Post 44 - Kona is elusive

2014 is over, from a triathlon point of view anyway. I didn't qualify. I thought I had a sniff after 10 miles of the marathon but then I had serious stomach cramps, lots of toilet pit stops, and a sore and restrictive knee. So I couldn't run like I wanted to for the second half of the marathon. It was an ugly, painful final 14 miles. Sport at its worst. I think a 9 month intense season is too long. I hit a seriously good fitness peak in June after 5 months of tough training, and I think I went into Wales perhaps a bit over-trained, and certainly not as fit as I was pre-hospital. Some time off will follow now, and a bit of thought will go into 2015 plans. And a race report and photos will also follow soon. Apart from the disappointment, it was actually a really good weekend. The support in Tenby and Pembrokeshire is awesome. And the weather was great too. I just didn't get the damn elusive Kona slot...

Post 43 - The night before Ironman Wales

And so this is it. The night before the triathlon season ends. In 23 hours, one way or another, I'll be done with Ironman Wales 2014. I'm number 533, you can follow me on Ironman Live Athlete Tracking (look it up on google).

I am not in bad shape, fitness-wise. The weather forecast is good. Everything is set up and ready. But I have no idea how this knee is going to hold up. There is a 2km run from the swim exit on the beach, up the cliff path, through the town and to the main transition area. I might get out of the swim and not even be able to run up the cliff path. I might not be able to pedal the bike. It might really flare up halfway through the bike. I might do a decent bike and be unable to run the marathon. Or I might finish well and even qualify for Kona. I have no idea. I'm totally winging it.

I've rested and iced and nurofenned my knee as much as possible this week. I went and had it taped up today. And for good measure, I had both of them taped. I thought it would be my left knee, not my right knee that gave me problems. It's a terrible feeling to have zero confidence in my body. Everyone is saying "you can do it", "think of that finish line", "think positive", but realistically, with the best will in the world, if I physically cannot pedal or run, then no amount of strong willpower or positive thinking can help.

As shown in the photographs below, there are scary jellyfish to contend with. There are rumours of a protest. There are dodgy knees with rainbow tape. Also, there is a tough, tough course. I've no idea how it is going to go. I will do the best that my body allows me to do. And let's see.

Also below is the awesome view from the hotel room, overlooking the transition area.

 

 

 

Post 42 - Race week

At the start of this week, I was feeling quite positive about Wales. I'd had a good rest/recovery week, had a good massage, I'd had my painful ice bath. I'd been eating well. Foam rolling. Drinking the beetroot juice. All the training had been done.

My targets for Wales were the same as they would have been for Bolton: Qualify for Kona. I'd take that, however I get it. I'd rather not rely on the roll-down at the awards ceremony - I've experienced this last year and it's a terrible experience. I'd like to cross the finish line knowing I've done it, and not have any uncertainty. Ideally I'd like to challenge to win my age group, although this is a big ask. It would be great to get a podium in my age group and finish in the top 3. This would get me an Ironman trophy, which would be nice. Top 5 in my age group would get me a Kona slot. The weather looks good for the weekend, which is one less thing to worry about.

I've made an educated guess based on past results that I need something like 10 hours and 10 minutes to qualify. I think this is do-able, but far from easy. It could turn out that 9:55 might not be good enough to qualify, or it could turn out that a 10:25 would qualify. You just don't know.

I need to swim 60 minutes. I'll allow myself 10 minutes for the long first transition. I biked 5:53 last year and wasn't too pleased with that. I'd need to do something like 5:35 - 5:40 this year. I give myself 5 minutes for the second transition. I ran 3:34 last year and again wasn't happy with this at all. I need to do 3:20 or so this year. That gives 10:10 in total. Which I think would be there or thereabouts, and which I think I am capable of doing if everything goes well.

Buuuuuuuut, in keeping with my "tradition" of not having great fortune in my Ironman races, I have developed a sore knee in the last couple of days. I wouldn't have been too surprised if it had been my dodgy left knee, but it was my right knee this time. It just got sore, and it just hurts to put weight on it when it is bent. Stairs are hard work. It's not a great situation. I don't really know why it got sore. I did a couple of things that weren't "routine" for me in the last week, but they weren't risky. I rode my road bike on Tuesday night rather than my triathlon bike, as my triathlon bike was getting serviced. I slept a bit awkwardly one night. I stretched with a pillow rather than a cushion on Monday night. Small things. I did much "worse" in France, lifting and carrying stuff, sleeping on a hard camping mat, battering up long mountain roads...

But for whatever reason, my damn right knee is sore. I've been icing it and taking anti-inflammatories. I tried an easy 20 minute bike earlier this evening and I seemed to get away with it, but an easy 20 minute bike is hardly a tough 10-hour Ironman. It doesn't inspire great confidence, going into an Ironman with a knee that I have no idea will hold out. Saying that, at least it wasn't painful during the 20-minute bike earlier today.

