Dec 11, 2021
I dropped, and I dropped early (Petites Gap, mile 8). As I sit here with a low-grade migraine, dizziness, and gut distension the size of a canteloupe, I know I made the right decision. I'm at peace, but I've still cried a couple times. I love racing, Iove this race, and I love running. If I felt a DNF was avoidable and not dangerous for my health or jeapordize the experience of the directors and fellow participants, I'd still be racing now and hopefully approaching Bearwallow Gap in the next 45 minutes from the time I wrote this sentence. However, I showed up. 90% of making progress is about showing up. A DNF is far better than a DNS in my opinion. A DNF shows bravery and hope.
In a nutshell, as I was gently pushing against and praying for my body to just relax already, I came head-to-head with how I'd been postponing healing in order to race, when I should have been prioritizing healing so that I can race.
The back story is that for years, especially the years following 2017 and the 270 days of antibiotic use for Lyme disease + coinfections, I've suspected gut dysbiosis and eventually, SIBO infection. Last year, I had struggled to heal from Epstein Barr Virus, which is hard to manage if there is anything in the body like chronic stress, leaky gut, or underlying infection existing. I had developed some kind of dairy intolerance this summer as well as intolerance to prebiotic and probiotic foods, especially around the time I ran Grindstone 100. During that race, extreme stress was placed on my gut due to high heat in addition to the obvious prolonged racing time, and I was unable to fuel the final 30 miles very well due to nausea which I believe was caused by a combination of heat and low stomach acid, the latter of which allows bacteria to make harbor in the stomach and small intestine (where it does not belong!).
I had scheduled an appointment the first week in October with my Functional Medicine Practitioner prior to Grindstone because I wanted to address this in a lull in my training. $1000+ in testing and appointments later, I came to learn that I have Hydrogen-based SIBO, Klebsiella Oxytoca bacterial overgrowth in my large intestines, and severe inflammation markers in my large intestines. The treatment protocol was as follows:
- Begin a 14 day treatment of Rifaximin + Guar Gum and regular diet to tolerance to catch and kill the bacteria unaware
- Upon finishing Rifaximin, Integrate Candactin AR + BR for 4-6 weeks, and 2 weeks after starting, begin a Low FODMAP (Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyols) diet to starve out remaining bacteria and provide broad spectrum yeast, viral, and bacterial overgrowth treatment in the small and large instestines. Integrate also ginger as a synergist for digestive support, motility, and inflammation
The first snag I quickly ran into was the cost of Rifaximin, $2000 with insurance, in the United States. So with the help of friends, I found other countries who ship quality prescriptions to America at a fraction of the cost. However, the shipping time was long. I ordered rifaximin officially on Nov. 9 and it is "en route" somewhere after it was last received in Germany. I have no idea when it will arrive. Now, I had applied for Hellgate also in early October, thinking the hardest parts of treatment would be behind me by race day. As race day approached, my growing concern was whether to throw away a hard-earned spot and hefty race entry (and my first official sponsorship opportunity) or commit to the race, accept a delayed healing protocol, and see what happens. I chose the latter. Neither was wrong entirely.
For a time, therefore, I was in no man's land, unable to start this treatment protocol without the medication, and so after consulting with my doctor, I began Candactin AR + BR, though the jury was out out on when to begin the Low FODMAP diet because it is intended for 4-6 weeks use due to starving unfortunately the good bacteria in the gut. The equation was relatively sensitive and complex. Once started in mid November, I began experiencing higher levels of inflammation and swelling in my gut, as expected because of the battle being waged there. I saw my times and performances start to sharply slide back, and how I felt in my skin and body grew increasingly more uncomfortable. Then, I began experiencing challenges with stomach emptying, heart burn, and cramping, where laying down was even a challenge. My heart rate variability was suffering, and more importantly, my tolerance to life stress began to dwindle.
I did not want to begin a low FODMAP protocol entirely before Hellgate because the carbohydrate consumption overall is signfiicantly lower in addition to the limited amount of time appropriate to be on it, but I did begin seeking carbohydrate/electrolyte sources that contained less fructose, because fructose is a high FODMAP. Enter Maurten drink + gel, a high performance product designed to crush goals. I ordered it on Black Friday (Buy 1, get 1 50% off!), but it arrived the Tuesday before my race. I tried a CAF gel on my final morning workout, and while my stomach felt overstuffed and I nearly threw up, my legs felt fine.
