Friday, March 23, 2012

A Public Service Announcement: Endurance Athletes, Air Travel, and DVTs

I've flown internationally probably 100 times in the last 20 years. That may be a bit of an exaggeration, but I've been to around 35 countries, most of which I entered by plane travel, and many of those I've visited multiple times. Regardless of the number, I am not new to flying, and not new to flying half way around the world. But somehow I missed the memo on the risk of deep vein thrombosis (DVT) to me. I'm young (well, sort of), fit, and I guess, a bit naive.

If you want to read about my experience with DVT and then PE, please read the last 2 posts. As far as I know, this was my first experience with either. This was what is considered a provoked incident of DVT. That is, it was brought on by a long flight, and a couple of other factors (birth control, and I'd argue endurance athlete) that seem to increase the risk. It's fairly easy to look at the risk factors and see why it happened to me. I don't know if it's accurate to say that endurance athlete equals an increased risk, but if you do some googling of DVT and runners or endurance athletes and flying, you will quickly come across many different reports, stories, etc. that indicate that it is not uncommon in endurance athletes and a statistic on states that 85% of air thrombosis victims are "athletic, usually endurance type athletes like marathoners."  I have no idea where this data comes form, but arguing the validity of the data isn't really the point of this post.  The point is to raise awareness that this seems not to be an uncommon problem amongst types like us, so to exercise caution when stagnant for long periods of time, like on long flights or long road trips. Kim, an ultrarunner from Ohio sent me the link to her blog where she talks about DVTs in runners and about two running friends with DVTs.  Some other blogs/articles that discuss DVT in athletes can be found here, but again, some quick googling will lead you to any number of related posts (past several words are hyperlinked to some examples).

I am typically a fairly active traveler. Assuming I'm on an airline I fly often, I always sit in an aisle seat so I can get up whenever I want (frequent flyer status often dictates what you're left with, but again, I fly overseas a lot so I generally have some level of elite status and get my preference), I carry on a water bottle, and fill it on the plane so that I can drink often and more than what those little plastic cups hold (also cuts back on use of plastic cups), I often wear compression socks (but not sleeves--try it or think about it and you'll understand why I don't, even though there are any number of websites recommending sleeves for travel, as well), I get up regularly (because I'm drinking a lot) and usually want to stretch my legs. However, I also tend to sleep easily on a plane, so it's not uncommon for me to fall asleep for long naps.

I've also done some really stupid things like when I flew to Nairobi the day after running the Pine to Palm 100.  Getting to Nairobi from Portland involves 2 or 3 flights, 2 of which are going to be 8+ hour flights. Definitely not fun after running a 100 miler, and looking back, probably a bit dangerous. But to date, I never have had another DVT incident that I can remember.

I've received a lot emails from ultra runners who have shared similar stories, great advice, how they dealt with DVT/PE, or tragic stories of friends who died from PE after DVT. Mine is definitely not an isolated incident, so I'd really just like to ask all of my ultra running friends to be careful out there.  Maybe everyone already knows about this seemingly increased risk to endurance athletes, but I didn't.  Had I known, I would have been more cautious. Again, I feel like I'm already fairly cautious, but not because I knew of the risk of DVT, more so because I get uncomfortable sitting still.

I can guarantee that I am going to become the traveler that everyone hates.  That person who is pacing the aisle, and getting up every 10 minutes to fidget. I encourage you all to do the same. I may need to leave a day earlier in the future on trips to destinations where multiple long flights are necessary, like any destination in Africa, either to have a rest day after two long flights, or a scheduled stopover in between long flights, because going forward, the thought of falling asleep for more than 30 minutes scares me. I will be that annoying chick with the alarm that is set to go off every 20 minutes.

