Saturday, December 7, 2019

Haglund's deformity removal surgery (calcaneal osteotomy and bursectomy)

For several years I've battled insertional Achilles tendinosis and bursitis. Or so I thought. In reality, I've had a misdiagnosed Haglund's deformity. I will spare you the details, except the "tells" of Haglund's deformity in a runner:

1. Pain rapidly subsides after activity, unlike tendinosis which usually aches. If I had heel pain after a run, I might have trouble walking for an hour afterward, but by the next morning it almost felt good as new. Even if I race a 50 miler and incurred immense pain by the end, I felt ready to run in a couple of days.

2. A hard lump in the heel that does not go away with icing. Bursitis and general inflammation should go away with a week of rest and ice foot baths. Mine did not.

3. Tightness that does not improve with stretching and targeted bodyweight exercises. Insertional tendinosis should respond to eccentric heel drops, dynamic balance exercises with kettle bells, and light, dynamic stretching. Mine did not.

I finally had enough of the run-around with botched races and constant heel pain, and went to see an orthopedist with some specialization in athletes. I was diagnosed with a Haglund's deformity right away. If you have symptoms matching mine above, I encourage you to seek an opinion from an orthopedist.

What is a Haglund's deformity? In runners, it is probably caused by running through a long bout of Achilles tendinosis, when the calf muscles and Achilles are generally tighter than normal. The tightness puts excess tension on the calcaneous (heel bone), which responds by growing upward and outward, forming a sharp corner in the heel across which the Achilles tendon glides, obviously leading to irritation and pain. It's an obvious solution from the bone's perspective - to relieve tension, grow toward it!

There is no way to fix this condition with conservative treatment. I have run with heel lifts and have removed the heel counters from my shoes, and even that provides minimal improvement, so I eagerly agreed to a surgical approach.

Below, I will document my recovery so you can judge whether you should undergo surgery. As of starting this entry (3 days after surgery), I can say I already do not regret it, but I know it will be a long road to recovery.

Day 0: surgery

I have not eaten since 5:30 am, and my surgery is at 3:00 pm. It's actually not that bad. I spent the day getting the house ready, setting up an air mattress with lots of pillows in the living room. That will be my home for the next 2 weeks while I'm in the surgical splint.

I was taken to the pre-op room where I answered some questions, met with my orthopedist and anesthesiologist, and got my IV set up. The orthopedist is optimistic - I'm relatively young, healthy, and thankfully do not have to have my Achilles tendon detached/bisected, so my recovery should be fast (bone heals faster than the Achilles). Incisions are usually made on the lateral side of the foot, but because most of the deformity is on the medial side, I will have a medial incision. This will require two nerve blocks instead of one. The bursa will also be removed - so no bursitis ever again on the right side, which is a fun bonus.

 In the pre-op room. You can see the bony bulge on the right foot - it's not huge, but this is its fully-rested state with no swelling.

The anesthesiologist gives me a sedative to help me space out as I'm wheeled into the operating room. I'm conscious enough to say "hello" to the nurses and flip myself onto the operating table. The anesthesiologist spends what feels like an eternity setting up the popliteal nerve block - my leg spasms, I feel electric, burning's not that fun. The popliteal is required for both lateral and medial incisions, so nobody misses out on the fun. The adductor nerve block is easy and I don't feel a thing. I crack jokes with the anesthesiologist, which I think means the sedative is wearing off. Soon I drift off into general anesthesia...

...and awaken feeling terrible. I'm nauseated and having hot and cold flashes. I can't tell who is doing what around me, but people are trying to get me dressed. They give me some food. Somehow I make it to my car and my wife drives me home. I get queasy, and she passes me a plastic bag. A few minutes later I vomit in the back seat (no big deal, I'm well-trained in vomiting). I get home in a haze, eat a cup of broth, take my oxycodone, and drift off to sleep. I wake up and decide to take the higher dose of oxycodone on the off-chance the nerve block wears off.

Day 1: nerve block wears off, the night of living hell

I'm still in a haze when I wake up and don't have an appetite. I take a Zofran and feel well enough to sip coffee and have a little food. My toes are starting to tingle and I'm beginning to feel some pain in my heel, so the nerve block is starting to wear off after about 16 hours. By noon the pain is setting in, but it's manageable. I try to watch TV but it's hard to focus - I'm still exhausted from the surgery and anesthesia, and the pain keeps working its way into my thoughts. I keep the foot elevated well above my heart, which seems to help the pain a lot.

 The beefy splint, elevated on a few pillows. In the background: Night Court. I am unable to pay attention, which may actually be for the best.

Also, interesting side note - I was sent home without crutches but a very burly splint. I'm only supposed to hobble to the bathroom and to get food. My guess is this keeps the blood flowing and prevents total stiffening of the ankle. I am, amazingly, able to hobble without too much pain.

Toward the end of the evening I can tell the night is going to suck. My heel bone is starting to burn and I can now feel the incision. Up until now, the pain has been dull and diffuse, but when specific features hurt it becomes mentally hard to manage it all. I'm on the maximum dose of oxycodone, so I have no recourse if things get worse.

