Monday, April 7, 2014

Still running a few pints low

And then, it was six weeks later. I'm not sure how time got away from me, but I apologize for not updating my blog sooner.

To recap: Over the last 2-3 months, I have lost a lot of blood and become clinically anemic (low hemoglobin) because I have fibroids in my uterus. There are three of them and one is the size of a 16-week old fetus and the other 2 are about 6 weeks along. In fact, the big one completely fills my entire uterus! I got to see them in ultrasound pictures but decided not to get a printed copy to hang on the fridge. The main, troubling symptom is massive blood loss and the only way to recover from that is to take iron supplements and, well, stop bleeding.

Last time we met, my hemoglobin had tanked to a low of 9.7. Over, the past six weeks, I got it up to a high of 12.4. My goal is to be around 14. My running mileage and intensity increased steadily with my blood levels. I began feeling so much better with each incremental gain in red blood cells. I have also found that this is not necessarily a linear process. Some weeks, my blood levels rose in what appeared to be regular increments while in others, they didn't go up at all, even under the same supplementation regime and without any blood loss. Then, some weeks, like last week, I lost so much blood that I ended up losing ground and became anemic again.

Here is a quick record of my blood levels and corresponding workout milestones:

2/14/14
Hemoglobin: 9.7
Hematocrit: 29.3
Running workouts: Kept all workouts to short speed efforts. Ran about 3-4 days per week, ~20 miles/week. Felt very tired running. Had to stop numerous times to get through an easy run. Had to walk rest breaks when doing speed work.

2/18/14
Hemoglobin: 10.8
Hematocrit: 33.7
Running workouts: Still keeping to short speed efforts. Ran about 3-4 days per week, ~20 miles/week. Still felt very tired running. Still walking in rest breaks when doing speed work.

2/25/14
Hemoglobin: 11.2
Hematocrit: 35.4
Running workouts: Finally starting to feel better. Ran a long run at around 7:30 pace midweek and it was hard. Heart rate averaged 88-90% of max for the whole run (usual pace at that HR range is ~6:10). Did a short speed workout over the weekend and it was the first time I didn't have to walk the recoveries! 48 miles this week. Felt less tired running in general.

3/6/14
Hemoglobin: 11.7
Hematocrit: 35.7
Running workouts: Not much change here. Pretty disappointed that my hemoglobin didn't rise more over the last two weeks despite the iron supplements. I guess recovery from anemia isn't a linear process. I did some running on hilly trails and felt much better than I thought I would. However, I had to cut my first lactate threshold workout into chunks a few days later because I couldn't hold 6:15 pace for more than 800m:(.

3/12/14
Hemoglobin: 12.3
Hematocrit: 38.7
Running workouts: Had my first long workout with 9 miles at alternating marathon and lactate threshold pace. Ran all of it, but boy did I stop a lot. Averaged about 6:25 pace, but I did stop about 6 times during the course of this "continuous" workout.

3/21/14
Hemoglobin: 12.4
Hematocrit: 37.8
Ferritin: 35
Running workouts: Had my blood drawn on my own and decided to get ferritin checked too. Was happy to see that my iron stores are still up there! Ran a couple of lactate threshold workouts and stopped in at least one of the miles to complete at the faster paces (5:58-6:07). I don't recommend this, btw. It's not the way you're supposed to run them, but this is what happens when your brain is disconnected from your anemic body: you think you can run faster than you actually can and then you die during the repeat.

3/28/14
Hemoglobin: 11.9
Hematocrit: 36.8
Ferritin: 19
Running workouts: I had my blood drawn because I had experienced another major episode this week and was very worried about the effect on my blood levels. I had good reason to be concerned. Not only were hemoglobin and hematocrit low, but my ferritin took a nose dive because my body was really needing the stored iron to make new RBCs. I also changed my supplements a little this week from taking the liquid ferrous sulfate 3 times/day to taking it once and adding in a "gentler" product called "blood builder" with non-heme iron, folate, and B vitamins. I won't do that again. That stuff doesn't work for me.

_________________________________________________________________________________

So, that was last week and I had a race yesterday. Maybe you can imagine the deflation I felt when I was making such good progress with my blood levels and then, BAM, I lose nearly a month's worth of progress and turn into anemia girl again. IN TWO DAYS!!! I had hoped I might be close to normal by the time the race rolled around.    

I was a bit conflicted about whether or not to even run the race. I had missed two other races I had signed up for in March because of my health issues. The first race in early March was a 10 miler and I couldn't even run 10 miles at any pace without stopping to catch my breath at that point, so that was kind of a no brainer. Then, there was the hilly but beautiful Race across the Bay in San Francisco where I did so well last year. I was feeling better by then, but wasn't sure I could run without walking the hills. No go.  

With yesterday's Sactown 10-mile race, I knew that the anemia was going to affect me, but I decided I didn't want to miss another race. There is this little thing called ego that tried to get in the way of my decision, but I decided to just suck it up and go for it. I'm really glad I did. I had hoped to run around 6:30 pace for the whole race and try to pick it up a bit if possible in the second half. I stuck to my plan and was at least able to even split the race. I ran 31:59 for the first half and 1:03:57 overall. I was very pleased with this given the fact that 3 weeks ago I couldn't hold that pace for 9 miles. What I have to forget about is that I was running 30 miles/week at less than 6:20 pace two months ago in training.

The good thing about being anemic is that I will feel like a freakin' rockstar once my hemoglobin levels get over 13. I still have a long way to go, but I am hopeful that the meds I'm taking to control the bleeding will eventually kick in. I have been able to keep my mileage up around 60 these past couple of weeks and will be gradually increasing as I get closer to the Eugene Marathon.

