This week - still not improving

I'm not improving. But then again, I haven't rested well. I wanted to, but with the bathroom remodel comes certain obligations, unless I want to spend even more money, and it's already stupid expensive. I took Sunday & Monday as rest days, but I had to paint on Monday & Tuesday (Tuesday was a holiday here, and I'd arranged for the long weekend). I didn't want to, but that was how the timing went with the remodel. I did have some help from Kathryn (church friend) and Calvin, thank goodness, but even with that it was VERY taxing. It's not a small room, and I had to do the ceiling, and I wanted to do a really, really good job since the rest of the room will be a high end remodel thanks to my amazing contractor Jesse. I got it done, but at the cost of my health I'm afraid.

Add in the 10K "race" I was registered for that I did on Tuesday (the Deseret News 10K, which I usually LOVE to do), walking casually with Calvin, and racewalking just 3K (time 1:22), and that put me over the edge. I was really just dead on my feet. 

I went back to work on Wednesday and felt terrible. Definitely no exercising. I intended to just work a few hours and take some sick time, because of how I felt, but I ended up staying for my usual ~7 hours. Same on Thursday, though I felt a bit less terrible and did 20 min elliptical before work. On Friday I actually felt better, and did 30 min elliptical before work.

On Friday I also had an appointment with the hematologist to see what he thought about my anemia. Remember, I have mild anemia with a hemoglobin of 12.3 and hematocrit of 37.5. Normal for women is 13 and 39, minimum. I have a history of at least 7 years of mild anemia and my family doc thought I should get it worked up with my continuing fatigue and my desire to racewalk competitively. Add in a low white count and mild neutropenia (low # of neutrophils, which help fight infection) and it was cause to get a referral. The hematologist was excellent (and in fact, knows my boss in a roundabout manner), and we hit it off well. He looked me over carefully, took a thorough history, and had good news and bad news. The good news is that I don't have a major hematologic disorder (like, say, blood cancer). The bad news is that I have what they call "anemia of chronic disease", which means that my anemia is merely symptomatic of some other disease process, likely chronic inflammation of some type or some autoimmune disorder. Since I've been to rheumatology (the autoimmune specialists) and they didn't find anything, this is more perplexing. There is something wrong, but no one knows what it is. He suggested an immunologist, perhaps, but the direction is a bit unclear from here. I am definitely going to go back to my family medicine doc and sports medicine doc and see if they have further advice.

Meanwhile, something is very, very wrong, and I have no idea what or how to feel better. It's bad enough now that it is affecting my work and personal life, which is worse than just affecting racewalking. It's bad enough that social media is painful because then I see all my racewalker friends' accomplishments and feel worse. On the bright side, I seem to be over the worst of it as far as my antidepressant withdrawal. I'm still pretty emotional, but the nausea, dizziness, headaches, and brain zaps are gone. Still, it will take my body a while to make more serotonin, and I'm likely to feel fairly lousy for a bit because of that, which is definitely not helping things. I'll get through this, but it's not fun.

a new low

I'm feeling very, very bad.

I think it's mostly because of quitting the escitalopram, but this is the worst the problems have been in years. Fatigue, headache (splitting, in the morning - ibuprofen and acetaminophen at max doses calmed it enough so I could get to work on Wednesday & Thursday).

So...

Wednesday and Thursday - rest days. Just felt awful. Made it through work and all the other required activities, but just barely. To be fair, work has been unusually demanding in terms of attention required (many undergrads in lab) and time (just a lot of experiments going on), which is fine, but adds to exhaustion. Plus our bathroom remodel has demanded a fair amount of decision making power, which is a good thing, but adds in to the mix.

Friday - went to the track, which I was supposed to do on Thursday. Warmed up, and my legs were like lead. I feel like I have to do the workouts now though, because of Spain. But as you'll see, a course correction is in the plans now. Anyway, I did the warm-up, then 3x1km @85% effort (though perhaps I gave it a little more - it's hard to hold myself back). I felt really terrible, and was extremely slow - 6:15, 6:18, 6:22 with HR in the low to mid 160s. Not good at all. This is the worst it has been, and my muscles HURT.