After sleeping for a couple of hours, I wake up to waves of severe pain deep in my heel. I have to bite the comforter and swing my good leg just to get a grip. I put on some headphones and listen to some heavy music to try to bury the pain, but all I can do is hold on until it's time for another round of pills. Rinse and repeat until the morning.

Day 2: pain redux, dressing redo

The heel and incision pain is fading, but I now feel an incredible tightness above my heel that constricts my Achilles and makes it impossible to hobble. I am now crawling around the house. After waffling back and forth, my wife pushes me to call the orthopedist's office. They tell me it sounds like the dressing is too tight, so we go in to get things adjusted.

 Getting the dressing re-applied so it isn't so tight. I'm amazed at how healthy the incision looks.

The stitching looks healthy! Very little blood and just a bit of fluid. Removing the dressing gives me immediate relief. I was previously wrapped with gauze, surgical wrap, and a stretch bandage - the surgeon decides I can go home with just gauze and a loose bandage, since the wound is healing and I haven't had any work done on the Achilles.

 A closer look - not bad for having the bone sawed down two days ago.

After fussing with the splint I find a setting where I can walk again without pain. While I'm still on the maximum dose of oxycodone, I can tell the bone is settling down.

Day 3: pain subsiding fast

I am now down to the regular dose of oxycodone, and my appetite has fully returned. I can fully focus on tasks - doing a little bit of work, watching some TV, and giving myself a quick bath with a wash cloth. Walking gives a bit of bone pain, but it fades immediately; I can only feel the incision when something presses on it.

Day 5: opiates done, cruising the neighborhood, CBD helps

Totally off oxycodone now, which has lifted my brain fog so that I can get a bit more work done and be there for my family.  I borrowed some crutches from a kind neighbor, and can help my wife walk the dog around the neighborhood. I can put about 30% of my weight on my post-surgery foot on these walks without incurring much pain. The most important tip I have is to keep elevating the foot, keep hydrating and eating to support recovery, and keep moving as much as pain allows. My rule is that the pain should improve day to day - if it doesn't, I pushed it too hard.

Also, once I ceased the hydrocodone, I started to feel some burning pain in the heel bone, especially on the lateral side. Tylenol helps, but doesn't get me over the hump. I've found that supplementing with CBD, as long as I don't consciously focus on the pain, allows me to go about my daily life without noticing anything. To be fair, it might only be a 3/10 on the pain scale, but that gets annoying day in and day out.

Day 7: Boot sucks

Who designed this thing? The rivets for the straps sit right over my ankle bone; even with foam padding the pressure causes my ankle to hurt unless I slide my foot too far forward in the boot. I'm spending time with the boot off and my foot elevated, and it feels amazing. There's also some strange kind of acne/hair follicle irritation developing. Hopefully it doesn't get too crazy before I get this boot off in another week. I do feel like the gauze was wrapped in a way that limits my ability to dorsiflex my foot. Not sure if that is intentional or not, but that also limits my ability to load weight on the foot.

More than the rivets, the boot just doesn't seem to be designed for my foot/leg. I have muscular legs and wide feet, but an ankle as narrow as anyone else, while the boot is shaped for a leg with roughly equal width from toe to knee. Probably fits seniors and the obese, but not me.

Originally, I tackled the oddities of the boot fit with some sheets of plush fleece from a fabric store. However, that padding seemed to take pressure off of one region and put it on another, and it didn't breathe so well so the boot got damp. Instead, I've removed all of the extraneous padding from the boot, especially around the heel, so that the heel, rather than being padded tightly in place, is more or less floating in empty space. Way better solution. Awkward to walk in, but a way better solution.

Day 8: pushed it too hard 

In an effort to get to be early, I rush around the house cleaning up, turning off lights, locking doors, etc., and then hop into bed. Not a minute later, I'm greeted with the nastiest pain I've felt in recent memory (much worse than night 2). Burning, ripping, tearing pain and electrical shocks in my heel. I have to pull a pillow over my face to muffle my screaming. And within a couple of minutes - gone, never to return.

I think I'm learning my limits still, but it's quite hard because I can't tell if I'm overdoing it until it's too late.

Day 11: no pain

Basically none, now. I can put full weight on my heel so I don't need to hobble - I just walk with one foot a couple of inches above the other, so my gait appears something like half-man and half-duck. I am getting occasional nerve tingling in the heel and up my leg, but that's probably from being in a splint for two weeks. I've had to pad my heel because I've created a divot in the foam base.

Day 14: stitches out!

Getting the gauze off felt amazing. As the nerves are reconnecting, the skin around my heel and even on the bottom of my foot is very sensitive - the texture of the gauze wrap was almost painful at times. With that wave of relief I barely noticed the stitches getting removed. I think the wound looks pretty healthy, the only issue right now is some latent bruising around my arch and the lateral side of my foot, almost like the bruising when someone breaks their ankle and fluid settles and swells the heel.

Stitches about to come out... 

 And they're gone! The orange lines are benzoin to make the steri-strips, which will go on to ensure the wound doesn't open over the next few days, stick better to my skin. Spoiler: it didn't really work that well. My feet sweat too much.

