Post Concussion Syndrome to Ironman Louisville 2011

Well I'm now a 3 time Ironman Finisher.
This latest one may have been the toughest because of questions regarding my health going into Ironman Louisville.  My full race report will follow in about a week.  But this post will describe the events leading up to race day.

As you may recall or you can read from my last post, I finished Full Vineman Ironman Distance Tri on July 30.  A week later I attended my cousin's wedding in San Diego.  That's when my problem started.  Well perhaps it started the day before the wedding.  The week after Vineman Ironman, I was tired physically and mentally.  Remember I had also competed in Vineman 70.3, 2 weeks earlier.  My swim that week was crappy.  I cut the runs short to recuperate from the 26.2 miles I had just ran.  That weekend's workout called for a 5:3 Brick!  Well Coach gave me a break and told me 3:1 was OK.  So the day before the wedding, I did a 4:1.  ( I felt 3:1 was too short, Ha Ha...)  It was hot...

Perhaps I did not recuperate fully before driving out to San Diego early the next morning.  It was an outdoor wedding.  The day was already getting hot.  When we arrived, the guests were standing in the shade fanning themselves with the fans given out as wedding favors.  Well time for the ceremony, time to sit under the hot sun... I was so glad when the ceremony was over and it was time to move indoors for the open bar.  I "rehydrated" on Rum and Cokes.  I believe I had 3 drinks.  Then it was time for lunch and a glass of wine.  In between the Rum and Cokes and the wine, my sister ordered me a Bloody Mary and I had about half of that drink as well.  Well after the main course and before dessert and the wedding cake, I decided to use the restroom.  I remember using the urinal and then the next thing I know I'm looking up at an unfamiliar ceiling with a pain in the back of my head.  It took me a few seconds to realize I was on the floor of the Men's restroom and that I had passed out.  I somehow managed to get up.  ( Perhaps somebody helped me, but I don't recall that.)  I remember washing my hands and then making it out to a sofa and apparently I "passed out" or fell asleep.

Well to make a long story short, I was escorted back to the hotel and took a nap.  I missed the evening dinner and reception.  The next day, I woke up with a headache.  I tried to workout at the hotel treadmill, but running made the headache worse.  I decided to swim a few laps and that was tolerable.  The headache got worse as the day progress and I bought some Tylenol and took a few.  Well apparently I got a concussion and as the days went by my symptoms included dizziness, vertigo, headache, light sensitivity.  I couldn't go to work all that week.  In fact I laid in bed under a pillow to cover the light.  I couldn't read, watch TV, or surf the internet because any mental activity worsened the headache.  Even most music aggravated the headache.  I could only tolerate mellow music and some classical music.

I got checked out a few days later in the ER.  My head CT was fine.  I had Post Concussion Syndrome.  My main concern at that point was when can I return to my Ironman training / workouts.  The answer was when my symptoms go away, but how long they will last was a big question mark.  I started to worry that Ironman Louisville was in jeopardy.  I informed my Coaches and they all wanted me to back off and take my time.  Don't rush it.  Apparently returning to strenuous activity too soon after a concussion can prolong the Post Concussion syndrome.  What's worse than that was the fact that if I had a second concussion immediately after a recent concussion, I could suffer from severe brain swelling which could lead to "DEATH".

Well this is what I was dealing with as I headed into Ironman Louisville.  My initial goal was to PR, but I modified it to just "Survival".  If I can get in a 2 hour swim,  8 hour bike,  6 hour marathon, I would be happy.  Over the next 3 weeks leading up to race day, my symptoms did improve.  I got in a few bike rides, a few open water swims, and a few runs.  Running and swimming were the last activities to come back.  Initially running really jarred the brain too much and made the headache worse.  And I was afraid of getting into trouble during the swim, so I took my time with that as well.  I probably lost some fitness, but since this was taper time, I figured my body needed the rest.  When I departed for Louisville on Thursday August 25, I was 99% better.  I still had occasional headache and dizziness, especially when I went from a supine or lying down position to a sitting or standing position.  When I did that I found that if I closed my eyes for a few seconds the dizziness subsided.  The flight did worsen the headache slightly and I took some Tylenol and Motrin.  I figured I will take some during the race as well.

