2021 Tor Des Geants – Pizza, Gelato, and Rhabdo

I don’t feel like there’s a lot to say about my Tor Des Geants race itself, but the outcome is something that I think is worth sharing. It could happen to anyone doing these things and people need to be more aware of it.

The race is a 200+ mile lap around the Aosta Valley in the Italian Alps with around 110K feet of ascent, and this was my first time putting on an actual race bib since the Spine in January 2020. It’s the most beautiful course I’ve been on, has amazing local support, and the start/finish of Courmayeur has pizza and gelato around every corner. The Aosta Valley also isn’t just special for the mountains, or the food, but also the people. I cannot thank my Aostan crew enough for their support of a complete stranger who didn’t even speak their language, especially to Marlène Jorrioz who took on the role of crew chief. As with Wainwrights and Pennine Way, I’ll be sending them each a tiny token of appreciation through Trees Not Tees.

But the main reason I returned to the race was unfinished business: after putting myself in a great spot for the podium in 2019 I ran into serious sleep and nutrition issues over the final stretch and slipped all the way back to 16th. I had learned from that experience, created a better plan, and the support crew meant I would have my gear and my own preferred food more frequently available.

The Race

This year I started out strong and confident, in good position up the first climb and sticking to my plan. Other than frustration at seeing people blatantly cutting straight through switchbacks on the first descent, I was feeling good. I arrived at the first checkpoint with a La Sportiva teammate, Petter Restorp (who would go on to a great race and 3rd place finish). A spot on my foot was heating up a bit on the long descent so I stopped for just a couple of minutes to tape it. After my Wainwrights foot issues, I wasn’t taking any chances that early.

Unfortunately that meant that I left the checkpoint alone. I’m pretty good with navigation off-trail in complete wilderness, I’m decent on trails, and I’m absolutely terrible in towns. There’s no telling how much time I lost wandering around villages in the Spine. And so inevitably, coming out of town I turned right onto a trail where the race color was spray painted on the ground. I ended up climbing about 500m the wrong way before realizing what I’d done. In a panic I started bush-whacking back towards the route. Of course I nailed the navigation down through gullies, over blown down trees, and around rock faces. It’s the roads that get me. I was also glad I had upgraded to a Vertix 2 before the race, with the topo map on the watch reassuring me that I was following the right contours in the terrain.

When I rejoined the race I was no longer tied for third. I had lost 20 minutes, which at that point in the race seemed huge. So momentarily I gave into the urge to try to make up the time, putting in a burst of effort up the next climb. But the thing is, once time is lost like that, it’s gone. There’s no making it up. If there had been room in my schedule to make that time up then my original schedule was wrong.

I realized my mistake and eased up, but the damage was probably already done by then. Redlining puts muscles, the stomach, lactic acid, and many other things in a spot where they really can’t be for 200 miles. I’m not sure how much that contributed, relative to other factors like warm weather and altitude, but I found myself increasingly unable to eat or drink. I should have stopped long enough to reset myself. It’s the only thing that could have saved my race. But I was fixated on not giving up any more time.

Everything fully came crashing down just before midnight as I went over the top of one of the highest passes, Col Entrelor. I was struggling to get to the top, my legs feeling like lead weights that I might have to start manually lifting with my arms one at a time. There’s hardly a body part that hasn’t given out on me before in an ultra, but oddly enough I actually couldn’t recall it ever being my legs. Normally they stay strong while everything else crumbles around them.

Shortly after starting the descent I stopped and started dry heaving. Halfway down I started vomiting. I drug myself the rest of the way down to the next checkpoint, knowing how cold I would get if I stopped too long on the exposed mountainside.

I sat in the tent in a daze. I knew I needed to eat, but if I tried, I puked. I knew I desperately needed to drink, but if I took even a sip of water, I puked. I had suffered some altitude issues at that same spot in 2019, and a 15 minute power nap magically renewed me. So I tried to rest – 15 minutes, then 30. I got up, and I puked. I laid back down – 15, 30, 45 minutes. I got up, tried to drink, and I puked.

