Thursday, July 28, 2016

More on being allergic to summer

Beat's hummingbirds. There's so many that we've been going through 1.5+ liters of sugar water per day.
 The asthma doctor had great reviews and seemed very nice, but I could tell that he wasn't necessarily going to be sympathetic to my cause. He worked through the usual questions, but a slight frown appeared on his face as I explained my "problem."

"I just get winded so easily. Sometimes while walking up my stairs at home, I have to slow because my breathing feels so constricted that I become dizzy. I do twenty-mile runs, feeling like I can barely breathe for most of the time, holding back so I don't have an attack. Yet I don't feel tired or sore after I stop moving, so there's no indication that I'm overdoing it. I use my emergency inhaler at least once for most of my workouts. I think it does help. It was never like this a year and a half ago. Not before I had pneumonia last summer."

"You do twenty-mile runs?" he asked.

"Well, yes," I said. "I just have a lot of trouble with more intense exercise. Even moderate intensity. I really start to feel bad."

I could only guess what the doctor was thinking. Clearly I'm still capable of doing things that 95 percent of the population doesn't do, and that no one really needs to do, so what's the problem? A lung function test showed my lungs are operating at 102 percent of the average for someone my age and weight. A chest X-Ray turned up normal. My resting heart rate is high (78! High 70s are what I've seen a few mornings in a row when I checked first thing. In California, my resting heart rate was always in the high 50s / low 60s.) But my blood pressure is good.

I got the sense that I might get shoed away with only a renewed emergency inhaler prescription, but I pressed for a skin test by expressing interest in starting allergy shots after I return from Europe in September. I had one done last October in California, which was informative but somewhat unremarkable. This Colorado-based test was impressive enough that the nurse demanded my phone so she could take a picture.

Those middle rows pretty much say "grass is poison to you." The rest can be translated as "You're mostly okay with indoor allergens such as mildew and dust mites. You could languish away in a moldy basement for the rest of your life and be fine, but don't go outside!"

Anyway, the doctor agrees that I'm a likely candidate for allergic asthma that's mainly induced when I am exercising outdoors. He said it would be a good idea if I returned to using the maintenance inhaler I used from February to April, as well as a steroid nasal spray for my very bad nasal congestion. I'm glad to try these treatments as I believe they will help me feel better when exercising, although of course there are still many unknowns. I may not have asthma. For several reasons I hope I do, because although asthma can be a life-long disease, it is also treatable. What isn't necessarily treatable are birth defects like a patent foramen ovale (a hole in the heart, which one blog reader told me may effect as much as 20 percent of the American population, but who often experience no symptoms until they go to high altitudes, to which they'll never adapt), as well as lung scarring and other obstructions that can't be detected by an X-Ray (although my lung function is good.)

So ... there is hope! I recognize that I am quantifiably healthy and can't complain too much about this condition. Right now I am optimistic about medication, still looking into allergy shots, and also moving toward acceptance of working with whatever fitness I have if these treatments don't help. I also remain optimistic that mostly what I need is for summer to go away, and I'll quickly build strength the way I did last fall and winter (with relapses into asthma symptoms that I believe were directly related to respiratory illness.) There's still time to launch into "training season."

The plan is to get back on the bike tomorrow. Honestly I'm a bit scared of my bike right now — not only because of the weak arm/steering issue, but because you can't hide from more intense efforts on a bike. Running, you can always slow to a plodding walk if you need to, but keeping a bike upright on a steep hill requires a minimum of effort, even with a granny gear. It seems this minimum of effort puts me in the hypoxia cave. But yes, back on a bike tomorrow and most likely a long run into the high country this weekend.

I'm excited! Even if I am starting to think of summer the way other people view winter — an uncomfortable time to be endured until friendlier weather returns.

Tuesday, July 26, 2016

Adventures in hypoxemia

 I'll be honest. I thought getting back on my bike was going to be a more joyful experience than it's been. On Monday I set out for a four-hour ride that felt wonderful, at first. But as the miles wore on, I slipped into indifference, which deteriorated further into a dark mood not unlike despondency. I was pretty bummed out. Why? I had no idea. The ride had gone reasonably well. I wasn't particularly strong, but I didn't struggle, either. My hand didn't hurt at all. My breathing was steady and the faucet in my face turned down a few notches even though I've been off antihistamines since last Wednesday. It was a beautiful if slightly warm day, and my route was full of new and beautiful scenery. So what was wrong?