There isn't much I can do at this stage other than to rest it, ice it, take some anti-inflammatories, and hope for the best. It might be absolutely fine, and give me no problems. Or I might not even make 3 miles on the bike. Or it might give up halfway round the bike. Or I might get through the bike and then just not be able to run. I have no idea.

Argh. Again.

 Pain bath



Offending knee

Post 41 - Recovery/tapering

Training done this week:

Monday 1^st September 2014: Rest
Tuesday 2^nd September 2014: Rest
Wed 3^rd September 2014: 40 minute turbo, 20 minute run
Thurs 4^th September 2014: Swim 1.5km
Friday 5^th September 2014: Rest
Saturday 6^th September 2014: 1 hour turbo, 20 minute run
Sunday 7^th September 2014: Swim 2.5km

Totals: Swim 4km, Bike 36 miles, Run 6 miles

This was intended to be my first week of tapering, but in reality it was more of a recovery week. The previous few weeks had been really tough, and for most of this week I felt very fatigued and listless, with low energy levels. The toning down of training has meant that I’ve been able to get to bed early every night this week (some nights as early as 9pm), which has been a benefit, although I haven’t been sleeping quite as well as I’d like. I’ve been doing a lot of foam rolling to try to iron out my muscles. With training less, eating well and being in bed for longer, my body has been recovering.

Towards the end of the week I felt some energy coming back. I had a couple of tough, painful sports massages. My back and legs were really tight and painful to poke and prod, so these massages were painful but necessary evils. I’ve learned lessons from the last time, so the leg massages were much shorter in duration, avoiding the prolonged hair follicle irritation and hospital stay that followed my last massage. Maybe if I continue into next season I’ll shave my legs. We’ll see. I have to say, my legs and back do feel a bit looser and fresher than they did at the start of the week.

I hope that next week will be a good week, in terms of feeling good, rested and fresh. I hope there are no unexpected problems. I’ll be heading down to Wales on Friday morning. I’m keeping a close eye on the weather forecast, although it is difficult to predict what the weather will do as we are still a week away. The weather for the next few days in Tenby looks good, but the forecasters seem to be hedging their bets for Sunday next week – there is a little cloud symbol, with some raindrops, and a sun peeking out. 4 seasons in one day. It wouldn’t surprise me, we had scorching sun, wind, cold and rain last year. I hope it’s nice this time around.

I’ve made a few more purchases this week. Loads of energy gels and bars, some waterproof clothing, new swimming goggles, and a new wetsuit. In France a few weeks ago my wetsuit seemed to be letting in a bit more water than usual. It’s a Blue Seventy Helix, a really good wetsuit, very fast and buoyant. But the better (and more expensive) the wetsuit, the more fragile, and the time has come to replace it. I don't want to be puling it on an hour before the race in Wales, and have it rip or something. I want to keep as warm as possible in the swim, and have as fast a swim as possible. So I need a new one... I got another Helix, but a 2012 model rather than a 2014 model. For this reason, I got a 40% discount, which was a bit of bargain, but still an expensive purchase. Hopefully it will seal really well, keep the cold water out, and help me to a decent swim time next week, leaving me in good shape to get on the bike.

 

I’ll also try to put on some lower gears on the bike (a compact with a 28 rather than a compact with a 26). Last year I went with a compact/26 and it was a tough push up some of the later hills. I’d rather spin easily up the hills and keep my heart rate as low as possible. It is a hilly bike course, and I know this year to make sure I don’t expend too much effort too soon. I need good legs on the final 30 miles of the bike, and I need to get off the bike with a bit left for the marathon. And it’s a tough marathon too.

 

There isn’t much flat anywhere on the bike course. Parts of it are really exposed and windy. Parts of it are narrow and twisty. Some of the road surfaces aren’t great. Some of the descents are dangerous, especially if it’s wet. Suffice to say, it’s a challenging bike course. The run course isn’t much better:

 

Basically, the run course involves running up a hill for about 5km, running back down the hill, and then touring almost every street in Tenby, before heading back to the hill and doing it all a second time. And then again for a third time. And finally for a fourth time. Then you can cross the finish line, where there may or may not be a Kona slot waiting…

I’m due to talk to the cardiologist tomorrow about the results of my 48-hour heart monitor, but I don’t expect anything other than, “You’re fine, carry on.” The bike will be serviced again. I’ll be foam rolling and stretching. I’ve got 8 bags of ice on order from Asda Home Delivery, so I’ll be having an ice bath. There is a pond out the back of the house, so I’ll be donning my new wetsuit and getting in the pond to splash around. I need to wear it in the water to break it in. Ideally I’d go to swim in it, but I don’t have time to take it to a lido or to the sea. So the pond will have to do. I’ll be sleeping as much as I can, and doing a few training sessions. In 7 days, triathlon will be all over for 2014.

During this week, I rediscovered a brilliant song. There used to be a sports programme on TV that I watched when I was maybe 7 or 8 years old. 22 years ago! This particular song featured on the opening and closing sequences. Despite the fact that I was just a youngster, I remember that it was quite an inspirational and evocative song, even though I could never make out the lyrics. It wasn’t particularly mainstream, and I haven’t heard it since. But in over 20 years, the tune has never left my head, and I’ve often wondered what on earth the song was.

