March 2, 2024

2023: Long COVID?

TRIGGER WARNING: In this post, i talk about COVID and its effects on my personal physical fitness.  The effects of the disease can be considerably worse and i do not mean to make light of it at all.  If the reader feels that i am too glib about the disease and don't understand how it can destroy lives, i respectfully request that you go f__k yourself and go someplace else.  

Anywho-  

Despite coming up with an interesting hypothesis for my disappointing finish at the 2022 CIM, there was one detail that i failed to mention completely.  

The day after the race, Gianina and Adrian tested positive for COVID.  Since i was asymptomatic, i opted not to test at the time.  However, after developing the sniffles a few days later, i swabbed myself and came back positive as well.  Despite all my rationalizing about wearing a jacket, etc. perhaps my subpar performance during the CIM was REALLY indicative of the fact that i was actually sick with COVID.  There's no way to know for sure.  

My slow finish at Tokyo was not really a barometer of anything, since i that was the plan to begin with.  What was strange to me was that - at least based on my Garmin watch and app - my VO2 Max dropped by 10% between CIM and Tokyo.  I had not backed down on my volume or intensity to any significant degree, so this was really mysterious.  

(There was a side issue of frozen shoulder requiring a shot of steroids, but i can't see what that had to do with anything.)  

Truthfully, even without my watch's measurements, i had FELT my VO2 Max drop.  Throughout the first half of 2023, despite all my training, climbing up a flight of stairs gave me palpitations.  

Palpitations.  After ONE FLIGHT OF STAIRS.  I mean, i'm no Dean Karnazes, but i'm a F*#$!%@ marathon runner for crying out loud.  A flight of stairs should not even register.  

So then i went for a treadmill exercise test with my cardiologist... 

...and passed with flying colors.  

I tried inhalers (which i prescribe to my patients all day every day), with no relief.  

It made absolutely no sense.    

Eventually, around June of 2023, the gears clicked into place.  Decreased exercise performance? Palpitations climbing up stairs, with no clear cardiac or pulmonary cause?  Persisting months after a confirmed COVID infection?  This sounded familiar.  In fact, i had advised many of my own patients about this.  It seemed that i had contracted the near-mythical "Long COVID."

No one understands what Long COVID really is.  It has a myriad of manifestations, but as far as my particular symptom of exercise intolerance, i did find data showing that victims on the average develop a 10% drop in VO2 Max (such a coincidence that that's how much i dropped by), with a physiologic profile and looks just like deconditioning (i.e. being out-of-shape).   Unfortunately, since no knows WHAT IT IS, no one knows HOW TO TREAT IT, either.  Argh!  

Instead of searching randomly for a miracle cure, i decided to apply what i know.  

How do we treat deconditioning?  With regular exercise.  

How to we improve VO2 Max?  With high-intensity intervals.  

So i procured a chest strap heart rate monitor (i had been relying on wrist monitors built-in to my watch all these years, which are not as accurate) and now concentrate on staying in "Zone 2" for most of my runs.  The point is to build up endurance without stressing the system.  I've been training this way for about 8 months, and it's been... eye-opening. 

First of all, my Zone 2 is a ridiculously low heart rate, to the tune of somewhere between 130 and 140 beats per minute.  In order to stay in this zone for the duration of the workout, my "run" is barely faster than my walking pace, clocking in at around 15 minutes per mile, or 4 miles per hour.  On the flip side, i feel like i can maintain that level of exertion for a looong period of time without expending my energy reserves.  In fact, even if i get a 90 minute workout in at 5 in the morning, i still feel like i have enough energy for the rest of the day.  

After 4 months or so of Zone 2 base-building, i finally started training for my next marathon.  I began to incorporate some hill work and picked up the pace.  As of today, i feel i'm able to run faster with the same heart rate compared to the beginning of this whole exercise.  Whether it's an effect of my training, or just me naturally getting over the Long COVID is unclear.  

