Thursday, February 27, 2014

Catching Up

Folks, we've got some catching up to do.

Because you just missed the ENTIRE first trimester. 

Pay attention and get out your fat pants because we only have 24 weeks left in this party.  And if you think I’m jumping the gun on that one, two weeks ago my husband said:

Liz, I think we should go to your mom’s house and get your fat pants.

13 weeks and I had to dig out my maternity clothes.

How did this happen, you ask?  Let’s just say it did not involve a night of booze and limited inhibitions.  It did not even involve a tumble in the hay.  No, this was purely a calculated product of science, a lot of ultrasounds and over 200 injections (yes, I’ve been counting).  Three responsible letters:  IVF.  One day I’ll go back through the entire process (which took 3 months, start to finish).  Until then, I’ll recount some of the joys of the first trimester! 

Week #1 and #2:

For most women, weeks #1 and #2 of pregnancy are bonus weeks.  But for IVF women, weeks #1 and #2 are a frenzy of preparation.  After much waiting, some testing and preparing my body: on December 9th, I had the transfer.  Because of my age and history, we transferred both embryos: a boy and a girl.  On transfer day I learned two things: 1) I have a freakishly large bladder which means I got to keep emptying it ever so slightly (much harder than it sounds on paper) and 2) You can overfill a bedpan (but years of pissing myself during races prepared me for the hour I had to lay on my back in my own pee).

Week #3:

This is the week I got pregnant!  In fact it was just 24 hours after transfer when I was (slowly) walking to a store that I felt implantation.  Like someone running a zipper up and down on my right side.  I thought to myself – WOW!  It’s happening!  For the next few days, I felt assorted symptoms that I knew were probably more a result of being pumped full of estrogen and progesterone.  My first symptoms of pregnancy have always been odd and vivid dreams. Those started a few days later.  Indeed I tested positive a very early 3 days after transfer!  From that point on, I peed on probably over a hundred dollars worth of pregnancy tests to convince myself it was real. 

Week #4:

I AM PREGNANT!  But – yikes – it’s so early and I can’t tell anybody.  This is going to be a long haul of secrecy.  I also cannot workout, drink wine or coffee.  As long as no one talks to me or looks at me, everything will be ok.  To pass the time, I embraced all things holiday.  All of the time I used to fill working out or drinking coffee, I spent carting my family from one holiday outing to the next.  This year we even skated with Santa!  I really needed a Christmas intervention but think my husband knew better than to say anything.  This week I had one day of feeling “weird” – extreme nausea, fatigue.  Other than that I was symptom-free.  I went to the doctor who also confirmed that I was pregnant. 

Week #5: 

My progesterone keeps going up and down so the doctor raises my dosage; and did so every week until I was shooting 2 cc of progesterone into my rear end every night until week 16.  YOW.  This week, I kept symptom searching.  Any women who’s ever been through infertility just wants to feel pregnant – disgustingly, overwhelmingly, cannot function head in the toilet throwing up pregnant.  Like most IVF’ers, I also poked my chest repeatedly – are they sore?  Sorer than yesterday?  The answer was yes, they were really sore.  And thanks to the progesterone, they were suddenly huge.

Week #6:

I obsess every day about whether or not I am pregnant.  My HCG keeps going up but I want to be on the floor throwing up all day long just to be sure.  I worry about it not working, I worry about miscarrying, I worry about feeling like a failure yet again.  Some days I feel nauseous, other days I feel normal.  Then, on 6 weeks 5 days, I’m driving the car and feel like I’ve peed myself.  Very possible given previous childbirth and about 20+ years of track workouts.  A trip to the bathroom reveals that I am not just bleeding, I am gushing blood.  Off to the ER.  In the ER, though I am sympathized, I am not important.  I am just “threatened miscarriage” while others are having orthopedic emergencies.  Finally, I’m taken back to ultrasound with an angel of a technician who shows me the fluttering heart of a perfectly growing baby (no twins!) and the subchorionic hemorrhage that is causing the bleeding.  My doctor wasn’t sure what caused it but assured me that 50 percent of IVF pregnancies have bleeding.  Which wasn’t reassuring at all.  Tick tock.  All I could do was rest, wait and see.