And if you find yourself with DVT, there are a lot of scare campaigns out there associated with DVTs and PEs, being on blood thinners, and what you can and can't do with regards to aerobic activity. There is also no good data to support a doctor's advice to tell you to either jump back into it, or avoid activity, and because there is a risk of death associated with PE and no data to support either approach, many doctors seem to take the conservative approach and ask that you avoid activity for up to several weeks/months (that was my first doctor who scared the living bejesus out of me).

There's the issue of physical activity with DVTs and then there's the added fun of being on blood thinners (which is necessary to be active with DVTs). Luckily I'm not a mountain biker, because I definitely wouldn't be comfortable mountain biking on Warfarin, but am comfortable running. Heck, I never fall (obviously not true for anyone who knows me). While I do fall regularly, head trauma is the major concern with falling on thinners, and I can count the number of times on one finger when I've hit my head during a run. If I scrape my leg, I might bleed a little more, but assuming my INR level is where they want it to be (between 2 and 3), I won't bleed to death. There are warnings out there about using blood thinners that go so far to say "don't use toothpicks" and "use an electric razor." I've been assured, that unless I get my INR up to 7 or so, I'm not going to start spurting blood out of a hang nail.  I will have to be diligent about making sure my dosage is correct and that means twice a week visits to the anti-coagulation clinic at this point, although that will become less frequent in the coming week or two.

On a very positive note, I found a doctor I like, and one who works with athletes and has worked with other cases of DVT and athletes.  I'm back running (the past 3 days), and am easing my way back into it and hope to still be able to compete in Italy at Worlds on April 22nd. There's still not a 100% chance that is going to happen, but a few days ago, I would have told you I had about a 2% chance of competing, and now I'm optimistic that it's a possibility.

Monday, March 19, 2012

From DVT to PE

So, while DVTs are painful in their own right, the real fear with DVTs (deep vein thrombosis, see previous post) is that the clots in your legs will break free and travel to your lungs, known as a pulmonary embolism (PE) which, worst case scenario, can result in sudden death.

After being diagnosed with DVT on Wednesday after a mis-diagnosis on Tuesday (again, see previous post), I stayed home from work on Thursday, in part, because I wasn't feeling stellar, although much of the pain was in my leg, which doesn't exactly keep me from working at a computer. But I wanted to keep my leg elevated and this is easier done at home on the couch so I picked up my computer from work and half-heartedly worked from home. By Wednesday night it had become hard to walk normally, as I couldn't extend my heel to the floor.  My calf was a tight painful mess, and the painful area had spread quite a bit.

Why I really stayed home from work was that my eyes were puffy from crying, and I didn't want everyone to see me red-eyed at my desk all day.  I was still adjusting to the fact that I was probably going to have to back out of worlds and wasn't sure if I'd be fully back to normal.  Being put on blood thinners is not usually a short-term solution, and results in at least 6 months of medication, monitoring and taking precaution against things like crashing, which while training, can be part of my daily routine. And it goes far beyond running--having a clotting issue can be a life-changer in terms of hobbies and routine.  This wasn't a regular running injury and wasn't something I'd be able to cross-train through.

As I was lounging on the couch on Thursday afternoon I started having chest pains, although it was mild enough that I couldn't decide if it was imaginary, or maybe even heart burn. The signs of PE are chest pain and shortness of breath, and knowing that DVT can result in PE had me a bit paranoid. I woke up early Friday morning with more intense chest pain (enough so that I yelped in pain on at least one occasion).  Around 5 a.m. a DC friend texted, and I commented to her that I was laying in bed trying to decide whether or not to head to the ER.  The pain wasn't bad, and the ER seemed a bit extreme, but I also knew the sensations weren't normal, and I had just been diagnosed with DVT. I promised my friend I'd go to the ER, but figured I'd wait for my roommate to wake up and run it by him.  In the meantime, I washed my hair (because I figured if I was admitted to the hospital I wouldn't get to wash my hair for a few days), did some laundry, started to clean my room, ate a big breakfast, etc.  I couldn't decide if the the pain was serious, and at the same time started to worry about getting admitted to the hospital when my room was a disaster from not having unpacked after the previous two trips.  What if someone needed to go get clothes from my place and they saw the state of my bedroom?