I feel like the true benefit of all this Zone 2 running is that it's taught me how to recover properly.  My slow runs are run at an appropriately slow pace so as to prevent damage from accumulating between hard workouts, and i am not as achy and tired as i normally am at this phase of marathon training.  A completely unexpected outcome of this is that i can now run continuously for hours at a time, as long as i take it easy.  I still feel like the run-walk-run method is the key to running longevity, but at least now i have another tool in my kit. 

This is a work in progress.  I'm in this for the very long haul, and hopefully the changes i've instituted are able to keep me healthy in the future.  Only time will tell.  

Onward to LA

March 12, 2023

5:33:06 (AKA A Run-Walk-Run Tour of Tokyo)

Last week, i finished the Tokyo Marathon in 5:33:06.  Contrary to what one would think, i am perfectly okay with my time.  


I was actually supposed to run Tokyo back in 2020.   For obvious reasons that event was cancelled and i deferred my entry to this year.  An important logistical nuance is that Adrian was in elementary school back then and relatively easy to pull out of his classes for a week.  Now that he's in high school, that is practically impossible to do.  Of course, Gianina and i couldn't simply take off and leave our son to fend for himself halfway around the globe.  Therefore, i would have to go to Japan alone.  

There was nothing necessarily wrong about the solo trip, after all, i had done it before.  However, Santa Rosa is close to home and - even if something had gone catastrophically wrong - Gianina could have driven over at any time to rescue me from harm.  There is absolutely no way she can do that if i am 5000 miles and an ocean away, so i would essentially be operating without a safety net.  As soon as we realized that i would have to go by myself, we agreed that my focus should be to race in such a way that there would be zero chance of injury.  Hence, a deliberately slow pace.  I checked the cutoff time: seven hours after the gun.  Excellent, a 15-minute-per-mile pace should be perfect.  

It also occurred to me that the race was in Tokyo, which as the late great Anthony Bourdain pointed out, is "one of the most fascinating and deeply enjoyable places to visit."  Japan itself has been closed to tourists for the past two years, and just opened up.  Running 26.2 miles through this city is a privilege that not everyone gets to do in their lifetime.  It's an experience to be savored, not merely survived.  


Almost from the get-go, i flipped my Garmin's screen to the interval timer and pointedly ignored my pace.  I ran by feel - a relaxed jog for 3 minutes, then a leisurely walk for one, walking through all the aid stations, DRINKING 2-3 cups at each aid station, and stopping for selfies and taking videos whenever the opportunity presented itself.  I also planned to call home and livestream the end of my race with my family.  At one point i saw the sweepers, but this was on an out-and-back; they were MILES behind me.

Mile splits.

The sweepers.

I am happy to report that i successfully executed my plan.  Honestly, i actually finished FASTER than i wanted, averaging around 12:30-ish minutes per mile.  BUT i never got close to bonking.  AND i crossed the finish line in decent shape and made my way back to the hotel tired but not terribly sore.  AND i was able to get through the next day with some achiness but nothing debilitating.   

Right before crossing the finish line.  Still fresh. 

RACE NOTES: 

1.  Packet pickup was horrendous.  Believing that immediately after they opened on the first day would present the thinnest crowd, that is exactly when i went to the expo.  Was i ever wrong.  After getting off the train and walking over to the entrance of the convention center, i was greeted with a long snaking line akin to one you'd find at a Disney amusement park.  At least it moved along steadily.  Ultimately, a volunteer confirmed my identity and  "locked" my profile in the health app, at which point i had to LINE UP AGAIN (!) to get my actual bib.  

Just getting in to the Bigh Sight convention center was a chore.

More lines...

Although there were a total of 21 booths distributing the packets, it seemed that only 6 of those were open to foreigners (or at least that's what it looked like to me).  The first 15 were devoid of any significant queues.  Look, i understand servicing your nation's citizens first, but i feel like there should be some flexibility in the matter.  If the first 15 booths have virtually no one in line while there are thousands lined up at the remaining six... maybe they can pick up some of the slack.  Meh.  After 30 or so minutes i finally got my packet.  The crowd thinned out quite a bit after that, and i was able to wander around the expo.  There were multiple vendors on site and some "photo-op" areas.  I managed to get some freebies but there was nothing super special.  

