What is a Real Runner?

A couple of days ago I had an interesting conversation with a woman. We were talking about exercise, not just for fitness sake, but for enjoyment. About fitness as a lifestyle worth living. I asked her how much she runs, and she explained that she “only runs a few miles several days per week.”

“You seem like a real runner,” she said.

I remember feeling an involuntary wrinkle in my brow and being taken aback for a moment. 

Because even though I started running as a kid and I still run a lot today, I don't actually didn’t think I ever perceived myself to be “a real runner.” 

When I think of a real runner I picture Karen Gaucher, Ryan Hall, Deena Castor and Meb Keflezighi. I tend to conjure mental images of people who have dedicated their lives to running in ways that I never could. In someway, I think I had classified a real runner as somebody who could consistently run 100 miles per week during their training periods or win races.

A real runner, I had always thought, never loses that focus on the future. Keeps her eye on the goal. She visualizes achieving her aim. Always thinks about finishing, and how it will feel.

But as I thought about that, I started to think about my friends who I think of as “real runners.” And I immediately came up with several that don't run outrageous distances. None of them run for paychecks. All of them truly love running.

John Hunt, Anjulee Johnson, Phủỏng Mai N, Sarah Graham, Mimi Jacobson-Kwok, Brynn Ewen, Laura Duplantis. These are my friends, normal people, and they are all “real runners.” In one way or another each one of them has impressed me. I have seen pictures of their runs and have been inspired. The way they have described a specific run, the way they felt, what they get from running has made me smile. 

What I realized is that their stories, their reasons for running and how their descriptions of running touches me is always about being in the moment.

It's about rows of palm trees on the Stanford campus. The smell of running through the redwoods. The beauty of oaks and pine trees passing overhead. It is about sunshine and fog and feeling alive. It's about being grateful to be fit, and able to run. It is about enjoying movement in a beautiful place, right now.

Its not about pace or distance. Its not about how many finisher medals hang on the wall. Its not about being a Kenyan. And its certainly not about how the next marathon finish will feel, tomorrow, next month or next year.

Its about gratitude. An instagram pic of a beautiful setting or a genuine smile in the middle of a long run. Its about now. The way it feels to run 47 blocks in Oakland, one way, today.

And then she asked me what my last run was like.

I didn’t think about how the run fit into my Ironman training plan. I didn’t think about the pace I kept. I described the feeling of warm sun on my shoulders, strength in my legs, 7 deer quietly feeding on the side of the trail, the amazing blue of Crystal Springs set a against a sea of green trees hugged gently by a thin blanket of clouds under a clear blue sky. I though about how that run made me feel so alive, in that moment. 

And I thought, “maybe I am a real runner.”  



Dr. Christopher Segler is a 12-time Ironman Triathlon Finisher, but more importably he is a real runner.  His podiatric sports medicine practice caters to athletes who think that there has to be way to stay fit, keep training, yet still heal an injury. He often lectures at medical conferences on the treatment of complicated running injuries, running biomechanics, and subtle fracture patterns of the foot and ankle. If you have a question about a running injury you can call him directly at 415-308-0833.  You can also learn more about running injuries at www.AnkleCenter.com and www.DocOnTheRun.com

Ironman Lake Tahoe Race Report

Wednesday September 18, 2013

Driving through the mountains on I-80 I heard myself say, “If this wasn’t number 12, there is no way I would be doing this.”

Sitting in my truck with my P3 nestled comfortably in back I was on the way to Lake Tahoe and talking to my friend Henry on the phone. I was trying to explain what I was about to do. And I was having a hard time buying my own reasoning.

Today I was driving from San Francisco to Lake Tahoe simply to drop my bike and gear bag with Megan Lewis and SAG Monkey extraordinaire Nick.  I was then going to drive to Reno where I would spend one night in a casino hotel, only so I could get a little sleep before I had to wake up the next morning to see if I could make it to the very front of the line at athlete registration. Next I would fly to Las Vegas where I would be giving a lecture at a medical conference that afternoon. I would lecture again the next day before flying back and hopefully make it back from Reno to Squaw in time for the dinner and athlete meeting. Then of course, I would do Ironman Lake Tahoe.