Day 17: nerve pains, walking gains

I'm able to go on walks around the neighborhood with real shoes on. My lord, my ankle and Achilles are stiff. I'm not hobbling, but I am walking like an old man with arthritis. The foot is still quite swollen, so I'm going to focus on elevation today - but isn't swelling and inflammation the body's healing response? Do I want to really limit it that much? It's like icing - it feels good, but it also limits healing.

Lots of weird electric shock sensations on the bottom of my heel, and when I push my range of motion I occasionally feel a sharp pain. I'm confident this is just hypersensitive nerves readjusting, especially since my skin is extra taught from the stitching. I do occasionally feel pain where there is bruising, but it's dull and doesn't worry me too much.

Just letting this warlock air out a bit. My ankle bone remains buried under fluid. 

Day 18: a breakthrough

Well, I still have strange nerve sensations, but they are rarer and more diffuse. The skin on my heel is desensitizing and I can feel the incision starting to smooth out.

At the back corner between my property and my neighbor's property is a dense grove of Siberian Elm. These are not native to Colorado, but they thrive in dry, cold winters and harsh summers, so even though they grow somewhat disorganized, they're still valuable for shade and wind breaks. A big one was chopped down maybe 10 years ago, but the root system was left intact - and of course, being the amazing tree it is, it sprouted about 20 smaller trees from the old trunk and from the exposed roots. It's looked a bit of a mess for a while - I'd call it a rat's nest of a tree, with branches down to the ground - but I finally had enough and asked my neighbor if I could hop the fence and trim everything up.

So, I popped into some old running shoes and spent 4 hours trimming away the lower branches, thinning some of the canopy, and clearing out leaves and old blown-out wood fencing and trash. It looks great! And I have little fatigue from all that work, and no pain at the end of the day laying in bed. I actually think the isometric loading helped my heel and ankle loosen up and calmed the nerves down. So if I could suggest anything...once you feel stable enough to do some light activity that doesn't require lots of walking, do it!

Day 34: growing pains, no more scabs

All the scabs have now fallen off and the scar is turning pink - a good sign! The skin was initially very hard and lumpy around the incision, in part from the stitches. I've been massaging cocoa butter firmly into the scar twice a day for 5-10 minutes and it seems to be loosening things up. The skin around the incision is much less sensitive. However, I can feel a lot of...reconstruction happening where there used to be a Haglund's deformity. At this point, I'm guessing the bursa is growing back and the body is reshaping the Achilles tendon. There's some latent swelling along the tendon, but I'm getting more and more flexibility back.

Really, even a week ago this still looked like a war zone.

I believe, however, that I developed some peroneal tendonitis either in the boot or while weaning off the boot. The boot required me to walk with my toes pointed outward (otherwise I would be moving forward like a bike with square wheels...up...down...up...down). Now that I'm walking normally, the peroneal tendons on the lateral side of my foot are quite sore, especially near their insertion and near their guiding ligaments. Some resistant band exercises, heat, and elevation for the occasional swelling are taking the edge off. Since the scabs have fallen off, I am officially good to go on hot/cold water soaks.

Day 42: scar tissue, nerve block remnants

I went for my 6 week followup - it's usually 8 weeks, but they put me on an accelerated schedule because I'm a "young athlete". X-rays show complete healing of the calcaneous to the correct, non-Haglund's shape, and the swelling is essentially gone, so they let me loose with the instructions to ramp up activity - hiking right now, and then adding a few short runs to the hike. Swelling will be my guide.

The peroneal tendon pain is waning, probably from the exercises, but I still have some mild tingling in that area and on the bottom of my heel. Apparently the nerve blocks can have some long lasting effects, but I imagine that continuing to floss the nerves and get the ankle active are only going to help.

Whenever I stand from sitting, my ankle is still stiff, but when I stand from laying down, it's actually not too bad (it's generally best in the morning), so I think some of this could be due to the mobility of the entire leg, not just the ankle. I'm going to start doing eccentric heel drops, glute activation exercises, etc., to try to move things along.

So far, even without having returned to running, the surgery has been worth it. I don't feel that achy Haglund's deformity pain when I walk around or squat to get something off the ground; it's a weight that's been lifted from my soul. It has always been this shadow that reminded me that I wasn't physically well and it crept into everything I did - even work around the house or the yard.

Day 95: nerve dysfunction, tight peroneals, running getting real

I'm running up to 5 miles at a time now, with some brief swelling that pops up at random. It seems triggered by sitting for a long time, or running with a tight ankle (see below).

The good news: I can walk normally with minimal nerve issues, I can run normally after about half a mile of warming up, and I can run in shoes with a hard heel.

The bad news: I still have to floss my sural nerve, and I have discovered it is my peroneal tendon that is super tight. Both are slowly improving with some theraband work. The nerve is really bothersome - I can feel its tightness when I stretch my calf or get up first thing in the morning. It is not the Achilles, because the tightness results in tingling on the bottom and lateral side of my heel, well away from the tendon and the former Haglund's deformity. I put my money on some damage from the nerve block, to be honest, after reading about the complication rate (it was quoted to me as "less than 0.02%", but it turns out that complications lasting up to 12 months aren't counted...). I would suggest you refuse the nerve block; mine wore off pretty fast, it was painful going in, and it seems to be causing me trouble months later.

