Busting out?

I spent a week Googling and brooding on breathing issues, only to become more and more perplexed. Not only do I feel more stupid and crazy, but aimless Internet research also strengthened that tinge of anxiety that my problem is terminal or something that requires a grain/dairy/fruit/sugar/cat/exercise/winter/outdoor-free existence that might feel terminal. I did reach a reluctant conclusion on three things: 1. Regardless of the cause, breathing difficulties are something I will probably experience again. 2. It will likely take some time to figure out which treatments/lifestyle changes (if any) will remedy the problem. 3. In the meantime, I need to figure out if and how I can cope.

My breathing felt limited during my hikes in Utah, and fully strained while running in California on Thursday. I thought about taking two weeks off from any cardio exercise. Taking a long break at this time would probably be my last gasp, so to speak, for any hope of participating in even a short-distance Iditarod this year, but I was starting to feel desperate. Meanwhile, I had signed up for this 50-kilometer trail run that started in Stinson Beach on Saturday. There was much quiet yo-yoing about the thing before my thought pattern ended on an upswing: Why don't I just go out there and see what happens? If it goes south and I'm still gasping, that will be the answer I need. That will mean I don't have the lung capacity for a long effort, at least anytime soon.

The Steep Ravine 50K started at 50 degrees under light drizzle, with a forecast that called for steady rain picking up throughout the day. The Marin Headlands received a healthy dose of precipitation in the preceding weeks, so the hills were vibrantly green and the trails were saturated with mud. The fog ceiling hovered only about 200 feet above the sea, and visibility above that altitude was reduced to a few feet at times — not the most appealing scenery for a course that boasts nearly 7,000 feet of climbing. Despite the foreboding weather, the race director announced that nearly 50 people had checked in for the 50K — not a bad turnout. I quite like running in cool, moody weather, but my heart was filled with dread. The parameters I'd set for Steep Ravine had harsh implications — if I failed, I not only had to withdraw from Iditarod, but also risk falling deeper into the rabbit hole of questioning and uncertainty.

My strategy for the run was to focus entirely on controlling my breathing: take deep, steady breaths, keep my heart rate in Zone 3 or lower, and slow down — or stop if necessary — the second I felt that "sharp edge" pressure in my chest that seems to precede an attack. I also brought my trekking poles because I realized that the steep, rooty, muddy trails would put me on my face more than once if I focused too heavily on my internal affairs, unless I had crutches to prop myself up. I've run three or four local 50Ks with trekking poles, and yes, I'm always the only one, and yes, the people I'm around usually express envy later in the race. Running crutches are awesome. I'm still waiting for them to catch on in the U.S.

So it went from the start — breathe in, breathe out, breathe in, breathe out, which such focus that I almost forgot I was running. My Zone 3 — which is what I consider 145-160 beats per minute — doesn't afford a satisfyingly speedy pace, but it does make for a relaxing, meditative experience. Breathe in, breathe out, up Steep Ravine, over Cardiac Hill, down the endless switchbacks, slip-slide on the horse trail along Redwood Creek, up the Dipsea roots, down the Dipsea stairs. Repeat.

Rain continued to come down, and the trails deteriorated into channels for flowing runoff. It was slippery, often steep, and reasonably technical — conditions that would normally stress me out during a trail race. On this day, however, mindful breathing put me in a dreamy, Zen-like state, and I felt no fear. On the second ascent to Cardiac Hill, around mile 11, I splashed into a puddle and felt a sudden surge through my chest, as though my lungs had burst open. It's difficult to describe the sensation, but it was startlingly invigorating — almost alarming. At first I confused the sensation for the beginnings of an asthma attack, but as I slowed to a stop, I could feel all this warm, humid air moving in and out of my lungs. It genuinely felt like a higher volume of air — or perhaps a more oxygen-saturated version of the atmosphere. I commenced jogging and felt great. I could have sprinted up that hill, but I wouldn't let that happen. This little runner's high wasn't going to derail my commitment to Zone 3 and steady breathing. At this point, I was steadily floating.

