Set Backs, Getting Back

Ask me how my training was going at the end of September, and I would have replied, "Stellar!"  I had just broken a 7-year-old personal record in an uphill running time trial.  My summer training hours had been higher than ever, and I was feeling great after a high volume altitude camp on the Haig Glacier.  My glacier training had been followed up two weeks later with a 10-day intensity block, during which I won the Trail Loppet half marathon and came in second in the Northshore Rollerski Marathon.

At the Haig Glacier, feeling on top of the world.

But after resting from my intensity block, things started going wrong.  The over distance skate session the day after I set my uphill record was my first red flag.   In my training log I wrote on Sunday, September 25th, "3:27 Afton OD skate, feeling very sore and tired indeed, but made it through."  Never a good sign.  No worries, though.  Normally, a full day off, some yoga, and I'd be back to 100%.

Tuesday I was slated to do a workout I'd been itching to do all summer: Level 4 repeats on Afton's River Road.  It's always an intense workout, and hard to fit in, because a driver is required to shuttle you down the hill after each repeat.  Piotr was lined up to drive Caitlin and me, so I was psyched.  Warming up I took a hard fall during a pick up and got laid out on the wet and gritty pavement.  I was mostly okay, not even bleeding, since my tights had protected me, but I had landed pretty hard on my hip.  Mostly I was shaken up.  But falling (especially tripping yourself with your own pole) is indicative to me of fatigue, as a reflection of decreased coordination and agility.  Ten minutes later I was hammering up River Road hill.  Two minutes into the interval I hit a brick wall and felt like I was skiing in quick sand.  I hadn't felt like this all summer and it was alarming.  After attempting a second interval and feeling worse, I called off the workout.  I was disappointed and frustrated.  I told myself I needed to refocus, take some serious time to rest, and listen to my body.

Thus began my tortuous quest of getting back to where I was just a week a prior.  For the rest of the training week I averaged an hour and a half a day, all of low-intensity distance.  I ended the week cheering for the Twin Cities marathon on my bike and felt tired and achey just from this effort.  The next day was the first day of my new training month so I psyched myself up for a really solid month focused on volume and level 3 training.  I started the month with a day off and a massage.

The training week began with Wirth Bog level 3 running intervals, a workout that I had been doing since the beginning of June and had steadily improved at during that time.   Here is what I wrote in my training log: "Running intervals with Jojo, start nice and easy, going by feel, trying to get max volume in, didn’t feel well. Effort felt very difficult, HR elevated, breathing very heavy."  I managed less than thirty minutes of on time running at a reduced pace before I called the workout off.  Now I was getting worried.

I scheduled a doctors appointment for that afternoon.  I had a whole smattering of blood tests run, including iron, hemoglobin, red blood cells, white blood cells, thyroid; over 20 different measures of blood health in total.  And all of them came back normal.

It would appear as though I was as healthy as a horse.  But I didn't feel healthy.  I carried out the rest of the week keeping the volume and intensity low and continuing to feel lethargic, uncoordinated, and increasingly sore and achey.  I started having headaches and would sleep 9 hours in a night and take a three hour nap during the day, all while training only one to two hours maximum in a day.

Mid-fall: The time of year you want to be revving up your training in preparation for the impending race season, not spinning your wheels trying to figure out why you feel awful.

The next week I scaled my training back even further, usually only managing a 45 min jog in a day.  I returned to the doctor.  I wanted an answer.  This was not passing illness or fatigue.  I described how I had been in Hayward in July, pulled a deer tick off of me that was probably attached less than twelve hours, but had never experienced any symptoms or a bull's-eye rash.  I told him about the itchy rash I had all over my body when I got back from the Haig that had been diagnosed as an ambiguous "contact dermatitis" and was treated with prescription cortisone and had mostly gone away on its own.  Eight more blood tests all came back within the normal range, including one for the Lyme antibody.   So still no answers.

I was at a loss and getting desperate.  Not only desperate, but depressed.  When you devote yourself to your training, your self esteem and outlook on life can tend to hinge on the status of your physical fitness.  And when despite doing everything you can, you are still struggling, you begin to view everything with a dismal outlook.  But I wasn't giving up yet.  I re-upped my commitment to nursing myself back to health from whatever was getting me down.  I went grocery shopping and dropped half a month's grocery bill on nothing but fresh fruit, vegetables, high-quality protein.  I loaded up on Greek yogurt, quinoa, avocados, flax seed, rooisbos tea and kefir.  I continued my regular regimen of yoga one to two timers per week, and even saw an acupuncturist who put me on a wheat-free, dairy-free cleanse diet for 10 days.  I would have seen a witch doctor had I thought it would help.  But I continued to feel my absolute worst.  My muscles were sore and knotted as if I had done an intense strength workout.  I had no energy for anything and simple daily tasks became overwhelming.