I will do my best to describe to you this primary symptom: basically my digestive tract felt full from my abdomen to my mouth. Taking in more food, no matter the quality was unappealing and unpleasant when done. My stomach wasn't emptying, and bowel movements didn't seem to be an issue, but again, the distension and swelling in my abdomen was uncomfortable. At times I had hearnburn, but taking TUMS, while temporarily relieving, actually harms the production of stomach acid, which is needed to create a hostile environment for microbes in the stomach and small intestine.
Leading up to the race, I spent the morning sipping on 320 Maurten drink mix, very viscous, sweet without flavor, visiting my amazing chiropractor, Dr. David Glazer, eating a nice breakfast with my husband at Heritage Bakery Café, then taking a long epsom salt soak and putting my feet up until it was time to hit the road. I ate approximately 200g of carbs, knowing I was also in high hormone phase and needed to make sure I was getting that 10% ish extra carbs to offset hormonal needs. I felt calm and assured in my race plan, ultimately with the goal of enjoying the experience and finding peace in whatever the outcome may be.
We drove to Camp Bethel in the increasing rain, picked up my race bib and t-shirt. Once returned to the car, I stuffed my Salomon vest full of the things I needed to run through the night and emptied my SenseRides of any remaining dirt, both of which provided by Bluestone Bike & Run. Off to the pre-race dinner, which was delicious! Last year, I had skipped it out of precaution. We debated on whether to attend the pre-race meeting and ultimately decided that I was here to get as much joy out of the experience, so we went! No regrets being in a room full of people who love putting foot to soil in the mountains as much, if not more, than I do, listening to an ultrarunning legend. Not to mention, Dr. Horton was all about reminding us not to be stupid. I was trying not to overthink this given my circumstances.
Mike and I retreated to the car, where I changed into my race clothing (I noticed everything felt snug, itchy, like I could feel every seam... tried to put this out of my head and that I'd resolve late with anti-chafing products) and slept a wink, up at 10:30 to accept riders into our car at 10:45 so that we could drive to the Hellgate trailhead. As we drove, heartburn and "icky" came over me. Adrenaline probably played some role here, but a week before, I was struggling with this same issue on a trail run, that overstuffed feeling, and no place for the contents of my stomach to go, for whatever reason. After the other runners exited the car, I told Mike I wanted him to be at Petites Gap. I chose to change the plan because otherwise the next time I'd see him was mile 24ish at Headforemost Gap, which is a long way to go if the stomach issues worsened.
We had already discussed that if nausea and GI distress struck early on, I would pull the plug because I was causing further harm to my already suboptimal state. And I'd be at peace with it because my health should always come first in these endeavors. I'd be a terrible coach if I recommended otherwise.
I was happy to be in a trail race that was a single wave, singing the national anthem all together. I kissed Mike, stepped under the Hellgate road gate, watch syncronized, and on the final countdown, began the race.
The first mile was wide, rocks and roots here and there, but easy to navigate. I quickly let go of top females like Shannon Howell and Alondra Moody and settled into what I believe was an all day pace, walking a smidge here and there in the second mile with growing elevation, narrowing trail, and increased likelihood of tripping over rocks hiding beneath the leaves. Runners were either falling back or moving forward, and it didn't seem I fell into pace with anyone, which I was neither here nor there about. As we ascended, the same dogs from last year were losing their minds barking. Can you imagine once a year, 150 runners with bobbing lights come barreling by your home in the smack dab middle of the night? It's kind of comical.
Anyway, we find ourselves in a muddier section, mid calf for me... squelch, squirch... onward! I was leading a shorter line of runners at this point as the double became single track, bringing us to a couple of creek crossings and minutes later, to Aid Station 1, where trail meets gravel. Here comes one of the longest climbs of the race, and I jog right through the AS. I notice that I have sipped about 50% of my Maurten 160, but no actual food yet. I had no appetite for it. As we started climbing, I felt the contents of my stomach push up my esophagus, creating that stomach in throat feeling. Occasionally gagging but reluctant to vomit, I focused on my breath and short, quick cadences for efficiency over this 1500 foot climb, doing all I can to not think much upon how fast the entire field was moving in these first 5 miles... it felt much faster than last year.
