Ironman St. George 2012 Race Report

Since the Houston Marathon a couple of months ago, my sports medicine practice has been too busy to keep up with the training. Overworked and moderately trained, I even had to skip Ironman 70.3 Oceanside due to a sinus infection. That particular illness left me with a period of about two weeks with zero exercise.

Since that time I had been ramping back up on the run training and putting in about 150 to 200 miles per week on the bike. However, I have only been swimming one time since last October. That short swim in San Francisco Bay at least let me remember that I did know how to swim, while pointing out my lack of fitness.

Yet in spite of my significant lack of condition, I decided to show up for Ironman St. George and take my beating like a man.

On race morning my alarm went off at 3:45 AM. I had my coffee, banana and peanut butter jelly sandwich. I grabbed my things and headed off to transition.

While walking through transition, I saw Meredith Kessler. “Hey Doctor Chris!” she said. I stopped and said, “OK Meredith, I can feel it, it’s going to be just like Ironman Canada. I will be just heading out on the marathon and you will be coming in for the win. So when you hear me screaming Go Meredith Go you will know you have another championship under your belt.

I checked my run gear bag in T2, dropped off the special needs bags and waited in line to board a school bus.

After about a 20 minute bus ride from T2 to the swim start, a engaged in the standard routine of finding some friends to talk to while waiting around for the start, trying not to feel anxious.

Swim 2.4 miles

Because I had only been swimming one time in the last 6 months my strategy was simple: get in the very back of the pack, find some clear water, and stay out of the way. I was actually looking forward to the swim, because I knew that it would be a real adventure. I was confident that I would complete the swim however was unsure how long it would take even my poor physical condition. I decided that I would relax and enjoy the day instead of worrying about time specific goals.

I treaded water amongst a group of athletes who looked far more nervous than I was. The cannon went off and away we went.

The swim went relatively well until I made the first turn. Only moments after I rounded the red buoy, I felt as if a large barge had floated by, bumping us in its wake. A few moments later and I encountered the same sensation again. It was then that I realized these were actually swells, not rescue boats causing wake. At that point, I still enjoyed it, thinking that it would make it more of an adventure.

But as I rounded the next red buoy things changed. The buoy, which normally looks like a floating pyramid, was being blown so hard in the wind that it appeared to be upside down, tugging at its mooring. Just as I was making the corner, I watched a rescue kayak flipped over on top of a group of swimmers. A large rescue boat was bobbing precariously and drifting out of control toward the athletes.

Rounding the second red turn buoy sent us heading down a one mile mile straightaway, directly into 3-5 foot swells. This was more adventure than I had bargained for. It seemed like about half the time I would swing my arm over my head I would drop off the side of a wave swinging into empty air. The waves were so big that I couldn’t even see the course.

At one point I started to tread water in order to wait until I was on top of a wave to see the course. I spotted a yellow buoy and took off after it. I would later learn that some of the course buoys had been ripped from their moorings and were blown off course. This made sense since I felt like it one point I was swimming 90° to the proper direction.

Further down the reservoir I noticed that there were about 30 or 40 athletes standing on a tiny sandstone island. I assumed that they were all standing there in order to get a visual and figure out where the course was going. But as I approached them I realize no one was jumping back in. They were all waiting for a rescue.

It was about this time that I heard another athlete screaming. I looked up and there was this guy treading water with a look of terror on his face. He looked at me and said, “how do I get a rescue boat?”

“Waive your arms above your head!” I said.

He responded with, “I can’t I have to tread water.”

I tried to reassure him, “Well you are wearing a wetsuit so you couldn’t possibly sink even if you wanted to. It will be okay. Now I’m sorry but I have to go.”

He was waving one hand over his head as I swam away.

A little bit later I started floating the try to get on top of a wave and get a visual on the end of the straightaway. I saw 4 or 5 yellow buoys stretching way down the reservoir. I couldn’t believe that I had that far to go before I made the last turn. I had already been swimming for an hour and a half. I am usually out of T1 at this point. Did I get lost?

Eventually I made the last turn and headed toward the swim exit. I crawled out of the water it one hour and 58 min. My slowest time by a long shot.

As soon as the wetsuit strippers pulled off my wet suit, I was freezing in the breeze. Not wanting to re-visit my hypothermia episode of Ironman Canada, I elected to sit in the sun and out of the wind for about 10 minutes in order to dry off before I got on the bike.

