Friday, December 28, 2018

The Day My Asshole Tried to Kill Me and Why I May Never Race Again...

If you are easily offended by foul language, unmentionable body parts, bodily functions, and details about surgeries, then you are dismissed. This post is not for you.   

If you are curious as to what happened to me and would like to offer some understanding, support, and encouragement during my attempt to find myself again, then you may proceed. 

This post, actually, is for me (and for others newly diagnosed who need some help making sense of WTF is happening). My blog. My journal. My body. I write about the good. I will write about the bad too. 

Why am I sharing all this personal stuff?  
First, because I train a lot of athletes who are wondering what the heck happened to their coach. I care about my runners and I want them to know what is happening to me. I want to be a role model of perseverance and I want to show them that when I tell them to never give up on themselves, I also practice what I preach. 

Second, I am really sharing it publically because for the last three weeks all I have seen are horror stories. There seems to be no hope for people in my situation, just problem-focused misery. I have been desperately seeking examples of people who are managing this condition well. I want to read about people who are living life. I want to see athletes succeeding despite this condition. But I have not found one post, not one comment, no blogs from anyone who racing marathons or playing sports competitively in my condition. (I am sure they are out there but they just may not want to talk about their asshole). The people who are sharing their stories are the people who have seemed to give up. I don’t want to give up!  

If I can’t find a success story, then I want to be that success story. I want people, like me, who are desperate for hope to find my blog. I want them to read about the hard reality that I am facing (this is bad and I can't pretend it isn't). But I want people to also see that I have found my way and they can to. This is not pretty and it is not problem-free, but I am managing it. If I can manage, others can manage.     

What happened? It has been just over 3 weeks since my asshole tried to kill me.  Jeez, make one too many self-deprecating jokes about trying to not poop your pants on a long run and the universe decides to blow up your anus. Not cool. I didn’t even know this was a thing. 

For those people hate "vague-booking" here you go. Careful what you wish for! 
On 12/4, I was rushed into emergency surgery because a crypt gland several inches inside my anal canal became very infected. Why? No reason. The gland, whose job is to lubricate the anal canal malfunctioned. It became impacted or maybe succumbed to bacteria. This type of infection is most often linked to Crohn's disease, Ulcerative Colitis, Diverticulitis, Diabetes, Obesity, etc… none of which I have. I have Bad Luck. Sometimes Really Bad Luck.

The mounting pressure from the pus needed a place to go. Rather than take the path of least resistance and discharge through my anal canal, the raging river of infection decided to go on a seek-and-destroy mission to find a new exit out of my body through my left butt cheek. On its way, it bore a tunnel through my both my voluntary and involuntary sphincter muscles. This tunnel is called a Fistula.

On its way out, my river of infection decided to divide and conquer splitting into two branches to make what is called a horseshoe fistula. This is bad. My fistula never actually busted through the surface of my skin but rather created two huge pockets of infection, one inside my body and the other near the surface of my left butt cheek. When sitting, could feel a large hard mass in my butt cheek. After many days of this (it took two visits to get this diagnosed correctly), I became septic. A few moments into my second doctors visit, my doctor realized that I was septic and ran from the exam room to book an Operating Room ASAP! I had surgery a few hours later. 

Here is a short cartoon that shows what happened (there is no sound):


When I woke up from surgery, I was not prepared. I was told I have a very large complex fistula that was incredibly infected and it passed through both my sphincter muscles. This meant it could not be repaired. Instead, my surgeon inserted two seton drains and a larger tube drain. The setons will stay in place for 4 months. The tube was removed 10 days after surgery.

The setons look like large blue rubber bands that are threaded through the fistula tunnel and looped out my anus and then tied and sutured in a knot outside of my body. Not comfy. 

The setons keep the fistula tract open so that the infection can continue to drain as needed for months. The setons help “mature” the fistulas by irritating the tunnel causing scar tissue to form inside the walls of the tunnel. 

The third tube-like drain was inserted to keep the large fistula exit hole the surgeon cut into my butt cheek open so that it could continue to drain the infection and so I would not have to repack the wound each day. The doc stuffed a huge wad of gauze packing inside the tunnel during surgery. I got to pull that all out 24 hours later. I needed to wait 48 hours before trying to walk. I was told to wait a week before trying to do any exercise. And I was told to wait 2 weeks before lifting anything heavy.  

The setons stay for 4 months to provide an escape route for any new infections that will (likely) form in the future. 

Then I went home. And cried. A lot. For three days.

WTF just happened to me? Here is an excellent video that very clearly explains the different types of fistulas and the different types of treatment. Mine is one of the complex types. I do nothing half-assed.  #OverAchiever.

First please know that any type of anal fistula is incredibly rare and they all suck. The majority of those who have fistulas have a “simple” fistula. These are very close to the anus and do not cross any muscle. These simple fistulas are easy (but very painful) to fix with one surgery that “lays open” the track by cutting through the skin, opening the tunnel, sewing it open to lay it flat. It heals slowly and painfully over time. Without muscle involvement, there is no risk of losing one’s ability to control bowel movements.

A minority of people with fistulas will experience “complex” fistulas. These are the type that have burrowed through one or both sphincter muscles, which control our continence. We have two sphincters, a voluntary and involuntary sphincter.  Once these muscles are cut too deeply (like during surgery), they will stop working forever. However, the fistula doesn’t damage them enough to impact bowel control. Surgical intervention will leave a person incontinent if too much muscle is cut. 

The first type of complex fistula is called an intra-sphincter fistula. It crosses through only the internal involuntary sphincter but does not touch the voluntary sphincter. There is some hope for bowel control. If this type of fistula involves less than 30% of the one sphincter muscle, this fistula may also be “laid open” as well with low risk of incontinence since most of the sphincter muscles will not be cut. 

