Race PostMortem : 2nd attempt at UTMB/OCC and request for advice

In 2016 I attempted OCC for the first time and made a couple of newbie mistakes that probably lead to my first DNF on this course:

• I arrived the night before the race and didn’t account for jet lag and elevation difference
• I treated race as a fun run and took many amazing pictures and video on course whilst not paying attending to cut off times
• I didn’t make the cutoff at Trient and was (very nicely) pulled off the course by the Sweeper Sisters.  

You can read all about that attempt here.

I trained for two years, learned from the first failed attempt and tried again this year.   I almost made it but an old foe came back which was the dreaded nausea problem I sometimes have.  My friend Jake (of Hike It Like It fame) recommended I writeup a post race report not so much to account how beautiful Chamonix valley is (it is) or how infectious the village gets race week (it does like no other race event) but more a clinical account of the race with the hopes that someone can chime in who has personal experience solving race nausea, so I could someday finish OCC.

PreRace:

• Arrived four days before race day and got two days of acclimation runs in at La Brevent (at elevation of 2525m and did 6.5miles/1956ft vert one day and 7.3miles/3294ft vert next day):
• First Acclimation Run
• Second Acclimation Run

So here is a description of the race from and environmental, mental and replenishment point of view.

The race starts in the Swiss city of Orsieres at 8:15AM and according to the village temp/clock it was 20 deg C (68 deg F)

• 4:00AM – had simple breakfast of yogurt, bread, pear with coffee and water.
• 5:00AM – took multivitamin and single acid reducer pill (Ranitidine 150mg)
• 5:30AM - 1.5 hr bus ride from Chamonix to start.
• I took mouthfuls of water from my hydration pack every 15min and took one salt pill (Thermotabs – buffered salt supplements) per hour.   I switched from SaltStick caps because the Themotabs are much smaller.  Each Thermotab has 287mg of Chloride; 180 mg of Sodium; 15 mg of Potassium – 451mg sodium Chloride). 
• Every hour I took one pouch of Ultimum Sport Fruit sacks (each pouch is packed with 207 kcals and comes in many flavors)

My checkpoint times, hydration, food and supplements

• Champex-Lac – 8:78km; 01:46:03; 10:01:51AM          
• Major aid station with food.  I had two cups of bullion with noodles; filled up my spare Salmon softflask with carbonated water (new discovery is that plain carbonated water makes me feel wonderful)
• LaGiete – 20.51 km; 04:18:48; 12:34:36PM
• Trient(*) – 25.45km; 05:12:38; 01:28:26PM (14:30 cutoff; had one hour buffer; spent 15min at AS)
• Another major aid station with food. Had two more cups of bouillon with rice; refilled soft flask with carbonated water.
• This is where I DNF’ed in 2016 so I took one Zofran
• Les Tseppes – 28.92km; 06:47:41; 03:03:29PM
• By this point the outside air temperature was ~10 deg C (50 deg F) so if you stopped it felt cold but while you were moving felt great.
• Vallorcine(*) – 36.16km; 08:21:13; 04:37:01PM (17:50 cutoff; had one hour buffer; but spent 30min at AS)
• Another major aid station. Uh oh had two cups of bouillon with noodles but not sitting well. Had a sip of carbonated water. Opps. Lost it all in the garbage can near me.  Left rest area for porta potties and lost rest of stomach.  Made it back to rest area, refilled soft flask with carbonated water and ate two small pieces of water melon. Left AS after 30min.
• Took my last Zofran
• But stopped eating Ultimum Sport (no more 200 kcal of energy)
• Argentiere(*) – 44:59; 10:33:33; 06:49:41PM (19:30 cutoff; had 40min buffer; but couldn’t keep food/water down and dropped from race)
• Major AS, but couldn’t drink fluids and watching someone eat from Ultimum pouch of fruit puree made me sick.
• Sat in chair for 10min because I had time. Talked with friend Damien from England about how I was feeling and he was very encouraging and trying to get me to go with him for the last push up and over La Flegere.  At this point I was nauseous and just not feeling it.  I apologized and talked with AS lead and officially dropped. She asked me to confirm twice and also tried to get me to continue on because ‘I looked fine’. 
• Got bib clipped, walked to Chamonix Shuttle bus stop, waited for bus and sat there sulking for the ~15min bus ride back to Center.  

Race related issues/illnesses that often cause nausea:

• Hyponatremia (low blood sodium levels)
• Diverticulitis (inflammation of digestive track)
• Acid Reflux
• Hyperthyroidism (overly active Thyroid). Doctor should test for TSH levels. The most common
• treatment is radioactive iodine to reduce thyroid activity.  One key symptom is heat sensitivity (which
• definitely have)
• Dehydration

PPost race – had steak and potatoes for breakfast.  My stomach is fine within 12 hours of rest.

• I have doctors appointment Sept 10th to discuss my experience and to get full blood workup,
• If there is anyone who has experienced similar 'race nausea' like what I have experienced several time and has suggestions what to do about it including just run shorter distances I'd like to hear from you!
• I was tired but legs still felt good.  The nausea was just too much to deal with and couldn't get my mind around another 1000m of climbing and finishing last 15km.  I know "don't be a wimp" but it just wasn't happening then.