Shoes, Supplements and Strength

After months of posts about my health issues, I am happy to move on to much more important things: shoes, supplements and strength training!

First, I should update you on my training. I can't say things have been as great as they were around the time I ran the Parkway Half Marathon. That truly was an exceptional time for me. My blood levels were peaked and I felt awesome. Since then, my blood levels have dropped quite a bit and I had to miss a race because of it. This regression is upsetting, for sure, but I am learning to cope with my new 'normal'. My condition is progressively improving, but that improvement curve is more sinusoidal than linear.

I am learning a lot about patience and attitude. When my blood levels are higher, I have great workouts and when they are lower, my paces slow. BUT, I am doing the work that I need to to become a faster marathoner. I have really had to work on my attitude when my blood levels start to drop. I know it will affect my performance and it is really hard to even motivate myself to go out and run. I know that my goal for each workout is not how fast I run it, but just that I get it done at the right level of effort. As my blood levels rebound I will naturally get faster and paces will feel easier. The work I put in, regardless of how I feel, will pay off in fitness gains.

I make this sound easy, but it's not. I am in the meat of my training for the Eugene Marathon right now and am doing the big Jack Daniels' workouts. I generally have two long runs per week with 10-14 miles of marathon and/or threshold pace mixed in. In the last week, I ran two marathon paced workouts of 10 miles. The first one was run with reasonable (not great) blood levels and the second was a week later with lower levels. The first workout felt absolutely great. I cruised along for 10 miles @ 6:10 - 6:20 pace with ease and felt fantastic. This was a pretty remarkable workout for me given how far out I am from the marathon (8 weeks!).

In contrast, the one I did Thursday of this past week was not so fun. I had experienced the worst bleeding since March and am likely close to anemic again. I knew going into this workout that I was going to suffer. I drug my feet all day about even doing it and finally pushed myself out the door at around 7 pm. It was 85 degrees. This workout was a total of 14 miles with a continuous workout of 6 miles marathon pace + 1 mile threshold (T) + 3 miles marathon. I was mostly dreading that T pace. I started out into a headwind which really pissed me off and I decided to run back and forth on a two-mile stretch of the bike trail to get relief from that for at least half the workout. For some reason, this is easier for me to handle mentally than running out 5 miles and back. I broke the run down into two-mile chunks in my head. I started off around 6:25 pace for the first two miles into the wind. It felt hard. I turned and, with the wind at my back, was able to speed up ever so slightly. 4 miles done. I got some water and turned back into the wind. My pace remained steady around 6:20 through 6 miles. I had already decided to ditch the T pace mile if I was feeling crappy and almost forgot about it until I hit the half mile split in mile 7. I saw that my split was 3:03 and I decided I should try to get under 6:00 (my T pace) for this mile. I actually felt okay running 5:59 for that mile and then slowed for the M pace to complete mile 8. I stopped again for water and then finished up the last two miles under 6:15 pace. So, all in all, this workout was only 1-2 seconds slower per mile than the one I did the week before even though it felt less comfortable. I was mostly proud of that 7th mile.

This entire workout was a HUGE mental battle. I kept feeling sorry for myself and let the worry slip in at every curve. Would I be able to finish the workout? For how many days would my blood levels continue to drop? Will they recover in time for my half marathon next weekend? Would they keep me from running a good marathon in Eugene? When will the madness end? I must have had the most horrible look on my face the entire workout, but I will say I was glad when I finished.

So, my marathon training is actually going well. I am up to around 70 miles per week and I won't go much higher than that this cycle. I am doing major workouts and they are tiring, but they are really giving me confidence in my marathon fitness. I have never run so many long workouts this close to goal pace this far out from a marathon. Fingers crossed that the stars align and I get to the starting line in Eugene fit and healthy! I am defending my title, after all.                                

SHOES

I've been meaning to write about some changes I've made in my running footwear over the past months. Typically, shoe changes lead to injury for me. It normally takes about 3 weeks for me to see the effects, but my last couple of changes have been right before I became pretty majorly injured. I normally wear the Nike Pegasus as a training shoe and the Nike Lunaracers as my racing shoe for all distances including the marathon. One thing that I dislike about the Pegasus is the fact that I wear them down quickly. I get about 200 miles out of them before I start to lose support and need to swap them out. This is about 2 1/2 weeks of training for me, so pretty expensive. So, I began adding shoes into my rotation to break things up a bit and to just see what would happen (I can't leave well enough alone). Here's what I'm wearing.