Less than a week before I had unpacked my bike.  It had been in the case since I flew back from Ironman Texas in May.  Last week I assembled it and took it to Tam Bikes in order to get new cables and a new chain installed. I hadn’t even had a chance for a test ride yet.

Work and daddy-duties had been so busy that I had only done about 8 bike rides, 5 swims in the pool and 4 runs (of about 3 miles each) in the past 4 months. Pretty hard to argue that I might be ready for what was about to happen.

But as I was explaining to Henry, if I could just finish before midnight, that would be 12 Ironmans and I might finally get a “Legacy Slot” and a chance to stand on the starting line of the Ironman World championships in Kona. 

Seems like that might be worth any dose of suffering.

Thursday September 19, 2013

I woke up at 4:58 AM, 2 min. before my alarm clock was scheduled to sound.  I hobbled out of bed, put on some clothes and went down the casino elevator to find some coffee and breakfast. When I got back to the room I returned some patient e-mails and packed my suitcase. I stopped by the lobby just long enough to drop my key card in the express checkout box and choke on some casino smoke.

And away I went, back to Lake Tahoe.

Less than an hour after packing in the hotel I was in the Squaw Valley parking lot looking for athlete registration. They were still setting up tables and chairs. Goal #1 was accomplished; I was first in line for athlete registration.

This was important as registration was not scheduled to open until 9 AM. My flight from Reno to Las Vegas was at 11 AM. And Reno is about 45-50 minutes from Tahoe.

At 9 AM sharp I was handed a form which I quickly filled out and signed. I made my way through athlete registration, got my timing chip, picked up my transition bags and then ran through the expo tent the buy a visor for my brother-in-law Todd who is currently training for his first Ironman.

I then ran back to my truck and pointed it at the Reno airport. As I was driving I got a text message that my flight had been delayed by 5 hours. Not good. This meant that I would miss my first lecture.  Luckily I was able to call the airline and reschedule for an earlier flight. I would still be in good shape.

A few hours later I landed in Las Vegas and went to the Wynn hotel and casino to check in. Once I got to the room I showered and changed into my suit.  I checked in with the International Foot and Ankle Foundation conference administrators and rechecked my talk to make sure everything was in order.

A couple of hours later I was at the podium lecturing on tarsometatarsal fracture dislocation patterns and how not to miss them. I sat through the closing lectures and 9 PM headed back up to my room to get some sleep.

Friday September 20, 2013

I woke up at 4 AM so that I could review the slides for my next talk.  After a quick review I went down to the exhibit hall floor so that I could spend some time in the DG Instruments booth.  DG instruments currently licenses and markets the surgical instrument which I invented. So I try to spend some time in the booth to see if any surgeons have questions about the instrument, or its use in surgery.

Later that morning I gave a lecture on lateral process fractures of the ankle. I was able to attend a few more lectures before had to fly back to Reno. Unfortunately on my way to the airport I received a message that my flight was delayed.  Switching flights wasn’t going to help.

At about 9 PM I was picking up my bike and gear bag from Nick. Because Nick is the official Ironman Lake Tahoe SAG Monkey, I said, “I appreciate your help, but certainly hope I don’t see you on Sunday!” 

At about 10 PM I was knocking on the door of the awesome ski cabin arranged by Andrew Muff. I met Dana and Christine who were super nice.  But I was in bed before I met anybody else. 

Saturday September 21, 2013

Shortly after I got up, the rest of the housemates started to trickle through the kitchen. We all had coffee before heading out for breakfast.

At that point, since I had just assembled the bike and had new cables installed, I was still hoping to get to take the bike out for a short test ride. But now it was raining. I was already worried about the cold, so I wasn’t willing to soak my cycling shoes (or anything else) just to verify that the guys at Tam Bikes did a great job. I chose to trust instead.

After breakfast, I went to pick up some last minute supplies and see if I could find some additional layers. Dana and I found a ski shop that had some consignment gear. I found a used medium weight cycling top for $20 that fit just right. I also found some glove liners for $12.  Perfect! $32 worth of insurance to insulate me from the predicted chill.

Back at the cabin I packed my bags and prepped for the gear drop off.  All of this was fast and simple as I have detailed race-day packing lists. I even have pre-packed zip-locks with the proper contents for each of the special needs bags. By packing them in advance, I think (and worry) way less than I used to. 

