Friday, 23 May 2014

MRI Scan | Results | Next Steps

Courtesy of Circle Reading Facebook Page
MRI Scan
After not being too impressed with my physio; having an argument with her; and then convincing the doctor I needed an MRI; I eventually saw an Orthopaedic Consultant (and lead Trauma surgeon) at the Circle Reading. The hospital is private but I managed to see him on the NHS (very lucky!).

From the outset I was highly impressed. The building looks like a modern office block and the decor and service inside wouldn't look amiss in a 5 star hotel!

After registering and taking my complimentary coffee, the Orthopaedic Consultant came out to greet me in person. I'd only been waiting 5 minutes. Very impressive. I explained the history of the injury and almost immediately he told me he was going to scan it! Yeah! Those were the words I'd wanted to hear ever since I gone the bloody injury months' ago! I asked what it could be and he suggested a bruised bone or any one of several tendons in my foot. I immediately felt comfortable with this guy. 

Circle Reading
He led me down to Radiology and an appointment was made for an MRI scan for the next working day! It was Thursday evening and the scan was booked for 7:15pm on the Tuesday. Given the two Public Holidays, I was highly impressed. I would not have got that service had I gone to Royal Berkshire Hospital in Reading or any other NHS hospital; and yet here I was in a private hospital receiving private care on the NHS. A friend of mine who works at Royal Berks (you know who you are Fran!) say this is not unusual, but I think for most people is this unusual (or at least, generally unknown about). Anyway my MRI scan was now booked! One happy Mike!

I arrived on the Tuesday evening at 7:10pm and was immediately greeted by a very friendly Radiologist who said they were ready for me. After removing all metal items from my being, she led me into the MRI room; and there it was, a huge MRI machine. 

Circle Reading
I laid down on the couch top outside the scanner and she made me feel comfortable whilst adjusting the braces around my feet. I was told the scanner will make a loud buzzing/tapping sound so was offered really comfortable ear defenders. I also had the choice of music to listen to. I chose The Killers - I definitely needed something to make me feel alive prior to entering the plastic coffin that was the MRI machine. She also gave me a buzzer that I could press at any time which would alert the radiographers should I feel uncomfortable.

I was told procedure would take around 30 minutes and before I knew it she had left the room and the bed started to be pulled into the machine. It eventually stopped at my waist. I had to lie as still as possible so the best quality images could be obtained. It was quite relaxing: I was on a comfy bed; head on a comfy pillow; listening to good music and, after a long day at work, I was almost falling asleep! Before I knew it the scan was over. I was told I'd be contacted by the consultant the following week (week commencing 28 April) for the results.

So there we have it - I eventually got the MRI scan I was after. Now it was time to wait for the results - something I am more nervous about because I suspect, irrespective of what the condition it is I have, I'll be told to stop running for a period of time...and that period, irrespective of how long, will knock-out all my long-distance running challenges this year. Let's see what happens....fingers crossed!
Courtesy of Circle Reading Facebook Page

Results
So  3 weeks and a failed marathon and successful ultramarathon later it was time to pick up my results. To be honest I was very nervous about the outcome and really wasn't looking forward to the visit.

I arrived at the Circle early (3:45pm) for my 4:30pm appointment. At 4pm the consultant came out and ushered me into his office. My heart was beating fast and before he could start I told him about my last 2 races and the pain in my foot. He remained calm and then quietly explained what the MRI showed as he read off the Radiologist's report. The full report is below in all it's medical-speak. In essence what what we thought was a damaged tendon is in actual face tibialis posterior tenosynovitis (an inflammation of the tendon sheath and not the actual tendon); whilst the MRI also picked up a number of other injuries to the foot and ankle as a whole:

MRI Right Ankle:
  • The tibiotalar joint and talar dome are normal.
  • A small tibiotalar joint effusion is present.
  • A large os trigonum is noted with a synchondrosis posteriorly.
  • Subtle oedema is present with some subchondral cystic change.
  • The subtalar joints and sinus tarsi are unremarkable.

Medially:
  • Soft tissue oedema overlies the medial malleolus.
  • There is a moderate amount of fluid surrounding the tibialis posterior tendon without intra tendinous high signal, consistent with a tenosynovitis.
  • The flexor digitorum longus and flexor hallucis longus tendons are normal.
  • The flexor retinaculum is intact.
  • The neurovascular bundle is unremarkable.
  • The deltoid ligament complex appears intact.

Laterally:
  • There is soft tissue oedema overlying the lateral malleolus.
  • The personeal tendons and peroneal retinaculum are intact.
  • The lateral ankle ligaments are intact.
Other:
  • The Achilles tendon is normal in signal, but there is a slight loss of normal convexity of the anterior margin.
  • The Achilles tendon measures 13 x 6.5 mm, 4.5 cm above the Achilles insertion. 
  • The plantar fascia and mid foot are unremarkable.

Comment:

Tibialis posterior tenosynovitis. No tendinopathy detected.

Os trigonum with subtle oedema and subchronic changes of the synchonrosis suggest a degree of posterior impingement, but clinical correlation is recommended to determine the clinical significance thereof.

Mild chronic Achilles tendinopathy.