My final dilemma as I picked up my race packet at the Expo, was whether or not to list Post Concussion Syndrome on the medical release forms.  I decided not to.  I knew that no medical professional would jeopardize his medical license and clear a participant with Post Concussion Syndrome for one of the most physically strenuous endurance events in the world, the Ironman Triathlon. I was taking a risk by competing in Ironman so soon after a concussion, but this was like the Superbowl or the Conference Championship game, I couldn't miss it.  

Stay tuned for the Race Report.

Vineman Ironman Triathlon

Several weeks have passed since I completed Ironman #2: the Full Vineman.  This race was marked by major GI distress on the second loop of the bike course and during the marathon.  Here is what happened: 


I went to a Chinese restaurant in Santa Rosa with my family on Friday night.  I woke up early Saturday at 3am and had a normal bowel movement.  I drank about 20 oz Zico coconut water.  Had a couple bananas, one FRS energy chew, and a Hawaiian bread roll.  ( I was fine with this for Vineman 70.3)
I got ice from the ice machine and mixed it with bottled water and my usual Cytomax powder. ( ? ice is not my usual routine, but I did not have a fridge and I was expecting a warm / hot day)
Pre-swim I had Gatorade G1 and my usual energy bar, along with about 4 oz gatorade at T1 aid station.
I used the Port-a-Potty and had a soft BM ( not diarrhea) ( no soap / hand sanitizer  ? contamination)

Swim 1:21:52 which is a great swim time for me since I'm not a very good swimmer.  No GI issues. ( ? Swallowed a little river water)

T1 8:14

Bike 6:20:24  which is a pretty good ride, but considering that my first 56 mile loop was just under 3 hours, the second loop was slower than I would have preferred.
I was feeling good to great through the first bike loop.  Then on my second loop I started to feel very "gassy" and whenever I got into the Aero position, I felt abdominal pressure and the sensation that I wanted to have a bowel movement.  So not being Aero and the fatigued legs probably contributed to the slower 2nd loop on the bike.  I just tried to suck it up until I could hit the Port-a-Pottie in T2.
I had 2 bottles of Cytomax and 1 of Gatorade from the aid station, along with 1 pack Clif Shot Blok Margarita flavor and 1 or 2 energy bars during the first loop.  I also took 1 salt tablet around hour 3.
Second loop I had 1 bottle of Cytomax, 1 bottle of water, 1 bottle of Monster Maize which I took in last 45 minutes of ride.  I had 1 pack Clif Shot Blok Margarita, 1 pack Shot Blok Tropical Punch, 1 pack Power-bar gel blasts, and 1 salt tablet around hour 6.

T2 6:43  I had a slow T2 because I had to use the Port-a-Pottie and as I had feared it was diarrhea.  I couldn't eliminate completely because I wanted to get out of T2 ASAP.  ( Again no soap / no sanitizer)

Run 4:49:58 which is not good for me, since running is my strength.

  

I started the marathon and the first 9 miles I was OK, although I felt gassy and I could hear the fluid sloshing around in my bowels.  I wanted to "fart" but was afraid I would have a diarrhea accident, so I tried to hold the gas in, which led to cramping and a lot of abdominal discomfort.  I didn't drink or eat as much because I didn't want to contribute to the "gassy", fullness sensation.  I skipped the first couple aid stations and then had a small cup of cola or water at the other aid stations.  I carried a pack of Powerbar Gel Blasts and I ate them sometime during the first or second run loop.  