1. Nike Pegasus 30. I now wear these about 1-2 times per week for easy runs.

Pegasus 30

2. Nike Flyknit Lunar 1. I'm on my third pair of these lightweight trainers and really like them. I like that they have a higher heel drop, good cushioning and are super lightweight. I've been able to get away with wearing them for my long (14-18 mile) workouts. I've been getting about 150 miles out of a pair of these before needing to retire them.

Flyknit Lunar 1

3. Nike Lunaracer 3. These are my racing shoes and I train in them when I'm doing fast and short speed work. I'm not sure I'll ever change these out. They work way too well for me.

Lunaracer 3

4. Hoka Kailua Tarmac. These were a big gamble for me. I wanted to try them because of the extreme cushioning they provide and thought that might be beneficial for recovery days. I also wanted to see if I could get more than 200 miles out of them. The risk was the low heel drop. Each time I've tried to go lower than my Nikes, I have ended up with niggles and injuries. So far, I haven't had a problem with these and I can't quite say why that is. Perhaps it's the rocker bottom that they use, but I don't have achilles or calf soreness from the low drop. Instead, I feel like I get that cushioned ride that I was looking for and can tell the difference running in them. I'm at 200 miles on this pair and I feel like I can wear them longer. My legs feel better recovered after a recovery run. I wear these on my easy days 1-2 times per week.

Hoka Kailua Tarmac

5. Hoka Stinson Trail. I started running on trails a few months back and decided that my road shoes were a hazard. I invested in these right after getting the Kailuas. These are like running on marshmallows, and I really appreciate the cushiony ride on my easy days. I wear these on trails and when I feel like I need a little less impact on tired legs. I also like a heavier shoe for easy days which makes my light shoes feel like slippers.

Hoka Stinson Trail

So, that's my current rotation and it appears to be working well for me.

SUPPLEMENTS              

Right now, I am taking a boat load of (legal) stuff to try to "cure" my health issues and to help my body replace the RBCs I lose. On the sports nutrition side of things, I recently found a couple of products that I am really loving. They are manufactured by BRL sports nutrition. The first is a recovery powder that I also use as a mid afternoon snack. It is called Invigor8. I have tried both flavors and they are both excellent. I typically mix this in my Nutribullet with frozen fruit and either water, almond milk or coconut water. What I love about it is that it has everything in it already so I don't have to add things like probiotics, omegas, digestive enzymes, BCAAs, etc. While I don't ride the 'sugar is evil' bandwagon, this product only has 1 g sugar. I add my own sugar:)

The second product is one that I use more for pre-workout fueling. It's called TriFuel. It is also billed as a recovery drink and I sometimes take it after a workout. It is unusual in the sports drink market in that it has BCAAs, carbs, a load of electrolytes and some stuff that keeps you going and focused during your workout including caffeine. I typically take this within 15 minutes of a long workout and it holds me over for up to 2 hours. I was skeptical about the manufacturer's claims about improved mental focus, but I do notice an improvement in that aspect of my workouts. My recovery has also been very good especially now that I'm adding in a lot of extra stuff (see below).

STRENGTH TRAINING

Every day, I am bombarded with an endless feed of running-related tweets and articles about how important strength training is for runners. I have long been a believer in the importance of strength training for performance and injury prevention. When I was experiencing the worst of the anemia, I lost all interest in doing strength work. It took every ounce of energy I had to work and to run. Doing anything more was not in the cards. When I started to feel better, I still lacked motivation to do my usual extra strength, core and basic maintenance routines.