Breathe in, breathe out, along the socked-in return to Stinson Beach, then once more along the raging creek in Steep Ravine. After I successfully descended the infuriatingly endless hairpin switchbacks and the shoe-sucking horse trail a second time, it occurred to me that I was something like 24 miles into this run, and felt no negative effects. Not only was I breathing normally, but I didn't have any foot or muscle pain, no tightness in my IT band or ache in my quads, not even chafing. I hadn't even tumbled or slipped onto my butt, not even once! I was actually having pretty much the perfect race.

On my last visit to Cardiac Hill, I stopped to eat a few handfuls of soggy Shot Bloks and savored the experience. I posted this photo from my friend Chuck so you can see the beauty of Cardiac Hill in this weather — it's exposed, windy, and very wet. This guy actually volunteered to hang out here for 8+ hours doling out much-appreciated but waterlogged snacks and drinks in disintegrating paper cups. This is why volunteers are lauded as the true heroes of any trail race. I stood here nibbling on Shot Bloks as though they were fine pieces of cheese, and marveled at how great I felt. "It's all this moisture and oxygen in the air," I thought. "It's like crack."

As I floated down the Dipsea Trail, I passed two women who pulled over to let me pass. "We can't keep up with you and those poles," one commented. "You're fast with those things."

"Thank you," I beamed, even though I wasn't sure they meant it as a complement. (I think trekking poles are to the ultrarunning scene today what Hokas were five years ago: For the frail and Europeans only.) But I felt unstoppable, clickity-clacking down the slimy wooden stairs, down the gray-washed trail to Stinson Beach where there's normally a spectacular ocean view, and across the finish line. After hanging out with friends, eating chili from a tiny paper cup, and gradually becoming wracked with shivering, I noticed a chart indicating I was the first woman to finish the race. Clearly this was a result of attrition, as a few women probably dropped down to the 25K after the first loop, and there weren't many to begin with (I was first out of eight to finish the 50K.) Still ... winning a coffee mug is a nice cherry on top of a perfect race.

I'm really not sure how to make sense of this experience, since this is probably the easiest finish I've ever had in a 50K, just one week after the exhausting aftermath of a failed snow bike race. I can't gauge my health on this, because conditions were dramatically different — sea level, warm, humid — compared to the cold, dry, and high-altitude air I struggled with last week. I'm seeing my doctor on Wednesday, and I now have another confusing variable to add to the equation. But I think there's something to be said about mindful breathing, as well as the power of positive thinking when there's an entire passion at stake. 

Rusted wheel

Photo from Jamye Chrisman Photography

This is a photo of me and my friend Bill Martin at the start of the Fat Pursuit last weekend. We had a great time fretting during the pre-race hours and then riding together for all of five minutes before Bill and everyone else faded ahead of me, into the sunset. Seeing Bill was one of my favorite parts of the weekend. We first met shortly after I moved to Missoula in 2010, and bonded over our mutually oddball adventurelust. How many people will agree to leave from work on a cold October evening, ride bikes up a mountain until they hit snowline, keep on riding, get really chilled because it's October and 18 degrees outside, start pushing when the snow becomes too deep, reach the top, share lukewarm soup, and descend over fresh mountain lion tracks to return to town at midnight, on a work night? Bill was nearly always up for such nonsense, and at the time I didn't even realize how lucky I was to find such a kindred spirit in close proximity. He contributed to making 2010 one of the most memorable years of my life (meeting Beat also had a large influence on tipping the scales to "best year.")

Although I moved away five years ago, Bill and I still manage to reconnect about once a year at endurance races. It reminds me what I value most about this hobby of mine — the community.

This week I have been questioning my future in this realm. Endurance racing has been a struggle, and for the most part a failure, for the better part of a year now. Starting with my "altitude sickness" in the 2015 Fat Pursuit (same symptoms I had this past weekend, though slightly less obstructive), the "kennel cough" of my Alaska coast tour (It was a lung crud. I was coughing up gunk left and right), the Tour Divide pneumonia, more breathing attacks during UTMB, and finally the 2016 Fat Pursuit. It's an ongoing problem. But it's not exactly a typical medical problem. I'm faced with having to go to a doctor and say, "I'm having a lot of trouble with my breathing, but only when I engage in strenuous efforts for 12 hours or more."

