Saturday, December 17, 2011

The Enemy Within

A lot of the content I post here is witty, or tries to be, or entertaining, or tries to be, or educational, or tries to be, while also accurately portraying the ups and downs of my job and life(style; but admittedly without much style).  But some things you just can't make witty or entertaining, some things are just plain confusing and icky and drive you to pull your hair out - or in my case recently, lose it.

Back in early October I was preparing for my third and final IM of the season, anticipated to be in Cozumel.  I wasn't breaking any land speed records, but I was getting the day-to-day done, although some sessions were truly ugly.  Several weeks in a row I was at the gym on Sunday afternoon, doing the same session, and thought I would try this new-fangled idea of weighing oneself on a regular interval, on the same scale, to track weight.

Coincidentally this was at the same time I gained 20 lbs in two weeks, without trying.  I topped out at the heaviest I have ever been, even counting that winter I learned to lift weights alongside my high school's football team, and tri kits purchased for racing season no longer fit.  Hauling around all that extra weight made running painful, and soon I was in no shape to continue training, let alone build to IM training.  I have never really wanted to be pregnant, and this particular transformation pretty much cemented that sentiment. 
Clearly things were not as they should be. 

I have said before, in this space, that a human being in training is a machine delicately balanced, a balance with which the human involved is intimately familiar.  Bonk coming on?  Period a few days away?  Muscle about to pull?  Chiropractic adjustment needed?  I for one, can feel these before they happen.  Many of the reasons the machine becomes unbalanced are external, which while frustrating, are, at least, "see-able."  When something inside becomes unbalanced, it's not only frustrating, but also "un-see-able."  So ends the season and so begins the hunt and so crops up the road-blocks.  

One simple blood test and it became obvious hypothyroidism is the likely culprit.  Something PubMed, Google, and I had already diagnosed.  Who needs an MD when the internets clearly have all the answers and never lie? 

But getting an MD involved wasn't all rainbows and unicorns. 

The problems I ran into were 1) not having health insurance, and 2) doctors who did not see my problem as being "big" enough - some weight gain and slightly-off test results wouldn't be as big a deal to someone who works at a desk - and 3) doctors who did not understand that tests completed after three weeks on the couch did not accurately represent my "normal" life.  

In the middle of all of this, I started speaking with prospective new coaches.  "Hi, I race professionally, but will likely be diagnosed with a chronic illness, not to mention I weigh more right now than I ever have before.  I swear I am doing everything I can to fix this situation with all haste, but it will still take some time.  So...any chance you might interested in coaching me?"  There is a reason I don't sell cars.

I chose the path I did partly because he is an MD (but not my MD) and he offered an apt analogy that put things into realistic perspective.  
"Everybody owns a station wagon.  They are really familiar with their own station wagon, because they live in it, literally.  They know which door handle sticks and which window doesn't roll down all the way.  Doctors are familiar with the users manual for station wagons.  Then you walk in with a Ferrari.  A Ferrari operates generally the same way as a station wagon - engine, four wheels - but its tolerances are different, its up-keep is different.  You need to find a doctor who understands Ferraris."

Six weeks after I had pulled the plug on my season - the week before Thanksgiving - I had Googled to the ends of the Earth, learning more about my body than I ever thought possible, and started a forward-looking treatment plan.  The PCP I finally found proved to be the problem-solver with which I had hoped to work: someone who understands my particular needs and is willing to say "we will try until we get it right, and within the context of your normal life."

Now, a synthesis of things I have learned, because this sob story had to at some point turn witty, entertaining, or educational [DISCLAIMER: Please do not misconstrue what follows as actual medical advice.  Find your own MD.]: 

Hypothyroidism is like diabetes, but of the thyroid rather than the pancreas.  The thyroid system - which regulates energy creation and metabolism - doesn't have as much of the hormone, and various in- and out-puts, as the body needs and the body's metabolism slows.  A slow metabolism means that a 3 hour bike ride burns the calories of a 30 min bike ride, for example.  The symptom list includes: fatigue and weakness, swollen joints and muscle aches, bloated face and constipation, hair loss (women are particularly likely to lose the outer half of their eyebrows) and brittle nails, depression and sensitivity to cold, abnormal menstrual cycles and sudden, unexplained weight gain (bingo!).  I also had more-than-usual hair loss (though not my eyebrows), and I *think* some joint pain and maybe fatigue, but being knee-deep in IM training who can say they weren't just what I deserved.

Estimates vary, but some researchers think 10 million Americans - many of whom do not know it - suffer from low thyroid.  As many as 10% of all women may have some form of thyroid hormone deficiency. 

