Friday, July 18, 2014

Celtman – The great fail and the eventual diagnosis

No 1 thing you shouldn’t be saying to yourself before an Ironman: “When this race is over I’m going to get properly fit”.

View from our recce swim

Enjoying the wild life
Beautiful recce swim
Dedicated support crew
Certain aspects of the preparation went well, others not so well.  We made it to Scotland but we put a 5 litre bottle of oil through the van on the way there so we really didn’t feel like driving up and down the road to the Byre from Sheildaig.  
Our first view of the moutntain
We had to go out and register.  We had a swim and we went to pick up Lynn, the second member of my support crew from the station at Achnasheen.  All went well but it wasn't without stress with the van being so delicate.

Packing was a little more fraught.  It went on till late in the evening.  I was too excited and worried and I lay awake most of the night, staring at the lightened room, getting disturbed, worrying that the Vanu wasn’t even going to get us to the start and I would be trying to sprint to the start in my wetsuit on my bike.

A bit of silliness didn't get me to relax.
A lot of silliness finding TSK another warm layer to take up the mountain.  This one is tight fitting (mine).
On the morning of the race I had had 1.5 hours sleep.  The excitement of the last few days had taken its toll and I was Tired.

We were early to the start, racked the bike, picked up my tracker and got changed.  I waved goodbye to the support crew and got on the front of the first bus.  If anyone’s thinking of doing the Celtman event or any other with bus transport to the start, it’s the best policy.  You can get first place in the toilet queue when you get there.

The start was as atmospheric as it looks in the promotional videos.  There’s a piper, there’s fire pits, there’s a flaming event logo where we had our pictures taken.

I was interviewed prior to the start by race cam or Scottish TV or some-such.  I was a skinny blonde still wearing my colourful club colours instead of a wetsuit on my top.  I was suitably entertaining and upbeat yet dramatically terrified.  I can only remember thinking that I should have mentioned my resilient support crew and afterwards I could only think of the shame of mentioning my nervousness at the bike and the run and not mentioning the swim at all.  Perhaps I was trying to keep it out of my mind.  Still, in conclusion, being interviewed was not the best policy.  I had to rush to get into my wetsuit top and I had not warmed up properly.  I was already shivering before I got in the water.

I was glad of the people around me as we waded through the seaweed.  The sea didn’t feel particularly cold as we got in and I wasn’t really cold when we started.  I was totally consumed by the jellyfish in the sea.  At first I was twitchy about touching them with my hand but there were so many that there wasn’t any avoiding it.  Occasionally I skewered one with my finger and scooshed it through the water until it fell off my hand when my arm exited the water.  They ricocheted off my nose and all I could help think was, “I hope they’re not stinging, otherwise I’m going to be a mess”.

Out to the island was not a poor swim then there’s about 1700m clear distance to the larger Island of Tigh an Eillean which I had always dreamed of swimming around as a child.  To find my way I sighted on a house on the shore-line as instructed.  For 30 very long minutes that house didn’t seem to get any closer.  It probably was getting closer but because it started out so far away, it really didn’t seem to get closer.

As my body started to shut down I was finally alongside Tigh an Eilean and I tried moving in towards the shoreline to get some shelter from the imaginary tide that I felt was pushing me out to sea.

As the shivers set in good and proper I checked my watch.  I’d already been in 40 minutes and still had 20 minutes to do.  I could see the group in the distance, some would be getting out in 5 minutes.  I promised myself at least 5 more minutes.  I stuck my head in the water and paddled as fast as I could.  I occasionally reverted to breast stroke to give myself a change (as good as a rest right?) but that only made me feel like I was losing heat and being lazy, making my swim even longer.

