Wednesday, October 16, 2019

T-12 Days to Ironman Toothache Solved

Triathletes are Drama people
Nik, our dear triathlete, and awesome moresome photographer posted the above in relation to how tapering triathletes will tend to behave. The IG Story came right on que as most, if not all, of us taking part in the Malaysia Ironman (in Langkawi) is currently doing; tapering is important to keep both the body warm and ready, while not overloading on training. Think of it as an exam - where last minute attempt will often not result in favorable outcome.
Joining the Drama Wagon
About 5 months ago, during one of my travel, i had some issues with my tooth, it acted up and I thought it was due to the constant flying and air-pressure changes. I read it may impact, but I never had this issue in the past 4-years of having the privilege to go around the world. The pain comes and go, the typical uncomfy feeling in the mouth that doesn't radiates longer than an hour. sensitive tooth, maybe. In my last visit to the dentist (government dental clinic), i did scaling and that was when the pain started to be worse, and lasting more than a few days. The doctor wrote me a letter and asked me to head to General Hospital KL (GHKL) Dental department as they are not equipped for surgery to remove an impacted wisdom tooth.
Yes, impacted wisdom tooth.
No one love going to see dentist.
Not even Mr. Bean. Remember?
That's about the right reaction
So, with the pain that was radiating from the lower left jaw, pulsating and both dull and sudden throbbing, the past two days (T-12 and T-11), i had serious concern. When the pain did not go off after a few hours, then a day, I starts to freak out. The images of operation, cutting the gum, stitching it up, 2-5 days of recovery, root canal, and worse - Did Not Start (DNS) on race day.

Thanks Edwin Ng for the photo. Making me look good.
Emotionally, there is too much to bear after not being able to race since 2015 (my last race was 2014). Financially, these races and preparation are not cheap! I am not concerned of the training effort I put in, because I've been training as a lifestyle. I am prepared for races, just have to "brush" it up.
My plight for help was answered when a fellow Old Putera left a message on my posting
The Doc (friend from same Alumni), explained to me the risk of what I may go through. I was clear of what I will have to go through, be it before IM, or after IM. His last message was to "come see me". I made an appointment with him, as he is also teaching in the faculty (of dentistry), and I am never more glad. You see, I am supposed to see a dentist (a friend's wife) the day before, but she is out on vacation. I made appointment for Thursday (tomorrow, as this post is written on Wednesday). So, you can see how much i wanted to get this fix, soonest.
Part of Nizz's message after I pass her a brand new Garmin FR945. Operative word - RUSH OFF to dentist, which i never got to see yesterday (Tuesday)
And now, I have an appointment with a Specialist, and he is an Oral and Maxillofacial Surgeon at this University.
Arriving early at the Faculty of Medicine (Dentistry) of UITM was great for me. I've never knew of this place, as I will almost just stop at Sg Buluh Hospital. Arriving early also gave me the opportunity to relax. Yes, no one likes to go see Dentist. I am yet to know anyone that see dentist because it's "annual check up".
First One here, apart from the staffs of course!
Doc walked in right before 0830, the time we set the appointment. I then went to register myself as a patient (RM20 for specialist), and went to pay for X-Ray (RM30). Yes, it is unbelievable that the KKM (Dental) i used to go has never taken any X-ray of my condition, and refereed me to GHKL (Dental) directly - all these based on visual inspection of the tooth.
Love the colorful lead vest
The X-Ray confirmed that my left lower wisdom tooth (T38) is growing out side way (has been all these while). What I wasn't expecting was that the pain I am experiencing wasn't because of the T38, but T37 - the tooth right next to it. As the tooth was growing out at an angle, it limits my cleaning ability, particularly to floss between T37 and T38. The food residue has caused decay from the bottom at bone level (below the gum).
Red line is gum. Green is the decay. 
Based on the top pic, I was given two options:
1. Remove the wisdom tooth (cut gum, break tooth, work around jaw bone), then try to save T37 by filling it. However, there is no guarantee the filling will work (the prognosis will be poor), as there is no way to fill the hole under the gum/bone.
2. Remove T37. Leave T38 untouched. Live with the gap left by T37.
Doc explained to me in great details, making sure I am informed and know what I get myself into. The best summary he gave?
If i go with Option 2, i not only get to save T38, I get to recover within the next 2-days, and can continue to train.
That was the magic word. Now Let me share this photo again
Triathletes are Drama people
I agreed to the procedure immediately, more conscious of the his timing - and he told me it can be done in 30mins. I have freed up my morning, and I do not want to delay this more - if I can end the pain today, I do it. 
But of course, ONE photo before the procedure!
The game plan is to break the tooth into a few pieces and pull it out. It is not a normal extraction as it will involve breaking of tooth with hardware that whiz at 4000rpm. Then, it will involve carefully calculated steady hand movement to yank the pieces out, remove the roots completely, leaving the socket empty - and void. I swear the tongue will feel the void. 
Sparing the details of the minor operation, below were what I've learn in the process today:
1. I received no less than 4-injections to numb the left side of my face (and mouth) which is still numb after 1300hours
2. I may had been injected more as the process of pulling the tooth out was in progress (by then, the needle poking was dull in comparison to the force applied to yank it out - with forceps),
3. Why i have more bones in my jaw (torus, as dentist call it), which is due to the training (athleticism) I put myself in, 
4. I can graft these bones for any jaw surgery, if needed (wow),
5. I learn how much anesthesia should be given based on body weight (because Doc quizzed the other dentist in training while operating on me), 
6. I learn that Doc has impeccable bedside manners, i have lost count of apologies he said every time he believe he is hurting me (thank goodness I wasn't a sickening senior back in school). 
A photo after, being able to smile tells you I am happy the problem has been solved! A gauze was in my mouth
I made a joke before the operation, telling him about my resting heartrate - and promise him I let him know how my HR spiked during the operation. Here it is, the spikes happened during the time I was less than comfortable (I won't say "in pain", as he help me managed the pain really well). I started at 49bpm at 0826hours and ended with 45bpm at 0920, 10mins after the operation. The high was at 84bpm when I had my X-Ray taken, and it seems that the actual puling out only peak at 79bpm - when the last part was removed, including the root. See, Triathletes love their data - even when in pain.
Triathletes and Data
Thank you again Doctor OP sir. I can now rest assured that my tapering plan will go on as planned. See you soon, and the next time, hopefully we are swimming, biking or running!

