Route 40 Romp "Strategy"

This post is silly long.  Sorry.  Probably of most interest to people with adrenal insufficiency who exercise.

Again bolded at the start of topics so you can skip what you want.  Here's what I wrote about Past Failures, Steroid Guilt, Big Screw up, Endurance Exercise and HC Dosing, What I Started Doing Differently and Summary

PAST FAILURES
By the time this post is published, I will have started running the Route 40 Romp.  My ultra "career" has been plagued with multiple attempts at long distances that were thwarted by a lot of exhaustion, fatigue, nausea and vomiting.  It took me six years and many 100 mile DNFs to come to the conclusion that I was entirely responsible for my failures but in a different way than I had thought.

I thought I was not training hard enough, I was not training right, I was not genetically predisposed to running (probably true) and screwing up the race in the week prior by doing too much.  Well, yes, the fault was entirely mine but, in retrospect, I do not believe neither training nor genetic disposition were the problem.

Let me list my problems at about mile 60:

• Fatigue
• Nausea
• Vomiting
• Exhaustion
• Inability to stay awake
• Low blood pressure

What does this sound like to you people with Addison's?  Yes, poorly managed adrenal insufficiency!!!

STEROID GUILT

My biggest problem was that I was suffering from steroid guilt and didn't want to take too much hydrocortisone.  As much as I preach, take enough HC to make you comfortable, I didn't practice it.

BIG SCREW UP MAKES ME SEE THE LIGHT

At Vol State in 2013, I made a terrible error with my meds.  Long story short, I took 1/4 of the HC I needed by accident.  I suffered badly and even think my calf pull was due in part to not having enough cortisol in my system.  At Barkley in 2012, I did take enough HC and I performed surprisingly well for me.  Fast forward to Ancient Oaks 100 in December of 2013 and LOST in February of 2014.  I made the conscious decision, based on VS and Barkley, to change up my race strategy entirely.  By strategy, I do not mean what most people who run mean.  I am not coming up with some huge master plan of how I can win.  My "strategy" is how to manipulate my hormones manually to mimic what other's bodies do naturally.  What a pain in the ass.

ENDURANCE EXERCISE AND HC DOSING

With adrenal insufficiency, we are told over an over by doctor after uneducated doctor, that we should take as little hydrocortisone as possible.  We should not need much extra for exercise.  In reality, there are NO STUDIES of endurance athletes with adrenal insufficiency.  The studies I've seen about cortisol production and "endurance" exercise are of middle aged men on bikes for 45 minutes, 6 days a week.  Um, yeah.  Somehow that doesn't seem to correlate even to the pathetic endurance training that I do.  How can any judgments about cortisol production correlate???  The answer is:  they cant.  If I had taken a realistic look at my symptoms during the middle of the race, I would have seen that I was under replaced and possibly doing harm to myself.  Following my own advice of taking enough HC to alleviate negative symptoms, I would have performed better for the last six years.

WHAT I STARTED DOING DIFFERENTLY AND WILL DO AT R 40 R

Here is an (edited) email that I sent to my friend H after Ancient Oaks that sums everything up quite well:

I felt SO GOOD the ENTIRE race.  The only time I cried was with happiness for about 30 seconds.  My feet never swelled or hurt, they did get uncomfortable but not painful.  I was able to stay up all night except for one hour.  I was hydrated the whole time.  I ran right up to the end.  I didn't run every step but I certainly ran a lot.  My splits were, for me, extremely consistent.  I wasn't trying (to be consistent) either.  Someone mentioned it and I checked it out after.  Do you know how many 100s I've started and failed?  So many.  I usually ended up swollen, nauseous, dry heaving and so tired that I literally laid down on the side of the trail (not a good idea at sunset in the Winds of Wyoming).  Hmmmmmmm let's think about what those symptoms sound like, LOW CORTISOL.  Why did I accept those symptoms as "normal"?  Because I thought people who run long distances have these problems. It was normal.  What did I do differently this time???

·         Quit drinking on July 18^th (I was drinking a lot)

·         Quitting drinking helped me train better and more consistently

·         Lost weight, 14 lbs since the beginning of 2013

·         I was SO motivated after Vol State AND once the VS med debacle became clear, I took enough HC post event to heal properly

·         During the race

o   Took 10 mg of HC each and every hour without fail (was taking 5 mg every hour or two)

o   Ate every hour

o   Drank fluids consistently

o   Drank 1.25 L of COKE (more than I’ve had in 5 years combined)

o   Wore Wonder Woman socks with capes

o   Had my mug from Bonnie in the car [mug says: crying won't help]

o   Had an awesome pacer through the night for 22 miles

For all of the other 100s I’ve attempted, I was ruined after the race even when incomplete.  After the Bear (completed in 35:45!!), I was ruined too.  Taking double or triple in the days following helped my healing.  Within 72 hours, I was no longer sore.  In 48 hours, I was cleaning cages with no problem.  Recovery was so swift with added HC, good training, lower weight and no alcohol in my system.  I can’t freaking believe I stayed up most of the night.  This was monumental for me!

SUMMARY  

In summary, my strategy will be to take 10 mg of HC/hour, eat, drink, not cry and appreciate having Marilyn as a crew!!