In plain English what this means is the following:
  • I have a buildup of fluid in the ankle joint - this is what is causing the swelling in my ankle.
  • My right foot also has 'Os trigonum syndrome'. The os trigonum is an extra bone that sometimes develops behind the ankle bone. I've probably had this from birth. Only a small number of people have this extra bone. Thankfully this isn't causing me a problem at the moment...but it's amazing what they can find in your foot!
  • I have a subchondral cyst (fluid-filled sac) that is extruding from my ankle joint. Medical advice is to leave it alone. However it is indicative of early phase of osteoarthritis (breakdown of cartridge on the joint), and although the subchondral cyst improves without medical attention, the disease itself does not go away
  • I have an abnormal accumulation of fluid around the medial and lateral malleolus (the knobbly bone on the outside your ankle - mine is quite large!). Over time this will die down
  • What we thought was pain with the tibialis posterior tendon was in actual fact a damaged and inflamed sheath around the tendon, with yet more fluid
  • The Achilles tendon has been permanently damanged but this was done overtime. There is a slight loss of normal forward movement. The Achilles has also increased in size (stretched) to a point that it cannot repair itself. Again, this was done overtime. Achilles exercises from the physio should held retain movement. Need to be careful with sprint training and hills (both ascending and descending)

This means:
  • I have Tibialis posterior tenosynovitis
  • I have an additional bone, a cyst and quite a bit of fluid in the foot. This information needs to be passed back to my GP for a clinical correlation (i.e., he takes that information and compares to my entire medical history and what he knows about me to determine how significant this is and what the next steps may be if he does deem it significant)
  • I have mild chronic Achilles tendinopathy

The next steps are:
  • To let the pain and swelling disappear and then I can continue to run
  • Will be referred to see another Orthopedic consultant at Royal Berks who will look at the foot in more depth and see what can be done to mitigate further problems, given the collapsed arch I have. He will also look at the Achilles tendon. Will also likey result in new inserts to support the collapsed arch (gotta a horrible feeling I will need to pay for them!)
  • Speak to the doctor to determine whether the additional bone, the cyst and the fluid need to be a cause of concern given my wider medical history and what he knows about me
  • Continue to see a physio about strength exercises to support the collapsed arch (tibialis posterior tendon) and also the damaged Achilles.

What does this mean for my running?
I need to this about this a little more but my initial thoughts are:
  • This is a good outcome from what could have been a nightmare injury!
  • Once the pain and swelling goes down I will start back running (but gently to start with)
  • Will avoid off-road running (or running over tough terrain) for a good couple of months in order to allow the foot to settle down. This also means I will avoid wearing my off-road trainers where possible (as they are deliberately tight fitting)
  • Need to be careful with hill training/running and speed work - e.g., intervals. Just got to be careful with that Achilles, which is now actually damaged
  • Unlikely I will run the Trail Marathon Wales (due to the terrain) but 90% certain I will run Endure24 given the slower paced run and the gentle terrain
  • Will start to return to parkrun
  • Will probably take the next 5 days off from running and then start back.

Final Thoughts

I'm very lucky to get away with no damage to the tendon and that in theory I can continue to run, all be it I have to manage my runs to ensure no further injury. It's been a long and worrying time, but at least I now know what is wrong and can manage that going forward. I feel very lucky....

Friday, 16 May 2014

Product Test: Duracell Portable USB Charger

Unless you have one of the latest Garmin watches or the older 310XT then one of the limiting factors of your running watch (especially the older models) will be the dreaded battery life. For most casual runners this isn't so much of a problem. The majority of the Garmin watches on the market will last between 5 - 10 hours, with the 310XT claiming to last up to 20 hours. More advanced (and highly expensive) models have an even longer battery life, and so are ideal for long ultras and/or Ironman competitions. However if you are one of those people whose current watch has a stated battery life of between 5 - 10 hours, plan running for around that length of time or longer, and would rather not splash out on a new watch, then there is an alternative. The portable battery charger.

There are a number of these on the market and retail at around £18. The one I am testing is the Duracell Portable USB Charger 1150mAh, which I got a bargain-basement price of £8! The watch I will be using will be my trusty Garmin 305, which the manufacturers claim has a 10 hour battery life. 

Performance Claims
The packaging claims the following:
  • Smartphones: up to 3 hours
  • Portable music players (MP3): up to 7 hours
  • EBooks: up to 15 hrs
  • Bluetooth earpiece: up to 16 hours

Naturally a GPS watch is not listed so I have no idea of the expected charging ability of this little device. Hence the need for this test.


In The Box
The following was in the box:
  • 1 USB Charger
  • 1 Mini cable
  • 1 Micro USB Adapter

The USB Charger itself is quite attractive, relatively small and very light. Unlike older versions which took two AA batteries to charge, this latest version is charged by the mains or laptop (using a USB connection). This means the size and weight is kept to a minimum - very handy for when you are running with it.


The USB Charger has two connections: a standard USB and a Micro USB. The Micro is used for charging the device (input), the standard USB is for charging your external device such as watch (output).



Charging the USB Charger
Charging the device couldn't be easier. It can be done by either plugging into a standard USB port on a laptop, but more effectively by simply plugging it into the mains. Takes around 45 minutes to fully charge, with a little green light indicating when fully charged.

Road Test

I tested the device on a 9 hour run using an my Garmin Forerunner 305. Before I started I fully charged both the device and the watch, and then connected both devices to ensure the connection was firm. I also used a different cable than the one provided because I wanted it longer for ease of charging whilst running. My mobile phone cable was a good length.



I stuffed the portable charger, cable and the charging cradle for my watch into my hydration vest. After approximately 5.5 hours of running I noticed the battery indicator on my watch had gone from 5 to 2 bars. This was the time to test the charger. I clipped my watch onto the charging cradle and attached the portable charging device. I then put the watch back round my wrist. Note that it was on the last hole of the strap, so if you have slightly larger wrists you may need to fit a larger strap before the run. I then place the actual portable device into one of the chest pockets on my hydration vest. Due to the small size it fitted along side a bottle that was already stored in the pocket. I turned the device on and it started to charge my watch. So with the watch feeling a little bulky (but not uncomfortable) due to it being attached to the cradle on my wrist, I continued my run.