FYI: I will post my soon-to-be-no-longer-top-secret Ironman Packing List and Tips. (Feel free to swipe and deploy.)  Such a list will significantly decrease your day-before anxiety.

Because it was raining and I had packed all of my cold weather clothes in my transition bags, I was on my way to transition donning a trash bag as outerwear. But better to freeze today, instead of tomorrow. 

Because it was raining today and predicted to be freezing overnight, I had trash bags covering my handlebars and seat. Certainly didn’t want to start the day on a wet saddle or gripping frozen handlebars. 

As I racked my bike I noticed the guy next to me had no bags to cover anything. So I offered, “Hey would you like a couple of bags to cover your seat and bars?”

“Sure! Just one,” he said.

“Why just one.” I asked.

“I just need to cover my drive train to make sure it won’t still be frozen on the first descent.”

That was a thought I really didn’t need to hear.

I wandered off to find Andrew who had finished racking his bike and dropping his swim-to-bike T1 bag. We headed to Squaw to drop our T2 bags and meet the rest of the group from the cabin. I made an emergency sweatshirt purchase at the expo, realizing I that I had nothing warm (other than a wetsuit) to wear to the start.

By the time we got done at Squaw I was completely soaked and freezing cold. I was having a hard time imagining what it was going to be like to get out of Lake Tahoe and hop on a bike when it was this cold.  To make matters worse, as we were driving back to the cabin, it started to snow.

At the cabin I took a hot shower and later sat in the hot tub to warm up. There was ice on the deck and railing. The snow slowed, the stars began to twinkle. It was serene and beautiful. It just wasn’t Ironman weather.

Sunday September 22, 2013

Race Day

I woke up at 3:45 AM. I quickly put on my clothes, grabbed my gear and headed downstairs. Two peanut butter and jelly sandwiches and two cups of coffee later I was ready to go. We left the house of 4:30 AM heading for the squaw Valley parking lot to catch the shuttle buses to the swim start. 

Once I got to transition it was a simple routine. Drop the special-needs bags and put air in the tires. I pealed the trash bags off my bars and seat.  I kept the trash bags to cover my feet.  I had been warned that the sand was going to be extremely cold.  Knowing that my wetsuit was going to be much warmer than my blue jeans, I slipped into my wetsuit, but kept my sweatshirt on.   I heard someone say that it was 25°.

I put the trash bags over my feet and then put my socks back on to help insulate me from the sand when it was time to head down to the start. 

I dropped my green morning clothes bag and then went onto the beach in search of the 1:30-1:40 swim corral.  Normally (when untrained) I would swim 2.4 miles in about 1 hour 25 min. to an hour and a half.   But I figured with the altitude (and my paltry 30 hours of acclimatization) I would be lucky to make it in 1:40.

Swim 2.4 Miles

By the time the cannon fired and the athletes started filing into the water I was really cold. In fact, I was shivering. It was the first time I have ever been shivering while wearing a wetsuit. I wished that I had brought a neoprene swim cap and booties. 

As my wave started to approach the starting gait, I wandered over toward the fence to discard my socks and trash bags. And then the gods smiled upon me. There in the sand was a size large pair of ScubaPro neoprene booties. I quickly put them on and tucked them under the legs my wetsuit.

I suddenly felt much better and in the water I went. I checked the clock only to make sure the new how much additional time and needed to account for to ensure that I made it in before midnight. It was about 10 min.

As I waded into the water I found it interesting that sixty-something degree water actually feels considerably warmer than twenty-something degree air. But that didn’t last for long. 

There was an eerie fog hanging over the surface of the water that made it nearly impossible to see the buoys. Not being in any particular hurry I was not overly concerned about this. I figure all I had to do was keep moving in the right general direction in order to eventually get there.

I wasn’t swimming particularly hard because I didn’t want to strain anything. After all, I was in no shape to be doing this anyway. But after about 15 minutes I was shivering so much I was actually concerned about my capacity for finishing the swim. So I then decided to try swimming hard for about a quarter of a mile to see if I can get my heart rate up high enough to bring my core temperature up.

Note to self: if not accustomed to altitude, swimming hard at elevation is a bad idea. 

After only 5 or 10 min. of cruising through the pack of swimmers at a brisk pace I started having some mild spasms in my lungs. This quickly subsided when I slowed back down. 