The second type of complex fistula is called a trans-sphincter fistula, which crosses through both the voluntary and involuntary sphincters. Surgery to repair trans-sphincter fistulas are more likely to fail and more likely to leave a person incontinent because both sphincter muscles are involved. This is my type. 

The only thing that can make a trans-sphincter fistula more challenging to treat is the presence of multiple or horse-shoe tracts. This means the fistula split and took more than one route and is now longer than those that took more direct routes. The longer the fistula the harder it is to close. The more tracts, the harder to treat.

What do I have:  A complex, high, horseshoe-shaped, trans-sphincter fistula.  This is not going to be an easy fix. 

What is next:  Complete Cure vs Colostomy Bag? Only time will tell. 

Because the sphincter muscles cannot be cut, the seton drains are put in place and they remain for months. As I explained, this is supposed to scar the walls of the fistula tract to seal closed the inside and lower the risk of re-infection along the tunnel. However, this tunnel is directly connected to the inside of my anal canal. Anal canals are not germ-free places. Infections of fistula are to be expected while the seton is in place because fecal matter can still get in the fistula opening from the inside and there is nothing I can do to stop it. This is bad news.

At the present time, I can do what I need to do to keep the outside of my body clean and healthy. This means I take Sitz Baths every single time I use the bathroom at home. I try to not use the bathroom when not at home. I need to keep my new extra butt cheek hole covered with clean gauze since it drains (not a lot) all day and night. I get to wear menstrual pads every single day now to catch any drainage. This is fun. I feel bad for men with this condition.

In about 3-3.5 months from now, my surgeon plans to attempt to close the internal hole from the inside. There are a handful of methods, all with not very good odds. Some options are to pull a flap of skin over the opening from the inside, but that usually fails as the flap pops off. Another method is to try to stitch the tunnel closed, which also tends to fail.  Some doctors tried to create plugs, but those pop out. Some doctors try to use glue to fill the fistula, but that is not very effective. There are some promising results with laser cauterization, but this is still considered experimental and not available to the public unless you live in the UK. Some go to India for some special magical thread treatment that is not approved here in the US. Some have the seton drain rigged to be a "cutting-seton" and it is pulled tighter and tighter overtime to cut through the muscle slowly, but that has problems too. 
Some people do decide to leave the loose seton drains in for life. But over time, a risk of anal cancer can possibly increase because the drains are foreign bodies that are constantly being rejected.  

(Edit: When asked for research to support this of increased risk of anal cancer from long term use of draining, I cannot immediately find the resource at this time so I am adding this note for now to say this is not a common concern and many people do choose to leave setons in a long time, rather than undergo surgery. There is NOT strong evidence that long-term use of setons increases the risk of eventually developing anal cancer.  Balancing risks is important. As a cancer survivor, I am more worried about cancer recurrence than others may be so this detail struck me as relevant for my personal journey.)

Many people have multiple surgeries. Every time a surgical intervention is attempted, there is a risk of damaging the sphincter. The patchwork can fail at any time, days after surgery or months or years later. Reinfection rate for those with complex fistulas is very high, especially once the setons are removed. Multiple attempts to repair the fistula to stop the infections can lead to incontinence. As a result, some patients who are not able to fix the fistula are fitted with a colostomy or ileostomy bag. Usually, by the time someone needs a colostomy bag they seem to actually want it because the battle against repeated infections will finally be over.

Here is a link to some research about how hard it is to close fistulas. The more complex the fistula the lower the success rate for closure
. Mine is very complex.

When a fistula is horseshoe-shaped the failure rate is closer to 60%. 

Here is a flowchart that tells me what I can expect. I am in the Draining Seton Stage of the Complex side of this flowchart.  I can heal or I won’t. We shall see. What should follow after "Follow-up" if we loop back to recurrence is "Nothing is working, infections persist, colostomy bag needed..." 

So what is happening to me now?  

I am an ultra-runner at heart. Ultra-runners are solution-focused athletes. We endure.  We have a high pain tolerance. Meditation taught me focused on the "here and now" and to focus on what I can control. Acceptance is liberating.  

At first, I felt like the universe literally ripped my heart and soul out my asshole. I am a runner. I own and operate my own coaching business. My social life revolves around racing. I was a sub-3 marathoner. I ran 43 miles in 6 hours as a 40-year-old woman. Running is where I belong. It is who I am. I have one more class to complete in order to earn my Masters of Science (M.S.) degree in Kinesiology (Science of Human Movement). It was hard to focus on school after this. My entire life revolves around being athletic. I had almost completed 7 years running daily with an average of just under 8 miles per day. That streak ended on 12/4. My soul was crushed. My heart was broken. I took a few days to feel sorry for myself.

Then, I started searching for success stories. I found none. Not one. People shared about needing 15 surgeries over several years. People sounded hopeless. The stories of raging random infections were terrifying. They shared about getting colostomy bags and being grateful to finally be infection free.

Trying to become a Success Story (at least at Stage 1): 

So I decided to try to become my own success story! And for the last 3 weeks, I have figured out how to be myself again. For me, this is a small victory. Just one battle. Not yet the war. 

I needed a week before I could run again. So I walked. For the first week of running, I would only run on my treadmill or from my house so I could stop when I needed to. As my runs got longer I had Sidney ride a bike next to me in case I needed to stop. Then I met Kim at a park, but late in the day so I could use my own bathroom. And finally, I met Rich early for 10M and actually had to use the port-o-potty out in the world. And finally, that day, I felt like myself again. Yes the measure of success for me was being able to use a public trail-side port-o-potty.  I set the bar high. 

But truly this means I can run anywhere and for as far as I want now. I am not limited anymore! At least not for the next 3-3.5 months unless I get an infection (which could happen at any time).

The specific obstacles (TMI, but I don’t care. Others who have this issue may want to know this stuff). 