Week #7:

I went on modified bed rest, doing as little as possible to resolve the SCH.  So I got lazy. This was much harder than I thought and after a week my backached, my feet longed for movement and my mind thought I can’t believe people live like this every day!  In the meantime, my mom and husband filled in with everything I usually did – cleaning, groceries, daily life with Max.  I didn’t like this but it was working: the bleeding turned into spotting which seemed to lessen the less I did (ultimately it took 3 weeks to go away).  This week I also felt increasingly pregnant.  Nausea on and off throughout the day, up 3 times a night to pee, bizarre dreams, sore boobs, racing heart, breathlessness and fatigue.  While I had cravings with Max (bacon, steak, asparagus), this time I was having aversions.  I cannot eat vegetablesWhat was usually a twice a day kale habit became replaced with only being able to tolerate white pasta covered in cheese.  I don’t even like cheese! 

Week #8: 

Still spotting, still mostly bed-resting.  I thought I was tired in week 7 and then week 8 hit me.  I’m not the kind of person who gets tired.  I’ve trained for Ironmans, I’ve trained with a newborn but pregnancy fatigue is much, much different.  It’s not a matter of should I nap, it’s a matter of I NEED TO NAP NOW.  Then you just lie down and start sleeping.  Wherever you are – couch, car, office chair, floor of child’s bedroom.  I need a 2 to 3 hour nap daily.  When I’m not napping, I’m telling anyone who will listen how tired I am.  Some days I also had strong waves of nausea but other than that, fatigue is my biggest symptom.  Along with vegetables, this week I cannot eat chicken and gag at the smell of coffee or food cooking.  I continue on my awesome diet of cheese and white pasta.  

Week #9:

Still nauseous, still tired, still spotting.  But the weekly ultrasounds have indicated that baby is thriving.  Now released from the specialist, I see my OB/GYN.  A 45-minute meeting in which several times she tells me it’s because of your history.  Apparently when you have a 4 inch thick file of “past problems” you have a history.  My history means I’m risky, I’m vulnerable, I need more attention.  It makes me uncomfortable.  It makes me realize, yet again, that no matter how healthy, normal or perfect you think you are, your body will do as it chooses, when it chooses and this – like it or not – becomes your history.  I get on the scale for the first time in a long time and realize I am on the “gain a pound a week” pregnancy program just like with Max.  Of course after nearly 10 weeks of no exercise, I also realize I have a new accessory: saddlebags.  Great place to store emergency cheese sticks in case I get hungry!   

Week #10:

Finally my nausea and fatigue are subsiding.  I am starting to make it through the day without a nap.  I am still on high doses of hormones but look forward to one more week when I can start weaning.  I visit my OB/GYN for an exam and ultrasound.  She goes through all of the extra things I need to do because this is an IVF baby.  Starting at 16 weeks, I will be monitored for pre-term labor.  At 20 weeks, a echocardiogram because IVF babies tend to have more heart problems.  At 30 weeks, weekly monitoring because IVF babies don’t grow as well.  GEEZ!  Tell me something good, lady.  No?  Lastly, I am in my 39th year which means I am having yet another geriatric pregnancy.  OH COME ON, THAT again?  Next she scans for baby and on the screen we see it there - wiggling like crazy!  She also tells me that because my spotting has subsided I can start exercising, even vigorously!  I feel like a huge weight has been lifted.  That is, until I get back into the pool for the first time and swim my 100s in 1:50.  OUCH!

