Monday, November 30, 2020

Coming Back from Muscle Damage, Rabdo and COVID

2020 has been a hard year for almost all of us. In the running community, it’s been a year marked by race cancellations, constraints on group running, etc.

For me, it’s been all of those things along with other forms of adversity that have brought me to the place of recognizing that health is not something to be taken for granted. By the time June rolled around, my training for the Never Summer 100K—the only race on my calendar as the others had been canceled—was going solidly. My Achilles heel still wasn’t 100% (and still isn’t) but overall my fitness was improving and I felt upbeat about the race. I capped off June with a backpacking trip.

When I came back from the trip, I noticed I felt tired and sore. I didn’t think much of it and after a few days of rest embarked on my biggest-volume week of my Never Summer 100K training cycle. It was a hard week, and I finished it with a fairly strong 23-mile run along the Colorado Trail up at Kenosha Pass. After completing my run, I drove home, experiencing delays along the way due to weather and July 4th weekend traffic. The protracted drive home, along with an urgent DIY repair situation I had to address when walking in the door, resulted in me going over 4 hours after my last long run with zero nutrition.

The next week, I felt sluggish, fatigued, mentally foggy and like my fitness had gone on vacation. The following week, which would have been my second taper week, my lack of fitness felt even worse as my legs were completely dead. I could barely run 3 or 4 miles. By race week, my fitness and legs had deteriorated further, causing me to pull the plug on Never Summer. It literally felt like my fitness had gone off a cliff.

I decided I needed some rest but when I saw no improvement I went to my doctor. My doctor ran a bunch of tests and the tests showed that my liver values—notably my ALT and AST—were very high and my protein low. Everything else was normal. My doctor worried about hepatitis. As he said, some kind of toxin hit my liver. I remember leaving the doctor’s office that day worried that my liver was sick.

Additional blood tests and an ultrasound revealed that the cause of my liver values wasn’t a sick liver; it was muscle damage. The muscle damage had hut my liver. This explained why my legs felt so dead. I had apparently experienced significant muscle damage in my legs, leading to elevated liver values. We suspected that I’d experienced some mild rhabdomyolysis.

I have no proof of how I developed rhabdo except so say I wonder if I didn’t push myself over the edge on my Kenosha Pass run and then my failure to take in calories—especially protein—immediately after my run put me in the hole. I likely went into the run already a bit overcooked from the insane stress this year has brought on all of us and then sent myself over the cliff when I failed to take in calories after my run to help my body recover.

On doctor’s orders, I didn’t run for two weeks after we honed in on the likely cause of my issues in order to allow my muscles to recover. No running, weight lifting, core work, etc. So I rested. After the two weeks, I started back up with running very gradually and noticed some improvements in my legs, though I felt a hit to my fitness. But I stuck with it and eventually started to feel fitter.

It was right then that my wife and I both came down with COVID! We both had mild cases but even mild cases can really do a number on you. I didn’t run a step while I was sick and after my 10 days started back very gradually. My fitness has been slowly coming back, and my legs are better than they were in the late summer, but between both of these setbacks I have quite a ways to go in returning to a level of fitness where ultrarunning can be possible again. Currently, I am essentially in the aerobic base-building phase, though I am mixing in some higher-intensity workouts, such as going up the Manitou Incline on Black Friday.

Because I had COVID in October, I was very delayed in going back into the doctor to get follow-up bloodwork to test my liver values. Finally, in November, I got in and they ran all of the same tests that they had before. The test results showed my liver values were back in the normal range and my protein, which had been below where it needed to be, was back in the normal range. What a relief! As I think about all of this, I am left with some takeaways that I want to share:

