Friday, May 3, 2013
I guess the title of this post pretty much says it all. It’s been a combination of things, I guess. Life, basically. Plus, I have to get together with the webmaster and figure out how to update things. I’m so not a tech-savvy blogger. But, if you show me once, I’m usually good to go. Just got to find the time to meet up. Ugh.
Well, I ran a 50 miler about a month ago. It went pretty well considering that I did a not-so-smart, 10 week, couch-to-50 miles training plan. Okay, so not exactly from the couch. Let’s say it was desk-to-50 miler. When I got the email that said race day was 10 weeks away, I had only run 13 or 14 miles for my long run. I had that huge base, though, from the training for the race in October and I think that’s what got me through. I ran 7:20. All went really well until about the last 10 miles of it, when I had 3 lows in a row that hit so fast I had to walk for a bit to get some carbs in me and get my blood sugar up enough to start running again. Walking does a number on that pace. Oh well, I’m still happy with how it went.
I’ve also been thinking about future plans. I’d like to do more coaching and such, specifically with diabetic runners. I think if I can find a sponsor (or two or three), I could start something up. I guess I need to do more than think about it, though. To be honest, if I could make it work out financially, even just barely, I’d be all in for working with the diabetes community. I’m tentatively scheduled to go to the Diabetes and Exercise conference being put on by Insulindependence in August and I’m going to the International Diabetes Federation’s World Diabetes Conference in Melbourne in December. And, I’m thinking about trying to “donate” a marathon coaching plan to the JDRF Gala/Auction in DC in November (I haven’t told them that yet because I’m still trying to figure out how I’d make it work). I have a few races I want to work in, too.
Over the next week, I’m going to draft a set of posts on running and diabetes. I’ll put up the list of upcoming posts so that I feel obligated to get them up in a timely fashion. Since the email for the site is still effed up (ala me and my own techno-dumbness), you may want to post questions as replies. It seems like most people prefer to send an email. I shudder to think how many emails I’ve missed whilst the site’s email is down. I will see if I can at least try to view a list of what may have come in … but that may not work either.
You can follow me on Twitter. I’m @MissyFoyRuns. Or not. I don’t really have very many brilliant things to say. I’ll stare at the screen trying to think of something witty and then give up and post something lame, like today: I want a new pancreas please.
Okay, so that’s where things are right now.
Tuesday, October 23, 2012
Des Plaines River Trail Race 50 Miler – October 20, 2012
I went to Chicago with big goals. The short version: I didn’t meet my big goals. While I’m incredibly disappointed with how the race turned out – or, rather, didn’t turn out – I still feel fortunate to be in a position to take a stab at something as big as a master’s world record. And, I think that I’ll be able to turn things around and take another shot at it. But, first, inquiring minds want to know what happened.
The race started out fine. The first mile, I cruised along and felt light as a feather: 7:10. The second mile felt the same: 7:06. I decided to force myself to slow down a little because 7:00 to 7:15 miles were fine, but if I picked up the pace at all, I would be toasted. I slowed it down closer to 7:30 for a few miles and still felt good. But, around mile 8 I started to have a little bit of lower GI upset. Okay, I thought, I’ll just pay attention and hopefully it will be one of those funny little things that come and go in an ultra-marathon. Within another mile or two, it had gotten worse. I went through ten miles in 73:31 and the pace still felt very easy. I was barely even breathing hard.
I had to make a lower GI upset pit stop right after the ten mile mark. Okay, I thought, maybe I’ll start feeling better now. In the next five miles, I had to make two more pit stops for the same reason. By mile 16 (1:59:04) I knew that I wasn’t going to be able to run through whatever was going on. And, even though I was getting in lots of fluid with electrolytes, I could feel that I was getting dehydrated. I was losing too much fluid with the lower GI problem. My quads started to get sore. I felt cold and then hot and then cold ….
This is the point in a race where you start to wonder if there is anything that is salvageable. I tried slowing the pace. I tried singing to myself. I tried drinking fluids more slowly. I tried everything I could think of while still moving forward. And, as luck would have it, right after the 16 mile mark, there were no more mile marker signs. I had no idea how much I had slowed, so I just kept going forward. Oh well, it was no use to look at my watch.
Somewhere around mile 21 or 22 I had to make another lower GI pit stop … good grief, would it ever end?! I heard some cyclists rounding the curve behind me and heard them exclaim, “Yes! It is! Ha ha ha, you’re right ….” Could it get any worse?! Not only did I have this GI problem but now some cyclists had come around the corner and spotted me and were laughing. I started back running and just wanted them to go on by. But, of course, as they drew closer I could hear them slowing down. I wouldn’t look over because I was too embarrassed. And, then, one of them says, “Hey Missy.” I turned to look and it was my teammate Bob Schrank! And his wife, Joy, was with him. What a blessing! And, an even bigger blessing was that they had been so animated because they had spied a TT1 jersey and knew it was me! I was embarrassed for nothing – even more joy!
I told Bob and Joy what was going on. They asked how everything else was. That’s when I realized that my right foot was in terrible shape, “I think my right foot is bleeding.” Bob replied, “It can’t be too bad because your shoe isn’t red on top.” Okay, that’s one way to look at it. Bob rode up ahead to the Wadsworth Road canoe launch where my crew was waiting for me. It would be the 26.4 mile mark. By then I was nauseous, too, so there was no way that I could continue. With diabetes and insulin, nausea is a race stopper because if I can’t take in fluids and carbs, I can’t continue running. It was over. Joy rode with me while Bob rode up ahead. Joy was great company and it was so nice to have her stay with me. I have to admit that I think I now have the biggest girl-crush on Bob Schrank’s wife! She is funny and witty. She is super nice. She’s so cute.
I arrived at Aid Station #9, mile 26.4, at 3:18:08 and stopped my watch. I paced around for a few minutes to quell the nausea a bit. Then, I sat down on the ground and took off my shoe to get the blood out. The two toes on my right foot that were bleeding had been the least of my concerns with the GI problems. Bob Schrank took a picture for me. Leave it to my teammate to think my bloody foot was cool!