The Forerunner 305 allows you to continue to monitor all the data whilst charging. Other models such as the 310XT prevents you from seeing the data until you detach the charging device (a backward step in my view). I needed to see the data because I was using the navigation function and was constantly looking at my GPS position in order to follow the course.  After approximately 30 minutes of charging my watch was back up to 5 bars and fully charged. This allowed me to continue the race without the fear of running out of jungle juice. When I finished the run I still had 4 bars on my watch.


Conclusion
This is a great little device for those people who want to run long but worry their watch will run out of battery (especially good for those with a Forerunner 10, that only has a 5 hour battery life). Rather than attaching it to my wrist with the cradle I could have just attached it to my hydration vest, but on this test I needed to see the data. It did precisely what I needed and was easy to use. I'm unsure how much charge you can actually get out of the device. On a 24 hour run it may struggle to keep the watch fully charged (will give it an endurance test at Endure24 in June and then update this report), but for a 9 hour run this device was excellent. 
Pros
There are a couple of positives I'd like to highlight:
  • Cost - if you hunt around you can pick them up cheap (mine was reduced to £8!)
  • Weight & Dimensions - very light and small
  • Speed of charging - charges a GPS watch quickly
  • Multiple uses - can use it to charge your mobile phone in the case of an emergency
Cons
There are not many cons to this device for the money it costs, but there are a couple of things to note:


  • Power indicator - although it has a light to indicate when the device is fully charged, there is no light to indicate that the charge it can hold is running low
  • Whilst charging some watches you cannot see the data fields (this is a limitation of the watch as opposed to the device, but you need to be aware of that)

Wednesday, 14 May 2014

Race Report - Marlborough Downs Challenge


I finally did it - I completed my first ultramarathon!!!

To be honest at the beginning of last week and after pulling out of the Milton Keynes Marathon part-way through, I never thought I'd be able to achieve such a challenge. It's amazing what some stubbornness, single-mindedness, grit and determination, and a desire to achieve will get you; despite foolishly stepping onto the start line with a severe injury to my right foot. At long last I have found the type of running I really enjoy.

I may be hurting like hell now, but for me it was worth it. All the running I've done this past year has led me to this moment - the goal I wanted to achieve; the ability to really push myself in an environment I love (off-road). Mentally and physically it was a challenge (made worse by the injury): there were ups and there were some downs (real downs), but on the whole I will look back on this race and feel a sense of achievement; and that is something nobody can take from me.

So here is my story. A story of how my participation almost never was and how I overcame the challenges that was my first (and by no means last) last ultra.

It almost never was....
When I pulled out of the Milton Keynes Marathon (after running 24km) 5 days earlier, I swore to myself (and my friends via Facebook) that I wasn't prepared to take the risk of rupturing my tendon for the sake of a marathon. After the pain of that marathon I was pretty much resigned to the fact that I'd be out for quite a while; that I wasn't to put a pair of trainers on again until my injury had fully healed and that I'd listened to the advice of the consultant I'm seeing on the 22 May about the results of the MRI scan. Although it was the right decision I was gutted that I wouldn't be able to complete the Marlborough Downs Challenge or the two other races I have lined up this year (Trial Marathon Wales and Endure24 - both in June).

The Milton Keynes Marathon was in the Monday and Thursday was the deadline to get my Marlborough Downs Challenge place transferred to another runner. I posted adverts on various Facebook groups but had no interested (probably due to the short-notice). In the meantime my replacement Inov-8 Windproof jacket was on it's way in the post, and the OS Map I'd ordered a while back for the race had arrived. So there I was on Thursday morning with all the kit (and expense that goes with it), with a place on the run going free, and my goal of achieving an ultramarathon still not fulfilled. With the tendon starting to feel better I decided to share my desire to start the race with Stouty (Paul Stout - a fellow Newbury Runner and someone who's ran a number of ultras). Although he thought I was crazy to start, he did at least understand why I needed to do it. Most of all he wasn't judgmental - and that was something I greatly appreciated. What I didn't need was someone questioning my decision. We agreed that I wouldn't post anything on Facebook for that exact reason.

The reason why I chose to run was simple: I know the consultant on the 22 May is going to tell me to stop running for a while, and I know for various other reasons that it may be a long time before I'll be a position to train for and run an ultra. I could not let my running end on a failed run that was Milton Keynes. I needed to do this for myself. A real challenge; a desire and need to push myself. Yes I was in pain with the ankle, but if I ran carefully then I had a chance of completing the race. I didn't care about times - he only times I needed to focus on was making the cut offs for each of the Checkpoints. So not knowing when the next opportunity would come about I made the final decision to run on the Friday morning. This was it - I was going to do it!

All in the preparation
One of the things that really appeals to me about ultra running is the fact you have to self-navigate the whole run. Runners are given some basic directions (not always clear) and the grid references of the Checkpoints. For this race, which covered a distance of 33 miles, there were eight Checkpoints. The Checkpoints had food and water and your time was captured by the marshals manning the Checkpoints. In order that I didn't get lost I made sure I planned this race properly and gave myself plenty of back-up options.

The first thing I did was plot the route on the OS Map I'd bought. This was a labour-intensive activity. I plotted the map whilst also using Google Earth and the course GPX file I'd uploaded. This was really useful as it allowed me to see the route and not just plot it on a map. This whole exercise took me ages. At the end though I had the whole route mapped out. The Checkpoints were marked and then joined by a yellow high-lighter pen like a huge dot-to-dot. The plan was to use the written instructions in conjunction with the map and then as backup to use my watch. In order to use my watch I needed to upload the route GPX to it. I'd never run a course following the navigation function on the watch, so it was always going to be a risk. I knew the GPX file was right because I'd used it with Google Earth, so that at least gave me some confidence.

Watch & Charger Powering Up
I also needed to fully charge my watch. The Forerunner 305 has a battery life of 10 hours, but given it's age I wasn't sure how many hours it had left in it. I therefore decided to take on the run the portable USB battery charger I'd bought a while back but only briefly tested. I will shortly publish full review of the device in another blog entry. In essence you plug the device into the watch whilst running and it charges the watch whilst also giving you all the stats you need.