The makings of eggplant sloppy joe's: saute ingredients, add high-quality beef/elk/bison,  add spices, add tomato sauce, and voila!  Serve in a whole-wheat pita.  Now that's nutritious and delicious!

Not satisfied with my experience at my first doctor, I sought a second opinion at another clinic.  I got the same runaround as from the first doctor, saying my blood work was normal, it would be highly unlikely that I had Lyme disease because my tick bite was three months ago and my test came back negative, and that these things happen to people, they are mysterious, but they can come and go on their own.  She suggested I see a rheumatologist for my increasing muscle and joint aches.  I essentially demanded that she run more tests for other possible tick-borne diseases.  That, or give me antibiotics.  She relented and ran more tests, saying that a positive test result was unlikely.

I left frustrated.  I knew I had something and the doctors were missing it.  The next day I called my ENT and faked having a sinus infection so he'd write me a prescription for antibiotics, since I had struggled with chronic sinusitis last year and thought perhaps this could be the strangest sinus infection I've ever had.  At least I'd have some drug that might possibly make me feel better.

Over that weekend I thought I was maybe feeling a little better.  I managed two distance sessions on Saturday and an overdistance skate on Sunday.  Maybe it was the antibiotics I got from my ENT, maybe I got the rest I finally needed, maybe it was actually the acupuncture, or maybe it was my cleanse diet kicking in.  On Tuesday, I did my Wirth bog running intervals again and managed 30 minutes of level 3 at a conservative pace and felt "pretty good."  It was four weeks from my fateful failed rollerski workout and crash in Afton, and I was ready to move on from this episode and get back to feeling like myself again.

That afternoon I got the call from the second doctor: "We got your test results back and your Immunoglobulin G for ehrlichiosis is elevated, so I'm going to treat you with doxycyline."  That's it.  No explanation, no remark of surprise, no condolences for having fought this disease for a month without diagnosis or treatment.  Part of me was relieved for finally getting an answer and solution, another part just wanted to say to the doctor "Told you so, you know it all!" and a third part was angry that this could have been overlooked and handled so poorly by two different doctors.

Human granulocytic ehrlichiosis, also known as human granulocytic anaplasmosis, is a tick-borne disease, which is transmitted in the same manner as Lyme disease and with similar, but not identical, symptoms.  It is also treated with the same antibiotic.  Ehrlichiosis is a bacterial infection that attacks and kills white blood cells.  The reported occurrence is somewhere on the order of 0.7 cases per million.   It causes fatigue, headaches, and muscle ache.  Most people don't get rashes, but it can blunt the immune system, allowing fungal infections to take hold, which might explain the rash I got in September.

The culprit
 (image www.pestcontrolrx.com)

I don't know when or where I picked up the disease.  It could have been in Hayward in July, or in Alberta in August, or somewhere at home, perhaps on the St. Croix.  It has been a strange experience dealing with the medical system.  Looking back, I had all the symptoms of the disease, so it is frustrating that the doctors didn't put it all together and diagnosis me sooner.  Reading about the disease, it is advised that physicians treat based on history and symptoms, rather than waiting for a positive test result.  That would have saved me about three weeks of turmoil.

Since getting on antibiotics I feel better daily.  I am staying focused on nutrition, rest, and recovery, and gradually increasing my training volume and intensity.  I am now training at the level that I was at in late May/early June of this year, which is frustrating to be sure.  This sickness has taken me many steps back from where I was in September, which was probably my all-time best fitness.  I am leaving for snow in eight days, and the first races of the season are two and a half weeks away.  Yikes!  I have had to readjust my expectations and ambitions, knowing with patience I can get back to where I was.

This morning was my first level 4 intensity session since September 25th.  I did the 10k Go! Training time trial at French Park.  I  was prepared for a demoralizing and less-than-fun experience, which it was, but it is good to get such things out of the way.  I have definitely lost ground in my training from late September, but I am hopeful that I will return to full capacity in the coming weeks.  Most of all it is good to have some resolution and hope.