As I passed the port-a-potty at each aid station, I debated whether to stop or not, I ended up holding it in until the bitter end.
I ended up alternating between walking and jogging.  By mile 16, I hit the "wall", I felt behind in my hydration and nutrition, but didn't think my GI system could handle anything.  But I forced myself to drink some Gatorade and water and I started eating grapes at the aid station.  ( I stopped the cola because I thought it might be making the gassiness worse) 
I had to "slow down" and walk, so that hopefully I could recover and go faster in the end.  By this point I had gone over 130 miles and been out for over 11 hours, quitting was not an option.  

Fortunately this worked.  By mile 20, I was able to pick up my pace and start run / jog again.  
After 12:47:11, I became an Ironman ( for 2nd time and set a PR)  

Post-race I had diarrhea.  I was able to tolerate some soup, but I couldn't even look at solid food without causing some GI discomfort.  (This is very different from IM Louisville, where I was so hungry after the Ironman that I ate 3 or 4 slices of pizza and a sandwich shortly after the race and then after the L'ville course closed I went out and had drinks and more food at a 4th Street Live restaurant.)

I returned to cheer on my Ironteammates until past 10pm, but due to additional GI distress, I returned to the hotel and had several more episodes of diarrhea that night / Sunday morning.

Lessons learned: 

1) Avoid new restaurants the night before Ironman
2) carry sanitizer pre-race for Port-a-Potty
3) Avoid ice from hotel ice machine
4) Try not to drink murky river water
5) Re-examine each component of my race day nutrition and make sure they are not the culprit.

2 years after ACL Reconstruction: Vineman 70.3 PR and Full Vineman Ironman Next

Wow, so much has happened in the last month.  Training.  Racing.  Work.  Nutrition.  Sleep.  Repeat...
Vineman 70.3 was a great success.  I set a PR.  I completed my Half Ironman almost 20 minutes better than my Best Case Scenario Goal Time.  I was expecting temperature in 80s, but we had the best race conditions possible with temp in 60s and low 70s.  This allowed me to push it a little harder on the bike and still have a great half marathon time.  Now if I can only have those conditions again for my Full Vineman ( 140.6 miles) this weekend.  I am once again in taper mode this week.  I need to catch up on a few things, tie up some loose ends, and then start packing and trek up to Northern California again.  It seems like I was just there last week... Oh yeah, I was there last weekend for 70.3

Having a great time cruising up Chalk Hill.


With everything going on with Ironteam, finishing up my fundraising, and my work responsibilities, I almost forgot my 2 year anniversary of my ACL Reconstruction.  That's a good thing.  My knee use to remind me on a daily basis that I had surgery.  Now I usually don't think about my reconstructed ACL even after a Half-Ironman!  I was ready to PARTY after Vineman 70.3 and thanks to teammate Jazzy, we had a great celebratory get together that evening.
I am setting new PRs in triathlon.  Earlier this year I set a marathon PR.  I am about a minute off from my 5K PR ( and I don't run very many 5Ks since I've been training for Ironman).  So once again, my thanks to my great Orthopedic Surgeon: Dr. Raffy Mirzayan at Baldwin Park Kaiser.  Thanks again to my Physical Therapist: Nazly Behnia at South Bay Kaiser for pushing me and encouraging me during those tough months immediately after the surgery.  It was literally learning to walk again, jump again, and run again.  Tearing an ACL is never a good thing, but with the right surgical / medical team, a supportive social network, and one's own "will power" and determination, those of you about to undergo ACL reconstruction will once again be doing the things you enjoy most and resume your active lifestyle.  Good luck to all.