So with the navigation and technology sorted, I then focused on food and hydration. Now I have to be honest here it took me a while to figure this out. My hydration vest takes a 2 litre bladder on the wait and room for 2 water bottles on the chest. After much consideration I elected to go for 2 water bottles: one for the electrolyte and one for the water. I used the room where the bladder should be to carry extra stuff. I'm not going to list everything I packed away as it was embarrassing how much stuff I took (and didn't need). I'm an ultra virgin so I can be forgiven. I also stocked up with gels, nuts, wine gums...the list was endless. So there was I was, ready to go...I now just needed some sleep before the big day.

The big day
I got up nice and early and decided to stay clear of the porridge. After recent experiences I've learnt my lesson. Instead it was 2 humus-coated bagels, 3 slices of toast with Marmite and 2 Weetabix, all accompanied by strong black coffee. I packed everything up, said goodbye to Mary and Xavier, and at 7:15am headed off to Marlborough. 

Registration was held at Marlborough Leisure Centre and it was a very quick and easy process that took minutes. Whilst writing my contact details on the back on my bib number and attaching it to my leg, I started to chat to a fellow runner. This was the second time he was running the event and gave me some top tips - especially about the first hill! What struck me most about this event was the low-key nature of it. In total there were only about 120 runners, but it seemed so friendly and everyone seemed to want to help for offer advice. I checked a large OS Map that had been stuck on the wall and which outlined the course. Hay the route matched the one I plotted out! At least I still have the old mapping skills I was taught when I was a teenager in the Air Training Corps.

Whilst sitting waiting for the race to start I was struck by how much older the field seemed when compared to other shorter races I'd taken part in. I got the impression that although there were a few 'newbies' like myself, many of the runners had been doing this sort of thing for years and the ruddy complexions of the older runners and the high-tech kit of some of the others seem to be evidence of this. I overheard conversations about other ultra events and got a sense that for some this was just a training run for a far more difficult challenge, thus making my previous experience of one solitary road marathon seem quite pathetic.

We eventually made our way to the start line, which was in the grounds of Marlborough College. At this point I accessed the course on my watch and to my amazement it found the course and told me I was at the start! I planned on following the other runners until they all left me and then use the race instructions and map to navigate my way to the end. The watch was there just as a backup.

The race
Soon enough the short pre-race brief was given, during which the speaker advised to the nervous laughs of the crowd that the weather looked fine (in an ironic way) and that there was a 'little' mud (not sure anyone believed him!). With a low-key "5-4-3-2-1" we were off at a gentle pace out of the college grounds and within minutes heading up a steep and very muddy and slippy gully out of the town. Already I could see a pack of runners at the front disappear into the distance and onto the skyline and pretty soon we were approaching a steep decent through a field of cows and onto Checkpoint 1 in front of Clatford Bottom Woods. Within these first two miles I had already climbed muddy inclines, climbed stiles, jumped logs and managed to negotiate a field of cows and already I was enjoying the nature of this event, albeit I still had 31 miles to go.

The following 4.4 miles were hard going. Trudging (or wading) through heavy sticky and deep mud (up hill and through woodland) was really hard work. I had to be really careful of my ankle so was taking it easy. I kept glancing at my watch and to my amazement it was taking me on the right course. After passing through a second area of woodland the route veered uphill again and onto the ridge line of Tan Hill Way. It was here that the field began to spread out and I found myself running with a woman who'd run the event a couple of times' before. Being so high and exposed  there was quite a string head-wind and whether it was intentional or not we seemed to take it in turns to take the lead. Wonderful views could be seen to our left over the Vale of Pewsey and I found myself appreciating the scenery.

Checkpoint 2 was at the bottom of Tan Hill Way at about the 6.4 mile mark, crossing the Alton Barnes / Lockeridge Road. I had a quick cup of orange juice and was offered Jaffa Cakes, fig rolls, Jelly babies and other goodies. I took a couple of each, chatted briefly to the woman with whom I'd been running briefly with, then headed through the Checkpoint and uphill again over undulating grass paths onto the Wansdyke path, a medieval earthworks. I have to say this was more a walk up the hill, since the legs were sapped a little due to the mud. By this point we were joined by another woman and we were happy to take it easy on the uphills.

The next couple of miles were solo running passing the highest point on the course of Tan Hill before then heading downhill again towards Checkpoint 3. It's at this point the course splits sending runners that don't make the 2 hour 20 minute cut off time onto a 20 mile route. I fill my electrolyte bottle with water and half filled my water (or I should say the kind marshals did this for me). I munched on another Jaffa Cake and fig roll and took a gel. My legs seemed to have recovered from the mud.


The next section was along the Wansdyke for a further 1.5 miles. Running along the Wansdyke was a fantastic experience - the manual effort required to create this defensive work must have been incredible - still I was pleased they had created it. Running at an elevated level made for good views, the occasional gaps in the dyke did mean some technical running with a very quick down followed by a very quick up. Before long I was taking a left turn onto a farm track towards Bourton and Bishops Cannings. My watch was still giving me reliable navigation and I'd yet to look at the instructions or map. I also remembered this section from Google Earth.

The target in my sight was the Canal Tow Path. This required coming off the track, running around a couple of fields and then crossing a field to reach the canal. I have to be honest, reaching the canal section at around 12 miles I was starting to go through my first "lull". I was getting frustrated with having to constantly watch my footing due to the ankle and this was slowing my pace right down. The run along the canal to Devizes was just painful. It was slippy and I was constantly stopping to walk through mud as I didn't want to risk slipping and hurting my ankle (tendons) even more. This was sapping the energy from me; I had no spark and was really struggling to motivate myself to continue. I just wanted to reach the next Checkpoint. I passed a woman who had fallen and was bleeding. She must have called a marshal because he was there looking after her. My hydration vest was also starting to feel very heavy. I'd packed too much and was now starting to realise that the Checkpoints had enough food that I didn't really need to carry any.