To say that I’m disappointed is an understatement. But, I think I can still share some great information about my prep for the race, my training, and my post-race recovery. I also want to emphasize that, as always, I was very cautious about my decisions during the race when I started to have GI problems. I decided to continue after my GI problems began because at first I could still take in fluid and carbs and because my blood sugars were remaining stable. As far as the foot problem, it was related to a blister from a few days prior and the taping job that had cut open the neighboring toe. That’s not so much an injury as it is a discomfort for which everyone has their own personal breaking point. It’s not a show-stopper in my book. I had to go through a continuous process of evaluating and re-evaluating things when I started to have the tightness in my quads because I knew that meant I was getting dehydrated from the GI stuff. Once the nausea showed up, I knew that was it. I will run through a lot of things, but trying to run through nausea when you are on insulin is not wise. If you can’t take in fluid and carbs, you are placing yourself in a dangerous position. Nausea is a race-stopper for the longer events.
Despite the disappointing end, there were some really positive aspects to note. For instance, I’ve learned over the years to be intensely disciplined about my blood sugars leading up to race day. Good blood sugar control in the days leading up to a big race can make a huge difference in how I perform. I’ll give a short summary. On Thursday, two days before the race, my blood sugars were 102 at wake-up, 68 after a 13 mile run, 168 after lunch, 107 at dinner, 188 after dinner, 77 after 32 minutes on the elliptical, 109 at bedtime, 63 when I woke up in the middle of the night. On Friday, the day before the race, even with travelling my blood sugars were near-perfect. My blood sugar was 93 at wake-up, 139 after breakfast, 111 on the plane, 96 after the flight, 139 after lunch, 70 after a 10 mile easy run, 111 at dinner, 109 after dinner, 92 at bedtime, and a 46 in the middle of the night that I treated with 2 glucose tabs and 2 bites of a Clif bar. I woke up on Saturday morning, race day, at 107. I finished 26.4 miles of the race with a blood sugar of 79.
How do I keep my blood sugars so tightly controlled during the lead-up to a race? There are two very important tools: checking my blood sugar very often and practicing corrections and food responses. If I have worked hard to build up my glycogen stores during training, they are pretty much topped out just before a race. You can’t do much to change your glycogen stores in the days before a race, so in order to keep my blood sugars in check, I eat light and limit my food choices to things that I know through practice will work well. I avoid high glycemic index foods. I pick up on an upward trend right away because I’m checking so often. I know that I need extra insulin when I get on a plane. I limit caffeine. I add fat or protein to everything I eat to slow digestion. These are all things that I’ve learned through practice.
For my race recovery, I take extra basal insulin for two days and limit rapid-acting insulin. My body will have a lot of lactic acid and other metabolites to clear and those substances can make me insulin resistant. But, I can have unexpectedly fast reactions to my rapid insulin. So, upping the basal and lowering the rapid keeps me somewhere in the middle. Middle is good. I push fluids. I happen to love carbonated drinks, so I drink a lot of club soda in order to get some plain water back into my system. I should limit coffee but I already did that to myself leading up to my race, so I cave in the days afterward. I also eat a lot of complex carbs like brown rice, multigrain flatbread, oats, etc. and try to take in extra protein in a variety of forms (i.e. eggs, chicken, cheeses, fish, etc.). A favorite post-race thing for us to do is bake a quiche with a whole grain crust and to bake pumpkin soufflés for desserts. It makes the house smell great and gives us some nutritious food to recover with that we can just pull out of the fridge and reheat quickly.
Even though the race didn’t go well, I have built a huge aerobic fitness base and I think I can turn this around and get in one or two really good races before the end of the year. Thanks to everyone for their support! I’m sorry if I disappointed any of you out there, but I’ll do my best to make up for it!
Tuesday, August 28, 2012
It’s almost September. Wow. Time flies when you’re having fun. I guess that’s one way to look at it. Time also flies when you’re busy, busy, busy. I have the usual dissertation stuff that’s not even worth talking about because it’s the same-old, same-old … but it’s getting oh so close to being done. I have joined on as an assistant coach for the cross country team at Durham Academy. I’m a part-time assistant because of time constraints, but I love the kids and it’s a great deviation from work and from being obssessed with my own training all the time. Plus, an important thing I’ve learned through coaching others over the years is how to monitor my own training and how to be conservative when I need to be but also how to recognize the difference between “I don’t feel like doing that training” and “I’m too tired/sore/etc to do that training.” It’s important to know the difference! Working with the kids is giving me a whole new view on it, too.
And, amidst everything, I am training. I’m training a lot. I started gearing up in December after going out to Tucson for the Team Type 1 weekend to see if/how I could help with and be a part of their venture into creating a running team. They talked me into running the Tucson Marathon (unprepared) and that was, well, one of the biggest dumb things I’ve ever done. I ran something like 3:20 and thought my quads and calves would never quit feeling tight. But, it made me feel a little excited about doing some kind of low-key training. And, then, that was going so well that I decided I should start running some ultras with some kind of focus or goal instead of just building up to the distance and running something. Of course, I was derailed in May and part of June with the Brachial Plexus Neuritis thingy, but I seemed to bounce right back and pretty much picked back up where I left off, so to say.
Well, last week was my week off from doing a long run. But, the week before I ran 70K in 5:16:05 (but I also had 15 to 20 minutes of stop-time to check my blood sugar, refill water bottles, etc – I don’t fret that in practice because it’s sort of like doing intervals with a recovery). I was going to bump up to 80K this week but yesterday my lower back got pretty sore – it was coming on for a couple days. It feels a lot better today, so I’ll just continue with letting it calm down and if by Friday I feel fine, I’ll go for 60K and then next week plan for 80K … or something like that. I’ll see how everything shakes out.
