Ironman Texas Race Report

The Woodlands, TX. May 19, 2012

About 12 hours after finishing Ironman St. George (affectionately referred to as “my flogging in the desert”) I was back home in San Francisco staring at the screen on Ironman.com where I kept reading the words again and again...

“General Entry for the 2012 Ironman Texas is SOLD OUT. Ironman Foundation spots are still available! CLICK HERE to register via the Ironman Foundation.”

My sane-self says, “$1300 sure seems like a lot of money for an entry fee.”

My obsessed self counters, “But you know, you ARE going to be in Houston on that day anyway.” The insanity continued, “And it isn’t like you really ran the whole marathon in St. George, so really you are perfectly capable of having a better day in less than two weeks. This would also be the perfect training day for Ironman France.”

My sane-self says, “Perfect training day for France...what...how?!?!?”

My obsessed self interjects. DO IT! DO IT NOW! Quickly...before the sane one intervenes!”

“Click.”

And just like that, I was registered. Hardly time for a recovery ride before I would re-pack the bike and head for Texas.

My friend Henry lives in Houston and we have raced many Ironman events together. I called to let him know I was racing. He was thrilled.

I asked if his friend Josh was racing as well.

Henry said, “No, Josh never signed up. But he just did the New Orleans 70.3. In fact, we did the whole race together, start to finish. It was a blast! It was his first triathlon. But, actually they cancelled the swim, so he stall hasn’t done a big event swim yet. I think he is going to do Texas next year, but not this year.”

I said, “Well great...maybe you and I can do Ironman Texas together. It would be great if we could cross the line at the same time for once.”

Henry said, “I’m in!”

About an hour later Henry called back. He said “So, I told Josh that you said he was a “loser” since he didn’t sign up for Texas. He just got on his computer and signed up for a community fund slot! So I guess the three of us are doing it together!”

I immediately felt terribly guilty.

But I was suddenly really looking forward to a laid back race where the three of us would just spend the day together working up a Texas-sized sweat.

Having just finished Ironman St. George, and with Ironman France 3 weeks away, my race plan and priorities were simple...

1. Don’t get injured.
2. Finish.
3. Have a really fun time.

At 5:00am I quietly sneaked through the front door of my sister’s house and in to the dark humidity that is the early Houston morning. I climbed into Henry’s truck and bid good morning to both Henry and Josh.

Before I knew it we were in transition inflating tires, filling aerodrink bottles and building anxiety.

The sun rose as we walked the mile or so to the swim start. We discussed strategy.

“Ok. Let’s just all stay together through the swim, and then we can head out on the bike course together.”

The water in Lake Woodlands was much warmer than last year, so no wetsuit. The organizers were allowing donning of rubber, but only with the stipulations that they start 10 minutes later than the rest of the field and be disqualified from Kona slots and age-group awards.

About 1-minute before the cannon went off, the three of us kicked our toss-away flip flops in the growing pile at the edge of the boat ramp. We waded in and started treading water near the back of the 2800-or-so strong pack.

“BOOOM!” the canon fired, and thrashing commenced.

Josh almost immediately started to have a bit of an issue. He was sort-of
hyperventilating and a bit panicked. It was after all, his first mass start.

Henry and I both waited. “No problem Josh, we have 2 hours and 20 minutes. We’ll just let everyone go. Take your time.”

We had him hang on to a rescue kayak until the mass splashed ahead. Josh was unnecessarily apologetic. Soon, the crowd was gone and we continued on.

About 20 minutes later, the 10-minute-delayed-wetsuit swimmers caught us. “No problem Josh, we have 2 hours and 20 minutes. Lets just let them pass. Everything’s cool. Take your time.” We again had him hang on to a rescue kayak until the wetsuit group went by.

The rest of the swim was calm and uneventful, albeit slow. Josh was still having some trouble calming down and catching his breath so he kept up a consistent breast stroke. He couldn’t swim freestyle without his heart rate going back up.

While we were drifting along the swim course, I did notice that the water quality was better than last year. Last year I couldn’t even see my elbows when I was swimming. I also ended up with a sinus infection for a month (as did just about everyone else I talked to after that race). So I was hopeful that the slow pace and slightly clearer appearing water would let me escape with an excess intake of water-borne pathogens.

