Thursday 4 May 2023

Gastric Emptying (Dumping) Syndrome and running

 WARNING! The following is very definitely TOO MUCH INFORMATION. It's only useful if you have abnormal effects from sweet/carbohydrate food and want to know what to do about it.

2nd Warning. I am not any kind of doctor. I do not have a formal diagnosis of Dumping Syndrome. My only formal diagnosis in 45 years of consulting doctors about my symptoms is "you don't have diabetes and you seem to manage your diet OK. Whatever it is, it's not serious.". The friend who suggested Dumping Syndrome is a doctor however - a consultant in a teaching hospital.


I struggled with blackouts, dizziness and other symptoms from early childhood. One of my earliest memories is a trip to Barnsley hospital for a blood test for anaemia. I was booted out of school for bad performance at 16, due to blackouts and dizziness that always occurred after lunch. The GP said I should go to bed earlier (I had insomnia, nightmares and night sweats quite a bit as well).

I also struggled with mood regulation in the early evening - obvious blood sugar problems like being irritable, weepy and clumsy. Cold sweats were occasionally a thing, but not often enough to be obvious.

I finally started to understand what was going on when I started training in my late 30s for long runs, particularly off road marathons. When I ate anything sweet, almost immediately after I would get symptoms. These symptoms could vary but included:

  • nausea
  • bloating and stomach cramps
  • wind
  • dizziness
  • prolific cold sweats (followed by appalling chafing)
  • clumsiness and disorientation.
  • explosive diarrhoea (you do not want explosive diarrhoea on an ultramarathon...)
The penny finally dropped when I ran home from work along the canal - 23 miles of boring, pancake flat running. I put a couple of dextrose tablets in my water to keep my energy up. Until 18 miles I made good time, and I looked like being around 3 hours 30.
At 18 miles I realised I was thirsty and took a massive drink, probably 250ml in one go. So that's about 1 dextrose tablet.
Within a mile I was doubled over with excruciating stomach cramps. These didn't pass, but they eased off intermittently and gradually they got less acute. My legs were like lead, I had no energy or motivation, I was freezing cold but sweat was pouring down me and I was on the verge of tears for no obvious reason. It took another 3 hours to do the 5 miles home. By the end I was crying and felt like just stopping and lying down.

Obviously the problem was sugar.

A couple of weeks later I did the same run again. No food after lunchtime, plain water only.

3 hours 20 minutes, finished feeling fine.

So that was OK, because I just trained up to run to marathon distance without eating. Simples.

Until I started doing ultras.

The story doesn't go on much further beyond that point. Ever since then I try things, they work (or not). Peanut butter in a baby food pouch works well. Malt loaf works surprisingly well, especially with peanut butter. Cheese fixes a lot of things and is good generally. Pitta mini pizzas looked promising but are just 'ok', a good additional option but not a standard staple. Toast is OK-ish, un-toasted bread is a complete no no. Wholemeal is better, but still has to be toasted. Anything more than a small quantity of pasta is a bad idea.

There's no easy answer, it's just a constraint I have to work within.

Wednesday 3 May 2023

The Fellsman 2023 - it gives you something new to think about every time

 The original plan for this year's Fellsman was: Claire would run solo and finally get a handle on the scope of the beast that is the Fellsman; I'd do exactly the same as last year but without the navigation failures. It didn't quite work out that way, and as you might expect the reason was down to preparation.

For a couple or three weeks beforehand I was aware that I had a lot of tightness in my legs. I'm crap at stretching regularly, but I'd made time to stretch and roller for the last 2 weeks.

Oops. Should probably have left well enough alone.

My ongoing attempts to reconcile gastric emptying syndrome with ultra-running had resulted in a new go-to food: mini pizzas made from pittas and cheese. I opted not to take any peanut butter and relied primarily on the pittas. This was a BIG mistake.

So anyway. I drove up friday night after a quick and convenient meal of scrambled egg, potato and some veg. This was also probably a mistake as that meal has caused me stomach problems when racing before. I took all our kit to kit check, said hi to a few people and headed back to the camper to wait for Claire, who was coming up after choir practice. We got to bed around 11:15, and were up at 4:45 to drink some coffee and catch the bus down to Threshfield. Leaving the van at about 5:20 worked out about right for the 6:15 Threshfield to Ingleton bus.

We picked up our trackers, had a couple of cups of tea and by then it was time to set out. There was a minute's silence in tribute to a couple of members of the Fellsman crew who passed recently, in particular  Kate Metcalfe who had been greeting exhausted people at Threshfield for a good many years.