Week #11:

I’m starting to feel more like myself again.  I am slowly reintroducing vegetables.  I can now eat chicken.  I am easing back into exercising.  The first time I got back on my bike I averaged 74 watts for 30 minutes.  I used to find it impossible to hold under 100 watts while still putting pressure on the pedals!  I started walking on the treadmill.  This is nothing like running but I am not confident that I should (yet) return to running.  I still have waves of nausea and some fatigue but nothing like the weeks prior.  My only new symptom is a heavy depressive feeling that leaves me sad and crying every night staring at the ceiling.  I suspect it’s the hormones but still, there’s no excuse for crying at the end of Restaurant Impossible.  This week I also have to give thought on how I will attempt to give birth.  Can’t we get through the first trimester first!?

Week #12:

I feel better than weeks past but highly pregnant.  Yet at times I question my pregnancy – I haven’t had an ultrasound in over a week.  I realize that most women with “normal” pregnancies go long stretches without them but I am becoming a product of my history.  I worry.  I wonder.  I look for signs that I am having a baby.  A sign?  Look in the mirror: I am getting bigger.  I continue to exercise less than an hour each day on days that I feel good.  At this point, good means “did not require a nap today.”  New this week: constipation and an aversion to my husband.  Coincidence?  Poor husband gets the silent treatment for 3 days before he asks me what my problem is.  I break down crying, confessing that I don’t know but this feeling came over me and I can’t do anything about it.  Late at night I’ve found myself googling I’m pregnant and I hate my husband.  Turns out there are many more like me!  I assure Chris that my aversion to vegetables lasted about 3 weeks.  Give it time and this too shall pass.  

Week #13:

I love my husband again.  But once again I am increasingly exhausted soon after I wake up – how is this possible?  I am doing some exercise every day.  I am finding some fitness shining it’s way through!  I can actually average 100 watts – look out! Cravings: ready for this?  Not since Ironman #1 have I craved Cheez-Its! (and if you google that late at night you will also find countless pregnant women who shamefully crave them too)  Not just I could go for them but I need them now to get my personality back.  Worked like a charm: ate half a box and then collapsed into a 2 hour nap.  Woke up feeling awesome.  I am getting ansty about knowing what we are having.  My gut says girl but my gut also had three weeks where it wanted nothing but white pasta and cheese so we know my gut cannot be trusted!  A few times, I have felt the baby moving.  I didn’t feel Max move until 23 weeks!  It seems early but no mother can forget the distinct feeling of early movement.  It’s either baby or monster gas bubbles (with my current level of constipation - very possible and by the way, no living thing should go without a daily poop, EVER).

Week #14:

Shouldn’t the fog be lifting?  Pregnesia (the inability to remember even your own name at times when pregnant) is at an all time high.  I can’t remember the names of half the adults I coach at masters.  Instead I call everyone buddy, champ or dear.  Apologies to all.  Instead of symptoms waning, I’m increasingly nauseous, huffy and still napping at odd times of the day as well as sleeping 9 hours a night.  I had my second dream that I’m having a boy.  So much for my initial “it’s a girl” gut instinct.  Workouts are giving me a nice boost of energy for all of 30 minutes before I go back to saying “I’m tired”, “I’m hungry” or “My pants don’t fit.”  I’m swimming 3000+ yards, biking up to an hour and I even ran outside – for 20 minutes!  Other than that, I am getting bigger.  I’m up 12 pounds from where I started.  I actually met a woman who lost weight during the first trimester.  I’ll eat a few more Cheez Its on her behalf.  That reminds me of one more thing: indigestion.  Lots of it.

And now, it’s here.  Week #15 and the second trimester!  Some say the start of the honeymoon phase where you feel more like yourself except yourself keeps getting bigger (so doesn’t that mean I feel nothing like myself?).  The past 14 weeks I woke up every day feeling like I had ridden my bike 6 hours in 95 degree heat while surviving on nothing but Power Gels and Accelerade - and dropped my salt tabs at hour #1.  I felt that good.  Now I can finally walk up the stairs without getting out of breath, make it through the day without napping and can eat vegetables again.  I finally feel like my sassy, energetic self again.  Turns out, baby is also feeling energetic as I’m feeling kicks all day.  