It turns out that it’s a song by Enya called “Book of Days”. The Book of Days is a history/science book, first written in the late 19^th century. I put modern technology to good use and found out the song lyrics. They are no less inspirational and evocative than the tune was. It’s a great song. I don’t think, in my current situation, that anyone could possibly have written me a better song. Needless to say, it’s been on an endless repeating loop all weekend. The lyrics, and the song, are below:

Book of Days:

One day, one night, one moment
My dreams could be tomorrow
One step, one fall, one falter
East or west
Over earth or by ocean
One way to be my journey
This way could be my Book of Days

 

An Irish interlude:

Ó lá go lá, mo thuras, An bealach fada romham. Ó oíche go hoíche, mo thuras, na scéalta nach mbeidh a choích'.

From day to day, my journey, The long pilgrimage before me. From night to night, my journey, The stories that will never be again.

No day, no night, no moment
Can hold me back from trying
I'll fly (or “flag”, both work), I'll fall, I'll falter
I'll find my day may be Far and Away
Far and Away

Instrumental

One day, one night, one moment
With a dream to believe in (or “be leaving”, either/both work)
One step, one fall, one falter
And a new earth across a wide ocean
This way became my journey
This day ends together, Far and Away

This day ends together, Far and Away
Far and Away

Post 40 - Last tough training week

Training done this week was as follows:

Monday 25^th August 2014: 1:10 turbo (1 hour hard), 20 minute run
Tuesday 26^th August 2014: Rest
Wed 27^th August 2014: 20 minute turbo (5mins/2mins max), 30 minute fartlek run
Thurs 28^th August 2014: 1:25 turbo (10 x 4mins hard, 4mins easy), 20 minute run
Friday 29^th August 2014: Swim 3km (3 x 10 x 61m off 1 minute), 1:15 turbo (8 x 3mins L/R/both)
Saturday 30^th August 2014: 3:15 turbo (with 6 x 5min hard “hills”), 30 minute run
Sunday 31^st August 2014: Swim 3.8km (paddle drills), 100 minute run

Totals: Swim 6.8km, Bike 160 miles, Run 29 miles

This was my last tough week of training before Ironman Wales. My last week of Ironman training this year. Specific Ironman training started this year on 7^th January, so that has been 8 months of full-time, tough training, fitted in around a full-time, tough job. All that is left now is a 2-week taper. I’ll still train, but nothing too long and nothing too intense.

I feel very fatigued at the minute, because I haven’t really stopped since Ironman UK on 20^th July. I had a couple of days off after Ironman UK, and a couple of days off to rest up before going to the Alps, but apart from that it has been full-on. Normally I would never train hard for more than 2 weeks without then having an easier week. This time, for various reasons, it has been pretty much nearly 6 tough weeks in a row. So I’m in need of a rest.

I think I have maybe overtrained in the last few weeks. Overtraining isn’t a good thing. Generally, increased training results in increased fitness, but there comes a point where further increases in training do not bring the same proportional increases in fitness. This is the point where real fatigue sets in, where recovery takes longer, and where there is a much greater risk of injury. In France, particularly in the final few days, my back was getting sore on the bike. During my final long turbo session, where I incorporated 6 repetitions of 5 minutes at super-high resistance to mimic the hills of Ironman Wales, I wasn’t as powerful as I would normally be. I don’t put this down to a lack of fitness, I put it down to fatigue, heavy legs and overtraining.

I have got 2 weeks now before Ironman Wales to rest and recover, have a couple of massages, have an ice bath or two, do lots of stretching, lots of sleeping, lots of fuelling up and hydrating, along with a few nice easy training sessions. Hopefully by the time Wales comes around on the 14^th September, I will be fresh and ready to go. Although I’m fatigued, by and large I am healthy and injury-free, apart from a sorer-than-usual back. This will be put right by some ice, heat, massage and rest (I hope!)

Some stuff I’ll be drinking every day: beetroot juice is meant to be good for endurance athletes. Let’s see. It doesn’t taste, and comes with a warning that it is normal to have pink urine after drinking…

 

Some stuff I have been and will be eating every day… My meals taste awesome...

 

 

Some stuff I won't be eating every day. This is an actual product, on sale in an actual supermarket near me...

It’s difficult to gauge where my fitness levels are at the minute. I think I’m not quite where I was before I ended up in hospital, but I would like to think I am not far away. The upcoming two easy weeks will do me a lot of good, and going into the race fresh will be a big benefit. I haven’t really been fresh for any of the training sessions I’ve done in the past few weeks. Knowing the Wales course will also be a big advantage, and having competed there last year, I know what to expect and am better placed to plan and execute a better race.

Also this week, I have been wearing a 48-hour heart monitor. This is further to all the tests and diagnostics I underwent before I went to France. They all came back totally normal, and this 48-hour heart monitor is a final test, to be sure to be sure that there are no problems with my heart. It was a bit of an inconvenience to wear, and it made sleeping a bit awkward, with all the wires hanging off me, and the little recorder box having to remain very close by. It also made me look like a bit of a freakish science experiment, resembling some sort of cyborg half-human, half robot.

