Monday, April 17, 2017

So this is spring

Beat and I are nearing one year in Boulder, so we've experienced all of the seasons in high country. Of all transitions, spring is usually the most difficult for me. The quiet darkness of winter dissolves into a kind of uncomfortable mania; previously empty trails begin to feel crowded; new smells and sounds barrage the senses. My typical allergy season creates new weights, and the crushing heat, dust, and fire of summer feel too close for comfort. 

And yet I do enjoy the ease of mild weather, watching green return to the hillsides, anticipating the return of the hummingbirds, laughing at the antics of wild turkeys and watching a herd of elk graze in the back yard. Wildflowers and daffodils emerge from clumps and brown grass. That uncomfortable mania also breeds excitement. "Something is going to happen! I don't know what, but good things are coming." 

Even as I say this out loud, a larger part of me remembers that the state of the world looks dire, and it's difficult to veer away from this urge toward despair. I'm still haunted by my experience with the avalanche last month; I see blocks of snow tumbling toward me in wisps of dreams, before I awaken to early morning light, golden and rich in the springtime. It's all so fleeting, all of it, and it's infinitely better to appreciate the present than fear the future.

 My physical state still stymies me. Now that my thyroid levels have dropped, I'm sleepy much of the time. I catch myself dozing off while waiting in the dentist's chair. I steal the occasional nap during work sessions. I'm tired at bedtime, and usually sleep soundly through the night, which is strange. Perhaps this is just the way 37-year-old me is supposed to be, a trait that hyperthyroidism shielded.

Still, when I venture outside, I often feel more strong and alive than I did during my best season, winter. If I want to beat the fatigue and sleepiness, all I need to do is get out in the warm spring air for a ride or a run. Tree pollen has been bad lately — something for which I only have a "mild" allergy, so I haven't been treated for it — and I can feel pollen clogging up my sinuses and irritating my eyes. And yet, I can breathe. Sometimes I wish I could immediately recapture all of my former strength, but I'll settle for breathing.


 And the elk are here. Beautiful animals to watch from the comfort of the living room.

This one seemed enamored with the goldfish pond. Probably because of the water or his reflection, but I like to think he too appreciates the hardy little fish.

 On Sunday, Beat and I went for a long adventure "run." I call it an adventure and "run" in quotes because much of the route, for me, was a series of stumbles and careful footing over the rocky trails of the Flatirons. If I harbor any ambitions for summer, they lie in the realm of hiking and running. I wonder what I can still do with this sleepy, perhaps over-medicated body of mine. So I've been running, perhaps too much, and not as fast as I'd like. But every step feels freeing.

 We hit up South Boulder Peak, Bear Peak, and Green Mountain. It was hotter than we expected, and we both had to ration water even after stashing some below Green. That caused a bit more struggling than necessary up the rock staircase known as Shadow Canyon. Still, despite believing I'd just completed one of the sloggiest slogs in my long history, I still set a "PR" for that climb. After 18 miles with more than 5,000 feet of climbing, my legs felt pretty spry, although my confidence had taken a hit after slipping and sliding too many times on loose dirt.

 I also used the weekend to redesign the blog, as you may have noticed if you're one of the few who still looks at this blog directly. I aimed to make it less cluttered and a little easier to navigate, as the thing nears 2,000 posts and becomes increasingly more unwieldy.

I also made a "best of" blog page, mostly for myself, to compile my favorite posts over the years. Scrolling as quickly as possible through 11.5 years of blog posts was an exercise in bewildering nostalgia — to watch it all slip by so quickly, and marvel at the sheer bulk of time that's passed. It's all so fleeting, all of it, and it's good to remember how much a gift every day has been. 
Wednesday, April 12, 2017

Thyroid update

On Tuesday I visited my endocrinologist to follow up on treatment for Grave's Disease after seven weeks on an aggressive dose of thyroid-blocking medication. The results were encouraging. I'm responding well to the medication. My T4 levels have reached the normal range, T3 is close, and while my TSH is still very low, it's normal for that to take several months to return. The doctor is keeping me on the high dose of methimazole for now, but seems confident that medication will be an effective treatment against my hyperthyroidism.

One of my main issues is the presence of Hashimoto's antibodies, which means I've probably been hypothyroid in the past, and likely will be in the future. Controlling thyroid disease will be a matter of managing this rollercoaster, and its unpredictability. That will likely be a lifelong battle regardless of which treatments I eventually choose.

"Lucky you," my doctor said.

Still, it's good news. And I have been feeling notably better. This post is a quick (boring, I know, but helpful to me and hopefully others) update on my health progress.

• Breathing — I haven't experienced any significant breathing difficulties since February. I have been much more conservative with my activity levels. But the last major episode happened while I was walking up my staircase at home, perhaps too fast, and felt my airways tighten in the way that tends to induce panic. That was two months ago. Whether these episodes are "asthma attacks" or something else, I still don't know. There's evidence of Grave's Disease exacerbating already-existing asthma, and there's also evidence of "air hunger" as a symptom of an overworked heart. I am reasonably certain that bronchodilators improve my breathing when I'm having an "attack," so I probably do have asthma in addition to thyroiditis. Lucky me.