I sort of knew I needed to go to the ER, but was hesitant to do so, so futzed around forever before committing to going.  Jason and Eryn finally started stirring, and when Erny heard my complaints, insisted that she take me.  I continued to dry my hair, call my doctor, email work and let them know that I was "probably crazy but stopping by the ER on my way into work," etc, and then drove around looking for parking forever in trying to decide what type of parking I needed--2 hour, all-day, etc.  There was no sense of urgency until I walked into the ER and muttered the words "slight chest pain." They had me on my back and coated in stickers in about 30 seconds.  I wanted to point out to them that there was no urgency, as it had taken me several hours to get there after the point I had first considered it a good idea.  An EKG, chest x-ray, and CT scan later, they determined that I wasn't going anywhere as I had pulmonary embolism, or blood clots hanging out in the outer reaches of my lungs. Because I had multiple clots on both sides of my lungs, they wanted to keep me to monitor things, which I was happy to agree to, as I was petrified about going home and being alone. I wasn't in much pain at this point, and had no idea of how bad it would get over the next 24 hours.

As fast and efficient as the ER was, I was checked into the hospital, and proceeded to wait for about 5 hours before my doctor saw me.  In that time I wasn't allowed to eat, and the pain went from about a 3 out of 10 to a 9.9 out of 10.  Apparently clots in the lung can be really painful.  Breathing hurt, as did any movements like laughing or moving, in general.  I eventually got some pain meds ordered (dilaudid and oxycodone) and while  I had at first refused the pain meds, after the pain started to build, I was asking for anything they would give me.  The pain meds eventually kicked in, and life felt nice and fuzzy and I appreciated the friends that stopped by to cheer me up as I struggled to stay awake.

Life was OK until about 3 a.m. when I woke up in agony.  My day nurse and my night nurse had very different pain management strategies, and my night nurse only wanted to administer pain medication after I requested it.  This sounds alright on principal, but once I fell asleep, I didn't wake up until it was way too late for the lesser of two evils (oxycodone) and she went straight for the dilaudid, which I really wanted to avoid after I read about it online.  The oxycodone had seemed to work better the day before, the issue being you need to take it before pain is at a 10 because it takes 20 minutes or so to kick in.  So, as I whimpered in pain, I also tried to negotiate with the nurse to not get me to the point of needing dilaudid.  I also remember sobbing and pleading that I not be discharged in the morning.. I was panicking about the thought of going home alone and having one of these painful attacks, that felt like a cross between what I'd expect a heart attack to feel like, and a collapsed lung. Luckily the day nurse came back, and I got back on my happy schedule of oxycodone, but not before I had a hysterical break-down over the IV that wouldn't stop beeping and the fact that I couldn't eat without sounding the IV.  Luckily I don't have to interact with those nurses on a daily basis, because they both really saw me at my worst.

I was discharged Sunday and am starting to feel normal again. The chest pain is almost gone and I'm starting to breathe more normally. The pain in my right leg had disappeared during my hospital stay (likely because of the pain meds, but also because some of those clots were probably what dislodged and moved to my lungs) but now just feels kind of heavy and electric. I have no answers for where I'm going at this point in terms of recovery, and am actively looking to replace my initial primary care guy who both mis-read the initial ultrasound, and has provided little guidance on anything.  An example being that he just called to cancel tomorrow's appointment, so I've had no follow-up appointment since leaving the hospital (and I didn't see him in the hospital), and he says he doesn't need to see me for another month for an ultrasound, when he had mentioned that I could do screenings every 2 weeks when I last spoke with him. I do know that I'm not supposed to do anything active (according to him) until I have an ultrasound on my calf, so this means he expects me to just hang out and figure out what's going on until he sees me again in a month. Not to mention a thorough explanation of all of that goes along with being on blood thinners, and dosing, etc.  I went in for a blood screen this morning, and the dosage of my medication is based on the results of that test, but despite several calls to the office, I still don't know if I need to continue with a shot in the morning or not.  With thinners, they work to get your INR levels in your blood (which has to do with clotting) up to between 2 and 3, and it's something that is monitored regularly to make sure that dosing is accurate.  I've been on boosters, which they shoot into your stomach, daily since the first morning in the ER, but will get to stop those as soon as I get to where I need to be.