I had to:
(1) To figure out how to manage any chafing from the knots from seton bands (so far this is not a problem but I have not run more than 10.2 miles). I have an arsenal of lube to test when/if needed. Not needed yet and I don't want the lube to mess up the Tegaderm patches which are sticking well now.

(2) To figure out how to get comfortable running with rubber bands irritating my asshole, making me feel like I had to take an urgent shit with every stride…. but I got used to that and the sensation stopped happening.  Phew!

(3) To figure out how to run comfortably with gauze padding in my pants and (4) To figure out how to use the bathroom out in the world when I can’t immediately get into a Sitz Bath to make sure the open incision that I will have for months stays clean and dry as well as to make sure the rubber bands hanging out of my ass are clean. Fun stuff. 

My solution to 3 and 4 above: Tegaderm patches with gauze included. I am so happy to have discovered that I can cover the setons and open incision with a 4x4 inch plastic Tegaderm patches that have a square of gauze in the center. The adherent patch holds down the majority of the seton drains so that I don’t feel them move and they don't chafe me too badly. Sure, I feel them. The gauze collects any drainage completely so I don't need to use a big wad of gauze or menstrual pads when I run. And because the incision site and most of the lenght of setons are covered with plastic, if need to use the bathroom when on a run, some wet wipes are all I need to keep the area and setons completely clean. 

Based upon what I had read online from others with setons, running was not supposed to be possible! Reports of pain, chafing, repeated infections from just walking around or being out and about too long made running seem impossible. Not True.

So far I have made it up to 10.2 miles at 9:30 pace without any debilitating chafing or any significant pain. I have also run 5 miles at 8:10 pace, but that was hard and uncomfortable. The irritation level is not enough to stop me from running and I was even able to use the bathroom during my run and nothing bad happened. The Tegaderm stays put for the entire run.  Finally, I feel like myself again! 

I am in more pain, actual pain, when sitting and when trying to get comfortable to sleep. Running and walking is less painful than being sedentary.

The Plan: Train for a race, maybe
I have 3-3.5 more months before my next and first surgery to attempt to close the fistula (See flowchart above. This may be a long journey). My surgeon wants to try the LIFT procedure, where he will try to sew closed the fistula by cutting through my butt cheek, between the two sphincter muscles and stitch the fistula closed. I don't believe I can run for at least a month after that. The LIFT will likely fail. I know this.  Then I start over with another infected abscess, get new setons and wait again for the next surgery.  Based upon the research, for someone with my specific type of fistula (high, complex, horse-shoe shaped, trans-sphincter), the success rate is 40% (so it is most likely to fail) and the risk of some type of incontinence is 30%. So I am not sure yet this is the surgery I want to do. But most have those same odds. 

For now, each day I am infection-free is a day I can train. Each day I can run is a small victory!

My aim now is to find a race to run by the end of March, before I start the next stage of this journey. I may be cured with the first surgery (fingers crossed) or I may end up eventually in a colostomy bag at the worst if nothing works. I really don’t know what will happen.

But what I do know is that today, nothing bad is happening to me. Today I can run.  
Today I can dream about running at least one more goal race and maybe some other races just for fun along the way. I want to do what I can to make this time I can run count. 

Wednesday, December 5, 2018

My Streak, My Health, My Choices: Today I choose Freedom

I was not going to share my personal story (and I will not share my private health-related details here) but this is my blog and this is my journal. I also feel that as a running coach, some people do still look at what I do as a guide. Maybe by sharing my decision-making process here, I will help them make their best decisions or maybe even feel better about stopping something when they know their health depends on it. I also need closure and this will give me that.

My Streak will reach 7 years 12/27/18, but I will end it today.  I feel like this decision deserves an entry in my blog. 

When I first started streaking, my goal was to run daily as long as it was not going to make any situation worse. I didn’t want to run on crutches or run down the hospital corridor or run around the airport in my jeans if I could avoid it, just to check a box.  I did well with my streak. Streaking was not hard for me. I have just under an 8-mile per day average of almost 7 years! Owning a treadmill really leaves no excuse.

My goal was to run daily despite feeling “too tired” or “too inconvenienced” or "because weather was too cold" or “because others in my life were too impatient and I didn’t want them to wait on me.” So I managed these obstacles. I would get up early take care of me and inconvenience others less whenever possible. I learned to be assertive about my needs enough to tell my friends and family that I need to run daily. They understood easily that they would have to be patient and give me the 10 minutes at a minimum that needed to achieve my goal.

Streak running became a part of who I am but it never defined me. I didn’t post a lot about it. I didn’t get the T-shirt. I recently asked to remove my name from the registry. 

I just love to run a lot and I have been running since I was 9 years old. Streaking didn’t make me a runner. I don’t really even need to run daily, but running daily helped me run a lot per year and this taught me many lessons.

Why I love my Streak: Early in my Streak Running career, I found that the first 2-3 years changed me for the better as an athlete. It taught me that on those days I was too tired run, I would actually feel a lot better and more energized if I ran. I found that on those days I thought I was too sore after a race, that if I ran 1 slow mile, I recovered 2x as fast. As a result, I was back to training strong several days later. With faster recovery times, I was able to safely do more quality workouts without injury in one training cycle than I could if I needed longer rest between hard runs. As a result, my marathon time went from a 3:38 to a 3:15 early on and eventual down to a 2:55 now.  My ultrarunning improved since I learned that running 60, 80, 100 miles in a week was possible for me.

Streaking helped my body heal faster. I have an autoimmune disorder from chemo that used to send me to the ER 1-2 times per year. My fragile weakened immune system would crash and my body, face, and throat would swell dangerously. My lifestyle did not change much when I started streaking. But after a year of streak running (and building my training volume as a result), I never went back to the ER for autoimmune-related hives again! Sure they came back, but the condition was less severe and much more able to treat at home. Was the cure running daily? Maybe not. It was probably from running more and getting fitter, healthier, stronger, and more resilient.