So what is the solution to my medical problem? Well, the "easy" answer is to have a hysterectomy. In fact, the two gynecologists I saw prior to seeing a surgeon a few weeks ago, had already written my uterus off. When I walked in to see the surgeon, she said, "so, you're done with your uterus and just want to take it out, huh?" I told her that I never said that and, in fact, had told both of the other doctors that I did not want a hysterectomy. I wanted to see if I could manage the problem with meds before yanking the thing out.

This doctor was very good. She told me I had a few options available before resorting to major surgery. She explained these to me and said that I could totally live with my fibroid babies as long as I could deal with the symptoms. She also confirmed that they were living off a diet of estrogen and that, decreasing that would make them shrink and die. This is why they go away in menopause. I am a few years away from that big change, but it at least gives me a timeframe to work with.

What I have been doing is looking for other alternatives to reduce estrogen levels in my body and to shrink the fibroids. Those of you who've been regular followers will recall that I had my blood estrogen levels tested about 2 years ago (on my own because my docs said it was not useful) and was shocked that they were in the 500+ range which is the ideal level for someone on IVF treatment (very high). The medical doctors I have dealt with think estrogen tests are useless because they change with the monthly cycle, etc., yet they prescribe hormonal pills to increase them in order to remedy problems like I am having.

I am operating on the assumption that my estrogen levels are high (well, I have tests to prove that) and that my progesterone levels are low (taking BCPs for that). I am taking a product called Myomin to reduce my estrogen levels. It takes about 3-6 months to see reduction in fibroids if it's going to work. This is a long-term strategy, obviously. I also believe that I can quash the Occupy Jaymee movement inside my uterus by taking systemic enzymes that help to break down fibrin. This is based on internet research I have done and there is some science behind it, but it is purely a trial. I am assuming it can't hurt me to try.

In making this choice to try these alternative treatments and give my body a chance to kill the little bastards I have chosen a tough option. I won't get quick relief from this route, but I will at least know that I exhausted my non-surgical options. It is so tempting to think about surgery on the days, like the two days last week, where I am bleeding uncontrollably and know that I am becoming anemic yet again.

I am seeing progress. My blood levels aren't dropping as much as they were over a month ago every time I have a period, and I have new ways of coping with the massive bleeding when it comes. Ladies, if you are in the same boat as me and haven't tried the Diva Cup or Lunette, you are missing out on a wonderful world of leak-proof protection! Gross, I know guys, but this little device has literally changed my life. I can do everything I want to do without worrying about the flooding interrupting the party. It is perfect for runners and offers 12 hours of protection (for me that's about 3 hours, but way better than the 5 minutes I get from the other options).

And, I do believe my fibroid babies are shrinking. They are big enough that I can actually feel them in my abdomen (be grateful I spared you the baby bump pictures). They are definitely smaller than they were a month ago. As my symptoms subside, I'll try to get in for another ultrasound in a few months to see how much they have shrunk.        

I am happy to be able to share my story with all of you and add another anecdote to the interwebs about dealing with fibroids--one that is specific to athletes. I got confirmation of the educational benefit of my efforts from a fast guy runner yesterday who confessed that he has been reading my blog despite the warnings I have posted. He said, "I had no idea how much older women have to deal with!" I told him these problems are a lot more common than he could imagine, but most women choose to keep their stories private--and for good reason! I'm glad I didn't.

Sunday, February 16, 2014

Running with Anemia

Things are never so bad that they can't be made worse. ~Humphrey Bogart

I believe I first heard that quote while in the Air Force. It was probably in reference to a bad commander that I couldn't wait to see move on. The military tends to rotate commanders every 2-3 years so we would rejoice when a bad one left. I'm sure some crusty old Chief Master Sergeant saw us rejoicing and threw that quote our way. Inevitably, I learned from experience he was right when the bad commander was followed by someone much worse. I have held that quote in my brain for over 20 years not because I'm a pessimistic person, but because I am a realistic person who likes to be prepared.

I'm going to pick up where we left off because I want to chronicle this adventure for those of you who may find yourselves in a similar situation. I get a great amount of info from others' blog posts and articles I find on the web. What I have found so far is that the issues I am dealing with are estimated to affect up to 80% of women and athletes are not spared. However, there is very little information specific to athletes out there on these topics. I decided I would at least share what I am going through in hopes that others will do the same making more information available to female athletes (and their significant others) everywhere.      

Where we left off: Two weeks ago, I had dropped out of a half marathon race because I had an episode of blood loss the night before. I decided to contact my lady doc since I realized 4 weeks of continuous bleeding was no longer within a normal range of variability for me. She scheduled an ultrasound for me the Thursday of that week and my regular doc scheduled some blood tests for me. I was relieved to get the blood test results showing that I hadn't become anemic since my last blood tests in November.

Just when I thought things were pretty bad, they got much worse. On Friday, I had a meeting scheduled and came prepared in case I had a major flooding episode. Well, the flood gates opened during the meeting and I could not control it. I had to politely excuse myself and drive home. This was flooding of biblical proportion. I had a dinner date with a friend that night at her house and experienced another flooding episode that led to an embarrassing admission on my part and sitting on a towel for the rest of the evening. My friend was, as I of course expected, very gracious.

I went for two runs over that weekend. Seven miles on Saturday and 12 miles on Sunday. I was pleasantly surprised that I was able to pull this off and maintain a decent (7:30) pace. I was definitely tired, but I was never on the verge of passing out or anything extreme.

Last Monday at 2 a.m., I woke to heavy bleeding and decided I needed to take action. I immediately sent a message to my lady doc. It was returned immediately with an out of office message. Damn it! I was luckily able to make an appointment with my former lady doc for that morning.

During that visit, my doc started with my ultrasound results which showed I had fibroids growing somewhere in my uterus. One of them was a big daddy, protruding 7cm into the uterus. The doc explained this was the likely culprit causing my excessive bleeding. However, she said that the IUD I had in place should be spewing out hormones to counteract the bleeding. We decided to have her take a look inside the madness, do an endometrial biopsy to rule out super bad stuff and remove the IUD to see if maybe it was contributing to my problems.