 

I was given a spare set of electrodes and instructions on how to change them over, so that I could disconnect myself to take a shower, and not end up smelling like a mouldy rag. Ideally, I wanted to have a few cases of ectopic beats when wearing it. I also wanted to train really hard when wearing it, and get my heart rate as high as possible. This would allow the cardiologists to analyse my heart when under stress, and when the ectopic beats were happening. The nurse who wired me up instructed me to do everything possible to try to bring on these ectopic beats: drink coffee, drink Red Bull, get stressed, sleep badly, do whatever training I thought would bring it on.

However, I don’t drink coffee or Red Bull, I have recovered from the leg infections, I didn’t intend to deprive myself of sleep, and I’m a bit less on edge compared with the run-up and aftermath of Ironman UK. The holiday did me good. So my cases of ectopic beats haven’t been as often or obvious in the last couple of weeks. I did train hard, at high heart rate when wearing the monitor. I’m currently waiting for the results to come back, but I fully expect them to be fine, and so does my cardiologist. So there should be no problems.

It’s a strange feeling to think the season is coming to an end. All the work is done. All the tough sessions are done. It’s a bit anti-climactic to be honest. I had seen myself getting in good shape for Ironman UK, and hopefully qualifying for Kona with a good performance there. It was very deflating to have that knocked back. My entire 2014 and all the work I did had been geared to that race. However I am grateful that I have the opportunity to put a Plan B into action, even if preparation for Wales hasn’t been ideal. In an ideal world, I’d have had a come-down after Ironman UK, and some time off to rest and recover, and then another build-up to Ironman Wales. However, the world isn’t ideal, and time and work constraints have meant that I didn’t have much of a come-down after hospital/Ironman UK, and I have just blasted straight through to Ironman Wales.

But, this is the best I can make of the situation and I hope that I will have a good day in Wales…

Post 39 - Les Alpes

I've just spent a great week-and-a-half at a campsite by a lake in the French Alps, with my wetsuit, bike, running shoes, with great people, a massive tent, and a beast of a car christened the "Panzerwagon"...

I spent the summer of 2005 working in a hotel in Aix-les-Bains, not too far away from where we were this time around. I can't believe that was 9 years ago. Back then, I had never done any serious cycling apart from having a clapped-out bike for scooting around Aberdeen and scooting around university. 9 years ago I went to see the Tour de France in the flesh (I saw them all - Lance, Jan Ullrich and "Mr Shut Up Legs" himself, Jens Voigt, who was in the yellow jersey at the time). Having been a fan of the Tour de France since the days of big Miguel Indurain back in the early 1990s, seeing it up close was brilliant.

I learned that the Tour is not necessarily something you go to see, it's something you can go to be a part of, something you can go and do and experience for yourself. I rented bikes on my days off and went up a pile of mountains. I remember hauling myself up the 2645m Col du Galibier on a crappy rented mountain bike. It was properly tough. I remember hauling myself over the 2000m Col de la Madeleine on a crappy rented road bike, with terrible gearing. I remember bombing down the other side of the Madeleine to the small village in time to catch the last train back to the hotel, and I remember everything hurting - legs, arms, neck, back, and boy did my ass hurt too. The Alps are awesome. I've always wanted to go back and do a few more of the climbs.

Also, seeing as the Wales bike course is obscenely hilly, the Alps were an ideal place to train. I'm much more of a proper cyclist now compared with what I was 9 years ago, so I was looking forward to going and riding the mountains as a reasonably fit cyclist on a decent bike.

As I don't have a great deal of time to write this blog post (I have cooking, washing, ironing, cleaning, tidying and weights still to do, and I want to be in bed early), I am going to upload a pile of photos, with a few comments and thoughts on each one. They say a picture is worth a thousand words anyway, so I guess this will be a massive essay about the Alps...

 

The lake, view from the campsite. The water was surprisingly warm. Most people were fine without a wetsuit. I'm a skinny wimp, so I was only fine with the wetsuit on. Such a great place to swim.

 

 



 

 

More views of the lake. It was at almost 1000m altitude. This photo is looking north, down the valley. For most of the trip, a cold north wind funnelled up the valley. Nights were chilly!

 

 

 

The lake on a calm evening. Most of the time it was quite choppy, which made the swimming tough. But the Ironman Wales swim isn't going to be particularly benign, so this was good practice.

 

In the early morning (admittedly I didn't see many early mornings...), the air temperature was low - lower than the water temperature, so the lake was always steaming. Very atmospheric.

