Returning to Racing - BMO Marathon

Lessons:

1. Be ambitious and set high goals, but don't get fixated on the outcome. Sometimes things are completely out of your control, and focusing on what you can control is the most important.

2. Don't let ego and pride get in the way of what is best for your mental and physical well-being. If I had continued down the path of not seeking help or taking this medication, my condition could have progressively gotten much worse.

3. Life does not work in a linear fashion. In many circumstances, the path we once thought we were destined to follow is littered with potholes and obstacles which will require maneuvering and pivoting. Learning to cope with having to make changes to the original plan can be disheartening, but it may lead to a similar or even better outcome.

4. When all options have been exhausted, it is ok to accept help. Using an aide (permanently or temporarily) to get through a rough patch doesn't make you less of a person or the goal any less worthy of your effort.

5. Learn to listen to your body. Working hard and persevering is a quality that typically helps drive progress towards our goals, but there are circumstances where the negative consequences outweigh the benefits of the effort.

6. Developing an idea of what the future could look like can be helpful in alleviating anxiety of the future, but don't let that dictate what may be the best decision in the present. We can only control the decisions we make in the present, so make the best decision you can with the information you have and live with what comes in the future.

7. Don't dwell in the what could, should or would have happened.

8. Shared pain is half the pain.

9. Run your own race. Similar to life, each person has their own challenges, strengths, and weaknesses. The more we compare what we have or don't have or compare the outcomes of what we want to accomplish, we'll never be happy.

In this post, I'll be sharing the rollercoaster ride that comes with trying to find my physical and mental limits as an athlete with Ankylosing Spondylitis (AS).

My journey into the world of marathoning was inspired by my aunt who had run a number of marathons throughout her running career. She had told me about her experiences running in various countries and meeting other inspiring athletes, and I wanted the opportunity to experience the same. I toed the line at my first marathon fourteen years ago, here in Vancouver, at the BMO Marathon in 2010, and I have been hooked on long distance endurance (marathon and triathlon) racing ever since. I continue chasing the same runner's high I felt at that race.

BMO Marathon Performances to Date

• 2010 - 3:18:53

• 2014 - 2:57:26

• 2016 - 3:02:36

• 2017 - 2:51:53

• 2024 - 2:51:51

Over the years, I've flip-flopped between racing in triathlons and running races at various distances; however, running continues to be my favourite discipline. Running is predominantly an individual sport, since it is just me and the road, but I find the running community to be welcoming and inspiring. It doesn't take much to get started and it literally just takes one step after another (whether it is fast or slow). I have always enjoyed how running is like a puzzle, where I have to piece together the training, nutrition, pacing and recovery and it all has to come together on race day.  

In sport, there will always be both highs and lows, but this year in particular was my most challenging year to date, both mentally and physically.  When I plan my race season (typically a year in advance), I set new and ambitious goals to challenge myself, and this 2024 was going to be my most ambitious to date.  Spoiler alert, things don't always go as planned.  

Lesson:

• Be ambitious and set high goals, but don't get fixated on the outcome.  Sometimes things are completely out of your control, and focusing on what you can control is the most important.

Diagnosis 

My last competitive race was Ironman (IM) Korea in 2019; however, it was cancelled due to inclement weather, so I had spent an entire year training for a race that never happened.  Needless to say, I was disappointed, but at the same time a bit relieved.  Throughout 2018 and during the entire training season in 2019, I had been dealing with what I thought was a glute injury, which significantly impacted my training.  However, my goal was to win my age category at IM Korea, and I was so determined to try and perform at the highest level that I just gritted my teeth and pushed through the (sometimes debilitating) pain.  Some days it would be excruciating to complete easy training runs or endurance bike rides, but I've been known to be stubborn so that probably explains why I continued pressing on.  

Once I returned from Korea, I took a pause from planning my 2020 race season to evaluate my mental and physical health and realized I had been racing consistently for almost a decade and it had taken a toll.  I started to lose the joy of racing, so I stopped any formal training for the rest of 2019 and the beginning of 2020, which happened to be the start of COVID-19.  There weren't any races, so I would only go out for leisurely runs (nothing longer than 10 kilometers (KM)).  Over the course of a couple of months, I noticed a persistent pain radiating from my glute into my lower back which ached and was stiff.  The constant pain and stiffness significantly impacted my sleep; for a month, I was only sleeping for three to four hours a night. Despite stopping all running, the pain continued so I saw my family doctor who chalked it up to nothing significant and sent me home with a recommendation to take some Tylenol.  After another few weeks of being sleep deprived, my family doctor finally agreed to see me again and run some blood tests and identified that I have the HLA-B27 gene, which is a marker for people who have Ankylosing Spondylitis.  He explained that AS is an immune response to a certain type of bacteria which then sets off the AS symptoms (further inflammation). Shortly after, I was sent for magnetic resonance imaging (MRI) which verified that I had developed signs of increased inflammation in the Sacroiliac (SI) Joint.  AS is quite rare and only affects 0.1% to 0.5% of the world population.  My parents would be proud if my grades were in this percentile, because this was like scoring an A+ on an exam.