At times, I feel like I'm learning this pregnancy thing all over again.  Maybe in my geriatric age I've forgotten the details of my last pregnancy.  Maybe having a second child is kind of like doing your second Ironman.  You think you know what you’re getting yourself into.  You think your muscles (or body) will have memory.  You think all of this will make you go faster or feel better.  Anyone who has ever done their second Ironman knows that none of this happens.  You know nothing.  Anything can and will happen.  The same goes for each pregnancy!   With Max, I had a few days of nausea and maybe two weeks of afternoon fatigue.  I felt like myself except that I just kept getting bigger.  This time around I feel so, so different.  Last week  told Chris that at 13 weeks I felt like I did at week 30 with Max.  Which means at week 30 this time around I might need one of those cranes to get me out of bed in the morning (and, at that point, a bed pan – or two).

I’ll spare you any belly shots (I’ll leave it to the first time mothers who don’t have herniated belly buttons and stretch marks) but I’m looking forward to sharing what I’m up to and how things are going with baby! 

Monday, February 10, 2014

Saturday with Dr. Phil

On Saturday, I had the pleasure of attending a day long seminar hosted by Dr. Phil Skiba.  He’s best known in triathlon for his world championship work with both Joanna Zeiger and Cat Morrison but also coaches a handful of top age groupers.  He’s written two short but informative resources on training, both of which I highly recommend for any coach. 

The entire day was an amazing learning experience with a small group of 8 athletes and coaches.  It was entitled Data Driven Training and Racing for Endurance Athletes but it was much more than that.  Dr. Phil shared personal experience from his own coaching, research and current trends in sports science.  Currently, he’s the program director for the sports medicine program at a local hospital which means he’s reviewing and generating a lot of research.

Dr. Phil also covered a lot of “how to” with his Race Day Apollo software – it’s fairly impressive from a coaching perspective as it seems to do a lot of things that other software doesn’t do in terms of prediction models.  During the presentations, there were many graphs, charts and research results.  Throughout the day, Dr. Phil made it very clear that he’s not a genius or harboring any secrets: it’s basic physiology and models.  He also admitted that with each athlete, this approach can take some trial and error as you get to know the athlete. He shared that in finding an athlete’s edge, at times he’s put them over the edge where they need to “sit on the couch for a week and eat ice cream.”  Yet he also acknowledged that with proper communication from the athlete, it shouldn’t go that far (and as I'm sure every coach knows, this can be a problem because endurance athletes are sometimes a stubborn group who will push through and ignore their bodies – not always good, folks!).