Streak running helped my mental health. **** Everyone should recognize they need to take care of their mental health as well as their physical health. ****  I do not have a diagnosable condition.  But every single person is susceptible to the impact of stress on their mental functioning and psychological wellness. If you think are you are not, Good Luck to you. Just like how the body gets sick even when you are doing everything right and don't expect it to happen, the mind gets tired and beat down too, especially under stress. I get depressed. Not to the point that I need treatment. To the point that I need to pay attention and take care of myself. I get stressed out. Who doesn't? We all do. It doesn't meas something is wrong with you. It means you are human. Take care of yourself. 

Streaking taught me how to prioritize my need to take care of ME and not put everyone else first. When you learn how to make just 10, 20, 30+ minutes of “me time” for yourself each day, you also learn this discharges stress and makes room for the new stress of the day that will find you. Running daily was my personal time to decompress daily, even if I ran with people. Running often made me 100% able to give my heart and soul to all those who turned to me with their stress and life challenges.  

Remember, my work is split between inpatient mental health rehabilitation and coaching. My job is to help clients overcome their stress, mental health issues, life obstacles, and personal challenges so they can achieve their goals and dreams. I do this as a psychotherapist and as a coach. I sometimes see more adults cry in one month than most see in a lifetime. I often see more violent behavior than most people ever see. I learn of more of my past clients committing suicide than most people will ever know. I work in a volatile, labile, sad and/or dangerous environment and I need to leave my stress at the door when I swipe in. Running always helped me to do that.

Streaking taught me I was stronger than I thought I was as a runner. Streaking taught how to take care of myself first. Streaking helped me learn how to speak up and say "Yes" to myself and my reasonable needs. Streaking helped me to create running goals that were so non-negotiable that my non-running friends and family started to help me find ways to get my runs in no matter where we were or what we were doing. Streaking taught me the tremendous value of decompressing and releasing stress daily through exercise. Streaking made me feel strong. Streaking got me to almost 500 miles in 30 days in 2017. I was a machine. I could run about 16+M per day and not feel tired or beat up. I could jump on my treadmill to watch a TV series and 2.5 hours later walk off with 18+ miles and feel fantastic. Then run the next day, no problem.

The Ending

I always knew I would never run when Streaking would hurt me more. Today is that day.

For the last 5 weeks, I have been dealing with an internal infection that has beaten me down and made running feel miserable, but not impossible. So I ran. 

I have shared that I tore my hamstring, that I have bursitis and a minor glute strain. Funny thing about those injuries is that I could run 1 mile or more even when first injured. I would feel no strain or pain as long as it was slow and I didn’t stress the muscles, tendons, and bursa. Short, flat, slow running, while I tried to heal, did not seem to be hurting me. Yet, 6 months later I am still injured. I think now it is clear that daily running very likely delayed my healing and caused me to lose time as a runner.  

However, my hamstring, glute, and bursa are not what will end my streak. I have a PT and we worked together from August through November. I was finally cleared to run hard and race last month. I raced a 5k and it went really well. I won and beat my time goal by a lot. Then I had an MRI two days later (because that is finally when it was scheduled). It showed I was still not 100% healed and I still had all my injuries. So back to PT and I will be fine soon.

The major issue for the last 5 weeks has been an infection which I don’t need to share the full detail of and I won't here. Some issues can and should be respectfully kept private.  

Well, first I tried medication which resulted in systemic hives. Then I tried an out-patient operation to clean out and treat the infection, but it failed miserably. The infection returned 10x worse over the past 16 days. I was getting sicker from it daily. My poor friends got weeks of texts from me bitching about pain while I was desperately looking for any sign of relief. I am sure now that the strong long lasting anti-inflammatory prescribed for my hamstring tear was masking the pain of my infection each day (giving me false hope I was healing when I was not). Each night, when the meds wore off I was in too much pain to sleep.  

I finally made an appointment with my doctor on Tuesday (yesterday). It is a little scary when your doctor actually RUNS out of the office to find an OR "today!" I had no time to plan my life around this and even though I wasn’t immediately dying I know a fever with a large painful infection under the skin that can only be reached in the OR is dangerous and could become septic over time. He would not allow me to wait even one day to schedule this. I asked. He laughed at me and said "No we are doing this today! As soon as I get an open OR!"  

Last night I had a surgery.
It was a small area and a short operation. I was cut open to clear out the infection. I feel better now. The pain meds help.  I was stitched up and had drains put in which will stay in place for 4 months and allow the deep tissue to heal safely. 

Sepsis is dangerous. It can kill people. This was a real risk I faced if I waited too long. I am glad I caught this early enough to avoid that complication. This is why an OR was booked ASAP for me. I had a growing infection inside my body that left me unable to move comfortably and resulted in a fever. Yet, I STILL ran my Mile daily, lke a good Streak Runners should. “Run Through Everything”, right? And how do I feel about that: Like an idiot! 

In hindsight, I should have not run at all. Last Sunday (more than a week ago), I notice the restart of the infection after the first operation. I had a follow up appoint on Friday and my doctor didn’t realize I was infected then. I showed him my symptoms and he felt I was still healing from the first operation. He felt the symptoms were just skin irritation and the chafing from the first wound still draining. He felt it would resolve in a few weeks. 

In the next 4 days, I was in greater and greater amounts of pain. By Tuesday of this week (yesterday, 8 days after I noticed initial growing discomfort), I couldn’t do normal activities of daily living without some pain. Work was hard. Driving was hard. I still did things. I ran.  I ran 7 miles on Monday, the day before my surgery. I have a very high pain tolerance and I don’t really stop for pain. Due to pain at night preventing sleep, yesterday (Tuesday) I called the doctor to tell him I was in a lot of pain. He found time to see me. As I watched him BOLT out of the office to get an OR, I knew today was going to be the day to say Good Bye to my streak. 