When we exited the water, I had no problem finding my bike. There were only about a dozen bikes racked when we hit T1. I guess there is at last one advantage of a swim that takes 2 hours 8 minutes and 12 seconds.

We had a quick pow-wow in the change tent.

Knowing that this was a new adventure for Josh, I suggested pacing. The plan was for me to lead with Josh and Henry staying far enough apart to avoid drafting. Since I have a power meter, I would lead keeping an even sustainable pace based on wattage.

My typical average power output for a flattish Ironman would be 250 watts. Since Josh was on a road bike I suggested we head out at 225 to see how he felt.

At the first aid station, I looked back and they were gone. In a few minutes they caught up and said I had just dropped them. “No problem, let’s try 200 watts.”

I dropped them again. So we tried 175 watts. I dropped them again. Then 150, and I dropped them again. We then found 135-140 to be sustainable. And on we pressed through the Texas countryside.

The bike course was super-hot, but had some lovely shady sections. The terrain is varied enough to keep the boredom and saddle issues at bay.

At about the 100 mile mark, I rolled through an aid station and noticed Josh and Henry were gone. So I waited. And waited.

About 15 minuted went by before I saw them coming. They stopped at the medical tent about 50 yards behind me and I saw henry take of his helmet and lie down.

“Uh oh.”

I rode back to find out what was going on.

Josh says, “He’s done. Henry has been throwing up on the side of the road for like 10 or 15 minutes.”

I walked under the canopy and Henry simply shook his head and said, “I’m out Bro. Make sure Josh makes it to the finish.”

And then there were two.

Away we rode to finish the last 12 miles before starting the run.

After 7 hours and 23 minutes in the saddle, we were in the change tent and heading out on the run.

As we started the marathon Josh was feeling good and looking great. But as soon as I started to run, or even jog for that matter, my stomach rebelled. It was like a repeat of the last 15 miles of St. George. We only jogged a couple of miles at a 12 min pace, before my stomach just shut down completely. The only pace I could maintain was a fast walk of 4mph.

At that pace we would get in before midnight, but it was going to be a very long day.

And that was exactly what happened...6:45:14 for the run.

But we made it. As Josh and I rounded the last corner before the chaos of the finish chute, I said, “OK Josh, this is it, 100 more yards and you’re an Ironman. Now run...and go get that medal!”

We both started to run, and Josh peeled away like he had been shot out of a cannon. I was just down the straight part of the finish chute when I heard Mike Reily shout “Joshua Johns, YOU ARE AN IRONMAN!”

It was a really great way to finish indeed.

Right after I crossed the line I heard “DADDY!!!” and saw my four year-old son Alex. I handed my finisher medal to him across the fence. He promptly handed it back and said, “Can I have that instead?” pointing to the glow stick necklace.

“Sure! After waiting 16 hours and 37 minutes for me, I guess you can have whatever you want!”

Dr. Christopher Segler is a 9-time Ironman Triathlon Finisher who helps marathon runners and triathletes heal chronic injuries that don’t respond to conventional treatments. He also lectures at medical conferences about the treatment of complicated running injuries. He believes that if your doctor tells you you have to stop running, you should fire your doctor. You can learn more about self-diagnosis of running injuries and cycling injuries at www.AnkleCenter.com and www.DocOnTheRun.com

What is the Best Way to Diagnose Gout in the Big Toe Joint?

An attack of gout that affects your big toe joint may be one of the most painful conditions you can have in your foot. When gout strikes, you get pain, redness, swelling and extreme tenderness...usually in the big toe joint. If you think you have gout, you probably want to make sure that you get the right diagnosis. Getting the correct diagnosis is important for two reasons.

1. You want to make sure you get the best treatment as quickly as possible.
2. You don't want to have to change your diet and start the dreaded gout diet unless you're absolutely certain that you actually do have gout.

Gout is actually caused by uric acid crystals accumulating in the foot. The crystals actually get deposited as the precipitate out of your bloodstream and become embedded with in the big toe joint, a bursa, or even within the tendons near the joint at the base of the big toe.

There are 5 ways to diagnose gout in the foot
1. Physical exam by a podiatrist
2. X-rays of the foot
3. Blood tests to look for high uric acid levels
4. Joint fluid analysis from the big toe joint
5. Cytology (fluid analysis under a microscope)

This video, posted by San Francisco's Housecall Podiatrist, discusses all of the ways in which your doctor can arrive at a diagnosis of gout. Because gout is a condition in which uric acid crystals actually get deposited in the soft tissues of your foot in your big toe joint, it is important to actually identify those crystals in order to accurately make the diagnosis of gout.

