Waiting for erythropoiesis, and fall running plans

Two weeks into iron replacement therapy (using Floradix, which seems to be pretty good stuff), labs suggest things are slowly heading in the right direction. My hemoglobin has gone from 8.9 to 9.4, hematocrit from 28.4 to 30.4, and ferritin from 6.8 to 18.2. All of these are still too low, but we're going the right way. I haven't yet noticed much change in my exercise tolerance, though things certainly aren't getting any worse. Still, I'm ready for some more erythropoiesis. NOW.

I've been continuing to run, trying to strike a balance between training as much as I can reasonably do, and not getting injured, totally wiped out, or stuck 5 miles from home and in death-march mode. Results have been variable. My training log is sort of tragicomical:

Aug 29 (2 days after diagnosis): Run 2 very slow, painful miles, then walk 1.6 back home with moderate left plantar pain. Notes on run: "Ugh."
Aug 31: 30 min hill repeats. "Felt decent!"
Sept 2: Run 2 hours at Lebanon Hills. Cool temperatures. "Felt pretty good."
Sept 3: Run 5.4 mi, including some extra walk breaks. "Decent at beginning, tired by end."
Sept 4: Spin class, lots of biking around town.
Sept 5: Run 2.4 slow mi. "Tired again."
Sept 7: Run 4 hours at Lebanon Hills with a friend training for TC Marathon. Took some long walk breaks about 2 hours in, but then was able to run-walk again at the end. "Felt OK."
Sept 9: Run 2.6 mi, a little faster than I recently have. "Decent."
Sept 12 (today): Run 4.2 mi in beautiful, crisp, cool weather. "Felt pretty good."

Sweaty post-4-hour run picture with Deena last weekend.
She literally ran circles around me!

So to summarize: a bunch of short, mostly not-great runs, punctuated by two decent, longer efforts on the trails.

All this brings me to the question of whether the TC Marathon is still feasible at this stage. We're about 3.5 weeks out from it, and my original schedule (modification of Higdon's Marathon 3) had me doing my final 20+ miler this weekend, then taper. (Obviously, I've also missed/drastically shortened lots of those midweek long-ish runs (up to 10 mi) and not done anything resembling speedwork or a tempo in ages.) I'm certain I could complete the race, but would it be a good idea?

Other non-negotible events on the calendar include this Saturday's Babes in Bikeland, a fantastic women's alleycat bike race, and next Saturday's Surly Trail Loppet, which I love because (a) it was my first trail race, 2 years ago; (b) it's right in Minneapolis and I can bike there; and (c) it's sponsored by my favorite local brewer, Surly, with beer, bratwursts, and music at the finish line.

Oh, and there's the small matter of Wild Duluth, a trail 50K I'd really like to do two weeks after TC Marathon... oh, and then the Icebox 480, an 8-hour timed race in early November.

Lots of good stuff is coming this month and next (and next after that!) and I want to be healthy and enjoy as much of it as I can. So here's the tentative long run plan (with the usual weekday runs/biking/lifting/core as feasible, and assuming my hematopoietic system cooperates):

• This weekend: A shorter (2-ish hour) long run, then Babes, which last year felt pretty much like a 3-hour fartlek, only the next day instead of sore legs I had sore deltoids and forearms.
• Next weekend: A long (2-hour) warmup, then the Trail Loppet Half Marathon to make a 21-23 mile long run.
• The following weekend: Traveling to Salt Lake City for a conference. Attempt not to run excessively on amazing looking trails that start right in the city. But definitely some running, because dang.
• TC Marathon weekend: Either run the TC Marathon at training run pace, or 5+ hour trail run, probably at Afton. I'll decide a little closer to time which it will be.
• The following weekend: Taper. Seriously.
• The weekend after that: Wild Duluth 50K.

Whew! That's a lot of planning. And all pretty provisional. But I'm okay with keeping things tentative. I would love to do the TC Marathon some day, but if that's not this year, it's okay. I really want to get a fall marathon or 50K race, but I have several chances to do that if TC Marathon doesn't happen. (Even if Wild Duluth doesn't happen, I think I can do it at Icebox 480). I want to feel better and run with my friends and not be injured and have fun running. Those are my big goals. I think I've got them covered with this plan, regardless of how the little details shake out.

Run funk explained!

After four weeks of lousy runs (albeit in beautiful settings), I'd had enough. I made an appointment with my PA. "Why are you being seen?" asked the nurse. "Decreased exercise tolerance," I told her, slightly embarrassed. After all, I'd run 30+ miles the previous week (slowly and painfully), and had biked to the appointment. Still, that was the problem, and that was why I was there.

Luckily, my PA was a marathoner (until she had hip replacements) and is an endurance swimmer. When I told her I just couldn't run like I had been a few weeks ago, she got it. I wasn't sure what to make of the other symptoms I'd had (leg cramps, salt craving), but mentioned those too. "Maybe it's just the heat, maybe it's overtraining, but I just want to make sure it's not something else before I ramp up again," I told her.