Wednesday, October 02, 2019

Garmin Training Status Explained

I been getting a few queries about “Training Status” on the Garmin device, and why after the weekend KLSCM (Kuala Lumpur Standard Chartered Marathon), their “Training Status” went into “Unproductive”. The conversation triggered as I showed my “Unproductive” status after sharing my 42km run results. It raised a lot of questions. Many asked how can one be unproductive (as a negative verb) when you just, well, ran a freaking 42km? I realized this can be discontenting for some, while for me, having understand how this work, not too worried and fully understand the message that is being sent by the device, to me.
Should you be worried?
Training status is a feature by Garmin that analyses your historical training load and habit and put them into an easy-to-understand bigger picture. If you do not use your device when you go for your exercise, or loan your device to another person, this will screw up your overall reading. This is because many of the user settings are set based on your ability; your Maximum Heart Rate, Lactate Threshold, Resting Heartrate, sleep, VO2Max, and even your sleeping time. These metrics has significant impact to how the “Training Status” are derived.

What Training Status does is to help provide a guidance and help your training plan in future – should you consider putting more intensity, train longer, and if you are working hard enough to see changes. Your effectiveness of your current training is being considered (in the form of the past 7-days training load) and your fitness level changes.
Training Status vs VO2Max vs Training Load - All related!
If you look at the logic, if you reduce your training, your fitness level will decrease. But if your previous training load is too high (meaning you need rest), a break or slow down or “recovery” may actually result in increase of fitness level – hence sometimes you get a surprised “new VO2max detected” after a day or two or rest, followed by a hard workout such as interval and speed work.

Along the same way, logically, if you train everyday and have the training load (in past 7-days) to be high, and you are happy with your progress – only to see your fitness slip into unproductive (like in my case), you know you may be bordering on “overtraining” if you are not too careful.

So, if you been training consistently for weeks, and your fitness level has been good. You make small day-to-day improvement in terms of load (optimal), the device will identify this as “productive”. Similarly, if you keep putting in hard training (intervals, hill work, speed work) day after day, the device will detect this as overreaching and you may have to cut back down on the intensity, or even take days off from training to recover.

