refuse to be defined or limited by adversity.  And Matt Long is definitely one of these big inspirations.

Matt Long completed Ironman Lake Placid last week, with a time of 16:58 and change.  He made the time cutoff by minutes.  Watching videos (see below) of his finish is very stirring to me.  The audio is blaring, and the angle isn’t great – but I’m sure you get the idea.  Watching someone cross the finish line after overcoming so much is transforming, inspiring, and educating.

Matt is founder and president of the I Will Foundation, dedicated to helping people “with the will to work hard, overcome adversity and challenges caused by life altering illness or traumatic injury.

In addition to browsing the videos linked below, please take some time to check out the series of Runners World-produced videos associated with the article.  It’s a series of short (less than five minutes each) films about Matt’s training for the 2008 NYC Marathon.  Definitely well worth seeing.

 

 

easier to finish than to quit : the pacific crest trail FA race

The Pacific Crest Trail FA was my longest race, both from the standpoint of distance (28 miles) and time (eight hours).  It turned out to be much more than I’d bargained for.

After looking around for an August marathon, I found two free organized marathon-plus runs on the Marathon Maniacs Race Calendar.  This is a busy month for us.  A combination of family stuff, and Kris’ Ironman Canada event limited the open weekends.  The alternative was to buy a $400 plane ticket and fly into Wyoming to do the Running With the Horses Marathon in Green River.  It looked like a nice enough event, but I didn’t feel motivated enough to spend money on airfare and hotel, as well as spending 2-3 days away from home.  So it was the Pacific Crest FA, a freebie close to home then. 

I woke up just before the alarm went off at 4:45 AM on race day.  I had a simple breakfast of a bagel with PB&J.  I varied my normal routine a bit by quaffing down an espresso before leaving home, figuring it was mostly a training run, so what could this hurt?

Just after 6:30, I found myself at the Guye Cabin, home to the Washington Alpine Club signing in and doing last minute prep.  As the race was a point-to-point, finishing back at the cabin, we arranged carpools to drive out to the start.  Just after 7, I headed out with Tate from Portland driving, and three other runners from Oregon scrunched into the backseat.

The directions to the start looked pretty straightforward on paper, right up to the part that told us to stay on Forest Service Road #41 for 7.6 miles.  Have to say that the ride was something though – we had a short line of cars kicking up dust on the FS roads, winding up into the Cascades, navigating past some complex turns.  Tate wondered whether she would be able to find her car again, and the rest of us wondered whether we’d even find the start.  A bit over an hour later, we hopped out.  After a short time spent using the available restroom facilities (trees), and stretching, Jeff our leader said “Okay, it’s 8:17, have fun and I’ll see you at Stampede pass in a couple of hours”.  With that, we were off.

I ventured out early in the pack, figuring I’d get passed pretty quickly.  The early miles has a mild mix of up and down, which I did pretty conservatively.  The directions were easy – just follow the Pacific Crest Trail.  I found out pretty quickly that this was easier said than done.

About 55 minutes into the run, I took a wrong turn onto a fire road, missing the trail, and giving me another mile or so to run.  So much for running towards the front of the pack.  To be honest, I’m lucky I didn’t take more wrong turns on this run, doing so late in the race would have been easy to do, with a huge price to pay.  On the positive side, I got to enjoy a beautiful view of Mount Rainier twice, as I made my way out along Showshoe Butte.

My thinking was that Jeff had overestimated the time it’d take to cover the 10 miles to Stampede Pass.  As I watched the time tick off on my watch though, I began thinking that I’d either missed Jeff, or that I’d possibly taken a wrong turn.  I kept watching the signs marking the trail, to ensure that I wasn’t off course.  When I finally got to the aid station, I was surprised that it had taken me nearly two and a half hours.  I really thought I’d been going faster than the 4 mph pace that this time meant.  I loaded up on water and sport drink, and headed out.

Looking at the map, I’d convinced myself that it had to be longer than 10 miles from the start at Tacoma Pass to Stampede Pass.  As the race unfolded, I realized that the miles along the PCT were a lot more challenging than I’d planned for.

It was another 90 minutes or so before I reached what looked like a plausible halfway point at Yakima Pass.  By this time, I was again low on water and very fatigued.  As I passed the Yakima Pass sign across from marshy Twilight Lake, I wondered how one would go about taking a DNF (did not finish) in this race.  I’d never had a DNF before, but was considering it.  Given how I was feeling, I wasn’t sure I would be able to finish.  I was tired and a bit dizzy with another fourteen miles to go.  Covering the short distances between landmarks was taking a long time, and I had started doing ‘21s’ (two minutes of running, one minute of walking) as a rule.  As I covered the largely exposed route between Twilight and Mirror Lakes, this became mostly walking.