So, why am I rambling on about all of this? I have a goal. I don’t know if I can accomplish it, but I’m going to give it a shot. The women’s masters record for 50 miles is held by Sandra Kiddy. Kiddy ran 6:09:09 twenty-eight years ago. The record has stood for a long time and it’s an impressive record. But, it is breakable. I’d like to break that record. What made me decide to start training again for this goal? What kind of insanity made me decide to do this? There is one main reason that I am trying this. If I can take that record down or even come close to it, I can make a very important statement:
I do NOT need even one more way to live WITH diabetes because I am living WITH it fine … I need a way to live WITHOUT it. Period.
That, my friends, is why I have decided to take on this endeavor.
Monday, July 23, 2012
With the 2012 London Olympics beginning this Friday, I have a few interviews and a live twitter feed and such bustling about this week. My husband says it’s my fifteen minutes of fame for this four year Olympic segment. This one came out today:
If you haven’t ever checked out the Discuss Diabetes Blog, it’s a really good blog with great information.
On Wednesday, Seth Pilkington and I will be doing a live twitter chat at 8pm eastern time (hash tag #tt1). Seth is the son of Paul Pilkington who was a marathoner extroidanairre himself, earning his bit of fame when he was hired as the rabbit for the LA Marathon and when the lead runners wouldn’t go with him he decided to finish and win the race himself – he earned the rabbit fees (he went through in the agreed upon times) and the prize purse. The second place guy whined that it was no fair because the rabbit shouldn’t be able to win. Well, Paul’s win totally changed marathoning; nobody lets the rabbit go anymore! Seth is a very, very talented runner in his own right and stands to have an excellent running career himself.
Later this week, a few other items will be floating around cyberspace and as they come out I’ll try to mention them here. If anyone sees something, though, feel free to post it in a comment! Oh, before I forget to mention, I totally messed up the email archives for the website email and may have lost all emails before yesterday. Please try to send things again, please, I apologize profusely for my computer incompetence.
Wednesday, July 11, 2012
Last week I was at the Children With Diabetes’ Friends For Life conference in Orlando. Well, first of all, Orlando in July is sooo not fun with the heat and humidity, which is evidence by itself of how important I think that conference is! It’s been a while since I went to FFL and I was reminded over and over that it’s always important to do a refresher on “the basics.” The first reminder of this came when I did some interactive sessions with kids along with my buddy, Sebastien Sasseville (who has climbed Mt. Everest). The second reminder came when I had a very brief minute to chat with Diabetes Research Institute’s Tom Karlya, who also happens to be one of the nicest guys in the world. The third reminder came when I spent an evening hanging out with Steve Edelman, of Take Control of Your Diabetes, and caught up on lots of stuff and laughed til my face hurt! I love Steve! And, finally, I was reminded of this again when I joined a panel for parents to “Ask the Athletes.”
True to my usual style, I arrived and had to go straight to some sessions with kids, luggage still in tow because I didn’t even have time to check into my room. Sebastien had the kids started and I hit the ground running … literally. The questions that came up with each group that we worked with dealt with such basic concerns … these were kids after all, but I was still struck by how much I had forgotten about the fear of low blood sugars during exercise and about the logistical problems of carrying something to eat (and knowing when to eat it). One young guy wanted help figuring out how he could start playing soccer with his blood sugar close to normal and not have to ask the coach to take him out when it started to drop because he was afraid he wouldn’t get to go back in. A girl asked Sebastien how he knew when to eat something if he couldn’t use his meter. Where do you keep your meter, insulin, carb gels? What if the referee says you can’t have your pump on the field? How far can you run before your blood sugar will drop? And, the questions went on. Of course, the kids asked some cool questions, too: What was it like to stand on the line at Olympic Trials? How fast (and how far) can you run? Was it cold on top of Mt. Everest? How long did it take to climb Mt. Everest? It was a whirlwind of sessions, moving from one group to the next.
Later that afternoon, I had the pleasure of running into Tom Karlya. Tom’s daughter was diagnosed with Type 1 diabetes as a child and it completely turned their lives upside down. Ever since, he has dedicated his life to helping find a cure and he is “in it to the end.” Tom is tireless in his efforts and, somehow, he always remains so upbeat. He is a welcome sight at a busy place like FFL. As I tried to gulp down some food standing in a lobby area, I mentioned to Tom that DRI is so important because even though we need new technologies to improve how we live WITH diabetes, DRI is my only hope to live WITHOUT it. I’ve said that to various people many times … and I mean it. Tom looked at me, though, and said quietly, “Missy that’s a very powerful statement.” And, it made me think. Yes, it is a powerful statement and it’s a statement that should be history, not current sentiment.
I capped off the late afternoon going for a run with Sebastien, who unfortunately had to get in a long run in Orlando … in the hot and muggy afternoon … because he had to fly to France the next day. I had done my long run early, early, early the day before and really didn’t plan to run in the Florida heat and humidity at 5 in the afternoon, but Sebastien is my buddy and my teammate, so we do what we have to do for, I guess, family. I ran about 75 minutes with Seb. We talked about the kids’ sessions and both felt like we had been reminded not to take for granted all that we have learned about managing our lives around diabetes.
I took a quick shower and headed down to get some dinner and ran into Steve Edelman. Steve always has the most novel ideas about managing diabetes. He was the person who taught me the strategy of using Lantus as a basal insulin and programming my pump around its action. I know so many people who use that strategy now, but it seemed like rocket science to me at the time. A few of us ditched the dinner and went to hang out in the lobby bar where it was less crowded and less noisy. In his usual style, Steve started hounding me about not using a Dexcom … or any continuous glucose monitor. What are you trying to see how long you can practice stone-age diabetes management???? I played around with Steve’s Dexcom for a while and I have to admit, it was pretty cool. It was a lot smaller than I had thought it would be. So, then the running joke, every time I saw him, anywhere, was “what’s your blood sugar? oh, let me see, mine is …” Ha ha.
