Friday, May 25, 2018

Thyroid update 4

 I haven't posted one of these updates in ten months. However, the Internet informed me that today (May 25) is "World Thyroid Day." I've found benefit from reading about others' experiences online, so this seems a good day to bring my blog up to speed.

In summary, I was diagnosed with Graves Disease in February 2017. This is an autoimmune condition that attacks the thyroid gland and causes it to overproduce hormones to toxic levels. The mechanism that causes this is poorly understood, but an improper balance of thyroid hormones has a negative impact on nearly every function in the body. Thyroid hormones regulate the metabolic rate of all cells, as well as the processes of cell growth, tissue differentiation, and reproductive function. Symptoms of thyrotoxicity can be widespread and dangerous — the worst leading to heart failure. When I was diagnosed weeks before the 2017 Iditarod, I was warned under no uncertain terms that participating in a remote endurance race could kill me.

The experience has been a humbling reality check, putting to rest whatever remaining endurance-racer delusions of grandeur I managed to carry into my mid-30s. However, compared to many cases I've read about online, my experience with thyroid disease seems relatively minor. I managed to stay fairly high-functioning throughout, and I wasn't pressured into having my thyroid radiated upon diagnosis. This is actually the default treatment for many Graves patients — a gland that is necessary for life is deemed too unruly and removed, so the patient must depend on synthetic replacement hormone to the end of their days, with varying degrees of adaptation. There are worse things, I know, but I strongly did not want this treatment if I could avoid it. Happily I found an endocrinologist who not only decided that thyroid ablation wasn't necessary, but understands my passions and doesn't believe I need to give up adventures or endurance racing.

I'm being treated with a medication that blocks thyroid hormone conversion in the liver. Whenever a friend teases me for "doping," I point out that any thyroid treatment — whether blocking or replacing hormone — is going to make any normal person feel really bad. Emphasis: Extra thyroid hormone is not performance enhancing. It's quite the opposite; this is one of those things that needs to be perfectly balanced, and it's annoyingly specific to the individual. When I started treatment, I needed to take a considerably high dose, which does have negative side effects and over time can damage the liver. The hope is to bring down levels quickly, which in turn decreases antibodies, until eventually the thyroid can function normally without medication. Adjusting to these fluctuations has been a mostly unfun rollercoaster ride, but I continue to move in the right direction under an acceptable timeline.

Earlier this month, I reached the holy grail for Graves patients — normal TSH! TSH is a pituitary hormone that encourages the thyroid to produce more, so people with hyperthyroidism generally have none. My T3 and T4 both fell in the low range of normal, so my medication has been halved again — I'm now taking 1/6th of what I started with 15 months ago. I'm always nervous about a dose change, because there's usually an adjustment period for several weeks following. But my doctor thinks I may reach remission within four months. If this happens in that September-October range, and I'm still feeling good, I think I'll have to celebrate by committing to the 2019 Tour Divide. ;-)

Living in the "normal" range has been quite a revelation. Although outwardly I complained about my most prominent physical symptom — shortness of breath — the mental and emotional symptoms were quietly more disturbing. Before diagnosis in early 2017, I experienced strange brain fogs that occasionally settled in when I tried to read or write. I'd lose my train of thought and often not be able to return to whatever I was working on for the rest of the day. There were some really odd episodes when I started to wonder whether I was experiencing early-onset dementia ... for example, I was at the grocery store and grabbed a jar of mustard off the shelf, then had a lapse, for several seconds, when I couldn't read the label and couldn't fathom what I was holding. When I "came to," the realization of that cognitive lapse was jarring. I also had mood swings that boosted bouts of anxiety or depression. Back then, my thoughts often drifted to disturbingly dark places for no discernible reason. I blamed the political and cultural climate. There is some merit to this, but world affairs have not improved since last year, and yet my outlook is so much rosier. It's funny, really, when you realize how fervently we cling to an unwavering sense of identity, when so much of our intellect and emotion is based in our dumb body chemistry.

So, yes, it's been a while since I had a cognitive lapse, and I'm in an overall better mood. Yay! Like my other symptoms, it has not been a steady rise. There are continued ups and downs, and I don't anticipate just being better forever, as easily as that. But the overall improvement is encouraging.