So, a bit of a long post, but that's what I did this weekend.  I'm dealing with it better each day and break into tears less frequently and mainly when I'm alone.  My poor parents are going to flippin' freak when they get home from a South American cruise on Wednesday to find out what I didn't tell them.  Thanks to all of the friends who visited and called and otherwise kept me entertained during a scary weekend.  I'm open to any recommendations for good care in Portland, so if you have them, give me a shout.  

Thursday, March 15, 2012

Plane pain: Diagnosis DVT

The last few days haven't been fun.  I returned from a great work trip to Istanbul, but landed in New York with some weird upper calf pain. Tightness, but seemingly unrelated to running (or even sitting on the plane, for that matter). Some google research eventually convinced me by Monday night that I had deep vein thrombosis (DVT), or clotting in the deep veins of the leg.  A closet hypochondriac, I opted to get it checked out when the pains didn't disappear by Tuesday morning and seemed to worsen.

After a brief examination, the doctor said that DVT was doubtful, but to ease my fears, ordered an ultrasound.  The ultrasound technician let me know that she could not say anything to me about what she might find, but that if she told me to go home I was fine, or alternatively asked me to go back to my doctor or to the ER, I was probably not fine.  She spent a lot of time going over the affected area (the test has her starting at the groin, and following the vein down your leg and back around behind your knee and down).  So, when she breezed down the upper leg, and then focused on the painful spot for several minutes, I had a feeling I wouldn't be sent home.

Fast forward 30 minutes, and my doctor was calling the room to talk to me about my results.  No, I didn't have DVT, but did have superficial thrombophlebitis, or clots/inflammation in superficial veins.  Not something I should worry much about, except to take some measures to get rid of these, and prevent them for next time.  No prescription of blood thinners necessary, just go off birth control pills, take an aspirin a day, and elevate the leg when possible.  Exercise was questionable--he didn't know so would get back to me. I had explained to him that I was running for the US at the World 100K championship in 6 weeks, and that the answer to this question was a serious one for me.

I ran the next morning, and my calf wasn't happy.  It felt a good inch shorter than it's normal tight self.  The pain did seem to be worsening, and the doctor never called back.  I finally called and was told he was gone for the day.  Not long after that, his colleague called to say that the ultrasound had been misread; I had both deep and superficial clotting and would need to start blood thinners immediately, and not to exercise.  Most cases would clear up in 6 weeks or so.

I explained my situation to him--that I had a major race in just under 6 weeks, and that lazing about wasn't ideal. He couldn't really tell me anything that I wanted to hear.  He couldn't recommend that I keep training, and couldn't give me a timeline for when that might be possible. But that I needed to start on blood thinners immediately, which is why he was calling, and that I should further discuss with my doctor a plan going forward. A quick google of blood thinners had me a bit freaked out.  No playing with sharp objects or shaving my legs for a while.  Blood thinners and Amy just seem to be a dangerous combo being that I'm quite possibly the most accident-prone person I know.

That was yesterday.  I had a painful night--a feeling of knife stabs into my calf.  I'm no closer to having an answer from my doctor, who told me he's still working to reach out to specialists and get more answers.  I will have blood work done on Monday after I've been on the medication for 5 days which will tell something about the level of something or other in my blood.