I would just have to be cold.

I’m almost ashamed to say that this was actually the first time I have ever set foot in the water of Lake Tahoe. Probably not a great idea in terms of Ironman preparation but it is the truth.

The thing that I did notice more than anything else is that Lake Tahoe is ridiculously beautiful. It was cold but I was still enjoying it. I could see all the way to the bottom. And every time I took a breath I could see the freshly snowcapped mountains peering through the fog. Physically it was unpleasant. But aesthetically it was wonderful. I would consider it almost a fair trade.

On the 2nd loop I could see better, but I was getting hypothermic. My swimming was simply reduced to watching the buoys drift dry and thinking, “OK #8...I can make it #7.  OK #7...I can make it #6.  OK #6...I can make it #5.”

Soon enough I was out of the water. 1 hour 31 min. Not great, but good enough.

“One down. Two to go!” I thought. 

T1

I came out of the water andf I was thrilled to see the SF try club wetsuits stripping crew. It was really great to see familiar faces. That was when I was no longer curious if I was hypothermic. I knew it. 

The volunteer looked me straight in the face and said, “Can help you get out of your wet suit?” And I just stood there thinking about it. I knew that I had to get out of my wet suit yet I did not want to peel off the neoprene and be exposed to the cold anymore. Fortunately she was smarter than I was and just started helping me out of it.

When I made it into the men's change tent, it was warm, but it appeared as though they were having some sort of Guinness Book of World Records contest to see how many naked men they could shove in a telephone booth. In that respect it was relatively unpleasant. But at least it was warm...

I started to untie my transition bag and realized I was having trouble. I tied the bag like shoelaces so that it's easy to get it undone. But it wouldn't budge. I thought it was that my hands were numb. So then I tried to bite into the cords with my teeth. That was when I realized the entire draw cord had frozen solid into a block of ice.

I ripped the bag open (but was not happy about this). I was worried that would end up losing some of my swim stuff since I couldn't close it back up.

I dried off as much as possible and got into every layer I had packed in my bag. Tri shorts, tri top, arm warmers, compression socks, my new/used cycling top, SFTri windbreaker and glove liners. I put on a fleece hat under my aero helmet, with vent holes taped shut.  

I ran out through transition to find my bike and get going.

Ride 112 Miles

I figure getting on the bike and starting to pedal would help me warm up. I was wrong about that. It wasn’t until I hit the big hills about two hours later that I stopped shivering. 

But all said, it was going well.  I was being conservative, watching the watts and keeping well within the limits that I knew I could sustain.  I just kept telling myself, “All you have to do is NOT do anything stupid and you can make it.”

Near the end of the first loop of the bike course I did something stupid.

I was on the final climb, creeping uphill at about 3 mph. I was only passing the long line of athletes who had given up and traded pedaling for walking. And I was barely going faster than those who were walking their bikes. 

I head my head down, intently focused on pedaling and keeping enough momentum to make it to the top of the climb. Suddenly I heard, “GO SF Tri!, GO SF Tri!” It was a huge crowd of SF Tri members, many of whom were in their Sf TRi colors. Except for Miguel Mendoza...he of course was wearing a Buzz Lightyear costume. 

Miguel ran up next to me and started shouting Go Chris Go!!! You can Do it! GO, GO, GO!!!!!!” 

And so I went...

I upshifted two clicks, stood of the saddle and went as hard as I could. It seemed as though Buzz himself was catapulting me to the top of the hill.  I flew by the long, crawling line of bikes at about 10 or 12 miles per hour.  

I heard some waning cheers as I crested the final hill to start the descent.  As soon as I sat back in the saddle, I felt a sharp pain radiate from my butt cheek at the way to may left knee. I instantly knew I had pulled my hamstring. 

With every rotation of the cranks it felt a sharp twinge. “Way to go idiot!” I said to myself, “You just blew it.” 

I knew my day was over.  There was no aid station on the descent or I would have stopped. While on the descent I started trying to determine the cleanest exit. 

Knowing the course and the extent of road closures I was fairly certain that if I pulled out any time soon I would be waiting for most of the day just to get a trip back to Squaw from the Sag Monkey. 

Since I had nothing to lose, I figured I should just try to make it for the next 10 miles to see if the pain got any worse. It did, but not by much. 

