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This past Saturday I ran my first ultra, 50K at the North Face Endurance Challenge in Sterling, VA. I finished in 08:20:51. It took way longer than I thought it was going to and the humidity and heat was just brutal. Below is my full, totally long winded race report.

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Pre-race – I got up at 4AM and put on all the things I laid out the night before. Had a plain bagel with PB&J like usual and gathered my gear. I had a camelbak filled with watermelon nuun and packed with snacks, TP in a ziploc, and lip balm with sunblock (which I didn’t use and fortunately didn’t need.) J. and I have an agreement where she only has to come to new race distances (or if I talk her into a destination race where she’s just kind of there already and we can meet up at the end) so she took her duties very seriously and drove me out to the suburbs of VA, dropped me off and agreed to be back at 1ish, the earliest possible moment I thought I would be done.

I saw two Mr. Sweaty-Tops-Off before I was even on the shuttle. The ride took about 15 minutes to the race site, which is gorgeous. I’ve never been there before and I was treated to a breath taking sunrise over the river which really pumped me up; I felt so lucky to be there. So I hung out, I hit the port-o-johns like 16 times, and eventually meandered towards the start with the rest of the crazy folks, who weren’t crazy enough to do the 50 miler. Dean Karnazes announced the start, and say what you will about that man, he is crazy fit.

My plan was to hydrate every mile at least until I felt thirsty, and save my ipod which was strapped to my wrist, until I needed it.

Miles 0-5 – These were pretty uneventful miles. I knew that I just needed to pace myself so I tried to hang back a bit. So I just found people to pace off of. Paced off of two chicks who looked younger than me and super fit until like mile 4ish (to discover later that they were more than a decade younger than me and finished more than an hour after me – small victories). I knew the hills were coming around the five mile markers of the race and sure enough the elevation started around mile four. I was also trying to figure out the passing thing on the single track. I mean I know you kind of announce that you’re coming and where but I knew that I shouldn’t be going all out, certainly not at this point, but I really felt like I could be going faster at some points and just kind of felt conflicted about what to do. In retrospect I wish I had pushed it more when it was cooler, because later in the heat, it was just impossible.

But I ran behind a woman for a mile or so in head to toe pink with flowers in her hair who was talking about the litany of ultras she’d participated in – Javelina, the Vermont 100, then mentioned that she got hit by a car, possibly in two separate instances while volunteering at Badwater and then ran into the emergency room doctor that treated her later at another ultra. I hung out for a while just to hear her story and moved along.

Miles 6-10 – Aid station two came around mile 5.7. The first one was really early and small so I had a cup of water and pretty much ignored it. The second one was the famed ultra buffet and it was a wee bit overwhelming. I wasn’t really hungry but knew I should take fuel so I grabbed some water and unpacked some sports beans and had a few. Already I was having that long run reaction where as soon as I put the food in my mouth I was like, meh… I don’t want this. It really made me wish I did better with gels.

There was a significant amount of grassland in the single track of the first section which I didn’t anticipate (in places the grass was shoulder height) but this section was more of what I anticipated in terms of wooded canopies next to the river which was nice. Even though I face planted somewhere around mile six (no pokey sticks to the face or gut, so no worries) I was feeling pretty good for these miles, it was hot but not crazy, and I was pretty happy with my times. Mile ten-ish took me over some hills that I knew I’d be crossing again. They were pretty tough, tougher than I expected based on the elevation maps as it was less than 400 feet of elevation gain at the peak but it was a series of ups and downs for each hill set. I could already feel the effort in my quads a bit but it was totally dealable.

Miles 11-15 – Great Falls came around mile 12 and this is where we were co-mingled with the 50 milers doing these crazy sadistic not-quite-loops. Around mile eleven I saw a guy, dead behind the eyes who looked like he might fuel by reaching into a tree and grabbing a live squirrel. My guess was that he was the winner. The aid station here was this crazy triangle set-up with tons of snacks. I refilled my camelpak here, shocked that I had drunk at least two-thirds of my nuun. I had a shot blok, and orange slice and a piece of boiled potato. I really did not want to eat, which made me nervous this early on so I just made a decision to consume whatever seemed appealing. So I had a cup of water, the Clif electrolyte drink (which I think I really like) and some Mountain Dew, disgusting on a normal day, but suuuper awesome during the run. I hit the port-o-john and moved on.