I'm stubborn, but not stupid, and if exercise is highly inadvisable than I'll be a good patient, but I'm extremely frustrated at the moment.  I don't want to give up on Worlds, but am not sure when I'll be able to run again.  Regardless of what the doctors tell me, I currently can hardly walk, so even if I had the go-ahead today, couldn't run.  It's hard to believe that the Ray Miller 50 was just over 2 weeks ago. Like they say, ultras are all about peaks and valleys and I seem to have taken a nose-dive off of a high peak into a rather deep valley.  

Friday, March 2, 2012

Ray Miller 50 Mile: Focusing on me

I was hanging out in Nairobi on Wednesday evening, enjoying a few beers after co-facilitating a somewhat stressful 3-day training when I decided to check my itinerary so as to figure out what time I needed to be awake on Thursday to make my noon'ish flight. The airport is only a 30 minute drive from the airport, but that can extend to 3+ hours if you hit the wrong traffic circles at the wrong time (one reason I'm not a huge fan of Nairobi--getting around is complete chaos). It should have seemed odd that I was catching a flight in the middle of the day, as I'd always flown out of Nairobi at night (and that I would arrive in LA just 6 hours after departing with a 30 hour trip and an 11 hour time difference) but I hadn't given it much thought.

So, I checked and the itinerary read 12:35 a.m. Thursday....hmmm. What exactly did that mean?  I have always struggled with the 12 a.m./p.m. thing, and wasn't really sure if my flight was in 3 hours, 15 hours, or 27 hours. I've missed 12 a.m./p.m. flights before, and am relatively intelligent, so one might think that I would be able to figure it all out, but I can't. Luckily I can recognize my inadequacies and sought guidance.  I walked down to the bar and asked my friends to explain: "What does 12:35 a.m. Thursday mean?"  Yep, my flight was in just a few hours--midnight as opposed to noon. While I was bummed to miss a night out on the town in Nairobi, I was excited to leave Nairobi, too, and super excited that I figured this out before I royally screwed up.  Missing my flight would have made the Ray Miller 50 really really challenging (as my ankles would hardly have had time to decrease in size before the race started) had I arrived a day later.

3 flights and 30 hours later, my dear friend, Meghan, met me at the airport on Thursday evening as planned, and I struggled to form coherent sentences on the trip from the airport to her brother's place in Thousand Oaks. My luggage hadn't arrived, and this was a little worrisome, as I didn't want to spend Friday shopping for new clothes and shoes.  I crashed, and the luggage fairy delivered my suitcase sometime between 4 and 6 a.m., so all was well in my world.

Google map image of race course from the race website. Awesome course; loved the loop and out-and-back combo.  Climbs were tough but runnable, and descents were long and fast.
I decided to run the Ray Miller 50 for a variety of reasons, one of which was that I could squeeze it in between work trips to Nairobi and Istanbul.  My next big focus race is the World Championship 100K, and running a 50 miler 2 months out seemed like good preparation in what is otherwise a busy and hectic time for me that has put a damper on training. Nairobi is never a fun place for me to train (highlight is that it's at 6000 feet), but by having a race at the end of the trip, I could somewhat excuse a crappy couple of running weeks as a sort of taper. I'd also been on the Ray Miller trail once before, and remembered it as something special, and wanted the opportunity to further explore the area.

Friday was awesome.  Meghan and I drove over to run for 30 minutes on the course, and it felt like we were out there for 5 minutes. After 2 weeks of really unappealing running options in Nairobi, it felt so good to run on a beautiful dirt trail. It was blissful and ended much too soon. The run was followed by beer and delicious fried scallops.  Meghan and I talked a bit about the race on Friday and again on the drive over to the run on Saturday. I'd been having some confidence issues after a very blah attempt at Orcas Island, and my fear of racing seemed to be winning out. My main goal for Saturday was to focus on me, and not let external factors, like where others were in relation to me, stress me out and cause me to react in a negative way (backing off). It was going to be all about me.  Meghan is always super supportive and positive, and convinced me that I was fit and ready to let one fly. I hoped that we would let one fly together, as I love to run with Meghan.