San Diego Ride, Piuma, and Vineman Training Weekend

The last 3 weeks have been a blur.  First was the San Diego 100 miler.  We rode from Anaheim to Del Mar and up past Torrey Pines to UCSD.  It was my first time and I enjoyed the ride especially through Camp Pendleton.  The next day, we had a nice long run and then returned to Anaheim via car or Amtrak.  I rode back up with some bikes in Louis' car.
The following week was a big Brick workout; we started in Westlake Village and rode up and down Piuma, followed by an out and back around Westlake Village.  Then it was a 12 mile run.
Finally this past weekend we drove up to Santa Rosa and had Vineman training weekend.  Saturday was the 2.4 mile swim in Guerneville river, followed by 112 mile bike ride on the actual Vineman course.  The swim was so pleasant.  I ended up with my fastest open water swim to date 1 hour 20 min.  Then after a quick T1, it was off on the 112 mile ride.  Unfortunately my legs immediately felt tired and heavy.  It took a good hour for the lead in my legs to fall off.  I then started getting into a groove, but as the day progressed, it got hotter and hotter.  By the second loop, I had to cool off at the aid stations by dumping water over my head and onto my cooling arm sleeves.  The second time up Chalk Hill was tough.  I just kept pedaling and finally, I sped back to Windsor High School for T2 and a quick 2.5 mile run.
The following day, it was back to Windsor High for a 21 mile run.  The morning was very pleasant and I enjoyed the scenery very much.  But after 10 miles, it started to get warm.  I just wanted to finish ASAP, before the day got too hot.  So I probably ended up running at marathon pace.  I finished the 21 miler in a little over 3 hours.  Not bad on tired legs!
The worst part of the weekend was the 8 hour drive back home to LA.  Sore butt, sore legs, sore back... Yikes!  I had to go to work on Monday and I felt like I was half asleep.  Tuesday after work, I ran 3 miles, but then I was too tired for my Tuesday swim; I ended up going to bed early after dinner.
Today, Wednesday, I finally feel recovered from Vineman Training Weekend.  I had a nice bike ride up and down the hills of PV.  I will hit the pool tomorrow.  Stay tuned for more training updates...

Return of the Marathon Maniac

I've been busy with Ironman training and with work at the hospital.  After Wildflower, I jumped into Marathon mode.  I ran Back to Back marathons in mid May.  First off was the Palos Verdes Marathon on Saturday May 14.  It was a tough and hilly race.  The downhill running actually took more of a toll on my legs.  By mile 18, I slowed down significantly from my marathon pace.  I decided to treat this as a training run and after mile 20, I turned it back way down.  I even walked most of the last 3 miles.  In the back of my mind I was a little concerned about my marathon the next day.  My legs were very sore, again probably from the downhill running. When I finished, I immediately went into refuel and rest mode.
The next day, Sunday May 15, was the Pasadena marathon.  It was a great course.  Some hills, but not as bad as PV.  It rained the first couple hours, but the sun came out and the last couple hours were very pleasant for running.  I ended up running more than 10 minutes faster in Pasadena on tired legs than at PV the day before on rested legs!
What was my reward for this Marathon Madness?  The most important reward was the mental strength I developed which I will need to draw upon during Ironman.  Another reward is stronger legs and a more robust cardiovascular system.  Oh yeah, I also got a Phiten necklace for completing the PV to Pasadena Ultra Challenge.
On Memorial Day, I ran the Laguna Hills Half Marathon which is a hilly course as well.  I actually set my Half Marathon PR here in 2008.  I was out late the night before the race with my neighbors.  I probably had too much Johnny and Jack.  My sleep was not optimal at all.  So I actually had second thoughts when my alarm went off that morning.  Since I needed to at least get a training run in, I decided to attend the race.  I started the race feeling crappy.  My legs felt sluggish.  My breathing labored.  But after a couple miles, I started to find my groove.  Soon I was running at my 5K pace.  I knew I couldn't keep this up, but I decided to run fast as long as possible before turning it down and treating the rest of the race as a training run.  By mile 6, I had slowed to 10K pace, but I was still feeling strong.  I eventually started tiring around mile 9, but I knew at this point that I could race the entire course.  Well I just missed my PR by about 30 seconds!  I had not taper.  In fact with Ironteam training, I just went on a 5 hour-90 mile bike ride against a strong headwind 2 days before the Half Marathon!  This race just reconfirmed how far I have come from my ACL Reconstruction in 2009.
So my running is at Ironman level.  My cycling is close to Ironman level; I have a 6 hour ride tomorrow in which I should go well over 100 miles.  My swimming is another matter entirely.  I have been suffering from a sore Left shoulder for about 3 weeks now.  I would start to feel better, but after the 90 min swim workouts, I would go back to square one.  I finally rested and avoided the pool for 10 days.  This week I had a 60 min swim and the shoulder felt OK, but my swim stroke deteriorated.  I know I'll have to put more time into the pool.