Bike 112 miles

For the first 40 miles or so we seem to be heading either uphill or directly into a headwind. Every time I looked down, I was going either 6 or 7 mph. I’m normally going about 20.

Another athlete pulled up next to me and said, “Do you realize that we might not make the bike cut-off?”

Given that I am usually in the top 20% on the bike leg, that was a thought that simply never would have never occurred to me.

I looked at him and said, “Well, when we hit that downhill I plan on making up some time.”

He expressed his concern about the wind and getting blasted in the crosswinds on a speedy descent with deep dish wheels. We were both riding 80mm rims. He explained that he had not been riding much in windy conditions with those wheels.

“Well today is your lucky day,” I said, “I ride in the wind all the time. The gusts are terrain dependent. All you have to do is stay about 100 feet behind me and watch for when I get blasted across the road. It will help to be ready for the coming gust. You probably won’t crash, even if it feels like you will. You just have to be prepared. Watch me and you’ll be ready.”

Up over “The Wall” and away we went! At one point I looked down and I was going 50.5 mph. We were making up time indeed. The downhill must’ve gone for 10 or 15 miles. Suddenly I wasn’t so worried about the cutoff anymore.

Unfortunately we had to do another loop that included the brutal uphill. The wind was better on the 2nd lap but still a serious speed killer. As we got to the long climb that included “The Wall” I made the mistake of looking up. And there ahead of me, to my dismay, a full 50% of all the athletes had dismounted and WALKING their bikes up the hill.

I decided I just wouldn’t walk. I figured it would be easier to survive the lactate thrashing of grinding much easier than the ego bashing of walking. Man did it hurt.

But then we had the long downhill and flat section heading back to transition. Plenty of time to spin the spent legs out.

Back at T2, I hopped off the bike and realized I had been pedaling for 7 hours and 42 minutes. More than two hours longer than my typical Ironman pace.

The only good news was that I had been carefully monitoring my power meter and had been staying well within my limits, so my legs felt relatively fresh. While in transition, I did the math and realized that one benefit of a bike split that was 7 hours 42 minutes long is that it makes it mathematically impossible to have a run split that is longer than your bike split.

Run 26.2 miles

Knowing that the run would have some uphill and downhill section my plan was to run the flats, run the down hills and walk the uphills. Within minutes of heading onto the run course, I was passed by Meredith Kessler. “GOOOOOO MEREDITH GOOOO!” She waived and shot around the corner toward the finish chute. I could hear Mike Riley announcing her win.

Soon I was caught by Faith Bolliger from the SF Tri Club. “Can you run Segler?” I had the pleasure of riding with her for several miles. It was great to have a familiar face and someone to talk to. But then I had a long uphill in my run slowed to a walk. And away she went…

My plan was all going well until 11 miles into the run. I was craving salt and had been eating handfuls of pretzels. But then I started to eat handfuls of potato chips as well. I could tell that this was a bad idea so I decided to back off, before my stomach revolted.

Right about that time, I was walking through an aid station when a little girl who was about age 6 or 7 said, “ would you like a cookie?”

“Nooooo, none for me thanks.”

She batted her big blue eyes and looked up at me with her head tilted sideways, disappointment verging on tearfulness, and said, “But they’re home-made. They’re really good...I promise!”

And I caved under the pressure.

“You you know what, on second thought.. thank you so much for making these cookies it’s really nice of you to be out here today. I will have one. And thank you very much!”

With every bite, it was like a swirling mental conflict. It tasted so good, and yet I knew it was such a bad idea. But down it went.

Within about 5 minutes, it felt as though someone had thrown a hand grenade in my stomach.

For the next 15 miles, I walked. And every time I tried to run, I was doubled over on the side of the road heaving.

In case you haven’t tried it, it takes an incredibly long time to go 15 miles if you’re walking. But I kept up my pace enough to ensure that I would get in before midnight, lest I turn into a pumpkin.

And with less than half an hour to go I dug out the strength to run while fought back the cookie. I ran down the final stretch, into the finish chute, and heard crowds cheering louder than I could’ve thought possible. So it is true, they do cheer loudest for those that finished latest.

At 16 hours and 38 minutes I crossed the finished. And there was Meredith, the 2012 Ironman St. George Champion, who finished about 6 hours earlier. “Hey Doc!” she said smiling as she hung my finisher medal around my neck.

I started to laugh out loud. A great end to a very long day. It had been a grand adventure indeed.

