Tuesday, April 29, 2014

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.        


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:

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.

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.

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.

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:(.

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.

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.

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.