How do I feel about this? 100% Fantastic. I am happy. I am ready. I am not running and risking reinfection. 

I have taken off from work, which I never do, to heal. I could force myself to run 1M today if it was very important to me, but it is not. Today I will not do anything that will put pressure on the drains or shift the tiny plastic stent implanted in me that is lined up to drain this infection out of me for the next 4 months. Running 1 mile today will not help my healing. It will not advance my training. I will not help my stress level in any way.  I will not make me feel good about myself. So I refuse. 

Today, Not Streaking Running will be a gift. (And I will not start another one. I never want to feel like I HAVE to run ever again). Not Streaking will offer me my Freedom back. I will give me back control to make smart decisions and not do something just because of a routine at all cost. 

Harmonious-passion is a type of passion that allows us to fold into the fabric of our lives a healthy activity that brings us joy and makes our life better. We are still sad if we can't do what we love, but it is not the end of the world when we need to miss it for good reason. My streak has always been Harmonious for me. I loved that about it.

Obsession-passion is when we do something at all costs, no matter what the consequences to our health and our impact on others will be. Stress is caused by the need to do something compulsively is not pleasurable. Missing one day becomes too emotionally painful. I am not obsessive about my streak. I never have been and I won't start now. 

I don’t need a Streak to make me run. I love to run. I don’t need the Streak to make me a good runner, I know how to train smart. I don’t need a Streak to decompress my stress. If I miss a mile, I can meditate for 5-20 minutes and that works for me just as well. I don’t need to Streak Run everyday to feel strong, fit, and healthy.  I have the gym and I have yoga and both give me the same benefits in a much more well-balanced way.  

I am grateful to have been a Streaker for almost 7 years. It changed me for the better in more ways than it ever harmed me. I don't need to start another one. I won't. I am tired of counting days. I learned all I needed to learn from Streaking during this 7-year journey. 

I want to sincerely thank all who inspired me to become a streak runner, Mark Washburne, Freddie Murolo, Steve Tursi, Jim Merrit, and especially Jim Pearson, who I never spoke to often but when I did he was such a nice man. Pearson's 50 Mile PR, at 5:12 was an American Record and the 3rd Fastest 50M in the world. From a distance, he taught me early on that streak running and record-setting performances are not mutually exclusive.

Today I choose harmony. 
Today I choose to bow out gracefully from my streak, it has been a fun ride. 
Today I choose to heal.  

Today I choose to be free.  

Monday, November 12, 2018

Don't Fall, Just Run 5k, Bridgewater, NJ. 11/10/18

Oh, what a journey. You can skip down to the section about Today's Race if you just want to read about that. But I use this as my journal so I want to share some thoughts about what happened first. 

I have been running since I was 9 years old. Never have I had an injury that has lasted this long. In fact, I am still not even 100% sure what it is.  After going to Physical Therapy until my insurance refused to continue to pay for sessions, I was diagnosed with a myriad of problems all working together to keep me from training and racing. 

Initially, it was clear I had severe bursitis. Once that started to resolve, I was left with such significant hamstring weakness (could not move even 5lbs of weight) that a tear of the lateral hamstring was diagnosed. Based upon my radiating pain (down to my ankle at times) and limited to my ROM as well, sciatic impingement was also diagnosed. 

Today it has been more than 6 months and I still feel pain when moving in just a few specific ways that really challenge the flexibility of my hamstring. I can't lift as much with my left as I can with my right still.  I can do more than I could months ago.  For there to be pain this long after an injury is baffling. It is also baffling that running slow and flat did ever and does not hurt or leave me in pain later. Sitting, Bending, Lifting, Stretching, or trying to up the pace my left leg was excruciating. Jogging was not a problem.  

I did a lot of jogging over the last 6 months. I also did a lot of hiking and that seemed to help.  I also joined a gym and started doing 2-hour full body strength training sessions 3 times per week where I included all the personalized exercises my PT assigned for me.  I have relearned how much I LOVE the gym.  

So What Happened?  I suspect Overuse from a marathon that was very hard on my body, and then one week later I raced a Master's Women's Team Championship 10k race before I was actually healed from the Marathon. I felt obligated to show up to run for my road racing team. and I felt obligated to run as fast as I could. I ran HARD that day and had a great result, but I left that race feeling worse than after the marathon. Any other race effort, I would have just slowed down if I felt something was wrong, but when racing for a team, I felt that I needed to power through. 

Still, I did not actually realize how bad the inflammation and injury was. During the week I took training so easy and stuck to the flat bouncy treadmill. I felt the hamstring was much improved by that Friday and there was a local 5k I wanted to try to run that weekend, which ended up being the last race I ran before this one. I ran an 8M warm-up, felt a little stiffer than I would have liked to feel, but I was not in pain. I didn't even think about not racing. I just assumed I would run slow if something was too tight. BUT the race has a weird false-start, followed by too fast of a  restart before runners were back behind the line.  As I was walking backward to the get back behind the start, the started yells "GO!" and the rapid shift from stepping backward to then trying to push off forward with my left leg, was the final straw.  Again, I did not recognize the severity of the problem until after the run when I stopped and then tried to start my cool down.  I just couldn't run without pain by then. The damage was done.   

So again what happened? I broke a basic rule, week after week after week... I failed to listen to my body and I ran when I was in actual pain but I just didn't recognize it as pain.  I should have been more conservative. I know myself better. But I wanted to get myself back on track. I wanted to race hard in the Fall.  I wanted to resume my training I tend to have trouble recognizing pain. I broke my arm when I was about 6 years old and went to gymnastics class for a full week (complaining only that it hurt to twist my arm it into my leotard) before we realized it was actually broken and I needed in a cast. I used to have 13 piercing (just ears) but all of those except the first two, I just pierced myself with a stud, no ice, whenever I felt like I wanted another piercing and it would feel just a little sore but not painful. Once, I had a needle biopsy on my thyroid without any Novacane. Five times in a row this doctor shoved a needle into my neck without a numbing agent and all I could do was ask him if he was trying to save some money. To which he told to me "Cut it out, it is a thin needle!" (He was correct. It was and it really didn't hurt). 

