Wednesday, November 21, 2012

The Lost Year, or How To: Train At An Elite Level With Hypothyroidism

WARNING: Another largely non-funny post.  Unless you find imagining people 20+ lbs over their usual weight and wearing sweatpants, funny.

One year ago today I completed my first workout back after a full 40 days of no training.  I know that sounds like a firstworldpain, especially since all of my moving parts were capable of physical activity, but the 40-day interruption was rah-ude.  As in rude awakening - to thyroid problems.

There were plenty more such awakenings waiting for me.  For instance, that first workout back - a mere 25 min run - had me walking down stairs like the day after Ironman.  In retrospect, the initial on-set and diagnosis turned out to be the straight-forward, even if frustrating, part.  I knew what was wrong with me.  Now I had to learn to live - and train - with a whacked out gland.

Was I training it, or was it training me?  Anecdotal evidence supports the latter.  

** Get ready to re-write your owners manual.  The thyroid controls the body's energy production and use, and determines how the body responds to other (non-thyroidal) hormones.  The way your body has been doing these things might not be how your body will be doing these things once you start adding the right amount of thyroid hormone T4.  For example, I PMS completely differently: before I didn't, now I do.  [slow clap]

Over last winter as my condition was improving, more often than not, I was spending long hours (like, 4) each night staring at my ceiling for no good reason.  A friend suggested my once-daily-and-only-in-the-morning cup of coffee might be the culprit.  The next morning I switched to decaf and never went back to full octane.  I stopped having random, but major, episodes of insomnia, and more tellingly I didn't even notice, not even that first morning, not having a caffeine bump.  I've had maybe 3 on-purpose caffeine doses since April, and I choose every caffeinated gel or cup of real coffee weighing the short-term benefits against the consequences of not being able to sleep.  For a while I kept drinking a morning decaf because coffee was part of my routine, but over time, I have stopped drinking coffee all together.

I know, I'm ashamed of me too.

I suspect that as my thyroid function improved, the way my body metabolizes caffeine changed - for the worse.  Although I haven't experienced anything else quite as noticeable, I don't see why other thyroid patients couldn't see changes in how their bodies react to common allergy-inducing foods such as lactose, soy, nuts, or wheat/gluten.    

And in another chalk-one-up-for-opponents outcome, I have experienced acne this past year worse than any other period in my life.  Including when I was a teenager and was supposed to have acne (but had none).  I can only assume that it has to do with how my skin is expressing the internal re-balancing of androgen hormones.  I can only hope it goes away soon.

** Weather is no longer just a situational descriptor; weather is now a tangible training in-put.  If you can see the heat in the air or cut the humidity with a knife, your thyroid feels it.  When the Texas heat hit its stride in July I was extremely heat-acclimated and enjoyed some of my best sessions all year even in the mid-day sun, but my TSH (thyroid-stimulating hormone; the main oil-stick to determine thyroid function; the closer to 1, the better) doubled in less than 3 months. 

** Regulating a thyroid is like steering an air-craft carrier.   You start to turn the ship five miles early and only see the results five miles later; what you did three months ago shows up in today's test results, what you do today shows up in test results three months from now.  And never take your hand off the tiller.

By changing nothing but the weather, by the end of July, my TSH had doubled since the end of March.  I felt fine, but if the current trend continued, I soon wouldn't.  But since any blood test is just a split-second status update, was I in the middle of a continuing trend up or a stabilizing swing down?  Knowing how to change my medication means finding out which.  Finding out which means waiting a month and retesting at the end of August.  At the end of August my TSH is lower, but not near what it was in March and not enough lower compared to July to suspect that without changing my medication I will get back to where I was in March.  So we change my medication, and wait 4-6 weeks (until mid-October) to test and see how I have responded to the change in dose.  Fortunately, my mid-October test showed I was now in a medically-induced down swing.

It had taken 2.5 months to undo what it took 3 months to do, and before that it took 4 months to undo what may have been slowly simmering for a lifetime before boiling over in a chaotic two weeks.

I once told my PCP that I would prefer to have diabetes.  No offense to diabetes sufferers, but some aspects of that disease make it less stressful, in comparison.  Blood sugar can be tested as many times a day as you want to prick your fingers, and the results are available in seconds.  TSH changes so slowly that testing more often than once a month is a waste, and then the results take 2-7 days to receive; every other second of every other day is free to be spent wondering what your TSH is and worrying that it is going in the right direction.  Both diabetics and thyroid patients can choose to make positive changes for their health on a daily basis, but diabetics get to know almost immediately what good, if any, those changes are actually doing.

** Getting back on track has nothing to do with luck.  Occasionally (at least externally, the internal dialogue tears out a lot more psychic hair), I get a little "I want it all, right now" to my coach.  I'm not even talking about doing races, racing races, or winning races, I'm talking about simple things like being able to train for more than 3 months with the expectation of my TSH remaining stable.  He does a good job of not getting too exasperated (at least externally), but on one occasion he slipped and offered a bit of realism: "The fact that you are even back training at this level - EVER - is amazing.  Give me some credit."

