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Breathing question
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Hey slowtwitchers have a question to see if anyone else experiences this or knows any insight.

Every distance event more than 4 hours I have a really hard time breathing. Like to the point where I can only go for like a quarter mile without stopping to walk and even at like a 10 minute pace. It had been consistent at mile 8 of either an Ironman or 70.3. Any insight?

To make it a little easier I’ll give some background. I have a 253 marathon to my time and have not ever had this issue with marathons. My ftp is 330 and kept my Ironman bikes around 235 (which I feel is pretty conservative so I can run well) nutrition wise I’ve taken in around 300-400 calories an hour on the bike (played with it over the last few Ironman) . Just did Santa Rosa yesterday and was 8th overall coming off the bike and until about mile 6 and then the breathing thing came up and had to proceed to a run/walk as I couldn’t go more than 1/4 mile without having trouble breathing.

Has anyone else experienced this??

https://www.instagram.com/dylan.delacruz5/ https://www.strava.com/athletes/11645943
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Re: Breathing question [DylanD] [ In reply to ]
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https://www.mayoclinic.org/...-causes/syc-20372300

Have you ever tried an inhaler?
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Re: Breathing question [michael Hatch] [ In reply to ]
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Highly doubt exercise induced asthma. Timing is not right which is what makes this situation strange.

Is it always on the run? How about stand alone runs? Is your run effort harder relative to your bike?
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Re: Breathing question [DylanD] [ In reply to ]
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Re: Breathing question [michael Hatch] [ In reply to ]
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Hi Michael never have tried an inhaler or been diagnosed with asthma before

https://www.instagram.com/dylan.delacruz5/ https://www.strava.com/athletes/11645943
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Re: Breathing question [IMStillTrying] [ In reply to ]
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Stand alone runs have always been fine. Never any issues at all. Marathon distance has been fine. Standalone marathon pace is around mid 6:30s and for my race yesterday at least I started at 7:20s-7:15s which felt like I could hold it forever till like mile 7 when I just had trouble breathing. Legs felt great, heart rate felt pretty good, just odd.

Yeah it always happens on the run. Bike effort felt pretty darn “easy” as I stayed 100 watts less ftp to conserve for the run. But again for me 7:15s felt “easy” as well.

Idn don’t want to be all hypercondriac lol but maybe I’ll ask my doctor about it

https://www.instagram.com/dylan.delacruz5/ https://www.strava.com/athletes/11645943
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Re: Breathing question [DylanD] [ In reply to ]
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Ok, may be nothing at all, but generally speaking talking to a medical professional and them confirming its not anything is better than the reverse.

I got diagnosed with asthma when I was in my 30s after exactly the same symptoms, albeit not as bad, as you had. Essentially I'd had asthma my whole life and had adapted to having the restricted airways. When I fatigued during long sessions that stepped it up a notch.

Took a bit of a convoluted process to diagnose as my peak flow when having an 'attack' was actually in the midpoint of the range for my height /weight. However what then happened is that when we measured when using the inhaler and unrestricted I was 20% higher than the medium and found out I have freakishly large lungs. Now it's full controlled with 1 tablet a day (aside from once a year when I get a really bad cold/cough). I carry, but never use an inhaler when training / racing.

Also worth considering is if the long bike is leaving your core/abs fatigued and this is then referring to your diaghram as you continue into the run. Hard to be sure as you would almost need to be running an ultra to be able to show it was cycle>run related and not just fatigue from 4+ hours exercise. So perhaps easier to rule out the asthma first.
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Re: Breathing question [DylanD] [ In reply to ]
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https://www.mayoclinic.org/...-causes/syc-20372300

Strictly Dr Google, I'll admit. But you probably don't have asthma, but you have some symptoms.
Two of my kids had asthma, and a surprising number of things were involved in triggering it.
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Re: Breathing question [DylanD] [ In reply to ]
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It’s hard to really know what you have. Typically exercise induced asthma comes on with 15’ of activity onset rather than 4 hours. The 4 hours is really the fly in the ointment. Interesting idea re muscle fatigue but why now?
It would be interesting to see your Lung functions tests pre and post exercise. You can ask your doctor to order them that way
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Re: Breathing question [DylanD] [ In reply to ]
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Dear Dylan,
Have you noticed that all the arm chair experts that have answered your post so far have not even asked you your age, weight, previous medical history, medications you're taking, anything about the nature of your breathlessness or any associated symptoms nor do they have the opportunity to exam you or do any investigations. I would treat their advice with caution. See a proper doctor. Even if it turns out to be nothing it will put your (and my) mind at ease.
Regards,
Mark57
Last edited by: Mark57: May 13, 19 4:56
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Re: Breathing question [DylanD] [ In reply to ]
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Hi Dylan —

Go see your primary care doc. My guess is exercise induced asthma as well, and that he/she will give you an albuterol inhaler to use on events >4 hours.