I eventually hit Checkpoint 4 (around 15.4 miles) and the heavens opened! Despite this the marshals were so friendly and I was joined by other runners who were behind me. This seemed to lift my spirits somewhat. I was determined to finish this race and not pull out. I drank a few cups of orange juice, munched on yet more Jaffa Cakes and fig rolls, ditched some crap from my hydration vest (bars, gels, wine gums, nuts - basically anything with weight). I left a few gels and that was it. As I left the marshal apologised in advance for what I was about to face.

It was raining and I was faced with the very steep climb up Roundway Hill. This was a slow walk - in fact, it was probably the slowest I'd moved thus far. Every step just sapped energy. I couple of Irish guys came up behind me and we exchanged pleasantries. Half was up was a track and a couple of spectators where encouraging me to continue. I mumbled "thanks", gave them a smile (their presence really did help) and then continued up. When I eventually reached the top (in what seemed to take an eternity) I collapsed on the floor for 3 minutes or so to rest the legs. By this time there was nobody in front of me. My watch was still going good and the next section was through a small wooded area. I came out onto a downhill track and it was at this point my printed instruction blew away for the sheep to read when they get bored (the story of an ultra virgin and his lost instructions). 

I could see Checkpoint 5 in the distance. The rain started to come down heavy and the wind was blowing hard. The poor marshal was soaking wet, but he was really cheery. I felt much better on reaching this Checkpoint than I did the last. I grab another drink of orange juice, some Jaffa Cakes and Jelly Babies and then he pointed to where I needed to go. Yup, you got it, another hill! This time it was Morgan's Hill. I walked most of this hill. When I got to the top there was an open field with a slight ascent so I could not see over it. Although I had the map with my, I had yet to use it because my watch had such a sterling job. My watch was telling me which direction to run across the field. As soon as I went 3 or 4 meters out it will tell me I was off course. It eventually led me out of the field and into a farm. Nice one Garmin!

My little Garmin watch was a trooper, however I did encounter a couple of navigational issues which although not serious did cost me time (and gave me a little frustration). The first was it telling me to cross one field into another but I could not find the stile. That was my fault as opposed to the watch; I was wasn't paying attention to what it was telling me.

My second navigational error was caused just after the first. My watch was telling me to go through a small wood, so I made a left turn. Something didn't seem right though, so I back and tried to go around the wood (but there was no track and my watch was telling me I was way off course). I was getting a little frustrated at this point. Just as I was about to pull the map out, I spotted 2 runners across an open (but ploughed) field. I crossed the field but they said they were struggling to find the next Checkpoint. They then headed up an hill. I looked at my watch and it was telling me I needed to head in the opposite direction. I followed my watch and it eventually told me I was back on course. As I was running along it I was joined by the other two runners who had seen what I was doing and cut through another field to join me. The three of us could see a barn that marked the next checkpoint. My watch was really helping me.


Fantastic navigation
Checkpoint 6 was around the 21 mile mark. It was manned by a young couple and their two young children and dog. They were so friendly, but I couldn't face another Jaffa Cake, fig roll, Jelly Baby or gel. I topped up the electrolyte and water and then headed up the very steep climb to the top of Cherhill Hill. This was a single track, very muddy and very slippy. I walked the whole way, slipping a few times. This whole running lark through mud was really impacting my time. Had I been 100% I would have run some of the really muddy bits, but with a dodgy tendon I just could not take the risk. Upon reaching the top of the hill I could see the summit of  Cherwell Momument.

I'd heard stories of people taking the wrong path once they reach the summit and having to re-do it. Thankfully my watch told me the exact direction I needed to take. I was rewarded with a lovely downhill section where there were again a couple of spectators cheering me on. Eventually I hit the Old Bath Road track towards Avebury. After running along the track for a short while I came out onto the A4. This was the only section of the course that was on a main road. I ran along the A4 for about a mile then cut left just prior to hitting Avebury. Running along a narrow but very slippy track (so was walking bits of it) I eventually hit Checkpoint 7 - the penultimate checkpoint. 

Getting to Avebury and its gaunt stone circles meant the marathon distance was out the way; anything beyond this was ultra territory! I couldn't face food but was offered a cup of coffee just as it started to rain again. Thankfully we were under a barn shelter. I was reminded about the cut-offs so set off. It was the first time in the whole race I'd even thought about cut-off times. I needed to reach that final checkpoint before the cut-off. I grabbed some salted crisps that were on offer and headed off. The marshals were excellent as they had been at every Checkpoint, full of encouragement and with an array of sweets, water, cordial and Jaff Cakes laid out (even in the rain).

I ran through the centre of Avebury passing a few disinterested tourists and onto a slow climb (run-walk) towards Overton Down. This incline just seemed to go on forever, but when I got to the top the marshals were packing up. I'd miss the Checkpoint 8 cut-off by 4 minutes! I was gutted but not down-trodden. I just shrugged. Frankly I didn't care. I'd come this far and by god I was going to finish back at Marlborough Leisure Centre. There was no point in me trying to race back - even if I got back by 5:30pm (end of the race), my time would not count because I miss the final Checkpoint cut-off. So I just continued, knowing the end was near (and there were no more hills to face!).

After cutting along side a number of fields I came out onto a quiet county lane and 50m up the road was the finish line with a couple of marshals and some organisers standing there. They all cheered as I crossed the lined. I'd done it; I'd completed my first ultra marathon!