My next reminder of the importance of basics came with the Ask the Athlete panel on Friday. The questions that parents asked reminded me of how I had also wanted tangible answers to very basic questions when I was first diagnosed. How long after I take insulin should I wait to run? What do I eat before I run? How high should my blood sugar be? What do I use if my blood sugar starts to drop while running? How do I carry stuff with me? What do I do after I finish? It hit me that it wasn’t good enough to answer with the vague and general, well it depends …. So, I gave some very specific answers. If I run in the morning, I eat half of a bagel with butter and take one unit of Regular insulin along with the normal 7 units of Lantus. If I run in the afternoon, I make sure that I am at least 2 hours out from my last shot of insulin and I eat an energy bar that has a combination of protein and carbohydrate, like a MetRx Big 100 bar (which will last for an hour or more of running). After the panel, over the course of that afternoon, I had at least 20 people thank me for giving such specific answers because they said it gave them somewhere to start. If they had a starting point, they knew how to make adjustments based on how things worked, but it was scary not to know where to begin. Amen!
Well, Orlando was a whirlwind. And, it was hot and muggy. And, I don’t really like traveling much. And, I’m so behind on work. But, it was worth it. I was reminded of the basic struggle I deal with, of all the others who deal with the same thing, and of how important it is to be a source of information and, hopefully, a little bit of inspiration … hopefully.
Wednesday, June 13, 2012
I am on the mend and sooo glad! I had another followup appointment at Duke Sports Medicine yesterday and everything is improving better than expected. I’m cleared to start physical therapy now! I’m finally completely off the heavy duty pain meds and just on the small-guy stuff and only once in the morning and once at bedtime. I finally feel like I’m becoming a normal person again.
The shoulder area still hurts some. It’s nowhere near as bad, though. It is still pretty much constant, though. And, I still have numbness in part of my left hand as well as some odd areas of weakness in my left arm. The weakness is mostly my tricep and lats. I thought my deltoid was spared (it’s the more common site of weakness for this) but a quick check in sports med yesterday shows that I indeed have some weakness there too. The muscles that flex my wrist and control my thumb motion are weak as well. It could take as much as a year to recover the feeling and the strength. Oh well, at least I’m not a musician or a gymnast or something.
In the interim, I’ve had a few days that have been almost completely tied up with some kind of electronics issues: internet problems, computer stuff, programming and activating my husband’s new iPhone (he wore me down – I manage the phone and computer budget in our home – we split the bills up in odd ways but it works for us). I am so sick of being stuck on the phone with IT people that I have turned off all phones in the house for the duration of the day today. No phone calls, no trying to hold the phone between my ear and shoulder with this messed up shoulder thingy I’ve had, no talking for me today! I’m done with people for a day or two.
I’m back to some slow running. I managed to plod through 30K on Sunday. That’s a starting point to getting back on track. I’ll try 40K this week and then 50K next week. Once I get to 50K, I stay there until I can get my pace on track. Of course, I missed all that nice weather for long runs. Darn.
On a completely different note, we had an incredible once in a lifetime experience last week. A doe gave birth right under our bedroom window in the wee hours of the morning on the 6th/7th. She left the fawn in the grass under a tree. The wildlife resource pages online said that was not uncommon and listed some checks we could do to make sure the fawn was okay. Apparently, it’s completely not true that a doe will reject it’s fawn if it smells humans on it – it will just clean off the awful smell and then move the fawn and bed it down in another place close by. We found out that we would basically have this fawn under our protection for the next 5 or 6 days until it was big and strong enough to follow its mom. Oh my. Then, our outdoor cat that adopted us a few years back tried to attack the fawn because it must have looked like a rabbit or something (it was smaller than the cat). So, Juliette bought herself a week of porch jail. She just went back outside today. The fawn seemed pretty healthy and only did the bleating for mom thing once. We, of course, freaked out and were whispering loudly, shut up, be quiet, shhhh!!!! It looked at us like, WHAT? but finally laid back down in the thick underbrush in a grove of sycamore trees in the front. We kept our distance and just did visual checks so we only got one picture on that first morning. I still miss the little thing. I keep hoping I’ll see it with its mom out on the trail. We could see the little footprints (hoof prints?) in the soft ground the morning it probably left with the doe. Happy and sad day all in one.
Tuesday, June 5, 2012
I’ve been out of action for a month. I’ve been dealing with something called Acute Brachial Plexus Neuritis. It has totally sucked! So, what is this thing? Your brachial plexus is a set of nerve bundles that run from your neck and upper spine, between your shoulder blade and collar bone, through your shoulder, and down your arm and the side of your chest. Neuritis is an inflammation of nerves that usually includes some amount of loss of the myelin sheath that protects the nerve (sort of like the way your skin protects you from all the stuff outside your body). The thinking is that a virus or minor illness starts the whole process which culminates with your immune system attacking the nerve bundles.
This has been the absolute worst health event I have ever, ever dealt with. A hundred times worse than developing diabetes. It has been the worst pain in my life, more than I thought I could have without passing out or something. Well, it was so bad at some points that I was puking and pretty much incoherent. I’ve been back and forth to doctor appts, the ER, etc. My husband couldn’t go to work because I couldn’t take care of myself. He had to learn to give me insulin and how to use my meter (neither one of us realized that he didn’t really know how to do all that until this hit). I ended up on a TON of pain meds and other meds (there’s an interesting side note about one of the meds, neurontin, so in case I forget to mention that someone message me to remind me).
I’ve finally started to recover. The whole thing has been traumatic actually. When they told me that there is about a 10% chance it could recur, I suddenly felt like a PTSD patient. The thought of going through this again struck fear in me, for real! I’m way behind on all kinds of stuff and I’ll begin to catch up on things like the blog in the next couple weeks. I have a race report from Todd to post, but I haven’t been able to get up with my webmaster to get the picture posting thingy fixed because I’ve been out of commission for a month. I have a bunch of website emails that I haven’t answered as well and I’ll start getting to those over the next couple weeks. If you’ve sent me an email and I haven’t answered, I apologize. Others can attest to the fact that I usually reply within a day or two max.