My n=1 is I had pretty much the same issue with a similar background. Was a fast marathoner, never had any problems running up to 4 hrs. Started training for IM, and anytime I’d go longer than 4-5 hours I’d have difficulty breathing (burning when I’d inhale fully), especially AFTER stopping physical activity. As my “long” rides got increasingly long, the shortness of breath would get worse and worse until one time it was so bad I almost went to the ER. The main thing is there was clearly a duration-linked element to the onset of this, and to a lesser extent intensity (4 hours of a race effort might get me to flare up, but it takes more like 5 hrs at a lower Z2 training effort).

Anyhow, went to my PCP. She said it was exercise induced asthma. I was sort of shocked (how could I, a semi-elite runner, have asthma?!). Well, the albuterol inhaler worked like a champ, and I haven’t really had any issues since.

Of course listen to whatever your doc says, but I’ve experimented with how to use the inhaler a bit, and here is what I find works best.
— Training rides, brick sessions longer than 4 hours, or “sportive” rides: two puffs 20-30 min before activity. If ride is longer than 5-6 hours, may need 1-2 puffs after also.
— Races longer than 4 hours (basically half IM and up) — One puff 20-30 min before start. For 70.3, one puff in T2, two puffs after race. For full IM, one puff in T1 and another puff in T2, and 1-2 puffs at finish. (Note, you may need 2-3 inhalers for this).

Why only 1 puff before races? I find the inhaler makes my heart race a bit. Two puffs makes me feel anxious at the swim start, and it also makes my HR zones totally useless. One puff still elevates HR slightly, but doesn’t cause any anxiety and still seems effective at reducing the burning/shortness of breath after finishing. I also find the using the inhaler 20-30 min before start helps let the HR settle a bit.

But go see a doc dude. For some reason, one this happened to me once, it became more likely to happen after.
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Re: Breathing question [DylanD] [ In reply to ]
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DylanD wrote:
Hey slowtwitchers have a question to see if anyone else experiences this or knows any insight.

Every distance event more than 4 hours I have a really hard time breathing. Like to the point where I can only go for like a quarter mile without stopping to walk and even at like a 10 minute pace. It had been consistent at mile 8 of either an Ironman or 70.3. Any insight?

To make it a little easier I’ll give some background. I have a 253 marathon to my time and have not ever had this issue with marathons. My ftp is 330 and kept my Ironman bikes around 235 (which I feel is pretty conservative so I can run well) nutrition wise I’ve taken in around 300-400 calories an hour on the bike (played with it over the last few Ironman) . Just did Santa Rosa yesterday and was 8th overall coming off the bike and until about mile 6 and then the breathing thing came up and had to proceed to a run/walk as I couldn’t go more than 1/4 mile without having trouble breathing.

Has anyone else experienced this??


It definitely doesn't fit the classic presentation of exercise-induced bronchoconstriction (immediate to within 20 minutes). Does it feel like your chest won't expand or the breaths you're taking just aren't effective? Is there tightening of your airways (i.e., inspiratory or expiratory symptoms). When you go to the doctor for this, the more detailed you can be about your symptoms and what's happening in the environment, the more likely they'll be able to figure out what the problem is.

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https://connect.garmin.com/modern/profile/domingjm
Last edited by: domingjm: May 13, 19 13:15
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Re: Breathing question [Mark57] [ In reply to ]
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I understand that you are trying to sound a cautionary tale and agree that seeing a doctor is the correct approach but there really are some good pieces of advice on this forum. It just requires filtering through the crap that others put out there. There is some much awesome knowledge here. Although I'd be the worse person to ask advice re: automobiles, the economy there are certain things that stick out about Dylan that make those things less urgent to know. Most of us in any biz can get to the heart of the matter with a few pointed questions before the real probing questions begin. Whereas the medications and past medical history would be helpful, we actually can make some reasonable (I believe) assumptions. I had a mentor who would try to figure out diagnoses within the first 2 or 3 sentences when being presented with cases. It was truly amazing and humbling to see what really smart people can do.