So then I thought I would go another 10 miles to see if it continued to get worse. It didn’t.

When I was on the road approaching Squaw Valley I got passed by one of the pro women. It was Angela Neath on her final loop.  A year ago I attended a workshop and met Angela. That weekend I did a long run with her and her boyfriend. “GOOOOO ANGELA, GOOOOOOO!” I shouted.

Just seeing her inspired me. I thought I could at least finish the bike. As Angela turned left toward the bike finish I continued onto the second bike loop. I realized that if I altered my position just a little, my hamstring didn’t hurt very much. So I just focused on keeping the low-pain position and a high cadence. 

A few hours later, rolling by the lake at the bottom of a short hill I saw “100 MILES” painted on the road. I knew I would finish the bike. This realization was the spark I needed. It grew like a freshly kindled camp fire into the sudden roaring belief that I “might” actually be able to make it through the run, too. But only if I had enough time. 

T2

I stopped at the dismount line and handed my bike to a volunteer. Limping toward the change tent I realized that most of my limp was actually due to my back and neck. The awkward position required to quiet the hamstring had really cramped my back and neck. 

But I know from experience that all of my back and neck issues will relax from running just the opening few miles. I decided that I would head out on the run course. If the only thing I got was to loosen the back and neck, it would be worth it, even if I had to DNF.

Run 26.2 Miles

When I saw the clock I realized I had 6 hours and 28 minutes before midnight. I did the math. 

At Ironman St. George last year a long day of drinking vile “Perform” taught me an unpleasant, buy useful lesson. Even when throwing up 2-3 times per hour, I can walk 4 miles per hour. That means I can walk a marathon in 6 hours and 33 minutes.

I thought to myself, “If you can just run 10 miles, only 10 miles, at 5 mph, you can walk the rest and get in before midnight. 10 miles in 2 hours. On a good day, you can run 13 miles in less than 1 hour and 30 minutes. 10 miles in 2 hours should be a snap. That is the new goal...10 miles in 2 hours. And you won’t have to come back in a year seeking redemption. Instead, you could be in Hawaii!”

I started to run. 

I watched my Garmin making sure to stay exactly on pace...11:30 per mile. This would allow me to walk through the aid stations and still stay on target. 

“Just run 1 mile. Stay on pace. Just run 1 mile.” I kept telling myself.

As I passed the first aid station I realized I was now standing up straight. My neck hurt, but my back was better. “Just 2 miles, run 2 miles.”

As I pushed off to start running again, I felt a sharp jolt in the back of my leg. Burt once I was actually running, it didn’t really hurt. 

Peter and others from the SF Tri club began cheering as I passed by. I was running.  Peter gave me a high-five. 

“Just run 3 miles.”

“Just run 4 miles.”

When I made it to mile 5 the pain in my hamstring was escalating. It was hurting with even the slightest up hill. But I knew I would make it. 

I ran all the way to the turnaround and at mile 11, then I started to walk. And I almost started to cry. 

I couldn’t believe that for 50 miles on the bike I had only thought about the logistics of my impending, unavoidable DNF.  I had even thought of the story I would write on the blog (in place of this one) discussing excuses, ill-preparedness and failure. 

But I had just run eleven miles and would walk to the finish with time to spare. 

Night fell. Cold descended. I reapplied all the layers from the morning bike ride. Used cycling jacket, windbreaker, glove and fleece hat. A volunteer handed me a headlamp. 

I was cold, and it was dark, but I was going to finish.

On the final 3 miles it was foggy and really cold. I was shivering, pretty much the same as when I came out of the Lake early this morning. But I was in motion. The volume of noise increased as I made the final few turns through Squaw Village.

I walked amidst the cheering crowds and I fought back the nearly overwhelming urge to retain my dignity by jogging down the finish chute.  One foolish act was enough. “Just walk...no jogging...no further injury.”

The lights were bright, the cheers were loud and the hands were many that offered a victorious high-five as I walked to the finish. 

As I crossed the line I heard Mike Riley say “Christopher Segler...YOU...ARE...AN IRONMAN!”

And just like that, Ironman #12 was done.  16 hours, 28 minutes and 23 seconds. 