With my diagnosis confirmed, my Rheumatologist reviewed the way in which AS would impact my life, in particular how I would likely experience back pain and stiffness persistently in the morning and it would likely get better throughout the day.  However, as the disease progresses, it could lead to a hardening or fusing of the spine which could limit mobility and spinal motion.  In addition, I could develop cardiac and vision issues.  As this is a life-long progressive disease, the best course of symptom and pain management was continued stretching and mobility exercises and medication.  I was prescribed a non-steroidal anti-inflammatory drug (NSAID) called Celebrex, which I had to take twice daily to manage my symptoms. 

Taking any sort of medication was very foreign to me, and I hated the thought that I had to rely on a drug to help me live a normal/pain free life (this is my ego speaking).  I lived a relatively healthy lifestyle (eating a balanced diet, exercising regularly, alcohol and smoke free, etc), and I felt that relying on some exogenous drug to function made me less of an athlete.  I prided myself on being able to achieve my goals without any sort of outside aide.  Given the amount of constant pain I was in, I had to push my ego aside and have been taking the medication everyday since, which was both a humbling and somewhat depressing experience.  

Lesson: 

• Don't let ego and pride get in the way of what is best for your mental and physical well-being.  If I had continued down the path of not seeking help or taking this medication, my condition could have progressively gotten much worse.  

Conceive. Believe.

I once saw the motto "Conceive. Believe. Achieve." and it embodied what I have always felt kept me in the sport of racing.  It's choosing a goal, believing you can accomplish it and doing anything possible to achieve that goal.  This has fuelled me to continue to explore the limits of what I think I can accomplish in life.  After a three year hiatus from any strenuous physical activity, I felt I had a good handle of my AS. 

In September 2023, I signed the Canyons 100KM Ultra Marathon Trail Race in California, which gave me about eight months to train for my biggest footrace to date.  I figured I had sufficient time to slowly ramp up the volume so that my body could acclimate to the increased physical toll this would require.  Over the next couple of months, I had become comfortable with running the half marathon distance quite easily again and was encouraged by my progress without any pain from my AS.  With the increased confidence in my ability to build my fitness back up, I was tempted by my triathlon friends to sign up for Ironman Penticton in August 2024 and shortly after registered for the BMO Marathon.  I succumbed to the peer-pressure (this happens more than I would like to admit) and started integrating swimming and biking slowly into my training regimen.  I used training as an outlet to help cope with the stress of my father's dementia and passing.

By January, both the intensity and duration of my workouts were close to what I was logging in 2018 and 2019 (approximately an average fourteen hours of week) spread over the three disciplines (primarily biking and running).  All of my training was on track, until I started to feel the niggling pain in my glute and slight tightening of my back I experienced at the peak of my training in 2018 and 2019.  I dialled back my training to see if that would address the discomfort.  Over the ensuing weeks, the pain continued to escalate to the point where sleeping through the night and getting out of bed in the morning were nearly impossible.  I started taking additional extra strength pain medication to simply function during the day.  In February, I stopped training all together and my friend (Thomas Wan) who is a physio (Shout out to ReBounce Physio), attended to the pain with all the tools at his disposal, but he could only provide temporary relief.  

Pivot (sometimes, a necessary step on the path to achieving your goals)

I consulted my rheumatologist to see what other options I had available.  He recommended that I consider switching medications from a NSAID to a Janus Kinase (JAK) inhibitor or a Biologics medication.  A JAK inhibitor is an immune modulating medication that prevents certain enzymes from reacting in the body and prevents inflammation from occurring.  Biologics medication would be the next level of medication if the JAK inhibitor was to be ineffective, but it works in a similar fashion.   Although these drugs have been found to be quite effective, I was concerned about the long term side-effects, which include an increased risk of infections and cancer (the drugs are immunosuppressants), cardiac and respiratory complications, and possible severe kidney or liver damage.  