And he's right, I should.  I do the physical work, and probably worry enough for both of us, but without some semblance of medically-logical guidance, all the work in the world only gets me back to where I was in November, 2011.  Literally.

His Hippocratic Oath has saved me on at least one occasion.  When I receive test results which are equal parts promising and distressing, of course I see the promising and think "pedal to the metal time."  He sees the distressing and says "I can't in good conscience build your training right now."  At least for dedicated athletes, thyroid patients need someone to say "no" more than they need someone to say "yes."

Diagnosed or not, ill-managed thyroid problems combined with more work only continue to dig the hole; I could easily be in a worse place in November, 2012, than I was a year ago.  I could weigh even more than the 175 lbs I did and could be wearing even larger sweatpants than I was.  I really couldn't be training even less than I was, though.

Instead, I need to be ecstatic that training-wise and pants-wise I am back where I was in August, 2011, which was before I even knew the storm was brewing.

** The worst small talk in the world is "so when is your next race?"  The "easy" part of a bike crash or running injury is that they present a visible evidence.  Crutches are a convenient way to tell everyone just how soon you will be racing.  For an athlete, physical accidents provide a distinct reason why "I trained yesterday, but I am not training tomorrow." 

Internal problems don't come with a brace, and leave no one, athlete or observer, with a good explanation of why or how or when or "please coddle my broken [insert body part here]."  In fact, when I was at most darkest, I cynically imagined that when I answered "so when is your next race?" people were hearing "blah-blah-bla-blahdy-blah" come out of my mouth.  They wanted a date and a name and nothing more.

Physical or external problems are just part of the sporting culture, and for better or worse, come with the expectation that the injured party will recover in an acceptably short amount of time (say six months on the outside) and get on about their business.

Of course we have the stupidity... nay, naivete...nay, audacity to believe that because we are young and resilient and have bounced back quickly before - and because we have found a way to be able to train, no matter what, every single day before, up to and including, this one.  And because by the time six months comes around the injured party is so bored and frustrated they get back to it on a partially healed body part (repeat several times until they are irrevocably broken and simply give up the sport.)

[buzzer] Times up.  Recover and get back to racing, or heed your expiration date and be gone.

Well, ask Joanna Zeiger or Julie Dibens (November 2011 Update) how that has worked out for them.

In retrospect, I too shared this mildly hysterically short-sighted view of my own situation.  I thought my thyroid would get back on track after a short interval, and things would move on down the river.  I mean, coming off 40 days of no training, I knew I wouldn't be race-fit by March, but I thought "late summer, for sure."  I had the audacity to actually expect and believe that simply because nothing else had ever side-lined me for that long before.

Then again, I had never before dealt with an ephemeral internal problem that came with a comical thought bubble containing "blah-blah-bla-blahdy-blah." 

** Plan to not have a plan.  Last fall I certainly did not plan that it would take an entire year to get my own body back under some semblance of control.  However, Karen Smyers not withstanding, I probably should have expected such a period of time as others' anecdotal evidence suggests 12-18 months is a healthy minimum of time.  Several friends have spent years re-balancing their thyroids and associated endocrine system, interspersed with various bouts of elite-level training, no training, and functional inability to train (aka "injury"), as caused or allowed by internal hormone shifts.

My totally non-medical opinion about why it takes 12-18 months is that a person can't get their thyroid back under control without knowing the new rules, and they only know the new rules by writing them from scratch.  A complete year takes an athlete through every cycle of their training season, and every cycle of the weather season, allowing them to figure out how their thyroid deals with each combination of training load and seasonal weather.  It takes getting each combination right or wrong once, in order to get it right the next time around.

** All stress is relevant.  I mentioned this in my previous post and heard it from several doctors, but it bears repeating (if only so I can discount its relevance in the next sentence): the end-game for thyroid treatment is hormone stability, under normal stress conditions, where stability is defined as a TSH close to that specific person's TSH pre-on-set, which is maintained between tests spaced up to a year apart.

 I think, again in my non-medical opinion, that specific end-game is a craps shoot for (elite) athletes.  Our daily currency is physical stress; our bread and butter is the constant and consistent application and unloading of a varying training load.  What are my "normal stress conditions"?  I have no idea!  Today it's a massage, tomorrow it's a six hour bike ride, and the day after that it could be a track workout.  Sprinkle in a month of Texas heat, and my only guaranteed outcome is that I will have a great tan.

However, I do believe there is an appropriate end-game for (elite) athletes.  It involves hormone stability through vigilance - with an eagle-eye kept on your "tells" such as acne, hair lose, weight gain, sleep irregularity - and more-frequent-than-usually-recommended tests timed to precede big changes in training and during long blocks of training to see how the thyroid is coping - with an understanding that every single bit of stress now "counts".  Your thyroid can't anticipate and respond to those every-single-bits, so you have to learn how to do anticipation and response for it.

Know how I know that?  I just spent a year learning it.

Just like those friends of yours who have had a bum Achilles for years, know on which day of the full moon they can do their long run if they wear two different shoes, use ivory orthotics, and take two steps with their left foot for every step by the right.

Time for my do over of 2012.  It's called 2013.

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