• Allergies — I do (did?) have a severe allergy to grass that has become worse over the years, and seemed to ramp up exponentially when I moved to Colorado. I've been treated for this allergy with immunotherapy shots since October. In the past two weeks I've been receiving catch-up shots to which I have not responded well — swelling, itchiness, fatigue directly afterward. Spring is coming, which I'm not looking forward to. Hopefully the treatment will curb some of my hay fever symptoms, and I won't go through the allergic asthma that I was dealing with last summer.

• Exercise — I've felt noticeably stronger during the past two weeks, although I still have fluctuations in energy levels, sluggishness while running, and mid-day sleepiness. Overall, though, I am much *much* happier while exercising. My breathing is better, my head is clearer, I'm more relaxed, and there haven't been any major bouts of dizziness or anxiety. I also have yet to "push myself" into a hard effort — similar to my efforts during the winter, when I was desperately trying to improve fitness for the Iditarod. Staying conservative is still my plan. All of my workouts since Alaska have been hikes and runs — mainly because I'm scared of riding bikes. It's harder to control my effort level on the steep climbs around Boulder. Since diagnosis, fear of provoking a thyroid storm has made me obsessive about maintaining control of my heart rate and breathing. In Alaska this proved necessary, as I had particularly poor reactions to situations where I failed to control my efforts, as well as stressful situations. But as my levels drop, thyroid storm, asthma attacks, and other poor reactions become less of a threat. It may be time to start testing the waters again — slowly and carefully, of course.

• Muscle building — My thyroxine levels are currently in the normal range, which means I'm less likely to experience the "thyrotoxic myopathy" that causes muscle weakness and breakdown. People with hyperthyroid conditions tend to lose weight, but a fair percentage of that is usually muscle tissue. One of the reasons I'm likely beginning to feel stronger is this slowing of muscle loss. I renewed my gym membership and am excited to work on building endurance in the weight room.

• Weight loss — I didn't experience weight loss with Grave's Disease, and I have yet to see a gain outside my normal fluctuations. This is possibly because years of endurance racing taught me expert-level calorie replacement, so as I was burning up muscle, I consumed enough food to replace it with fat (just a theory.) Now that I'm approaching normal, I'm trying to be more cognizant about my calorie intake — fewer snacks, fewer dairy products, more fruits and vegetables. There's still a lot I can do to improve my diet.

• The hand tremors that I believed were a mild neuropathy (I had carpal tunnel syndrome last year) have almost entirely disappeared.

• The swelling in my thyroid gland appears somewhat reduced (although still noticeable.)

• My resting heart rate is down — I tend to see numbers in the high 60s and 70s rather than 80s and 90s.

• The frequent skin rashes that I believed were related to allergies haven't returned in a couple of months.

• I still have what I consider to be a higher-than-normal heat sensitivity, but I can't really expect that to go away since I've always been adverse to hot weather.

• Mentally I feel so much better. The dull, gray fogginess that I had been experiencing is becoming more apparent now that I'm beginning to come out of it. My mood has overall improved. I hope these clearer thought patterns will improve my writing efforts this spring and summer.

I think that's about it for now. Now I'm heading out for my first bike ride of the spring. Wish me luck! 
Thursday, April 06, 2017

A good week in Boulder

Although I was excited to return to Colorado after five weeks of roaming around Alaska, there was a bit of apprehension as well. Home meant a more structured work routine, with attempts to write when my thoughts still resembled oatmeal tossed into a ceiling fan. Home meant living at 7,100 feet, when science showed that five weeks at low altitudes had been long enough to lose most of my mountain acclimation. Home also meant a return to a regular exercise routine. While I had no intention of launching into any kind of training, even the usual runs and rides at the easiest pace possible seemed overwhelming. 

During the autumn and winter, I'd been in a lot of denial about my fitness. Such was my desire to return to the Iditarod Trail. Although I did complain about feeling off, I wasn't honest with even myself about how unfit I'd become. Most runs were a gasping mess. In January, I told my friend Corrine — before she helped diagnose my thyroid issue — that I was looking forward to the Iditarod being over so I could become a couch potato. 

"I'm just tired of feeling bad every time I go outside." 

I also worried about the 80-degree days Beat described when he returned to Boulder in March, given that 20 degrees felt plenty balmy when I was in Fairbanks. Thankfully, Boulder eased the temperature transition with a snowy April shower.

Because the weather was so fantastic on Friday — well, it was 35 degrees and snaining — I decided to attempt my first "run" in more than six weeks. There had been a fair amount of hiking in Alaska, but only brief moments when both feet were off the ground simultaneously. I started out extremely slowly, padding through an inch of wet snow in well-worn Hokas. By mile 1.5, I was feeling surprisingly good, so I turned onto the Green-Bear trail and picked up the pace. Descending into Bear Creek on the wet, rocky trail involved fast turnover and high-kicking steps, which felt both strange and exhilarating after all of the slogging I did in Alaska.

"Running! I love running! It feels amazing."