Training & Recovery
  • I am sure I went into the last long run of my Never Summer 100K training cycle a bit overtaxed but I feel I could have gotten out of the hole I was in had I refueled properly right after my 23-miler. I did not. I went 4+ hours with zero calories and zero protein, which my body needed after such an effort, especially at elevation. I believe this all resulted in significant muscle damage in my legs, which led to my very high AST and ALT values and my likely case of mild rhabdo.
  • At age 47, protein has taken on a new significance in my recovery. I simply can’t get away with sloppy recovery. I am now consuming Muscle Milk after more strenuous efforts (and sometimes even before) and have put more of an emphasis on consuming protein at the right times. With my protein level back in the normal range, I believe these efforts are paying off.
  • Stress is stress and your body doesn’t recognize what kind it is—physical, mental, emotional, etc. It has been a stressful year for all of us. I believe I entered my Never Summer 100K training cycle with elevated stress and, coupled with the training load, my body hit its breaking point. Stress can’t be compartmentalized. It all has the same effects and has to be taken into account when designing a training plan.
At this point, I absolutely do not know if I’ll return to form. Only time will tell. I am cautiously optimistic I’ll be able to race ultras again but there could be lasting effects.

  • I had a mild case of COVID but even then I was quite sick. I was very achy, had a cough, experienced bizarre stomach issues, dealt with severe headaches that wouldn’t go away, and was extremely fatigued. I didn’t run for the full 10 days they say you are infectious and when my 10 days were up started back very gradually and cautiously.
  • COVID can cause myocarditis, which is heart inflammation. I did check in with my doctor to see how I should return to running and he said to stop immediately if I felt off. I never felt off—only out of shape. Athletes with myocarditis from COVID face the risk of heart attack. Return to running must be done carefully. 
  • As I was recovering from COVID, I dealt with near-crippling brain fog, irritability and non-diagnosed depression. When you have an illness that has killed over a million people since March—a tragedy that is not getting the attention it should get—it really has an impact on you. 
As I think about 2021, I feel quite excited to race again. I feel motivated to get fit and enter some long races, including a road marathon and also the Never Summer 100K. In 2020, I discovered that I really love backpacking and so I will use that as a way to complement my training, while at the same time enjoying relaxing time outdoors. I honestly feel more motivated to get back to racing than maybe ever before. 

Health should never be taken for granted. In 2020, I have faced two health setbacks that reminded me of the importance of health. May you be well.

Friday, January 3, 2020

3 Things in Ultrarunning that Are Concerning (At Least to Me)

Long time no post. If people actually still read blogs, I might post more!

All is going fairly well in my world. The last few years I have dealt with pretty bad pain in my ankles--likely the result of multiple sprains on the trail, with inadequate therapy to restore mobility and strength. Of particular note was a major sprain I suffered in 2013 during the Leadville Trail Marathon (one of my best-ever races) and that I then trained through (with no real therapy) and ran a 22-hour Leadville 100 on 6ish weeks later. You pay for stuff like that...maybe not then but definitely later. Well, "later" has arrived for me and being in my mid-40s I can't ignore the issue anymore.

Over the holidays, I finally started to get serious about addressing the matter and so I spent a lot of time working on strengthening my ankles and improving mobility. Happily, I am seeing results! My mobility is much better, the pain has improved significantly and I am overall hobbling less. I am also feeling more shock absorption in my ankles--a good thing.

On the not so great side, I am dealing with some minor Achilles issues. I have four dry-needling sessions scheduled in January and in the meantime am working hard with the foam roller and also have reduced my running volume and frequency. I took 8 days off from running over the holidays and used that time to cycle a ton on our Peloton while also working on my ankles. Let me tell you--you can get a killer workout on the Peloton, especially when it involves power zones! Not only do I think I didn't lose any fitness in those 8 days; I actually think I gained fitness.

I am now back to running but with my Achilles still not quite there I am running every other day, with Peloton riding on the "off days." I also started weight lifting and core training back in October and have seen some really nice gains from that work. My "overall fitness" right now is great and I think I'll be ready to start ramping up for the Never Summer 100K pretty soon.