A volunteer wrapped me in a mylar blanket. She asked if I was okay. Someone else said “congratulations” and placed a medal around my neck. I said, “I’m okay, but really, really cold.” My teeth were chattering. 

“We need to get you to medical,” she said.

I nodded. 

Once I got the medical tent, they had a “warming area” where I waited for help. I was cold, tired and really hungry.  I just wanted to go to bed. 

After a few minutes, I stood up and one of the medical personal said, “wait...where are you going?”

“I am going to get my bike and my gear bags. I am going home.”

She replied, “...but, where is your bike tag, where is your family?”

I answered “my bike tag is on my bed at the cabin. I am here by myself.”

In an excited voice she said, “But you are hypothermic, you can’t just walk out of here! You could die just walking across the parking lot!”

I titled my head to one side and said, “Of all the dumb things I do, and all the ways I imagine I might die, walking across the parking lot at Squaw is just not one of them.”

“Thank you. And good night.”

Dr. Christopher Segler is a 12-time Ironman Triathlon Finisher.  His podiatric sports medicine practice caters to athletes who think that there has to be way to stay fit, keep training, yet still heal an injury. He often lectures at medical conferences on the treatment of complicated running injuries, running biomechanics, and subtle fracture patterns of the foot and ankle. Next year he will be volunteering with other SF Tri Club members at Ironman Lake Tahoe. If you have a question about a running injury you can call him directly at 415-308-0833.  You can also learn more about running injuries at www.AnkleCenter.com and www.DocOnTheRun.com

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

Houston Marathon Race Report

2011 was a year plagued by urgent sports medicine consults and surgery. With a sports medicine practice structured to provide rapid access to aching athletes, my own training seemed to get buried. So I planned 2012 to begin as a year of racing myself back into shape.

The Chevron Houston Marathon, just two weeks into the new year seemed a great place to start. This was my third year registered for Houston, but would be my first attempt at this event. I was a no-show for both the 2010 and 2011 editions of the marathon, again forced to stay in San Francisco to take care of patients.

Just two days before my departure this year I would have a work matter come up that threatened to thwart my marathon again. I re-booked the flight, so I could fly in at the last minute. Sleep deprived running would be better than no running. A plane with a “broken hose inside the wing” left me anxious and sitting at LAX for an extra 5 hours, but eventually I made it to Houston.

I was excited to run as I would be joining my sister and my brother-in-law. It was his first marathon. My sister Laura however is a veteran.

After a few hours of sleep the three of us were up in the dark and parked in downtown Houston. The temperature was 41 degrees but forecasted to rise to about 60. Perfect!

Because 2011 was so busy with work, I hadn’t actually run more than 13.1 miles since Ironman Texas. That was eight months ago. So the plan for my race was simple. Run steady. Don’t walk. Don’t do anything dumb enough to cause an injury.

I went out for a test run about a week ago to plan my pace for the marathon. I ran 13.1 miles, from the San Francisco zoo, along the Great Highway, up through Golden Gate park and back. I covered the half marathon distance in 1:42. So I figured that a 3:40 marathon would be a reasonable goal.

The Houston Marathon is a huge event, but the organization was great. Runners were separated into corrals based on expected pace. I found the 3:40 pace crowd and waited for the start.

After the mayor spoke and the national anthem was sung, the wheelchair start was off. Ten minutes to gun-time. I took off my warm-up pants and tossed them over the fence into a growing pile of running wear that was to be gathered and donated to the homeless. It was cold, so I kept the sweatshirt on.

The gun went off and anxious shuffling commenced. Thousands of runners trying not to bump into each other, trudging through the shoot, pointed out of town. Like magic, as soon as I hit the start timing mat, running began. Almost instantly the mass was at a seemingly coordinated 8:00 min per mile pace.

As we rounded the overpass, it was a fascinating sight to see. Dawn cast an orange hue on the horizon. There ahead, as far as I could see was a street stuffed with a colorful gyrating mass of bobbing heads flowing through the street.

One mile in and I was finally warm. I bid my sweatshirt goodbye and tossed it into a pile of clothes on the sidewalk. A couple of slow runners suddenly appeared in front of me, creating a challenge to dodge them, without elbowing anyone or stepping on any heels. Time to ignore the crowd and stay on pace.

