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So Now What?

There are a lot of emotions and physical changes that tend to happen after you finish an Ironman triathlon. First, you go through the obligatory that-was-miserable-and-I’m-never-doing-that-again train of thought. It kicks in shortly after finishing, when you feel like someone has smashed every one of your toes with little hammers, stabbed knives into every inch of you thighs, hit you with a baseball bat in your lower back… you get the picture. If the borderline embarrassing inability to walk straight without deviating to one side or ascend/descend stairs without the fear of falling is not enough to convince yourself that these races are perhaps too much, the legendary sunburns and chaffing scars you bear should be enough for us to realize that continuing on with these races is crazy. After I finished my first Ironman Louisville, I told a close friend in the finisher’s chute, “Never again.” Despite those words, I of course continued on with the sport. And about 2 hours after I finished Ironman Louisville this year, my boss texted me to find out how many people I passed and how much I had raised as a result of the fundraiser. My reply was simple: “1,977 passed @ $17.77 per person. Total plus flat donations just over $54k. Someone else is racing next time. That one hurt. Not doing an Ironman again for a long time.”

After I had the ability to recover a little, and started walking without a severe limp, I naturally begin critiquing my race. It took a week before I downloaded my Garmin file from the bike and actually objectively evaluated how I performed. I concluded that I swam well, but pushed too hard in the early stages of the bike, attacked a few too many hills, meaning I burned a few too many of my matchsticks, and when I made it to the run – the legs were cooked. Then of course, the high temps and >105 heat index didn’t help. The original plans for Louisville were 1. pass as many people as possible, and 2. garner a Kona slot. I placed 8th in the age group, only to find out I was 7th because of a questionable athlete’s run split which was subsequently DQ’d. In the past rolldown slots in my age group rarely go beyond #6 or 7, so I didn’t return on Monday morning, only to receive a text at 11:15am that my name was just called for a rolldown slot and of course, I was already home – so no go. Despite my shear disinterest in performing another Ironman earlier in the week, by the time the next weekend rolled around, I found myself wondering “so what’s next?”

So what came next is literally one of the physiologic changes that tends to occur following an extremely physically challenging event such as an Ironman – immunosuppression. Studies have shown that following an Ironman competition, the immune system of an athlete shifts. Whereas there is a normal good balance of immune cells whose job is to identify and manage inflammation and injury compared to those that recognize and fight infections. Post Ironman, there is such a widespread inflammatory response, that the percentage of cells on board ready to address and manage inflammation go sky high, and the numbers of infection fighters fall fairly low. Combined with the altered levels of Cortisol, and other physiologic processes – beginning 2-3 days post the race and lasting as long as 3 weeks out – we become very prone to infections. If you’ve been around me the past 2 weeks, I’ve been coughing and sneezing like I’m working up one of my lungs. I’ve completed antibiotics, but I still have the crud. The kids, Shannon, everyone’s fine. No one else at work or any of my patients are sick – which is very good! Its just me, sounding like I’m coughin’ up a wishbone or something.

I wish it was this easy

The other common phenomenon that happens among Ironman athletes is a post race depression. When you consider it, it took almost 4 months for me to get ready for Ironman Louisville. Every morning, every workout, and essentially every day, I re-evaluated what I was doing and considered how it was going to benefit me for this race. There was so much work and hype building up to the race, and suddenly its over. I have not minded the reduction in the workload required to upkeep this website over these past few weeks, but I have been a little down during this time. Similar to the shift in the immune system, there have also been studies suggesting that the shift in hormone levels post race contributes to relative fluctuations in our anxiety levels and as a result our mood levels. Combined with the fact that the past 2 weeks have perhaps one of the busiest stretches of work for me all year, I’ve been sick, working my tail off, feeling terrible or otherwise too tired to workout, and borderline hating life along the way. Needless to say, I’m ready for either a vacation or another race, and better yet, why not both!

It was just today that one of the physicians I work with, and also someone I consider to be one of my mentors, posted a link on Facebook. Its kind of grim, but the subject is the top 5 regrets that dying patients have when approaching the final moments of their lives. This may seem like a complete derailling of my train of though, but this hit me today at the end of a rough stretch, and really made me open my eyes to the concept. I’ll summarize the important points, and below is a link to the full article if interested:

Top 5 Regrets of the Dying 1. I wish I’d had the courage to live a life true to myself, not the life others expected of me. 2. I wish I hadn’t worked so hard. (This was the top regret of male patients!) 3. I wish I’d had the courage to express my feelings. 4. I wish I had stayed in touch with my friends. 5. I wish that I had let myself be happier.

I believe I’m pretty good with living my life how I want to, but I am definitely guilty of #2, and there are definitely ways I can improve on #’s 3-5. If I had to adjust this list in any way and use my own regrets, #1 would be “I wish I had more time to spend with my family (that one directly overlaps with #2),” and I’d have to add to the list that “I wish I had more time to do many of the things I want to do.” Now, although I cannot or at least I do not feel as though I can easily change my occupation and simply reduce my hours, there are many things I can improve on to make my days more efficient. Namely, the treatment suite I am trying to fundraise for is one of them. Before even reading this article, I’ve been thinking a lot these past few weeks about doing a better job scheduling time off and making family vacations happen rather than throwing something together at the last minute. I feel as though I work all the time, and then when I realize I have a day off, I still come in and work half the day, and my family gets some of the remainder. Combined with my recently re-acquired passion to rejoin the Ironman brigade, I’m working on my own #1 and #2 regrets above. So, I just signed up for a few more races this year and I plan to continue using these events to not only enjoy my hobby but to include more family time and fundraising along the way.

So, Ironman 70.3 Austin on October 26th is a go for me as a quick refresher, and Ironman Cozumel / Family-Thanksgiving-Vacation-in-Mexico-and-much-needed-break-from-work on November 30th will be my getaway with the family.

Here is the link to the Regrets of the Dying Article from The Guardian.

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