And then we were off. The speedy people rushed to the right of the field and jockeyed for position (no one going left this year), and the rest of us followed behind. Once we got out onto the road I said goodbye to Claire and picked up my pace a bit.

I made a steady pace to the top of Ingleborough, overtaking a lot of people who'd rushed off but keeping a lid on it to the extent that Claire briefly caught me up near Crina Bottom. During the last climb there was a chap in front of me who was recording his video impressions - I'd see him on and off all day, including a spell sat together at Cray CP.

Ingleborough to Whernside was uneventful. As I got off the end of the corner cutting path on Whernside I spotted Karen ahead of me. It was very early for me to be catching her up, and she had the posture that I've seen before that meant something was wrong.

I stopped to tie my laces, then checked in at Whernside summit and headed down towards the wall crossing, seeing Claire climbing up towards the summit. Dropping down towards Kingsdale I caught Karen and sure enough she was struggling with back pain. After a brief chat I overtook her and carried on up to Kingsdale CP. A quick water refill then on up Gragareth.

I felt OK climbing Gragareth, although I had no chance of keeping up with Bill Johnson from CVFR who powered past me on the last steep bit (I later found out Bill had retired at Park Rash). A quick out and back to the trig for the CP, then back to the wall. We hopped over the wall briefly to avoid the worst of a bog, then on towards Green Hill.

Approaching Great Coum I remembered that the path veers away from the wall and followed it to the gate. Others went to the top of the field and climbed over by a large boulder, so that route is passable. The next stile would be a good one to take for the CP, but once again I carried on (this time climbing over at a high viz left on the wall, rather than backtracking as I did last year).

At Great Coum CP a lot of us carried on to the north west. I was following the route used by Damian Hall last year, on the assumption that he'd have asked around/reccied and found the best lines.

Wrong. I should have figured that out when I saw his route in Langstrothdale.

Once the view down to Flinter Gill was clear I took a bearing and headed down across the rough ground, along with many others. Partway down I fell heavily and both legs cramped up - quads and calves. They stretched out to the point of being able to run, but they caused me increasing pain all day to the point in the early hours where every descending step was painful.

As I made it back to the wall path (which I took last year, and is far superior [and mentioned in the Points to Observe - oops!]) Karen came past, looking a little better than she had earlier. I caught her on the approach to Dent, where she was struggling with the rocks on the steep path in her new Inov8 shoes. She left Dent CP before me and I didn't see her again after that.

A cheese and onion pasty courtesy of Mytholmroyd scouts at Dent, then out along the road. I chatted with another runner on this section as far as Boot of the Wold, where I lost everyone while I stopped to get out the next section of map.

I'd thought Damian Hall's route across to Blea Moor was slightly different, but it actually just follows the trod the whole way. Sticking to the left of the crag, I inevitably ended up in the awful bogs just before the CP. I'm not sure there's a good alternative, I must look.

I tried to head straight for the path through the woods from the CP, hopping over the fence early. This was a mistake as I ended up a little too far east and missed the path. It's probably not worthwhile taking that shortcut, but if I do I should aim off slightly east to counter the tendency to drift downhill. Someone shouted me as I dropped to the forestry road and I picked up the path and followed them down the hill towards Stonehouse. Thankfully no vengeful poultry were in evidence at turkey farm (although Claire encountered the geese a little later) and I got onto the road and down to Stonehouse CP.

A short stop for something to eat in Stonehouse and off I went again. My legs were really starting to hurt and my concentration was slipping. I left the CP without my section map & compass, and had to drop back down to the CP again.

There was a little rain on the climb to Great Knoutberry (although it was very localised because on Blea Moor it absolutely pissed it down!). As I reached the top and the stile I spotted another runner heading up the wrong side of the wall and called him back. I was keeping my cadence up although holding back from actually running, and drew ahead of the others. I saw lots of people I recognised on the way up, including a much healthier looking Karen.

As I arrived back at the stile to head towards Redshaw I spotted a woman heading down the other side of the track in the direction of Widdale. I yelled to her that she was going the wrong way which she didn't seem to hear, so I blew 2 sharp blasts on my whistle. That did the trick and we were able to direct her back onto the route. I headed onto the trod towards Redshaw and took a fairly immediate descent to the wall, handrailing to the stile. A higher line would probably be better.

