Friday, December 11, 2015

Hope Springs Eternal

Hello? Hellooo?? Anybody still out there? I know it has been a long silence here.

On the running front, it's been a rough year. Despite all my best efforts, I just seemed to be circling closer and closer to the drain. One bad race after another where I just seemed completely spent, overly winded and lifeless in the legs. Sadly, training wasn't much better. Even slow paces had me huffing and puffing and my legs didn't seem to work right. Worse yet, they just ached and ached and ached sometimes so badly that I woke up in the middle of the night.

Something was very wrong - I just knew it. Running wasn't fun at all anymore and I was upset and frustrated. I tried to explain all this to my primary care doctor (a marathoner herself) last April and ended up in tears in her office. Crying, muscle aches, trouble sleeping, a feeling of doom, lack of energy, loss of enthusiasm for previously joyous activities...Well, she put it all together and diagnosed me with "moderate depression" (I skipped right over mild!) and she put me on Cymbalta, which along with treating depression is approved for muscle aches. But she did refer me to a neurologist because I kept telling her my legs just weren't working right.

The neurologist practically laughed at me because I had no trouble with any of his tests. As to my complaint of weakness, he told me I was stronger than any other patient he had seen all week. He assured me that I did not have a neurologic problem. And then he changed my anti-depressant prescription.

I was willing enough to give the anti-depression meds a try, but I don't think I ever bought into it. I don't have hang-ups about mental illness or feel ashamed by it, but it just didn't seem to fit. I stopped the meds two weeks before Western States; I didn't feel like they were giving me any benefit and I didn't want to be on any unnecessary drugs for such a physically demanding event.

I knew I wasn't trained as well as I wanted for WS, but I still expected better than I did. By Forest Hill, I was spent. I had been working way harder than I should have been and once again my legs felt so weak. What did I expect?? I had done less than half the mileage I had done for WS the three years prior. I tried to put on a happy face- hey, it was still a silver buckle as Western States; how bad could it be? But inside, I was even more worried.

That was right around the time all the articles came out on over-training and they just seemed to confirm my worst fears: I was just another one of the washed up over trained ultra-runners with flash-in-the-pan success before running themselves completely into the ground. Several periods of rest would make me feel marginally better, but I would be back in the toilet after any moderately hard run. I was obviously in the deepest stages of overtraining. The clincher was trying to pace Liza Howard at Leadville. I had felt miserable for the ten days prior while we were in Colorado, and I kept warning her that I wouldn't be able to keep up with her, but even I was aghast when I got dropped after three miles. Three fucking miles! Yeah, Liza is super speedy, but I'd like to think if I am fresh and she has 50 miles on her legs, I'd have the advantage! As soon as we were climbing Hope Pass, I just could not get enough air, my legs were so weak and I kept getting so dizzy. Altitude sickness, everyone assured me, but I knew it wasn't right, and when I got back to Oregon and good old sea level, I was still wasted. Though it practically killed me, I resigned from the US 100km team; I was in no shape to run 62 miles three weeks later.

I sought out a new primary care doctor, this one an experienced triathlete with an ultra marathon on his resume to boot. He agreed I was probably overtrained noting that I had put my body through a lot the last few years and I started back on anti-depressants.  He sent me to a cardiologists just to make sure, you know, since I am over 40 and all now. My heart rate soared on a stress echo - it escalated way faster than it should have and I was breathing so hard. My legs ached, but I had no problem completing the test. The cardiologist said that it was odd but I had the max heart rate of a 28 year old and my ejection fraction (heart strength) was way above normal, so from a cardiac standpoint, I was fit as a fiddle. The primary care doc said I was just "deconditioned."

All during this time, I had lots of labs and they all came back perfectly normal - hormones, electrolytes, and nutrition all totally awesome. The new doc recommended three months off with nothing but yoga. Oh, and double the dose of Cymbalta for depression.