So, to get myself back into the groove, I decided to start going to group training classes to motivate myself as well as try some new things out. It started with Bikram yoga. I signed up for a new student special at Sacramento Bikram yoga and was shocked back into the torture of this practice. The first day I went, the 105-degree room was filled with the vaporized sweat of about 50 people. It felt like Florida in there. I just about hyperventilated for the first 10 minutes and literally swam in my own sweat when I got down on my mat for the ground poses. I have continued to do bikram 2-3 times per week and have noticed the following changes:

• Doing yoga in a very hot room hastens heat acclimation due to physiological changes that occur when exercising in the heat (e.g. increased blood volume). My transition to running in the heat (80-90 degree temps) has been very easy so far this spring.
• I am gaining flexibility in my lower back. It wasn't until I started yoga that I realized that the area with the least amount of functional mobility on my body is my lower back. All of the twists we do in this class are making tiny improvements in this area.   
• I can sleep on my stomach without pain now. This may not have anything to do with running, but I had to stop sleeping on my stomach about a decade ago because my neck would start to stiffen up and ache after about 10 minutes. It took about 4 weeks for my neck to loosen up but it did and I am happy.
• My balance is improving all the way from my toes to my head. Several of the poses require balancing on one leg and holding various parts of the body in strange configurations. I wobble and sometimes fall, but each week I can tell I am getting better and believe this will translate to being steadier on my feet while running.

Will bikram yoga make me a faster runner? I don't know. For now, I appreciate the positive changes I am seeing and it is helping to motivate me to get in additional strength work.

I also joined a studio called P2O or Hot Pilates here in Sacramento, of course taking advantage of a 30 days for $30 new member discount. They offer a lot of different classes. So far, I've only tried the TRX class. This class is a butt buster. It challenges your core muscles while also getting the heart rate up with some calisthenics. The thing I like most about it for runners is that it challenges your range of motion, especially in the hips, in a very functional way for running. I'll try their hot pilates class tomorrow after my long run and see how that goes.

Right now, I am doing some form of strength-based training (yoga, weight lifting, pilates, TRX) at least 4-5 days per week. That's a lot more than the zero days per week I was doing a couple of months ago. I feel so much stronger and can actually feel the improvement in my core strength during my runs. I have also been quite pleased with how much more quickly weight has come off over that time period. My weight peaked during the winter when I was dealing with all of my health issues. I was eating a lot of ice cream to make myself feel better and wasn't doing a lot of running. That's a bad combo. I am just a few pounds off of my racing weight now and quite certain I'll get there in the next 8 weeks.

Next weekend, I race another half marathon. I really hope that my blood levels rebound from this last drop in time for the race. I am downing iron shots like they are whiskey three times a day and crossing my fingers. Hopefully, I'll have a race report to share next Sunday!
                 

The one where I run my fastest half marathon in almost five years

I am giddy about what has happened over the past four weeks. I have felt progressively better as my body has recovered from the most recent bout with anemia. I found out last week why when I got my blood test results back:

Hemoglobin: 14.0 (11.9 a month ago!)
Hematocrit: 42.6%
Ferritin: 38 (19 a month ago!)

These are numbers I have dreamed about. They are the levels that Jack said he thought I should be striving for. I didn't think it was possible for me since they are higher than I have ever tested! How did I do it? Well, the biggest factor was the lack of blood loss. I have swung in the opposite direction of where I was two months ago. I haven't lost any blood in nearly 30 days! This is unprecedented for me, but I am NOT complaining!

I have also continued to supplement with liquid iron 2-3 times per day. I had been taking other products and was watching my blood levels either stagnate or decline. Once I stopped taking those, I seemed to do a lot better. It is really difficult to determine cause and effect with the supplements. What I know works is: liquid iron supplement + no blood loss.

The challenge with this condition is that you never know when the flood events will hit. I have been walking on egg shells these last couple of weeks just waiting for one to hit. I can't say exactly why I haven't had one, but I suspect the progestin-only BCPS and all of the things I'm doing to reduce my estrogen levels must be contributing. It is also possible that the fibroids are shrinking. I can still feel them, but they do seem smaller. Wishful thinking? Maybe.

I decided a month or so ago that I wanted to plan some races. I had to cancel two of the three races I had planned for the winter/early spring racing season due to this health issue and  was anemic for the one race I ran. So, I wanted to test out my fitness in a low-key half marathon. I chose the American River Parkway Half Marathon. This race course runs along the American River Parkway Trail which is where I do all of my training.