Shortly after returning home, I checked the measurements on our pulse oximeter. My blood oxygen saturation was at 88 percent, with a recovery heart rate of 115. After just a few more minutes that number rose to 90 percent, and within a half hour it was back at my more typical resting measurement, 94 percent. My mood had vastly improved as well.

 In general, blood oxygen levels below 90 percent are considered low. During exercise, dips below 90 percent can indicate a maxed-out effort, which is typically what forces people to slow or stop because they're "out of breath." I've experienced this, but I also seem to be adapting to lower oxygen levels. Now I wonder how much time I'm spending in the 80s, without realizing it. I don't feel great but I also don't feel terrible, so I keep going. But it can't be good. Less oxygen is never good.

After the weird bike ride, I set out today to test my blood oxygen levels during a six-mile run to Bear Peak. I realize this is an unscientific experiment, but I thought it would be interesting to compare the numbers to how I felt:

I checked the oximeter ten or eleven times during the run, and took photos of the readings. For some reason a dark strip obscured the screen in most of the photos. I'm not sure why. So I'm only posting the photos where I remember the numbers. This is from mile 1.5. Oxygen saturation was 89 percent, heart rate in the 150s. For the most part, I felt fine.

 This was the lowest reading I saw, and only briefly, about halfway through the steep climb. Mile 2.8. Oxygen saturation 86 percent. I was beginning to feel dizzy and would have stopped soon to catch my breath anyway. I don't remember my heart rate at the time.

 At Bear Peak, after resting for about two minutes. Mile 3. Oxygen saturation 92 percent, heart rate 136.

Shortly after returning home from the six-mile run. Again, I felt a bit down in the dumps immediately afterward. But this run was only 90 minutes long, so time spent at low oxygen levels was minimal. I perked up quickly. (A cold soda helped.)

Blood oxygen saturation is typically lower at high altitudes, so my resting readings of 94-96 percent are right around normal. Still, I worry about those dips during exercise. Operating at lower blood oxygen may be harmful to my organs and brain. But I'm already working at what I consider moderate intensities. My heart rate would indicate this as well. If I go much easier, I'll have to give up cycling and hill-climbing altogether. Maybe become one of those Nordic walkers clicking along a flat bike path with trekking poles.

Anyway, I am going to see an asthma doctor on Wednesday. Since I recently moved, I'm basically back to square one in regard to testing for allergies and lung function, then moving forward from there. I suspect these tests will check out as normal, as I don't have issues while resting. Exercise still seems to be where most of my breathing difficulties arise. So it may take a while to weed out all of the potential causes for shortness of breath and find any real solution. It does bum me out to realize that I can't be "happy" while exercising because I'm running low on oxygen. And it bums me out more to wonder whether hard efforts might have long-term health implications, and thus become something that I need to avoid.

In the short term, I'm considering working on breathing techniques to maximize my oxygen intake and CO2 exhalation. A combination of altitude, allergies, and past respiratory illnesses may all play a role in my problem. I feel like I did well when I was using a daily maintenance inhaler (I haven't since April), so I'll bring that up with my new doctor. I'm also looking forward to the departure of grass pollen and other allergens that are clogging up my sinuses to such a degree that I haven't had a sense of smell since early June.

On a positive note, after four months off a bike, I was able to ride for four hours on Monday and my butt didn't hurt one bit! It's my one superpower — iron butt — but it rarely lets me down. I'll get this breathing thing figured out. I may start posting about it more often, mainly because it's helpful to have that record to refer back. 

Saturday, July 23, 2016

Not-so-triumphant return

On Monday morning, I pumped up two completely flat tires, added lube to the dusty chain, tightened the stem, installed pedals, and sat on a bike saddle for the first time in four months. Although tentative as I rolled out from my driveway, a smile spread across my face as I coasted down the first hill. I was riding my bicycle. It's a simple but fathomless joy that I think only cyclists and 6-year-olds understand.

The smile admittedly faded some as I ground the pedals up a three-mile climb, with dust swirling in the hot wind and my underdeveloped quads straining under the workload. My right hand only recently became useful again, so my whole arm all the way to the shoulder is significantly weaker than the other. I've improved my grip with hand exercises, but that doesn't do much for biceps and triceps, which were burning by the time I reached the next descent.

My hand surgeon said I should be able to start riding again six weeks after surgery, and so July 18 was the date I'd been looking forward to since June. She told me to stick to flat pavement at first, but there's only a few miles of pavement close to home, and absolutely nothing is flat. Still, the gravel road climb went okay, and my grin returned on the second descent.

"I can probably ride a few miles out the trail."