The course is really gorgeous here. I put on headphones just after the aid station and had saved this week’s AMR podcast for this week for the race. There was one point where Dimity was recounting catching a glimpse of her shadow during her Ironman training race on the bike, saying that her own legs moved “like pistons” and getting choked up, almost in disbelief that she was capable of undertaking such an effort. I  paused the podcast when I heard the rush of the river over the rocks to my left, and felt my feet hit the ground almost silently as I’d trained myself to do, and saw the runners coming towards me after they hit the turn-around, quads flexing, arms swinging saying, “hey good job” as they passed me, and I got a bit choked up myself. I was there. I was running my ultra. It’s so cliche to always point back to the post-cancer accomplishments, but at this point in my life I am just amazed at what my body is capable of.  I descended to the turn-around point, rounded the turn and took the ascending hill at a run.

Miles 16-20 – The Old Dominion aid station was mid-loop through the 50 miler loop and it was crazytown. I lost so much time here because I was totally overwhelmed. There were multiple tables, tons of volunteers, and I just didn’t know what to do with myself. It looked like a sweaty party — maybe I should mingle? I also started to realize that I was soaked. I couldn’t have been more wet if I had jumped in the river, which I started to fantasize about. Fortunately the race volunteers were amazing. An EMT doused me with a gallon of cold water, another opened a bag of pretzels for me as my hands were too wet to do so, I grabbed a shot block, had a single pretzel, an orange slice and the water, soda, electrolyte drink combo that I decided seemed to be working for me. I chatted with a 50 miler in the port-o-john line who was super nice, had put in 32 miles already and let me go in front of him because I would be quick, and he had stomach issues. I wished him luck and was back on my way.

This section also hit Great Falls again around mile twenty. I was feeling tired at this point and knew I wasn’t taking in enough nutrition. So I had a couple of bites of a banana, and more soda, water, electrolyte drink. I should have refilled my camelbak here but I was afraid of how long it would take and I felt like my hands, and brain quite frankly weren’t working and I just couldn’t process how to make a refill happen and didn’t just go to a volunteer and say hey, can you do this? Which I totally should have done.

Also somewhere in here was the rock scrambling section which the coach (who is wonderful and wildly encouraging) I had enlisted to help me about two and a half months prior had mentioned encountering when she ran it the previous year, and then there were all of these crazy wooden stairs. That part was super fun and exciting. I did some fancy downhill footwork around miles 18-19 (I usually love these miles in a marathon for some reason) and passed some volunteers who seemed a little surprised at my speed and good spirits.

Miles 21-25 – I had my first down moment around mile twenty – twenty-one. I knew it would come and I was prepared for it. I remembered what fun I had hiking the AT in the Poconos back in April, so I just decided to speed hike it until my joy came back and sure enough, within about a mile I felt better. This was the next section of hill repeats so there was a lot of necessary walking through here. Also at some point my Garmin got off track because I thought I was way further along than I was as was evidenced by the extra mile it said that I ran on Saturday.

There’s a flat section around miles twenty-three to about maybe twenty-seven, twenty-eight. This is where the wheels came off for me. The heat peaked and I just felt like I was baking. I started looping around the same group of runners. All of us would run a bit, walk a bit, try to encourage each other. For a few miles I fell into a group of about six guys who were trail and ultra seasoned and really interesting. One fellow had run Bear Mountain earlier in the year and was running about a marathon a weekend for several weeks. Another guy had run with Scott Jurek and Chris McDougall earlier in the week. So we chatted and just walked for a while. I just didn’t have the will to move any faster. I knew I was low on water and nutrition. I tried to eat but it just wasn’t working. I felt like I was going to puke if I moved any faster.

Miles 26-finish – It felt forever to the next aid station. I felt like I could feel the entirety of my quad muscles and where they attached to my leg as a whole. I fell back in with the ultra guys for a few miles and then just broke away. I tried to run two minutes, walk a minute which descended to running thirty-seconds, walking for two. I chatted with runners and we tried to pass out encouragement. There were smaller hills here, which felt huge and my quads were screaming and I realized that camelbak had possibly chafed a huge section of skin off of my back. It was uncomfortable but I really didn’t care. Fortunately after the last big section of hills it felt a little cooler and I started to run/walk with more frequency. Unfortunately, it was this point where I realized for certain that my Garmin was at least a mile off, if not more, and before I reached the finish, I would have to hit that aid station that seemed so close to the start.