At Redshaw a guy with a camera who'd seen me go back for my compass at Stonehouse checked I still had it. I demonstrated it dangling from my wrist where I'd attached it. I popped into the tent at Redshaw and asked if anyone had the tracker working. The crew told me Claire was only about 30 mins behind me which cheered me up a lot. I was flagging a bit here though and really should have eaten more. This was mistake number 2 (number one being the stretching regime).

I headed out into the sunshine and listened to the moorland birds as I climbed up to Snaizeholme, chatting with a couple of others. My stomach was starting to get troublesome, and I forced down a cheese pitta as the others drew ahead. At the wall crossing where the Dales High Way joins they overshot and I called them back to the gate. They drew ahead again soon after, and I quietly made my way towards Dodd Fell. At the Cam Road junction Roz was spectating, I stopped for a quick chat and let her know Claire wasn't far behind.

The climb up Dodd Fell is easy-if-you-know-it, although I was going quite slow. I checked the bearing of the path at the top to be on the safe side and sloshed through all the filth to the wall corner. Karen had mentioned that there was a good wall crossing where a stream went under the wall. The only one I could find was blocked with pallets and while Karen could probably get through there my 6' 12 stone would have done damage. Another option was a sheep hole low down in the wall (I think Rory might have taken that), but in the end I followed the wall round to the gate the conservative way.

At Fleet Moss I was feeling distinctly ropey. I had a cup of tea and some food - I don't remember what, something from my bag - and set off after 20 mins to get the road leg done. I was very sore and struggling to make any pace on the road, in huge contrast to last year when I ran fast all the way down to Yockenthwaite. I managed to run most of the way though, then got onto the Dales Way to Yockenthwaite and up to the turning point on the track.

I later worked out that although the cramp had given me problems to this point, I was remarkably close to last years time. I reached Yockenthwaite in 11:04 in 2022, against 11:08 this year.

Climbing up to the turning point I checked my height against my planned leg start, and climbed right up to the flat spot. From there it was an easy cross country leg to the gate, where I met a guy called Keith who joined me for the next leg across to the CP. We aimed just below the CP on the wall - about 2 contours, and pretty much landed where we wanted to be. We chatted with the marshals for a bit then Keith took off and I followed rather slower towards Hell Gap.

Lights and Fleetwood Mac greeted me as I arrived at Hell Gap and Christopher Street's off roader. The music gave me a bit of a boost, although as it faded behind me I heard the curlews calling and that was absolutely joyful. I could feel my mood imploding and knew I'd messed up food badly.

The crew at Cray are used to wiped out people staggering off the moor. They wrapped me in a blanket and gave me a cup of tea, and kept checking on me to make sure I really wasn't hypothermic. I was clear enough to be able to reassure them that I was just hypoglycemic and knew how to manage it. After an hour spent wrapped in a sleeping bag, drinking tea and eating malt loaf I felt well enough to get to Park Rash, although at that point I wasn't too sanguine about finishing completely. The first aiders and crew were fantastic, very careful but ever so helpful and kind. Just as I was about to leave (wearing 2 primalofts, a waterproof and my winter hat) I checked the tracker and discovered Claire was practically there. In fact just as I checked she arrived and rushed over.

We talked things over. She'd had some nav issues in the clag and felt a bit nervous about the night section. I wasn't able to move any faster than her, so we decided to finish the event together. Jackie and Phil arrived while we were sorting out, and moved on almost immediately.

Claire and I headed out into the now quite thick fog, crossed the road and headed up toward Buckden Pike. I opted to handrail the big reentrant in the clag, although I'd forgotten that we needed to go through the first wall we met, so we had a brief excursion to the right until I looked closely at the map. Lesson for next time: write down the heights of stopping features on climbs!

We plodded up to the top of the Pike, clipped and got on towards the fox. I popped over to the monument and asked the fox to keep an eye out for us for the rest of the night, then we puzzled over some poles stuck in the mud by the path for a while and shouted into the fog before following the wall down.

The next leg is one of the trickier ones, but I know the area pretty well now and had prepped reasonably (although I think I'm going to recce a couple of other lines before next year). We followed the path down to the track towards Buckden, then turned off onto the path towards the old mining tips. I took a careful note of our height to make sure we didn't drop and that helped us to stay on the path. We hit the big reentrant below the tip (which looks deceptively small on the map) where we found Jackie and Phil reorienting themselves. They climbed up to meet us and we climbed another 5 metres or so to cross above the reentrant and get back on the path.

At some point between here and Top Mere CP I slipped on a wet rock which really, really hurt. A catalogue of swear words and dragged myself to my feet, and kept on going.