Wildflower Long Course Triathlon 2011

Team in Training evening before the race

Well another successful Wildflower Long Course Triathlon is in the books.  I managed to make slight improvements in all aspects of the race and set a new PR by beating last year's time by 26 minutes.  I probably could have shaved off 15 to 30 more minutes if it wasn't for the strong winds.  But the breeze did help cool things down a touch, so the race wasn't as hot as 2010.
The swim could have been better.  I was a little off course after the first buoy and drifted too far to the left.  Minor bumps along the way, but no major disasters.  The bike was windy and hilly.  The run hilly and warm, but I dumped water at every aid station to cool off.  The downside to dumping water is wet feet and I finished the last 10 miles with a blister on my left foot.  Ouch.  I was also wearing relatively new shoes.  I got the New Balance Minimus Trail shoe 2 weeks earlier and ran 7 miles the week before.  Perhaps that also contributed to the blister.  I know, I know... Nothing new on race day...

 Now more training... for Ironman 2, 3, and 4


Cooling down at the Finishline

Ironteam Finishline

New Balance Minimus ( mine is the large foot)

2 Years after ACL tear

2 years ago, a fabulous day of skiing in Calgary / Banff turned into the worst day of my life.  I had never broken a bone or been seriously injured until I tore my ACL that afternoon.  Here is an excerpt from my blog 2 years ago:

"It's hard adjusting to the transition from training so hard for Wildflower ( I completed the swim, bike, and run workouts in Canada at high altitude and even ran 14 miles in 2 hours the day before the accident) And now being on bedrest with my foot elevated and an ice pack on my knee!"
"I'm pretty depressed. I always took running for granted. It was so effortless, unless I was pushing 7 min/ miles. Now a fear I have is that I won't get back to my previous running form with a bum knee. I still dream of becoming an Ironman. I still dream of qualifying for the Boston Marathon someday. Hopefully with the support of family, friends, coaches, and teammates, my dreams will still be realized one day."

Well after ACL reconstruction with meniscus repair in July 2009 and PT/ Rehab, I resumed marathoning in October 2009 and became an Ironman in August 2010.  My fear of never running fast again was conquered when I set a marathon PR in Arizona January 2011.  I can run 6 and 7 min/ miles again ( for short distances).  I'm biking faster than ever before and swimming better as well.  The weakness in my surgical leg last year affected not only my running, but also the biking and swimming.  Now with my leg basically 100%, I'm much stronger tackling hills on the bike and my swim kick is stronger as well.

I heard popping noises from the surgical knee last year, but that has resolved.  Before exercise, my surgical knee can be a little stiff, but after 5 to 10 minutes I'm fine.  After a long run, my surgical knee is a little more sore, but there is no swelling.  I was wearing a knee brace last year, but I ditched that last summer.  I am very happy with my ACL reconstruction and I'm glad I had the surgery.  I even went skiing in Feb 2011.

I recently ran the Los Angeles Marathon.  Now I'm in training for Wildflower Long Course Triathlon ( Half Ironman) on April 30, 2011, Vineman 70.3 on July 17, Full Vineman ( Ironman distance) on July 30, Ironman Louisville on August 28, and finally Ironman Florida on November 5, 2011.

Obviously there is life after ACL Reconstruction.  Good luck to everyone.