As for my main physical symptom — breathing difficulties — that's also improved significantly. But this is also a messy thing. Along with thyroid disease, I also have allergic asthma — a separate autoimmune condition. The way my thyroid condition affects my heart results in general breathing difficulty that reduces my ability to exercise. However, I also experience occasional exercise-induced asthma attacks from constricted airways. There's research that shows that people with one autoimmune disease become susceptible to others, often during periods of illness or high stress. Anyway, I believe the allergic asthma came first, but has really ramped up in recent years. I'm also being separately treated for this condition with immunotherapy (allergy shots), so I'm a regular pin cushion with enough daily medications and supplements to fill a pill case. And you know what — I'm okay with this. As allergy season ramps up, my symptoms — which also include the usual itchy eyes, sneezing, etc. — remain greatly reduced compared to last year. Yay Western medicine!

One of my benchmarks for good breathing health is "effortless PRs," which I continue to reach ... admittedly by putting a small amount of effort into them. But I'm no longer a gasping mess — I actually feel quite good when I'm pushing myself. Again, I don't expect to feel this way always — I've had a number of downturns in the past 15 months, and no reason to believe this is over. But for now, this mountain air is filled with oxygen, and it tastes so good.

Two other metrics that I can track more easily than hormone levels are heart rate and blood pressure. My resting heart rate was never at the crazy levels you hear about from some Graves patients. But I used to see 85-95 bpm; it now falls closer to 60. I didn't even realize I was having blood pressure problems until this past January, when I applied for a prescription and was denied because my blood pressure was too high. The nurse took several readings before encouraging me to come back the following morning before coffee, where it was still registering 130s/100s. I've been monitoring my blood pressure ever since. It looked bad through February, but has improved significantly since I returned from Alaska in April.

Then there's the metric everyone will ask you about — weight. Some people with hyperthyroidism lose a ton of weight. A few gain weight. It's not always the instant high metabolism some think it is. My weight has remained fairly stable throughout my illness and recovery. Although I intend to address any big changes, I haven't done much about it yet (I'd like to focus on achieving mental sharpness and good breathing first, thank you.) However, I was a bit alarmed when I came home from Alaska in early April and realized I'd put on eight pounds in a month. I've assumed normalizing my thyroid would pack on some weight, but this was happening more quickly than I expected. Then, during the past six weeks, I lost most of this amid my usual routine. There's probably something to be said about how much inflammation develops during a tough endurance race, and how long that takes to recover. Anyway, I continue to believe that weight is not necessarily a good health metric, except to gauge how bad for your body endurance racing really is. ;)

There are a few other symptoms that have improved greatly in the past few months — insomnia, hair loss, hives on my shin and ankles, and muscle weakness (okay, that could have been caused by endurance racing, too.) It's funny, because as my nighttime sleep improves, I've picked up more daytime fatigue — again, I view this as probably more "normal" than symptomatic in the other direction. I also find myself feeling cold when sitting around, and again, it probably just means that I've not as overheated as I once was.

After an encouraging visit to my endocrinologist on Thursday, I celebrated with one more jaunt up Trail Ridge Road in Rocky Mountain National Park. I'd been led to believe they weren't opening the road until Friday, but to my dismay it opened two hours before I arrived Thursday afternoon. Traffic was already thick — not ideal, but at least drivers in national parks are generally courteous. Still, I don't see myself making this trip again this year, unless it's to ride the gravel of Old Fall River Road before it opens in July.

The weather was typical Colorado springtime — lovely at intervals, and then a squall would move in, the temperature would drop 20 degrees with blasting 40mph headwinds, followed by a burst of rain. Then it would be lovely again.

I was amazed how much snow had disappeared since I was here two weeks earlier. I guess my window for spring snowshoeing closed during the broken toe episode. Summer is here, but that's okay. I have to admit that the weather in these mountains frightens me, and I'll miss this relatively benign season. Winter is for 75mph west winds and avalanches, and summer is for microbursts, hail and lightning. Fall is probably a good season to plan big efforts, after monsoon but before the snow.

Beat installed new tires on our road bike, "Sworxy," so I took it out for its first ride since late 2016. Oh, how I missed this bike. So nimble and fast, if a bit squirrelly. Without even trying, and despite a huge backpack (see aforementioned fear of mountain weather) and blasts of wind, I cut more than a half hour off my climb time verses the mountain bike two weeks ago (16 miles of near-constant climbing from 8,000 to 12,000 feet — that's pretty much Jill heaven, right there.) This time last year, I felt like I could barely breathe at 12,000 feet, at any level of effort. The improvements are no doubt only noticeable to me, but I find them staggering.

