Dreams DO come true!!!

I haven't stopped smiling for hours now! I am just totally speechless (I know, crazy...)

Next year I will be racing in Orange!!!!

Logorrhoea

I have so much to talk about and no solidarity of thought so this blog is yet another version of word diarrhea (Which I learned from endurancegirl is actually LOGORRHOEA!).

***My current life:



I have officially turned bum and moved back in with my parents. I'll be spending the next 3 months in Milwaukee. It's really, really nice to be back home for awhile. I've been in Cleveland for 8 years and my trips home have gotten less and less frequent over the years. Now I have a large block of time to have dinners with my parents, take my nephew to the movies, go to a Packer game with my brother, see the Badgers at homecoming and take a family vacation to Vegas. It's such a wonderful opportunity. While I'm here I'll be doing a self-made Sports Medicine elective with some highly talented surgeons in the area, and then will be flying around the country to INTERVIEW for December and January

***INTERVIEWING!



Yes, residency interviewing season is upon us. I will be applying to Emergency Medicine residency programs all over the country. My first stop is Orlando Florida, which I have, by complete coincidence, scheduled for the Tuesday after Clearwater. So.... I'm going to the HALF Ironman World Championships!!! Wooohoooo, it's the Ironman double. Which would be so much more impressive had I raced either one....

Anywho, I have interviews currently scheduled in Orlando, Las Vegas, Indianapolis, Nashville, Phoenix and Cleveland. I am EAGERLY awaiting hearing from programs in Davis, Tucson, Albuquerque, Denver and Charlotte. Come on, give a girl some love!

***Body image



Why is it that I am constantly battling this inflated image of my body size? I'm sure I'm not the only one out there, but being in Kona made me feel like a fat pig. This is not anything new to me because unless I am <115 pounds I feel huge. The weird thing is, whenever I see a pic of myself I think I'm fat, but then 6 months later I look at the same pic through a completely different lens. WTF??? Don't worry, as I told Paulo I don't have nearly enough will power to develop an eating disorder....

***They try to make me go to rehab, I said yes, yes yes!



I am officially on the full blown rehab trail for my shin problem that has been nagging me on my right leg. I took 2 weeks off running, have been doing core body strengthening and balance exercises and am now running 5 whole minutes every day (with a 55 minute elliptical warm-up). Watch out, though, next week it's moving up to 10. Hopefully the leg will cooperate because I really want to run the Vegas Half marathon in December

***More sports medicine blogs coming, I just need a little bit of motivation and time. Thanks for all the comments on the Kona blogs!

Tales from the Med Tent

Yes, the guy I am standing next to is in fact Andrew Baldwin (The Bachelor). He was leaving his shift as I was coming in. Not a big TV fan so I wasn't star-struck, but I did recognize him. Seemed like a really nice guy. Probably too nice to be subjected to the nastiness of that awful TV show. Blech.

OK, onto the report!

My shift was the 8pm-midnight. At Kona that is pretty much closing time from the get-go. If you're in Kona you're likely <13 hour finisher so it wasn't the busiest shift of the day. I didn't get a doctor's smock because I don't have a medical degree yet, so I was a "runner" for the night. My job consisted of running to get soda, water, crackers, barf bags, blood samples, test results, and anything else the athletes or docs needed.

I'll just talk about 2 of our athletes in the tent here, as examples of two completely opposite ways to mess up your nutrition and end up needing medical assistance: Underhydration and overhydration.

She walks into the med-tent and doesn't want to sit down. She paces back and forth for several minutes and then sits down, a little disoriented and starts to vomit. She's fidgity and can't keep anything down. We weigh her and she is up 13 pounds from her pre-race weight

**NOTE**

(rant on)

Someone really dropped the ball this year with athlete weights. Rather than make everyone weigh-in, they let athletes write down their weight if they knew it. DUH! Come on people, do you really think that a triathlete woman is going to choose to step on a scale? No freaking way. And they will also underestimate their weight when asked. They didn't institute the weigh-in rule for intellectual curiosity, they did it because it is extremely helpful to the medical staff after the race. This blunder made weight pretty useless to us.