In the device, these are the typical indicator to help you understand. These definitions is available in your Garmin Connect and also on Garmin website.

Peaking – You are in ideal race condition! Your recently reduced training load is allowing your body to recover and fully compensate for earlier training. Be sure to think ahead, since this peak state can only be maintained for a short time.

Productive – Keep up the good work! Your training load is moving your fitness in the right direction. Be sure to plan recovery periods into your training to maintain your fitness level.

Maintaining – Your current training load is enough to maintain your fitness level. To see improvement, try adding more variety to your workouts or increasing your training volume.

Recovery – Your lighter training load is allowing your body to recover, which is essential during extended periods of hard training. You can return to a higher training load when you feel ready.

Unproductive – Your training load is at a good level, but your fitness is decreasing. Your body may be struggling to recover, so pay close attention to your overall health, including stress, nutrition and rest.

Detraining – You’ve been training much less than usual for a week or more, and it’s affecting your fitness. Try increasing your training load to see improvement.

Overreaching – Your training load is very high and has become counterproductive. Your body needs a rest. Give yourself time to recover by adding lighter training to your schedule.

No Status – You typically need a week or two of training history, including recent activities with VO2 max results from running or cycling, before we can determine your training status.

So you been “unproductive”
The mystery of this can easily be explained this way. If you been running and exercising and you get this beep on your device that says “Performance Condition +5” or “Performance Condition -10”. On Garmin Connect, Performance Condition is defined and classified as this:

“As you run, performance condition analyzes your pace, heart rate, and heart rate variability to make a real-time assessment of your ability to perform compared to your average fitness level. During the first 6 to 20 minutes of an activity, your watch displays your performance condition score. Performance condition can also be an indicator of fatigue level, especially at the end of a long training run.”
Performance Condition indicator
Now it starts to make sense… despite having a good “fitness base”, the 42km run that I did returned a performance condition that denotes me having only a “fair” condition, which is below my baseline. Hence, the decline and the fatigue indicator.
The KLSCM 42km, my Performance Condition has been at average -3, which is "Fair", which resulted in "Unproductive"
When my Vo2Max went from 55 to 56 about 3 weeks ago, my Performance Condition during a 5km BRICK run was on the +4 and at baseline. The device algorithm checked this as Productive and hence the increase.
Compared to this 5km BRICK Run, which I completed in 22mins, It's on "Good" level, which help me to record new VO2Max
I will not touch into the Training Load for this article – as I am assuming the concern here is because despite a good Training Load, the status is on the decline. If your Training Load is already sub-optimal, it is expected your Training Status will be on the lower end as well.

Your Training Status ties in very closely to the Performance Condition at the time you are doing the exercise. If your heart rate (hence why finding your HRMax and LTHR is important) is higher at a particular pace (hence why it is important for you to put in the correct lactate pace in your User Setting) for your Garmin calculated VO2Max then you will have a negative Performance Condition. 

Likewise, If your heart rate is lower at a particular pace for your Garmin to calculated VO2Max then you will have a positive Performance Condition. Make sense – as you are now more efficient (lower HR threshold) and running at a higher speed (pace), a good indication you are improving.

To maintain a Productive status you must be working out above your Training Load while keeping positive Performance Conditions during workouts that calculate your VO2Max.

My personal take on this Training Status is to use it as a guidance, and to provide insight into our own training regime – we tend to fall into three categories; training too hard (in desperation to improve) or thinking we are training hard (in denial that the fitness is on decline) or training insufficiently (or wrongly) because of other factors. For this “Unproductive” status to show on my device since September 24 – it closely relates to the detraining status in the run up of KLSCM, and the 42km itself being take much easier (ave HR Z2/3) vs a very slow pace (Z1/2 threshold pace) which resulted in the “unproductive”.
Ruled By Device #FeelMyPain
Am I worried? Not really. I believe it will go up back again within the next 2 weeks. Even if it doesn’t show “Peaking” before my Ironman Langkawi on October 26, 2019 – I will still be racing at my own personal peak condition. Use these as guidance, not absolute indicator, very much like how Maximum HR calculation of 220-age is too generic for someone that is active and train at least 7 times a week!

Hope today’s article help you to understand how to continue to maximise your Garmin device!