My overall health and fitness cycle for the past year and a half would put late June at the bottom of a slump, so it will be interesting to see how I hold up this month. Either way, I am grateful for every good day I receive. Good health is priceless. 
Sunday, May 20, 2018

Mist season

It's been one of those perfect weeks of spring, where decidedly "Un-Colorado" weather settles in for a few days — long enough to saturate the dry ground, but not so long as to wear out its welcome. Some of the "300 Days of Sunshine" proponents might disagree, but I enjoy this short season of gray mist. It reminds me of my favorite long runs in California, or the rose-colored glasses I now have for Juneau. I loved this misty weather even when it was 38 degrees and pouring, and I opted to go to the gym instead of enduring a sloppy bike ride — because you don't need to get needlessly coated in cold mud to appreciate spring hydration.

 The animals seem to be enjoying spring as well. Deer and turkeys have taken over the place, hummingbirds returned in force, our outdoor goldfish are full of vigor after their winter stupor, and neighbors are posting photos of a mountain lion family on the prowl all over the neighborhood — which may explain why the deer are bedding down so close to the house. I also encountered my first black bear of the season, while driving home on Thursday. A small bear, he appeared to be hanging out more or less in our driveway before I startled him, and then watched his adorable bear paws bound along the edge of the road before he veered into the brush. My parents were visiting at the time, so I went inside to warn them — just in case they had any food in their car.

Our friends Dan and Amy from Alaska visited earlier in the week. So it was a busy week where the weather was often rough and I didn't get outside all that much, except for the afternoon before my parents arrived on Wednesday, when summer made an appearance. There wasn't a cloud in the sky and temperatures nudged past 80 degrees, so I slathered on multiple applications of sunscreen — still not enough to avoid second-degree burns along my wrist, arm, and a sliver of my lower back — packed three liters of ice water and a sandwich — which I neglected to eat after getting too wrapped up in making good progress over a six-hour ride with a deadline — and borrowed Beat's cross bike for a blistering fast ride on still-muddy gravel and gravel-strewn pavement.

It will probably surprise no one but myself that I fell in love with the cross bike. Beat has owned this bike for more than a year, and I'm just now trying it out. I've always been a cross/gravel skeptic because they seem like bikes that are just a little worse at everything. A road bike is better on pavement, and a mountain bike is more fun and comfortable on dirt, even non-technical dirt. Shortly after we moved to Colorado, when my breathing issues were at their worst, I abandoned my road bike because I physically could not pedal it up some of the steepest grades near our home. Back then, even my low-geared mountain bike would stall out on the Flagstaff Road grinders, and I'd crawl into a nearby ditch to catch my breath and sometimes cry a little bit. These were bad times. I didn't talk about them widely, because I was ashamed.

My sometimes-decimated and still-unpredictable fitness is the reason the road bike hasn't been ridden in two years. Now it needs new tires and a little work before it can reasonably be used again. After two years of grinding away on knobby tires and studded tires and loaded fat bikes and bikes with suspension, the cross-bike intro has been a startling revelation. This bike demands so little of me to fly up gravelly hills and 25 miles of rollers along the Peak-to-Peak Highway. There was a 12-mile descent where I could pedal much of the time — my mountain bike is geared so low that I usually have to lazily coast, often while freezing my butt off because it's winter, for 45 minutes. I was buzzing by the time I met Beat in town, because it's not every day I can enjoy so many miles and so many hills with so much scenic goodness for so little effort.

The following morning I was sporting an embarrassing patchy sunburn to meet my new primary care physician. The physical went well — most notably, my blood pressure has dropped to 108/68 after regularly hitting 138/100 for much of February. When I mentioned this to an observing nurse practitioner, she said, "Well, you're probably more active now than you were during the winter." Yeah, about that.

But, really, it's satisfying to identify as healthy ... for now at least. The doctor graciously agreed to examine the toe I broke three weeks earlier, and concluded, "you're probably okay to run." I expected more caution than that ... I'd been dutifully limping around in my orthopedic sandal until recently, and the toe still hurt. These doctors I manage find ... always encouraging me to go wild and take chances. Where are all of the supposedly conservative medical providers all of my athletic friends seem to complain about? Anyway, since removing the buddy tape, I've noticed that my previously curled and crooked pinkie toe has actually straightened a bit. The once-sideways nail, which is already ruined from constant pressure against the side of my shoes, now faces upward. Genetics left me with bad toes, and injury actually fixed one of them.