Before I knew it I was out of downtown and in the Heights. Five miles into the race I passed my sisters house, which happens to be right on the course itself. There on the sidewalk were my twin nephews who offered up a matching pair of enthusiastic high fives.

We kept rolling south through Montrose and towards West University. Bands played. People cheered. A priest stood in the street, waiving a palm frond dipped in holy water, blessing the flowing crowd of runners.

The course continued, flat as a pancake, through historic neighborhoods, under the shady tunnel of trees near Rice University and out through Memorial. As we hit Memorial Park, I had my last energy gel and knew I would make it. All I had to do was keep running and I would be in somewhere close to my goal.

Just then I saw my friends Henry and Josh cheering wildly, a great boost for the final stretch. The last few miles had the only real sequence of hills. But my frequent runs at Lake Merced, Crystal Springs and through Golden Gate Park, made them seem like speed bumps. In the last 4.5 miles I passed 162 runners, but only got passed by 10.

Right turn on Shepherd then left on Allen Parkway. The crowds got bigger, the cheers louder and the buildings of downtown steadily grew into the sky. As I felt the headwind pick-up, I realized it was the wind funneling between the skyscrapers. I was downtown, just blocks from the finish. I felt great and was tempted to turn up the juice, but then the voice of reason rang through me head…”you haven’t run more than 13.1 miles in 8 months. You have Ironman St. George and Ironman France coming up...DON’T DO ANYTHING STUPID!”

And so I stayed on pace. Round the corner and down the longest finish chute I have ever seen. Across the line in 3:41, actually a new PR. Today, I will call that success.

2012 is officially off to a very good start.

Dr. Christopher Segler is a marathon runner, 6-Time Ironman Finisher, and sports medicine podiatrist in San Francisco. He lectures to other foot and ankle surgeons at medical conferences on the topic of complicated running injuries. His practice focuses on runners and triathletes who have complicated injuries and cannot seem to get an accurate diagnosis. You can learn more about foot and ankle injuries at www.AnkleCenter.com and learn more about housecalls for runners in San Francisco at www.DocOnTheRun.com. He performs second opinion consultations for runners and triathletes world-wide through www.RunnerSecondOpinion.com

Sesamoid injury in a runner?

I recently got from a question from a runner who had been ramping up for the California International Marathon in Sacramento and started having pain in the ball of the foot at the big toe joint...

"Hello Dr. Segler, I have been training for my first marathon and read that hills would be a great way to get super strong. I really wanted to do well and finish in under four hours so I started do hill repeats on Fillmore Street in San Francisco. Things were going great and I really felt like all the training was starting to pay off. Then one morning I got up and noticed this little aching pain in the bottom of my big toe joint every time I stepped on my right foot. It seemed to be worse on the hard tile in the kitchen. I have been really ramping up the miles and I am worried that this may be a stress fracture. Can you tell me the best way to tell if this is a stress fracture or something else? It hurts right in the ball of the foot under the big toe joint. Here is a picture of where it seems to hurt the most. Thanks!"


Great question! And thanks for sending the pic.. Here is your answer...

Pain in the ball of the foot can occur under the big toe joint for several reasons. Based on your description and the location of the tenderness, I would be most worried about the following conditions:

1. Sesamoiditis: inflammation of the sesamoid bones under the big toe joint (first metatarsophalangeal joint). You stand on these two little bones. Because they get stressed more when you run uphill, you may develop sesamoiditis when doing lots of hill repeats. If you push right on the hard little bones, and one hurts more than the other, it is probably sesamoiditis.

2. Flexor Hallucis Longus tendinitis (FHL tendonitis): strain, inflammation and/or micro-tearing of the tendon that pulls the big toe down against the ground allowing you to push off when you run. The sesamoid bones are actually embedded within the FHL tendon. If you push right under the big toe joint and the whole area is tender (and doesn't really hurt more on one specific sesamoid bones) it may be FHL tendonitis. If you pull upward on the big toe (away from the ground) you will stretch the FHL tendon. If this hurts, FHL tendonitis is likely.

3. Sesamoid Stress Fracture: a tiny little crack in one of the sesamoid bones from too many hill repeats and or too much running volume. If this is the cause of your foot pain, it will hurt more on one sesamoid than the other, it will also hurt when you pull the big toe upward, and your foot will most likely be swollen and/or bruised. The best way to diagnose a stress fracture of the sesamoid bone is with an MRI. X-rays don't always show stress fractures right away. X-rays will only show a stress fracture in a sesamoid that has fractured or completely cracked. Based on your story, however, this seems unlikely.