When she started checking under the hood, she got a concerned look on her face. She told me she couldn't find the IUD. She then checked the ultrasound report which would certainly note a foreign object in my uterus had it been present. No notes. She said that she has seen this a couple of times in her long career, and it was always associated with heavy bleeding. So, it appears I am now a human pez dispenser of IUDs. It seems crazy to me that something that big could come shooting out of me and I would not have seen or felt it. She said it is rare, but it happens. When I told my mom about this her response was, "well, I always told you you were special".  

It was a convenient explanation for what was happening. At some point, I lost the IUD and the hormones it was pumping into my system. When that happened, everything went haywire. So, the temporary solution was to put me on a heavy dose of progesterone pills and see what happens. We also went over the options that may be available to me depending on the results of the biopsy. Surgery of some kind looks like a probable next step. She explained that she was happy I had the blood tests done the week before because anemia was the most immediate concern with this issue. Since I wasn't anemic, we had some time to experiment with different treatments.

Not so fast...I got the blood test results back that I had taken after my appointment with the doc on Monday evening. I had become anemic over the weekend. Since this mess started, way back in November, I had wondered how much blood loss I could sustain before becoming anemic. This made me even more impressed with the two runs I had been able to complete over that weekend. This wasn't like low ferritin making me lose a few seconds per mile in my workouts. This was full on anemia. Interestingly, I asked to have my ferritin checked and it was 28, which is the same as it was in December. So, the iron supplements were clearly maintaining my blood iron levels high enough to continue to store iron.  I thought this was particularly germane given my discussion in last week's post about hemoglobin and ferritin. I just didn't expect to become Exhibit A in my own experiment so quickly.  

The progesterone started working within the first two days to reduce the bleeding but then, Wednesday morning, I woke to mind-blowingly painful abdominal cramps. I complained a bit to the Genius before he left for work, but told him I'd be fine. Then, I wasn't fine. I tried to stand and started seeing stars. I became clammy and sweaty. I looked in the mirror and was pale as a ghost. My fingertips were ghostly white. The pain was unbearable and NSAIDs were doing nothing to curb it. I called the Genius and asked him to shuttle me to the ER. He raced me there as fast as he could while I lay moaning in the seat next to him. I pleaded with him to run a red light when we seemed to be stopped there for hours.

As per usual, the ER was an adventure, but not as great as the one I had there that time I left with a full leg, bi-valve cast. I was lucky to have a good ER doc this time who has actually been following up with me via email. He gave me an IV to help hydrate me and a big dose of ibuprofen to help with the cramps. It wasn't until I got the narcotics that the pain finally went away. They also ran more blood tests and the results came back showing I had become more anemic in the last 36 hours with a hemoglobin level of 9.6. The doc discharged me, declaring this heavy menstrual cramps and told me to keep up with the iron supplements. I will admit I felt like a bit of an idiot having gone to the ER for "menstrual cramps". I should return if the bleeding came back full force or if I pass out though he reassured me that I could still lose a lot more blood before it would be dangerous enough for them to transfuse. Comforting.

I had follow up blood work taken on Friday, and it came back showing no improvement over Wednesday's results but at least it wasn't worse. My results for the past few blood tests are shown below for reference:
And that's what a week of blood loss will do to you.
This weekend, the mad scientist came out in me, and I decided this was a great opportunity to see how much the anemia affects my running. I first asked the ER doc if it was safe to exercise and he said that I could exercise to tolerance but to try not to pass out. Doctor Mom did not agree with these  medical instructions and ordered me not to run. Sorry Mom.

I ran Thursday, the day after the ER visit and it was slower than the runs over the weekend, but I didn't pass out. Yesterday I decided to run a workout. It was the workout I was supposed to have done earlier in the week. After deciding to push my next marathon to the summer or fall, Jack put me back on short repetition training similar to what I had been doing last winter.

I must admit that I was a little afraid about how my body might respond to high levels of exertion, so I brought my iPhone with me just in case. I also used the livetrack feature on my new Garmin 620 so that the Genius and my mom could track me during the run. I ran to the practice track at Sac State and had to climb over the fence to gain access. I realized that I must be pretty determined to get this workout done if I was willing to climb the fence to get to the track.

After huffing and puffing through a few strides, I started my workout:

4 x (200m Rep pace/200m jog + 200m Rep pace/200m jog + 400m Rep pace/400m jog)

The first split was 37 and I felt it. I jogged the next 200m and decided I would try to slow the rest of these down. The 400s were tough. I got heavy-legged in the last 100m like I had done 10 or 12 400s before the first one. I walked a bit of the 400m recovery lap and then slowly jogged to the start line to start again. I was shocked at how well this workout went. I ran within a few seconds of my prescribed (non-anemic) paces with the 200s averaging around 39 and with every 400 in exactly 82 seconds. I was tired for sure, but I wasn't passing out. I did notice the anemia during the recovery jogs which became recovery walks for the first few meters between reps. That didn't compromise the workout at all given that the purpose of a repetition workout is to improve running economy by running fast with good form and without strain. This means taking full recovery in between each repeat even if it means taking a little longer to start the next rep.

I jogged back to my car feeling really proud of myself. It wasn't so much about having run a great workout despite my condition. I was happy to have overcome the fear of the unknown. I have felt tired from low iron stores before, but this was serious stuff that had me staring down the barrel of a potential blood transfusion. How would my body respond to the effort? Would I pass out at some point? Would the effort trigger more blood loss? These were the fears I started the workout with and effectively slayed.