It's treatable, but not curable.  Once the thyroid in unable to make as much hormone as necessary, you will always have to replace some or all of it via pill.  Unlike diabetes, people with thyroid conditions take one pill per day, and complete blood tests anywhere from every four weeks to once a year, depending on how stable their medication and physical symptoms are.  Because every human body requires a different amount of thyroid hormone even when the gland is working perfectly, every bum thyroid is circling the drain at its own unique rate, and synthetic hormone is available in numerous increments, the general approach to treatment is "start low and test often," until such time said lab results and physical symptoms become stable.
Interestingly, the list of things that can make a thyroid start to circle the drain is long, but does not include increasing amounts of physical training stress, per se.  Meaning, my thyroid did not stop working just because I train "a lot."  Some people are born with under-functioning thyroids (think Type 1 diabetes) and some go bad because of an under-active pituitary gland, pregnancy (or significant shifts in reproductive hormone balances...hello, 30!), radiation exposure, severe iodine deficiency, or auto-immune-induced inflammation.

This last one is particularly notable in light of recent diet fads and gender-specific responses to these diet fads.  An auto-immune response means the body fails to recognize its own tissue, and attacks it, with T-cells and whatnot, and causes tissue-damaging inflammation.  So hypothetically, a body can - and sometimes does - attack its own thyroid just because.  However, some foods - gluten, dairy, some nuts - are "inflammatory" because they engender an auto-immune response (an allergy; i.e. celiac disease) in the human body.  When someone with an allergy, even a mild one, eats the offensive item (say, gluten) their body's auto-immune function kicks in and attacks the food culprit and the greater digestive tract.  Unfortunately, other delicate parts of the body get caught in the cross-fire: the thyroid becomes inflamed as well, its cells get damaged, and the gland starts circling the drain.

The gender-specific response - and this next part is the most adamantly not me providing medical advice - relates to the insidious inclusion of soy in the modern American, high-protein, low-carb diet.  Soy naturally contains lots of estrogen, which women already have enough of, and isoflavones.  Some researchers say "great, bring on the isoflavones!"  For example, how many dry cereals, historically made of grain and full of carbs, now boast (inexpensive to manufacture) soy-based protein?  Other researchers believe that, in abundance, estrogen and isoflavones attack thyroid function directly and/or build up to levels so toxic the thyroid's function is suppressed through a chronic imbalance of its in- and out-puts.  The jury is still out on what, if anything, soy does to thyroids, especially in women, but both sides have enough ammunition to fight a civil war for some years.  Until then, my nutritionist and doctor have me off the (soy) sauce.  My nutritionist actually referred to tofu as "flavorless chunks of lard."

Of course, the rest of the body tries to cover for the failing thyroid and right the ship.  Some, but not all, testable levels will be off.  [It is important to understand that "normal" levels are just ranges, designed to include a decent number of the five billion variations on a single theme.]  Some doctors are unwilling to treat thyroid issues in these cases, but their hesitation can mean that we station wagon owners never learn that something we think simply comes standard with a used car, is really something a little spit and polish will fix.

Another aspect of hormonal - thyroid, insulin, estrogen, etc - imbalance is what "normal" truly means, especially with regard to test ranges.  It is far more important for a single patient to be "normal" relative to themselves - meaning, to their own previous test results - rather than relative to a range dictated by who knows who and how many of them.  In this respect, my own general good health has come back to bite me in the ass.  Before this fall I had never had comprehensive, in-depth blood tests.  Before this fall, my last true, non-gynecological physical was...twelve years ago? fifteen?  although more likely, never.  So instead of numbers from previous blood tests, the only basis for "normal" my PCP and I have to go on is that before this fall my hormones were balanced enough to keep me from gaining 20 pounds on a whim (although my metabolism may have been off kilter somewhat).  The only reasonable short-term goal for a return to "normal" we can have is reaching my pre-fall weight and regaining an appropriate weight control mechanism, meaning I lose what I burn and I gain what I don't burn.  The simple idea that supports New Years resolution makers the world over, but an un-checked thyroid condition makes even that a pipe-dream. 

Over the years, who knows what will happen in me, and in others.  My thyroid may never get any closer to the drain, or it may takes years to get there, or it may fall in tomorrow.  And it could have been getting ever closer to the drain since I turned 3, for all I know!  Not to mention that each of these scenarios represents a completely different treatment and testing plan.  Which is why I was so determined to find a problem-solving doctor and a coach with an MD.  Essentially, it's the educated guessing game of medicine on top of the educated guessing game of training, and I wanted people on my team who know how to make educated guesses.

But the message I want everyone to leave here with is this:

** Thyroid conditions are not a death sentence.  Heck, the longer I "have it," the more people around me I find out "have it" too.  My training partners, my massage therapist... Karen Smyers doesn't even have a thyroid! 

** Thyroid conditions and elite-level athletic function are not mutually exclusive.  See: Karen Smyers...and probably a lot more people than you or I think.  If fact, admitting you have a problem and getting treatment, will probably bring about higher level athletic function because your body will finally be operating in balance.

** You are not alone and you are not diseased.  I will admit that when I first seriously considered the reality of having a thyroid condition, I felt alone, the extreme over-abundance of internet chat-rooms and forums not withstanding.  "I broke myself and now I am doomed to regular blood tests and a daily pill...for-e-ver."  Add to that the alienating language and terminology involved in applying for health insurance - "pre-existing condition" my a$$, I bet I am still healthier than 95% of all Americans with health insurance - and I felt not only alone, but also mere steps from uselessness and the grave.  You are not alone...because I am here!

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