Day 105: hitchin' post

This (the whole experience, surgery to now) is the hardest running challenge I've ever had to deal with. I don't know if the sudden bout of cold weather did it, or pushed slightly too hard, but the nerve pain stopped getting better and my Achilles is still a bit sore near the insertion point. I've taken 3 days off running and feel much better. I think at least a 5 day break will get this in check.

I've started doing eccentric heel drops, which are really helping.

Tuesday, August 20, 2019

An asymptomatic stomach ulcer: the internal grief of the people

My summer races have been catastrophically dissappointing. I've DNF'd Bighorn, Never Summer, and Bigfoot, for one consistent, justified reason: uncontrollable vomiting 5-7 hours into the race.

I have vomited in races before, and it's always due to an electrolyte/fluid volume mismatch or too much food and too much effort. The fix is easy - rehydrate and keep eating. Preventing it is also easy - just take in adequate electrolytes and don't eat too much too fast!

Let's rewind to Bighorn. I assumed the weird vomiting episode I had at the Quad Rock 50 was a one-time thing. By Cathedral Rock at mile 33 at Bighorn, I was getting the same symptoms: a bitter, acrid taste in my mouth and an extreme revulsion to food and water. An hour later, the vomiting began. It continued until I reached Footbridge again, at mile 66, at which point I called it. I had vomited 20+ times, sometimes wretching nothing more than a teaspoon from my stomach. You cannot really move through the mountains, let alone run, absorbing no calories or fluids. I sat near the fire at Footbridge, trying to eat, but constantly wretching and vomiting for the next 5 hours. Sleeping it off seemed to help, but for the next two days I had no hunger.

So I thought, maybe it was my switch to VFuel gels this year. I ate VFuel at both races, and it does taste kind of weird, so I decided to go back to an old stand-by: Cliff Shot gels. At Never Summer, the same thing happened: the same pre-vomiting bitter taste, the same non-stop vomiting.

Other runners and volunteers are obviously always trying to be helpful, but when you vomit for hours on end, no matter what you put in, sometimes vomiting nothing but bile - being told you just need some ginger, or electrolytes, gets patronizing very quickly. I've won a 100 miler, I think I know how to eat and drink!

So at Bigfoot I decided I'd try one last thing - getting even more electrolytes into my body. I focused on a steadier stream of salt by using some Tailwind and S-Caps cracked open in a bottle of water, rather than the occasional S-Cap or broth. Both of these drinks have served me well in the past. Same result. No matter what I do, even eating or drinking nothing, I vomit.

I did the only thing I could do: I set up an appointment with a gastroenterologist. And you know what? I'm not an idiot. Well, I am an idiot for taking this long to go to the doctor, when I knew I couldn't be doing anything bone-headed with my hydration. But the vomiting has been completely out of my control.

I have all of the symptoms of severe gastric reflux driven by an ulcer that would otherwise be asymptomatic. Apparently, you can have a non-bleeding stomach ulcer and not really notice it - unless, of course, you subject your stomach to the intense stress of eating and running in the mountains in hot weather. Being unable to eat for a day or two afterward? That's the ulcer calming down.

The supposed solution? Prilosec for a couple of weeks, and some anti-vomiting pills just in case. Will I go to Tahoe? Oh absolutely. I'm the kind of idiot that shows up to a race no matter what, but I think I've wrangled this thing. If I can run Tahoe, even badly, without uncontrollable vomiting, it will be the greatest physical victory I will have ever had in my life. I can't let that slip away.

Friday, May 17, 2019

I’ve run Quad Rock 7 out of its 8 incarnations. But this year’s Quad Rock was the first one I’ve ever thought about DNF’ing on the second lap. I think if you do the same things over and over again, you eventually fill out the full phase space of races - from great to horrible. The worst rarely comes first, and as a rule when you least expect it. Last year was great, so it was a bit of a whiplash to follow it up with my worst.

My training this spring has been solid, peaking at around 70 miles per week with a lot of vert. That training may have actually carried the day.

I kept the pace relaxed off the line, cruising up and over Horsetooth with little effort. While it wasn’t that cold, I came in heat trained, so I had a pullover on until the second or third hour. Everything was clicking until shortly after Towers at mile 14. I decided to fill my bottle with VFuel drink mix - I gave it a test and it seemed pretty mild. I’ve never had it, but I figured if it didn’t taste salty it was probably fine.

By the time I got to Arthur’s, I was feeling totally nauseated and puked shortly after the aid station. I don’t know if the mix was stronger than normal, but I switched to pure water and that immediately alleviated the nausea. Unfortunately, my stomach was refusing to budge. Everything I put down would come up within a minute. I’ve done 10 long runs this year in the 20-30 mile range, without so much as a touch of nausea, and here I was 18 miles into my usual spring tune-up race and I was floundering.

You wouldn't know I vomited twice in the previous five minutes. This photo is by Erin Bibeau, who has been to every single Quad Rock.