I was congratulated and I told them that I didn't mind not getting a time; finishing was more important. I was given a blue mug which was absolutely awesome. I will cherish that mug; I earned that mug! There was an 8hr 30 min deadline for the race and I crossed it in 8hr 4 mins. But I don't care. On any other day and without my injury (and over cautiousness with the mud) I would have easily made the cut-off. I hobbled over to the leisure centre and eat some warm food they'd put on. There were a couple of runners still around, but on the whole most had gone home. I didn't care; I was left with my thoughts and how proud I was of myself to achieve something like this with such an injury.


Conclusion
There are some who thought I shouldn’t have run this race; and I have to be honest they had valid reasons. Only a few days earlier I’d pulled out of the Milton Keynes Marathon part-way through due to my injury; and although I completed the Manchester Marathon a month ago, I struggled in the latter stages due to the same injury. My physio (now ex-physio) told me not to run these races. However,  sometimes you just need to do what you think is right; listen to your body and take some calculated risks. Not only did I complete the Manchester Marathon but one month later I completed my first Ultra. Neither were perfect races due to the injury, but at least I completed them and took great satisfaction from both. More importantly I had the balls, commitment and confidence to attempt them with an injury, and I even threw in the Milton Keynes Marathon for fun!

This race, my first ultra, was hard. No denying that. Running 34 miles (55km) is tough when the only long distance running of late was the Manchester Marathon. Neither my training nor the races prior to this event stood me in good stead due to the injury (both physically and mentally). In actual fact on this race, although my ankle hurt at times, I made it through unscathed. For a few days after the race I had some inflamed tendons, but ironically not the main tendon I have the issue with!. I made the distance over some ankle-killing terrain because I managed the situation and environment carefully. Yes it meant running slower; yes it meant ultimately not getting an official time (by 4 whole minutes!); but it also meant I could complete the distance and course and feel a great sense of personal achievement. Imagine what I could have done without the injury?

This experience has now made me want to run another ultra, and another, and another after that. I enjoyed it so much. I found it more rewarding and more challenging than any standard road marathon. Over this distance (and greater) it is not about how fast you run, it is about how you run, how you manage your strategy and navigation, and the sheer determination and commitment to put one foot in front of the other and push for the finish line. As Stouty once told me, and which I now apply to all my races: better to try and fail than never to try at all. Well I tried and I completed, and that is something nobody can take from me…

Lessons Learnt
Given this was my first ultra, there are naturally a few lessons I learnt for the next:

  • Don’t pack so much stuff – it weighs you down and it is not needed when you have good aid stations
  • Keep an eye on the time – I didn’t look at the time once during the race; if I had done then I may have pushed a little harder during Checkpoint 6 or 7 to ensure I made Checkpoint 8 before it closed
  • Limit the number of sweet things – it got to a point in the latter stages when I could not hack anything sweet like gels, Jelly Babies, etc.


I’m sure as I reflect more there are other lessons to learn.

What went well?
I was quite surprised that a lot of things I’d been testing out in training, although painful at times, worked out well for me in this race. They include:

  • I didn't suffer from any blisters, despite off-road trainers I've not run many miles in (mainly down to a good pair of double-layered socks and Vaseline)
  • Hydration was perfect for this race. I took the right amount of water, electrolytes and salt to ensure I was fully hydrated and didn't suffer from cramp
  • Navigation on the watch – worked amazingly well!
  • Charging my watch on the go whilst also following the navigation. I’d tested it in training and worked a dream on this race. My watch has 5 bars, when it got down to 2 I charged it; 30 minutes later it was back up to full charge. Result!
  • Wearing my glasses. I tend not to wear glasses when running due to sweat, rain or misting. But I can’t see without them. This is okay for a road race, but more difficult off-road. I needed my glasses for this race, not just to see where I was stepping but also other runners and land marks in the distance. I wore a cap and it kept the sweet out; although when it rained it was a pain but that is something I will need to get use to
  • My hydration vest worked well. Almost 9 hours of running and it didn't rub once. That can’t be said for all packs….

What next...?
I’m going to take a while off from running to allow my injury to heal itself. I will see what the consultant says on the 22 May and then make my final decision. I suspect a summer (or at least a couple of months) without running will be a good thing. As I say, I will see what the consultant says and will listen and act upon is advice.

In the meantime I can reflect on my achievements over the past 4 weeks whilst sitting in the sun, chilling out with a beer or two, and eating some BBQ food without thinking about training. I’ll be making the most of it because rest assure, like night follows day, I will be back training again. A second ultra has my name on it…..

Thursday, 8 May 2014

Race Report - Milton Keynes Marathon

I'm not too sure how to start this blog entry because I am feeling quite low at the moment.

I did not complete the Milton Keynes Marathon. I withdrew from the race after 24.5km due to pain in my tendon; the only race I have ever withdrawn from. As many of you will know from my previous blog, my confidence going into this race was low. The primary cause of this was two-fold: firstly the pain to my right posterior tibial tendon (the main tendon moves the ankle and which I am awaiting the results of an MRI scan on); and secondly my self-diagnosed (although will probably be picked up as part of the MRI) tendinitis on the top of my right foot. So with injury a problem from the outset I started the race with a real confidence issue.  

If there is anything positive I can take from this failed race then it is the following: 

It's the first race I've run where I've been thinking about my family and the consequences of my actions as opposed to being 100% focused on my ability to complete the run. 

This is a first for me. For the most part once I'm at the start line I am purely focused on the race and nothing else comes into my mind. Not today. My wife and son came to my mind quite a lot, and ultimately it is because of them that I withdrew. So with that in mind, let's begin the post-race analysis so I can explain my thought process in more detail and what the immediate future does / does  not hold for me.