Physical exam (even by a podiatrist) is not 100% accurate simply because gout also mimics other conditions such as an infection in the soft tissues around big toe joint, infectious arthritis of the big toe joint, or even conditions that affect diabetic patients such as Charcot foot, where the foot bones start to break. All of these conditions can present themselves with redness swelling and extreme pain around the big toe joint. Physical exam by itself is just not the best way to diagnose gout.

Foot X-rays are almost always performed in a doctor's office when you have a red hot swollen foot in order to make sure that you don't have a dangerous infection or a fracture in the foot that could be just appearing like it is gout. But x-rays of the foot won't typically show much when an attack of gout has recently started.

Blood tests in order to determine whether or not you are one of the patients that has a high level of uric acid in their bloodstream (and more prone to gout) are not really effective at determining whether or not the pain and swelling around your big toe joint is really caused by the crystals in your joint. In fact, often times these tests are negative, misleading doctors to think that you might not have gout.

A more reliable way to determine whether or not the pain in the big toe joint it's actually caused by count crystals is to perform a joint aspiration where the fluid is removed from the joint to see if there is any chalky white material that looks like collections of gout crystals. This is much more reliable than physical exam, foot x-rays, or even blood tests.

But by far the most reliable way to make the diagnosis of gout is through cytology. This is where your doctor takes the joint fluid that was removed through joint aspiration and then sends it to the pathologist so that they can look for the actual gout crystals under a polarized light microscope. If you do have an attack of gout that is causing the pain in your big toe joint, the pathologist will be able to see needle shaped uric acid crystals within the joint fluid. This is a 100% accurate method of diagnosing gout in the foot.

Dr. Christopher Segler is an award-winning foot and ankle surgeon and sports medicine podiatrist practicing in the San Francisco Bay area. He provides housecalls for people with gout in San Francisco, Marin, Mill Valley, Tiburon, Oakland, Berkeley and Palo Alto. To learn more about the causes and treatment of gout in the big toe joint, visit the gout information page at www.AnkleCenter.com. if you would like to learn about how to get the fastest treatment possible for gout, you can learn more at www.DocOnTheRun.com.

To Pop or Not To Pop: Blister treatment for runners explained by San Francisco's Running Podiatrist

Dr. Oz recently ran a segment on his television show instructing his audience to pop blisters whenever they occur on the feet. He went on to explain that if you successfully get all of the fluid out, the top layer of the blister will form a adhere down to the tissue underneath and create a "biologic dressing."

While this may be sound advice for a typical healthy woman who gets a blister from a new pair of high heels, the real question for Bay Area runners is: "Should I drain a blister" if I am a runner training for a race such as a marathon or triathlon?

The best answer is "sometimes you should, and sometimes you shouldn't."

The medical term for the type of blisters on the feet when running are "friction blisters." Blisters on the feet occur from a combination of skin friction and pressure. When your foot slides around inside the running shoe, you get friction. Rubbing the skin over and over in one spot (such as the back of the heel or ball of the foot) causes the layers of the skin to begin to separate. Fluid then seeps into this newly created space between the layers forming the blister.

Keep irritating the area and the blister continues to get bigger. Even if you simply continue to apply pressure to the blister (like pressing it against the heel counter inside the running shoe) it will continue to get bigger. This is because the fluid will try to spread outward and keep separating the skin layers. Then even more fluid seeps in to make the blister bigger.

If you keep rubbing the blister long enough, the skin on the top of the blister will tear effectively popping on its own. The blister then starts to ooze relieving the pressure as the fluid leaks out. So should you take charge and drain it yourself?

What sports medicine podiatrists know about blisters in runners is:

1) small non-painful blisters heal quickly
2) large painful blisters hurt less if drained and not irritated, but hurt more and have a slightly higher risk of getting infected if they are drained and the activity (such as running) is continued
3) blisters with the overlying blister roof removed will heal, but hurt more initially

So If you are runner with a small blister on a toe and it doesn't hurt don't drain it. It will heal quickly and has a very low risk of infection. If the fluid can't drain out, bacteria can't get in. If you have a blister that is small, put a felt pad around the blister. You need a donut shaped or U-shaped pad for this to work. You need to put the pressure around the blister and not on the blister. This will stop all of the rubbing that could make the blister get bigger. It will also stop the blister from hurting.

