Personal Report of Utah Half IM Duathlon

Triathlon Forum
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Personal Report: Utah Half IM Duathlon

My Background

On February 24, 2000, at the age of 55, I had what I describe as a near heart attack, followed by surgery (angioplasty). At 5’ 9” and 235 lb, I was obese. But I knew I could win the battle against heart disease and obesity because I love to exercise. I had run 9 marathons, including a 2:58 marathon 20 years earlier. So I set a goal to run a marathon (I have since run three) and a triathlon (I have since completed two, a sprint and an Olympic). The Utah Half IM would have been my third but . . . I’ll get to that soon enough. Anyway, since February 2000, I have lost 65 pounds, lowered my cholesterol from 291 to 154, my triglycerides from 283 to 70, and increased my HDL from 33 to 59.

The Utah Half Ironman 5/31/03

This race is an official national (and international) triathlon. In 2002, it was supposed to be a full Ironman race, but a triathlete lost his life in Utah Lake, so this year the race was reduced to a half IM. The organizers were obviously skittish about the prospects of another accident. So when the swim was supposed to start at 7:00 a.m., the lake had waves (small ones in my opinion), so the swim was cancelled for age groupers like myself. The pro triathletes still did the swim.

        So what was supposed to be a triathlon ended up being a duathlon.

I was disappointed. I had just made a breakthrough in my swimming, and was excited to do a long course triathlon. I can’t blame the organizers. I probably would have made the same decision, but most of the athletes felt like they were being overly cautious.

My Nerves

As I mentioned in a previous post, I was having difficulty controlling my nervousness. The new challenge was certainly exciting and important to me. But I succeeded in getting myself under control and was ready for the challenge. I felt calm, collected, and confident before the race on race day.

The Bike

It was a mostly flat, scenic course. In my other triathlons, I pushed too hard on the bike and had nothing for the run, so this time I wore my heart-rate monitor with the idea of keeping my heart rate around 75% of max. Once on the bike, however, that goal went out the window. I watched my HRM the entire ride and my HR stayed very close to 82%. I felt comfortable at that pace, or at least not any more uncomfortable than I feel when I run marathons. At 82% of max HR, I could maintain a bike speed of 21-23 mph on the flat straight-aways.

        My time for the 56 mile bike ride was 2:45:23, an average speed of 20.3 mph. I couldn’t be more pleased with that, especially because I pushed the pace, had negative splits, and still felt strong at the end.

Transition

I didn’t rush the transition because I wanted to make sure I took ibuprophen (I have a slightly sore foot) and re-applied lots of sunscreen (I burn easily).

        My time was 3:06.

The Run

Unfortunately, Utah is having a record heat wave. By the time I started the run, the temperature was 85-90 degrees, and probably above 90 by the time I finished. I had not trained at all in the heat. In fact, in the past 6 months, I had run exactly twice with the temperature above 55, because my married daughter and I run together early in the morning and often in a cool canyon along the Provo River. 90% of our training runs over the past 3 months have been in the 35-40 degrees range. So I was not prepared for a run in the heat.

        To make matters worse, I had not done one brick workout since August 2002. Again, because I run with my daughter (we’re training to run a marathon together) early in the morning (6:00 or 6:30), I don’t have time to bike before I run. 

        My time for the 13.1 run was 2:01:02, a 9:15 pace. Given the circumstances, I felt great about that, in spite of the fact that a year ago I ran a 44-minute 10K (7:07 pace) and a 3:53 marathon, but both in much cooler weather.

My total time was 4:49:30, about 40 minutes faster than I predicted for the Bike-Transition-Run. I finished 8 of 13 in my age group (M55-59), 391 overall of 703 finishers.

Overall Impressions

The Ironman people really put together a great race. Everything was so well organized, with hundreds of volunteers, well marked courses, fabulous aid stations (although some of them ran out of ice by the time I got to them), good expo, and lots of great post-race food.

        Except for not being able to do the swim, it was a great day.
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Sorry it wasn’t a triathlon … but you certainly did make the best of it…

However, you might make a special note:

Taking Ibuprophen during (much less before) an any IM distance triathlon is a BAD (if not dangerous) idea.

You should…“Avoid nonsteroidal anti-inflammatory medications such as naproxen and ibuprofen before or during your race, as these medications can impair your ability to conserve salt. If you must take a pain reliever, acetaminophen (Tylenol) is safer and doesn’t affect salt balance.” - Prevention of Under and Over-Hydration Rules for the Long Road by Carolyn McClanahan, M.D
See:http://www.1stplacesports.com/hyponatremia.htm

It’s best to avoid any NSAID at least 48 hrs. prior to the event.