My legs felt so unbelievably strong, but I felt swollen, feeling hot spots in all the atypical (for me) places. Run 150 steps, walk 50 steps, sometimes running more, but unable to really get away from the burning and rumbling feeling in my gut. However, I decided to embrace this section. It might be my favorite because in the furthest distance, you can see the top runners' headlamps bobbing and ascending high above, with additional switchbacks of closer runners lighting the way on a switchback leading towards that highest group of runners. And then, all the orbs of lights become a question of headlamps or stars. It's magical. And you're breathing and finding a run/walk cadence appropriate with the climb. I really do love this part of the course! I was also regaining ground on male and female runners who took off earlier on, toggling back and forth depending on where we were with run/walk cycles, but ultimately, I'd move on.
However, by this point, given my symptoms early on and knowing what they could lead to, I knew I'd be dropping. I was proud not to voice my sadness to fellow runners. While I wasn't making friendly conversation, it was important that I not add negativity to anyone else's race. I stayed present and enjoyed the first 8 miles of the course despite the fullness I felt throughout my body. I was grateful to see Mike at the aid station as discussed, because I was concerned he wouldn't be there (there's always that chance, and all participants should be prepared for the absence of crew due to GPS failure or emergency). He quickly ushered me to my box of gear, but I was already ending my run on my watch. I very calmly looked at him and said "This is it. I'm done." I told him that it was like being stuck in an endless warm up, my stomach and tense body just weren't jiving (and it was not an effort issue; in fact, my heart rate was stabilizing), even though I reached this aid station with muscular ease around 4 minutes faster than last year. Like any good crew, he checked to make sure I was sure. I told him I was sad about it, but the distress felt early on in my stomach was a non-negotiable. Running with those symptoms should earn me the "stupid award".
We notified the aid station volunteers of my drop and drove home, where I shivered for a time, gagging several times and reeling on the tighter curves. Upon arrival home 1.5 hours later, I stripped, threw on a fresh pair of underwear and my Comfy, climbed into bed, waking up around 7:30 AM. I came downstairs, sat on the couch, and sobbed a bit. Have I mentioned how tired I am of dealing with this? I could say "why me?", but I already know.
Over the years, I have shared what I've learned about caring for and learning to truly listen to the body, pursuing dreams, practicing relentless self-compassion, but how could I have shared those things and impacted others positively who have struggled and suffered, seemingly alone, and unsure of what to do with that season?
Ultimately, you've got to be at peace with where you are and trust that no matter the outcome of performance, or lack thereof, there's a pot of GOLD on the otherside. My doctor said to me, "If this is how you perform with all these things going on, imagine what you can accomplish once you heal." I want that. I want that more than anything. I want to figuratively split myself open with the raw energy that is in my spirit. But it's an equation: optimal spirit + optimal body = optimal wellness and performance. Like the simple view of reading, yes, this is a thing, suboptimal levels in either one of these components, expect your performance to be suboptimal.
Simple View of Performance™ (I am trade marking this) Suboptimal Body Optimal Body Suboptimal Spirit I will work on defining this. I will work on defining this. Optimal Spirit I will work on defining this. I will work on defining this.
So what's next? Healing. Healing is next. Today, I've already studied the Low FODMAP diet again. I'll boil organic coffee for my first coffee enema. I'll take an epsom salt bath while it cools. I'll foam roll, stretch, and do some gentle strength. I'll read my Gut and Physiology Syndrome book and snuggle up with my amazing husband. He was a treasure yesterday and this morning.
Depending on where I am with healing, Boston 2022 will be either be a push race or an experience race. Ideally I'd like Chicago and New York Marathons to be strong performances, and I have plenty of time to heal for them. My hope is to integrate shorter, faster races in 2022 and take a long needed break from Ultrarunning (I ran my first ultra in 2015).
Thank you for reading my report. If you take anything away from this, it is that no chronic condition is normal; seek help and don't accept a poorer quality of life as your new baseline. Optimal spirit + optimal body = optimal wellness and performance.
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