About that DNF though – we were running far from the road.  The best I’d be able to do would be to try to appeal to a camper along the way to use their cell phone (presuming there was any signal at all, which is doubtful).  I’d call Kris and try sketching out a set of complex directions for her to pick me up along one of the serpentine fire roads winding up through the Cascades.  It wouldn’t work, and I thought it would actually take me less time and effort to Just Finish.  With that, I recognized the that only way I would DNF was to be carried off the course by medics.  As tempting as that felt, it wasn’t going to happen by choice.

On the way to Mirror Lake, I ran across a nice cold stream that I drew water from.  I gulped down about 40 ounces of Cytomax and water, and felt quite a bit better.  The lifesaver for me was having a water bottle equipped with a set of filters, enabling me to take water from streams and lakes.  Without this, I would have been in big trouble.

Coming alongside Mirror Lake I took some more water.  The many backpackers and campers there were testament to the beauty we were privy to in the woods.  By now the trail was sheltered and much cooler.  I learned later that the temperature at Snoqualmie Pass climbed to over 90, meaning this was the hottest event I’d participated in, as well as the longest.

Shortly after Mirror Lake I was passed by a group of three runners, two women and one man.  They were all training for the Cascade Crest 100 miler (coming up later in the month).  By now, the combination of the fluid intake I’d had as well as running in the shade had turned things around.  The other big plus was the sign that told me that I was just 8 miles from Snoqualmie Pass.  I had mentally reentered the race and felt I could actually finish.

I caught up with the three other runners and chatted with them for a while.  Friendly bunch – I ran with Caroline for a while, as well as Charles (I’m blanking on the name of the other woman right now).  I think that settling in with them solidified me for the last 8.  Turns out that Caroline had run out of water – although we were headed for another aid station at Olallie Meadow, but we had no feel for how long it would take us to get there.  Indeed, in looking at the course description (which I’d carried along), there wasn’t information telling us how far Mirror Lake was from Olallie Meadows, so we were just winging it.  I volunteered some water to Caroline, definitely appreciating the ability to draw drinking water from the streams along the way again.

By the time we made it to the aid station, according to the maps and descriptions, we’d covered 24 miles.  We’d also been out for well over six hours, already much longer than I’d previously taken to finish an event.  And I was pretty ready to be done.  Banking on the final four to be largely downhill, I picked up my pace and started to run more.  Two big issues with that though.  First, the trail was very rocky, rendering the footing very iffy.  I’d nearly face-planted a number of times already, and the frequency of near-misses picked way up.  The other problem was that we began climbing about a mile or so after the meadows.  The combination of these things relegated me to mostly walking.

By then, I knew I could finish.  But I was definitely feeling a lot more fatigue than I’d felt on previous marathons.  We saw a tantalizing view of I-90, leading us to believe we were right around the corner from the finish.  In fact, we were still over 2.5 miles out, which took nearly an hour to cover.  My sense of distance and scale was totally gone by now.

A short downhill stretch took us to the end of the PCT stretch for the race.  We could see the interstate and buildings for the ski areas, so it almost didn’t matter how we got there (the distance would have been just about the same).  After scanning the fire road a bit, I reconnected with Caroline and crew.  They started jogging when we got down to the ski buildings, which put them a couple of minutes ahead of me.  After enduring nearly ten minutes along a sun-baked stretch of road, I made it to the finish.

8:06:11

I was amazed at how long this took.  Proud that I made it.  And very very tired.  I signed in, then called Kris to tell her I was on my way home.  I will replay aspect of this event in my head for a while, trying to figure out how to better prepare for a 50k in the mountains (a goal of mine for a while).

There were some things I couldn’t control.  First of all, this was the hottest day of the year in the mountains, with the temps at Snoqualmie Pass topping 90.  Also – the information on the course wasn’t what I’m used to getting, and didn’t provide a very clear set of expectations or ability to plan my race (even as I was doing it).  On the other hand, learning that I can complete a race in weather like this, and with sketchy info is good.

Next time, I also need to do a lot more mountain trail running prep.  Essentially I went from running 8 miles over two hours up Mount Si a couple of weeks back, to running 28 miles in 8 hours along the Pacific Crest Trail.  The inclines were actually a lot easier on the PCT, but the distance was very difficult.  I need to scale up in training to an event like this – some runs along the Pratt and Melakwa Lake routes (approaching 18 miles) would be very good.  Also – throwing in several routes up Tiger too.

I thought I’d packed more fuel that I would use.  In fact, I’d packed for a six-hour event, but not for eight.  I had just about enough Cytomax (consuming four 20 oz bottles), but not enough gels (needed another two), and not enough Endurolyte capsules (needed an additional two hours worth).  Again, the filtered water bottle was a life saver. in the truest sense.

All in all, some great lessons learned on a long day in the beautiful Cascades.