FWIW Joe Moya

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Congratulations!

Now, just like Joe says, don’t take ibuprofen during a long hot race again…it is really VERY dangerous for your kidneys. This is serious, dialysis-waiting-for-a-transplant-serious. Individuals may get away with it for a while, or it may be the first time one tries it, and BOOM…you’re screwed. If you choose to take a pain reliever, don’t make it ibuprofen during long/hot exercise.

I hope you get to swim in your next event, you certainly have come a long way!

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Joe,

I’m glad I mentioned the ibuprofen because I was totally unaware of the dangers. I have taken ibuprofen just before and during all three marathons and all three triathlons I’ve completed over the past 2 years.

Not anymore.

Thanks for the tip.

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Congratulations for the race and thank you for the report, Scott!

I hope that your next try at the distance will be a complete triathlon so that you can take advantage of your new found swimming abilities.

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Joe and Yaqui,

Do you have some more specific information to share about the dangers of ibuprofen? I was surprised to hear such dire warnings about a product that is quite often handed out on the course at endurance events. For instance, single doses of Motrin were handed out to racers at the recent Vancouver marathon (I declined).

Joe - the article you refer to seems to be based, though I may be mistaken, on a year 2000 study (http://www.ucsf. edu / pressrel/2000/05/050301.html) that revealed a link between hyponatremia and ibuprofen - but also says more study needs to be done to confirm the link. Also, the suggestion was that a painkiller was an aggravating factor and not a cause (the causes being too much water intake and not enough salt intake.

Yaqui - the National Kidney and Urologic Diseases Information Clearinghouse (http://www.niddk.nih.gov/health/kidney/summary/analgesc/)does warn about potential dangers of painkillers to kidneys but also clearly states “These drugs present no danger for most people when taken in the recommended dosage”.

My main beef with painkillers on the course is a different one - that they do exactly what they say they will do: mask pain. Hiding that important signal from your body is understandable, but still foolish IMHO.

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Here ya go:

The following basisly says those with less experience with distance events have greatest potential for problems. Also notes that vomiting is the only delienating difference between symptoms of dehydration and hyponatremia.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12544163&dopt=Abstract

And, this one which indicated the most detail and most referenced:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11399389&dopt=Abstract

And, this study even associates pulmonary edema with NSAID usage (and the NaCl absorbtion problems it seems to cause):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10787364&dopt=Abstract

FWIW Joe Moya

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Anybody know… is aleve the same sort of thing as Ibuprofen?

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Hmm, that does tend to give one pause. I’m 8 weeks post knee surgery, and have been on a regime of Vioxx (25mg/day). My doc knows my athletic undertakings, and has said nothing about any potential problem. I’m interested/concerned, however, as we’re preparing for CdA, and this is my last build week…longest of the past month, and it’s been hot here. I wonder if I should get off it now, and stay off it through the race?

Also, a couple of years ago in Kona, they were conducting a study on the prevalence and effect of NSAIDs use among the participants. I wasn’t taking any, so I didn’t participate in that, and don’t know the outcome. I think Dr. Bob (former IM med dir.) was involved.

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The fact that you doctor didn’t say anything doesn’t surprise me… it not uncommon for most non-athletic (or sport specific) doctors to be aware of this potential problem. It seems the level of intensity and length of time for LC triathlon’s is waaaay beyond the norm and not typically even considered when making drug choices (…nor are the potential problems from such extreme activity included during the research phases of the drug development).

FWIW Joe Moya

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TonyG wrote: - the National Kidney and Urologic Diseases Information Clearinghouse (http://www.niddk.nih.gov/health/kidney/summary/analgesc/)does warn about potential dangers of painkillers to kidneys but also clearly states “These drugs present no danger for most people when taken in the recommended dosage”.

You don’t really think that doing a long endurance athletic event in the heat is characteristic of what “most people” are doing in their lives, do you?

Talk to ANY nephrologist about the dangers of taking ibuprofen when dehydration is a possbility. You will see their face blanch at the suggestion, it’s not safe for use in this situation. Read the label, read the PDR, realize what we are doing as triathletes isn’t “normal”.