I generally only drink water during training, and even races, lately - I find I don’t need salt, at all, unless it gets really hot and then it seems to help with digestion. Actually, after ditching that one bottle of VFuel, I never ate any salt for the rest of the race except for a couple of sips of broth at mile 40. I think I went with the VFuel because it seemed like it had very little salt, but I think that because some of it is in the form of sodium citrate, it’s harder to detect by taste alone. Big race strategy error: do not deviate from what keeps you happy, unless something’s already broken! Plus, I was heat trained, which means that I needed even less salt than normal. Double duh!

I was feeling terrible coming into the turn-around and thought about dropping, but a few sips of Coke gave me enough of a boost to want to get back out there. Of course, I continued to vomit for the rest of the climb up and over Arthur’s Rock and Westridge. I was deep in Shitsville at mile 30, having absorbed essentially nothing since mile 14, and my muscles and tendons were getting painfully tight. A friend I had been running with heard me griping and passed me an anti-emetic pill. That was just what I needed, and by the time I got to Arthur’s, my thirst and hunger were roaring back. I parked myself on a bench and chugged Coke for about 10 minutes, and then waddled on down the valley trail, burping along and letting this awkward mass of fluid seep into my system.

Once I hit the meat of the Mill Creek climb, I found a bit more energy and started to power hike like I meant it. I managed to pass a few people before Towers, regaining some of the places I had lost at Arthur’s, and continued to push it up and over Horsetooth. There was a low point here where the wind picked up, the sun went behind the clouds, and I found myself getting chilled to the bone on the ridge surrounded by snow drifts. It wasn’t that cold, but the lack of food and remaining dehydration didn’t give me a lot to work with.

There was plenty of power-walking on the way up to Towers from Horsetooth aid, but I had stemmed the tide and wasn’t ceding any more ground. I nearly ran out of steam right at the top, but I took a minute to sip broth and get my head back for the final bone-rattling descent down Towers. Four folks came into the aid stations and rolled through just as I headed out. That was enough to convince me to suck it up and press on. Stout trail at the bottom of Towers just about killed me with its short, steep rollers, but when I got to the creek valleys on Loggers and Mill Creek I picked up the pace a bit and almost enjoyed myself. The final few miles from Arthur’s back to the finish hurt quite a bit. The constant vomiting in the middle of the race  - 15, 20 times - had strained my chest muscles and left me completely drained of energy. Fumes were all I had. I still almost caught someone right at the end.

I think my training gave me the ability to keep moving, sans water and food, for almost half of the race, and still just barely run my slowest time. Even a year ago, I would have taken the hint at the turn-around and dropped if I started vomiting on the first lap. Puking early in a 50 is as sure a sign as any that the race is already rolling toward the gutter. But I think it was worth it to hang on and see how I could fare. It was a bad day, but it was also a great day.

Sitting on a reclining chair by the finish line, bowl of chicken tortilla soup in lap and beer in hand, I fluttered in and out of sleep as the occasional shower drifted in on the breeze. I don’t think I’ve ever felt so challenged by a 50 miler, but I also don’t think I’ve ever been as satisfied by a 50 mile finish, either.

Monday, May 21, 2018

Quad Rock 50

I haven’t had a good Quad Rock experience since 2014. In 2015 I couldn’t run the race because of the reschedule - but judging from my other performances that year, it wouldn’t have been so great. In 2016 I dropped down to the 25 because I had major issues with an Achilles tendon. In 2017 I cratered the last three hours and wilted in the heat.

Yesterday was different. Despite the conditions and some user-error in electrolyte management, I ran my second fastest time and fastest time on the modern course. I get points for that, yeah?

 Erin Bibeau braved the wet to take this photo of me squinting in the rain, feeling a bit peeved by the weather.

While my Achilles is not 100% better - the stiffness may never really go away completely - it’s well enough that it doesn’t hold me back during races anymore. I can’t count the number of times I’ve done eccentric heel drops, applied a heat pad, and done self-massage with a scraper over the past three years. So many mornings I would wake up with a sore heel that made it hard to walk out of the bedroom. So many days I would sit with a throbbing heel, trying to focus on work, finding myself distracted by the despair of it all. Sometimes it felt like nothing was working, or that things would never change. I've tanked half of my races because of this injury.

It’s so easy to let your dreams and passions wither and die when it feels like your own body is conspiring to prevent you from running at your full potential. But we all have unique burdens our bodies and our lives bestow upon us. The kind of difficulties I face can be overcome with focus and dedication, and there are people for whom the same cannot be said.

The injustice of life is that you can’t choose your burdens. You can wallow in them and succumb to bitterness, or you can choose to lift them upon your shoulders and struggle with them to the top of the mountain. It will hurt, and it will lay bare your weaknesses, but it will make you stronger and will temper the sorrow of your life with meaning. People don’t run these races to show off, to fill a void in their lives, or because they’re crazy. Every day, the world tells you all of the reasons you are disadvantaged and should demand better. But if you can be courageous and accept your vulnerabilities, you can move mountains. These races aren’t some saccharine byline, they’re an embodiment of this virtue and its power to make the world a better place.