Pre-Race Stuff
I woke up on Monday morning and my first challenge was to eat a bowl of porridge without gagging. I really do hate the stuff: hated it as kid and hate it even more now. I even tried to hide the taste (and texture) with fruit, but to no avail. So porridge consumed I headed out to Milton Keynes on what was a very sunny (and warm) day.

The pre-race organisation was good, and the football stadium was the start and finish to the race. I wasn't nervous about running; just worried about my tendon and whether it would hold up. The start was crazy: so many people packed into a narrow road (around 6,000 I think). I had trouble finding the 4 hour pacer but I eventually found him. I planned on sticking to him like glue and to see how far I could go.

The Race
The hooter went off (but I could not hear it) and we all started to shuffle past the start line. There were quite a few people following the 4 hour pacer and the first couple of km were a little frustrating as I was tripping over people who were running really slow. Nothing wrong with running slow (I'm a huge fan of it), but I just feel they started in the wrong position which meant faster runners were coming up from behind and tripping over them. Strangely I didn't find this an issue at Manchester, but it was a huge problem here.

First 13km pace
As we made our way through the pack I stuck with the pacer and even chatted as I ran along side him. The pace was comfortable although the temperature and humidity on the day was high. The pace to run a 4 hour marathon is 5:42 min/km; however the pacer seemed to be running somewhat faster, and I could hear a number of runners comment on this. I asked the pacer what the expected finish time would be and he informed me he was going for around 3hrs 56 mins. 

At both the 5km and 10km I looked at the average pace on my watch and we were clocking around 5:33 min/km. This was slightly quicker than I was planning on running, but the pace felt comfortable. Running with the pacer also seemed to help.

This was supposed to be a flat course - yeah right! All we seemed to do for the first 10km was go up and down hills, with sharp corners for the loop-backs. It was a little leg-sapping. The crowds were good but far less than in Manchester.

                                                  Fighting the Demons
Remaining kms
Despite feeling the pain in the tendon from the start of the race, and more especially when we turned corners or went up hill, it wasn't until the 17th km that I started to feel the tendon tighten up to a uncomfortable level. This was not a good sign. I stopped to stretch it a few times, by which time the pacer was in the distance and there was no way I could catch him. I carried on but my pace slowed as I was concerned about the tendon; this was a repeat of Manchester: start/stop, start/stop; it was energy-sapping because I had no consistency in pace. I didn't want to give in. I wanted to complete my second marathon. I trundled on past the half way point and was wondering how I'd finish. Deep down though I really wanted to continue...that was until I saw something at the 22km that changed my whole approach to the race.

There was a woman collapsed on the floor with paramedics surrounding her - she looked unconscious. A lot of runners started to slow down; it wasn't a very pleasant sight and it started to make me think about my wife and son. If I were to rupture the tendon then what would the consequences be? I don't want to spend the next 12 months having reconstructive surgery and intensive physio on my tendon, and therefore unable to play with my son or even drive to work for a good 2-3 months. I was also thinking of the Newbury runner who died at the London Marathon. All these factors started to play in my mind.


Decision to Pull Out
No sooner had these thoughts come to my mind than I made the decision to pull out. I ran to the next marshal and withdrew from the race. It was not worth the risk; not for a marathon and given the injury I have. 

Post-Race Feelings
I started to feel pretty depressed; and that feeling hasn't really disappeared (even now, 3 days after the event). I'm frustrated, angry and disappointed. These feelings are not necessarily about the actual pulling out of the event but more a realisation that I really need to stop running to allow the tendon to heel (however long that may take). I feel like a bit of a failure at the moment.

What the Future Holds
To be honest I'm not sure. Much of this will depend on what comes back as part of the MRI scan. I suspect my running season for 2014 is over; and given I wasn't planning on running much next year, then I think it will be a good couple of years more before I get back into it. So what does the future hold? It holds uncertainty until I at least get the MRI results on the 22 May. Both the Trail Marathon Wales and Endure24 (both next month) are almost certain to be scrapped from my calendar (can't see the Orthopedic Consultant saying to me on the 22 May: "Yes Mr Nicholls, you've well and truly fucked up your tendon, and of course you can run those two races - one being a tendon-crippling woodland marathon in Snowdonia and the other being a suicidal 24 hour race"). Okay, that may not be the exact words he'll use, but you get my point. Not running those races really pisses me off.

Lessons For Other Runners
Two major lessons:

  1. Starting a marathon (or any race come to think of it) with an injury is not advisable, both physically and psychologically
  2. If you have to run a marathon (or any other race) with an injury, then know when to pull out of a race!


Conclusion
Not really sure how to conclude this blog entry since all my feeling are laid out above for everyone to see. I made the right decision to pull out, but that is little comfort when I know I'll be pulling out of the rest of my races for this year. I'm a pretty shit runner really, but I do enjoy it and it helps me stay in shape (sense the irony in that statement!). So no 2nd marathon medal this year, nor an ultra experience. At least I got to run a marathon; and not many people can say that...

Monday, 5 May 2014

Taper, Taper, Taper...

No sooner had I recovered from Manchester and back in training than I'm back to tapering again! Unlike tapering for Manchester (which involved only 1 week of tapering), this time I'm allowing two weeks (partly to rest the legs and partly to rest my right foot).

NRs - Off Road - Snelsmore
My only run during my first week of tapering was an off-road run around Snelsmore Common with the Newbury Runners. The plan was to meet at the car park opposite the Castle pub in Donnington; however I wanted to use this run for a number of purposes:

  • To get my feet used to running in my off-road trainers again (not worn them since December 2013)
  • See how my tendon and wider foot would react to wearing off-road trainers, as they do not have a medial support and are purposely tight-fitting
  • See how much water I can comfortably carry whilst running (with one eye on the Marlborough Downs Challenge in a couple of weeks)

I therefore decided to run from my house to the Castle pub (approx. 5km) and was joined by Simon Adams, another Newbury Runner.