 

 

First big cycling day. A 3-hour drive over the Col du Lautaret to Briancon, to do a big loop on the bikes which took in the Col d'Izoard. The Panzerwagon needed fuel so we stopped in Bourg d'Oisans at the foot of Alpe d'Huez. We tried about 4 different petrol stations. None had Panzer fuel (Unleaded 98). The sat-nav ended up directing us to the top of Alpe d'Huez for fuel. Just a 90-minute, 1000m altitude detour. Madness. We got to the petrol station running on fumes. The photograph shows Steve, a relieved man. This was my first time on Alpe d'Huez and it was seriously steep. But then I always find that hills seem worse in the car than they do on the bike. The Ironman UK bike course looked awful when I drove it. The Ironman Wales bike course looked even worse. And I got round them OK on the bike...

 

Briancon (and France, and Europe in general) embraces cycling... These bikes were on the first roundabout coming into town.

 

 



 

Approaching the Broken Desert on the ascent of the Col d'Izoard, arguably the most scenic col in France. The hills are usually 15-20km of steep climbing, usually taking over an hour to ascend. I usually went up these hills pretty hard, sometimes getting the heart rate over 180bpm. I'd get to the top, turn around, and head back down to meet up with Steve, wherever he had got to. He was usually about 5 minutes behind me. Then we'd ride to the top together and I'd take a few photos.

 

 



 

Selfie at 6000 feet on the Col d'Izoard, at 175bpm. That's not a smile!

 

 



 

Final turn before the summit...

 

 

 

Approaching the summit...

 

 



 

Les grimpeurs sur le sommet...

 

 



 

 

Post-ride reward - awesome stuff!

 

 

 



 

Home for a week and a half...

 



 

At the foot of Alpe d'Huez, maybe the most famous road in cycling...

 

 

 

...21 hairpin bends and 50 minutes of pain later! I went up Alpe d'Huez as hard as I could. The top pros (possibly with the help of doping, but cycling is cleaning up its act) can get up the Alpe in 40-odd minutes. Marco Pantani went under 40 minutes. Lance Armstrong time-trialled up it in 2004 in under 40 minutes. When the Tour goes up the Alpe, a million people line its 14 kilometres. It is awesome to watch. I'm going to watch the Tour there someday... 

 

Anyway, I'd like to think I am reasonably fit, I have a reasonable bike, and it was a reasonable day, and I hammered that Alpe as hard as I could. There are two "summits" a few minutes apart. The first summit is where all the ski station shops, restaurants and bars are. This first summit is where the road flattens for the first time, then it winds its way through the town, over a couple of roundabouts, through a tunnel, and it rears up again towards the upper ski station where it finally finishes. I got to the first summit in 50 minutes and 3 seconds, and had nothing left at all for the final stretch. I got to the second summit in 55 minutes. Then I freewheeled back down to meet the others, and climbed up again with them.

 

 

Allez, allez...

 



 

Some of the famous hairpins on Alpe d'Huez. I knocked off another 100km that day, including two more climbs. It rained and I got soaked. I got off the bike knackered, cold and wet, and forced myself to go for a run. Surprisingly, I felt really good on the run.

 

The campsite toilets even had instructions for use. "Ouah I'm dying to go..." and "Oups I stink!"

 



 

 

 

The others did some "Via Ferrata", which translates as "The Iron Way". Basically it's rock climbing, but built into the rocks and cliffs are iron rungs, bars, ladders, tightropes, rickety bridges, you name it. There is a safety rope also secured beside the fixtures so you can't fall (far). It looks terrifying. I really wanted to try it, but I was afraid I'd injure myself or cack myself. There are Via Ferrata courses all over Europe. They are not for the faint hearted. They can take hours to complete, and can involve altitude gains of over 1000m, with sheer drops.

 

 



 

 

 

Swimming in the lake on a grey day. My wetsuit is 3 seasons old. It's a very good wetsuit, but the more expensive these wetsuits (and therefore the faster the wetsuit), the more fragile they are. My wetsuit has been patched and glued a few times and I think the arm/shoulder seams could go at any time. I had to glue it in France a couple of times. It also doesn't feel as fast as it used to, and the seals are starting to deteriorate. It's letting in more water than it should, which means I get cold and more fatigued. I think I need a new one before Wales, but they aren't cheap...

 

 

The "Dead Man's Pass" on the way to Mont Ventoux.

 

 

 

Selfie on Mont Ventoux, just before reaching the lunar landscape. There are three routes up Ventoux. Our strategy was to do each of them. So we took the first ascent at a comfortable pace. We got to the top, but the weather down the other side, where we intended to descend, was awful. And it was blowing over the mountain towards the town of Sault, where we had parked the car. So we descended 6km to the hotel/shop, where I decided I would go back to the summit as hard as I could, and descend back to the hotel, while Steve bought a few bits and pieces. I got to within 400m of the summit, and decided it was getting too wet, so I turned and headed back. We descended all the way to Sault in drizzle. Back in Sault, the weather was good, so I decided to do a bit more. I did 10 hard hill repetitions, each of 3 minutes. I almost fell off the bike at the end. The repetitions were tough. But, being handed a Yop drink perked me up again.

 

 

The summit is calling...