After 5 minutes of intense effort my whole body was shaking and my breath gently muttered to itself.  I moaned out breaths and snatched them in.  I started to worry about the state of my health leading up to the race.  I had gradually been unable to train properly and despite 2 weeks of taper and a week of enforced complete rest I had not recovered, never regained that coiled spring feeling.  If I was seriously ill then this cold water could be really really dangerous.  My legs went into cramp – first in the thigh, then in the hamstring and I flailed for attention from the Kayak, calling out, “hey” as best as I could – though it still wasn’t loud.  By the time the lovely chap reached me and asked if I was really sure, I was absolutely positive that I wanted to get out and quit.  You don’t make that decision lightly after hundreds of pounds and time invested.  For me, it felt like it was get out of the water or die there.  I really thought I might have a heart attack.

Quitting in the water is the worst place ever, I am now convinced.  You have to stay in the boat until all the other athletes are finished.  When you get on the boat you’re convinced you’re going to freeze to death.  When you get off the boat, you’re warm, rested, recovered and ready for action!  Fortunately I had a steady stream of compatriates to re-warm and rejuvenate.  I had a fairly pragmatic approach to quitting this race.  By the time I reached race day, my fatigue for ironman training (we’ll get on to the causes of that later) had led me to start looking forwards to the next training session for the next big plan.  Although I was disappointed and concerned about my support crew and the damn fucking waste of space that I felt, I am proud to say that I’m the only person who didn’t cry on the boat.  Others had invested even more than me – the trips from Switzerland and Paris, the travel up from London.  To be quite honest I was too consumed in helping the bloke from London warm up and stop throwing up that I had little time to think about my own demise.

We were welcomed on the quay by a small clapping crowd of people.  It was gracious and not at all patronising.  We were told that we could go out on the bike if we wanted to so I walked up to transition with my support crew, got changed and I set off, full of beans, with Simone from Switzerland.

Simone lived up to her name.  She was so pissed off at herself that she swore all the way up the first hill.  I tried to engage her in conversation but she continued to swear at herself throughout the climbs so, when she stopped with her team car, I continued alone.

I started to get cold on the Torridon valley and added a windproof layer which, to be honest, is so thin, it doesn’t really count for much.  I tried to eat some wholesome food but it wasn’t going down well so I tucked into a nice sticky Torq bar.  That made my temporary crown fall out into 5 pieces.  As I picked the hard crunchy bits out of my mouth, Simone came past me again.

I chased her all along the valley to Kinlochewe where I resisted the temptation of the caf and turned left towards Gairloch.  Simone was with her support crew again and I called out, “only 15 miles to Gairloch” where there was a hot breakfast waiting for us.  I also knew that this stretch was quite flat so I was looking forwards to seeing what speeds I could achieve.

It was still cold though so I eventually rang Andrew and asked him to ride back to me with my knee warmers.  My logic being that if I could ride with him for a while and be warm, I might actually feel like continuing beyond Gairloch.  I also didn’t want him to drive the vanu any more than necessary.  I instantly regret not asking dad to drive his car out to me instead.  The road I was on was slightly uphill and I had a slight headwind.  I just didn’t feel right and had to ride down at 10 miles per hour to keep my heart rate anything like normal.

10km later I had my leg warmers on and some of the last 10km to Gairloch is a flying downhill.  I felt fine and didn’t even stop for the breakfast but instead whooped past my support crew saying, “Onwards and upwards”.

I rode past a pipe band playing outside the town hall and felt fine then I reached the first hill and everything fell apart.  Half way up the hill I turned into a driveway, sprawled out on the handlebars and gasped for air.  I knew that the next 30 miles were peppered with climbs equally sharp and one really long 5%er.  I looked at my Garmin displaying 50km and thought, “that’s the perfect training distance for an Olympic Triathlon”.  I told Simone I was done as she passed me again and called my support crew.

Again, as soon as I stopped I felt fine.  I wasn’t sprawled out in the car park, exhausted.  I just couldn’t ride up hills anymore.  I’ve never been a particularly strong climber but this was just ridiculous.  Three weeks ago I’d ridden Holme Moss and the Snake Pass.  Granted, those weren’t particularly fast either.  I put it down to over-training and decided I wanted to go and get some breakfast and head up the mountain to cheer on the other athletes.