With the doctor's blessing, I was able to squeeze in one hike with my dad — a conservative five miles along the gradual west ridge trail to Green Mountain, walking slowly while wearing my ancient hiking boots. Dad was patient with me as I ambled along, grumbling about toe pain. Only later did I realize that if I remove the buddy tape, my toe doesn't hurt at all — I was probably wrapping it too tightly. But it was nice to spend a couple of days at home with my folks, even if our adventures were underwhelming. It seems as though I'm either injured or sick or recovering from surgery every time they come to visit.

 Beat went out for a long run on Sunday in prep for the Bryce 100 in two weeks. I was filled with FOMO — last spring I was doing my own long runs before the Bryce 100, and I admittedly miss compulsory adventures. The optional ones are okay, I guess. The weather had again turned sloppy and cold, so I donned the big boots for a hike up the west ridge to Bear Peak. At the summit, I felt so good that I continued down Shadow Canyon to wrap around the Mesa Trail to Fern Canyon, having forgotten how long that route really takes — it turned my one-hour hike into almost four. But my toe felt fine, and it was fun to splash through ankle-deep mud in the big waterproof boots and breathe in cool, humid air.

Fern Canyon, with its 1,800 feet of climbing in 0.85 miles, is always a fun fitness test. I pushed it a little and missed my PR by just five seconds. Five seconds! This was intended to depict tired satisfaction ... yay, I haven't been running in a month, and it's wet and muddy and I'm wearing heavy boots, but I almost got it.

As this cold front came and went with the lowest temperature registering a balmy 37 degrees, it's time to accept that winter is truly over, and the window for hopeful instances of late-spring snow has closed. This is always a somber realization for me ... summer is coming. But it's nice to head into the hot season feeling healthy, if a bit aimless, for now.
Saturday, May 12, 2018

Happiness curve

I recently read an article in the Guardian about the "Happiness Curve" — a concept that life satisfaction is highest during childhood, declines through adulthood until it bottoms out in our 40s, then begins to curve upward as we grow old. It's an interesting concept to ponder, as I stare down the long tunnel of middle age.

The author of a book about this curve told the Guardian, “The most surprising thing is that age tends to work in favor of happiness, other things being equal. The most strange thing is that midlife slump is often about nothing.”

More interesting than the article itself were the reader comments, which I admittedly spent a couple of hours reading. They ran the spectrum, but the general pattern was people in their 20s and 30s listing the reasons why they were justifiably miserable, people in their 40s declaring their financial and family status along with other permanent stressors, people in their 50s arguing strongly either for or against the happiness curve, and people in their 60s, 70s and 80s chiming in that yes, life is hard, but, actually, it's pretty good.

The unsurprising conclusions: Older people have had time to develop their sense of self and become secure in their values. They're prioritized relationships and experiences over achievements and status. They're more willing to live in the moment. Less driven to compete with others. No longer as beholden to the tyrannical whims of their hormones. More likely to feel gratitude for what they have, rather than yearn for what they don't have.

Of course, the golden years aren't an easy ride. There's a reason for the mantra "old age is not for the faint of heart." There's a lot of loss during that period of life, declining health, pain and sickness, reckoning with past regrets and imminent mortality.

Still, the point of the happiness curve theory is that these realities don't necessarily mean misery. Said one 73-year-old commenter whose husband is mostly bedridden and dying of a lung condition: "The other day he said to me: 'I feel like I’ve never been so happy in my entire life as I am right now.' I agree with the research! For us the past five years have been like a second honeymoon — a time of great joy — in spite of knowing his lungs are compromised and there’s no cure, short of a lung transplant (for which he’s too old)."

I was thinking about this article on Wednesday when I set out for a solo ride up Trail Ridge Road in Rocky Mountain National Park. I didn't want to let spring go by without squeezing in a ride up here, while road crews work to clear away many feet of snow and the higher elevations remained closed to vehicles. It's a Colorado spring classic, and Wednesday presented an ideal weather window.

As I pedaled into the park, I noted my fortune in having the freedom to spirit away on a day-long bike ride, on a weekday, on a whim. I don't feel like a care-free retiree — I still feel driven to do work, to fight for the things I value, to create. I still have goals and ambitions. And yet I acknowledge that, in some ways, I skipped over the middle part of life — ladder-climbing career, status-building, amassing wealth, raising children. I still have my father's pragmatic side and a plan if my current situation upends, but acknowledge that it doesn't carry the security a typical late-30-something desires. I already have health conditions to which I'll forever be shackled, so if I lose my health insurance, I'll have to do everything I can to gain it elsewhere. But I don't feel regret. I don't believe regret is coming for me, either.