Postlude

Once it was all over, I would learn of the carnage. The final episode of Ironman St. George had a 29% DNF rate...the worst ever. 80 athletes were rescued during the swim. 40mph wind gusts caused 269 fail to finish the bike. Another 61 would drop out of the run. Postings all over the web were calling it the “hardest Ironman in history.”

I’m not sure if that label is really true, but it was certainly the hardest for me. It was the slowest time for me in every single leg. Even slower than my very first Ironman.

But there is always tomorrow. So I got home and signed up for Ironman Texas...seeking redemption in less than two weeks. And this time, I think I’ll pass on the cookie.


Dr. Christopher Segler is a 7-time Ironman triathlon finisher. He is also a San Francisco based sports medicine specialist and foot surgeon. His practice focuses exclusively on providing the best treatments available for the rapid treatment of running injuries. His goal is to help runners and triathletes stay fit while recovering from injury as fast as possible. He makes house calls for busy athletes in San Francisco, Mill Valley, Tiburon, Berkeley, and Oakland. You can learn about running injuries at AnkleCenter.com and DocOnTheRun.com

Achilles Tendonitis in a Runner...from dropping out to 4th place.

We recently received this inspiring patient testimonial from a runner who had been suffering with chronic Achilles Tendinitis that was so bad it actually forced him to drop out of a race. Dr. Segler saw him and helped him heal the Achilles tendon with some simple treatments..and NO surgery. He didn't even need a PRP injection to heal the Achilles tendon. He went on to run a half marathon, full marathon and compete with his team to win 4th place at the PA/USATF 2011 Cross Country Grand Prix.

"I'm a runner who competes in the PA/USATF. I injured my achilles (tendinitis) last summer and needed to recover before the start of the cross country season (1st week of Sept).

This injury had been bothering me chronically for the last year and a half, impairing my training and in some occasions, forcing me to drop out during races. I called Dr Segler following a drop out from a local race last July. My achilles was very painful and I had difficulty walking. I'm generally a point-scorer for the team (top 5 runners) so my return to competition was much anticipated by my teammates.

Dr Segler came to my house and assessed my injury, explained what type of tendinitis I had and gave me a number of options and treatments (I think 12 in total). Most importantly for me, Dr Segler understood my need to not become totally out of shape before the XC season. Since he is a triathlete himself, he knows what competition means, the efforts you've put into your training, and the satisfaction of a good race. For my type of injury, most doctors would simply recommend to (heavily) use NSAIDs, rest and not run at all for a number of weeks.

Dr Segler gave me additional options to maintain a minimum level of fitness while my tendon was recovering. I followed his advice to the letter and got better in a few weeks, while maintaining some training. I returned to competition on Aug 27th, ran many of this year's XC races, and contributed to my team achieving 4th place at the PA/USATF 2011 XC Grand Prix. More recently I completed a half and full marathon part of the PA/USATF road racing Grand Prix and was part of the "A" scoring team. A great feeling ! I think we will take 3rd place in the Grand Prix this season, the best the club has done in years ... Thanks Doc !"

- Patrick M., San Francisco, CA

Dr. Christopher Segler is a runner, triathlete and 6-time Ironman finisher. His practice focuses on rapid recovery of running injuries. He offers a range of services to help runners get back to running as quickly possible. He provides PRP injections for Achilles tendonitis and ESWT therapy for heel pain in San Francisco, Marin and Palo Alto. He also frequently provides second opinions for runners through remote consultations via web conferencing for complicated injuries world-wide. The best treatment is fast treatment! If you have a question about running injuries, you can reach Dr. Segler directly at 415-308-0833.

Top 5 Reasons to Avoid the Emergency Room When You Sprain Your Ankle In San Francisco

Ankle sprains are the most common of all sports injuries. Everyday nearly 10,000 people show up with painful, swollen rolled ankles. Although the Emergency Room may seem like a logical choice when you sprain your ankle, there are five reasons that you might want to reconsider.

1. LONG WAIT

The average time a person waits in the emergency room is over six hours. If you have an ankle sprain, the wait could be even longer. The reason is simple. A sprained ankle is not a life-threatening emergency. Every person who shows up in the Emergency Room with a suspected heart attack, stroke, appendicitis, or whomever gets transported to the hospital via ambulance is marked as a higher priority. Its easy to understand when you’re sitting at home reading this, but not so easy if you are sitting in the ER waiting room with a throbbing ankle.