I stopped the meds all together two days later and started looking for a new doctor. Thankfully, doctor #5 was a godsend! Dr. Yates is a multi-time Kona Ironman finisher and one time Masters Ironman world record holder who served as the Portland Winter Hawks (minor league hockey) team doctor for 23 years. His special interest is in medicine for endurance athletes and he is right here in Salem! He listened to me for about 20 minutes and adamantly told me "This is not depression!" and "Of course your heart is fine! You have asthma - this is classic!" I have a history of asthma and have had a few bad attacks, but I was still skeptical; this didn't feel like an attack. "But I don't wheeze and my chest isn't tight," I countered. Though he couldn't entirely explain why, he told me leg pain and weakness are common symptoms of asthma in endurance athletes. Is my HR too high? Do I breathe really hard? Do I cough after workouts? Do colds always end up in my chest? Do I feel like I am not getting enough air even at rest? Is it worse climbing hills or at altitude (places the body needs more oxygen efficiency)? Do I start out feeling ok and then just fall apart? Yes, yes, YES! Well, holy shit, why didn't somebody tell me this 18 months ago and why the hell did I take so much anti-depressant medication?? Plus, he told me three times that I am only 41! Best doctor ever!

Unfortunately, that's not the end of the story. It turns out I also have gastric reflux. Well, how did I get so lucky? Apparently asthma and reflux have a tight correlation: 75% of asthma patients also have reflux. I did not know this and I am a doctor for gads sake! One more thing I didn't know: distance running increases the risk for reflux- all that pounding and increased pressure in the abdomen can weaken the lower esophageal sphincter. And all those crunches and ab workouts...well, they don't help either. So there's your excuse to skip core workouts! It is thought that either refluxing acid gets into the throat and irritates the lungs or that the acid irritation in the esophagus causes nerve irritation that in turn constricts the airways. I am not sure why all this started, but it seems like once it did, things just kept snowballing until they were out of control.

The good news is that I now have an idea of what has been going on and why I have felt so bad for so long. And I am not overtrained! (OMG - I am so woefully undertrained!). I can't say that having a bunch of chronic illnesses makes me happy, but they should be treatable and after just three weeks I see a HUGE difference. Heck, I even won a race last weekend. Ok, it was a small time 5.2 miler but it had 1000 feet of gain and at no point did my legs feel weak. Actually, I felt totally awesome at the end of the race with that post run euphoria that I had been missing for so long. I don't know that I'll ever get back to my 2013 top form, but I don't know that I really need to to be happy. More than anything I have been missing just feeling smooth and easy and finishing a workout thinking "Man, I love to run!" I am building back very slowly with only easy runs and no speedwork yet, but even so these past three weeks I have started to feel "fit" again and I can honestly say, "Man, I love to run!"
Yes! This is what I love! (ph:Nine22 Photography)
So I am cautiously optimistic, but feeling good enough that I am excitedly pouring over race websites and dreaming of big races and adventures for 2016!


Jill Homer said...

Hi Pam. Thanks for writing so candidly about this. For much of 2015 I battled respiratory issues and can relate to much of what you wrote about your experience. I had many of the same symptoms ... and a doctor who told me I was recovering from pneumonia. But the symptoms persisted. Of course I have to include the disclaimer, "I'm not an elite athlete but ..." I also considered the ever-nebulous "overtraining syndrome" and the resignation therein. My own family doctor was quick to write off asthma, but I sought consultation with an allergist and that was more enlightening to issues I've been having for years. Exercise certainly exacerbates the symptoms, but it's not likely the cause. I'm optimistic by next spring I'll have a better idea for long-term treatment ... or maybe I'll just follow my dream of living somewhere where it's winter for most of the year. (I'm severely allergic to grass pollen, which is just about everywhere.) Anyway, your optimism at the end of this post gives me hope ... and your post title made me smile. Thanks again.

Pam said...

Jill -Thanks for the comment. Sorry to hear you've been having respiratory troubles too; it is so not fun! I am also grass pollen allergic, but did the allergy shots a few years back. Right now the oral med monteleukast (generic Singulair) seems to be helping me tremendously. Best of luck to you.

Unknown said...