Saturday - rest day, because I just have to. My body feels dead and unresponsive, and I am VERY sore - reminiscent of the weird muscle soreness I had back in 2013-2014. Makes me think that it might have to do with the escitalopram, since the time proximity is correlated. But correlation is not causation, and this might just be a random relapse with nothing to do with the medication change. Regardless, I'm doing some VERY easy trim painting today and some light errands, but otherwise have been resting. Got Calvin and Loren to do some necessary yard work :) but I think I also need to do some laundry. Have also been planning for our trip to Spain, getting some accommodations and asking friends who live there (Jill) or are from there (Paula, our kids' former teacher) for advice, so that's coming along.

On the bright side, the bathroom remodel is coming along, and I'm posting pics of the new windows. We are enjoying them even though it's just a big empty room with lots of drywall dust and a lonely toilet right now!

Track Tuesday

Sunday: rest day. I was SO dead after 12k Saturday PLUS helping a friend move for 3 hr PLUS two major shopping excursions (bathroom tile because we're redoing our master bath, and Costco because I promised a friend I'd take him). Oops. I tried to rest a lot on Sunday but I had some social obligations so my rest was more limited than I'd have liked. I did get good sleep Friday, Saturday, and Sunday nights.

Monday: My body was still tired so I did a 45 min (or so) casual walk with the dogs for exercise. It felt nice to move w/o pushing things at all.

Today: speed work. I was to do a 3K fartlek with the fast segments at 85% effort, 4' rest, 4x500 @85% effort. It's stupid hot outside right now; I woke up later than planned so I couldn't do the outdoor track before work. I slept very poorly because 1) I went to bed too late because I had a meeting re: our hosting for the SL Fellows program next year, 2) there was a massive and loud thunderstorm at 11pm, and 3) Sugar barked on overdrive at something (who knows what? probably a raccoon?) at 2 am. Grim face at left after my workout, at the gym - outdoors was hot behind me (it's only 90F right now or 32.2C, which is not THAT hot for July, but it is no picnic for RW).

I went to work and did a bunch of stuff, then managed to pull myself away for my workout at 11am. I felt dizzy, probably from lack of sleep, but also maybe still a side effect from not taking the escitalopram (my last dose was Sunday the 8th). I had tired, achy glutes before the workout, and I have no idea why - I felt recovered from moving the boxes and from my Saturday workout yesterday. So what the heck is this soreness???

Mentally it was SO hard to stay positive. My inner critic was on overdrive. I tried to shut it up by reminding it that it is not helping me get better. That worked for a bit and then it just kept kicking back in. When I do a workout and am SO MUCH SLOWER than I EVER have been historically, it's so hard to make that voice shut up. It is just painful to do speed work because of it! I swear if there was a good easy way to make it go away, I would. I wonder if the escitalopram helped it quiet down, and that's why it's worse now? Or maybe it's the lack of sleep. It was a most unpleasant workout because of that.

I did keep from doing an all-out effort. I had to keep reminding myself to hold a little back. So...yeah, I was VERY slow.

Converting from the 292.6m track, my fartlek was 19:10.3, with fasts and mediums (585.2m each, converted to 500m times) of 3:02.7, 3:18.2, 3:07.5, 3:18.7, 3:11.5 (!UGH!). My 500m were approximate - I had to make an educated guess based on my lap times where the 500m split was. Assuming I was close, my 500m times were 3:02.3, 3:04.1, 3:06.4, and 3:03.2 (that's similar to outdoors last week, so that's probably about right).

It's hard to shut off the voice that says I'm too slow to go to Spain. It's hard not to compare to where I used to be. It's hard to feel really sick (I'm SO fatigued and dizzy today). I should probably go home early from work and take a sick day but I have stuff to do, and let's face it, work is a higher priority than recreational hobbies like racewalking, because it has to be.

hilly 12k; brain all a-mush

Today went well given the circumstances. I still feel like things are turning the corner though I know from this workout it doesn't look like it. But I have optimism anyway, because I feel like once I am feeling a little better things are going to turn the corner.

