Saturday, September 24, 2016

First days of autumn

I was glad we were returning from Europe just in time to catch the peak of autumn in the Colorado high country, and hopeful that summer and all of its supposed air toxins were long gone. This apparently wasn't the case, as I'm back to sucking in the outdoors all over again. Maybe my breathing difficulties will eventually clear up, or maybe they're all in my head ... something I'm inclined to believe, as any discernible pattern or cause remains elusive. 

Last week in Italy, I engaged in 20 hours of moderate to strenuous effort, largely between 5,000 and 10,000 feet, over 65 miles with more than 26,000 feet of climbing, and had no issues, not one. Pretty much all I ate in Italy was pizza, bread, and pasta. My sleep was poor and I was stressed out for various reasons, but physically I felt fine. After three days in the states, I'd returned to struggling mightily and sucking on the inhaler I hadn't touched in a month.

 Full disclosure: I neglected my asthma medications for the last two weeks of the trip. I have no excuses, and obviously I'm the one who has to suffer if they were in fact working. For the first two days at home I felt great, jet-lag be damned. So on Wednesday I set out for a long ride, hoping to kickstart winter training season.

Maybe six months mostly off the bike has left me in poor shape for a 50-mile ride with 7,000 feet of climbing. That seems likely. Anyway, it was going well for the first 30 miles, but I became a bit stressed descending the singletrack at Betasso, which perhaps triggered the airway obstructions that almost prevented me from making it home.

 One and a half miles from the top of Flagstaff Road, I became so light-headed that I had to pull over and sit down on a culvert. This break set off a bout of hyperventilating that became worse and worse. I texted Beat and said, "I'm on Flagstaff, having tough breathing issues. If you're home can you come pick me up?" I already knew that he was out for a run, so I waited ten more minutes and commenced crawling up the road, pedaling as slow as physically possible while taking short, rapid breaths. If it wasn't Flagstaff I certainly would have walked, but my ego won that battle. The whole episode was embarrassing. When I finally made it home, it took nearly a half hour to finally "catch" my breath. Beat tested my blood pressure, oxygen saturation, and heart rate. Everything looked normal. I'm honestly baffled. "It's all in my head" is about the only explanation that makes sense.

 The hyperventilating episode took so much out of me that I took a day off on Thursday. I set out Friday for another "test" effort, this time hiking up Bear Peak from Boulder. This is the route that gains nearly 2,000 feet in the final mile before the summit. For me, steep hiking is more strenuous than cycling. But it seemed the safer bet, since I'm currently in much better hiking shape, and also I'm afraid of riding a bike right now. I didn't push the pace but still bested my PR. No breathing issues at all. What gives?

 I guess it goes without saying that I'm faithfully back on asthma meds now, and gearing up to likely start immunotherapy in mid-October. I expect to feel terrible during this treatment, but it's worth a shot (Ha! Shot.) I'm also considering cutting wheat out of my diet, as this seems to be the thing to do when one has a mostly inexplicable health issue. Wheat has been tied to grass allergies in the past. Full disclosure: I'm loathe to do this and may put it off for a while to see whether immunotherapy works first. I'd basically rather suffer through horrific allergic reactions twice a week than cut out pizza and cake. (Okay, I'd rather cut out cake. But all of my research points to immunotherapy being the one thing most likely to work. And if it doesn't, psychotherapy may be next.)

 Anyway, Beat and I got out for an autumn hike up Niwot Ridge on Saturday, and I was struggling again. After seeing summer temperatures all week, we were surprised when it was 44 degrees at the trailhead, and it only got colder from there. A fierce wind raced down the ridge, driving flurries of snow at face-stinging velocities. Neither Beat nor I had the ideal number of clothing layers. But I loaned him my mittens and stayed mostly comfortable, except for the weird light-headedness and staggering.

 Beat found a nice wind-block just before we turned our backs on winter and returned to fall. Without knowing what's causing my breathing issues, it's difficult to say whether I'll even be able to handle winter training. I'm still hopeful that once the snow flies, everything will turn around. 

