Saturday, October 23, 2010

Rest And Renewal

As a pathologist, the cornerstone of my job is the diagnosis and evaluation of cancer. But the reality is that over 90% of the specimens I see are benign. A good portion of my work day is spent evaluating acute (inflammation, ulceration, necrosis) and chronic (scarring, healing, hypertrophy) reactive processes in tissue. But it was only in the last couple of months that I have come to appreciate the differences between acute and chronic fatigue.

Western States was a bit of a Pyrrhic Victory for me: I won the battle (or at least got F10 in the battle!), but my body was ravaged by the effort. The nine weeks between Western States and Angeles Crest weren't fun. Running was a chore and mechanically, things just didn't seem to be working right. Somewhere around mile 37 of Angeles Crest, the full weight of my ongoing exhaustion hit me and by mile 50, I was ready to surrender. It wasn't a good outcome, but it forced me to accept how tired and beat up I really was.

All I can say is that I was in a pit of deep, chronic fatigue. I don't mean that in "Chronic Fatigue Syndrome" kind of way, but rather an on-going cycle of physical exhaustion.

A couple people said, "You probably have endocrine fatigue." It is a term I have seen on before, too. I don't know what endocrine fatigue means; it is certainly not something that was covered in medical school. Frankly, I don't buy into it at all. For starters, I had my endocrine levels tested, and they were all fine. I've had several other friends with fatigue issues at one point in their lives, and (with the exception of one person with post-partum hypo-thyroidism, not running related) none of them have ever had out of whack endocrine levels. I also talked with an endocrinologist colleague of mine about the possibility of adrenal malfunction secondary to intense physical activity and he looked at me like I was from Mars before he politely said,"I have never heard of such a thing." However, I do believe there was some physiologic alteration that was underlying this and that it wasn't just "burn-out" or "all in my head" (That's what all the crazies say, right?). Seriously, though, my resting heart rate was constantly elevated, but even more noticeable was my elevated breathing rate, even at rest. And things just got worse with physical activity. I wonder if this was some sort of alteration in autonomic nervous system functioning, but I don't really have any proof of that either.

Whatever the underlying mechanism, low mileage for nine weeks hadn't helped. Taking day or two off didn't really help, and so the only option I could see was to take time off - completely off, not even any cross training - and truly just REST. (Ryan Hall sounds like he has recently had similar problems and came to the same conclusion, not that I am trying to compare myself to Ryan Hall!)

Three and a half weeks of nothing. People asked me if it was hard to give up running for that long, but really it was easy. Who wants to run when each step hurts, your legs ache for hours after a run, and even the easiest of paces feels like a monumental effort?

My 36th birthday marked my return to running. It seemed symbolic, to start on my new year, but really that was not my intention. The real reason I started running again that day was because a friend called me up and said, "Hey, let's go for a run and then let's get a group together to go out for a beer for your birthday." What can I say, not all decisions are based on profound reasoning. ;)

So I have been back for one month and I feel great. I was definitely out of shape when I started back, but I didn't even care. It was just so nice to have my legs moving in a fluid motion again and no aching afterwards. It is amazing how fast the body progresses and remembers, too. In just 4 weeks my 1000m repeat times have dropped 30 seconds (mostly that reflects how out of shape I was the first week).

During the past month, I have done four runs of 20+ miles. I have felt good on every one, but I am always dead the rest of the day. That is nothing new; I experienced that way before I was an ultra-runner as I remember how much I cherished a nap after my marathon long training runs (in the pre-kid era). Yet the first couple of times, it put me in a panic: "OMG, did I just do too much? Am I headed back to that awful place?!?" But I now see this as acute fatigue, something that is essential in training to signal adaptation in the body and improve fitness. It is tiredness, but is something the body can bounce back from in a day or two. The key, of course, is allowing your body that time to recover, to keep those incidents of acute fatigue from piling up and morphing into something worse, such as an injury or chronic fatigue.

Live and learn. And get plenty of rest.


Charlie McDanger said...

Good move, Pam. Whenever I read your stuff, it has poker-applicable wisdom all over it.

Pam said...

Yeah, you gotta know when to hold 'em and when to fold 'em. Unfortunately, I decided to fold'em after I was "all in" in a 100 mile race!

Ronda said...

Thanks for the post Pam. I think in my years of ultra running I have had some sort of overtraining/over-racing fatigue thing 2 times. As you described it much more than just an off day it lasts and morphs with elevated HR, bazaar breathing and aches that don't make sense.

Glad your feeling better. Just in time to get fired up about your summer :)

Hone said...

Rest is good. It is easy to get back into shape.

Great post and glad you are back on it.

Drs. Cynthia and David said...

Very interesting post. I think I may have some of that chronic fatigue, not from doing 100 milers (only a failed attempt) but from frequent ultras, run despite injuries. I wonder too if my age (54) has something to do with it. Maybe I shouldn't be blaming it on age and just accept that too much racing isn't helping.

I believe there is a lot modern medicine still doesn't know and understand about health and would not be surprised to hear there was a real underlying basis for "adrenal fatigue." Elevated HR is supposed to come from too much sympathetic activity (higher levels of epinephrine?) What did you have tested? I'd also be curious about the role of nutrition here too- you need to keep calories high enough to keep your body from fearing starvation (like becoming amenorrheic), but what role does adequate carnitine, omega-3 fatty acids, vitamin A and other vitamins etc play?

Great blog, and I've enjoyed reading your posts!