The climb to 12,000 feet was long and tedious — at least, from an outside perspective. Nearly 20 miles, 5,000 feet of elevation gain, on a gravel-strewn paved road winding through woods and then snow-covered tundra. On the surface, I felt a dull ache from my shoulders — delayed-onset muscle soreness from a tough weight-lifting session the previous day. My broken toe felt pinched in a hard-soled boot. The weather at that altitude was unsurprisingly cold and windy, yet I chose to come underprepared and thus remained uncomfortable.

Below the surface, though, I felt strong. My recent thyroid numbers have all come within normal range, perhaps for the first time in years. All of the mental weirdness I was experiencing last year ... the brain fog, memory lapses, disconnected thoughts and inexplicable depression ... all of those symptoms that had me worried about declining cognition ... early-onset old age ... have evaporated. Just like that. For now, I'm not beholden to the tyranny of my hormones. It feels really good. Also, I can breathe!

Deeper still, I felt content. If pedaling my bike was something I could do all day, every day, I'd probably remain happy. It's not something I want to try, because I value my relationships, my efforts to create, my medications and food and other things I wouldn't be able to afford if I just rode a bike all the time. And yet, this aimless forward motion is enough to create deep satisfaction. I discovered this young, perhaps too young, as I drifted away from my career path at age 24 to ride an overloaded touring bike across the country. But I don't regret this either. I'm still involved in journalism where it matters to me. Sure, I am not super successful. I don't mind. Accolades and awards and the respect of my peers are other things I could probably skip altogether.

So what do I want? That Guardian article was a good prompt to consider what I most value in life: Meaning and truth. The first is why I keep moving forward, battling my nihilistic inclinations, even though I realize nothing will be resolved before my final breath. The second is even more cryptic, hidden behind flawed human perspectives and emotions. Yet it must exist. There must be a definitive answer to everything, even if hidden in layer upon layer of quantum mechanics, forever inaccessible. I suppose this is my discontent in life — that I'll never understand it.

Perhaps there's a life hack to this happiness curve, but I believe it lies closer to the early end of the spectrum. The awe, wonder, and magical possibility of children — these are perspectives we're all too prone to set aside in adulthood. There's good reason for this — such perspectives require a hefty dose of uncertainty, discomfort and fear. Once we've formulated a story that makes sense to us, it's too easy to become complacent. More gratifying than knowing something is the hunger to know it better.

I reached the end of the line for Trail Ridge Road — a big sign declaring the road was now closed to all users. Just around the curve and out of sight, I could hear heavy machinery working and figured the road was still buried in 12 feet of snow beyond that point. Not quite content to just head home, I descended all the way to Little Horseshoe Valley and tried my luck on the gravel climb, Old Fall River Road. Near 10,000 feet I hit the first snow drifts. Still not content to stop, I waded through the mush, gingerly placing my tender foot. A few steps found purchase, but more often I crashed through rotten snow into thigh-deep holes with water at the bottom. The bike bogged down to its hubs, and I had to lift it up and plop it down with every step. This was dumb. But what was around the next corner? Beautiful mountain views! Maybe the next switchback would be more sun-exposed, with more open dirt. Curiosity drove me forward.

After a mile of mud and increasingly larger drifts, the road became entirely snow-covered. My toe was hurting. This was probably more walking than I'd done in the two weeks since I broke it, and it was not friendly walking. Finally the adult in me won over, grumbling as I retraced each uncomfortable step with my now-soaked feet and waterproof hiking boots filled with snow. Still, I kept looking over my shoulder. What was out there? I have to know, so I'll have to come back. I could say this of a thousand places. Millions of places if my life were long enough, but it's quite short. Still, if I can retain that childlike wonder, even if my body breaks down entirely, I think I could arrive at the end of my life happy.

Maybe this is the life hack: Skip the angsty fluff in the middle and embrace the sharp edges. Accept life for the absurd, novel, impermanent, fleeting, amazing thing that it is. As an 80-something commenter put it: "As far as I'm concerned, life is a huge amount of fun and if the old man with the scythe came to collect me in the next few minutes, I wouldn't feel I'd been short-changed."