Promising Peripheral Arterial Disease Collateral Hemodynamics or Sure Surprised Me!

White Lake 2022 Half Ironman race report, especially concerning an unexpected observation.

Peripheral Arterial Disease Collateral Hemodynamics
I knew this was where my problems with peripheral arterial disease claudication would kick in, to kill my run.

The 2022 White Lake Half Ironman was well organized, by kind, helpful staff and volunteers. The main objective of this report concerns my peripheral arterial disease collateral hemodynamics, which means the nature of blood flow through my calves and feet, assessed on the basis of calf claudication and foot numbness as I tried to run. I have been working to improve this impaired blood flow, due to peripheral arterial disease (PAD, diagnosed five years ago on abi test), with lots of walking and run training, in addition to several critical adaptive modifications, invented as I went along: (1) whole body running, conditioned by lots of water running, (2) lowest impact stride that can be achieved, combined with “soft feet,” (3) lots of leg and hip muscle strengthening (conditioning) and lengthening (stretching), (4) minimal shoes, permitting a healthy conversation between my feet and road, and (5) my just developed toe flexion method, which is what makes my running possible. It seems to pump blood through my feet, but it’s not easy.

The race comprised a 1.2-mile lake swim, a 56-mile flat bike course, followed by a half-marathon (13.1 miles) as a double loop of 6.55 miles, on a flat course. Water and Gatorade were available at stops along the way, and I carry my own gels (100 calorie, medium glycemic index).

Swim: Slow and easy, enjoyable swim. Wetsuit legal, so I did.

Bike: Flat 56 miles as a 28-mile double loop. Bit of a nasty headwind during the last ten miles of each loop. Noticed I was undertrained for the bike, with some quad (front thigh muscles) strain, but that didn’t surprise me. I had been distracted by the struggle to learn how to run with peripheral arterial disease.

Run: I Didn’t expect to complete the run, hoping to finish the first loop, before claudication brought me to a complete halt. As expected, after a quick transition, I approached the run start with trepidation.

Within a few yards of running, my right calf locked up and I felt my feet going numb. I stood still for a slow count of twenty (duration optimized while training), felt the intense pain of my calf muscles refilling with blood, and started walking. After a hundred feet or so, I started to run again. Same thing happened, and by the end of the first mile I was wondering when things would ease off, and whether the previous 56 miles on the bike was prohibitive for subsequent running with PAD.

ASIDE: During pre-race run training, claudication and foot numbness on running slowly declined, allowing longer periods of running and less painful walking intervals. This I had tested up to about three miles, prior to the race, but the third mile was the least painful.

Back to the Race – At four miles into the run course, claudication pain was much reduced, and I was able to run for longer periods before being forced to walk due to calf pain.

During the fifth mile, I suddenly realized that the claudication pain and foot numbness had disappeared, completely. It vanished. It still was a challenge to run, but this was due to strained quads from the bike. I didn’t want to pull a quad, so I settled into run 50 yards, walk 50 yards, until the end of a race.

A race I never expected to finish.

Race conclusion: Undertrained on the bike, leading to quad issues during the run.

Peripheral Arterial Disease Collateral Hemodynamics
One extremely, but happy, old guy. I sure look exhausted. I was.

As I approached the finish, knowing I’d missed the 8.5 hour cutoff by about 10 or more minutes, I expected to be turned away. But they waved me in, saying ahead and finish. As I crossed the finish line, to be followed by three other very happy young athletes, I was faced by four serious looking people, two men, two women. One of the women came up to me, place a medal over my head, and shook my hand, saying, “Amazing! I don’t know how you do it.”

I replied, “But I missed the cutoff. I was undertrained on the bike.”

She replied, “At your age, I’ve no idea how you do it.” I didn’t mention PAD – too complicated, but I was very pleased with their kindness and patience with us late arrivals at the finish line.

A little kindness goes a long way, don’t you think?

Peripheral Arterial Disease Collateral Hemodynamics Conclusion: In science, this report is classified as “anecdotal data.” For me, it’s data! My first thought is that it takes a while for training-induced arterial collaterals to fully open up (by the way, a few weeks ago my vascular surgeon’s resident couldn’t find a pulse in my right foot, with a portable ultrasound device – bad popliteal occlusion – I’m literally running on collaterals). My second thought is that this issue might benefit from further research. I’ll keep you posted as to my progress.

Maybe it will be possible for me to finish the Arizona Ironman in November, with my friend Frits, who came along on this race, too – some of his ashes, anyway, kindly permitted, by his widow, Machteld. He comes to all my races, and he admonished my level of bike training in this one. “Thank you Frits!”

kev aka FitOldDog

peripheral arterial disease collateral hemodynamics
MRI scans through the thighs of three guys. Grey is muscle, white is fat, clear ring around the central white spot (bone marrow) is the femoral bone. Note the loss of both muscle and bone mass in the sedentary guy.