When the race started at 6 a.m. it was still fairly dark, so I fell in behind Shawna and just tried to follow her footsteps.  I chatted briefly with Jimmy Dean and Mark, two of my favorites, and who I would end up seeing throughout the day.  After a few miles and just before the top of the first climb up Point Mugu, I passed Shawna, and continued to push the pace from there. Much of the first 20 miles felt too fast, but I couldn't seem to back off the pace, and kept pushing.  Around mile 18 Tommy, another favorite, caught up to me on one of the many fun descents and didn't want by, so I continued to set the pace, although now with a little pressure to not impede his progress so pushed it a bit hard into the aid station (mile 19.3).  I was hurting at this point, and didn't really even notice the fact that I was surrounded by super heroes.  How does one miss that important point?

Some of the Super Heroes at Danielson Ranch AS (19.3). I'm not sure who these characters are (a giraffe superhero?) but the more traditional Wonder Woman/Superman were also there.  How I ran through all of this without even realizing that were super heroes present is hard to explain, except that it was the start of my only major bonk. Photo by Jack Rosenfeld.
I followed Tommy out of the aid station after an emergency pit stop, but at a much slower pace and lost him quickly. The next several miles were the long climb up Sandstone Peak (roughly 7 miles). It looked like the day could turn into a slog as it felt a little like I'd just raced a half marathon.  Mark passed me on this climb, and he passed me like I was standing still.  It was a ~6 mile climb, and quite runnable, although I was walking at this point.  He commented that I had taken off at a blistering pace.  Yep, probably a bit too blistering.  I continued to slog, running when I could, which wasn't that often.  This section of the course was gorgeous, with great views of surrounding mountains and the ocean in the distance, and really cool rock formations, like the butt crack rock, which was pretty hard to miss.  The climb eventually ended, and Jimmy caught me as I ran back towards him, second guessing a turn.  I had some confusion at one of the intersections marked with arrows that weren't ours.  I probably spent 3 or 4 minutes standing and then proceeding and then returning to question the turn again.  He commented that "the girls" were a couple minutes back.  Crap.  I was surprised I hadn't yet been caught by anyone as slowly as I'd ascended the climb, and then with minutes wasted trying to decide which way to get down to the aid station.

At Yerba Buena AS I picked up my second bottle, and continued on to the turn-around.  Within a quarter mile of picking up my second bottle, I decided to drop it and pick it up on the return.  I'm simply not strong enough to carry 2 full bottles, and wanted to do it for as little of a distance as possible, and would need to carry both for the 11 mile stretch after Yerba Buena the second time through.  At the turn-around (approx mile 31) I calculated that I was about 8 minutes up on Shawna 10 or so on Meghan and Angela, so knew that I needed to keep pushing.  It was getting to be that point in the race where I had led for so long that I'd resent being passed.  I was glad that there were two big descents coming up because I was confident that I could hold my own on the downs.  By the turn-around, I was starting to feel relatively good again and everything was runnable until we started the steep climb up out of Yerba Buena. I left YB with two full bottles and downed one as quickly as I could to avoid the weight of two. Even holding on to two water bottles was driving me crazy, and I bemoaned the fact that I hadn't thought to pack a pack. Packing for a race two weeks prior while packing for a work trip at the same time leads to crappy preparation.  I tried sticking one down my bra, and it reminded me that being boob-less is a good thing, as it bounced around and annoyed me.