This was beyond altitude issues or dehydration, and beyond even the ulcer I had experienced on my first Pennine Way attempt. Discerning the subtle differences between something hurting and something being wrong requires a pain palate refined over many years of doing unreasonable, ill-advised things. Here, something was really wrong. Pulling the plug on something that so much effort has gone into, not just from me but from those supporting me, was enormously difficult. That was especially true in the wake of the Wainwrights. But I’m never willing to put my health or safety at serious risk for a race.

I dropped out, slept about 6 hours in the basement of one of my support crew’s home, and only then was I finally able to get some liquid down. I found a tiny hotel room in Courmayeur (which no doubt would have cost five times as much just a few days earlier before the race) and spent most of the next few days eating pizza and gelato and trying to figure out what had gone wrong.

The Aftermath

I believe it was the second night when my research and messaging with others all started to point fairly conclusively to the same thing – rhabdomyolysis. Rhabdo is a rapid breakdown of muscle tissue that releases large amounts of myoglobin, which can lead to kidney failure.

I immediately chugged a liter of water and continued to do so about once an hour, including in the middle of the night when I inevitably woke up to pee. Ridiculously high fluid intake is the best treatment, preferably with an IV. The goal is to be peeing as frequently as possible – each time flushing toxins out of the kidneys to prevent a dangerous level of buildup. I also read some research saying acetaminophen (AKA paracetamol) could help, and high potassium levels are a problem, so I also started taking Tylenol and avoiding bananas.

But I am not that kind of doctor, and seriously, if you think you have rhabdo get yourself to a hospital. The problem might not peak until days later, and kidney failure can sneak up even further down the road if things aren’t treated properly. As opposed to my entirely unnecessary trip to an Italian hospital after Lavaredo, I probably should have gotten myself somewhere for treatment. I likely would have if I had known everything up front.

I was watching my symptoms like a hawk, though, and after the race I was able to work with InsideTracker to get a full set of bloodwork to ensure there wasn’t lasting damage. The key metric in this case was my creatine kinase levels, but the other information from periodic bloodwork is valuable in understanding my body and tracking whether there are any other trends or deficiencies that might be an issue for racing 200 miles around the mountains.

Honestly, rhabdo is something that I always associated with massively undertrained people joining CrossFit and immediately going way too hard in their first week. Now that I knew what the problem was, my research immediately shifted to the why. I was at a loss. The paragraph below is copy/pasted from an email to my coach, David Roche.

I‘m really scratching my head. I’ve run further, harder, in hotter weather, gotten more dehydrated, with more vert… I mean at the end of the day this was a very slow 50 miler. Never have I had anything like this. Was it from life stresses? Was it residual from Pennine Way plus half of Wainwrights? Was it lingering heat stress from Wainwrights plus time in the US? Is it connected or correlated to the weeklong DOMS I had after the Bob Graham support a couple of weeks ago? Is it diet related? Is it somehow just a crazy rare combination of all the above coming together at once? I am 100% at a loss, and I don’t want to have to be constantly worrying about it every time I do something like this in the future.

By the end of my stay in my Courmayeur hotel prison I was ready to write a full research paper, but of course I still didn’t have a definitive answer. There are too many variables – every situation is unique. I’ll forgo the full research paper, but if you’d like to dive deeper down the rabbit hole here’s a review article with 132 further references to explore.

Below is the summary of what I think are the diagnostic factors I found that are relevant to my case, with the root cause in parentheses. 

1. Ischemia / hypoxia (altitude)
2. Dehydration / electrolyte imbalance (heat, humidity)
3. Pre-event fatigue / stress (general stress / anxiety, recent recovery from minor illness / infection, pre competition anxiety)
4. Nutritional deficiencies (e.g. CoQ-10)
5. Medical conditions (e.g. viral or bacterial infection)

Sickle cell trait and exercise induced asthma are also significant risk factors, but those aren’t relevant to me. Also, hemlock intoxication from eating too much quail… just a word of warning to everyone who likes to gorge themselves on quail before a race. 🤷‍♂️

I don’t think the outcome was due to any single cause, but a crazy combination of many of them that I had never experienced before and hopefully never will again. That’s what typically makes black swan events seem random – there are so many variables that a particular catastrophic combination has probably never been observed before. I will without a doubt be more aware of those risk factors in the future, much more attentive to any symptoms I’m experiencing, and much more careful of keeping my hydration and electrolytes where they should be.