  1. Roger Renne says

    Congratulations Kevin on finishing the race.

  2. Tracey Himmel says

    Congratulations! You’re an inspiration!

  3. Papo Mendez says

    Congratulations again, Kev!
    Your positive attitude is remarkable! Your desire to accomplish a goal o goals is very inspirational to many people with PAD, Post AAA or other Cardiovascular conditions!!
    I’m in my 7 week post Repair AAA. Pain continues in my stomach & back muscles. Numbness in both legs, but running stable bicycle for 20 min = 5.2 miles. Also, Swimming slowly 50-60 meters 3xweek.
    Reading your summary of your race provides me more desire to slowly continue my training. My guess is that maybe in 2 more months I’ll feel much better… I’ll keep you posted. God will be w/you!!

    • Kevin Morgan says

      Hi Papo, thanks for the encouragement, and pace yourself.
      But you know that.
      Kindest regards,

  4. ROBERT LEVIN says

    Kevin: Congratulations on your inspiring race. I give you credit for starting a race you thought you were likely not going to complete.
    I just want to tell you that I had a stent put in my leg even though I heard you say that your vascular surgeon warned you that it could result in the loss of your foot. I did not get such a warning. So far, it has been a life changing surgery.
    Although I have stopped taking the statin drugs, I still worry that could be a mistake. The research I have read suggests strongly that folks with PAD are very likely to have other cardio issues and complain that statins are unutilized in that population. I recognize that issue, but I am concerned about muscle damage and other side effects. Additionally, it seems that some studies show the benefits of statins might only be minimal. However, the majority of the doctors strongly insist they are essential.
    Have you given any thoughts to the statin issue other than seeing the muscle damage in an animal?

    • Hi Robert, when it comes to biochemistry, I try to get to the bottom of it.
      Drug-body interactions are essentially biochemical in nature, including the ADME (Administration, Distribution, Metabolism, Elimination) part. I worked for PHARMA for about 16 years, and developed a large transcriptomics lab., with several excellent colleagues. This involved some depth of understanding of drugs and what they do, and what havoc they might cause. No one understands all of biochemistry, in fact I don’t think there is a person on the planet that understands 1% of it, including yours truly.

      Statins inhibit a primary enzyme, HMG CoA Reductase, in the complex and magical chain of cholesterol biosynthesis. That said, not all dyslipidemias are dyscholesterolemias. Mine is mainly dystriglyceridemia, a completely different bottle of fish (or is it wax? OH NO! It’s kettle of fish.). If you want to make the right decision, don’t for one minute think your physician/cardiologist knows all this stuff. They don’t, and they can’t get me out of their office fast enough.
      Here’s another point, although statins inhibit HMG CoA Reductase, you can bet your bottom dollar that they also interfere with other biochemical networks (they aren’t pathways, they are networks. Pathway thinking causes lots of biochemical myopia.

      The best thing for you to do is to know the relevant lipid biochemistry (Much is in Harper’s Biochemistry, easy reading, plus PubMed, not so easy.), it’s not that difficult, and know the specific issues that might suggest a need for you to consume a muscle toxin on a daily basis. PHARMA would love you for it. You have to think this through. It’s a personal benefit risk decision.

      Biochemistry consumed much of my thinking for years, including the study of the mathematics of biochemical networks, but now I write novels. Biochemistry is mind boggling complex, even if you don’t consider the underpinnings of chemistry, thermodynamics, quantum mechanics, and things that go bump in the night.

      Understand what you can, and make your decision based on all the variables you can master. Everyone is guessing, but your body knows best.

      I wrote a blog post about this, in a different context:

      I’m not trying to be difficult, I’m just stating the state of the pharmaceutical arts. ONLY Ironman training corrected my life-threatening dyslipidemia, but it’s not for everyone, I guess:


      Hope that helped, though I could go on and on and on, which doesn’t help.


      • Robert Levin says

        Unfortunately, I have never had a background in biochemistry. As a lawyer by training I never got any education in that organic chemistry.
        I am curious how your vascular surgeon and cardiologist reacted to your refusal to take statins? Obviously you can defend your position.
        With a primarily vegetarian diet do you concern yourself about the amount of protein you take in?
        What is your next planned race?

  5. Machteld says

    Hi Kevin, it is amazing that you were able to finish with such a condition. An unexpected and therefore evn more happy achievement.
    And I am so honored that you keep Frits’ spirit alive. I am positive that he will supported you along the way to the finish. Way to go! Love, Machteld

    • Hi Machteld. He does support me, but he does tend to lecture a bit, especially when there’s head wind. I never forget the secret sauce in training. -kev

  6. Bill Hall says

    Congratulations Kev. Both your race and narrative are encouraging to all. The message of , “if you can’t do it one way, try another” is helpful to all us old dogs.

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.