(rant off)

We took a small sample of the athlete's blood, concerned about her sodium level. I waited for the test results because we were all a little concerned about her, especially given the presumed weight gain. Her sodium level was 121 (normal 135-145). She was very hyponatremic. We have her lay down and start an IV of hypertonic saline (concentrated salt). She is a little bit disoriented and agitated and can't stop moving her legs. She says she feels like if she stops her legs from "running" her hips and butt will cramp. We give her some Benzodiazepines which stop her legs for a minute, but then she starts again.(*one indication for benzos is to abort or prevent seizures, a serious side effect of hyponatremia) A repeat sodium was taken 30 minutes after her salt infusion and was just mildly improved. Another IV of hypertonic saline is started after giving her some magnesium for her cramping. Another dose of benzos settles her down. She has stopped vomiting and is starting to clear up. She sits up and is feeling better, finally. A couple hours after entering the med tent her kidneys kick back in and she starts using the bathroom. Regardless, given how serious her condition was, she is sent to the hospital for observation overnight.

Why does this happen? The biggest contributer is over-drinking of free water. People think they need more fluids than they actually do and force drink throughout an event. The longer the event, the greater the risk. Gatorade endurance would definitely help with this since it has a lot of sodium, but not completely foolproof. Another culprit here is excessive sodium loss. People who have one copy of the recessive gene for cystic fibrosis (I think it's about 1/32 in the US population) lose excessive salt in their sweat. These people are more susceptible than average to excessive free water intake during sports events because in addition to diluting their blood with water, they are taking more salt away through sweat. Thirdly, there are hormones released when the body is stressed or in pain that actually reduce the clearance of free water from the kidneys. Some think that the pain of an Ironman is enough to induce SIADH , which in itself can cause hyponatremia.

What is the big deal if your salt is low? Well, the big deal is that it forces water into your brain down the salt gradient. Your brain is in your skull, so there's not much room for expansion. People are at risk for brain herniation and death. Did anyone here read about the radio station that was having a "hold your wee for a wii" contest? A woman in the contest, which was to see who could drink the most without peeing, died in her home a couple hours after the contest. Hyponatremia is a big deal.

Scenerio #2

Man walks into the med tent about an hour after the race saying that he started to feel dizzy in the food tent. He weighs in 3 pounds under pre-race weight. As he sits down and is talking to us he says it seems like he is blacking out. His blood pressure is 70/40. His face has no color. A 1 liter IV of fluids is started and he briefly passes out. He drifts in and out as the first liter goes in and still doesn't feel steady to stand after the first liter. As the second liter of fluid goes in the color comes back to his face. He is given a third liter before feeling back to normal and has a normal blood pressure.

This is a pretty classic case of hypovolemia. When you see this in the Emergency Department you immediately think that the patient is bleeding somewhere and losing blood volume. At the Ironman, it's much, much, much more likely to be fluid loss from inadequate fluid intake and excessive sweating. Most people who finish an Ironman are going to be slightly fluid depleted. Immediately post-race you will see many, MANY people cross the finish line, stand around, and then get dizzy and pass out or nearly pass out. This is because they are dehydrated and then when they stop moving and pumping those leg muscles blood pools in their legs. All you really need to do for these people is put their feet up for a few minutes until their body re-equilibrates. That is why the Ironman medical tent has a "weak and dizzy" area.

When people get into trouble like the athlete mentioned above is when they have lost more than the normal amount of fluids and also don't feel well enough after the race to replace the fluids they lost during the race by mouth. Maybe they are sick to their stomach from all the sugar, or just completely exhausted. These people will need IVs to get back that fluid volume. Most likely that will perk them right up and they can limp home

So these are two athletes that I saw at the race that were sick for opposite reasons, but both were able to be brought around by the great medical staff in the tent with no serious complications.