The expo itself.

Hunting for free stuff.

2.  It's quite simple to get a decent breakfast on race morning.  Since the gun was scheduled to go off at 9:15 AM, i got up at six, with a plan to leave the hotel at around 7.  There are 24-hour convenience stores all over the place with good food options.  I unfortunately made a near-catastrophic mistake that morning: forgetting that one should never try anything new on race day, i consumed the Pocari Sweat "ice slurry" that they gave away at the expo.  Within half an hour, i felt flushed and developed palpitations and restlessness.  I thought i was having a panic attack (which has never happened before).  I still don't know what exactly was in that stuff.  Even though the ingredients don't list it, i suspect that it contained niacin or something similar that causes flushing.  I'm glad it wore off in another 30 minutes.  

A convenience store breakfast.


Ready to go.

3.  Getting to the race location was easy.  Thanks to Tokyo's extensive rail system, you can get to the starting line - the Tokyo Metropolitan Government Building - from basically anywhere via train.  The race organizers were also considerate enough to provide 24-hour-unlimited subway passes to the runners.  Come race morning, i studied the route, made note of alternatives, and took copious screenshots in case i lost internet access.  I soon learned that i needn't have worried: nearly all the runners were taking the trains, and the only thing i had to do was follow the crowds to get to the start.  

The official 24-hour subway pass.

Basically everyone on the train was headed to the race.

From the train station, making my way to the my gate took roughly another 10 minutes.  Then i had to clear "security" - in quotes because they didn't really check much... just asked me if i had a bottle in my bag and trusted me when i said no.  They also checked on the health app if i had reported two negative COVID tests (although there was no way for them to verify the self-reported results).  Then it was a lot of walking around until i got to my actual corral.  It was all well-organized.  I don't know if there were enough porta-potties at the start, but the lines were looong, and i'm glad i didn't have to go.  In fact, despite the admonition from the organizers to not use public bathrooms at the train station, etc., i did see plenty of people lined up for those before i even entered the runners' area.  There was some water available at the corrals.  

The line to go through security.


Drinks and candy at the corral.

Another admonition - to not change clothes in public, was similarly ignored.  I saw plenty of people on the sidewalk doing just that.  And it wasn't necessarily foreigners; it appeared that locals were doing it too (or maybe they were foreigners of Japanese descent, or maybe i'm just racist and can't tell, or maybe i'm NOT racist because i can't tell).  

4.  The weather can apparently be finicky, but on that morning it was a perfect 40-50 degrees and overcast.  The forecast predicted 30% chance of precipitation, to start late in the afternoon after the race ended.  

Trudging to the start line.  That guy doesn't seem cold at all.

5.  The field was HUGE.  The official report from the organizers pegged the number of runners at around 38,000.  Smaller than the other "bigs" that i've run, but still A LOT.  It always felt like i was running with a crowd.  The mass of people presents a particular problem with my chosen run-walk-run method: i have to make my way to the side every time i slow down to walk, but on the other hand i have to weave in-and-out of traffic when i speed up again and pass some slower runners.  This is not an issue with small events.  I think i ended up running 27 miles because of all this lateral movement.

Ready, set...

Go!

So. Many. People. 

Crowds everywhere.

The official runners handbook instructed us not to discard any articles of clothing at any point.  Same with the other warnings/requests/instructions, this was not universally followed.  I saw plenty of discarded pieces at the starting line.  It seemed orderly, though.  



6.  The course consists of multiple "out-and-backs" through various Tokyo neighborhoods.  Because of this, the cityscape isn't as varied as New York (which runs through all five boroughs), but it was pretty.  The course is advertised as one that "symbolizes the past, present and the future of Tokyo."  There were plenty of old buildings, some shrines and temples, and some other notable landmarks.  In terms of difficulty, it all felt pretty flat to me.  The last kilometer is nice to run... a narrowish path on a cobblestone-y street lined by trees and spectators cheering you on.  The race ended close to the Imperial Palace.  I don't think i was paying attention, because i didn't see it.  