I wanted to explain what this condition is and what all happened because the auto-immune part of it means that, even though it is an uncommon condition, those of us with Type 1 could definitely have this happen. A quick diagnosis can help tremendously.
I woke up on a Wednesday morning at the beginning of May feeling like I had slept funny on my neck. My neck was sore, my upper back felt tight, and the neck pain reached to the tip of the upper crest of my shoulder blade. I had to drive my husband and step-daughter to the airport and by the time I got home, the pain was pretty bad and I took a tramadol. I have a prescription for tramadol because the thyroiditis issue I have can cause muscle and joint pain sometimes and I can’t take non-steroidal anti-inflammatories like ibuprofen. It works on the same cascade that anti-depressants do and so it works very well for the type of pain that thyroiditis can cause. And, it gives you a subtle, but good mood boost. I usually take half of one – I’m not very big. I took a whole one when I got home from the airport. By dinner, I was in really bad pain and called my former training partner who is an ortho doctor now. I ended up looking for some old pain medicine that my husband might have left over from his shoulder surgery over a year ago. Found that and took that. By midnight the pain was so bad I was nauseous and the pain med from my husband’s surgery pushed me over the edge and I was in the bathroom puking.
First thing in the morning I called my primary care doctor’s office and the nurse told me to come in. Okay. Damn, I couldn’t drive. Daddy to the rescue! My parents live about 15 minutes from me now, so my dad came and got me and took me to the doctor. He needed to get his allergy shot anyway and he goes to the same doctor that my husband and I go to.
My primary care doctor stays up-to-date on medical stuff, thank goodness, and he knows my wierd auto-immune problems very well: asthma, T1, thyroiditis, and a few odd events of inflammation between my ribs called costochondritis (last one was years ago thankfully). He immediately knew it was most likely auto-immune, but I was running a low-grade temp, but inflammation can cause that sometimes. He put me on hyrdrocodone for pain (the oxycodone had made me puke but usually people who get sick on one can take the other – he was right); an antibiotic, biaxin, just in case there was some infectious thing going on; and a prednisone taper to get the auto-immune thingy to stop it damnit. Perfect approach actually. Problem was that I completely failed the prednisone taper right from the get-go and the hydrocodone didn’t even touch the level that the pain had reached. The first dose of prednisone and I started to spill huge amounts of ketones and started peeing like crazy. Even keeping my blood sugar normal, I couldn’t get the ketones to clear up at all. We stopped the prednisone. The ketones kept on. Long story short on this point: I lost 8 pounds by the end of that weekend.
As the immune system attack traveled along the brachial plexus, the main focus of the pain traveled as well. Some parts of the process proved to be much less painful, but some were much worse. The worst pain came when everything was inside my shoulder joint, still under my shoulder blade, and beginning down my left arm. I also lost the feeling in my left index finger then and it caused some numbness on the tip of my middle finger and the tip of my thumb. That numbness is still there, by the way. It might be permanent. Oh, and I have muscle weakness in my left tricep, lats, and some of the muscles in my lower arm.
By the time I hit the worst pain, I ended up in the ER. A series of errors and falling through the cracks in the medical and insurance system led us to contact the sports medicine program that followed me when I was running the pro circuit and in the Olympic Development Program. They told us to come straight in, that they would let the front desk know we were on the way, and within an hour of talking to them on the phone, they got me in, diagnosed it (they’ve had a few cases over the years and have one guy right now), laid out a treatment plan (mostly pain management because the window of opportunity for the prednisone taper was gone), and explained to us what was going on. Duke Sports Medicine is full of the greatest people! They are so on the ball!! I love them! I don’t know what I would have done without them. Really.
They put me on some heavy hitting pain meds and added neurontin (gabapentin) to the mix. Technically, neurontin is an epilepsy medicine. It quiets nerve impulses and can help trememdously with controlling nerve pain, which is the worst kind of pain (yes, I can attest to that!). It definitely makes the pain medicine work much better and so not only was my pain controlled better but I was able to cut back some immediately. They put me on an every-two-hour schedule. Your first thought is probably, what did you do for overnight. Well, I set the alarm. It wasn’t bad because before this pain management regimen I wasn’t sleeping because the pain was so bad I had to pace back and forth. With this regimen, I was actually sleeping for the two hours in between the alarms. Wow, sleep helped sooo much! My husband still had to help, though, because I was so out of it when the alarm would go off. Before bed, we started writing out a schedule so that when the alarm went off we’d know what we were supposed to do at that point: check blood sugar, take half this pill and whole that pill, drink half of water bottle with electrolytes, check for ketones, etc.
Oh yes, the interesting thing about the neurontin! After I took the first dose, almost exactly two hours later, I was sitting outside and I started to have spots in front of my eyes, the kind I get sometimes with a low blood sugar – the big bright spots right in the middle of my field of vision. I felt fine, though. I went inside to check my blood sugar anyway: 46. WTF? I treated with dex tabs, etc. Later, after I ate dinner, same thing. I had taken 3 units of Novolog with dinner just like normal and was expecting my bg to go high since my activity level had been so low. Nope. Bad low. Wow. The next day, same thing: 42. Etc, etc. I kept cutting my insulin and ended up realizing that I could take my Lantus and then pretty much eat like a normal person with sometimes no extra insulin at all or maybe one unit. I ate two cheeseburgers, chips, baked beans … one unit, blood sugars: 152, 79 (3 cookies), 75, 99, 94, 82, etc. Another time: eggs, bacon, toast, chocolate cheesecake: no insulin since 5 hours prior, 116, 128, 132, 129, 85 (dex x 1), 87, etc. I could go on. Once the neurontin was increased to twice/day, the highest blood sugar I had was 183 after pizza. I’m down to one/day at this point so the miracle is wearing off. On the down-side, it gave me hypo unawareness to a degree and when I’ve been able to start some jogging, my blood sugar has been hard to keep up. On the upside, though, I have definitely taken advantage of eating things that had been thoroughly excluded from my insulin life! Bread, pizza, cake, cookies, spaghetti, potatoes, bananas …. YUM!