Oh, and all you athletes out there- GET ON THE SCALE BEFORE THE RACE! No one is going to look down on your for being over your race weight (I've been there. I weighed in at 130 at CdA which is pretty huge for shortie me). And it will help YOU out if you get into trouble on the course.

As the night went on the tent got quieter and quieter. We could hear Mike Reilly doing his countdown to midnight and then call in the last "finisher" (in quotes because it was after midnight) who finished several minutes later. The ambulance was called to take a few people to the hospital and the crew was already taking down the tent. There was a SUPER sweet nurse who was a native Hawaiian who gave me a big hug and told me she would see me next year. I left the tent, 20 hours after waking up that morning, totally exhausted!

In all, working in the med-tent was a great learning experience and a ton of fun. The athletes were very gracious and happy and there were a lot of smiles to go around. I WILL do it again, and next time I will be wearing a doctor smock!

Totally forgot about this!

My interview came out a couple weeks ago!

Here it is!

And here are some photo books from my trip:

Race day 1

Race Day 2

underpants

Early Kona

Las Cruces

And a couple from Tracy's camera:

Me, Tracy and Hillary Biscay



Me, Tracy and Rachel Ross



BEACH DAY! (Paulo, Tracy, Khai, Danny, Misha, Jonny and me)

Kona 2008- Race Day

Race day snuck up on us quickly, as we all knew that it would. Everyone was up and full of nervous excitement by 4am and ready to head down to the pier. Our faithful Chauffeur Khai took the helm and drove us all down to transition, dropping off Will and Danny before parking. We snapped a quick pic of Danny and Misha before leaving and then were off to start a long and successful day in the Kona heat:




When Khai and Stephanie (Will's most awesome fiance) and I got down to transition we ran into Sergio and I gave him a big good luck hug (I should have known better than to think that I would be good luck)



We then found a spot on the stands that would thought might allow us a glimpse of the swim start:



Then a guy came around handing out COWBELLS!



We had all thought that we had seen the last of our athletes, when Will found us! We were all very excited to see him. This was his very first shot at Kona. He had never raced here as an age grouper or pro and had been super nervous all week. He's a great cold weather racer and the heat is his enemy. My only words of advice were to start freebasing salt early in the week and keep it going to the finish line.

We had a little joke going with Will all week that he needed to win the race. But the race we were talking about was the women's race. We had a short list of people for Will to focus on and Chrissie was at the top of the list. It was no disrespect to Chrissie- quite the opposite. We knew she was going to race like a rockstar and it would be a tough battle to cross the line before her, man or woman. So we left him that morning with one last "make us proud Will, don't be second woman!".



And a very cute picture of Will's family and friends having a pre-race pow wow. He had quite the entourage in Kona!



Then it was time for the pre-swim ceremony by the local musicians



Boom goes the cannon!



After the age-groupers went off I ran over to the hot corner so that I could get some good pics of the athletes starting the ride. Here are some of the pics that I took. I missed most of our crew. I saw them, but I wasn't quick enough with the camera.

First to the hot corner:



Then the SECOND bit of bad luck on the day for Sergio. First, his chip fell off in the water and that held him up in T1, then just as he went by me we all heard something that made our hearts sink. A flat. It was Sergio. Unfortunately when he went to change it, the new tube burst as well. So 10-15 minutes later and a new wheel he was off to try to make up some ground:



While Sergio was fixing his flat, Chrissie came screaming by!


And then Will! Go get her Will!


I saw Jacqui, Tracy and Danny ride by looking strong and then took a break back at the condo waiting for them to return.

We watched the online coverage until the cyclists made it to about mile 100 and then Misha and I rode our bikes to the 1 mile marker of the run. When the helicopter made it back into town we knew they were back.

The first to reach us was Sinballe. He was not looking very fresh and it looked like he wouldn't be in the lead for that much longer.


Stadler wasn't far behind...


And Faris was a bit farther back in the field


Oh my gosh, is that Shawn from NUUN?

:-)



And there comes ANDY POTTS! (SUPASTAR). As he went by he asked Shawn what place he was in. He was completely stoked to hear he was near the top 10. It was cool to see him so happy.