Along the way I passed a couple of people just laying or sitting next to the trail. There was a woman pouring water on the head of another runner who was puking into the grass. A few runners asked if she needed help and she asked if we could send someone back at the next aid station. Even though the marathoners still had a loop at the next aid station, we were all still so close. At this point I realized that just finishing was enough.

At the aid station I had two cups of soda, electrolytes, and water. An volunteer pulled a gallon of water from a cooler and asked if I would like to have some poured on me too cool me off I said absolutely, mentioned that my phone was in my pack, so he told me to tip my head back and poured the water over the bill of my cap and it rushed down over me. I gasped. It was a shock to the system, a fantastic one. I thanked him profusely and asked how far it was to the end. He said one and six tenths of a mile.

So I took off, walking one minute, running (really, shuffling) for a minute. There started to be spectators, which helped. Once I saw the finish I was able to shuffle for the rest of the way. I heard my name as I approached the finish and saw J. coming towards me with the camera and I couldn’t believe it. I was done. It was over. I didn’t know whether to laugh or to cry. I think I did a little of both.

Post-race – I wanted ice bath, beer, t-shirt in that order. I chatted with some of the runners that I spent time with on the trail. I drank a ton of water. I was a little disoriented but so, so happy.

The bad: I think I needed to run more trails and hills and maybe I should have overdressed for some of my runs, but I’m not sure how I could have prepared adequately for that heat and humidity. I need to rethink my camelbak and/or practice quick filling it or just be okay with taking the time to fill it because I was definitely out of water around mile twenty-five.

Also, sure I am sore but the worst is the roof of my mouth, towards the back of my throat is sore and my jaw is distractingly achy. What’s up with that?

The good: Listening to Steve Reich in the woods is pretty amazing. I met a lot of cool people. The volunteers were incredibly accommodating. I didn’t walk away hating endurance racing or the distance but for now I think I’ve hit the limit of the distance I’m prepared to cover and I’m okay with that. I’m looking for my next race.

Later that evening: After getting some food we decided we could make it the house of dear friends for their housewarming-turned-engagement party. My friends expressed their surprise that I made it and made a fuss over me, which was sweet, poked at my quads which was actually kind of funny and indulged my race story blow-by-blow race accounts.

In DC when you chat with new people everyone always asks what you do – it can get pretty tedious. This was the first time that instead, what I did that day was a topic. The race had been a floating topic of conversation. One fellow had heard the distance and looked at me and said, “So it was a cycling race.” I replied no, and watched him think for a minute. “Wait, so you were running?” I said yes. “So you ran almost 32 miles.” Yes. “That’s crazy!” Sometimes people say this about marathons and I pass it off, because ultimately it’s hard, but not totally out there. But that evening, I took a sip of my adult beverage, looked at him, and agreed.

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To whom it may concern,

I am writing to relay my experience at Washington Hospital Center on the December 20th-21st.

I was scheduled to have the 3rd step of my breast reconstruction with my plastic surgeon, Dr. Susan Otero, after being diagnosed with breast cancer in 2006 and undergoing two mastectomies at another hospital in 2007. Prior to my surgery date the WHC staff called me for my pre-op check-in and were also very attentive during the check-in process at the hospital. I was very pleased with the treatment and care I received prior to surgery and post-op during my recovery. Three nurses in particular, Birdie, Claudia, and Joan provided me with very high quality care. I was very pleased with the treatment I received in recovery.

However, the first major problem came when my initial recovery nurse, Birdie, called repeatedly to find me a room. My surgery was over between 2-3pm, and I recall being fully awake and able to be moved to a room around 5pm. Around 8pm I was moved to a different, larger recovery area and put under the care of Joan and Claudia, and told that I would be moved to my own room soon. After over a four hour total wait, I was finally transferred to my own room around 9:30pm.