I’m back to doing some jogging/running but slow. I’ve lost some fitness, of course, but it doesn’t feel too far away. I think I’ll get back up to speed pretty quickly as this thing goes away. I’m still in some pain, but the character of it is different at this point. It’s not as intense and diffuse, but it’s still a constant pain and that gets pretty irritating and frustrating at times. There’s no position I can get in to relieve it and it doesn’t respond to icing or massage. It just keeps hurting. Thankfully, it’s much less and it doesn’t feel like a bone pain sensation any longer. I’m still on the heavy duty pain stuff at night, but only at bedtime and 2:00am now. During the day, I’m on just one neurontin and tramadol. I still can’t drive because of the night-time pain meds. Until that goes down to a certain level, no driving. I’ve been feeling stranded, no doubt. My head is clear enough now that I’m getting back to work, so that’s a huge positive!
This whole experience has taught me a big lesson about perspective on life. What have I learned?
Make your house a home. It is so comforting to feel safe and calm in the place that you live. Sights like landscape and birds and animals; sounds; smells; spaces … all of these things gave me a way to get through some of the really tough spots. I want to have a place to grow old that I love. All of us need a home.
Care about your family and friends. Our family and friends helped soooo much, sometimes just by being available to come over, sometimes just calling, a few times getting called in the middle of the night to help out. I could do more to step up to the plate. I now know that it makes a difference. One of our neighbors called the other day (she was one of those who got a late night phone call and came down right away) to check on me and told me that she was compelled to help because we had done so much for her when she had some gall bladder, etc things going on. I took her to appts a couple times when she couldn’t drive or we went to the pharmacy or whatever for her. I never thought we had done anything extraordinary, but it was huge for her, just as those small kinds of things were huge for me.
Figure out what you believe in spiritually. At the risk of sounding melodramatic, I had a lot of time sitting, while in pain, or alone at night because I tried not to wake anyone up, or pacing and trying to take my mind away from the pain … what I figured out was that we don’t live forever and we better find something that we understand and feel okay with on what the end of life is all about. I think what drove me to think about things like that was feeling like a hospice patient or something with all the pain meds and the constant pain and the seclusion that it surrounds you with.
Ask for help when you need it. People cannot read your mind. If you don’t say very clearly that you need help and what you need help with, they don’t know. They are not being inattentive and it’s not that they don’t care. We have to tell people what we need and not try to make them guess or try to manipulate them into doing what we want/need. Just state it … very clearly: can you get up with me right now (middle of the night) because I’m confused and hurting and I need someone to make sure I’m taking the right insulin and I need some emotional support right now. can you sit with me even though I don’t really have anything to talk about, I just need some company.
Stand up for yourself. There were some big flub-ups that delayed me getting the appropriate medical care. Even though it may not have changed the course of this illness, I certainly would have had better pain management sooner and would not have had to experience pain so intense that it made me puke, pee on myself, and collapse on the floor. I don’t necessarily know what I could have done to make things go differently but I’m already pursuing this and talking to my doctor and others to trouble shoot so this kind of mess does not happen again. We have already made a plan for the possibility of a recurrence. I would go into the hospital for a couple days of managed care of the prednisone taper so that I could get through it safely. If you can’t get things fixed for the current problem, at least pursue potential future remedies and make people aware that things didn’t go well and that you won’t tolerate that again. Make them come up with a different scenario, like our plan for a potential recurrence. Make them verbalize that they understand what went wrong: the ER resident getting so set on pursuing the possibility that I had a disected aorta (really) that when the CT showed my aorta to be fine, she ejected me from the ER before the ortho fellow could do the consult that probably would have diagnosed this that night. My primary care doctor’s office refusing to do anything more for pain management – if they couldn’t do anything better, they should have referred me to a specialist instead of having a nurse call and say that the pain prescription the doctor wrote is the best he can do. WTF? So, are you saying I should just head back to the ER now? WTF?? Stand up for yourself and if you can’t do it effectively right then, go back and make it clear where people failed and make them state what they should/could do differently.
Get your priorities figured out. What are the important things in your life? What are the things that seem important but are really just a bunch of crap things that you place importance on because of what other people say or do if you blow those things off? The world won’t crash to an end because I don’t get an article written on time or because I wasn’t able to attend a tv interview. The world doesn’t revolve around me. So, what are the important things? Where in this world can I make a difference or have an impact? Can I shape someone’s life in a positive way?
Be important. What a waste to take up space in this world and do nothing of substance for anyone or anything. Importance is a matter of perspective of course but, damn, do something that makes a difference! Get outside yourself and think about the bigger picture. Leave a legacy even if nobody will know that it’s your legacy … leave a mark on the world.
Do something you love. You don’t have to justify it to anyone. If it is your pleasure, make it fit into your life consistently. I love to run, so I run. I don’t have to explain to anyone why I do it. I also love nature. I create gardens around the yard and I look at nature photography and I watch nature shows. I love watching wildlife so I find a way to do that. It brings me joy and peace, so I make it part of my life.
I think those are the main things that I came up with. I’m on the mend and I’m getting some slow miles under my feet now. I’ll get caught up on the back log soon. Thanks for all the support I’ve gotten from some of you whom I’ve never even met in person! It has meant a lot!