She did a physical exam (normal) and ordered some lab tests. We started with a reasonable set of tests for fatigue: a complete blood count, basic metabolic profile (chem-7), thyroid tests, and a urinalysis. The clinic runs some basic tests on site, so I only had to wait 10 minutes for results from the CBC, metabolic profile, and UA.

"Well, I see why you're having trouble running!" she announced, coming back into the exam room with a printout. "I think that 11 mile run with these counts was pretty heroic!" I'd had a CBC two months ago as part of my hardware removal pre-op physical, so we had a baseline to compare the numbers to. My hemoglobin had dropped from the low end of normal (11.7 g/dL) to well below normal (8.9 g/dL), a 25% drop! Hematocrit and RBC count were down similar levels, and my MCV (average red blood cell volume, which decreases in iron deficiency anemia) was still within normal limits, but significantly lower than it had been.

She added on some iron tests, which showed evidence of pretty marked iron deficiency -- my ferritin was 6.8 (normal is 10-300), iron was 14 (normal 40-150), iron saturation 2% (normal 20-50%), elevated transferrin and total iron binding capacity. Other test results, including the metabolic profile, thyroid tests, and UA, were normal.

Here's the weird thing (or maybe not): Yes, this is alarming. Yes, we're working me up for GI iron loss. But my first reaction was: I feel so validated. Four weeks of crappy running -- explained! Salt craving -- explained! General feeling of being in a funk -- explained? Maybe. With a clear diagnosis came a clear course of action.

I've started taking a funky iron + herbal supplement called Floradix, recommended by my PA. Good iron bioavailability, no bad GI effects (constipation) that iron pills typically cause. Because I don't have a diet that's obviously iron deficient (I'm still eating pretty close to Whole30, with lots of vegetables and meat, including beef 1-2x/week), we're concerned that I may be losing blood in my GI tract, so we're working that up. (It's a little bit of trouble, but beats the heck out of missing a colon cancer or gastric ulcer).

It supposedly takes two weeks to see a measurable effect of iron supplementation on blood counts. I've been taking iron for 9 days now. Hard to say, so far, whether there has been any detectable change. I ran 2 hours easy on Labor Day at Lebanon Hills, and it was fine. (The cooler weather certainly helped). Did a couple more runs this week that were so-so. I'm impatient. But now that I have an explanation for run funk, I'm also hopeful.

This was a very very wordy post, so I'll finish with some gratuitous pictures from our Outer Banks vacation. Those boys played hard in the water! It was a great trip.

Vacation running, and the run funk

It's been four weeks of bad running around here, starting the week I ran at Afton. During that run, I had no gas in the tank, walked the hills, felt wiped out. The next day I tried to run trails with some friends and, even with them going slow for me, still dropped out after 30 minutes. No energy.

I rested. Didn't run at all for five days. Heck, I even took a pregnancy test, just in case. (Spoiler: it was negative.) Did 11 road miles with a friend training for the TC Marathon with me, and once again I was spent.

What was going on? I increased my carb intake, got more sleep, did some yoga and strength work instead of running. I was getting muscle cramps at night and I craved salt. I put together a very mediocre week of vacation running in western Minnesota, then a decent week of running here (including a 3.5 hour run at Lebanon Hills and the Endless Summer Lebanon Hills 7 miler). 

I headed to the North Carolina coast on vacation last week with plans to try and get an 18-miler, to continue my marathon training. But once again, I just couldn't put together a decent run.

The temperature was 70s to 80s and muggy, with a breeze on the beach. The scenery was certainly beautiful. The first full day there, my mother and I set out for a run from our rental house in Duck, NC, on the Outer Banks:

We headed up Duck Road (the only north-south road that far north on the island), and quickly found the boardwalk that skirts the sound. :

This part led right down into the sound.

The boardwalk goes for maybe half a mile, along the town of Duck.

Lots of trees with wet feet. The sound is freshwater, ever since the northern end of the island sanded/silted over in the 1800s. Geology is happening in real time out here.

Live oaks grow all over the Outer Banks. They're cool old trees.

Wetlands bordering the sound.

After the boardwalk ended, we continued north on the much less charming highway. We were in good company -- the whole area was jammed with runners and cyclists (everything from serious looking road cyclists to families on beach cruiser rental bikes). But by the time we turned around, 25 minutes into the run, I was already getting pretty tired. (And it wasn't the speed -- Mom's running motto is "Old, Slow, and Persistent"). By the time we were back to the boardwalks, I was taking frequent walk breaks. Maybe it was the heat or humidity, maybe it was being tired from traveling, but whatever it was... the run was not happening. I tried three days later and despite starting in the comparative cool at 6 am, I couldn't even put 5 minutes of running together.

I did get some nice sunrise pictures, though.

So after that, I pretty much gave up on vacation running. Oh, I did some yoga and bodyweight strength work (squats, lunges, calf raises, planks). We were certainly pretty active, swimming in the pool and ocean almost every day and riding bikes. I caught up on sleep, read a trashy book, played games with my family, and got a lot of sun (but avoided sunburn). It was a good vacation. It was actually a very good vacation.

When I got back this week, though, I called my doctor for an appointment. It was time to figure out what the heck was going on.