Fortunately everything turned out fine for me, and I’m back to normal training and planning other challenges. One of these days, I’ll figure Tor Des Geants out and have the kind of race there that I know I can. For one, I need to figure out how I can better prepare for altitude within the constraints of my life (this has now become even more important since I got into Hardrock next year). And speaking of those constraints I need to get a number of them taken care of and lower the stress level a good bit – I think it’s easy to forget how that can manifest itself physically in very big and unpredictable ways.

But in the end, there are no bad round trips into the mountains as long as there’s a safe return. I’m tremendously disappointed with my Tor Des Geants performance, but I’m fortunate to have gotten to spend some time in such an incredible place (even if half that time was in a tiny room chugging water). I also spent time with great friends, made new ones, and got out for some of that time alone most of us need.

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Gear

Note: I do have relationships with many of these companies. These can be found on my Partners page, along with some discount codes and affiliate links. If you consider purchasing anything I would greatly appreciate those links being used – if I’m lucky it might even provide enough to cover the costs of hosting this website.

I went with the La Sportiva Jackal for shoes – they served me well on the Pennine Way and since I don’t consider Tor Des Geants all that technical I thought they would be good here. They did do well, but next time I’ll probably go with the Cyklon or the Mutant for the first half of the race and then switch into the Jackal for the second half (hopefully I make it that far next time). The second half is a bit calmer, with some highly runnable sections and without as many long, steep climbs. For those big climbs and descents early on I’ll go with a shoe that fits a bit more securely with more support and stability.

I used my go-to running vest, the Ultimate Direction Mountain Vest. I’ve found that this is the most versatile one for me and can provide great utility while still being lightweight and comfortable. I also used the Ultimate Direction FK Poles and FK Gaiters.

I was excited to use a COROS Vertix 2 for this race. The battery life is even longer than the Vertix and I expected to be able to make it through the entire race without recharging. I was also able to load topographic maps onto the watch, which was extremely helpful when I lost my way after the first checkpoint. When I dropped out after nearly 17 hours my watch still had over 90% battery remaining, and I think it was nearly a month later when I finally needed to charge it. Since then that’s actually been the normal schedule – charging it about once per month (on normal GPS mode during activities and with continuous heart rate disabled). The ability to scroll through screens and use the lap button while the watch is locked has also been extremely useful as the weather has gotten colder and I’ve been running in gloves.

For lights, I went with my usual combination of a lightweight Petzl Actik Core for short stretches that have easy navigation and good footing, and a more powerful Petzl NAO+ for longer stretches or where I might just need a stronger light (e.g. a technical descent or a section where the trail isn’t very clear).

With my foot issues at Wainwrights attributed to a rare combination of warm, wet, and steep conditions, along with my gross negligence in drying my feet out at stops, I stuck with my usual sock and base layer strategy. I had XOSKIN toe socks with a regular pair of XOSKIN socks over top, and a pair of XOUNDERWEAR liners under my shorts. Of course I only went 50 miles, but I at least had zero issues in any of those areas.

Nutrition

No, I didn’t attempt to fuel off of just pizza and gelato. In fact, with the issues I was having I didn’t have much at all. My Supernatural Fuel pouches were really the only thing I could get down throughout the race. They go down easy and don’t require as much fluid intake for digestion. With my dehydration issues it was extremely difficult to eat anything else – I recall getting down a couple of Oreos and honestly I think that might have been the only other thing. I was excited this time to have crew that could regularly resupply me with the foods I prefer instead of relying on the aid station dried meat and cheese, so I brought a massive amount of food with me. I ended up leaving most of that with my crew, so hopefully they at least enjoyed some of the homemade and UK-sourced treats. 😅