By this time I had missed all the meal times and was hungry and tired and wanted to be in my own room, which should have been much quieter than the hustle and bustle of the recovery area. When I finally got to my room I was checked in and asked about getting food of some kind. I was told that the meal times were over. I pressed the issue as I was very hungry, not nauseous in any way, and definitely feeling up to eating a small meal. I was told that a boxed lunch could be ordered for me. In the interim, my nurse brought a large cup of juice.

Around midnight no food had arrived and it had been about four hours since I had received pain medication. Around 12:30 when my nurse, Jillian, came into my room I told her that my pain was increasing and asked for more pain medication as well as lozenges for my throat which was very sore after being intubated. She said she would order the medication and told me that no meal had been brought. She eventually found some cereal and milk for me, which was kind of her, as the food that was ordered apparently never arrived.

At approximately 1:30 I received throat lozenges. Around 2:30am I still had not received any more pain medication and my incisions felt like they were on fire. It was almost impossible for me to rest. I had not been seriously uncomfortable post-op until around midnight when I had asked for the medication and as I stated before, had been very well cared for. In recovery I was asked about my level of pain and the nurses responded appropriately. Therefore I went from being very comfortable to being in an unacceptable amount of pain for an extended period of time even though I knew that my surgeon had ordered Vicoden for me during my recovery in the hospital. I paged my nurse. She said that the drugs hadn’t arrived from the pharmacy yet but if they didn’t arrive in 10 minutes she would go check on them herself. About 15 minutes later she came with the pain medication, apologized and she told me that it would probably take me two cycles of drugs to really feel better since the drugs I had received so much earlier were almost completely out of my system.

Around 6am my surgeon arrived and told me that I would be discharged that day, which I had expected. My nurse followed shortly thereafter and brought another round of medication. I was feeling much better by then and was awaiting breakfast since I had yet to really eat anything. When breakfast did arrive, I discovered chicken broth, jello, and more juice even though I had already eaten solid food and had requested a vegetarian meal. I was not able to eat any of the food that was brought for me. I paged a nurse and a tech arrived. When I told him about the problem, he got the person who was delivering the meals and explained the situation. The delivery person said that he had an extra breakfast and would bring it to me. It never arrived. By this time I wasn’t surprised and simply wanted to get out of the hospital so I could recover properly.

I am amazed that I was able to receive both the best and the worst care I have ever had in a hospital at the same facility in 24 hours. My diagnosis has necessitated six surgeries in the past 14 months and I have never had to wait so long for medication or food in any hospital – especially things prescribed for me by my doctor and/or things that I could have had at home. I would have fared far better if I had left the hospital and gone home after my time in the recovery area, which is unacceptable. I am at a loss as to the reason why I was not able to get the medication prescribed for me, in the hospital. Considering that during previous recoveries in other hospitals I had serious issues with nausea and required far more pain medication, my experience at WHC does not make me feel confident that it could provide me with a level of care that would keep me well and comfortable. If it was so difficult to get the medication specifically prescribed for me, I can only assume that if I became nauseous or needed a non-prescribed drug right away there was no way I would have gotten it.

While I appreciate the kindness and dedication of the majority of the WHC staff which I came into contact with, overall I am appalled by my experience there. As portions of the WHC were rated among the US’s best this year, I have to believe that I experienced huge flaws in an otherwise well-functioning system. Nonetheless, I consider my experience to be unacceptable and I feel I would be remiss if I did not relay the details of my situation in the hopes that the system can improve and others can enjoy at least a modicum of good quality care that was missing in the majority of my experience at WHC.

The last few weeks have been a little whirlwind with starting a new job and finally getting back to feeling more normal after my last surgery. I’ve recently gotten a gym membership and have been going off and on for the past three weeks. Even though for the first week and a half I was only walking on the treadmill, I developed a little bruising and would be in so much pain the day after that I had to go visit my plastic surgeon. Apparently all was well, but the internal sutures hadn’t dissolved yet, so were causing all the trouble. My surgeon gave me a refill on my Valium prescription to take as needed. The combination of that and the dissolving sutures (you can seriously tell that they’re slowly going away because they’re poking out of my skin) has allowed me to exercise more often and for a longer period of time, which at this point, feels like a luxury. The next surgery is scheduled for December 20th – looks like I’ll be getting new boobs for Christmas.