This was an enjoyable evening run, with lots of mud. I deliberately ran slow, but my foot became very painful very quickly. It was the twisting and turning through the woods that did it. Greg and Jason were funny in trying to navigate through the woods and there was certainly a lot of back-tracking; this made it even more fun. I was deliberately going at a slower pace than everyone else as I was testing the above items out. After the run my foot started to really hurt. On this run I discovered the following:

  • I now have major concerns about off-road running with a dodgy foot - this puts not only Marlborough but also the Trail Marathon Wales (in June) at risk
  • My off-road trainers are naff at gaining traction on the road (they are designed 100% for off-road; as soon as you run on a road they loose their grip!)
  • When my hydration vest is fully loaded with water (2 * 750ml bottles on the front and 2ltrs in the bladder) it becomes too heavy to run with over hilly terrain. I need to make a decision on race-day: uses bottles or use the bladder. May get away with both if I use my smaller 500ml bottles (one of which leaks slightly)

The total distance I covered on that run was 18km; 8km of which was off-road. I miss running off-road; I would do it more if it wasn't for the tendon.

Another Parkrun PB!!!
Having only run on Wednesday I was in theory more fresh for my next Parkrun PB attempt on Saturday; or so the theory was.

New Parkrun PB of 23:20
I set the Virtual Partner to pace me at 4:30 min/km. This was ambitious as it would have given me a 22:30 time; however I was hoping that should I not fully hit that pace then at least I'd still come under the elusive sub-23 mark. I met my race partner from last week (Brian) at the start, and we headed off.

We tried not to make the same mistake as last week and get stuck in the crowd for the first km; in fact we made completely opposite mistake and went out too quick. I clocked 4:17 min/km for the first km - this was too fast for a controlled run! As I reduced the pace a little Brian just kept on going - that was my motivational pacer gone; I was on my own with only my watch to motivate me.

I kept a fairly consistent pace for the next two km at 4:33 and 4:35 respectively; however I started to find it hard to breath and took a number of short stops to catch my breath. The 4th km was done in a terrible 5:06 min/km and I realised I was way behind target. The final km was just painful but I did it in 4:42 min/km for a total race time of 23:20 and a new personal best. I shaved 7 seconds off last weeks' time. Okay, not the sub-23 I was after, but certainly going in the right direction. In the end I stopped 5 times - last week I only stopped once! I need to get the pace right in that first km, as that is having a huge impact on the remaining race. I did however get a new maximum HR of 190 bpm. I've come to the conclusion that I'm now starting to enjoy Parkrun again and that perhaps I should come more often.

Free Run - Tendon Tester
Immediately after completing Parkrun I then set off on what would be my final mid-distance run before the Milton Keynes Marathon. My foot felt fine during Parkrun, but no sooner had I set off than it became sore again. This was what I like to call a "Free Run" - i.e., just running without the constraints of time, pace or HR. I can run as fast/slow as I want; stop when I want; and never look at the HR. They are certainly more enjoyable runs and the the kind of runs most people do when they are not in training. All my runs this year have felt like I have shackles on; mechanisms for controlling training. I'm looking forward to the days of not training....

Variation on the Tesco - Garden C
The route I took was a slight version on the Tesco - Garden Centre loop I did last week with a total distance of 17km. It was a pleasant enough run but I had to stop an awful lot of times due to my tendon. It was really sore and as I was running I was pondering whether I'd actually make it to the start line at Milton Keynes. This 17km was a struggle - a marathon is 42km! My running has been on borrowed time; I should have stopped running a long time ago (when I first got the injury) but through stubbornness on my part I've continued. Maybe this run (and the one earlier in the week) is a sign that perhaps my borrowed time is starting to run out.

I completed the 17km run in 1hr 44 mins but it felt like I'd been running a lot further and for a lot longer. So ends my first week of tapering. A huge reduction in mileage with some highs and lows. The final week of tapering (where I do very little running) is probably something that my body needs...and my confidence (which I have very little of at the time of writing). 

Zone 2 Taper Runs
Having taken a few days off to allow my foot to calm down I then went out for the first of three gentle 5km taper runs around Wash Common / Wash Water. These are pretty uneventful runs and they are gentle plods. They only really serve two purposes: firstly to get the legs moving as I'm stuck behind a desk most of the day; secondly it helps psychologically since doing no running at all for a week is pretty depressing, so getting out for 30 mins or so is a good thing for the mind. Fitness-wise they serve no benefit, since I will neither lose nor improve my fitness within a single week.

Despite what I just said above, the taper runs this week are also there to update me on the state of my foot. The first run was not good. I could feel the pain on the top right hand side of my foot. I have a feeling this is tendonitis - not good when you are just about to run a marathon! My second and third taper runs were also uneventful - so much so they are not worth writing about. The only thing I will say about them is that my HR monitor is playing silly buggers, and that my foot is still sore. Nuff said really.

So am I ready for my 2nd marathon?
The answer is no!

Despite pumping in some good mileage after Manchester, the past two weeks through tapering has meant I've felt sluggish. My foot is still sore and that is giving me a concern. Unlike Manchester when my foot was not sore before going into the race; this time it is sore and I also have the knowledge of knowing the pain this will play during a 26.2 mile slog. And that is what it's going to feel like on Monday: a slog and a painful one at that. I just hope I can complete it... I will be taking painkillers before, during and after the race...

So there I will be at the start line on Monday: not feeling healthy and also seriously injuried. I should pull out...but I can't. I need to run it...and follow it up 5 days later with my first ultra. Time is running out and I need to bag these races whilst I can...the realisation of the enormity of my stupidity is starting to dawn in me. In order to counter the physical pain of running these two races I need to be 100% focused and my mind and desire to finish needs to be strong.

I have just two runs next week - just two little runs. Please body and mind. Please get me through them...