Then... who is that coming up the road??? Is that WILL?????


It is!!!


And he's being CHASED!


Looking strong, he came back the other way!



But she was catching up!


And here comes T-racer!



And now for some comedy relief...


Coming out of the energy lab, she has taken the lead!


And Will is starting to look a bit rough....


Next up, Sergio enters the energy lab


Followed by T-racer


Followed by Jacqui


Then Sergio is out. And this is where I got a glimpse of why Sergio was so far back in the pack. Not only did he lose his chip in the swim and flat twice in the first 2 miles of the bike course, but he also crashed in the wind. Look at his shoulder here. Despite all that had gone wrong, he pulled himself together to finish the race. Sergio, you are my new hero :-)



Then Rachel Ross headed into the energy lab:



Then Tracy came out. The volunteers there were not really stellar and ended up stopping her in her tracks with little warning:



But she was quickly off again and headed home


Then it was Danny heading in!




And Jacqui was closely behind headed out to chase Tracy:




Then I jumped on my bike and headed to the finish to catch everyone (except Will, who was already done) finish.

When I got there I saw Will and Stephanie. Turned out that Will sucked it up and gave chase in the last 4 miles, repassing Chrissie with a mile to go and finishing with an awesome 31st place finish with a 3:01 run at his first Kona! The funny thing is that when Chrissie got her flat, Will was the guy who stopped to give Chrissie CO2 to fill up the new wheel. I guess when she passed him in the energy lab, he told her that she better win the race! Good stuff.

The post-race glow:


Tracy and Jacqui both had awesome races as well, both with PRs for the run. Tracy took 21st place at her first Kona as a pro. And Danny had very solid day out there too. A great day in all for the crew.

I'll post later some reflections on the race and on the med-tent.

:-)

Taken during our morning swim

Yesterday was amazing. More on that later. Now, I'm going for another swim!

Swimming with Dolphins, Running with underpants and riding 112

The last 3 days have been super busy, jammed pack with fun activities, conference stuff, and preparations for the big day.

For starters, on Wednesday the whole crew went down to the swim course for our first open water swim. Khai, Joel and I went right for the Coffees of Hawaii boat where that you can swim up to and get a hot espresso shot while bobbing in the ocean. When we got there we started noticing pure awesomeness- Dolphins! They were everywhere! We're not talking a couple. There were dozens of them all over the swim course swimming with all the athletes. For the next 45 minutes we followed the dolphins around as they played and frolicked. I picked up my head for awhile and saw that there was one who was doing tricks- he was jumping out of the water, spinning a couple times and falling back in. Totally amazing. The Coffees of Hawaii peeps got some pics of the fun!




Then on Thursday it was the long awaited Kona Underpants Run! Khai, Will, Tracy and I put on our best attire and went down to do a killer loop around the Kailua, with calisthenics and our 300 or so closest friends. What a blast! Here are some pics:

The whole crew taking over town:



T-racer showing off her special made NUUN bikini:



And the crew after the race showing off our outfits (Khai LOVES his compression socks):


And showing off our HUGE muscles!




Then today I headed off on my own to tackle the bike course. It's a one-loop out and back from Kailua to Hawi (pronounced Ha-vee). The first (and last) 35 miles or so are pretty baron and windy and through miles and miles of lava fields. Then you make a turn towards Hawi and get to face strong headwinds AND a long climb up to town. The climb isn't that bad in itself and it's actually very pretty. You go from black lava to lush green in the span of 10 miles. It was my favorite part of the course. One very important message about this bike course that I learned today, though is:

- No matter what direction you go, you ALWAYS have a headwind. ALWAYS.

The way back was a bit brutal. It's windier on the way back than the way out, especially from miles 75-90. And for someone who hasn't ridden > 40 miles in seemingly forever, my neck and butt were killing me! But I made it back, and now we are all chilling before our early appointment with bed tonight. BIG RACE TOMORROW!!!!!