I had previously planned on sneaking off the race course to buy souvenirs or snacks.  Unfortunately all the possible points of exit were closed off by security tape.  While i felt like i could still have snuck out through a gap (or perhaps even just broken the flimsy tape), buying a Kitkat wasn't worth a DQ/DNF.  

The Kaminarimon Gate leading to Senso-ji Temple. 

The Tokyo Sky Tree and the Asahi Beer Hall with the "Golden Poo."

The Tomioka Hachiman Shrine.

On the Kuramae Bridge over the Sumida River. 

Tokyo Tower.

The Sangedatsumon Gate to the Zojoji Temple.

7. There were plenty of spectators along the course, and i don't recall it ever feeling "empty." It definitely wasn't a constant wall of sound like New York, but there was always someone cheering. While loud enough, it was still somehow subdued and... polite. There was no lack of entertainment, either. Every two miles or so there was someone singing or dancing.

Hula dancers in the distance.

Singing duo.





A singing group.

Cheerdancers.

And more cheerdancers.





8. There were ample aid stations. Beginning at the fifth kilometer, there was an aid station every two and three kilometers until the end. This is not the way i normally hydrate, but i made do. There was significant chaos at the first station as people figured out the layout. In theory you were supposed to go to the table whose number corresponded to the last number on your bib (being 76858, i was supposed to go to table "7-8"). The Pocari Sweat (electrolyte drink) stations were laid out before the water stations. By the second station we had it figured out and so it was less chaotic. There was food somewhere, but i didn't partake. It seemed like there were porta-potties at each aid station, but there was always a long line to use them.  Thankfully, despite my aggressive hydration strategy, i never needed to go to the toilet.  In retrospect, i was probably running dehydrated.   

Who is Pocari?  Why is his sweat so delicious? 

These aid/hydration stations were ESSENTIAL, since the race had a "no bottles" policy.  Specifically, "absolutely no canteens, water bottles, plastic bottles, cans, and other such containers are allowed."  I'm not clear as to the rationale behind this.  They don't want anyone to litter?  They want to push their own hydration products?  They don't want the course to get wet?  I saw at least one person using a hydration pack; good for her that it didn't get confiscated, but i personally wasn't willing to take that gamble.  

9.  There was no post-race experience to speak of.  I crossed the finish line and kept walking. Eventually i was handed a finisher's medal.  Someone took my photo.  A short distance later, i was given a mylar blanket, and then a (finisher's?) robe.  A little more walking, and i was in front of Tokyo station.  I just crossed the street from there and headed back to my hotel.  If they had been present, it would have been easy to meet up with my family.  

Thanks a lot, guy whose arm is covering my face.

Sharing the moment.


Tokyo Station in the background.

So... Tokyo 2023 is now in the books.  I'm still considering when/where i want to race next, but i think i'll take a little hiatus over the next few months.  Being in constant state of training has worn me out a bit.  

This race was my third "marathon major."  I am still undecided if i want to do to all six; honestly the large crowds are just exhausting.  In the end, i probably will... but not in the foreseeable future. 
 
Honestly though, i rather enjoyed just plodding along for this race.  I feel that i should follow this new philosophy for future international races: go slow and treat the journey as the destination.  After all, if i sat on a plane for 11 hours just to run 26.2 miles, then i should take all the time i need to enjoy racing the distance.  

The shirt is from 2020, i wasn't willing to buy a new one for this year...
They also gave out the 2020 medal (finally).



Updated 3/23/2023 to include Marathon Finisher's Certificate. 

December 13, 2022

5:07:42 (Bad)

Last weekend, i completed the California International Marathon in 5:07:42.


I am extremely unhappy with my time and feel like a catastrophic failure.  

This being my second running of the CIM, i should have done better.  In fact, i feel that i was better prepared overall: in contrast to all my other races, i was familiar with the course; in terms of training, i hit all my essential workouts and had a decent weekly mileage that topped out at 52 miles.  Everything was going according to plan.  I was completely set up for success... 