I have felt pretty ill the last couple days - avert your eyes and skip to the next paragraph if squeamish. Otherwise, read on....you've been warned. Thursday night I went to bed a bit late (~11?) after reading an e-mail that stressed me out a bit (everything is fine but it was anxiety-provoking). I woke up at 2am because I had diarrhea (probably from the antidepressant leaving my system - this has been a persistent and annoying symptom) and I started thinking about the e-mail and then could not get back to sleep for 2 hours. Then I slept from 4-6 and woke up and couldn't sleep more. I still felt pretty sick.

Friday morning, despite feeling a bit ill (dizzy, fatigued, mild brain zaps, a touch of nausea, sleep-deprived) I got on the elliptical for 20 min, because exercise does help one get through the day even if stupid tired. I think it helped. I made it through a tough day at work and when I got home I crashed for about 30 min. Got up and made dinner, then after dinner I went to bed at 8:00 and went to sleep at 8:45. I slept for almost 9 hours :) and woke feeling a bit better, but still dizzy and fatigued. I have not taken any medication since Sunday night, when I took 2.5mg of escitalopram. I'm hoping to gut it out this weekend and hoping that the symptoms ease by Monday so that I can work.

Today has been stupid busy but I'm sorta managing. The 12K was slow; I did the first 6k alone and then 6k with Calvin and at one point in the last 6k I got really emotional. Poor Calvin got kinda mad at me and wouldn't walk with me again until I apologized, which I did, because I was being stupid. It's just hard to be so slow, and to know I'm signed up for World Masters, and to know I can't train as hard as I want. I'm still going to try. The 12K was 7:02/km for 1:24:30 with ave HR 141. Also, it was warm and humid (for here), at 26.1C (79F) and 42%. (That was at 6:30am...ughhh!).

You probably don't care that then I helped our pastor's family move (Calvin helped too), and then went tile shopping for the bathroom because it's impossible to get over to the showroom before 4:30 on weekdays and the tile place my contractor likes closes at 5. Or that I then took our summer roommate Jonathan over to Costco because he doesn't have a membership and needed some things. Or that when I got home I was stupid tired and I might have yelled at the kids and husband because the dishes weren't done (I'd asked the kids to please do them while I was gone and the husband to please stay on them to do it), or that Calvin put a hot pan lid on our dining room table, which is my one favorite piece of furniture, aside from the piano, and the only really nice furniture that I have ever purchased new, and that it now has an ugly ring (which is admittedly faint but I'm still very angry). I might have gotten very upset and was angry not just because the table is now marred, but also because I do love Calvin much more than I love the table and am angry at myself for being angry at him. I might have had a meltdown while making pizza dough for our homemade pizza (Saturday tradition) and Calvin might have given me a very sweet hug. I told him how I felt and that I love him more than the table but that I'm still angry about the table but also that I'm mad at myself for being mad at him. I think he understands?

It might be time to take a short nap before I melt down more. I'm so tired.

SugarHouse Park - overcast, warm, humid

With the boy I love much more than my table...sigh.....

dragging

Dragging today.

Last night: brain zaps (minor, but annoying), fatigue, diarrhea. Up at 2am feeling very ill, and was awake for ~2hr stressing about various things including the finances for the bathroom remodel (which turns out to be mostly fine now that I've run and re-run the #s, though it's gonna be close...) and the tile choices and other things. Finally went back to sleep.

Got in to work and realized I'd messed up something and will have to work late today and a bunch on the weekend to fix it. Sometimes I really hate research. Actually, it's more that I hate my own stupidity.

Feel dizzy and ill but am trying not to take any more escitalopram. Want to be done with it.

I did 20 min on the elliptical hoping it would make me feel better. It didn't make me feel worse.

It must be Friday the 13th.

Back to work insanity now.

6x500 @85% effort --- feeling hopeful

I'm hopeful. Not because my workout was fast (it wasn't), but because 1) I felt decent during it, 2) I feel good (quite good) afterwards, and 3) I think I might be over the worst of the antidepressant taper. I feel more energetic than I have in a while. Maybe that's just placebo, or wishful thinking, but I feel good.