You explained so well all the things that did not work but not what did. I have very mild exercise induced asthma. Was diagnosed as a soccer kid. So how are you treating it? I've always kind of ignored it as a runner. Maybe I shouldn't?

Pam said...

Hi April- Right now I am still tinkering and trying to get a medicine regimen figured out, so I am not so sure what works just yet. However, Montelukast (aka Singulair), has been super helpful. It is an oral once a day anti-inflammatory. I am also using an inhaler (Ventolin) before all runs. Right now I am doing pulmonary steroids to get things under control and then Prilosec for GERD. I am hoping the latter two are 4-8 week medications (especially the steroid inhaler), but it remains to be seen if I can get away without them. The Prilosec may end up being long term just so the reflux doesn't trigger a nasty cycle again. If you have mild asthma only, I don't think it is dangerous to just ignore it, but if you feel bed or have off days, you may be able to avoid some of that if it is due to asthma acting up. Nick Nudell the head of the ultra running medical team says asthma or reactive airway disease is SUPER common in trail runners and it can get worse over time. Fresh air is great, but all that dust and pollen can irritate the lungs!

Liza said...

Well now my I-dropped-my-pacer story isn't nearly as cool. Yeah!!! for Dr. Number 5. Come run Bandera. :)

M @readeatwriterun said...

Pam, thank you SO much for sharing this. You're not only helping others with the specifics that might be similar for others, you're making many of us feel less alone in trying to work our way through issues and getting them named and addressed. It's very generous of you.

I'm so glad you found the right doc (wish I could see him). It makes such a huge difference. I wish I could find a doc who's an athlete and would understand.

Sounds like I should get tested for asthma, I guess. (I know I have allergies, but I've stopped taking allergy meds due to side fx of dizziness & fatigue). I did a test years ago where you push the ball up by exhaling - I sucked at it. The doc had me try an inhaler (which was nasty) and it didn't help, so he assumed it wasn't asthma. When some allergy meds stopped working, I was given Singulair tabs to try and had such a frightening reaction I only took it once. Had an ENT tell me they're all pretty nasty in terms of side effects.

I'm so frustrated trying to figure out if I'm ok or not, if how I feel is the best I can feel given my various conditions, and what to do to improve......I already have dx of hiatal hernia w GERD (past ulcers), trying desperately to wean off Prevacid after 6 yrs b/c of side effects (low absorption of essential stuff) but without getting the hernia fixed (risky surgery, not great success rate so probably not) I may be stuck on PPIs. Also have no thyroid (thyroid cancer caused removal) and was previously Hashi's/hypo. Have read lately that even having the right TSH/FT3/FT4 numbers may not mean body is getting what it needs, theory being one dose very different from how the thyroid trickles as needed, could affect performance, recovery. On top of that, AFib. AND perimenopausal at 49+ so it can all get blamed on hormone swings too! Such a fun collection of medical crap, and trying to tease out what might be causing what symptoms or problems is frustrating and time consuming. (and oh, there's things like trying nutrition changes, dehydration, sleep problems caused by the above or by life stress - and 2015 has had a huge amount of life stress....and well, I can give many reasons why 2015 has been a very challenging year for my training and racing. I just want to figure things out and fix them - I plan to have a fantastic 2016, even better than my 2014, with the bonus of turning 50!

Wow, sorry for the TMI data dump and what sounds like whining. I'm very grateful, as I know I'm far luckier than many folks, including some I know and some in my family. I'm grateful for every run and for being able to participate in the sport I love so much. I'm just frustrated, tired of trying to figure out "what's wrong with me?!" (and of things BEING wrong with me) and can occasionally get discouraged in how hard it seems to be to make progress toward my goals.

I'll use this piece to push my DH (again, still, yet, more) to get checked for asthma - he had nasty pneumonia in June and doesn't feel he's come back, everything is more effort, he's more fatigued, etc. I keep telling him the pneumonia might have triggered asthma in him. Maybe now he'll believe me. :)

Thank you again and I'm so glad you're on the way back to feeling better, maybe even competing back at your level again!