 

 

A poignant spot. Just before the summit of Mont Ventoux, there is a memorial to Tom Simpson. He was a British cyclist who died here in the 1967 Tour de France. The Ventoux is a tough climb, some would say the toughest. It is very hot, windy and exposed. We got it on an usually wet, cool and calm day. Tom Simpson had been ill with stomach pains and diarrhoea before the Ventoux stage. This, and a combination of brutal heat, relentless pace, pressure, and a cocktail of alcohol and amphetamines (the primitive doping that many riders were involved with), led to his death.

 



 

 

The barren lunar landscape of Mont Ventoux.

 



 

 

The summit sign.

 

 

 

Looking over Provence from the summit.

 

 

The summit of Mont Ventoux.

 

The town of Sault. Little French towns are great places. There were so many people out playing "petanque" (French bowls) in Sault. There was also a bike shop in Sault. In this bike shop was a really cool framed picture, which wasn't for sale. I should have asked more about it and taken a photo of it. I'm currently trying to track it down on the internet, without much luck. It was a painting/drawing of the main street in the town of Sault, with the residents totally absorbed in a game of petanque. Even the police were looking on. They were all oblivious to the fact that their game of petanque was holding up the entire Tour de France, and all the riders were waiting on their bikes with peeved looks on their faces. Petanque is obviously taken very seriously in Sault!

 

 

Post-Ventoux filth!

All in all, a great time in France. I enjoyed speaking some French again, and it hasn't done my fitness any harm. But it was very hard to come back to London after spending time out there.

Post 38 - Cardiology

The past few weeks have been a difficult time with all the problems and issues I’ve had. I’ve been monitoring myself and my body very closely, looking for signs of recovery, signs that I can up the training again, or signs telling me to ease off and give myself more time to recover. The trouble is, if I am to compete at Ironman Wales on 14^th September, I don’t really have a lot of time. Further trouble is that I am due to spend ten days in the French Alps from next week, avec mon vélo/with my bike. I’ll be staying at a campsite by a lake, with loads of high Tour de France mountains nearby. It will be great training for Wales, because not a single part of the Wales course is flat.

However, health is the number one priority. If I’m not happy that I’m healthy enough and recovered enough then I can’t push myself in training, I can’t ride up 7000-foot mountains in France, and there will be a question mark over Wales.

I’ve recently noticed a few odd heartbeats. Nothing prolonged, or nothing that makes me feel like I’m about to collapse, but just the very odd soft/hard beat, along with a strange feeling. Everything is normal, then boom, the funny flutter and funny feeling comes, and then a second or two later, it’s gone. These feelings have perhaps been compounded by being fairly stressed over the past weeks, and perhaps because I am very lean at the minute, and had a high level of fitness, and a low but strong resting heartbeat, I’m more inclined to notice my heartbeats.

I was wondering what on earth was going on. Was it something benign and not to be worried about, or was it something that the infection had brought on? Was it something serious? Was it risky to train hard? Should I be training at all? I realised that thinking about doing another high level Ironman so soon, or even going out to the Alps to train at altitude, was something that could only be done after an investigation and an all-clear.

I’d already been checked over a million times in hospital, I’d had a medical check-up just before Ironman UK, and I had a more thorough medical check-up immediately after Ironman UK , which included an electrocardiogram heart analysis. All of these checks were absolutely fine, but I felt I needed something a bit more in-depth. An electrocardiogram only monitors the heart’s activity for a very short period of time. I knew that an ultrasonic echocardiogram, which takes longer to carry out, looks in detail at the heart’s structure. I also knew that 24 or 48 hour electrocardiograms were possible, and if I had one of these, hopefully it would pick up one or two of these irregular heartbeats to allow it to be analysed in detail.

I also know that doing Ironman triathlons and the associated training, elevating the heart rate for prolonged periods of time, does put a lot of stress on the body. Many other athletes at a similar level would be getting regular detailed heath and heart check-ups. I’ve never had a detailed heart examination and felt it was something worth doing, for peace of mind and to get the confidence back that I can push myself hard in training and racing.

I knew the whole process would be a nightmare. Arranging appointments. Travelling around London in its maddening crowds and maddening public transport (I really, really hate doing this). Spending ages in waiting rooms. Possibly having to take time off work, or leaving work early, or coming in late. Compromising my training. Possibly compromising my sleep. A nightmare. But it had to be done. So I phoned the NHS (National Health Service) non-emergency number to ask for advice. They said the first thing to do was to see a doctor. I know that it can take weeks to get an appointment, so I phoned the surgery at exactly 9am the next morning, right at opening time. I got through straight away and asked for an emergency appointment. Later that day, I saw a doctor.

I explained the situation and he did some initial checks, and said everything seemed fine, but that a 24-hour electrocardiogram would be a good idea. He said that on the NHS, it would take a few weeks for the appointment to come through. This was no good to me. I had 2 weeks before going to the Alps. I wanted an all-clear before the trip. Fortunately, I have private medical insurance with my work, so I was able to go to a private hospital after a lengthy phone call with my insurers to discuss the problem and cross my fingers that they would cover everything. They said they would, so very soon I found myself talking to a cardiologist at a private hospital in east London.