This weekend I saw Ani Difranco at the Meyerhoff. It was a great show. I love to see how she adapts her show to the space in which she’s playing. I also got to eat at one of my favorite Top 5, Top 5 restaurants – the Helmand. I haven’t been there in years, but the food is still amazing. Four of us had bread, appetizers, an entree, wine, and Turkish coffee for $30 a person including tip. It’s quite a deal.

pretzel dogSpeaking of food I seem, to have developed a slight addiction to pretzel dogs. If you like tofu dogs, you should really try these little things. They’re quite yummy, and relatively healthy. It’s too bad that I’m not supposed to have a serving of soy more than once a week or I think I’d be eating them all the time… now that I’m thinking about it, maybe it a really good thing I’ve got to limit my soy intake…

I think I’m fighting off a cold, so I’ve got the first pot of vegetable soup of the season on the stove, and I think it’s off to bed with me early tonight.

Today I met up with my Castle Connolly, top rated plastic surgeon, for the 2nd post-op visit. She asked me how I was doing with the pain. I was honest and told her that when I was able to rest whenever I wanted during recovery, I was down to taking the pain meds from every 5 hours to every 8 or so, which was a big improvement. Yesterday I had some appointments and errands to run downtown, so it was kind of my test run day to see how I’d do on the metro, walking all over the place and generally having a more normal day than I’ve had since surgery. As I informed my Dr. this pushed me back down to needing the meds every 5-6 hours again. I told her that I had been doing pretty well but refused to suffer in pain when I didn’t have to. She quickly agreed that there was no reason for me to suffer through it needlessly and that I was smart enough to figure out when I didn’t need the drugs again. I also told her that I’d been taking some darvocet that I had left over from severe back pain that I was experiencing this summer which seemed to knock me out and make me feel a little more out of it which let me sleep (otherwise I would wake up in the middle of the night for meds, or sleep very badly and wake exhausted). So she gave me a prescription for that as well.

Since I was still in pain, she said that she’d wait to fill my tissue expander until next week. I said, “No, no, no!” as I had geared myself up for it, had taken some anticipatory drugs and had the rest of the day off. She asked if I was sure, and I said, “Absolutely – let’s do it!” She called my favorite nurse, who gathered the needle and the saline bag and then used a magnet to find the metal valve in my expander so the saline could be inserted. When she got to 100ccs she asked me if I wanted to stop – I told her, I’m ready, I’ll take as much as you’re willing to give me. She stopped at 150ccs, which, according to my understanding is quite a large expander fill and if I have the conversion correct it’s about the equivalent of about 5oz. So now there’s essentially just over a serving of juice that’s been injected to a silicone container which sits half under and half over my newly split pectoral muscle supported by alloderm, and a whole lotta stitching. orange juice

To give you an idea of what this feels like, it’s as if someone has placed a concrete block on the left side of my chest, and occasionally pokes the outer perimeter with an ice pick. The actual filling process is less intense, but still increases according to the amount of fluid being inserted. If you’re familiar with the Peaches song Operation, where she all but screams, “I can take it!”, that’s what was going through my head towards the end of the fill.

Now I’m safely at home with a nice cocktail of valium, vicoden, and darvocet-n coursing through my veins, and thanks to Joanna, sushi waiting for me in the fridge. You should be impressed that I was able to type this out at all.

Tonight a friend of mine brought us a really lovely dinner of tomato basil soup and a zucchini and rice dish. The food was wonderful and I do love the camaraderie of breaking bread together. There is something wonderful and neighborly about sharing a home made meal.

I slept a ton today. I woke up for pain meds around 9, fell back to sleep until about 1 when it was time for more pain meds and then took a nap again from about 6-7:15. I really believe in the restorative powers of rest. Fortunately it’s getting easier for me to get in a comfortable position for sleeping which was really difficult the first few days. I still rely heavily on the pain medication, but I’m definitely improving, which is great.

I ran across this feature on CNN about Lindsay Avner who, at 23, made the decision to have a prophylactic bilateral mastectomy based on her extensive family history of breast cancer. If you can stomach the wide range of comments included with the feature it illustrates the controversy around this procedure and demonstrates how frankly clueless many people are about it. The comments range from making statements that her decision was “paranoid” to others who think that the decision was “…actually quite easy. Not only is she safe from cancer, but now she can have the perfect and paid for breasts.”