Over the past week+, I have listened to a lot of year/decade-in-review ultrarunning podcasts and read quite a few articles about the overall state of ultra. Given I've been running ultras for about 15 years, I think I bring a decent perspective to things and so I'd like to share three concerns on my mind. Not sure I have good solutions to any of them (I probably don't!).

First, the unstainable growth of ultra and the impact it's having on the community and the environment is a massive concern. As one example of what's happening with this growth, the Western States 100 has seen a nearly four-fold increase in lottery entrants since 2010. While there is no doubt ultra has grown over the years because it's an awesome pursuit (growth in the number of people wanting to run trails is usually a good thing), the concern is around a big part of that growth not being among people who will be good stewards of the trail but rather me-first bucket-listers and buckle chasers who are used to others cleaning up after them.

Like many veteran ultra runners, I have seen in recent years a concerning uptick in trail litter, poor trail usage, poor trail ethics, crews that resemble celebrity entourages, and overall bad behavior, raising questions about the state of the community now versus what it has long-valued. If the community is growing with folks who aren't good trail stewards and who care about nature and the environment in their words but not in their actions, then it's going to be harder and harder for races to navigate permitting, minimize impact, work with property owners, create strong community partnerships, etc. because the bad behavior will bring problems that can't be undone--meaning more and more races will start to disappear.

I think for a long time I took for granted that it's well-understood we run on the actual trail, pick up what we drop (and even others' litter), and basically show respect for each other and nature. It seems those values should not be assumed to be in others anymore. Every day on my runs I pick up litter. In every ultra I run, I see more and more wrappers on the trail. Yes, the vast majority of trail runners are good stewards of the trail, but a growing number appear not to be.

Not everyone has time to volunteer or do organized trail work and that's OK. But we can all abide by solid trail ethics and do our best to leave no trace. We need to make sure that new entrants to ultra actually understand and practice the values of the community--and those values start with leaving no trace where and when possible.

Second, how clean is ultrarunning? Beneath the glossy veneer of ultra these days are a lot of simmering issues and PED use is one of them. A lot of people who really watch ultra closely share this same concern--there's just a reluctance to bring it up in the "public" domain in absence of a smoking gun.

A few years ago, PEDs in ultra was a big subject. No longer, I guess because it's not a fashionable subject anymore or maybe more and more of us just expect it in sport and so it's not outrageous anymore that there are some athletes who will cheat by taking banned substances that boost performance. As an aging runner who doesn't get around as fast as I used to and seems to always have a tweak somewhere on my body, there is the allure of a magic pill that will make me feel younger (ah, the fountain of youth) but then I'd have to live with myself and actually look at myself in the mirror every day. The mirror doesn't seem to work as a moral compass for everyone these days.

Most races operate on a shoe-string budget and could never afford drug testing so we are likely at the place where we just have to be honest and do it the right way and hold each other accountable. And God no to a governing body (yuck). There have been too many oddities not to question the cleanness of ultra. It is massively naïve to assume people will cheat only when money is on the line; ego plays a role, too.

Third (and finally), the toll ultra takes on the mind and body is gravely concerning because people's health in the long run can be profoundly affected. Ultra is an endeavor that can be quite a healthy pursuit but the line between healthy/sustainable and unhealthy/destructive is narrow and sometimes a bit indistinguishable when you're in the moment. I have been on both sides of that line (above, I mentioned a failure on my part to care for my ankles as I felt the greater need to get in the miles for training--and now here I am with ankle issues I'm trying to fix). Keeping it sustainable, I think, goes back to one's purpose. If the purpose revolves around impressing others, then that is likely going to lead to unhealthy outcomes.

My hunch is that the high number of casualties in ultra these days could be traced to those who just want to cross off a bucket list item, those who can't resist the temptation to impress others on social media with their (over)training, and those who understandably register for too many races when there are a growing number of options out there and then find themselves burned out from too many events. I have flirted with all of that and fortunately came out the other side but not all do or will. Not sure what we can do about this except reinforce the importance of healthy training practices, recovery (not easy!) and balance across all aspects of life--including diet.

That is all.