So anyway. It was cold, breezy, and misty, and on occasion the atmosphere gave us a college try at some rain. The valley trails were pure slop when we started. By the afternoon they were slip-n-slides with giant chunks of churned mud. Some of the rocky bits were a little sketchy in the dampness, but the soft trails took the edge off the distance.

I think I played the first half of the race well. I know I did because I was able to attack the climb back up Timber. As it was cold, I wasn’t drinking much up until the turn-around, and when my fluid intake is low I don’t find the need for electrolytes. But as the day wore on, I inevitably got thirstier. Rather than reassess my strategy, I continued to plug along without much in the way of salt. By the top of Mill Creek I was nauseated, but it took me until Horsetooth to piece together my blunders. Cue vomiting up the final climb. Puking really takes the wind out of your sails. Yeah, you keep moving and suck it up, but you’re going to run slower because you haven’t been absorbing anything for over an hour. I let my stomach settle on the way down Towers and resumed hydrating near the bottom. Not enough to truly turn things around, but enough to give me some pep in the final few miles.

I’m proud of my time, but I also see the vast potential for improvement. I didn’t have any gear issues, my body held up fine, my feet are undamaged despite being soggy all day, and my fitness is finally back to where it used to be. I think with some tweaks to my salt game I can set myself up for a solid run at Bighorn. The eat-food-and-sip-pure-water strategy works for a 200, but it doesn’t really work for a shorter race. My knowledge of physiology is limited, but I imagine that the body does need more help absorbing fluids when the intensity is higher. Here I am, reinventing the wheels I used to ride on years ago. I swore off salt pills, but I think I’ve just got to bite the bullet and accept them back into my life.

Terry Grenwelge took this photo. Here, I'm showcasing my multi-tasking and my ability to ignore sodium cues.

Looking ahead, Dry Fork is drying off and Jaws is looking as wet as normal. I'm ready to work hard for that rusty spur.

Monday, October 30, 2017

Weeks ending October 15th, 22nd, 29th

Backlog of entries here.

Oct 9th: 6 miles, 1500 feet of gain, Mesa out to Table Mesa and back.

Oct 10th: 6 miles, 1500 feet of gain, same thang.

Oct 11th: 7 miles, 1500 feet of gain, Mesa out to Table Mesa and back, plus some Shanahan trails.

Oct 12th: Off.

Oct 13th: 7 miles, 1500 feet of gain, same thang.

Oct 14th: 8 miles, 1500 feet of gain, South Shanahan loop out to Shadow Canyon.

Oct 15th: Off.

Totals: 34 miles, 7500 feet of gain. Felt tired this week, but I think that's the previous weeks' training catching up. Next week I'll taper hard into the race and see how things go.

Oct 16th: 3 miles, 500 feet of gain, Shanahan mini-loop. Felt more pep in the legs today.

Oct 17th: Off.

Oct 18th: 4 miles, 1000 feet of gain, Shanahan loop.

Oct 19th: Off.

Oct 20th: 3 miles, 500 feet of gain, Shanahan mini-loop, before heading up to the Fort to stay with a friend.

Oct 21st: 27 miles, 3000 feet of gain, 3:43, Blue Sky Marathon. It felt good to be racing again, even though I was a about 10 minutes slower than normal. Taking the past two years into perspective, I am happy with what I was able to run. I think I've lost quite a bit of sustained speed on the runnable sections, but I think my recent training averted any embarrassment.

The pace out the gate was insane, by any standards. I hung back in about 15th or 16th, giving my legs time to wake up and my mind the energy to weather the battering, cold winds on Towers. I started feeling queasy early on and had to step to the side to dry heave on the descent down Stout. Maybe the wind hitting my face, coupled with the first seriously fast run I've done in...two years...was racking my brain.

I passed a couple of folks on the Towers descent and caught up to a few more around the 9 mile aid start/finish aid station. After a quick shedding of my arm sleeves and gloves, I tore off under the bridge and hit the Blue Sky trail. Blue Sky is therapeutic. I've come to embrace it. I used to finish this race and cuss it out, vowing to never return. On paper it sounds easy once you get past the climb up and down Horsetooth. In reality, the trail is a snaking, technical grind interspersed with heavenly stretches of cruisy terrain. The biggest challenge is getting to those with enough fuel in the tank to take advantage of them.

When I got to the start/finish aid station, I saw no one around the curve in the trees. I figured that meant I was at least 3 minutes back from the next runner. By the time I reached the Indian Summer aid station, I saw at least four people within a minute of me. I passed two on the climb up Indian Summer; one guy at the top was slogging it pretty hard. On the descent I started to close in on the next runner, who was starting to surge a bit to hold me off. I lost sight of him after the aid station, but shortly after cresting the slickrock I could see him and another guy in the distance. In a few minutes I passed one on the way up a steep slickrock roller and slid by the other through a tricky section on the proceeding downhill. This was probably the first time in any of my races here that I felt in command of my body through the Devil's Backbone playground. The angled rocks, quick ups-and-downs, and endlessly snaking trails can really rack your body and turn you into a zombie.