The Homestead Trail is actually just an old doubletrack with a few eroded ruts, but for the most part it's smooth, evenly graded, and as non-technical as a "trail" can possibly be. I took that "yay bikes" selfie on the climb, and started downhill feeling rather pleased with the comeback ride. My wrist didn't hurt at all, there was no numbness, and I'd received the best confirmation that surgery worked. I was healed!

Old habits returned and I accelerated quickly on the descent, eyes wide and grin spreading when suddenly the bike flipped end-over-end. I still don't know why I crashed. There was nothing on the trail to hit. My best guess is that my brain hasn't adjusted to my arm strength imbalance, and I made some tweaky move with the steering that launched me over the handlebars. Or I'm just woefully out of practice. Whatever the reason, I was crumpled beneath my bicycle and struggling with my stupid bad arm to lift the damn thing off myself. Just like that, all of my joy flipped a complete 180 to crushing bewilderment.

This was one of those stories I wasn't going to tell anyone, because it was such a devastating emotional blow at the time. I had to tell Beat because my arm was torn up with new trail rash and there were several new bruises to add to the patchwork across my legs. But I didn't want to admit this to anyone else. I've had an inordinate number of running crashes in the past few months, and then there was the return of breathing difficulties, and now that I can finally ride a bike again, well, I can't even do that right. I pretty much suck at everything. Why do I suck at everything? I sat on the dirt for several minutes, crying and berating myself. I knew this was childish and unreasonable, but sometimes it's better to just let it all out, especially when there's no one else around to witness embarrassing meltdowns. Physical pain does help release the emotional stuff.

Now that it's five days later, I do feel better about it. I haven't gained much confidence, but I realize it's not going to come back instantaneously. Four months is a long time, especially since my last cycling experiences were in Alaska, and now that I think about it, my last dirt ride also ended in a crash (when the front rack came down on top of the wheel one week before the Iditarod.) I took the mountain bike out again on Wednesday and stuck more closely to pavement — specifically, the climb up Flagstaff Road. With 2,000 feet of climbing in 4.5 miles, Flagstaff closely resembles the profile of another road I used to ride regularly in California, Montebello. Flagstaff does differ in that it's more gradual at the bottom and becomes unconscionably steep for the most of the last 1.5 miles, but I figured it was a good place to compare performances. Well ... I don't really want to talk about that either. It was a little pathetic. There were some low-oxygen dizzy moments. Temperatures were in the low 90s and my face was oozing because I'm off antihistamines ahead of another skin allergy test next week. But I did it, and I didn't put a foot down. It's got to get better, right?

After Wednesday I needed a break from the ego bruising (plus my shoulder and arm are quite sore), so I've been running since then. I will get back on a bike soon enough. The universe approves, as evidenced by this double rainbow over our backyard.

South Boulder Peak, perfectly framed by the rainbows. I love afternoon thunderstorms — as long as I'm somewhere safe while they're happening — so I'm enjoying the arrival of monsoon season.

On Friday I traveled down to Colorado Springs to give a short talk about winter bikepacking during a "Bikepacking 101" event at Cafe Velo. My friend Dave Nice planned the event, and there was a great turnout. It was fun to chat with folks about cycling in Alaska, a subject of which I never tire. Several folks came up afterward and said they enjoyed hearing me talk about it so exuberantly, even though to them it sounded grueling and horrible. People have said this to me in the past. I once gave a video interview for an exercise science course at Stanford, and still hear from the instructor about how much her students love the segment. Joy is infectious. It's what sustains me when I'm down on myself for clumsiness and wheezing, counting the days until winter.

Anyway, since I was driving all the way to Colorado Springs but didn't have much extra time, I figured I should check out the iconic Manitou Incline. The incline is an old cable car track with the rail ties still in place, forming a staircase that gains 1,900 feet in 0.8 miles. I was not all that impressed with the steepness because in Boulder we have rocky trails that are just as steep (Fern Canyon), and most photos I've seen of the Incline were not that interesting. Still, when in Colorado Springs ... it seemed like one of those things I had to try once. I had to sit in Denver I-25 traffic and then pay ten dollars for parking in Manitou Springs, which made me grumpy. But all of that melted away once I started marching up the steps.

View from the top — actually, it was quite scenic and I was surprised. The climb was fun as well. Some of the steps are knee-high, but for the most part the steep ascent is evenly graded, which assists in steady breathing and focused forward motion. I took it fairly easy and stopped to take a couple of photos, but this would be a fun spot to return for PRs. Too bad I live two hours away.

Let's see how I can embarrass myself this week. It can only get better, right?