After our gourmet breakfast at Kinlochewe I was just pissed off (unreasonably) with Celtman and confused at myself.  I felt a great urge to go to sleep so we took the tracker back to base to officially quit then went to Shieldaig and my support crew ate sandwiches and I slept whilst Lynn arranged to stay in the youth hostel so she could ride back to Achnasheen station at a reasonable hour to get to work on Monday.

Back at the Byre we set Lynn on her way then did very little with the rest of the day.  We had no internet so I couldn’t plan my next event and so I wrote a few things down.

“Just as there are diverse levels of ability in the sports that I do, so there are diverse levels of the ability to cope with the cold.  This year I challenged myself to achieve in something that I am so inherently bad at – cold water swimming.  Whilst I made improvements, they were too meagre and too late to enable me to complete this year’s race – the Celtman Extreme Triathlon.

Once I had been through the experience of being dragged, chattering, cramping and weakened, it was a relief to find that I could not physically go on to complete the bike ride.  I had left something substantial behind in the water.  For me it was my legs, for Simone it was her lungs, for Mark it was his stomach contents.
On the road across Ben Eighe nature reserve I was cheered up by the sound of wildcats fighting in the woodland.
I started to think about planning my next event to take my mind off this.  Something nice and short like a standard distance tri.
I’ve made a conscious decision to leave Ironman alone.  It conflicts with so many things, not least: my enjoyment of non-tri sports like cyclo-cross and fell running, hill walking and ski-ing (the cost of an Ironman easily works its way through the ski holiday budget).  I am immensely looking forwards to shorter open water swims and doing my job properly…”

At that, I fell asleep and woke 3 hours later at 6pm looking forwards to the rest of my life.
In the evening I went through my yoga set which left me invigorated and looking forwards to looking after myself over the coming weeks.  

“Not trying something new but repeating something from before but better.  It would be boring and presumtious of me to go into details but I hope it gets me where I want to be.  If not, I am either over-trained (not known), doing it badly wrong, chronically ill or genetically predisposed to not doing it at all.”

"Every Ironman athlete tells themselves that it doesn't matter massively if they don't finish because at the end of the day, they have enjoyed the journey and enjoyed the training.  Then, when you get there, to making that really tough decision to quit, you start to think that might be a load of bollocks because actually,  that training has stolen the last 9 months of much of your life.  Chances are though,  is you're now fitter, stronger than you have ever been in your life and you will not want to go right back to whatever happened before.  While I have called time on my iron campaign,  I am massively looking forward to putting the same level of effort into my future endeavours and going better,  not just further and harder."

The morning after the worst race day of my life we decided to go for a ride to Applecross. 

The Culin of Skye from Applecross.  If you click, you might just be able to see Jesus walking his dogs on the water.
I got frustrated with myself having to stop on the hill climbs heading home and felt relieved I hadn't continued the Ironman.  The seeds of doubt were sown though.  Why did I feel like this when I hadn't even tried yesterday?  After a day of slobbing around the Byre drying out wetsuits and reading books for the rest of the day, we decided to check out and head South.  I could’ve spent more time in Torridon but driving the Vanu up and down the Applecross road was not a risk I was prepared to take so I sold TSK on the idea of climbing Ben Nevis.

The day we left Torridon was gloomy and dank.  A good day to travel then.  By the time we got to Glen Nevis the weather was perfect again.  I went for a run through the forest.  Faced with a wall of fallen trees, I jumped and climbed from one trunk to another, persevering with the route to get myself back on the path 15 minutes later and 300m along.  It was worth it as the path had not been used for some time and I witnessed a Golden Eagle around 5 m away, soaring into the deep forest.  Day... Year... MADE.

I walked up most of the hill, choosing the steeper more interesting routes over the wide-open forest track and here is my view from the top.

Looking across the forest towards Stob An.

Mindful of the day ahead I descended again to base camp, a good meal in the pub and an early night.  We were back on the trail before 8am the next day and there were already plenty of people about.