2. COST

Care provided in the ER is expensive. In fact, the ER is the most expensive place for the delivery of health care in the United States. The hospital knows that many uninsured patients show up there with very real emergencies that cost a fortune to treat. If a guy with no insurance gets run over by a car, the ER can’t simply turn him away just because he can’t pay. As a result the Emergency Room fees are priced high enough to recoup some of the costs of indigent care. In a sense, when you go to the ER, you are paying your bill and the bill for the guy next to you who can’t pay. You could expect to pay as much as $1,500 for an ankle sprain work-up in the emergency room. If you sprained an ankle and are searching for the most expensive option, this would be it.

3. ANKLE SPRAINS ARE LOW PRIORITY

The fact is that ER docs are busy saving lives. When your complaint is just a painful swollen ankle, you can’t expect to get the same sort of attention as the patient in the stall next to you who’s going into cardiac arrest. You aren’t going to die today from an ankle sprain. In the ER physician’s mind, an ankle sprain is no big deal and one that can be treated later by a specialist. You can only expect basic first aid and a referral to a specialist. You just cannot expect specialized care in the Emergency Department.

4. MISDIAGNOSIS

ER docs are the most skilled at treated lief-threatening emergencies. But they are not that focused on non-life threatening injuries. You really wouldn’t expect the best treatment for a stroke from an ankle surgeon. By the same token, you can expect an ER Physician to provide the best treatment for your sprained ankle. An award winning-study at the University of Utah found that subtle fractures of the ankle are more than 10 times as common as previously thought. These fractures are frequently misdiagnosed as ankle sprains. Don’t expect an emergency doc to diagnose this type of ankle injury correctly. Without the right diagnosis, you won’t get the best care.

5. INADEQUATE TREATMENT

The number one risk for continued pain, ankle instability and continued ankle problems is inadequate ankle sprain rehabilitation. Because the ER docs don’t focus on ankle injures, they typically give you some basic first aid, a brace and instructions to follow-up with an ankle specialist. The ER doc fully expects you will get the care you need from an ankle specialist later. But many people don’t. The reality is that the final stages of ankle treatment are the most important. You must have an ankle expert guiding you back to strength and health.

If you sprain your ankle, you should know that most ankle sprains will fully recovery...if treated correctly. You need the best treatment to make a full recovery. If you want to see yourself running instead of limping on a weak ankle, you have to start with expert care. Knowing that the ER will send you to a specialist anyway, you can save weeks of recovery, just by starting with an ankle specialist to heal your ankle sprain fast.

Dr. Christopher Segler is a San Francisco based foot surgeon and nationally recognized foot fracture expert. In 2004 he won an award from the American College of Foot & Ankle Surgeons for his research on the accurate diagnosis of difficult to identify fracture patterns in the foot called Lisfranc's injuries (also called tarsometatarsal fracture dislocations). In 2005 he won an award from the American College of Foot & Ankle Surgeons for his research on the accurate diagnosis of difficult to identify fracture patterns in the ankle called Lateral Process Fractures. If you suffered an ankle sprain that needs the very best treatment as fast as possible, he can see you at your home with an emergency house call visit at your home or office. You can also learn more about the typical experience of an ankle sprain patient in San Francisco here. If you have an ankle sprain and just have a question about whether or not it needs to be treated, you can reach him directly at (415) 308-0833.

Do I Need X-Rays if I Sprained my Ankle?

San Francisco's Ankle Expert Explains When You Need X-Rays

If you are out trail running in Marin or Golden Gate Park and roll your ankle, your first thought is going to be whether or not you will be able to run with a sprained ankle. If the ankle is bruised and swollen, you will also probably wonder whether or not you need an ankle x-ray. This video explains how ankle surgeons and emergency room physicians decide whether or not you need to have x-rays after an ankle sprain.



Every single day thousands of people wait in line at the Emergency Room to get x-rays after they roll their ankles. After all that waiting, the ER doc will typically send you to an ankle specialist anyway. By seeing an ankle expert instead of going to the ER, you can be sure to get the best treatment for your ankle sprain. If you sprained your ankle, see an ankle expert today!

Dr. Christopher Segler is a sports medicine podiatrist who specializes in the diagnosis of sprains and fractures of the foot and ankle. Has has won multiple awards from the American College of Foot and Ankle Surgeons for his research on fractures of the foot and ankle that are often misdiagnosed as sprains. As a runner and triathlete himself, he believes that non-surgical treatment is best whenever possible. You can learn more about ankle sprains at the Bay Area's best ankle sprain info site. YOu can also learn more about ankle sprains and x-rays here. You can reach Dr. Segler at 415-308-0833.