If you running a marathon or competing in an Ironman triathlon and get a huge blister that makes it hard to walk after the race, drain it. You can do this by poking a small hole at the edge of the blister. Heat the needle or soak it in rubbing alcohol. This will sterilize the needle so that you don't introduce any infection causing bacteria when you puncture the blister.

Cover the blister with a bandage that will soak up the fluid as it continues to leak out. If the fluid starts to build up again, then repeat this process and drain the fluid again. Marathon runners with big blisters may have to do this a couple of times. The blister can be quite irritated after running 26.2 miles.

So what are the "exceptions to the rule" about popping or draining blisters in runners?

1. If you notice the blister at mile 13.1 and still have another half-marathon to go, don't pop the blister. This is where the advice from Dr. Oz doesn't fit with runners. If you drain the blister on your heel then continue to run, more fluid will seep under that skin. The skin will slide back and forth. If the drained blister skin slides around, it can't work as a "biologic dressing" because it never has a chance to stick to the underlying raw area. The roof of the blister may also tear. That is what happened in the blister pictured above. All of the rubbing of the heal inside the running shoe caused the blister to rip open. If the roof of the blister tears, it needs to be removed (called "de-roofing" by podiatrists).

If the blister is drained, you need to secure the overlying skin in place with a dressing. Wait until the race is over. If you drain it mid-race it will hurt like hell, there is a higher risk of infection and it will take longer to heal. You also need to wear a pair of shoes that won't rub on the raw blister after it has popped. So once you drain the blister, apply a dressing that will hold the skin securely in place. Change the dressing daily. Studies show that hydrocolloid dressings works best to bake blisters heal fastest. But there is NO evidence than antibiotic ointment helps blisters heal any faster.

2. All blisters should be drained, completely de-roofed and treated by a podiatrist if you are diabetic. The risk of infection is much higher in diabetics. A blister anywhere on the foot in a diabetic runner is a medical emergency. I have personally performed many amputation on diabetics where a blister became hugely infected and spread to the underlying bone. Seek immediate medical attention if you have diabetes and a blister anywhere on the foot, heel or toes.

Although it is easy to prevent blisters, they still often occur in runners. In fact research shows that blisters on the feet are by far the most common running injury reported among marathon finishers. If you get a blister on the feet, treat it right and it will heal quickly so you won't have to miss much training at all.

Dr. Christopher Segler is a sports medicine podiatrist in San Francisco with a focus on runners. He is also a marathon runner and Ironman triathlete himslef. He makes house calls all over the Bay Area to treat running injuries like blisters, stress fractures and Achilles tendonitis. If you have a question about a running injury you can email him or call (415)-308-0833 to reach him directly. For the best source of running injury prevention information in the San Francisco Bay Area, visit MyRunningDoc.com or AnkleCenter.com.

San Francisco Podiatrist Posts Video on 1 Hour Ingrown Toenail Relief in San Francisco

Ingrown toenails are easily the most common reason that a podiatrist will see a doctor for pain in the toe. Ingrown toenails can be prevented with some simple tips:

1. Cut normal nails straight across.
2. Keep your nails just shorter than the end of the toe.
3. Avoid shoes that cramp the toes.

The most common way people cause ingrown nails is by cutting them too short. This is often in an attempt to relieve a painful ingrown nail before it becomes infected. Unfortunately, this usually backfires. But even if you try to take it out and make the ingrown toenail worse, you can still get relief. This video explains how you can get ingrown toenail relief in San Francisco in only about an hour, even without going to a podiatry office.





Dr. Christopher Segler is a San Francisco Podiatrist and toenail surgeon. He treats podiatry emergencies (such as ingrown toenails) like they really need treatment now. He drives around San Francisco seeing patients at home, in their offices or even tourists on vacation in their hotel rooms. No one needs to suffer with a painful infected ingrown toenail. If you need immediate relief from an ingrown toenail in only an hour, you can reach him directly at (415) 308-0833. You can learn more about ingrown toenails at San Francisco's Podiatry House Call Site and San Francisco's Best Podiatry Patient Information Site