I'd like to end with a look back at why my experience is relevant to you, my readers. Many of you will never have to run with full blown anemia, but if you do, at least you'll have my experience to draw from. I will be continuing to post about my progress in recovering from the anemic state I am in and how it affects my activities. There is a ton of information about running with sports anemia (low iron stores) and pseudo anemia (relatively low concentration of red blood cells due to higher blood volume in athletes), but I found zero about running with clinical anemia. If it's out there, I'd love to know about it and post a link.

And, for you lucky ladies heading into your 40s, there is a good chance (maybe as high as 80%) that you either have or will have fibroids. Many women never know they have them and get along fine. For others, they can cause crazy problems like the ones I am experiencing (assuming it's the fibroids doing this to me) but might even present as a sports-related injury like this Aussie triathlete describes in this interview (be sure to click on "show" next to the word "transcript" on the page to read the interview). Her fibroid was pressing on nerves in her spine giving her severe leg pain that wouldn't resolve and made her stop running altogether. It's a great story of courage and the power of pushing back on those in the medical profession.

I will continue to use my body as a laboratory of sorts and post the information. I am most interested in follow up blood work and how my running and racing times and perceived exertion levels change along with my CBC readings. I am of course curious to see how long it takes to dig myself out of this anemic state as well. I have read predictions of 1-2 months all the way up to a year. I imagine this is an individual thing, but I will at least share my experience.                                        

Thanks to everyone who has wished me well through this journey. I wish it were nearing conclusion but I have a feeling it has just begun.

Until later,

Anemia girl, signing off.


           

Tuesday, February 4, 2014

This one's for the ladies

My title is intended to serve as fair warning to readers of the male species and any women who are uncomfortable with girlie talk that this sh*t's about to get real. Fast. I really, really don't like talking about this stuff, even with close friends, so writing about it is not fun either. This blog has never been about comfortable writing for me, though. So, I'll just do what I normally do when I feel uncomfortable and picture you all naked, reading my blog, eating cheetos on your couches. There. That's better.

I dropped out of my half marathon race on Sunday. Not a proud moment for me, but a necessary one. With all of the hard work I had put in, it was a great disappointment to not be able to test my fitness in a race. Again. Conditions were pretty abysmal, as all of the rain California was missing for these past few months blew in and dumped on the race course that morning. Seriously. I saw waterfalls in Golden Gate Park draining the burgeoning drainageways into lower lying areas. Given that and the fact that my Garmin completely fritzed out, I'm not sure it would have been a great test anyway. I still have no idea how fast I ran the 8 miles of the race that I did run before walking off the course. What ultimately stopped me was a health issue that has been developing for months.

I know. I just got through an injury that sidelined me for months and now this. It sucks.

My health problem is no doubt related to being in my mid-40s and likely some wackadoodle hormonal changes associated with my age. I've blogged about that before. However, this time, I am not talking about feeling a little tired or taking a day longer to recover. Here I am talking about, to be indelicate, bleeding like a stuck pig. I can't begin to quantify the amount of blood I have lost over the past few months, but it is a triumphant amount.

Of course, with the loss of blood comes anemia, and that's what is limiting me right now. I am supplementing as much as I think I can safely (liquid ferrous sulfate in OJ, 2x per day) and doing everything right in terms of not eating calcium rich foods, no tea or coffee with it, etc.  I just think supplements are no match for my archenemy or, as I like to call her: She Who Must Not Be Named (SWMNBN).

I have tested my ferritin levels (iron stores) regularly since last June and have seen a gradual decrease in those values over time: 70+ng/ml (June), 38 (Sep), 38 (Oct), 25 (Dec). So, clearly my body is losing iron stores despite the supplementation. That last downward jump, between October and November happened after my first encounter with SWMNBN. It lasted for 5 hours straight and, being my first episode, I was so afraid, I had the Genius on standby to take me to the emergency room if it didn't stop.

I started really feeling the effects in my training about 3-4 weeks ago. My legs started getting that heavy feeling, and it seemed to take more effort than necessary to hit paces. I especially felt the effects after a big episode. I've now had 4 of these with a lot of "normal" ones in between. I would need to take 1-2 days off from running right after the major events and felt like I needed tons of sleep to recover.

Without mentioning SWMNBN, I ran my fatigue and lower ferritin levels by my coach and said I thought that was contributing to my lower energy levels. He explained that a given ferritin value isn't really that useful. What is useful and important is the trend in values. He explained that hemoglobin levels were also very important in evaluating whether low iron stores were having an impact on sports performance. This all made sense to me when I read a bit more about how ferritin and hemoglobin interact to form red blood cells in this link.

Jack explained that a ferritin value of 20 ng/ml may be "good" if it was, say, 15 a month before. That indicates the body is storing iron and that iron can be used by hemoglobin to make red blood cells. If the value was 30 a month before, then there's a problem, because iron stores are being depleted and that will affect hemoglobin and hence RBC levels. He also mentioned that ideally I would want a hemoglobin level close to 14.0. He said the difference between a 13.0 and 14.0 hemoglobin level is about 40 seconds in a 5k.

I didn't have my hemoglobin levels tested every time I had my ferritin tested, but I did have a value from right after the first major incident (when my ferritin was 38 and normal), and sure enough, my hemoglobin was the lowest reading I've ever recorded: 12.4. So, even though my ferritin level appeared normal (for me), it was on a downward trend (from blood loss + high intensity training), leaving me with less and less available iron for my hemoglobin to turn into RBCs. As a comparison, my hemoglobin level was 13.9 when my ferritin levels were 70+ ng/ml. Without sufficient hemoglobin, I'm not producing enough red blood cells and performance eventually suffers, in a big way.

