Still gasping

On Friday night, Beat and I started the Fat Pursuit 200-mile snow bike race in Island Park, Idaho. Our intent for this race was to test ourselves and our Nome gear in a more demanding environment than our typical training rides. I'll probably write more as I process my experience, but I ended up pulling the plug at checkpoint one (mile 80) because I'd had difficulty breathing for ten hours, there was no joy or benefit in the hypoxic struggle, and I'd already failed my personal test. For whatever the reasons or causes, I still experience respiratory distress during higher levels of exertion. In an endurance race setting, it's distressing and frustrating. In the Alaska backcountry, it could be extremely dangerous. This is something I need to address immediately, rather than grasp onto the fraying threads of optimism that "this is something I can control" or "this will get better" just to keep my Alaska dream alive.

I DNF'd another race, and I am disappointed about that, but that disappointment is far outshadowed by the idea of giving up the Iditarod. This is the dream I've been fighting for since the first signs of breathing difficulties developed during the 200K version of the Fat Pursuit in January 2015. But I'm not performing remotely well at this level, and the Tour Divide showed me that these issues just go from bad to worse over days and weeks. Also, when I'm experiencing breathing difficulties, every molecule of joy is sucked out of the endeavor. Beyond my personal safety and concerns about my health in the future, I won't abide the gray, disoriented, distressed and joyless state of oxygen deprivation just to prove I'm tougher than myself.

So, what happened? The shorter version — the race started at sunset and I immediately fell off the back of the field of 25 or so. Okay, that's fine, but I was already stressed about what I viewed as a tight cutoff, and realizing that I was starting out so slowly caused some anxiety. As darkness fell the course entered a series of rolling ski trails, and I surged to keep my momentum up short but steep hills. This necessitated hard breathing that soon triggered a feeling of pressure in my chest, and I remained completely winded for the next ten hours. If I pushed too hard, I could hear a chirpy wheezing in my throat after I stopped to catch my breath. I tried using my albuterol inhaler, but it was not spraying adequately in the 15-degree cold, and holding it in my hands for a few minutes didn't warm it up enough to work. Hiking up steeper inclines (and soon all inclines), I needed to stop and rest frequently. Before I reached the checkpoint, I was stopping every five minutes or so even on flat terrain. Trail conditions were relatively slow, with fresh grooming (which churns up the hardpack) and an inch of fresh snow, but I struggled to maintain 4 mph and I saw that as the minimum pace for making the final cutoff — if I could hold it together for another 34 hours. This seemed unlikely, needlessly punishing, and potentially reckless. Beat waited for me at the 80-mile tent checkpoint for nearly two hours, and convinced my still-foggy mind of the futility of pushing this limit. He was concerned enough about it to stop his race and ride the 12 miles back to Island Park with me. He did warm up my inhaler to a point where I could take a puff and feel much better, but the effect was short-lived when I started riding again.

The Fat Pursuit feels like my "Come to Jesus" moment. My problem is probably not just allergies, high-altitude, anxiety, over-exertion, pneumonia, cold weather, or any single-cause incident. It's a complicated pattern. Endurance racing is the constant. Exercise-induced asthma would be one possible explanation. But my pattern doesn't fit the classic profile of asthma or even exercise-induced asthma, since I've only experienced breathing difficulties and congestion in the more extreme situations I put myself in, and during the recovery/aftermath.

I spent some time reading reviews of relevant scientific studies. I'm not trying to diagnose myself via Dr. Google, assume I understand all the factors of these studies, or even assume they relate to me (most of those studied were professional athletes, not amateurs.) But the articles did provide some interesting observations. From what I can gather, in a nutshell: People who spend large amounts of time breathing heavily outdoors — especially when exposed to allergens, pollutants, high altitudes, or cold — appear to have a higher incidence of respiratory disorders than the general population. Among the findings:

"Chronic physical training might arouse a faulty adaptation of the main lung components, at the alveolar–capillary interface or at the airway level, particularly when exertion is carried on in particular environmental locations, as in cold or in hypoxic conditions at even moderately high altitude. The result is that the negative influences of these respiratory system limitations will be greatly intensified during exercise performance, especially in highly fit individuals."

 — "Respiratory disorders in endurance athletes – how much do they really have to endure?"

 "With all of the preceding discussion relating to exercise triggering, can exercise really cause asthma? The answer turns out to be yes: there does appear to be an asthma variant caused by extremes of exercise and cold air exposure. In this syndrome, elite athletes, especially those who train in cold climates, may experience non-atopic airway inflammation and subsequent airway hyperactivity. The best understanding of this process has come from studies on Alaskan sled dogs competing in the Iditarod race. Compared with nontrekking dogs, race participants demonstrated a dehydration injury of their airways leading to an inflammatory process associated with airway hyperactivity."

— "Dispelling the myths of exercise and asthma" 

 "The available literature indicates that participation in high-intensity exercise in certain environmental situations is implicated in the development of airway pathophysiology. Thus, whilst the benefit of regular physical activity for health and well-being is widely recognized, there is legitimate concern that the intensity of hyperpnoea necessitated by elite-level exercise may be detrimental for respiratory health."

— "Airway dysfunction in elite athletes – an occupational lung disease?"

"Possible mechanisms involved in the development of asthma in athletes are still uncertain; however, the content and physical characteristics of the inhaled air seem to be important factors, while immune and neurohumoral influences could play a modulatory role."

— "Prevalence and Mechanisms of Development of Asthma and Airway Hyperresponsiveness in Athletes"

I intend to see a pulmonary specialist as soon as possible, in hopes there may be some physical evidence that I can address and treat. But I recognize I might not find readily available answers, and that I may need to take a prolonged period away from endurance activities to improve, and that it may never get better.

A number of people have reached out to share their own experiences with respiratory distress. Some manage their exercise-induced asthma with medications, some had to readjust their training or move to a different location. One woman who had breathing difficulties and multiple bouts of pneumonia for years finally got a CT scan, which revealed a cyst that, once removed, cleared up all her issues. So ... there's hope, too. But this is where I'm at right now. Uncertain, disappointed, but grateful I still have good overall health that I intend to maintain.