I slammed it pretty hard up and over the ridge and back down to the aid station. At this point the queasiness was rushing back, which really limited what I was able to pull off up and over the final Indian Summer climb. I didn't really lose ground so much as I didn't gain it. At the final aid station I was a babbling but relaxed mess. Zen and panic. That last little booter of a climb back up to the Blue Sky trail did me in, and for the next mile I was almost shuffling. My mind was cloudy and I felt sick.

I pulled off to the side of the trail and barfed. A whole lot. A groaning, aching barf. Somewhere in the mix I was passed, but after that the weight was lifted. For a mile or so I was able to run unbridled, but then the queasiness set in right before the finish line. So it goes.

Well, I'll take it: 10th, 3:43. So yeah, slightly slower than normal but my pacing was spot on. Pacing has always been my weakness. Maybe if I focus I can wrestle that demon.

Oct 22nd: Off. Eating. Etc.

Totals: 37 miles, 5000 feet of vertical gain. Blue Sky was a good race for priming a winter of running. Bit of a confidence booster, but also motivation for working hard to get faster next year.

Oct 23rd: Off. Still need to give the legs a break.

Oct 24th: 3 miles, 500 feet of gain, Shanahan mini-loop.

Oct 25th: Lifting. 5 sets of bench, squats, and weighted pull-ups.

Oct 26th: 4.5 miles, 1000 feet of gain, Shanahan loop. Very sore after lifting for the first time in a long time.

Oct 27th: Lifting. 5 sets of incline bench, deadlift, barbell curls, and dumbell rows.

Oct 28th: 4.5 miles, 1000 feet of gain, Shanahan loop. Not so sore today, but still somewhat stiff. In spite of that, I can feel the pep back in my stride.

Oct 29th: Lifting. 5 sets of dumbell press, sumo deadlift, and overhead press. I decided to try out chalk during my deadlift routine to help my grip. My gym has older bars with well-worn grips and a patina of sweat and oil. It also has rules against chalk use. The spirit of the rule is to prevent the chalk dust from coating everything in a mile radius. No one wants to clean that. So, I decided to make some homemade liquid chalk. I mixed some climbing chalk with 2 parts rubbing alcohol and 1 part water - a couple of dabs worth, just enough to coat my hands. Whoah. What a difference. And easy to clean up. There's no cloud of chalk that rains out and coats everything and it comes right off the bar with a damp towel. It's allowing me to focus on form, rather than finding creative ways to prevent 250 pounds from slipping through my fingers.

Totals: 12 miles, 2500 feet of gain. Lots of lifting and eating this week to rebuild and stoke the fire. I'd like to gain back the few pounds I lost in September and October.

Monday, October 9, 2017

Week ending October 8th

Oct 2nd: 9 miles, 2000 vert, Shanahan/Table Mesa/Skunk Canyon. I suppose technically I'm running Skunk Canyon and Kohler Mesa. I don't know. All of these terrain features are so small, it's hard to keep track of the names. Rainy, boggy, barely above freezing. It was honestly energizing to get out in the elements and feel my body fight a little to stay warm. It reminds me of running in Seattle over winter.

Oct 3rd: 6 miles, 3000 vert, Bear Peak via Fern Canyon. Saw the mountaintops dusted with snow, decided I needed to get on that. Snow line was at 7000 feet, although the coverage was patchy until just over 8000. The top was somewhat of a mess - rocks in the shadow of trees were iced over by refrozen meltwater, but the snow in the trail was crunchy and grippy. Definitely a hands-and-knees affair coming down the first quarter mile, though. I should have brought spikes.

 Green Mountain from the Bear Mountain summit.

Oct 5th: Off. Somewhat busy work day.

Oct 4th: 12 miles, 3000, Royal(e) Arch. With cheese. This is becoming my favorite mid-week mileage booster. Rolling terrain at the start/end with a steep, angry climb smack in the middle. My focus right now is on technical, steep trails followed by runnable terrain. It's race-specific training for the Blue Sky Marathon, but it's also perfect training for longer races where I need to transition between runnable terrain and steeper ascents/descents.

Oct 6th: 9 miles, 2000 vert, Shanahan/Table Mesa/Skunk Canyon.

Oct 7th: 18 miles, 4500 vert, Green Mountain loop. Up via Shanahan/Mesa/Bear Canyon, down via Ranger/Gregory Canyon, quick jog over to Chautauqua for water, and then up Chautauqua and south on Mesa back home. Looks vaguely like the Blue Sky course with a climb at the start and rolling hills in the second half. In reality, this is more vert than Blue Sky in substantially less mileage. Still, I felt great the entire run. I started a little sleepy and out of it, but by the start of the big climb up Bear Canyon my legs were pretty warmed up. The up-and-over on Green was speedy, and my descent off the backside was definitely my fastest. The Chautauqua, Enchanted Mesa, and Mesa trail climbs were cruisey - I was tired, but I was able to extract a lot of speed out of my legs without feeling "tired". I feel like I'm slowly getting my body back in shape after years of mediocrity. It just needed some hard work.

Oct 8th: Off.

Totals: 54 miles, 14,500 feet of gain.