I held off signing up for the race, because my calculations showed the next scheduled flood event would occur somewhere within the week leading up to the race, if I stayed on schedule. As I mentioned above, that didn't materialize but the anticipation was overwhelming. It also meant paying an extra $25 for the race ($75), but I figured that was worth it, especially since some of the funds went to support the Parkway Foundation. I use this trail so much, I was happy to contribute to that cause.

I have been running well in training and doing some hefty workouts again in preparation for the Eugene Marathon in July. My lactate threshold pace is back down around 6:00/mile and my marathon pace has been around 6:20-6:25. I suspected, on a good day, that I could at least hold the same pace that I did for the 10 mile race a few weeks back (6:25 pace). I decided to start out around there and then try to negative split the race.

Race weather was as perfect as you get here in Sacramento in April. It was foggy and cool. I actually wore arm warmers and gloves! The announcer said at the start that he was expecting some really fast times as a result. After the inexperienced and over-exuberant racing chaff separated from the wheat in the first 400m, I found myself pacing with a couple of guys. One was a friend who is faster than me, but he was doing a brick workout so had ridden for 90 minutes before the race. I was happy about that because for me it meant I had a chance of keeping up with him. Even though there was little to no wind, drafting is still a huge advantage in a race. As we clicked off the miles, I saw that our pace was faster than I wanted to go out. However, the advantage of having a group to work with was much more valuable than running my own race. I would try to hang with the boys for as long as I could.

My pack. Isn't this a great photo? Thanks to Randy Wehner!

We were averaging about 6:15 pace for the first 6 miles, and I felt good. We hit the one major turn on the course and headed back toward the finish. When we hit the 7 mile marker, our pack leader proclaimed that they had turned us too far down on the course and we were going to be running long. I looked at my Garmin and the total distance at 7 miles read 7.66. This sucked the air right out of me. I was so irritated that the course was going to be long and that I wouldn't get the chance to see where I was fitness wise.

Normally, I would have shaken this off better. It's only one race, right? Well, consider how difficult it has been for me to get to the starting line of a race for the past 3-4 months. Experienced runners know how rare it is to have the stars align on race day where you are healthy, you feel great, the weather is perfect, you have a pace setter. I mean, this was my day! I cogitated on this for the next mile or so but held on to my pack. Then, I saw the Genius at around the 8 mile mark and blurted out, "the course is long!" Something about vocalizing that made it real and I let one of my pacers go at that point. I slowed to 6:20-6:25 pace for the next few miles. I was feeling sorry for myself and tried to figure out how I could salvage this race given the circumstances. I knew that I was pretty far ahead of any other female runners, so I would at least get the win if I stuck it out. I will never pass up the opportunity to win, no matter how small the race!  

At around mile 11 I decided I could salvage the race by lapping my Garmin at 13.11 miles. I would then at least know what I had run for the distance. That time was 1:22:25. This lifted my spirits. While my PR is just under 1:20 for the half (set in 2009), I haven't run faster than 1:23 since July 2009. It felt really satisfying. I continued on for another kilometer and crossed the finish line as 5th overall and 1st female. I will say that I had little motivation in that extra kilometer to push myself and I didn't. 

Immediately after the race, there was a flurry of Garmin checking and discussion going on about the distance. I had the two lead men run up to me and ask what my Garmin read. They had traveled from Southern California to run this race and were trying for a qualifier for some collegiate event. I felt horrible for them but I told them to talk to the timing company. They would help them however they could to make it right. That afternoon the timing company measured the extra distance we ran and adjusted times accordingly in the results. While I would rather have run the right distance, I was pleased with their quick action and am grateful that my time was adjusted. It was pretty close to what I had split at 13.11 (1:22:35).

I have some really tough training ahead and have my fingers crossed that I will stay healthy for it. My fitness is in a really good place right now given the  times I was running at this point in my marathon training for Twin Cities 2009 (2:46) and Chicago 2010 (2:45). I am right on schedule if not a little fitter. Wishful thinking has me hoping the health nightmare I have experienced this year is completely in the past, but only time will tell. All I know is that running is effortless and fun again and I will cherish the healthy miles I get.        
                

       

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.

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.


           

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.

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!

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!