We clipped at Top Mere and headed on up to Park Rash as the Scarfes drew ahead. At Park Rash I badly needed another rest, so we stopped for half an hour and I had some tea and more malt loaf. Eventually I felt up to carrying on and we waded through the bogs up to the top of Great Whernside. Clipped at Great Whernside and got onto the trod towards Green Hill.

We followed the trod right into the wall corner rather than cutting the corner, to be certain we were in the right place, then handrailed the fence down to the bogs at the bottom. Following the trod out away from the fence to avoid the big meres that mark the fence corner, we picked our way across to the boulder field and down to the wall. It was starting to feel like the end wasn't so far away, although it was still a fair trek.

Capplestone Gate, a clip, and on through the broken wall, and on to the clear trod nearby. This time I knew where I was, although the fact that the gate is impossible to open foxed me again. We clambered over and walked up the track until we reached the beacons. From there it was field paths clearly marked all the way to Yarnbury.

At Yarnbury I sat down for ten minutes and ate a couple of bourbon biscuits. This was a calculated risk - I needed fast energy but I knew it would hurt. It did. We got about a hundred metres beyond the CP and I started to get stomach cramps. Thankfully it was nothing more than moderate cramps and I could carry on, bent forward slightly.

We passed a guy who was clearly absolutely exhausted, but still moving. He was very cheerful and after we'd made sure he was properly lucid we got on down the road.

The curlews and lapwings were singing on either side of us now, and these changed to hedgerow birds as we neared Grassington. The sky was starting to lighten as we reached the town and walked into the school. 

A hot shower and a fry up improved things considerably, and we were ferried right back to our van by a kind bus driver. We slept from 8 until 12, then a bit more, and finally got up and headed into Grassington for a coffee and more food.

We finished around 20:48 in the end. A very respectable time given the 2 hours I'd spent managing my blood sugar in CPs and the fact that my legs had been cramped up since Great Coum. We'd had the opportunity to hear a wonderful dawn chorus and we'd spent a good chunk of the event together. The Fellsman was pretty kind to us this year.


Kit:

  • Raidlight performer long sleeved top
  • OMM 1.0 flash tights
  • thin Drymax socks
  • Altra Superior (the 'altrananas')
  • Montane cap
  • Primaloft buff
  • Couple of other buffs
  • Montane Ember insulating layer
  • Inov8 Insulating layer
  • Columbia waterproof (ultralightweight white one)
  • Evadict waterproof trousers
  • Montane windproof
  • UD Fastpack 20
  • Rab powerstretch gloves
  • Buffalo mittens
  • Montane Prism hat
  • Silva Trail SR headtorch
  • Zebralight H60w backup torch
  • SOL survival bag
  • First aid kit + gaffa tape & penknife
  • maps: Harvey Fellsman map, plus printed OS 1:25 on waterproof paper, annotated
  • Silva Ranger compass
  • spare socks
  • glasses (just in case)
  • cheese emergency food
  • spork
  • Whitefurze screw top mug
  • ...there may be other things...









Food:

  • 6* cheese pittas (ate 3 or 4?)
  • 3* quorn sausage rolls (ate 2)
  • cheese (ate most of it)
  • malt loaf (350g, ate all of it)
  • quorn cocktail sausages, didn't eat
  • cheese and onion roll at Dent


Lessons learned:

  • I've got out of the habit of carrying peanut butter on races. It's messy and a bit fiddly. It's also guaranteed to work for me. Next year: peanut butter, more malt loaf, fewer cheese pittas. Generally try to aim for some variety instead of trying to simplify things too much.
  • Read ALL the Points to Observe, and mark them on the map
  • Mark important heights on the map.
  • The Fastpack 20 rucksack was far better than the 15. In fact the whole event was like an Ultimate Direction fan club meet, there were hundreds of Fastpacks of varying sizes and colours.
  • 2 thin primalofts gave me just what I needed when it went a bit wrong.
  • When closing one eye to squint at the map, close the one with the DISTANCE contact lens in!
  • Opentracking trackers fit really neatly in the chest pocket of a Fastpack20
  • Fellsman tallies are awkward to get at in the side pocket
  • So are pittas
  • Do not, under any circumstances, forget to plan what times to eat



Conclusion

Although if I'd managed food better I'd have moved faster, I was still struggling with cramp. The outcome was good despite the mistake - walking in was painful and slow and we didn't always enjoy it much, but the last walk in with the birdsong was worth it.

The Fellsman always comes with lessons.