Surprisingly, I caught a few guys heading up the climb, including Jimmy, and then caught up to Mark on the big descent, which went on for miles and miles.  "Back from the dead," I commented as I caught up to him, and passed, although he latched on.  I really let it go on the downhill, and my shins and lower legs were starting to feel stressed as it went on for several miles.  I'm not sure how quickly legs forget how to climb and descend, but I hadn't been on a hill in my 2-weeks in Kenya, and my legs seemed to recognize that. But there were a lot of really long and bombable descents, which were hard not to bomb.
Grinding up the final climb. I always seem to be looking at my feet. Photo by Jayme Burtis.
After making the turn off the of the Sandstone Peak climb (the out-and-back section), the course starts to roll a bit while continuing generally downhill towards the last aid station (mile 45.5).  Mark and Jimmy passed me back, and I didn't have the leg speed or will to suffer to keep up.  I passed Tommy back at this point, who looked to be cramping.  The rest of the run was pretty uneventful.  I was alone, although I'd run alone almost all day except at the beginning, and a few miles with Mark and Tommy.  I tried to keep pushing, as I knew I hadn't been too far ahead at the turn-around, and, again, it sucks to lose the lead in the last 5 miles after leading for 40+ miles.  I was taking in calories well (strictly gels), for the most part, and besides some lower leg trauma from the descents, feeling pretty good.

The race finishes coming up and over a 2-mile climb, and then turns onto the Ray Miller trail for a really sweet downhill finish.  The Ray Miller trail is the first trail I ever ran on the west coast, back when I had come out to run Coyote 2 Moon, and I remembered it as stunning.  It was just as stunning as I'd remembered it, and the downhill 2-miles to the finish was fast and fun (or at least that's how I remember it a few days later--at the time, I think all of the muscles/tendons in my lower legs were on the verge of a major protest).  I finished in 8:10, 2 minutes behind Jimmy and 5+ minutes behind Mark for first chick and 6th overall.  In the end, I could have relaxed on the Ray Miller trail as Shawna (8:44), Meghan and Angela (8:51) weren't in sight, but one never knows. Felt good to know I'd put 25 minutes on them in the last 20 miles.

My quads definitely weren't ready to run downhills like that.  I was completely trashed on Sunday, and it wasn't until Wednesday morning that I was recovered enough to get in a run. I walked on Sunday, and Monday and a massage on Tuesday really helped work out the funk.  Thursday my legs felt 100% better, so it was a short but severe case of quad death.

The final downhill miles to the finish on the Ray Miller trail.  I love this trail and enjoyed every minute of it.  Photo by Jack Rosenfeld.
Overall, a great day for me, and exactly what I needed.  I stayed within my own head, wasn't afraid to race, and went after it from the start.  I'd been having some confidence issues and just feeling lackluster, in general, about where I'm at.  Life had gotten in the way and caused my mileage totals to be lower than I would hope over the past several weeks, but this left me confident that I'm in a good place, regardless.  This was a great motivator for me to show me that I am in shape, and with a good training cycle through Worlds, can throw down a great performance.  We've got a great team lined up, and I can't wait to see what we can do in Italy in April.  After Orcas I was ready to throw in the towel, but after Ray Miller I'm excited and feel like I belong on the team. I'm shooting for 7:48 at Worlds and top 10 to ensure a spot in South Korea in 2013.  There, I said it.

I highly recommend this race--great course, great aid, great weather.  There aren't many 50 milers this early in the season, when the schedule seems to be dominated by 50Ks, which I've decided I really don't much care for.  I'd guess after the favorable response it got this year, Ray Miller will fill quickly in years to come, and for good reason. Thanks to Keira and all of the volunteers out there--this one's a keeper and I can't wait for another go at it!  Southern California in February is pretty dreamy to us Oregonians (although I looked forward to returning to the cold drizzle after 2 weeks of entirely too much sun).  And to my travel companion, Meghan, many thanks for the talks and laughs, and I'm looking forward to several more destination races in 2012.

Tomorrow morning I'm off to Istanbul for a week--I'm excited to explore a new place (to me) and can't wait for some morning runs along the sea.

Sunday recovery soak in LA.  A painful day, as my quads were trashed and the jet lag/post-race combo led to about 1 hour of sleep on Saturday night.  I was dead on my feet by the time I got home late Sunday night, but it was worth it. It appears that I'm smiling here, but I think it's more of a cold water grimace. Photo by Meghan Arbogast.