Get better as fast as possible and good luck in your marathon!

Learn more about sesamoiditis, FHL tendonitis and sesamoid stress fractures at www.AnkleCenter.com

Dr. Christopher Segler is a nationally recognized expert on running biomechanics and foot surgery. He has been invited to lecture to foot surgeons, sports medicine doctors, podiatrists, triathletes and runners in training all over the United States, as well as Canada, New Zealand, Portugal and Turkey. If you have foot pain caused by a running injury, you can send a picture of where it hurts and a brief description to him. Your picture and answer to your question will then be posted on our blog so others can learn how to deal with running injuries as quickly as possible and keep running pain free. You can email your pic and question to DrSegler@DocOnTheRun.com If you have a quick question about a running injury and you are not in San Francisco, you can actually call him directly as 415-308-0833. He schedules house calls for runners and triathletes in San Francisco, Marin and the East Bay through DocOnTheRun.com.

Good News for Ironman Arizona Athletes!?!?

This week, the dam that holds the water in man-made Tempe Town Lake burst. That may seem like bad news for a triathlete. Unless you have ever been swimming in that lake.

There is a reason that they don't let people swim in the lake right next to the University campus. The stagnant water is just plain filthy. The first time I went for a dip there was in 2007 at Ironman Arizona. The day before swim practice began I walked up to the edge and saw a two-foot long carp munching on some pond scum.

I asked another athlete about the water quality. He said, "My understanding is that the city has organized a method to fight the stagnation in the lake by allowing 2000 athletes to splash around in the water this weekend." Great.

During the swim I made an effort to leave the water in the Lake. A guy a met at registration was not so lucky. He took in a couple of accidental gulps. That small error led to several bouts of vomiting out on the bike course.

Although I do hope the dam is repaired in time for Ironman Arizona 2010, I have to say that I also hope the unintentional draining of the lake will mean the cleanest water conditions on record for the race. But even if the water looks clean, I plan on keeping my mouth shut during the swim.

Dr. Christopher Segler is a sports medicine podiatrist in San Francisco currently training for Ironman Canada and Ironman Arizona. He makes house calls in the bay area to treat stress fractures, Achilles tendonitis, and other triathlon-related injuries. Learn more at San Francisco's best running injury prevention site.

Should I take Calcium if I have a Stress Fracture in my Foot? San Francisco's Running Doc Explains

If you are running and get a stress fracture, you likely want that bone to heal as quickly as possible. When you break a bone in the foot, the bone has to heal just like any other injury. Although calcium is the mineral that makes bones strong and visible on x-rays, it is not the only factor in bone healing. For this reason it is particularly important to make sure that you eat a healthy well-balanced diet when you are healing a stress fracture in the foot.

We know that your body needs many different nutrients to heal a stress fracture. For example, vitamin K is important in the clotting process right after a bone breaks. Vitamin C is essential to collagen formation that is an early step in the formation of soft bone callus that precedes the deposition of calcium where the bone broke. Calcium gets laid down in the repair of the fracture, but supplemental calcium won't be absorbed well without Vitamin D. Lysine is an amino acid that helps you incorporate calcium into the bony matrix as the fracture heals.

The medical literature is conflicting about whether or not supplements help bones heal faster. However there is general agreement that know that adults need about 1000 mg of calcium and 800 I.U. of Vitamin D daily for good bone health. Many nutritionists suggest that you will get all of this in a standard healthy diet. Having said that, there is very little risk and much potential benefit with taking some extra calcium.

Obviously your body will be working harder to repair the fracture by laying down calcium as the bone heals. You could take some Calcium and Vitamin D to help make sure you healing fracture has all the calcium needs. Just be certain that the Calcium supplements you take also have Vitamin D.

Dr. Christopher Segler is a runner, multiple Ironman Finisher and Sports Medicine doctor in San Francisco who focuses on running injuries. If you have a question about a possible stress fracture in your foot from running. you can post a question or call him directly at 415-308-0833. For more info on running injuries see San Francisco's best running injury site.