All my best, M

Pam said...

M- Sorry to hear of all your struggles. Allergy and asthma also go hand in hand and if you have performed poorly on respiratory tests before, it may be worth exploring the possibility of asthma. I am taking Singular and it has been a life saver. While everyone is different, Singulair has an extremely low side effects profile. Also, be sure you get taught how to use an inhaler. I know that might sound silly, but most people don't do it right. The inhaler should not actually touch your mouth and should be an inch or two from your face. That might make it less nasty. But first and foremost the right doctor is absolutely key. You may want to start with an endocrinologist or asthma/allergy doc. Wishing you the best and hoping you can feel like normal again. -p

Pam said...

Liza- you are still cool in my book! As to Bandera...I really don't think I need to be reminded how easy it is for you to drop me!

Anonymous said...

Pam - did you have any other symptoms of gastric reflux? Burning, digestive issues, etc?

Pam said...

Yes- I was burping a lot (previously not much of a burper) and I would get pain after eating, mostly with fruit. I sometimes had a pain/pressure right in the center of my chest. After I got diagnosed with asthma, I thought that was what was causing my chest pain, but it never went away with treatment despite feeling so much better otherwise. The new doc knew the tight association between asthma and reflux so he had a high level of suspicion. Abdominal and throat exam were consistent and I had my first cavity in like a decade which can be due to reflux (or could be random, who knows?).

Henry said...

Pam, Thanks for the article. I understand completely where you are. I am a couple of decades older but have been taking asthma medication for 25 years. There are days I can be half a mile into an easy run and my heart rate and breathing will be similar to running mile repeats. I can start a track workout and stop after my warm up as my legs are dead weight. I know simply to go home. I was on Advair but was switched to Dulera a couple of years ago. Since the switch I have had less problem. Thankfully, I do not have the acid reflux but I frequently get ear and sinus infections. Hang in there. You need to me more in tune with your body than you have before. You can manage and live with this and get back to where you were.
Henry Bickerstaff

Jon Olson said...

Congrats on finding some answers. Medicine is so tricky and our bodies are so inter-related.
As an allergy sufferer my whole life, I had allergy shots for years, but I started taking my medicine at night (single 24 hour dose medicine) so that when I woke up for my run in the morning the medicine was already working. This has really improved my overall well being in the morning. Zyrtec seems to be the best option for me. At the same time as moving to taking my meds at night, I added Vitamin D! This has been a huge gain. I believe that the addition of Vitamin D has been a better boost to my system then the allergy drugs. Something to consider as you continue to recover! Welcome back and we will watch with baited breath your race schedule.

(thanks Ultrarunner podcast for linking)

Clare Abram said...

Oh Pam...I just read your blog with tears welling up. I'm really struggling with breathing issues myself...people recognize me at ultra races *from behind* because of how bad my breathing sounds! Sometimes I feel so frustrated and down, thanks for giving me and others the strength to keep asking and learning....and the patience to keep trying different treatments. I did Hardrock this year...and my lungs are still mad about it :-0 Certainly, finding a doctor that understands (elite and non-elite) endurance athletes makes a huge difference...after normal pulmonary function tests with my primary care physician, i was sent away feeling like I was making a fuss over nothing, but as soon as I would try and do any exercise i could not breathe, I knew something was not right. My wheezing is on the inspiration rather than the expiration, so not "textbook" asthma, but may be more like a perfect storm of minor chronic conditions...but Singulair has also helped me. Do you know if Nick Nudell has any recommendations to prevent breathing issues in trail runners getting worse over time if he sees it so commonly? And I'm super glad to hear you are excitedly filling your 2016 calendar!
*thank you*

AJ said...

Pam this sounds like adrenal fatigue. Depression or asthma only explained away a couple symptoms. Your insomnia is a nervous system issue caused by adrenal fatigue. (Is it difficult to calm down after you've been excited? Is your texting heartbeat significantly higher now? )
Unfortunately this concept is not understood in western medicine but there's a lot of info online or you can see a naturopath. I went through a very similar story and adrenal supportive herbs were amazing for me as well as increasing the "yang" in my diet, and addressing nutritional deficiencies.