I wish I could say that I was surprised or amazed at these responses but quite honestly they simply make me sad. For another human being to simply wave off a gut wrenching decision made in an effort to live a long and healthy life is mind blowing to me. A breast cancer diagnosis at any age is abjectly terrifying and life altering for you, your partner, and your friends and family. Every new doctor appointment, every scan, every excursion under the knife, brings with it the potential for a worse diagnosis, more invasive treatment, more of your previously normal life being ripped from you and replaced with more time spent simply trying to be well. The decision to have reconstruction was anything but easy. I can tell you I would much rather have the natural parts of my less-than-perfect body, because it was mine, because it was real. The lack of genuine thought and feeling behind these kind of statements is unfortunate at the very least and at it’s worst extraordinarily callus.

Today has been spent lazing around for the most part. I’m still feeling pretty good but the pain management gets trickier. The pain is constant and present even with the vicoden and valium. Last night I had a brief meltdown while trying to go to sleep, it seems no amount of pillow arrangement would do the trick and no matter how I laid it felt as if my left pec muscle was being ripped in half. As a result I’ve upped the medication dosage to just a little more than prescribed, and am just trying to distract myself until I fall asleep. This usually entails falling asleep to something on TV. All in all it’s still not bad, but my goodness, moving around, is certainly an exercise.

I think I mentioned before that I was very upfront with my anesthesiologists before this surgery. I let both of them know that I was in an unacceptable amount of pain after the last surgery and had a completely unpleasant experience in the recovery room where, according to my dim recollection, I had to practically beg for pain relief. If this little discussion didn’t help, I’d be shocked because my experience this time was completely different. I felt as if I was taken very seriously in recovery and treated very, very well. One of the recovery room nurses recognized me, fed me ice chips, and provided me with vaseline for my dry, post-op lips.

I find the approach to pain medication by different medical professionals fascinating. My surgeons have always taken my discussion of pain seriously and have never denied me pain killers when I’ve requested them. My anesthesiologists have always behaved in a similar manner. That said, in my last hospital stay it was interesting to get the reaction of various nurses to my telling them I was in more pain than I wanted to handle. A few times it was explained to me that I only needed to click on my morphine pump when I needed it and the drugs would only be released every 20 minutes. I thought it curious that someone who had just underwent major surgery was expected to watch the clock and click appropriately and/or wait a little while to see how the pain was before clicking. My strategy was to click the button when I remembered. Morphine really doesn’t make you the sharpest individual, so I clicked when I could.

Later, after my doctor gave me the go-ahead to leave, I asked the attending nurse about my prescriptions just to make sure that I had what I was told I would get – an antibiotic, vicoden (for pain), valium (as a muscle relaxer for the tissue expanders). First she said no valium – but she’d double check. Then when she did find the prescription for my valium, she 1) assumed that I was taking it regularly pre-suregery, and 2) couldn’t understand any reason why I’d be taking it other than to put me to sleep. At which point I had to explain the tissue expanders, and the muscle spasms which result in trying to get your muscle and tissue to make room for a foreign object.

There were other instances too with various nurses who didn’t seem to have a clue as to why I was there and what I needed. I was asked to hold things, which I couldn’t really do. I was given a monitor on a pole whose wheels didn’t work properly so it was almost impossible to move by myself (I requested and received another). Finally when I left the technition who “helped” me get to the car, grabbed on to my left arm tightly to maneuver me around the wheel chair foot holders which she placed in my way. When I asked her to please not touch that arm, she watched me struggle with the car door.

This is less a rant against nurses and more of my amazement at a system that permits those providing immediate care to those who are almost wholly dependent on them to have a very limited knowledge of the situation of each patient. I had some wonderful nurses each time I’ve had surgery (5 times in the past year in fact). The night nurses that I had this time around were especially attentive and sweet. Overall my hospital experience was good, but there are aspects that make me a little nervous, especially if I were less coherent than I’ve been while staying in the hospital.

That said, I’m still enjoying sex in the city, and playing the sims 2. Joanna went on a bagel run this morning so I’ve had my weekly lox and bagel fix. yippee!

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