I signed up for the Blue Sky Marathon, which is coming up in a couple of weeks. Is this a way to kick my training in gear? To give me a benchmark? To get my fifth finish? A resounding yes on all accounts. I remember always falling flat at Blue Sky around the second Indian Summer climb. I guess the question is "who doesn't?", but I'd like to see if I can slam it home this time. Taper time.

Sunday, October 1, 2017

Week ending October 1st

Sept 25th: 9 miles, 2000 vert, Shanahan/Table Mesa/Kohler out-and-back in the mist.

Sept 26th: 7 miles, 2000 vert, Shanahan/Table Mesa out-and-back, easy pace.

Sept 27th: 12 miles, 2750 vert, Royal Arch via Shanahan/Table Mesa/Enchanted Mesa/Flatirons Loop. I have to cross north quite a ways along the Mesas to get to the first Flatiron (I start in Shanahan), so this is actually quite a solid run. Didn't realize the trail up was closed, so I climbed the Flatiron Loop and then threw in Royal Arch as a consolation. Rock steps in the rain are a bit terrifying.

Sept 28th: Off.

Sept 29th: 9 miles, 2000 vert, Shanahan/Table Mesa/Kohler out-and-back in the mist.

Sept 30th: 17 miles, 5800 vert, South Boulder Peak, Bear Peak, and Green Mountain loop. 3:22. This route left me spent. I went sans food and definitely bonked on the final few grunts at the end.

I set out up the Shanahan South Fork trail, climbing up through the damp and the dark of the old ponderosa stands. It was going to be a blue bird day, but the rains over the past week soaked everything and made for a humid warmup.

After topping out on the ridge, I cruised the Mesa trail over to the Shadow Canyon north spur. The  steep, rocky rollers along the base of Bear foreshadow what lays around the corner in Shadow Canyon. I've never gone up Shadow Canyon - only down. And for good reason. The "trail" is a debris pile in the steep canyon that ascends 1700 feet in one mile. Ouch. Lots of large boulders and rock steps necessitate some seriously high knees, and it quickly takes a toll on your muscles. I probably pushed too hard, but I was trying to top out on the saddle before it got too hot.

Just before the saddle the trail mellows out into a series of sandy switchbacks that were a pleasure to run, if only to cool my hiking muscles. The final jaunt up to South Boulder is a steep, narrow trail, and I transitioned into a hands-on-knees power hike, blasting by a few other folks on the way up. After scrambling up the pile of boulders at the top, I turned around to retrace my steps back to the saddle and cross over to Bear. After tagging Bear, which was a detour of at most a few minutes, I started the slick descent down the backside of Bear. The trail cuts its way through a talus slope, and at the pace I was dropping I was sending piles of stones skittering off the trail. Sometimes I wonder how much humans are accelerating the erosion at the tops of mountains. Makes me feel a bit guilty. I'm of the belief that there is almost no "sustainable" human activity.

Anyway, back to more lighthearted things. The west ridge of Bear is one of the most cruisey trails in the Boulder system - it's the perfect grade, and the curves are the perfect radius, for getting up some solid speed. Crossing Bear Creek, one begins the climb up to Green rather abruptly for a few minutes until the trail chills out a bit. I like running up Green-Bear and the west ridge of Green. It's a minimally technical, steady climb that's runnable with a bit of effort. The last mile up to the top isn't so bad - by that point, it's only another 500 feet of vert. I felt some fatigue up the final quarter of a mile to the summit; the rock and log steps burned my quads and knees, the ghosts of Shadow Canyon lingering on.

I decided to descend the front-side of Green via Greenman and Ampitheater. It was packed to the gills with groups of students and older folks getting out the enjoy the weekend weather before the storms hit again. It's an extra challenge to manage while ping-ponging boulders, hairpin curves, and slick rock.

After hitting the bottom at the Gregory Canyon trailhead, I did my usual punishment slog up Bluebell-Baird and Ski Jump and dropped down to the Chautauqua station for water. It was heating up so I chugged half a bottle, refilled, and then got to it back up the Chautauqua trail. It's a steep, punishing 600-700 foot ascent through the crowds back up to Bluebell-Baird. But I knocked it out pretty fast this time and dashed over to the Mesa trail without much effort. The climb up and over Enchanted Mesa felt pretty rough, but once the trail leveled out above Skunk Canyon I was able to get my speed back up to snuff.

The final few miles are gravy - it's the middle of my daily run so it's a series of climbs, booters, and rocky stretches that I know well. That's useful to me, because I can compare how I feel on this section to what I feel like fresh. I was definitely bonking here, but I was able to muster enough gas to push it up and over Shanahan Ridge without too much embarassment. All around a good push. Maybe I'll throw in Flagstaff next week for extra mileage.

Oct 1st: Lifting, 5x5 overhead press, bench, squat.

Totals: 54 miles, 14,550 feet of gain. That's stout! If I can continue this kind of training into next year, I think I'll be doing well.

Given the numbers, and the effort per mile, I think this week is equivalent to a 65+ mile week back in Fort Collins. I know I can add more mileage by running 6 days per week, but for me that treads into injury territory. For now, focusing on five solid days of quality running seems to be paying off.