I should note that a hemoglobin level of 12.4 is not considered low for non-athletes, just like a ferritin value of 25 or even 15 isn't generally considered low. However, most coaches and athletes who have dealt with "sports anemia" know that there is a real impact on performance for athletes when their levels drop below a certain point. That point may be different for each athlete, but performance is affected well before a clinical diagnosis of anemia would be made based on the ranges most doctors use. There is also a lot of discussion on the internets about "pseudo" anemia which is actually a dilution of hemoglobin in the blood due to athletes having a higher blood volume. Some have hypothesized that the normal range of 13-14 that Jack gave me are high for fit athletes. If true, then my hemoglobin levels are normal for a fit athlete. The link I posted above discusses this. Bottom line: there's a lot to be learned about all of this stuff and we don't quite understand cause and effect yet. The best we can do in the mean time is track our own stats and performance values to try to come up with our own normal ranges.

Once Jack pointed out the hemoglobin/ferritin trend link, a lot of the conflicting research results I had read in the past regarding ferritin and performance started to make sense to me. If you look at just the ferritin value and not the trend then, there likely isn't a strong correlation with sports performance. However, speaking to the trend effect, in studies where women with low levels of ferritin have been given iron supplements and experienced an improvement in iron stores (ferritin values), they generally show an improvement in fatigue levels and performance.

One of the biggest challenges I have faced and I know other athletes face, is getting a doctor to give you tests often enough to see whether there is a trend. I have gotten around that issue by ordering (and paying out-of-pocket for) my own tests through Healthtestingcenters.com. It's $39 for a ferritin test and I get the results in 2-3 days. I will now be ordering hemoglobin tests too!    

So, Saturday night before the race, SWMNBN paid me a major visit (even though she had been taking up residence for the past 9 days already). She swooped in with particular force, and I knew that didn't bode well. I still felt like I needed to see what would happen on race day, allthewhile knowing the odds were against me. I started the race and it felt hard to run. I'm pretty sure I wasn't going that fast. I wanted to at least make it to the point on the course where it hits the ocean because there's a nice, long downhill section where I thought I might be able to get my stride. Nope. We hit the ocean and ran into a major headwind for another 3 miles. I gave it a mile more before I dropped.

Over the next few weeks, I'll be trying to find the cause of this troublesome issue. I have decided to abandon my plans for a spring marathon in favor of keeping myself healthy. Along with low iron levels often comes injury, or at least that has happened for me a couple of times. I will be even more vigilant these next few months as I **fingers crossed** kick SWMNBN out the door and fight tooth and nail to store some iron in my muggle bones.

Saturday, January 25, 2014

Playing with intensity and volume

My training has been going very well this past month. The running injury I sustained from being overtrained in September is a distant memory. I knew that, when I resumed full training, I would need to do something differently, and the decision to work with Jack Daniels was a good one. I am excited to get my training plan every month, and it always surprises me. I have been able to execute the plan without an issue, and it is not an easy plan by any means!

One thing that is very different with my current plan is the amount of quality running (defined by me as anything faster than marathon pace) I am doing as a percentage of my weekly mileage. When I saw that my mileage was to be kept at 55 miles per week (MPW) through January, I was a bit concerned having always believed that I had to run high mileage to be super fit. I am trying to prepare for a marathon in March, and I have always taken my mileage up to at least 90 MPW before a big race. I also know that Jack won't increase my volume by more than 5-10 miles per week, every three weeks, so projecting forward, I won't be running much more than 70 MPW max for this marathon. Do I need to in order to run a PR in the marathon? I don't think so.

Why? Because of the volume of quality training I am doing. For example, this week, 50 percent of the 60 miles I am running will be run at faster than marathon pace (range of 5:30-6:30 pace; average ~6:15-6:20).  That's 30 miles of running at faster than 6:20 pace! I have never done that much quality volume in training. And, because my total volume is lower, I am handling it just fine. I am not sure that I could handle it if I were running 80+ miles per week. This is significant because I used to get my race-ready confidence from being able to hit goal marathon pace for 9 miles (3 x 3 mile workout) before my marathon. Now, I'm running anywhere from 10-12 continuous miles at a few seconds slower than GMP a couple of times a week and that is an amazing confidence booster. As we all know, so much of marathon performance is based on confidence in our training and ability to hold GMP.

What I notice with this high quality training is that I go into each run feeling relatively fresh. I don't have dead legs to contend with because I'm running 5-8 miles easy, often including 6 strides, on the days between them. The other thing that I really like about this training is it gets me back to having distinct phases of training with a specific training focus for each. I know that I do much better when I progress from speed to strength to race specific training. My last program alternated speed and strength workouts on a weekly basis, and I didn't respond as well to that.

The biggest lesson I've learned about training lately is that one size does not fit all. And, even if the size fit a few years ago, it may no longer fit today. The best plan for each of us is the plan that keeps us running consistently, and we are often the best judge of what that plan looks like. There are a number of different ways to train to become a faster runner. Trying something new is a gift, even if it doesn't pan out. At least you've learned something new about yourself as an athlete. Maybe this big experiment I am undertaking with quality and volume won't pan out, but I don't care. I am hopeful that it will, but I will learn something no matter what.
Photo by Ian Shive (text added).
Maybe the most significant thing that has changed in my life recently is that I quit my day job. Well, sort of. I actually had about 4 jobs I was juggling and now I have 3. The one I quit was paying most of the bills. I had to make a tough call about whether I could put up with some things that I felt were very wrong. I realized I couldn't and decided I would suffer the consequences, if there were any to be had. I had enough independent work built to make the transition financially workable.

Theoretically, this should give me more time to train, right? Theoretically. Like magic, my time shifted to so many other places. I have been somewhat stunned. I had grand visions of enjoying bon bons, wine and napping anytime I wanted. Uh, not even. What this means for those of you who were disappointed that I was not taking any more coaching clients is that I have room to grow now!

One of the wonderful things about making this decision is how much it has freed up my brain to dream about what's next. Maybe I'll continue to work as an independent consultant. Maybe I'll find the perfect fit with a non-profit, University or for-profit company. Maybe I'll start my own non-profit. What I know is that, when I set my mind to whatever it is I decide I want to try next, I have a high level of confidence that I can make it happen. I have running to thank for helping me find that confidence in myself.