Monday, March 12, 2012
This is just a quick post to let people know that my friend Nat Strand, who is T1 and who won the Amazing Race, is going to be doing a live chat on dLife. You can register for free or if you just want to post a question, you can do that. The link is:
Monday, February 20, 2012
I’m not really sure what has motivated me to address this particular topic on this particular blog on this particular day. It certainly doesn’t seem to follow the interview with Tommy Neal very well. But, I will follow up on that interview with a post about the science of training and on what we know about endurance training and the importance of insulin. I’m talking to a few exercise phys people to make sure I have references and details correct. Then, I’ll get the post written up for here. And then, hopefully, there will be a bigger article in a magazine later. We’ll see how all that pans out and I’ll keep you updated.
Okay, so favorite things. I was thinking about this while I was running this morning in the 2 inches of really fluffy, wet snow that we got yesterday and last night. The ground is so warm here this winter because it’s been so mild this year that the snow is almost completely melted already and it’s not even lunchtime yet. But, it was pretty to run in early this morning. There’s something about the muffled sound and the damp, cold smell. There’s something about the way the sun bounces off the snow. It’s just beautiful. I’m not really a snow lover but a small snow like this is really special.
So, I thought I would share some of my favorite things that I thought about while running this morning.
Being the first one to wake up in the morning and standing outside to watch the sun come up – any time of year, any type of weather or temp.
The smell of a hotdog vendor on a street corner in NYC.
The smell of a cigar – it reminds me of my Uncle Tex and being a kid in NJ.
Having my cat snuggle up under the sheets, press right up against my belly, and then start giving herself a cat bath – and, it’s extra special when she gives me a couple sand-paper toungue licks on my arm for good measure.
Getting through a really difficult personal encounter (I hate confrontational things) and knowing that I handled things maturely and that I was reasonable, but that I was successful in holding my ground.
Doing something good for someone else and remaining anonymous, resisting the temptation to get a self-congratulatory pat on the back.
Chocolate. Period. Well, okay, really good, dark chocolate. Period.
Feeling the warm sun on my back while I’m working in the garden.
Having time to be in the library trolling through the stacks without knowing what I’m looking for and not worrying at all about how much time I’ve wasted.
Talking to people.
Being strong enough and fit enough to run for a really long, almost ridiculous amount of time, then taking a hot shower followed by a cup of coffee out on the back deck. If I could do that every day and not risk injury (and, of course, still have the bills paid), I would.
Sharing knowledge with others and learning from others. I could teach or go to lectures every single day of my life and never get bored with it.
A ribeye steak cooked on a charcoal grill, a big salad with ceasar dressing, and a baked potato with butter and sour cream.
Putting together jigsaw puzzles of cool scenic photographs.
Walking outside in the middle of the night when there’s a full moon.
The smell of sheets hung on the line to dry.
If I sat here long enough, I guess I could keep thinking of more and more things. Everyone should spend some time now and then to make a little list of some of your favorite things. Every time you write one down, you get this flood of thoughts and memories that go along with it. It’s fun. It teaches us to remember not to take life for granted. It makes us want to carve out some time for special things. It helps us create a life full of great memories and few regrets. It gives us perspective.
Again, I’m not sure why I felt compelled to write such a sappy post, but it probably has something to do with spring being on the way. I always get excited as spring inches closer. I’ll get back to the running and the diabetes topics next time around.
Wednesday, February 8, 2012
On January 14, 2012, Tommy Neal ran into the history books by finally bringing a diabetic runner back to Olympic Marathon Trials. Twelve years earlier, Missy Foy became the first diabetic athlete in history to compete in Olympic Marathon Trials when she qualified for and ran in the 2000 Olympic Marathon Trials in Columbia. Tommy recently spent a week at the Foy’s home in North Carolina. With questions submitted by readers of Missy’s website and from those who have been following the new Team Type 1 Running Team (who sponsored Tommy’s training camp in North Carolina), here is an interview with this rising star on the U.S. professional running circuit.
Missy: Thank you so much for taking the time to do this interview. There have been a lot of questions submitted, so I’ve tried to group them together. Before we get to the questions, though, can you start out by telling us a little bit about your running career so far?
Tommy: Well, thanks for having me out here and thanks to the people at Team Type 1 for making it happen. This has been such a help. I grew up on a farm in Missouri. I actually started running because my mom made me run a mile before school every morning to use up some energy and keep me out of trouble. I became a top-ranked runner in high school and then went on to run in college for the University of Central Missouri. After college, I finally ended up in Colorado Springs, running for the Boulder Running Company’s Adidas team and being coached by Scott Simmons and Renato Canova, one of the best distance coaching combinations in the world. I had gotten my 5K time down to the low 14s and ran 29:32 for 10K and then ran 1:05 flat for the half marathon in Duluth, Minnesota in June, which qualified me for Olympic Marathon Trials.
Missy: So, at that moment, you thought your running career was taking off, right? What happened after the half marathon?
Tommy: Yeah, so shortly after the half marathon, the wheels fell off. Actually, things had started to happen even before that but I kept ignoring it. I had problems with really low energy, a series of bad workouts and races. I just didn’t feel right. I was constantly dehydrated and went from 145 pounds down to 128 pounds [note: Tommy is 6’ 2”]. Blood work showed a high hematocrit and high ferritin levels [note: iron stores]. I tried to lower my iron levels but still couldn’t keep up with training, so I went in for more blood work. My blood sugar was so high that they sent me straight to the emergency room. I felt bad, but not that bad, so I thought they were over-reacting.
Missy: I think for all of us, that day of diagnosis gets burned into our memories. I remember thinking that my running career was over.
Tommy: Oh yeah, definitely, I thought that was it. It was the nutritionist who gave me a little hope, telling me that running was actually good for my diabetes management. But, still, I just didn’t know what to expect. I couldn’t give myself a shot. The first time, I had to touch my skin with the needle first. I was like, oh okay, there it is. I would keep touching the needle on my skin, trying to find a place that wasn’t so sensitive, some place that I could get it in.
Missy: Okay, so this is probably a good place to get to the questions. The first questions: Do you use an insulin pump? How many times per day do you test your blood sugar?