Back to Dylan. . . as I see it, Dylan is a youngish man (Based on his instagram pics) who can run a 2:53 marathon which already puts him in a relatively rarefied air compared to most humans. This alone reasonably suggests that his cardiopulmonary system is working extremely well and suggests that he likely does not have any significant medical illnesses (or hasn't been diagnosed with one) in order to achieve such performances.


The timing of his breathlessness really is troubling and does not suggest asthma as a likely etiology for his symptoms.

According to Uptodate.com (well respected medical reference site)
Patients with exercise-induced bronchoconstriction (EIB) typically have initial bronchodilation during the first six to eight minutes of exercise [28,29]. The initial bronchodilation is followed by bronchoconstriction, which begins by three minutes after exercise, generally peaks within 10 to 15 minutes, and resolves by 60 minutes (figure 1). Typical symptoms are shortness of breath, chest tightness, and cough.

The onset of breathlessness only with running (off the bike) rather than biking (or running standalone) makes it hard to make a more definitive diagnosis. The fact that he can bike hard makes it significantly less likely that he has either a cardiac or pulmonary etiology as work is work. Generally speaking the body just knows that it needs a certain output. If he is working as relatively hard at biking as he is running (which he seems to be) plus he can run a stand alone marathon at 6:30 pace then there should be absolutely no reason that he would have trouble running 7:15s. Just doesn't work that way. It's analogous to having a car that can go to 0-60 in 5.5 sec then it can certainly do that in 7.5 sec unless something is broken. A car should not have trouble because that is not what is limiting it unless something else is broken.


If I were to guess without asking any further questions I'd wonder if there was some paradoxical movement of his vocal cords that would make him seem like he couldn't catch his breath. As I suggested previously I think baseline and exercise pulmonary function tests would be extremely helpful in making this diagnosis.


Dylan, I had sent you a PM if you wanted to discuss more in detail.


I hope this helps. BTW, if you haven't figured it out, I am a proper doctor, a pulmonologist. ;-)
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Re: Breathing question [DylanD] [ In reply to ]
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You can probably go see an allergy/asthma doctor and get tested for both.
Be sure to tell them your fitness level to help them. You don't want them comparing your breathing to a less active patient.
Bad allergies can build up over time outside and cause some breathing issues. I know this from my experiences.

They can test you and give you a few samples to try or rule out either of those 2 things.

Rob
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Re: Breathing question [IMStillTrying] [ In reply to ]
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"It just requires filtering through the crap that others put out there"

Think about that for a moment. Unless you are prepared to help the non medically trained posters everyday on this forum then perhaps you should stop offering potential diagnoses without all the facts to emulate your awesome mentor. This forum is full of terribly bad advice and has a tendancy to dismiss potentially life threatening problems as trivial. It did my head in reading some of the stuff written by some so called experts. BTW another triathlete died in a race recently. I would suggest you act as a filter if you want to post and NOT profer diagnoses if you want to be helpful and medically responsible.

Cheers.
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Re: Breathing question [Mark57] [ In reply to ]
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When I meant filtering I meant that there are clearly people who’s professional lives deals with these topics. It’s pretty clear reading though posts who they are.

I was Simply looking at the data that he was providing and giving my thoughts. I apologize to the OP if my assumptions are incorrect. I was simply going through my thought process rather than showing my awesome google-fu. If that offends you then I’m sorry. (Btw I only comment on pulmonary topics on slowtwich which and prefer to stay in my lane as there are other much more knowledgeable people)

I hope this will provide him with a framework with which to approach his problem with his doctors because it is highly probable that they might blow him off given that the is a sub 3 hour marathoner who gets short of breath at 4+ hours. That’s just so out of the realm of people’s imagination
I’m sorry you are offended by my efforts but he didn’t seem to be wanting the boilerplate “go ask your physician” which he clearly knows
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Re: Breathing question [IMStillTrying] [ In reply to ]
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I respect you and what you said. Keep on doing you and sharing your knowledge. It's very much appreciated.
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Re: Breathing question [DylanD] [ In reply to ]
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just to throw out something different to consider. I met someone once.....
anyway, he figured out his problem was his diaphragm was 'cramping' or something such.
his aggressive bike position was probably restricting his diaphragm for several hours. then he started running and either the position or bouncing caused it to 'seize up'. he said he had to bend over and heimlich maneuver himself to get it working.
good luck