Calvin came with me to East High and we had the usual football player traffic at the end of the workout. Teenage boys are SO oblivious. Fortunately, when you yell at them "MOVE PLEASE!" they usually oblige (IF they hear you!).

Warm-up was sluggish but I felt more fluid and limber as I went. 1600m w/strides on the last lap.

The workout was good. I told Calvin I thought I'd do 3:05-3:10s but was surprised to do 3:02-3:07. VERY slow historically, but I don't care about that now (at least that's what I'm telling myself). It was warm, at 25C with 51% humidity, but a little breeze helped and I actually felt fine. Didn't feel overheated at all. Had some nice cold water between intervals :). Calvin did 2:15-2:39 (haha he went out too fast!) running. I tried to keep mine to 85% but I'm pretty sure the last 2-3 were a harder effort than that - my HR was up to 163-164 at the end. Still, I felt good, so I'm not worried. I could've pushed harder, so maybe it wasn't too fast?

workout updates

June 25: Easy 5K at Zermatt Resort; 33:12, 6:38/km, ave HR 145. Felt a bit tired, but not bad.

June 26: 45 min elliptical at Zermatt. Felt good.

June 27-29: recovering from huge anniversary party on the 26th (25 years!) and prepping for vacation to Indiana. Stupid busy and stupid tired. Did nothing. Also, feeling pretty ill from not taking the escitalopram; have had to take 2.5mg every few days to just manage, but don't really feel great.

June 30: easy 5K in Grand Junction, CO, where we were camping on the 1st day of vacation. 34:05 for 6:49/km with ave HR??? Forgot my HR monitor :/. My Fitbit says 123 but that's not right...that must include a stop or 2 for photos/rest at 2.5km point.

July 1: rest day - camped in Salina, KS and thunderstorms kept us up much of the night. UGH! I felt lousy.

July 2: easy 6K in Indiana at Laurie's house. SO HUMID. 40:30 for 6:45/km with ave HR 147 according to my Fitbit. Seems close anyway.

July 3: Cross-training - rode Matt's bike outside for 45 min, and went about 19km (11.8 miles). Much more comfortable than walking in that humidity.

July 4: easy 6K in Indiana. Still SO humid. 40:55 for 6:49/km with ave HR 140 according to Fitbit.

July 5: felt lousy. Took another rest day. Just couldn't face the humidity!

July 6: Drove to Peoria, Ill., and met Ollie for lunch. Did 10K at his pace (1:20:53, 8:05/km), which was fine given that it was 27.2C (81F) and 54% humidity, which is high for me (and for Calvin, who tagged along). It was definitely cooler than normal for there in summer, but felt pretty hot to me. I have to do some heat training....(ugh). Maybe when I feel a bit stronger. Then we drove to Keokuk, IA to meet up with my family members (aunt, cousins, etc).

July 7: Finally some good weather! Did 9.5km at 6:54/km and ave HR 131 according to Fitbit, for what it's worth. It was 17.2C (63F) with 77% humidity. It felt really nice out. My legs got really tired at the end, and it was a bit hilly (60m elevation gain along the route), but so nice to do a bit of a nostalgia tour of where my grandparents used to live, and where my parents went to high school. Then we drove all day and camped in Ogallala, Nebraska.

July 8: rest day - driving home! Got home about 6pm and made dinner. Felt very nauseated/headachy/dizzy so took 2.5mg escitalopram. Felt better later in the evening.

July 9: Legs were really off from being in the car so much, but went out for a walk anyway. It was warm at 23.9C (75F) and quite humid for Utah at 54%, and my legs were definitely annoyed with me, and I felt sluggish. 6K at 6:58/km with ave HR 139. In other news, signed up for WMA 2018 in Malaga, even though I'm deathly slow. Maybe I'll feel better by then. Maybe I won't. I won't be last, so I'll probably compete. I'm having trouble getting excited about the trip to Spain, and sorta wishing I hadn't bought the tickets, except that my kids and hubby are super excited to go. Sigh....I was hoping this mystery illness thing would be better by now.