I returned home after 7.5 miles, bemused by the experience. That run really shouldn't have been so easy. I'd become convinced that six weeks on an aggressive dose of anti-thyroid medication had finally pushed me into hypothyroid territory, given how difficult it had been to simply stay awake earlier in the week. Now this — running well during my first day back at high altitude. What does it mean? No matter, I'll take it.

On Saturday afternoon, my friend Wendy and I tackled the 10-mile Walker Ranch loop. I insisted on a super easy pace, and freaked myself out enough on the rocky downhill segments that I don't think I could have pushed it much faster.

Rocks and mud are hard. But runnable. I was in running love. Not overdoing it this week was going to be difficult.

Beat, in turn, had been quite ill since we returned to Colorado, and had to languish in bed. He finally went to the doctor and tested positive for strep throat. This is generally highly contagious, and since I hadn't been careful around him at all, I assumed I'd wake up one day with a throat on fire. But I never did. This reminded me of an interesting conversation with a friend in Alaska, who also has autoimmune diseases, and almost never becomes conventionally sick (cold, flu, etc.) Her reasoning was that because her immune system is constantly attacking her body, it manages to kill all the invaders as well. I'm not sure what science says about this, but it would be interesting to research.

Sunday and Monday brought pleasant temperatures in the 50s and 60s, along with intense April sunshine to make quick work of the snow. On Sunday I climbed up Bear Peak and again felt strong, which brought memories of many dizzy ascents in the recent past. It wasn't that long ago that I pushed myself hard enough to become unnervingly lightheaded, my vision flickered, my throat burned, and I'd gasp for air until I had no choice but to stop and rest. Steep hiking ascents are the only aspect of mountain "running" where I consider myself reasonably proficient, so this is the area where I always strived most to improve. I began to wonder how fast I could push this climb ... but no ... easy pace, steady breathing. I'm not going to overdo it right now.

So I went into a Monday Mount Sanitas loop with every intention just to saunter along at a conversational pace. The first mile ascends 1,300 rocky feet, and then there's a buffed-out runnable descent for four miles — the best of all worlds, in my book. The whole stress-free run seemed to go fairly fast, so later that day I caved and uploaded my stats to Strava. 

See, I sort of "quit" Strava a month ago, recognizing that the self-comparisons were an unnecessary source of angst. In truth I lost an old GPS watch during the first week in Alaska, but it was an opportune loss, and I didn't miss it. I swore that I wouldn't go back on Strava until my health was better and I was actually training for something again. Still, old habits don't go away easily. I guess I'm back for now.

Strava indicated I'd actually set a PR for the one-mile climb, even though my previous Sanitas runs were gasping efforts of striving for exactly that. This effort had been nothing more than a brisk hike, with calm breathing and a clear head. I looked back at the other recent Strava stats — more PRs or near-PRs on segments that I worked hard at during the winter. It was interesting to compare the actual numbers to perceived effort — as though suddenly, after a month of not running and being all over the map in terms of energy, I'd become considerably more fit. In reality, I think my thyroid levels are closer to normal. I'll know more about this next week. 

Tuesday brought more snow — 8 inches by dawn, and still coming down hard. You have to love spring in Colorado. I grew up in Salt Lake City, which has a similar climate, so 65 degrees one day and snow the next doesn't strike me as strange. But I could hardly ignore an opportunity for what might be the last snowy run of the season. Tuesday was a busy work day and I had to go in to town for a blood test first thing in the morning, but I still carved out a couple of hours for something resembling a run on the Ranger Trail of Green Mountain.


Okay, it wasn't even close to a run. The trail had only been "broken" by one person wearing snowshoes, which I did not have, nor did I have trekking poles or gloves. I went anyway, trudging through four laborious miles and sweating profusely even after I wrapped my puffy jacket around my waist. Four miles in 1:45. I didn't care. I love a good slog.

The morning was gray but lovely, with frost-tinged branches and thick flakes of springtime snow falling from the sky. I could have slogged along happily all day if I had the time.

By Wednesday morning, more than a foot of snow had fallen at our house. It was as lovely as an April 5 can be, 21 degrees and clear.

But the heat was coming. I knew it, so I opted for one last hike in the snow. I set out figuring this would be a hike instead of a run, but I was banking on somebody breaking trail on the West Ridge. It was not to be. High winds overnight had deposited drifts that swallowed my thighs. The snow was regularly knee deep, condensing quickly in the 45-degree sunlight. My lower body was entirely soaked; I felt like I was marching through a knee-deep Slurpee. Two hours of this became my most taxing effort of the week by far.

You gotta love spring in Colorado. I know I do. I really am happy to be home. A part of my heart will always reside in Alaska, but to be honest I think it becomes a little bit smaller with each passing year, each experience in a new place, and each connection with the familiarity we call home.

A visit to my endocrinologist next week should reveal how much of this (relatively) high-flying fitness is thyroid-related. It's interesting how many aspects of myself I question now — my moods, my thought patterns, my attention span, my fitness, some of my more extreme emotions. How much of this is "me" and how much is "Graves Disease?" Could I really be on a fast road to normalcy, or was this week just another spike on the long rollercoaster of recovery? The latter is much more likely, but it's encouraging all the same.