______________________________________
"Competetive sport begins where healthy sport ends"
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Re: Breathing question [DylanD] [ In reply to ]
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Although the perception may be of a lung problem a sudden reduction in how much blood the heart is sending to the lungs would also create the same perception, as could blood being sent to the wrong place or not containing the right stuff. There is also lots of spare breathing capacity in healthy people & you sound very much like a healthy person. Something is happening at the point the sensation of shortness of breath occurs. What is this… It is actually quite hard to explain with just lungs. Sit where you are and briefly breath as hard as you can; see it is way more than you need running. Also think of olympic athletes running; they never breath that hard… Pro-cyclist cracking on a climb…

My guess:
The long duration of exercise is effecting the electrolytes in your blood (eg. Sodium/Potassium) become abnormal. The top chambers of your heart stop working normally -the change- (“atrial fibrillation”): in otherwise healthy humans this reduces the pumping of the heart by roughly 10-15%, but probably more during exercise. This would make you feel terrible, although not kill you. A dog would feel much worse and an alligator would be dead…

Only a guess though. Best way you’d know is by having an electrocardiograph (EKG in USA) taken *during* an episode. Simple electrical recordings only show the electrical activity of the lower chambers of the heart & infer atrial fibrillation from the irregularities of lower chamber activities (eg. the new Apple Watch) , but a fast heart makes it really hard to see the irregularity (some is normal).

Does it ever ever happen outside a race?

BTW, if it was what I am guessing; a pro cyclist, whose name I’ve forgotten, was recently treated for it (media called it a “heart operation”🙄).
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Re: Breathing question [timeforacompact] [ In reply to ]
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This is an interesting idea. Not necessarily that the position causes cramping but rather the idea of diaphragmatic fatigue related to poor (relative) blood flow after prolonged exercise. One article quoted the magnitude and likelihood of occurrence as exercise exceeds 85% intensity. Another mentioned that the data on exercise induced diaphragmatic fatigue either worsens or gets better with increasing duration (so no help really). I've never seen this but my patients tend to run in the 70+ age group. They can stick pressure sensors in the OP and let him ride for hours to see :)
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Re: Breathing question [Eerke] [ In reply to ]
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Eerke wrote:
Although the perception may be of a lung problem a sudden reduction in how much blood the heart is sending to the lungs would also create the same perception, as could blood being sent to the wrong place or not containing the right stuff. There is also lots of spare breathing capacity in healthy people & you sound very much like a healthy person. Something is happening at the point the sensation of shortness of breath occurs. What is this… It is actually quite hard to explain with just lungs. Sit where you are and briefly breath as hard as you can; see it is way more than you need running. Also think of olympic athletes running; they never breath that hard… Pro-cyclist cracking on a climb…

My guess:
The long duration of exercise is effecting the electrolytes in your blood (eg. Sodium/Potassium) become abnormal. The top chambers of your heart stop working normally -the change- (“atrial fibrillation”): in otherwise healthy humans this reduces the pumping of the heart by roughly 10-15%, but probably more during exercise. This would make you feel terrible, although not kill you. A dog would feel much worse and an alligator would be dead…

Only a guess though. Best way you’d know is by having an electrocardiograph (EKG in USA) taken *during* an episode. Simple electrical recordings only show the electrical activity of the lower chambers of the heart & infer atrial fibrillation from the irregularities of lower chamber activities (eg. the new Apple Watch) , but a fast heart makes it really hard to see the irregularity (some is normal).

Does it ever ever happen outside a race?

BTW, if it was what I am guessing; a pro cyclist, whose name I’ve forgotten, was recently treated for it (media called it a “heart operation”🙄).

This is quackery not written by a medical practioner.
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Re: Breathing question [Mark57] [ In reply to ]
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Nonsense. Point out a single bit of ‘quackery’? Try opening a physiology book before talking nonsense.
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Re: Breathing question [Eerke] [ In reply to ]
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First off thanks everyone for the responses.

Second to answer you question it never happens outside a race that’s either a 70.3 or 140.6. Olympics, sprints, marathons, etc never an issue. And for 70.3 only happened once. Honestly just wanted to hear some inputs about it as I stay pretty conservative throughout so I can have a good run and still happens.

Im probably just being a little hypercondriac 😂

https://www.instagram.com/dylan.delacruz5/ https://www.strava.com/athletes/11645943
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