July 10: Knew I had to do some speed work, and am finally feeling semi-human from decreasing the escitalopram (though not 100% by any means). Jim had tasked me with a 5K fartlek at 85% effort for the previous day, but because of vacation did it one day late. Wow, was I ever slow, but hey, I'm just grateful I could do it. 33:30 for 6:38/km with ave HR 152.

July 11 (today): Cross-training. Rode my bike to work, uphill...about 25 min of good cardio. Then home (flying!).

fatigue/mystery illness update

I haven't posted in a year. I realize in reviewing my blog that it's actually quite helpful in many ways to have a record of stuff I've done to address the chronic-fatigue-like illness I've struggled with for the past 5 years. So I thought I'd post again to try and get the ball rolling and get back in the habit.

But where do you start after a year of not blogging?

Well, for starters, I have a bit of time to blog this morning, uncharacteristically. I'm with Loren up at Zermatt Resort in Midway for our 25th anniversary. We wanted a little R&R after hosting a pianist for the Gina Bachauer competition for the last two weeks (SO fun but also SO busy!).  We also really wanted to celebrate 25 years - that's a major accomplishment! Loren likes to sleep in, and I'm a morning person, so I thought I'd blog and exercise before he wakes up. I actually have the luxury of some time to myself this morning, and I'm enjoying that.

A few weeks ago I decided to give the medical professionals another shot at figuring out the fatigue. I have also been having some heart palpitations (for me, this meant an odd, intense heartbeat mostly noticed while lying down before sleeping). These were annoying and I doubted they were serious but wanted them checked out. After noticing them and talking with my friend Sarah (who happens to be an MD), she mentioned that the anti-depressant I have been taking (escitalopram, 20mg) could cause a heart condition called Long QT syndrome. Hmmm. I decided to pare down to 10mg escitalopram and see if that made me feel better. A month later it seemed maybe I had fewer palpitations, and I scheduled a doctor appointment to investigate as well as inquire again about my fatigue issues.

Tests ensued.

Heart - had an EKG and ended up wearing a Holter monitor for 48 hr to get it checked. I have PVCs - premature ventricular contractions - which are not usually serious, just annoying. Cardiologist gave me a clean bill of health. Good news.

Blood - Got CBC and metabolic panel as well has a blood smear (to rule out heel strike hemolysis). That showed my usual slight anemia (I've been slightly anemic with hemoglobin in the 12s and hematocrit 36-38 for as long as I can remember, which is obviously not great for a racewalker but is unlikely to explain the new onset of fatigue, as I have had this a long time) but also a slightly lowered white count with neutropenia. This probably doesn't mean much, but it did earn me a hematology referral. Because my iron (ferritin), B12, and folate are normal (yay for taking iron and B12!) it's weird that my hemoglobin is a bit low (for years it was low probably because my iron was low, but now it's unexplained). Perhaps my bone marrow isn't producing quite enough cells? Or they are getting destroyed by an inflammatory process? So. Something to investigate. I see hematology on July 27. I asked my doc if she was sure she was going to send me there, because my hemoglobin is not THAT low (12.3, and normal is 13 or more). I mean, the hematologist is going to roll his/her eyes that I'm walking in the door for help. She told me to advocate for myself, because I'm an athlete (or a wannabe athlete), and if LeBron James had a hemoglobin of 12.3 you bet the hematologists would take notice. Hmmm. Point taken.

Hormones - yeah, I'm old enough to be menopausal and that can contribute to fatigue, so got things checked. My LH and FSH are low enough that I'm not menopausal. Rules that out. While we're on the endocrine system, I got my TSH checked (thyroid) and it was normal. Rules that out too.

My doctor also gave me a referral to her sports medicine colleague to see if he had any ideas. He did.

We brainstormed and came up with a few things:

1) Lyme disease? Another blood test via Western blot - negative. Good. I'd hate to have that, and though I thought it unlikely (it's not common in Utah, though I've traveled some so that's always a possibility), I am glad to have that ruled out.