...but utterly failed to execute.  

After wallowing in self-pity for a bit, i beat the dead horse to a pulp to try and understand my poor performance.  I've concluded that it was due to dehydration.  

In the days leading up to the race, the weather forecast was unfavorable, with the possibility of precipitation predicted to be somewhere between 50 and 70%.  Not being a fan of running in the rain (i've had a few bad experiences in the past), i planned my attire accordingly, bringing along a rain jacket and waterproof socks.  Although i've never run a significant distance in that getup, it seemed like a good idea.  Even though everyone gets wet from sweat when running, i intensely dislike the clammy feeling of a wet shirt, and abhor running in squishy waterlogged socks. 

Waterproof jacket, check.  Waterproof socks, check.

So the morning of the race comes around, and basically everyone is pleasantly surprised that it's dry.  Then the gun went off and we started running.  After a mile or so, i heard a few people commenting in one way or another that it was great running weather.  In retrospect, that should have immediately tipped me off that i was going to be in trouble, because i personally felt that it was warmer than advertised.


The truth is that my body had already dropped me some clues that i was too dense to notice.  Just a few run-walk-run cycles in, i already felt a little sweaty inside my jacket.  I thought that it wasn't a big deal, that maybe my jacket merely wasn't as "breathable" as it was touted to be.  But it was really a sign that i had overdressed for the occasion.  I only realized this after around 6 miles, which is when i decided to peel my jacket off.  Once the cool air hit my torso, i felt a sense of relief... i had unknowingly been uncomfortably warm and excessively sweating up to that point.  


Looked warm, felt warmer. 

The premature dehydration was only one factor.  I've gotten through a hot and humid race before.  My real point-of-failure was in not keeping up with the fluid losses.  Around 3 miles in, i was already a little thirsty.  A bad sign, since i usually drink enough to keep ahead of the sensation.  Despite this, i obstinately kept to my usual hydration strategy of 1 sip/chug per mile.  Frankly, i probably even sipped a little less than usual, since the moisture in my jacket made me feel clammy and fooled me into thinking i was running cooler than i actually was.  At the end of the race, i finished with a not-insignificant amount of water still left over in my Camelbak, whereas it would normally have been bone-dry by mile 24.  

TL;DR: i sweated too much but didn't drink nearly enough. 

On reflection (and reviewing my splits), i was able to soldier through all of this until the halfway point.  Then my pace dropped by up to 30 seconds per mile despite trying to keep the intensity up.  


At around mile 16, i felt the beginning of a cramp in my left thigh but decided to "trust my training," attempt a negative split, and continue trying to make up for lost time (my target finish was around 4:45).  At around mile 21 (35K mark, on the official splits), it all unraveled as my left leg seized up and i stumbled to the side of the course.  I suddenly felt so lightheaded that i just wanted to sit down, but also realized that if i did that, there would be no standing back up.  So i gutted through the next five miles - running when able and walking when the cramps started again... and slowly jogged across the finish line.    

Trudging slowly to the finish. My expression reflects my self-disgust.

Such a bad race.  It was my tenth marathon, too.  An ignominious showing for what should have been a glorious event.  

Oh well.  

Lesson for the next time: if running with a jacket (which i am definitely not accustomed to), hydrate as if it's a warm race and don't push the pace.  At the minimum - pay closer attention to my body's cues and adjust accordingly. I've been able to do this in the past, but for some reason the weather forecast just spooked me and locked me in to a "cold and wet" mindset.  

No significant race notes, since i've covered the course in detail before.  A side note about the porta-potties - the line gets thinner the farther one goes from the starting line, and they virtually evaporate a minute before the gun goes off.  A slowpoke like me could literally wait until the gun goes off to use one, and still start running with the 4:30 pace group.  

Moseyed on over after using a porta-potty, around 7 minutes after the gun went off.

I am definitely going to run this again for redemption.  

Eating my "free" burrito after the race.

In the shadow of the Capitol building.

Next up, Tokyo.



Japanese food for lunch after the race.  Foreshadowing the next marathon.