11 comments:

  1. Really hope you figure out the mystery exercise-induced asthma! I have no useful advice except to say I totally know what you mean about thinking this might be "all in your head". I've self-diagnosed myself with "crappy lungs not otherwise specified" so when I do intense efforts in the summer I get a tight feeling in my chest with inability to take a deep breath, followed by either hyperventilation or loud gasping for air and it always feels like there's a huge psychological component. Embarrassment is sometimes part of it if there are other people on the trail, or if I'm with a group that I'm having a hard time keeping up with. And then of course I'll start crying *while* gasping and hyperventilating, which just escalates the embarrassment - so much fun! So like I say, no advice at all, just commiserating. You're not crazy! Some sports therapy might not be a terrible idea.

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  2. I have exactly the same symptoms - if I push the pace, my throat tightens and I have to back off - a lot (though I don't get hyperventilation, which may just be your reaction to the tightness). I tried a rescue inhaler (ventolin - a short acting dilator) once and it *seemed* to help. But another explanation for me is that I just never trained for high intensity and that's just my limit. On the plus side - that hasn't ever stopped me from doing *exactly* what I want. To be honest I think speed is the mortal enemy of longevity in endurance sports, so ... why fix this?

    Jill on the other hand is experiencing symptoms at much lower intensities than she used to. The correlation to allergens seems quite certain now (and grass pollen load is still substantial in CO even now).

    Beat

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  3. You probably don't experience allergy symptoms overseas because your body hasn't had time to develop any allergies in that region. "Keep in mind you won’t start feeling new symptoms until after you’ve lived somewhere about a year, since you need multiple exposures for the sensitization process to occur, she says." From this article, http://www.menshealth.com/health/allergies-over-your-lifetime

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  4. Best luck with desensitization! Embrace it, it will work - swelling and redness and terrible itching are all signs it's working. Durable response however can't be expected before about two years... don't give up, scientifically, it's the only thing medicine has proven. Gluten free "may" help, but correlation with allergies is just that - correlation.

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  5. No, no, Jill, this is is NOT in your head. Allergies are fickle and the smallest thing can set them off (a feather pillow or comforter, for example, or a certain food, a certain houseplant, a fragrance, a pollen, a mold or fungus, etc.).
    Gluten-free might work, or diary-free or soy-free or egg-free or....I have a mixture of indoor/outdoor/food allergies and I'm okay as long as two don't hit at once. If I eat an egg, for instance, there's a good chance I'll have asthma problems if the pollen count is high or if I've been around too much dust.
    Today I ran 14 hilly trail miles, no problem. I came home, ate dinner (which included a small bit of cheese. I'm allergic to milk but damn, I love me some cheese), and when we walked the dog I could barely make it up a small incline, not even a hill but an incline, without wheezing like crazy. It was embarrassing but not unexpected since it's autumn up here and autumn leaves carry mold, another of my allergens.
    Not sure if this helps but I thought I'd pitch in my experience. I used to take quite a load of allergy meds, but if I watch my diet (no eggs, milk and limited corn and soy) I can run without problems, and without meds, 95% of the time.
    Anyway, good luck. Follow your head and your instincts and I'm sure that you'll figure this out soon.

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  6. Thanks for weighing in. It's nice to hear from others with similar experiences.

    I do think it would be beneficial to experiment with my diet, but if there are other factors — such as change of season — it will be difficult to gauge what factors actually made a difference.

    The immunotherapy does sound uncomfortable. To be honest I've been wavering on submitting my final paperwork, wondering if I can maybe just accept being more inactive during summer and early fall instead. At the same time, I know my allergies/asthma could continue to get worse and start impacting more than just outdoor recreation.

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  7. I struggled mightily with allergies and asthma for the first 20+ years of my life. After a couple emergency hospital visits for asthma, I got tested like you did. Grasses, certain trees, and mold spores were all bad. I already knew much of this, so no surprises really. A serum was prepared. I started shots and stayed with it for almost 10 years. Twice a week at first, but towards the end I'd go in only twice a month. The shots essentially cured me of allergies and allergy induced asthma. I still needed to carry albuterol with me though.