2) He agreed the hematology referral was worth a shot.

3) He wonders if my anti-depressant might possibly be the cause of all of this. Well, that is a novel thought. The timing is quite suspect if it took a while for it to begin to impact my training, now that I look at things. I have always had anxiety and am prone to mild depression but just gutted it out for years. Finally at the end of 2010 I decided to try medication, mostly because I felt my anxiety was negatively impacting my children. The medication (citalopram, 10mg) was great. I felt significantly better and things were much calmer around our house, and also my seasonal depression was a lot better, which improved my quality of life. In early 2011 I stopped it for a bit due to pregnancy (miscarried, sadly, even though unplanned) and restarted in late spring just a bit before World Masters. 2011 and early 2012 were my best years racewalking, as my iron was high and the fatigue hadn't started. If the antidepressant took a while to start to cause fatigue this is all possible. Late in 2012 everything nosedived - I had a poor 40k performance that fall (poor in that I was trained for 4:08ish and did 4:22 and felt awful) followed by an injury and a subpar 30k (3:15) due to not being able to train. Then in spring 2013 the crippling fatigue and muscle pain began. When I cut back on exercise, I felt better, and the muscle pain diminished over 18 months or so and hasn't returned, but if I exercise too much now I get punished. I wish I had the timeline better but...I don't...so...continuing, sometime in 2013 (?) I upped the citalopram dose to 20mg because of ongoing depression about racewalking & the fatigue. It did seem to help my depression. In 2014? early 2015? I switched from citalopram 20 mg to escitalopram 10 mg - similar drug, just purer preparation (enantiomer), and same dose. The fatigue didn't change much at all and my training was about the same. Kinda crappy. But I was happier about it at least :)! Last year, I had a lot of anxiety in the late spring and early summer, and my doc recommended upping the escitalopram to 20mg. That helped a lot. BUT...I started trying to train harder, hoping to go to Spain for World Masters, and the training worked to a point but then after that was just completely ineffective. It's the weirdest thing. Nothing my coach and I have tried has worked at all. I train and get slower. It's like hitting a wall. You could argue this is age-related, but it's just too sudden, too severe, and the timing seems quite coincidental. Now, it's possible it's not the anti-depressant. I've gotten all excited about stuff before in the past 5 years - for example, going gluten-free in 2014 (didn't help; negative test for Celiac's), trying no added refined sugar, upping protein intake, etc. So I'm trying not to get all excited about this. It's one more thing to try, and I'm hopeful, but not hanging everything on it.

Going off the escitalopram has been, well, interesting. Took my last dose 8 days ago, on Sunday night (saw sports medicine doc Monday morning). All week I've been very tired, which can only partially be explained by hosting a pianist, I think. In addition I've felt very dizzy, and when I turn my head it takes the world a while to follow. I've had "brain zaps" - hard to explain but unpleasant. Finally, on Friday afternoon I got some nausea and drew the line at that, so I took half a tablet of escitalopram (5mg). Friday night I felt much better. By Saturday night I was dragging again and I'm still feeling iffy, but I think I might be past the worst of this. I haven't had any more nausea, though food has been oddly unappealing at times (and I'm a food addict so this is saying something!).

It's going to be interesting to see if this helps. I expect the timeline to be pretty delayed, so that's a bit of a conundrum, as I also don't enjoy anxiety and depression. Usually the depression isn't bad in summer so that's good. My sports med doc says there are other anti-depressants I can try, but I'm wondering if that's a good idea? I have some time to think about it as he wants me to do a 2 month trial without anything and keep a diary (hey, this blog works! Let's do it!).

So, back to today - exercise: might racewalk and see how it feels. Might do elliptical. No pressure. Just something to keep active and stay healthy. In reviewing my blog, it's sad that it's come to that, but on the other hand, at least I can still do something and for that I'm grateful.

And I'm thrilled to celebrate being married for 25 years to Loren. He's a rock in many ways - his calm to my storm has been a great help. He's a terrific father to our kids, and a steady partner. We've been through a lot together. Here's to 25 more!