After taking home a stack of pamphlets on the various types of Jak Inhibitor and Biologics medications and reviewing their respective potential side-effects, I broke down.  I felt I was in a terrible vicious cycle that had potentially worse outcomes than the benefits I was trying to achieve by participating in the activities I loved.  Through training and racing, I found a sense of purpose and achievement that I haven't experienced anywhere else in my life, and it allowed me to relieve the stresses of life.  But at the same time, these activities were part of the reason why I was in so much pain and couldn't sleep.  I also knew that bouts of stress from external factors (i.e. relationships, work/business, life in general), could spike the amount of inflammation in my body which would exacerbate my immune system further.  I have an anxious personality, so I thought about all the different scenarios that could occur, and I hit the lowest point since I was initially diagnosed.  

I considered giving up on competitive sport entirely, and thought this option would allow me to stay off the Jak Inhibitors and Biologics medication.  Similar to how I felt when I initially took medication to address my AS symptoms, I didn't want to take medication to have to function as a normal human being.  I construed this as having a "crutch" and not "manning-up" to dealing with the pain.  I wanted to achieve athletic success on my own terms, rather than to succumbing to using a drug for support.  However, this perception began to change after I spoke with a friend who shared his struggles with depression.  He noted that taking medication for an illness doesn't change who the person is, but allows the individual to be who they actually are without the struggles of the illness.  

I mulled over the decision about whether to take a new form of medication with potentially even more side effects than the medication I was currently taking.  Over the next couple of weeks, I wanted to take some of the pressure off trying to achieve such ambitious goals, so I withdrew from the Canyons 100KM Ultra and decided to train for the BMO Marathon. Having completed the marathon before, I knew that I could complete the marathon with significantly less training than the ultra marathon, so I aimed for a sub-three hour marathon pace as my goal and to qualify for the Boston Marathon.  

Lesson: 

• Life does not work in a linear fashion.  In many circumstances, the path we once thought we were destined to follow is littered with potholes and obstacles which will require maneuvering and pivoting.  Learning to cope with having to make changes to the original plan can be disheartening, but it may lead to a similar or even better outcome.  

• When all options have been exhausted, it is ok to accept help.  Using an aide (permanently or temporarily) to get through a rough patch doesn't make you less of a person or the goal any less worthy of your effort.  

Achieve

With less than two months left to train for BMO, I knew I had to be selective on the training sessions I could complete.  This was the first season where I didn't let ego guide my training.  I'm unsure if I've become a more mature athlete or just getting old, but this disease helped me learn how to listen to my body.  In the past, I would power through any workout that was on that day's training schedule; however, with the state of my body and mind, I gave myself the grace to skip a workout (or multiple workouts) if my body wasn't up for it.  I allowed my body to recover and didn't beat myself up when I didn't hit a target workout.  I also stopped comparing myself to my previous athletic achievements and my friends/competitors.   

Lesson: 

• Learn to listen to your body.  Working hard and persevering is a quality that typically helps drive progress towards our goals, but there are circumstances where the negative consequences outweigh the benefits of the effort.  

Despite doing my best in managing my efforts and recovery, the bouts of pain fluctuated constantly, so in mid-April, I decided to begin taking a JAK Inhibitor - RINVOQ.  I felt I was so anxious about the potential long term side-effects that it was inhibiting my ability to live in the present.  After seeing my father pass away shortly after retirement, I realized that future life/health isn't guaranteed, so I should take advantage of the time I have now, while I still can. 

Lesson: 

• Developing an idea of what the future could look like can be helpful in alleviating anxiety of the future, but don't let the fear of the unknown dictate what may be the best decision in the present.  We can only control the decisions we make in the present, so make the best decision you can with the information you have and live with what comes in the future. 

Unfortunately, I couldn't start the medication immediately, because of the long list of qualifications (i.e. obtaining Shingles and Pneumonia Vaccinations, reviewing blood tests, and reviewing past health reports).  Two weeks prior to the race start, I had started to feel so much pain, I thought I wouldn't be able to even toe the start line.  Fortunately, I was in the de-loading/tapering phase of my training which helped reduce the inflammation I was experiencing from training.  I started my first dose of RINVOQ on the Monday before the race, and I am happy to say it has been life-changing thus far.  

The results speak for themselves.  I set a course personal best (albeit by only two seconds) with a fraction of the training, and I have never felt better after an endurance race.  After this performance, I wonder whether I should have taken this new medication earlier and what my potential as an athlete would have been, but that's the past... onto the future:).