Now, get out there and train like it's your job!

Sunday, December 29, 2013

Ending 2013 on a high note

I honestly can't believe that we are at the end of 2013 and that I haven't updated my blog in almost a month! Sorry!

So much has happened these last several weeks, so I will attempt to quickly hit the highlights.

My 5 a.m. running crew.
They are up to running12 milers!
1. I am training Pain free. This is a HUGE deal. I have not had pain from my injury for at least three weeks and am now able to train like normal. I might go so far as to say that I am taking running for granted again. It is so nice. I know many of you can relate to the mental torture that an injury wreaks. This one was insidious. The pain didn't come on until after about 4 miles, so I wasn't really able to do out and back runs longer than 2 miles. I was stuck running loops so I could abandon ship if I felt pain. This also meant I couldn't meet anyone to run since I couldn't really guarantee I would make it all the way. This sucked because I love my running buddies and there's no better way to socialize with running buddies than running together. I am so glad I am able to train with them again. I am also back to running with my 4-legged buddies. We have worked very hard on not pulling.

2. I am getting fit. After spending 12 weeks on the injured reserve list, I was not sure how much fitness I had lost. I didn't completely stop running during that period, but not being able to run longer than 4-6 miles at a time takes a toll. These past four weeks, I have been able to execute my plan as written and it has not been easy! Whereas at the beginning of the month, I couldn't run over 8 miles, this month I've run four, 12+ mile runs! So, exciting. Two of those runs had 10 miles of marathon pace (MP) in the middle. I was nervous about these workouts given how little longer running I had done in the preceding 3 months. I was shocked when I ran the first 10-mile MP workout in 1:04:30. It felt awesome and my heart rate was well within the marathon zone (for me, anyway). Last weekend, I ran 13 miles with 10 miles at MP and was thrilled to run that in 1:03:10 for the 10 miles with the same average heart rate as the workout two weeks before. My interval workouts are becoming speedier as well each week. Clearly, I didn't lose much fitness during the time I was injured. I wonder about this since my mileage was so low, AND I decided not to cross train. This was a big change for me. I typically work my butt off cross training when injured, but I ran across a video of Coach Jack Daniels discussing cross training during injury, and it resonated with me. Of course being able to do some running and being able to do speed work were huge factors keeping me from going crazy. So, not cross training was palatable. Oh, and my Garmin 620 is a dream. Last time I mentioned that it was not quite reporting accurate VO2Max results, but that changed this month. As of today, my VO2Max is now at 59! That's actually pretty darn close to where I think it should be given my workouts and heart rates, though it might be a bit on the high side.  

3. Next Marathon? Right now, I am running ~50 miles per week with a long run of 12-13 miles. I am signed up for the Napa Valley Marathon on March 2nd. The math reveals that I have about eight weeks to go before that race. It's hard for me to picture a world where I can be ready to run sub-2:43 in eight weeks given where I am now. I actually feel really confident about my fitness, especially after running 10 miles at very close to goal marathon pace last week. However, I am not used to having so little weekly mileage and long run mileage under my belt at this point in a training cycle. On one hand, I feel like I should take advantage of the fitness leaps I'm making and just see how far I can get in the next month or so. I will absolutely not push my training to a point that will injure me, but maybe I don't need all the mileage and long runs. Could I run a marathon PR off of a max of 70 mpw and few if any 20 milers? My friend Jen reminded me that I have years of endurance under my belt and maybe I don't really need to work on that aspect of my training for this next race. It is a leap of faith. I have toyed with the idea of pushing my next marathon race to the Modesto Marathon, 3 weeks later, or even Boston in April. With Boston, I am waiting to hear whether I can gain entry into the elite women's field. The cut off is 2:48 for masters runners and I ran 2:48:50 in Eugene. They will give the remaining elite entries to those not meeting the standard, but I have been told they won't reveal this list until late January at the earliest and early March at the latest. Maybe a little too late for planning purposes.

4. Coaching. I recently jumped in the USATF Level 1 Coaches' training because it was being taught locally, and I wanted to be credentialed, officially. It was a serious time commitment, but I decided it was well worth it since I really enjoy coaching. I actually learned a ton from this course even though it was very focused on youth and track and field events. My coaching side business is soaring right now and I am having so much fun with the athletes that I help. I am learning so much from them and am grateful to have the time to be able to work with them. I have pretty much reached my limit in terms of number of athletes I can handle at this point. I might be slightly over, but that just means I sleep a little less.

The Coaches' training also gave me a goal for 2014. There was much talk about the pistol squat being this magical exercise that every athlete should be able to do. When I asked the trainers to demonstrate, not really knowing what it was, they looked at me sheepishly and pointed at someone else to demo the move. Once I saw what it entailed, I realized why they couldn't demonstrate it. It's hard! There are so many aspects of strength and flexibility needed to do this move. So, I decided it would become my strength-training focus for 2014. I am doing progressive training to get there, but it is going to happen! The Genius thinks I'll have it in a few months but my big limiting factor is my ankle flexibility. I will work on that and be pistol squatting to impress the masses soon enough. Here's a video of some knucklehead doing pistol squats, but it's really the most impressive example I could find.

Happy New Year Everyone!                    

Sunday, December 1, 2013

A race and a toy

Jaymee and Cindy #2-3 old girls at the Run to Feed the Hungry.
I am happy to report that I finally ran a good 5k: the best I've run in over 2 years. I ran the Sacramento Run to Feed the Hungry on Thanksgiving Day in 18:13 and placed 4th overall; second master. I love running this race and have done so nearly every year that I have been running. In fact, the throw-away shirt I wore to the starting line was from the 2005 event.