I wanted to share some bullet points of my interpretation of the material presented (I took a lot of notes and I’m sure a few things got lost in translation).  Some is basic physiology, some is data-driven, some is research-supported (he dispels a lot of smoke, mirrors and myths out there) but most is common sense.  Hopefully you can blend it all together to gain something for your own training or coaching.  Enjoy!
  • TSS does not include real life stress; life stress will also influence training response
  • Endurance coaching is being a fatigue manager, not a training manager.
  • There are no training secrets – what works is all based in physiology & science.
  • 60-80% of athletic performance is genetically determined.
  • Good coaches must work w/in the bounds of an athlete’s limits to help them set realistic goals.
  • Always look at training w/fresh eyes, ask yourself: “what haven’t I been able to do & why?”
  • Lactate is byproduct of burning carbohydrate, not a waste product.
  • Anything longer than 90 seconds is primarily aerobic.
  • Critical power/velocity (CP): his term for where your physiology changes (FTP is similar to CP – different terms, similar concept).
  • If you want to go above CP, oxygen consumption will rise until you pop (for example, if your CP is 200 watts and you go 201, your fatigue will continue to rise there until you pop).
  • Performance is not linear; fatigue & intensity of effort increases exponentially.
  • Every time you go above CP, you tap into your “battery” & it takes this battery a very long time to recharge.
  • As you increase intensity, you increase recruitment of fast twitch fibers which fatigue easily.
  • A good athlete can hold CP for 60 minutes, most others can hold it for 30 minutes.
  • You can perform below CP for a very long time.
  • When you go above CP, expect: 1) a big drop in fuel levels; 2) a big rise in waste product levels; 3) “bad things” that happen in your muscles.
  • The amount of charge in your battery is negatively influenced by recent exercise, glycogen stores & endurance training.
  • Endurance training to increase CP improves the ability to go long at the expense of going hard.
  • To make best use of your time, specifically target the systems you will use in racing as you get closer to racing.
  • Remember, to get good at endurance sports, you should be doing mostly endurance training.
  • Research: interval type doesn’t always matter; you can be “nonspecific” & still get adaptations (sometimes “just going hard” for your interval works).
  • Research: you recover more quickly by going EASIER in between intervals; keep recovery as easy as possible (ie., in zone 1 vs in low zone 2).
  • Athletes must be mechanically prepared to increase intensity (ie,. through strides); brain needs to be trained to fire muscles together.
  • Adaptation takes about 6 weeks; especially w/the swim & run, you need the skills before you can go after the speed.
  • It takes 20-30 minutes to recover/recharge battery from harder efforts during a race (when you go above CP).
  • Power spikes above CP early on lead to a rapid depletion of your battery.
  • Remember: the tank empties fast & refills slowly so don’t empty the tank!
  • Obviously: emptying the tank on the bike impacts the run.
  • Fatigue & fitness both increase immediately with training; both decay exponentially after training but fatigue has a shorter half life than fitness so it goes away faster.
  • Every 5-10 minutes in a race, ask yourself, “Can I hold this power & get off the bike to run my best ______?”  If not, back off!
  • Power meters: in long course, use them to slow down.  In short course, use them to pace the 1st half & push/stay honest on the 2nd half.
  • Avoid going over CP for more than 10-20 seconds; if you’re going there, you had to ask yourself why.
  • Stagnating results:
    • Often from doing the same stuff for too long.
    • Under-recovery ---- > overtraining.
    • Burning glycogen from training too hard + too often (takes 24 hours to restock stores) but if you keep depleting, your glycogen stores keep diminishing & never catch up.
    • Low carb/glycogen state ---- > stress hormones increase  which over time leads to stagnation & overtraining.
    • The only way to “cure” overtraining is to rest for an undetermined amount of time (could take a week of sitting on couch eating/sleeping, could never resolve)
    • If you keep training & don’t improve, “hands off the wheels & BACK OFF” 
    • Signs you’re overdoing it & it’s time to back off; RPE increases for same watts, sleep/mood disturbances, appetite change.
  • Research: most good cyclists self-select 90 rpms.
  • You will use the least amount of oxygen at 60 rpms but requires more muscular recruitment.
  • Research: Athletes are most efficient pedaling how they want to pedal OR by pushing down on pedals (versus pedaling full circles or pulling up).
  • Because we are built for running, the downstroke is the best place to generate power (simulates running motion).
  • To improve run efficiency & economy, “JUST RUN" (more). 
  • Plyometrics help to stiffen the legs (which leads to better running).
  • Research: less flexible = more economical, more spring in each step (as Paula Radcliffe’s running got faster over the years, her hamstring flexibility – sit & reach – got worse).
  • Research: forefoot running is seen in the least economical runners; rearfoot running is the most economical.
  • Pay attention to sources of research, good ones include: Carl Foster, Exeter, David Pool, Brian Whipp, Susan Ward, Jack Daniels (also note sample size & be sure it’s done on moderately trained athletes).
  • Good journals for research (in order of recommendation): Journal of Applied Physiology, Medicine & Science in Sports & Exercise, International Journal of Sports Physiology, European Journal of Applied Physiology.
There was much more covered about testing protocols and pacing strategies but this is enough for now!  All in all it was very worthwhile and made me wish I had the opportunity to sit down once a month with a sports scientist who could sift through all of the latest research and deliver me “the bottom line” on what I need to know.  The day also reinforced something I've held myself accountable to all along in this coaching career: though it takes time and money to educate yourself, what you get in return is priceless!