"Um ... so don't do that."

Next week I'm returning to see the allergist I visited in October. She's a highly recommended asthma doctor, but when I went to see her a few months ago, I was starting to come around from the Tour Divide crud and believed I was on the mend from illness. She listened to my assessment about having pneumonia during my summer "bike trip," being wheezy and weak from July through September, and feeling much better in October — which would be consistent for recovery from pneumonia. Then she tested me for allergens and determined I was highly allergic to grass pollen and cats. Since those allergens were absent from my life at the time, she recommended I return in April to start immunotherapy.

Clearly there's more to it than a one-time illness. Ahead of my visit next week, I wrote out the long saga of every breathing attack I can remember over the past year, the contexts, and my reason why I'd like to seek aggressive treatment as soon as possible. I'm only hoping this allergist takes me seriously, or can refer me to a pulmonologist who'd be willing to conduct more tests. Even if the tests reveal something, it's doubtful there's a quick cure-all. Asthma medications could be helpful, or not. My symptoms have many of the markers of exercise-induced asthma, but because they've only happened in extreme situations, a doctor might not be convinced there's anything wrong with me. To be honest, I'm still a slight skeptic that there's anything actually wrong with me. I'm a believer in placebos and I also believe in the power of psychosomatic symptoms. Maybe my primitive mind/subconscious finally found a way to stop me from engaging my oddball adventurelust — by making me feel like I'm trapped in my worst fear. My worst fear is drowning. I fear this so much that I would give up endurance activities permanently, without regret, if I believed breathing difficulties were an inevitable part of the landscape. Regardless of the physical dangers — and yes, of course those matter — the experience of this state is the biggest de-motivator of all.

I was wrecked after 92 miles and 18+ hours in the Fat Pursuit. Not in a tired, hungry, sore legs kind of way, but in a sleepy, raw throat and chest, pounding headache kind of way. Despite many doses of ibuprofen, caffeine, water, electrolytes, tea, etc., I could not shake that headache. It persisted through Tuesday night. Yes, this can be a symptom of spending time at moderately high altitudes. You know what else can cause a three-day headache? Being low on oxygen for 18+ hours because your airways are constricted.

I stayed with my parents in Salt Lake City through Wednesday morning, and then returned to California. On Monday and Tuesday I was able to get out for a couple of short hikes with my dad. Besides a desire to get out in the mountains, I also wanted to test my breathing in high-altitude, cold air. It wasn't too bad. At a moderate pace I did not become winded, although my top end has been lopped off entirely. Moderate paces are really the best I can do right now — I can sense there isn't enough oxygen to push any harder. This is what I experienced for weeks after the Tour Divide as well. As long as I kept my breathing and heart rate under control, I was fine. Any surges into Zone 4 quickly pushed me over the edge, into the gasping zone, and it tended to deteriorate from there. I feel that hard edge in my breathing again now.

This was reinforced today when I went out for a run at home in California, elevation 300, temperature 57 degrees. I tried my routine, hilly loop that I've been running each week at sub-9-minute pace. Today I felt winded at 11-minute pace. Just the way it is. This is how I unravel my fitness, one endurance race at a time.

But at least I went to some very nice places while hiking with my Dad:

 Returning to Big Cottonwood Canyon on the Broads Fork trail.

 Mill B North trail, early on a chilly Tuesday morning. Due to my work schedule, we had to leave at 7:30 a.m., when temperatures were still in the single digits.

 Dad still rallied even though cold temperatures are not his favorite. I believe his words on Sunday were "I hate the cold." He's probably plotting his snowbird move to the desert right now. He turned 63 on Wednesday!

Dad does love snow-hiking, though, because he can bound effortlessly down trails that are rooty and rocky during the summer, and not pound his joints. After hiking a mile in tracks on Mill B, we broke trail for about a half mile before we found newly broken trail — by a moose. The moose trampled all the way up the switchbacks, resulting in a postholed, ankle- and hip-twisting mess that we gave up on after another half mile. "Moose make the worst trails," I whined. Dad found it amusing.

I remain hopeful there's a better solution to my breathing problems than "Um ... so don't do that," and that I'll know more next week. 

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.