    In my mid-30's, I started cycling to get my weight and BP under control. I had become sedentary and very unfit. I found I liked mountain biking. It became a passion that took over my life. Lost 70 pounds, started competing, did well.

    But I could never break free of the rescue inhaler. The more fit I became, it seemed the worse my exercise induced asthma became. I nearly dropped out of some races due to gorilla sitting on my chest sensation. Albuterol would do only so much. I had no asthma except otherwise except when provoked by intensive efforts.

    After a routine check-up, my doctor recommended I take Omega-3's to improve my cholesterol ratio. My "good" cholesterol was low. I started taking a high-dosage Omega-3, 900mg of DHA + EPA. It didn't click right away, but many months later I realized I wasn't hitting my albuterol anymore. Then I randomly came across this study showing elite skiers reduced or eliminated exercise induced bronchial spasm with increased Omega-3 uptake. Hmmmm, could this explain why my asthma problems went away?

    It's been about 10 years now that I've been completely asymptomatic. Have not used albuterol in almost as long. I continue to religiously take high-dose Omega-3. Readings suggest the American diet is really messed up. No surprises here, right? You see, we used to eat meat that ate green things. Now we eat meat that is fattened on grains. The latter is poor in Omega-3 content. Add to that all the processed foods high in vegetable oil (Omega-6) we eat, our ratio of Omega-3 to Omega-6 is badly out of whack. It should be something like 1:1 or 1:2. Instead, it is more like 1:30. Omega-6 is an inflammatory, and bronchial spasm can be an inflammatory response. Omega-3 is an anti-inflammatory.

    I speculate, but can't prove, the changes in my diet got me completely past my asthma problems. Besides the fish oil, I eat more nuts and try to limit processed snack foods (not always successful!). Anyway, thought I'd throw this out there as another data point. Go for the allergy shots. I see that as low hanging fruit that will have long-term payback.

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  8. Hi,I've lurked for a while but never commented but was compelled. This is for Pentalith more than Jill, I think, but thought I would throw it out there. What Pentalith described is me in an extreme blood sugar low - especially the psychological "feeling". Last time it happened, I was on a multi-day trek and had been sick so wasn't eating much. My cohorts later described me as hysterical. Not thinking my breathing/crying attack was directly related, I ate a glucose tablet to keep me going. I didn't feel any burst of energy but immediately I stopped hyperventilating and crying. It was eye opening for me. Hope you both find some relief.

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  9. I agree with Cinthia on this: "I have a mixture of indoor/outdoor/food allergies and I'm okay as long as two don't hit at once."

    I'm allergic to everything but grass and my worst offenders are: furry animals, dust, mold, and tree pollens. It seems like my allergies are worst when my training load is highest, too. I can't tell if it's because of the increased outdoor exposure to those allergens or because my stress levels are higher from more running but it eventually pushes me over the edge.

    I've had to modify my training to work around these overloaded periods and it has helped a lot. Since making those changes and recognizing my triggers (speed workouts on windy days are worst for me), I've learned how to minimize issues and have attacks like the one you described only a few times a year.

    You might also consider visiting a naturopath. Allergists like to throw drugs at the problem without trying to find a cause. I've found relief in some natural remedies, but in the spirit of full disclosure, I'm still on several different medications.

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  10. Anonymous6:55 PM

    I am not saying you have what I'm about to talk about as if it were some kind of disorder. Just being clear. It just is what it is. And, there's help available out there. You just have to start looking at as part of your mental health rather than your physical health.
    Look up somatic symptoms. They're real, even if they're "in you're head." Your brain controls the rest of your body. I'm not just some internet joker posting- medical social worker who works with people with somatic symptoms every day.
    Or, you have allergies. I'm certainly not saying it couldn't be physical. But,far far far too often, we ignore our mental health because of the absolutely stupid stigma that our brain- the most important organ in our bodies- is supposed to work perfectly all the time but it's socially acceptable for everything else to need help.
    It's absolutely impossible for me to post all my thoughts about this topic in internet comments, btw.

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  11. Anonymous9:23 PM

    Have you had your new house checked for mold and other allergens?

    Tom
    Fairbanks

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