I had a lot to be excited about before the race. My Garmin Forerunner 620, which I ordered through REI in late September, finally arrived earlier in the week. I couldn't wait to test out all of the new data collecting features. It gave me such a warm fuzzy feeling inside while I was racing to know that my little watch was gathering all of this data that I could go home and geek out over later in the evening.

Let's back up a bit to review my last couple of weeks of training. I have been on a very conservative program to allow my leg to get its groove back. While I have been able to run short, fast workouts, I can't get past about 8 miles of running without feeling pain. My body is still using the same old, tired pattern that it's been using the last couple of months that causes my right glute to become very fatigued by around mile 5 and all hell breaks loose down the rest of the leg. If I run fast for 2-3 miles in the middle of that, I can get 8 miles out of the day.

This is obviously frustrating. While we may have pinpointed the hound-induced cause of the problem, so far we haven't fixed it. After laying off strength work and some of the exercises that John Ball had given me to do to allow some muscle activation exercises to work their magic, I am jumping back on the strength train. I noticed a marked regression the second week after stopping the strength exercises even adding in several complete rest days.

As a result of this prolonged injury, I have only been able to average about 30 miles per week for these past 9 weeks. A friend of mine said that she was glad I was being smart about the injury, but it's really not about me being smart. I would love to be able to be a dumb runner and continue to run through the pain. I literally can't run more than I have been. The pain stops me.

Given the state of my training, I was uncertain about what to expect in Thursday's race. I have had some great speed workouts, though they have been limited to 2 miles or less total volume of fast running. I have done a couple of tempo runs over the past month as well. I thought I might be able to hold 6:00 miles on a good day.

The hardest part about this race was getting to the starting line. Aside from the fact that I was nervous about having my leg give out during the race, I also hadn't run a decent 5k in a long, long time. The few short races I ran over the summer and into the fall were disastrous. I also don't like the special pain of racing the 5k. While I think that might be the case for many people, I do know some crazy ones that love the feeling they get from the 5k. This girl would much rather run a marathon.

I actually felt good during the race for the first couple of miles with splits of 5:42 and 5:51. The last mile was a 6:02 and definitely reflected my lack of endurance. Nonetheless, I was very happy with this race. It's clear to me that, once I can resume full training again, I have a great base of speed to work from.

When I got home and downloaded my data, I really did have a great time looking at all of the new information. The Forerunner 620, when coupled with the heart-rate monitor, has the ability to collect data on all kinds of running economy-related variables. It measures ground contact time, stride length, stride rate, and vertical oscillation. It also attempts to estimate your VO2Max. That one needs some work. After running an 18:13 5k, it told me that my VO2Max was 47 and predicted I could run a 22:30 5k. Um, yeah. UPDATE: Something magical happened and my VO2Max just increased to 53! While still on the low side, it's much closer to the 56 that I estimate it to be right now.

The other measurements may or may not be accurate, but they did change in a predictable way as I became more fatigued at the end of the race. Here are a couple of charts from my 5k race:


It's pretty clear that my efficiency decayed about halfway through the race. I got all bouncy and spent more time on the ground in the second half. I also liked being able to see what my heart rate was doing during the race. I never looked at the value while I was racing, but it was nice to confirm that what I have been calling my max HR is probably pretty darn close. My HR took about 2-3 minutes to reach a peak value of around 180 where it stayed the rest of the race. I have estimated my max HR to be around 185-190. It surprises me a little that I could run for 16 minutes that close to my MaxHR, but I guess that's why the 5k hurts so much. 

Another thing that's fun to do is to compare some of these values with different running efforts. I have done this below with an easy run and my 5k race. Notice the big difference in cadence, vertical oscillation and running stride length between the two. It will be fun to see how/if these values change as I am able to run more mileage and resume doing drills, strength training and strides.



All in all, I like the new Garmin. It's much lighter, fairly easy to use and only has a few glitches that I assume they can fix with firmware updates (can't transfer via wifi on some computers--appears to be a known issue). I am looking forward to testing out the 'find my runner' feature using the iPhone app so the Genius can find me when I'm out on my run. I think this will be a super handy feature to have during a marathon, where you will know exactly where your runner is on course at all times!  

At this stage in the game, I am taking my training day by day. I have a training plan but am never sure whether I'll be able to complete the workouts or not. It is emotionally hard but I try to have few expectations for each run. When I do, and they go poorly, it can ruin the rest of my day. This is why I do most of my runs in the evening these days (followed by some wine). Conversely, when they go well, it can mean a really fun ride until the next run. I am still riding the high of that 5k last Thursday.       
                     

Wednesday, November 13, 2013

Where the heck have I been?

I have been meaning to write an update post for weeks now. I kept putting it off until I had something concrete to write about. I finally realized that everything is always in flux, and you can't predict what will happen tomorrow. So, I will give you what I have now. So many things have changed.

1. I decided a while back not to run CIM.
2. I have a new coach.
3. I am running pain free again.

The CIM Decision

Marathon training was going really well several weeks ago, and I was really excited about CIM. When my IT band started acting up, I knew that I needed to be very careful. I tangled with Gerdy's evil tubercle in 2010 and was out of commission 7 long months. I now know that you can't force it with IT band pain. I also know that rest does not make it better. Treatment of the underlying issue is the only way to get rid of it for good.

Given that, it was pretty easy to make the decision to drop out of marathon training. It sucked slightly that I didn't have a good race to show for all of the training I had done. However, fitness does not disappear overnight. If I am smart and make sure that my body can handle the training load, I may set myself up for a brilliant next marathon training cycle.