So maybe what others would feel as pain I register as tightness? This is scary.  This makes me not trust my own judgment. As a result, I have spent the last 6 months missing a part of my soul because I have been too afraid to push myself. I did a LOT of damage and I needed those months to ensure that when I did try to run fast again, I would not retear my hamstring and have to start healing all over again.

This setback was hard. I dropped from 3 marathons. I was hoping to run a BQ at one of those races. For the first year of my life as a marathoner, I have not qualified for Boston. (I have mixed feelings about this. My brain needs a rest from the stress of Boston for me. I feel a sense of freedom now that I haven't felt since I raced the year of the bombings.  A break from the race will be good for me.)

Now for Today's Race: 

When I tried to restart my training in Spring 2019, I ran a "Check-In" 5k in 7:24 pace. That day back in March felt very hard and I felt sluggish. I expected the same feeling for this race, and because I am not actually back to 100%, I expected to be slower.  So for today’s race, I set a soft goal to just try to break 7:30, but My Job for this race was to find the fastest pace I felt was sustainable, just try to hold a "fast" pace for the entire way without hitting the wall or getting hurt.  

Today I did my job and it felt wonderful at the end but I was very worried about racing from the start. 

During my warm-up, I felt heavy, slow, and very concerned that this would a very very bad decision. I had a low sense of self-efficacy during those warm-up miles. I was afraid I would retear my hamstring. But training was going well lately and I have done some speed sessions at a fast pace.  I knew I needed just to run something to regain a realistic perspective. My last race was hard on my body and soul.  This race, if I do well, could reset my psyche.

This race was very small. But I wasn't racing people. I was there to challenge myself. I ran by myself the entire way, with 4 guys pulling ahead of me. I started entirely too fast and by 0.1M I was running 5:00 pace! I got swept away with the lead guy at first who ran a 16:39.  It took me most of M1 to burn off that speed and get down to a pace I felt I could hold for 20 minutes. To be honest, when I glanced down and saw how fast I was moving, my self-efficacy skyrocketed! "OMG, I CAN run! I can run FAST and my butt is OK!  I got this... now slow the F' down!'   M1 - 6:44

And then we turned into the wind, ugh. About halfway into Mile 2, despite the wind, I continued to feel strong and my confidence builds. "Ok, I can do this. I AM doing this!" A few spectators cheered us on and one confirmed that I was the First Female. This triggered me to think about placement. I wasn’t sure where the second place female was and I surely not going to look. Instead, I imagined she was chasing me and I ran as if there was someone right on my heels. 

In the middle of Mile 2, I start to realize I may actually win this race but immediately shook that thought away. "Stop that! Who cares what place you are in? This is not competitive! Your job is to manage your pacing today. Your job is to not fade at the end. Your job is to not get hurt. Your job is to run the mile you are in and stay focused on the now. It is way too early to think about the finish. Save that type of thinking for later." And I refocused on my pacing and effort. M2- 6:53 (I am ok with this fade because the mile was into the wind. My effort was even and I don't feel like I was getting myself into a hole I could not get out of)

With just 1.1M left, we turn out of the headwind and this helps. I started to feel strong again. I was still running away from my imaginary competitor, running as fast as I could run, pushing myself to keep the pace and effort as even as I could. 

And then I found myself thinking about a few people who love me and believe in me and how I know they will understand why running this race this well is a big deal for me.  And I thought about how many single leg squats I have done in the last month and how that has to mean something.  M3 - 6:48

As we turned back INTO the wind for the last 0.1(3) miles, I tried to find a kick but I felt I  was at my red line. I was not fading but I had no other gears. This was ok. Admittedly, I lost a little motivation to really dig deep and push hard once I saw where the 2nd place female runner really was. And since I had already achieved my goal (even pacing as fast as I could hold, ideally under 7:30 pace, without hurting myself) I did not want to actually force a kick that could re-injure my hamstring, glute, bursa, sciatica or whatever hurts me. Last 0.13 in 6:43 pace

I finished just as Lynyrd Skynyrd came on the loudspeaker. This made me smile. As an aside, today I wore a tech shirt with birds on it because one year ago today we were able to capture the beautiful stray parakeet who was flying into our yard for 7 months. Sadly, he was not well. He survived only 2 months longer (even with Board Certified Avian Vet care, a safe and healthy environment, and nutritious food :( ). The song felt special as if I could let a little of the grief I still carry with me at times go. I realize it may sound silly for a person to get so attached to a small stray parakeet, but I did and Skynyrd changed me for the better. Animals do that to people.

Final Time: 21:17 (6:49) 
OA Place: 5th
Gender Place 1st

This is a good start. My left side is still stiff, but it did not hold me back. I am starting to accept this as my new normal. But I do have an MRI scheduled to rule out any issues that might need more medical treatment in addition to the weeks of PT I already did to try to treat this problem.

Saturday, June 9, 2018

Lakeview 5k, Edison, NJ. 6/2/18

On Monday (Memorial Day), I had a wonderfully positive experience racing the Ridgewood 10k. I was faster than in 2016 (which is the training cycle I am using to model my Fall Training after this season). It felt wonderful to be “ahead of my pace bunny,” but in that race I could still feel the lingering soreness that manifested at the end of the Run for the Red Marathon. That pain in my butt had me walking it in the last 4 miles.