He did his initial checks and said everything seemed fine. He wanted to do another short electrocardiogram, then an echocardiogram, and a 48-hour electrocardiogram monitor. This needed another phone call to the insurers to see if these would all be covered, which they agreed to. The initial electrocardiogram only took a few minutes and involved him attaching about ten electrodes to my chest, shoulders and ankles. These then fed into a computer that produced a print-out of what my heart was doing.

I could see him looking at the print-out of the electrical activity of my heartbeat. I could see he wasn’t completely happy, and he said, “Now, I’m going to have to tell you this…” For a split second I was worried. He explained that the results showed that I had slightly thickened heart muscle.

I already knew this was common in endurance athletes, and I also knew that very thick muscle was a bad thing. He said an echocardiogram would determine just how thick, but that his initial impressions were that it didn’t seem abnormally thick. He then explained his diagnosis: Ectopic heartbeats. During our discussions, I really grilled him on everything I could possibly think of.

Ectopic heartbeats are actually really common in most people, but they are generally not noticed. There are a huge number of cells in the heart that must all fire electrically at precisely the same time to make the heart beat. There are four chambers in the heart, each of which will expand and contract. Sometimes, a very small number of these cells can fire prematurely, which causes the ectopic heartbeat. It is essentially a weaker beat, followed by a corrective stronger beat. It causes a strange sensation, but only lasts for a couple of beats. I was only experiencing them fairly infrequently, and so I was reassured by the cardiologist that there was nothing to worry about.

When you are more in tune with your body, and when you have a really low body fat and a strong, low heart beat, these ectopic beats can become much more noticeable. Also with a low heart rate associated with a high level of fitness, there is more time between beats for a few cells to fire prematurely, and for all of these reasons ectopic heart beats are more common, or certainly more commonly noticed, by people with a high level of fitness.

I grilled him some more on the effects of endurance sports on the heart, and again was reassured. He said that from a health point of view, I would get the same benefits from much more moderate, shorter periods of exercise, but didn’t see a significantly higher health risk from high-level endurance competition. He said that my heart muscles would not thicken significantly more with continued training. He spoke of the need to de-train properly when I “retire” from competitive racing, rather than a complete and immediate cessation. This could have detrimental effects, causing my heart muscles to turn to “jelly”. Not what I want.

He said that all of this would hopefully be backed up by an echocardiogram, which was scheduled for a couple of days later. He said that a nurse would carry out the procedure, and would be able to give me her opinion. She would then pass the results to him, and he promised he would phone me for another discussion.

So a few days later I was back in the hospital, lying on a bed with my top off, being jellied up by a humorous nurse. An echocardiogram takes about half an hour and involves being poked, prodded and rubbed by an ultrasonic probe. The jelly is applied to create a better “connection” between the probe and the body. A real-time image of the heart is then projected onto a computer screen, and detailed measurements and analyses can be carried out.

The probe occasionally makes noise, beeps, and transmits the whooshing, glugging sound of the heart doing its job. It was quite amazing. The nurse would tell me when it would make a noise, and what kind of noise it would make, I guess to stop any potential panic. Apart from when her pager went off. It was like in the movies, when someone is in intensive care, and all of a sudden the alarms start blaring, computers start beeping, and doctors and nurses appear from nowhere, galvanised into urgent and life-saving action. Her pager sounded exactly like this. Really loud, “BEEP BEEP BEEP BEEP BEEP BEEP….” For a split second it took me by surprise. But I was immediately reassured. “Don’t worry darling, you’re not dying, it’s just my pager!” I know that expectant mothers have ultrasound scans of their babies. I asked the nurse what would happen if she found a baby. “I hope I find a baby because if I do, we’ll be rich and famous…” Unfortunately, or fortunately, there was no baby…

The nurse’s impression of the echocardiogram was favourable, and she said she would pass the results to the cardiologist, who would phone me. They were as good as their word, and I had another lengthy discussion with the cardiologist. My heart muscle thickness was “in the upper range of acceptable.” If 1 was normal, and 1.3 was the upper limit of acceptable, mine was 1.2, which was pretty much “normal” for an endurance athlete. The echocardiogram had not shown up anything untoward, and the cardiologist was confident that I had a normal heart, with no problems and nothing to worry about. He was very confident in his diagnosis of harmless infrequent ectopic beats. I could continue training with no fear, push myself, go to the Alps, and carry on racing. This was great news.

Below is my heart, as shown in the echocardiogram. It's pretty amazing, and pretty taken for granted. Try making a fist, and squeezing it tight once or twice per second, even for a few minutes. It gets pretty tiring, pretty quickly. Try doing it for a lifetime. That's what the heart does...

 

The cardiologist was really thorough and I liked his attitude and approach. To leave no stone unturned, he suggested that I wear a 48-hour heart monitor in the hope that it would capture an ectopic heartbeat or two. This would allow them to be analysed in depth and absolutely confirmed as harmless. A 48-hour monitor involves having a few electrodes stuck to the skin, and carrying a small portable receiver box that captures the data over a 48-hour period. However, there was no time to do this 48-hour monitor before the Alps trip. The cardiologist was very confident that there were no problems and said he was happy for me to go and train hard, then have the 48-hour monitor done when I get back. His email report to me read as follows:

I really am quite happy with the result.