Lesson: 

• Don't dwell in the what could, should or would have happened.  

Race Report

Race Goal 

Needless to say, the lead up to this year's BMO Marathon was quite eventful; so I set my expectations at a sub-three hour marathon completion (4:16/km pace), which would give me a Boston Qualifying buffer time of five minutes for my age group.  Ideally, I needed a larger buffer in case there was a lot of fast qualification times (for 2024 qualification, I would have needed a 5 minute 30 second buffer). A few weeks prior to the marathon, I had completed a full distance marathon training run at a 4:32/km pace which put me right at the qualification time, so I was confident in completing within the time frame.

Pacing 

I started off way too fast for the first four kilometers at a sub four minute pace and then found my friends (Curtis - white and red tank and Mark - black tank) who were planning on running their own personal bests at a two hours fifty-two marathon pace (4:05/km pace), and I dropped back to run with them.  Although it was much faster than my goal pace, I figured the adrenaline would carry me through and my legs felt light so I stuck with them for the first thirty two kilometers.  My goal was to work together with them to ensure proper pacing and then break off for the last ten kilometers based on how I felt.  I was feeling strong but began to fade once I hit the seawall because I was running alone.  Once I started catching up to other runners, I started working with them to bring the pace back up.  Although we ended up breaking the pack during the last ten kilometers, I survived the first thirty-two kilometers because of the work we did as a team.  [Both Curtis and Mark finished with personal bests at the race as well - Congrats to them both].  Also thank you to the Fraser St. Running Club for all of the great training sessions!  

Lesson: 

Shared pain is half the pain. While running with a group, not only are you able to work together to break the wind and set the pace, but you're able to feed off the energy of your fellow runners.  There is a brief bond you build when you're running stride for stride with another athlete who is pushing themselves just as hard as you are.  At varying points during every race, there will be times where giving up feels so much easier than proceeding, but it becomes significantly less strenuous to take the next step when you hear an encouraging word or you hear the drumming of footsteps around you.  

Stats

Average Cadence - 187, Average HR - 158, Calories burned - 2,606

Nutrition Plan 

Two nights before the race, I began carbo loading.  I made a simple pasta and spaghetti sauce with turkey meat and tons of veggies and ate it for both dinners prior to the race.  I also supplemented my sodium intake with a Precision Hydration tab and concentrated Gatorade Powder.  I finished dinner at 5:00pm and went to bed by 10:00pm.  

On race day, I ate a large bowl of oatmeal with a banana and Maple Syrup with a coffee two hours to the race time.  I pre-mixed about 500ml of Gatorade which I sipped the half hour before the race.  I took one gel fifteen minutes prior to the race, and during the race I took one gel (mixed between caffeinated and non-caffeinated) every seven kilometers while intaking NUUN electrolyte and water on course.  

Weather 

The weather was absolutely perfect.  It was a dry 10-11 degrees Celsius at the start of the race and stayed relatively cool throughout with a slight breeze.  

Photo Credit - Stuart Mah. Thanks!

Final Results

Overall, I couldn't be more thrilled with the result of this race.  Given that I didn't even think I would start the race two weeks prior to finishing with a course personal best, I am very happy.  I felt I paced the course almost perfectly, completing the first half marathon in a time of 1:25:58 and the second half marathon in 1:26:53. I kept my emotions in check, listened to my body, and I was present the entire race.  With the electrifying energy from the crowds, this was my favorite and most enjoyable race to date.  I am already looking forward to the next!  P.S. Thank you to all of the volunteers, spectators, friends, and family that cheered us on and congratulations to all runners!

Lesson:

• Run your own race.  Similar to life, each person has their own challenges, strengths, and weaknesses.  The more we compare what we have or don't have or compare the outcomes of what we want to accomplish, we'll never be happy.  

What's Next... 

I continue to be thankful that I currently do not have any pain and hope that this feeling lasts for as long as possible.  The ups and downs of this disease have taught me to live more in the present and appreciate what I have now.  Therefore, I have dedicated the rest of this year to continuing the path to discover my truest limits.  My race schedule and goals are as follows:

• Vancouver Half Marathon - June 23, 2024 - Goal: Sub 1 Hour 17 minutes

• Ironman Penticton - August 25, 2024 - Goal: Sub 10 hours 45 minutes

• Portland Marathon - October 6, 2024 - Goal Sub 2 hours 40 minutes 

• Ironman California - October 23, 2024 - Goal Sub 10 hours 

Thanks for reading!