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OH, another thing…just because they hand out Motrin (ibuprofen) at a race doesn’t mean it is good for you. The Kryspy Kreme donuts they hand out aren’t good for you either, but, they don’t have the potential to wipe out your kidneys. Motrin can, and most importantly DOES wipe out people’s kidneys when used incorrectly…that includes drinking alcohol as well as dehydration…it’s on the drug insert that comes with the medication. Those papers aren’t just filler to keep the bottle from rattling around in the box, there’s important, serious warnings on them.

I’ve written this several times on this site, here it goes again: a local nephrologist stated that the majority of kidney failure in young people seen by him are young women that take too much ibuprofen during their menstral cycle. They may also drink a little alcohol at the same time and BOOM! Dialysis. On the transplant list waiting for a kidney. This isn’t benign stuff here, this is medicine, and it can ruin your kidney function if you step over the line. Since I don’t know where the line is for my body (and I’ll bet you don’t know where that line is for yours, either), I’m not going to take the stuff when dehydration is a possibility.

You also have to remember that dehydration is a relative thing…if you are exercising very hard, your body sends less blood to your kidney…your kidney may be experiencing defacto local dehydration before the rest of your body does. I know I’m jumping up and down here. It isn’t just for show, it’s a real danger that too many people don’t take seriously until it’s too late…and it can be a very steep cliff that you fall from once you ingest 1 microgram too much ibuprofen for the conditions that day.

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So what you’re saying is that the five 800mg Ibuprofen I took during IMCal 2000 were probably a bad idea?

I didn’t get any adverse reaction. Was I lucky?

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You may not know if you had an adverse reaction, you could have had some impairment of renal function that stayed under your radar screen…hopefully it has resolved, if it even occured. You also could have had no adverse reaction at all. I don’t know if you were lucky or not, but, you were doing something that was ill-advised. I’d go so far as to call it reckless unless you were urinating frequently during the event. That’s a big load of ibuprofen, and if you were taking 800 mg doses, you were taking a prescription strength (non-prescription strength is 200 mg). I’d pointedly question any doctor that OK’d that amount of ibuprofen during an IM to see why they thought is was OK. If you are in that much pain that it requires this kind of load to get you to the end, maybe you should reconsider doing events as long as an IM. But, they’re your kidneys, and it’s your health.

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Ok, now I’m concerned. I stopped taking the Vioxx as of Saturday (because of what I’m reading here), but I spent my entire swim this morning thinking about what you all have written, and wondering whether I’ve done myself any harm. I did a lot of hard miles (running and biking) in the heat last week; I tried to stay hydrated, and thought I had…I was following the hydration protocol I’ve used successfully in the past, and I was urinating at regular intervals. I understand that there are sometimes no symptoms, so should I get checked? What should I look for? Am I just obsessing?

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The simple fact seems to be that there is insignificant research to determine what is considered acceptable dosages of NSAIDs prior, post or during. However, based on what evidence that seems to be noted in research… it seems to be relative to an individuals tolerance, the environment and intensity/volume of activity.

The simple answer is that the medical profession doesn’t really know the full implications of NSAID usage for triathletes. However it is somewhat safe to assume (on the conservative side) that one shouldn’t take NSAID’s at least 24-48 hrs. (most recomend 48 hrs. - for a typical dosage) prior to an intense level and/or long period of activity. However, whether or not that is accurate can depends upon how long you have been on the drug prior to the activity and whether or not the activity in questions puts the body (specifically the kidneys) at more than expected stress.

I have heard of no one recommending that a person take an NSAID during intense activity… it would be a fair ASSUMPTION (there is that nasty word again) that taking the drug intense activity is the worse of all choices in terms of body tolerance. Whether or not this is true, (again) is relative to each persons tolerance (at that particular time) and what particular type and dosage of NSAID you take.

Taking the drug after intense activity is another question that is difficult to answer as well. However, it too should be avoid for some period of time until full body recovery can be achieved. What that time period may be is dependent upon the activity level and environment the activity occurred in. There are so many variables to determine when it is acceptable to begin taking NSAID’s after an event… but, it would be safe to ASSUME that taking the NSAID after and event is safer than taking it just prior to or (specially) during.

There is no sure fire answer to the toxicity levels of NSAID’s… it’s toxicity is very relative. For that reason, avoiding the drug during higher intensity and higher volume activity is recommended. Which leads to the second delimma, “If you train at a high level all the time, then would that mean you should never take NSAID’s?” The conservative answer is Yes… but, in real world most don’t follow that plan of action and use NSAID’s. Thus, putting themselves at risk (whether they realize it or not).