Our route choice was to summit via the easy tourist path then take a look a the Carn Mohr Dearg Arrette and see how we felt.  The weather was fine and we were fine so we went for it. Descended the hard way to the mountain stream where we cooled our feet then took the tourist path back down to the pub for a very nice pint of beer.  I'll let the photos talk for themselves. It was one of the best days I have ever spent on a hill.

Short snow section on the final climb to the summit with Fort William in the valley

TSK takes a drink of water on by the met station

Carn Mor Dearg Arrette beckons us forwards

Later we would descend the steep slope on the right direct to the river before retracing our steps around the mountain to the pub.

Perfect relief for tired, swollen feet (note still got my nail polish on)

Centre of photo (well disguised), a snow bunting.  There are only 60 mating pairs permanently resident in the UK. 10,000 migrate here in the winter.  These ones live off tourist scraps.
Drying off before the final descent
When I got home to Sheffield there was the Tour de France to watch.  Two days of doing very little except standing about.  In Harrogate I wondered why I had to keep crouching down amongst people's legs trying to find some oxygen and get out of the sun.  

On Sunday in Sheffield a tiny ride out to Jawbone Hill.  Just enough time to get warmed up then an impressive hillclimb to play with, lined with people.  The most embarrassing ride I have ever done (even more embarrasing than the duathlon champs where I had to adjust my bike position three times).  I stopped by the side of the road four times to catch my breath back, each time collapsing over my handlebars, my lungs screaming, waiting for the blood to make it back to my muscles with some oxygen.

We finally selected a spot - the point of my final refusal to go any further - and made friends with the people already staked out there.  The highlight of my day was running alongside my team mate, already riding in the Juniors Tour ahead of the main race.  I ran about 300m before an official pulled me out before the summit.
My last dying run - in cycling shoes - perfect three peaks training
I then spent a few days planning my season upto the Three Peaks and working on site in Norfolk.  I spent a lot of my time in Norfolk either yawning or sitting down.  Thankfully it was sunny so I could do that outside.  I managed a hill reps ride near my hotel and it was so satisfying to do some specific training for the first time in ages but my heart rate was hitting max and I only climbed 25m each time on a 3% slope but I actually felt my spring coming back.  My calf was sore so I went for a walk in the morning before heading home then foam rollered the shit out of it over the next few days.
A different kind of beauty
I had a mamogram booked on the Wednesday morning (happy genetic risk 40th birthday to me!).  Playing catch up on some health issues, I booked a GP appointment on Thursday morning, just before my dental appointment to fix those pesky crowns in place.  The cancer clinic had emphasised my doctor's advice to change my pill.  Each for different reasons but now that my Ironman event was out of the way, I felt safe about changing things.

The doctor wrote me a prescription for the pill and measured my calf muscle.  It was 1cm bigger than my right calf so he sent me to A&E just to be on the safe side.

I "popped into" A&E as instructed.  The triage nurse was a triathlete so I could talk freely about my experiences without any justifications.  When you're describing sore muscles to most medical people and they then discover you ride bikes over hills for fun or do fell races, they file you in the "nutter" folder and it takes some effort to convince them there's an issue.  She listened carefully and nodded in an understanding way then said, 

"you've not been suffering any chest pains or shortness of breath have you?".  

"Well, actually..."

She rang the clot nurse directly but she wouldn't see me straight away because I was too young and my bmi was too low to indicate that I might have a problem with a condition largely associated with sitting on your arse for too long.  Back to the age-old athletic issue...

So I was placed on a bed in a cubicle and set about waiting to see a doctor.  After a while it got quite tiring so I lay down and had a snooze before the doctor explained that I'd get a blood test and need to wait about 2 and a half hours for those results.  If they were positive, I would get my leg scan and if that was negative they'd look at my lungs in the CT scanner.  I asked if I could go to my dentist appointment and come back later to get my blood test results.

"We recommend you don't go anywhere at this point" she said.  

"WHAT THE FUCK IS WRONG WITH ME?" I thought.  Low risk went out of the window.