I was supposed to also race the 5k after the 10k at Ridgewood, but decided I did not like the tightness I felt high up in my hamstring where it met my butt. There was no reason to turn a great experience into a bad day so I skipped the 5k and returned home.

I have strained muscles before. I have some idea of what that feels like. This felt different. I took some recovery days, but noticed I was not really bothered when I walked or jogged. I could run eay and felt fine. Climbing bothered me when running but not when walking.  I was in much greater discomfort when sitting or when I increased intensity when running. It seems like the entremes were out but if I stayed in the middle of the intensity continuum I was ok.

That discomfort when sitting was isolated only to a small area exactly where my sit-bone is. This area is the ischial tuberosity and it is where the hamstring attaches.  This could be high hamstring tendonpathy or something else. After a few days of rest, by Thursday AM I was running 95% problem free.  With each day that passed, I was feeling better.  That is a pretty fast recovery for tendonpathy. I began to suspect something else. 

I had this 5k planned and figured if I was tight or sore I would not need to “race” it. I could just slow to whatever pace was not bothersome. Alanna who was kind enough to come join me for pre-race milage and the race.  3.1M is simply not enough for me right now. 

I ran 8.6M comfortably slow paced miles before the race. I was a little tight at the top of my hamstring but nothing hurt. It was hot and humid. I didn't expect to be fast. After a long warm up I felt like I could run 3.1M more.

The Start. 
The start was a little disorganized. There was a “Ready… Set”… and then nothing.  Then people spontaneously starting to run. And then, after a few steps, everyone suddenly stopped and started to take steps backwards to the starting line.  While taking backwards steps to the start, the starting gun then goes off and everyone starts running again. This was the moment I tweaked something.  Unfortunately, this sudden back and forth change of direction and my gut reaction to GO! when I heard the gun caused me to press off very hard on the side of my body that was already tender as I was stepping backwards. The force to suddenly get moving forward while momentum was going backwards triggered a sharp pain on these initial step. I gave myself a few strides to feel it out.  Due to the acute sting that settled down a bit quickly but not fully, the hill in mile 1, the humidity and heat, I simply had no power, felt less than 100%, and decided to not race.

Today was NOT the day to worry about time. I shut down my intensity, trying to find a place that felt comfortably fast but not problematic. That was as about 7:30-7:40 pace.  

However, by the time I hit the last mile, my hamstring/glute was aggravated. In the last tenth of a mile, my stride was altered. I skipped the 2M cool down I planned, walking just a few mintues instead, because walking did not hurt.

The race was small and not incredibly competitive.  I must say that Kathy Rocker was awesome and ran a wonderful smart race in tough conditions for the win.  I was 3rd Female.  Great work Kathy! 500 points! 

I was about 3 minutes and 17 seconds slower than my pace bunny from 2016... Oops. ;)  

So it is back to the drawing board for me. Time for more rest, more recovery, and to figure out when it will be time to see a PT about this. 

After doing some research to self-diagnose (like all panicked runners do), I have determined that I most likely have bursitis. I followed some recommendations about how to manage it and now 6 days later I am back running. I am not discomfort-free.There remains tightness that leads to discomfort if I try to push through it. I suspect this would become painful if I ran too fast (I am not sure. I haven't tried to test this). But slow paces are painless. I am back up to 8M without much trouble when running. I am still taking it easy and allowing recovery between longer runs. I am hopeful that soon I will be training and racing just fine again. 

Friday, June 1, 2018

Ridgewood 10k, Ridgewood NJ Monday, 5/28/18

So it has been about a week since my fumble at Run for the Red (Poconos Marathon). I rested, recovered, and felt about 95% ready to go for my target pace of 7:20 +/- 10 seconds for this 6.2M.  

Looking back over my logs from my best racing of my life, I ran this race at 7:10 pace before training on to eventually PR in everything I ran later in the Fall of 2016.  

I don’t need to best my PRs right now to feel like I have a chance at new PRs when racing and weather gets good months from now.  I just want to be close to the same place I was in the last time I took this journey.  I am comparing my past training volume and paces, nutrition, body composition and race performances along the way to determine whether or not I am on track to race well come Sept, Oct, Nov, Dec. Myself from 2016 is my pace bunny.

Being realistic, I aimed for 7:20 pace for this race because the last time I ran Run for the Red I was about 20 minutes faster. It didn’t feel smart to expect to be faster than 2016 myself at this race only one week later. So using my past performance as my guide I set a realistic goal. I hoped if I ran smart I would beat that goal. 

At Run for the Red, I ran with wild abandon, knowing I was too fast too soon but ready, willing, and able to take my beating when it came. It hit hard around 21M.  My ego was bruised. My hamstring too.

This 10k was a Masters Women’s USATF-NJ State Championship Team Race so I wanted to be a part of my team. We have some fast masters women and it feels good to be pulled along by some amazing people.  They make me want to do better.

Unlike Run for the Red, which was a Check-In Race where mistakes were encouraged, this was a race that I planned to practice some skills. Success was not measured by my finish time. I was measured by my execution of the pace plan. I wanted to practice negative splitting and self-restraint. There is no value in blowing up at every race. It is tremendously harder (from a discipline stand-point) to start slow than it is to start too fast, but it is better in the long run. There is value is practicing how to feel the sensation of running "as fast as possible while retaining one more gear" (or two) for the last 1/4 of the race. 

Today the weather was a gift. We had the best weather I have ever experienced at the Ridgewood Run. There would be a lot of PRs today!  Not for me, but for those who were ready for one. I line up towards the front of the race, a few rows back, more rows back than I would if I was fit and fast.

The starting gun is sounded and we are off.

I am careful to not get swept away with the crowd. 7:20 +/- 10 second from M1 is my goal.   There is no excuse to not nail this. I have a computer on my wrist that tells me exactly what I am doing. There is no need to be any faster than that target pace. I would love a 7:10. After Mile 1, I can forget the watch and feel for that sweet spot that is just fast enough but no so fast that I can’t get faster. When racing smart, I always want to know I have more speed in my legs for the end. M1- 7:09 (perfect!)