My New Coach

Finding myself suddenly injured, I spent a lot of time reflecting on my training. I realized that I made a classic training mistake in that I didn't obey my own 3/1 rule of build/recovery. This rule requires 1 week of recovery for every ~3 weeks of hard training. I was feeling so amazing that I thought maybe I didn't need the down time. Actually, I wasn't really paying much attention until I started having pain in my leg. Then, I looked at my training plan and realized what had gone wrong. I had stressed my tissues beyond their ability to recover. One of my favorite blogs right now is written by Craig Payne and called the Running Research Junkie. I particularly liked his recent post about how to prevent overuse injuries. One passage really sang to me:

"The training routine:
The key to load management is the training routine. That is where a good coach or at least good commonsense comes in. Its all about managing the load on the tissue to such a point that the load encourages adaptation and the load is not so high that the tissues get injured. Way back there was the good old 10% rule to not increase the weekly total by more than 10% or the length of the longest run by more than 10%. The evidence does not actually support that and most coaches have become more sophisticated than that. Its more now about increasing the load, then backing off a bit to allow some consolidation, then upping the ante again. It also the old fashioned hard day/easy day. This is where the value of a good coach comes in as every one will respond differently to training loads. Compared to the time way back when I used to run competitively, I am surprised how many runners have days off these days; but it is probably one of the more effective ways to prevent injury – reduces the cumulative load in the tissues."

I absolutely believe in this principle and am really good about employing it with the athletes I coach. However, one of the reasons I hire a coach is to help me with my training decisions because, left to my own devices, I will run myself into the ground. The injury forced me to evaluate where I was headed and I realized the coaching relationship I had wasn't a good fit for me. Nothing at all wrong with the workouts, but the program was too aggressive for me. The ironic thing is that I was adding little things in here and there and, in many ways, designing my own training plan. So, ultimately, the injury was my fault. But, I had to admit that the reason I was doing this was because I either didn't trust the plan I was given or just didn't like it.

I contrasted this coaching relationship with the one I had with Nicole Hunt from 2007-2010. I am not naturally someone who feels the need to challenge a coach's program or constantly make changes. With Nicole, I did every single workout she gave me and followed her advice to the letter. So something was off with this one. It was a valuable lesson to learn for my own future as a coach. I think it is a hard thing to find a good coach-athlete fit. When you do find it, my advice is to hang on to it.

So, who is my new coach? Well, I decided I needed to go big or go home. I am now being coached by Dr. Jack Daniels through the Run S.M.A.R.T. Project. I had contacted Dr. Daniels back in 2010 when I was looking to make a coaching change but ultimately decided then to go with a local coaching option. I am thrilled to be able to work with him now.

Running Pain Free

It's the craziest thing. After the torture fest in Arizona a few weeks back, I came back to Sacramento to heal. I wasn't healing very fast and kept in contact with Doc Ball. He explained that I needed further treatment and that I needed to continue to do the strength exercises he gave me. These exercises were designed as a long-term fix and not necessarily to get me back to running quickly. The strength exercises were fatiguing my muscles in a way that kept me from being able to run pain free for longer than 4-5 miles at a time.

I went to see Dr. Lau here in Sacramento, and he found some additional problems that he felt might be causing my symptoms. The first visit didn't quite get at the heart of the matter, but the second visit pretty much nailed it. He started testing my functional strength and noticed that my adductors on the hurt leg were not working. He traced that up the chain until he found that my obliques were all jacked up. The external obliques on my left side were hard as a rock (not in a good way) and the internal obliques on the right side were concrete. He worked through the adhesions and tested my strength again and that seemed to have done the trick. I ran that night for 7 miles with ZERO pain. I was only able to go about 4 miles prior to the visit before the onset of pain. I was ecstatic. The next night I ran a workout and again had no pain. Not every run has been as miraculous as those first couple because my body is still learning how to behave properly. But, I am making significant progress.

Guilty.
When I thought about the pattern he described in my obliques, I realized that the blame belonged to two little furballs that I run almost every day (they run about 30-40 mpw). I run them using a waist pack. The "fast dog" goes on the left side and pulls me ahead. The slow dog goes on my right and constantly drags me from behind. When I asked Dr. Lau whether that could be the cause he said, OF COURSE! STOP DOING THAT! Or, at least change sides with them every run. I knew that my abs were getting worked when I ran them, but I always joked that I was being more efficient and getting in a core workout too. Doing that a few times a week for 3-4 miles would probably be okay. 30+ mpw over 6 months is probably a bit too much. Add on the hard training and the lack of recovery and you get one big shitfest.

So, I am finally turning the corner with this injury. I have been able to run fast all along (ala Lauren Fleshman) but haven't been able to run more than 5 miles easy. I ran 10 miles easy on Sunday and that was a huge breakthrough. My new coach has had me doing speed work for the past 3 weeks the likes of which I have never seen in my running career. I have been pumping out 200s and 400s like a mad woman and have surprised the crap out of myself with the speed that my little legs have. I have always considered myself a marathon slogger, but I am somehow churning out 200m repeats in 33-36 seconds with 400s in 74-77. Cray! I have to say it has been a ton of fun to switch it up. Since I haven't been able to run long, I have really savored the faster running. It's not particularly hard for me. It's just a different kind of stress.

Needless to say, I am learning a lot about myself through this and about training in general. I am excited about seeing where this speed work, combined with the fitness I built before the injury, takes me over the next several months. I am tentatively targeting the Napa Marathon in March as my next big race. One thing I know for certain is that I won't push it if my body isn't coming around quickly enough for that race. I am in no hurry.

One very important lesson that I have learned from all of this is that I am ultimately responsible for me. I employ coaches, chiropractors and massage therapists to help me, but I have to be willing to listen to what they're saying or trust my own instincts when they either aren't speaking up when they should or are speaking a language that doesn't make sense to me. I ultimately make the choice about what to do next and can't blame anyone else for what happens.        

 If I'm being honest, I am excited to be spectating at CIM this year. I have 5 athletes running the race this year and am just as excited for them (maybe even more) as I would be if I were running it myself. The Genius is also poised to have a breakthrough race and I hope to witness that as well! This is a great year to be a spectator. The challenge is going to be getting around the course to see everyone. I can't wait!