So I waited in line for a blood test to check if I had the chemical in my blood which indicates that I have a blood clot.  By this point I was getting quite fed up with people telling me how low my risk was.  I was surrounded by elderly patients in wheelchairs.

Finally, a nice male Indian nurse came to take my blood but he didn't just take my blood. He put a fucking canular in my arm.  A FUCKING CANULAR!  I've never had one in my life.  The only people I have seen with one of those in have died or been suffering with the Cancer!  Then he said, "you can bend it if you want" and bent my arm.

"I don't want to!" I said and I started to cry.  Poor Indian nurse.  He scurried away and I was enveloped by fluffy lady nurses asking me what was wrong.  I felt a bit shit and I really wanted my new teeth.  Please send me back to just needing new teeth!  I rang the dentist but put off ringing Andrew till later.  I didn't want him to miss out on earnings because of my "low risk" condition.

After an unsugared (WTF!) cup of tea I rejoined the masses and fell asleep in my chair whilst all the old biddies chattered and complained about the state of the NHS around me.  I gradually allowed my arm to bend and listened to all the people who had complained get discharged because they'd "just got a sore leg".

My two and a half hours was up and the doctor reappeared in the waiting room, "Your test was positive.  We'll send you for your leg scan now."

The scan doctor was lovely.  We had a good laugh about the ease of finding my veins in my skinny legs.  When I told them I was there because of getting out of breath on hills on my bike, she said, "that's how the rest of us usually feel love".

They found nothing, possibly because they weren't looking where it hurt and I concluded that I really did just have a sore leg.  I was taken to sit in another chair to wait for my CT scan.  Although the thought of the CT scan was terrifying, I started to feel more terrified by the prospect of there being nothing wrong with me.  Suddenly the poor performance and shortness of breath started to make complete and utter sense.  If there was nothing wrong with me then I was faced with the prospect that I was just a shit athlete and that was more terrifying than a treatable illness.  The only thing scarier being *actual death*.  The months of banging my head against a brick wall doing more and more ironman training to the conclusion of seemingly no progress became less of a concern and more a process of disovery.

The CT doctor informed me that injection of the dye would cause me to feel hot, get a metalic taste in my mouth and feel like I'd wet myself (but I wouldn't have).  Great.  Reassuring.

She was right though I'd compare the last sensation to a shower in tea tree oil but I understand her more generic analogy.  Not every old biddy in Sheffield has taken a shower in tea tree oil.

I was a little unnerved by the CT machine since every Holby City and House episode we watch seems to involve someone having a seizure every time they go into the CT scanner, leading it to be known in our house as "the seizure machine".  I was asked to straighten my arms above my head (I'd just gotten used to bending it!) and they injected the dye which made my toes curl!  I was encouraged to close my eyes which was rather disappointing as I wanted to watch the machine which roars and whirls like a helicopter.  The downside to being an engineer.

A nurse said, "I'm just going to put this over your chest" presumably to protect my boobs which had already had one dose of radiation that week.  Of course when someone says that to you, you instinctively open your eyes and I caught the slightest glimpse of the stainles steel wheels inside the CT scanner rolling, things flying past my face at high speed, laser lights bouncing off my body.  Bang bang bang, I shut my eyes again.

A very clinical voice instructed to "Breathe in, hold it, breathe normally".  Over and over and then it was done.  A boy stripped the piping from my canular and people busied around me being REALLY REALLY nice.  I didn't feel like this was going to be good news.  I returned to my chair in CDU and rang Andrew.

Before he arrived my doctor returned.  "You have several blood clots in your lungs, we need to keep you in overnight.  We will be giving you blood thinners and your iron levels are very low.  In 2012 it was 140.  Now it is 91.  Do you know anything that might be causing this?"

I'll spare you the details of the deliberations and they are still ongoing as the doctors ask me more things, I remember more information and things that I used to take as normal are probably not so normal and I should've had them checked out sooner.