 

As we discussed on the 'phone I take a cut off of 1.3cm for the thickness of the left ventricular wall - yours is 1.2cm and so normal, especially for an athlete. The heart internal dimension is also within normal limits at 5.6cm, but again I would accept 5.8cm.

 

I note the comments about the RV appearing large, but this is subjective, appears OK to me and it works well.. There is also 'mild MR' (mitral regurgitation) but this is an extremely common finding with the sensitive equipment these days where some blood is seen to go back through the closed mitral valve, and it is of no consequence.
 

Again, putting the echo in the whole context of your symptoms I have no problems with you training and good luck with this.
 

I am of course very happy to go over this again in clinic when we have the results of the heart monitor too.

 

I'll have a few more questions for him, but having talked with him, and the nurse, and received this email, I'm satisfied there is nothing serious gong on. I’ve since done some reading up on ectopic heartbeats and have found people on various internet forums who have experienced exactly what I have felt, and who have also been investigated and given the same diagnosis and all-clear that I have been given. There seems to be a feeling that they can be brought on by a few things: caffeine, taurine. Too much sugar. Stress. High fitness and a low heart rate. Lack of sleep. Exercise. A change in fitness levels or exercise habits. Or they can happen for no reason at all. Most of these reasons are applicable to me. I was told that while wearing the 48-hour monitor I was to try to induce the ectopic beats. So maybe I’ll stop sleeping and start drinking coke…

 

A few quotes from various websites and internet forums that I've come across and can completely relate to:
 

• It's common in trained athletes and, especially if only occurring at rest, harmless. Usually felt as a 'flutter' (the early beat) and then a 'thump' (the next 'normal' beat that is more forceful than usual as the heart has had time to fill with blood during the time it needs to re-polarise after the early beat). As you say, caffeine can exacerbate them as can viral illnesses, hangovers and general tiredness. The slower your resting heart rate, the more likely you are to get them - all heart muscle cells are connected electrically therefore if one cell fires off, the whole heart beats. The sino-atrial node (pacemaker) has the fastest intrinsic rate and normal heart beats originate there but the slower it gets, the more likely other heart muscle cells are to depolarise (fire off) before it and cause an early beat. Studies have been done looking at people with frequent early beats and structurally normal hearts and there is no increase in risk compared to people who do not get them.

• ...you have the impression you miss a beat, then a next one is stronger, and your stomach feels exactly like when you're flying and the plane drops for a second or so...
• Happens to me once every hour or two when I start getting into exceptional shape. It's to the point now that it's become an indicator of when I'm reaching top form. Only happens when I'm not working out though.
• The feeling is very distinct, definitely like a 1-2 second free-fall followed by a super hard double-the-strength beat that is easy to hear internally.
• No worries. You have had the work-up and you know the cause. My resting heartrate in my 20's and 30's was about 36 so anytime I had caffeine I got the thump fest. Really unnerving, especially as a medical student rotating through cardiology and watching some of the patients die from fatal arrhythmias. Worse at night if you lay on your left side because then there is no way not to notice and also when sitting still quietly doing whatever. As an athlete you likely have sinus bradycardia and a larger more powerful contraction which really heightens your sense of what it going on. Now in my early 50's, my resting heartrate is 44 and the caffeine no longer has the same effect. As long as you are not having prolonged episodes, I would try to forget about it. Your heart will probably last your lifetime. ;-)
• That's when your heart beats out of synch for like 1-2 beats (one really slow, then a pause, then two fast ones or something similar), right? That happens to me sometimes (sometimes once a month, sometimes once a day). I got an echocardio and an EKG, there is nothing to worry about because it is something that is pretty common.
• Try cutting out the sweetener Aspartame from your diet. The little blighter crops up in all kinds of food.
• Caffeine, changes in workout routine, etc., all can be associated with some ectopy. You've been checked and cleared. The only time I'd get concerned is if you got into an atrial fibrillation rhythm, where your HR is constantly erratic for a long period of time.
• I go through periods of getting these when I'm resting. For me I think it coincides with my cardiac fitness making rapid shifts up or down - say I mostly get them when I stop training for a while, or bump my training back up, as though they are caused by my system readjusting to the change in fitness. Therefore, nowadays when I get this when I'm training heavily I actually take it as a positive sign that the training is working!  
• Anyway, don't understimate stress and how it might impact your symptoms, even though you may not realized you're not stressed. It may be that you're not relaxing. I went for three years thinking it had a completely physical origin.

 

I’m a lot happier now than I was a few weeks ago, and I do feel a bit sharper too. Hopefully ten days in the Alps next week will do me a lot of good, and then after that I’ll have one more tough week of training followed by a two-week taper before Ironman Wales. I really hope I go to Ironman Wales and deliver a performance that I’m happy with…