Dani Graham said...

I can so relate, I was diagnosed with asthma at 24 after having NO symptoms my entire life up to that point. Allergy control is important to prevent attacks, and montelukast and nasal sprays have been life savers, along with albuterol prior to hot, humid runs. Best of luck with everything!

Vern said...

Sounds like what I have. I've had asthma since a teen, but it very rarely affected me over my entire life. I was more affected by where I was in the world. Western Pennsylvania - a bit, NYC - a lot, Miami and Tampa - not at all, Hawaii - not at all, Thailand - where I've been the past 11 years, very rarely. However, the fact that you found it teams up with acid reflux... well, I seem to be having that a bit too. Never had it before. I was thinking maybe all this superhot Thai food was getting to my stomach and digestive tract.

I used to be able to run up this 500m elev. mountain in 38 minutes regularly (I'm 49). Over the last 18 months or so I've had months at a time where I'm either losing energy in my thighs during the climbs, or the breathing just isn't there. Heart rate spikes quickly on these runs and it feels far harder than it used io. There is no wheezing, but there is this feeling that the breath is just not up to par. It isn't easy and light - it's slightly compressed... slightly inefficient.

So yeah, maybe I have something similar. Maybe allergies acting up to give mild symptoms of asthma that inhibit the hard running and climbing.

Glad I found this article - referred by URP Daily News.


Ben Nephew said...

As someone who studies stress and endocrinology, and is starting to study inflammation this is very interesting. There has been some convincing research linking early life stress to asthma in kids, and I wonder if something similar can happen with intense endurance training? While you may not have any HPA axis irregularities right now, maybe a sustained period of intensive training caused a cortisol-mediated long term change in your immune system. Have you ever had a dexamethasone suppression test? I've always thought the ridiculously high rate of asthma in professional runners compared to the average population was mostly an abuse of TUE's, but maybe some are stress induced.

With the gastric reflex issues, do you often vomit at races? Do your lung function tests indicate fibrosis, or do you only have difficulties in response to exercise? The literature on reflex and fibrosis is interesting.

Have you seen an immunologist? I would be curious to see a broad cytokine panel.

Wyatt Hornsby said...

Glad to hear you're on the rebound, Pam. I really think this further exposes what's wrong with the medical profession--always treating what looks like the symptom and not getting to the root cause. You have a problem? Take this pill. Ridiculous. I'm glad you finally got the real answer. Keep truckin'!

Wyatt Hornsby said...

P.S. I saw you at Leadville as you were waiting for Liza in Winfield. Hope you come back and run it one day! I'll be at WS this year and will say hi if I see you.

Rob said...

Hey Pam! It is just wonderful to be able to hear from you and your distinct writing style,somehow it is always inviting to read. I am excited to hear about your plans for upcoming races this year as well. All the best in continuing to straighten out the medical issues.

David said...

Blogs like this make me appreciate having no breathing issues. My brother used to suffer from breathing issues and good breathing makes life so much better

Unknown said...

Thanks Pam! I am going to continue to ignore it for now. But I'm glad I can just pull out your regiment if it ever becomes serious for me. Also I am surprised its so much!

Unknown said...

Thanks Pam! I am going to continue to ignore it for now. But I'm glad I can just pull out your regiment if it ever becomes serious for me. Also I am surprised its so much!

Unknown said...

I had a severe asthma attack yesterday after a trail run. I didn't even know what was happening because I had no clue that I even had asthma but it was pretty scary. I thought all the symptoms I was experiencing just indicated I was getting out of shape. After running marathons and my first 50k last year I was getting winded by 3 mile runs. I went to the ER yesterday and was given steroids, allergy meds and an inhaler but I have to follow up with a specialist this week. Fellow trail runners referred me to your story and now I am feeling hopeful that I can get back to my usuak self. Thanks for sharing your story.

Pam said...

Sorry to hear this, Rosario. Good luck with the meds and getting back to normal!

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