The first blood-thinner came in the form of an injection into my tummy-fat.  A bit like a bee-sting I sat and cried until Andrew arrived when I pulled myself together an again started giving instructions to my support crew to rescue me with some comfortable clothes (I was still dressed for work), the internet (I'd forgotten all of my mobile phones), some fresh fruit and a copy of Triathlon 220.

Up on the ward I met Joanne, the only other resident under the age of 65.  She was around 25 so between us I think we brought the average age of our 6-person ward down to 60.  Everyone else looked dead so I set about cheering her up and vice versa.  She had a heart problem but was in for a kidney infection.  Having handed her notice in a week ago, she travelled to work on the bus just to prove to her boss that she was sick and promptly collapsed in the office.  I like making friends with people as nuts as me.

I didn't have a bad overnighter.  I had earplugs with me to protect against the shouty nurse who attempted to wake the dead to "do obs" every three hours.  My residual memory will be of her screaming "Doreeeeen" at an elderly patient at 3am.

I got a shower in the morning, refusing a bed bath, and proceeded to flirt with the male nurse and prowl up and down the corridor for hours, waiting to see the even more handsome doctor who came to review my ongoing care and discharge me.

I successfully convinced him to show me the footage of my cross-section and was gutted that I didn't take my phone to film it - geek that I am.  Sure enough, little black clots drifted past in my illuminated arteries, like comets in a negative of the night sky.  

The doctor delivered the saving grace: that I did listen to my body this year.  Although I knew it wasn't the best training, I repeatedly dodged the speed sets in my training plan - both this year and last.  I just couldn't bring myself to do them and potentially that saved my life because in the last two years of Ironman training with blood clots in my lungs and all, I haven't over-strained my heart.

On Tuesday I learned more about my condition.  Because of the clots blocking the oxygen flow through certain parts of my lungs, those areas may be permanently dead.  Alternatively, a new life might blow back into them once the clots have dissolved and gone away.  The clots will have come from somewhere else (not yet known) and have travelled through my veins to my lung.  It is caused by a range of things from inactivity to a trauma somewhere and one rogue cell that's decided to clot on the inside of the vein instead of the outside!  Outcomes include: going through life without even realising you have one to death.  Death usually occurs when a big clot gets lodged between the branch feeding both lungs and you just can't breathe any more.  So far we don't know where the origin clot is but we hope it will be dissolved within 4-6 weeks so we might never know.

They're still looking into my anaemia which can only be contributing to my shortness of breath.  That might be related to the female cycle, my 9 month flirtation with veganism or an underlying condition that needs to be treated.  I'm hoping the anaemia is massively contributing to the shortness of breath and the effects of the blood clots (which can be more permanent) are minimal.

Either I am going to be sick for some time or I will get rid of the clots and come out of this hell on a peak with increased iron and lung function and a strong heart and suddenly start kicking-ass!

I can't quite bring myself to pull out of any of the races I've entered this year so I'm hoping it is the latter and working really hard on my recovery (not doing much and taking the drugs like clockwork).  Progress is happening.  When I walk (even slow, short distances) I get tired and need to recover (sleep) for a while but I can manage to do some very gentle adaptation-type weights which was all part of my "getting properly fit" plan mentioned above.  I always wear my heart rate monitor to make sure I'm staying in the recovery zone.  
The new gym, complete with supervision

As each day goes on, I find it easier to breathe.  I no longer have to sit on the bed and hyperventilate after walking up the stairs.  Small victories.  

At least now that I have a diagnosis with this condition I have the full, immediate and unquestioning support and monitoring of the NHS.  How many other non-professional athletes get free full blood data every 2 weeks?

It is, by far, the biggest and toughest challenge to my health I have (ever?) needed to face.  I feel that I am justified in being a drama queen about it but also am looking forwards to the journey and finding out just what I can make out of it when it's over.  

Ironically, the treatment for an illness normally caused by inactivity is to sit around and do a whole load of nothing so for now I have 2 weeks of lounging around trying to make sense and looking forwards to the future.