Tommy: No, I don’t use an insulin pump because I’m still producing some insulin on my own. I use two different insulin pens, one with a rapid-acting insulin and one with a long-acting basal insulin. I test my blood sugar a lot. I test 6 to 10 times a day depending on what I’m doing. If it’s a workout day, like yesterday, it might come out to be ten or even fifteen times. What did we test something like five times during the tempo run?
Missy: Yeah, I think it was five times.
Tommy: If it’s a workout day, I want to stay on top of my blood sugar and prevent ketones, which can happen when I put in the hard efforts like with workouts and long runs. For racing, I have a plan for where I want my blood sugars in the days leading up to the race and it takes a lot of testing to stay on top of that. It’s not an easy thing to do so I test just about every time I eat or do something. Basically, I test a lot because I can’t make decisions about insulin and food and running if I don’t know what my blood sugar is and what it’s doing, like what the trend is. I need to know if it’s stable or if it’s going up or down.
Missy: The next set of questions deal with racing and with being a professional runner with diabetes. What is the most difficult part of having diabetes as an elite level runner? How do you prepare for races?
Tommy: The hardest thing right now is trying to balance everything. Once I inject insulin, it’s in my system and it’s not going to turn off just because my plans change. So, I have to schedule everything. I run twice a day and I work in between that. It’s really hard to make everything fit. I end up running in the dark a lot this time of year! But, even though I have diabetes, as an elite athlete I still have to push my body harder than the other guys I’m racing. And, if I think I’m sick and that there is a limit to my potential, then there is. I have to control my diabetes but at the end of the day I have to believe that I’m better than the other guys. As far as races … that’s a work in progress right now! That’s part of why I came out here. For Olympic Trials, I went with a basic plan of taking a little bit of insulin with a small breakfast several hours before the race and then stuck with water and Powergel during the race. I usually add electrolyte tablets to my water also. We practiced a race strategy yesterday with an 18 mile tempo run, a ton of blood sugar checks along the way as you drove around following me for 18 miles, and taking in Powergel and water at certain times. My blood sugar stayed pretty good. I think it was 122 at 5 miles and then stayed between 74 and 81 pretty much the whole way. You know, that’s what it’s about – you try to figure it out on these kinds of training runs.
Missy: The next set of questions all focus on your training in some way: What are your goals with running? What is your training like and what are you focusing on? What is a typical day like?
Tommy: Right now I want to run under 28.30 in the 10,000 meters during the spring track season to qualify for the Olympic Track and Field Trials. If I can keep my training in order and things continue to go as well as they’ve been going, I want to go for a win at the Penn Relays 10K. Then, this fall I plan to run a solid marathon, hopefully going solidly under 2:15. My training is really pretty typical for top level runners. I usually run between 100 and 140 miles/week with 2 or 3 hard workout sessions. The hard workout sessions usually involve running about 8 to 12 miles worth of 5:30 mile pace and maybe part of it as fast as 4:30 pace. Training at those paces and with that kind of volume will help me be able to maintain the effort I need at longer distances like that marathon. So, let’s see what was the other part of that?
Missy: A typical day.
Tommy: Oh, okay, right. I wake up at about 7 am, check my blood sugar, and then feed and water my chickens. For breakfast before my morning run, I will have a ½ cup of steel cut oats with a little of my parents’ raw honey, nutmeg, and almond milk. By 8:30, I’m out the door for my morning run, which is typically about 10 miles. I come home, check my blood sugar … it should be under 100 by then. I then fix a protein-based smoothie and adjust my insulin accordingly. My insulin to carb ratio is about 10 carbs to 1 unit. I also take my morning shot of Lantus [note: a long-acting basal insulin] then. I ride my bike to work, which is about 4 miles the hilly way or 6 miles the flat way, and eat a small snack when I get to work, check blood sugar, insulin if needed, etc. Depending on the day, I will run home or ride my bike home after work (I don’t really care what the weather is… yesterday it was -3 degrees wind chill). I will then fix dinner and have some nuts as snacks (almonds, peanuts, and cashews) while I’m waiting for my dinner to finish (maybe black beans with some veggies and spices), watch a little TV or play some video games, check my blood sugar, take my evening shot of Lantus, and then head to bed between 10 and 11. It’s not a very interesting life! And, it revolves around checking my blood sugar all the time!
Missy: Next question: Have you had to change anything about your training/coaching since being diagnosed?
Tommy: Yes, I carry Power Gels with me everywhere, just in case I start to go to low. I also do some sprints or hard uphills if I’m low when I start out the run so my glycogen stores will kick in and take care of it right away. I guess the main thing that’s different is how strict my schedule is now and how I have this constant calculator going on in the back of my head all the time … all the time.
Missy: What advice would you give to a diabetic runner about moving up to the marathon distance?
Tommy: Learn to love your gels for a quick sugar spike! But seriously, don’t increase just straight mileage, but increase the volume of your workouts too. You want to be able to run a lot but you want to run quality mileage for a good part of it.
Missy: What would you tell a high school runner with diabetes about training?
Tommy: Check your blood sugar often! Know what activities will raise your blood sugar and which ones lower your blood sugar. MOST importantly, pay attention to your diet and stick with natural foods and with low glycemic index foods like beans, steel cut oats, and vegetables.
Missy: The last question is a tough one; it’s from a sixth grader who says he wants to grow up to run faster than you! If you were offered a cure for your diabetes, would you take it and leave the rest of us behind?
Tommy: I would take it, a cure that is, and I believe so would everyone who has been diagnosed with any sickness. I would want you to take a cure if you had the opportunity and I didn’t. There’s no leaving anyone behind. There’s an old saying, “Remember, we’re all in this together.” My Grandma Doe always told me that and, well, she’s pretty wise.
Missy: Thanks for taking the time to answer questions and give all of us a peak into your life, Tommy.