Mile 2 has a little descent so I find my flow and start concentrating on my body, my legs, my breathing, and my effort. I want to appear to be working less hard than those around me not harder. I focus on myself, but notice how hard others around me seem to be working too. I try to gather information internallly and externally.  

I have no intention to race anyone in M2. I am ignoring the watch because I know my best running happens by listening to my body, not by watching the clock. I am in a comfortable place, in my own head, cruising along, knowing I can work harder later. I am not sandbagging, but rather riding what feels like just a few seconds slower than my red-line effort. My breathing is controlled and I am trying to run as smoothly as I can. M2- 6:50

I don’t look at my splits until the end of the race until after I finish.  I can tell if I am running faster along the way just by how hard I am working.  I think about the mile I am in and assess if I am feeling like I am running smart.  Today the answer is "Yes. Yes I am.”   

I start to notice people around me fading. I am starting to pass many who flew past me in M1 and M2. I am working hard. I am careful to not work so hard that can’t shift gears.  I adjust my pace as needed to stay in that sweet spot. I am ok with slowing a little to retain my gears. I remind myself that my best race will be determined by what I do in M5 and M6 not what happened in M3 and M4. 

I find my zone and I settle in for the ride. I have more to give, but now is not the time. M3 - 7:02

I am hitting a flow state. Oh, how I miss this feeling
. I can "hear" music start to play in my head. I am lost in the song. I am overtaking more runners than those who are passing me. I am moving in slow motion and everything else is a blur. Nothing else matters. I am working exactly as hard as I am capable of sustaining. Running feels like work. It is not easy. But nothing hurts. I am not worried that I can’t hold on. I know I can. M4 - 7:03.

I learned a while ago when racing a 24 hour race to think about the lap I am in by saying “Working lap [and naming the number]” rather than naming the lap I just started which then confuses me as I wondering if I had just completed that number.  I still do that now when I race. It keeps my mind on the mile I am in.  I think to myself “Working M5. Get ready to move at the M5 Mark.”  

In this mile, I allow myself to shift my focus from internal, task-focused pacing to external, ego- (or competition-) focused racing. This is when start to open the gates that I have put up to hold back my ego-focused side while I focused on my task. 

[Ego is not a bad word. Ego-focused just means Outcome focused. It is that part of you that is preoccupied with the overall results like finish time or placement. Task-focused is the part of you that is focused on smaller bite-sized tasks a long the way].

My task was to run hard but not too hard and to make sure no matter what I did, I had another gear.  The ego is the part that cares more about beating competitors and doesn’t care about the task. I race best when I am task-focused for 3/4 of the race and 1/4 of the race I let my ego pull me to the finish. It is a race, after all, and the point of racing is to try to beat competition. That is all ego-focused stuff.  If I let my ego-focused side take over from the gun, I can expect a crash and burn beginning to happen by the half way point. Discipline for me is to hold back my ego-focused runner-self until I know that once I let her loose she can do nothing to destroy my result, but only make it better. There wont be enough time for crash and burn if I wait long enough to shift gears. M5: 6:57

I am side-by-side with Karl. Karl has been part of my “pack” for a while. We both get faster and slower and sometimes don’t run together but over the years Karl and I have raced many miles side-by-side.  Runners who race a lot know who their pack is. Sometimes they are collaborators and work together. Sometimes they are "freinemies."  In racing, you get to work with your pack, but by the end it turns into a race and you are happy for whoever wins the day. You push each other to better times than you can alone in those last final miles when the race is ON. It is never certain who will take the lead over the finish line.

Karl and I greet each other in M5. I say something about how it is time to do work. M6 is a fast mile.  Karl asks “Where’s Ben?”  [I love this]. First I say (not getting it at first), “Well, he is on the side-line cheering and I think he is racing the 5k…(then I get it)... but right now, Ben is right there (and I point to the ground a few steps ahead of us)… Ben is one step ahead pulling the pace home.”   

Karl, Ben, and I were a pack. The three of us ran many races side-by-side just like Karl and I are today.  But Ben was injured when he was hit by a car while he was riding his bike and literally broke his back. His comeback has been miraculous. But he wasn’t racing the 10k today… in person.  But he was there with Karl and me. 

Karl and I do not like to let Ben win ;) so we kick it up hard, as hard as I could at the time. We picked up Laura, my teammate. Laura rises to the challenge and doesn’t miss a beat as Karl and I are flying. She joins us. Now we are three and we are haulingM6 - 6:33

Me and Laura flying. Photo by Blanca Alvarez Blaskovic 
My breathing is crazy. My body is working harder than it has worked in a long long time.  I am giving 110%. Karl pulls away. I can’t match him but I give everything I have to give.  

Laura is on my side. We are not giving up. We are in a race. There is no "let's finish together holding hands" :) or letting the other one have the win out of friendship. No. This is a race and we are racing. We will be friends after. ;)  It doesn’t matter who wins because we are on the same team. We push each other to a 6:06 paced last .2M and it feels amazing! I finish a half step ahead but Laura started behind me so she gets the win today!  

Laura turns to me and says (as I am hunched over dry heaving) that she just set a new 10k PR!  

Karl turns back after he finishes to say “I just set a new Age Group Personal Best because of that last mile.  That wasn’t just me out there. That wasn’t just you… it was Us… and Ben.” 

Karl is my pack. Ben too. And now Laura.     

42:49 (6:53 pace). Negative Split!
24th Female OA
8th in Age Group (40-44)

My final mile was the fastest mile I have run in half a year.  I followed my plan completely and beat my goal by over 15 seconds per mile. I am now ahead of my “pace bunny” <3

What a fantastic day!