I believe the key is moderation… both in activity and in drug usage. The best way to use NSAID’s is as directed. That would mean take them during long recovery days (yes, I said days - not a day or two). Take only in prescribed amounts or less… Better yet, don’t use NSAID’s to mask pain caused by inflamation. Typically that is reason for more than just kidney problems… but also joint, ligament, tendon, cartilidge problems.

What I notice is how we seem to blindly following a schedule designed to allow us the opportunity to do an IM in 36 weeks (why? because that what the article or books says). In the real world, you do IM’s (for example) when your body allows you to do it… maybe sooner the 36 weeks or more than 36 weeks. But, the bottom line is that NSAID’s over rides the bodies natural defenses of making note of abuses. It’s better to recover (w/ NSAID) than to work out because of the NSAID’s ability to mask the pain. Injury is not the only precurser to recovery needs. In fact, recovery (i.e., rest) is the key element toward prevention of injury.

As for being paranoid about the drug… that’s not necessary. However, it is very prudent to understands NSAID’s limitations and dangers. The fact remains is that mediceine doesn’t accurately know the relationship of what is TOO much in terms of activity and/or NSAID’s useage. But, rest asssured using them in conjunction with exteme activity poses a permanent threat to your health.

NSAID’s are designed to facilitate recovery…not facilitate perfomance. **And, the key to recovery is rest (not activity). **

FWIW Joe Moya

BTW, if someone out there finds a research article regarding dosage levels (i.e.,toxicity) and extreme activity… please post… I’d be very interested.

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Don’t obsess about it. If you are really concerned, there are several ways to determine renal function. I personally wouldn’t bother with these tests if I had had no symptoms of renal problems, but, if you’ve had blood in your urine (it doesn’t have to be red in color, brownish urine is potentially due to blood) after taking ibuprofen and exercising hard, or nagging flank pain afterwards (even if you thought it was muscular in origin)…then, yes, I’d say go get checked. Either way, at this point there’s nothing much to do but stop the potentially dangerous behavior. What Joe says in the previous post covers the subject well enough for laymen. I’m not trying to scare anyone, I just think too many people don’t realize what they may be doing by mixing drugs with training, especially ibuprofen and dehydration.

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Omigod.

I did the GCT 1/2 IM a couple of weeks back, on the heels of an ITBS flare-up that kept me from running for some time leading up to the race. Since Ibuprophen appeared to have helped combat the inflammation of my ITB, I figured I’d load up on it during the race. It was very hot on race weekend, I also took salt. I made up these little pill packs that included one Lava salt capsule and 400 mg. of Ibuprophen. I tore open a pack every 90 minutes or so during the race. I’d say I took in 1200 mg. (or more) of Ibuprophen on a very hot day. I guess it was pretty stupid to experiment like that without a little research. Maybe I just have too much faith in the class-action lawyers to keep me from harming myself…

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If class-action lawyers can sue the fast food industry, certainly they can find a way to sue the ibuprofen industry…even though they publish and include a circular with every bottle sold that warns about potential harm. Still, it’s your health we’re talking about, not theirs.

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If anyone cared about why you shouldn’t take NSAIDs while doing some serious exercise here it goes…

Your kidneys rely on a group of proteins called prostogladins to regulate the blood flo through your kidneys. The blood flow has to be maintained at a certain level for the filtering and proper functioning to occur.

NSAIDs (this includes ibuprofen, aleve (naproxen), etc.) block the synthesis of prostogladins through the inhibition of the COX enzymes. Thus making it harder for your kidneys to regulate blood flow.

This is especially a problem with extreme exercise. the fluid loss makes it difficult to maintain your GFR (basically kidney blood flow) this combined wiht an increase in concentration of your drug becuase of the volume loss. Now combine this with increased waste production due to muscle breakdown and what not… recipe for disaster

There are also effects on the kidneys ability to respond to your bodies signal to retain more water and concentrate the urine… this leads to more fluid loss.

Someone else asked about COX2 inhibitors (VIOXX, Celebrex, etc) same deal… the only difference is that these are selective for the COX2 enzyme which is induced at sites of inflammation while COX1 is found in your stomach (and some ohter places)

The concern about a “reaction” to the mediacation this is actually less of a concern because of the low incidence, plus if they were going to have a drug reaction (such as interstitial mephritis) this would have happened in other situations where they had taken the drug.

I hope this may have been informative.