Thyroid update

On Tuesday I visited my endocrinologist to follow up on treatment for Grave's Disease after seven weeks on an aggressive dose of thyroid-blocking medication. The results were encouraging. I'm responding well to the medication. My T4 levels have reached the normal range, T3 is close, and while my TSH is still very low, it's normal for that to take several months to return. The doctor is keeping me on the high dose of methimazole for now, but seems confident that medication will be an effective treatment against my hyperthyroidism.

One of my main issues is the presence of Hashimoto's antibodies, which means I've probably been hypothyroid in the past, and likely will be in the future. Controlling thyroid disease will be a matter of managing this rollercoaster, and its unpredictability. That will likely be a lifelong battle regardless of which treatments I eventually choose.

"Lucky you," my doctor said.

Still, it's good news. And I have been feeling notably better. This post is a quick (boring, I know, but helpful to me and hopefully others) update on my health progress.

• Breathing — I haven't experienced any significant breathing difficulties since February. I have been much more conservative with my activity levels. But the last major episode happened while I was walking up my staircase at home, perhaps too fast, and felt my airways tighten in the way that tends to induce panic. That was two months ago. Whether these episodes are "asthma attacks" or something else, I still don't know. There's evidence of Grave's Disease exacerbating already-existing asthma, and there's also evidence of "air hunger" as a symptom of an overworked heart. I am reasonably certain that bronchodilators improve my breathing when I'm having an "attack," so I probably do have asthma in addition to thyroiditis. Lucky me.

• Allergies — I do (did?) have a severe allergy to grass that has become worse over the years, and seemed to ramp up exponentially when I moved to Colorado. I've been treated for this allergy with immunotherapy shots since October. In the past two weeks I've been receiving catch-up shots to which I have not responded well — swelling, itchiness, fatigue directly afterward. Spring is coming, which I'm not looking forward to. Hopefully the treatment will curb some of my hay fever symptoms, and I won't go through the allergic asthma that I was dealing with last summer.

• Exercise — I've felt noticeably stronger during the past two weeks, although I still have fluctuations in energy levels, sluggishness while running, and mid-day sleepiness. Overall, though, I am much *much* happier while exercising. My breathing is better, my head is clearer, I'm more relaxed, and there haven't been any major bouts of dizziness or anxiety. I also have yet to "push myself" into a hard effort — similar to my efforts during the winter, when I was desperately trying to improve fitness for the Iditarod. Staying conservative is still my plan. All of my workouts since Alaska have been hikes and runs — mainly because I'm scared of riding bikes. It's harder to control my effort level on the steep climbs around Boulder. Since diagnosis, fear of provoking a thyroid storm has made me obsessive about maintaining control of my heart rate and breathing. In Alaska this proved necessary, as I had particularly poor reactions to situations where I failed to control my efforts, as well as stressful situations. But as my levels drop, thyroid storm, asthma attacks, and other poor reactions become less of a threat. It may be time to start testing the waters again — slowly and carefully, of course.

• Muscle building — My thyroxine levels are currently in the normal range, which means I'm less likely to experience the "thyrotoxic myopathy" that causes muscle weakness and breakdown. People with hyperthyroid conditions tend to lose weight, but a fair percentage of that is usually muscle tissue. One of the reasons I'm likely beginning to feel stronger is this slowing of muscle loss. I renewed my gym membership and am excited to work on building endurance in the weight room.

• Weight loss — I didn't experience weight loss with Grave's Disease, and I have yet to see a gain outside my normal fluctuations. This is possibly because years of endurance racing taught me expert-level calorie replacement, so as I was burning up muscle, I consumed enough food to replace it with fat (just a theory.) Now that I'm approaching normal, I'm trying to be more cognizant about my calorie intake — fewer snacks, fewer dairy products, more fruits and vegetables. There's still a lot I can do to improve my diet.

• The hand tremors that I believed were a mild neuropathy (I had carpal tunnel syndrome last year) have almost entirely disappeared.

• The swelling in my thyroid gland appears somewhat reduced (although still noticeable.)

• My resting heart rate is down — I tend to see numbers in the high 60s and 70s rather than 80s and 90s.

• The frequent skin rashes that I believed were related to allergies haven't returned in a couple of months.

• I still have what I consider to be a higher-than-normal heat sensitivity, but I can't really expect that to go away since I've always been adverse to hot weather.

• Mentally I feel so much better. The dull, gray fogginess that I had been experiencing is becoming more apparent now that I'm beginning to come out of it. My mood has overall improved. I hope these clearer thought patterns will improve my writing efforts this spring and summer.

I think that's about it for now. Now I'm heading out for my first bike ride of the spring. Wish me luck! 

A good week in Boulder

Although I was excited to return to Colorado after five weeks of roaming around Alaska, there was a bit of apprehension as well. Home meant a more structured work routine, with attempts to write when my thoughts still resembled oatmeal tossed into a ceiling fan. Home meant living at 7,100 feet, when science showed that five weeks at low altitudes had been long enough to lose most of my mountain acclimation. Home also meant a return to a regular exercise routine. While I had no intention of launching into any kind of training, even the usual runs and rides at the easiest pace possible seemed overwhelming. 

During the autumn and winter, I'd been in a lot of denial about my fitness. Such was my desire to return to the Iditarod Trail. Although I did complain about feeling off, I wasn't honest with even myself about how unfit I'd become. Most runs were a gasping mess. In January, I told my friend Corrine — before she helped diagnose my thyroid issue — that I was looking forward to the Iditarod being over so I could become a couch potato. 

"I'm just tired of feeling bad every time I go outside." 

I also worried about the 80-degree days Beat described when he returned to Boulder in March, given that 20 degrees felt plenty balmy when I was in Fairbanks. Thankfully, Boulder eased the temperature transition with a snowy April shower.

Because the weather was so fantastic on Friday — well, it was 35 degrees and snaining — I decided to attempt my first "run" in more than six weeks. There had been a fair amount of hiking in Alaska, but only brief moments when both feet were off the ground simultaneously. I started out extremely slowly, padding through an inch of wet snow in well-worn Hokas. By mile 1.5, I was feeling surprisingly good, so I turned onto the Green-Bear trail and picked up the pace. Descending into Bear Creek on the wet, rocky trail involved fast turnover and high-kicking steps, which felt both strange and exhilarating after all of the slogging I did in Alaska.

"Running! I love running! It feels amazing."

I returned home after 7.5 miles, bemused by the experience. That run really shouldn't have been so easy. I'd become convinced that six weeks on an aggressive dose of anti-thyroid medication had finally pushed me into hypothyroid territory, given how difficult it had been to simply stay awake earlier in the week. Now this — running well during my first day back at high altitude. What does it mean? No matter, I'll take it.

On Saturday afternoon, my friend Wendy and I tackled the 10-mile Walker Ranch loop. I insisted on a super easy pace, and freaked myself out enough on the rocky downhill segments that I don't think I could have pushed it much faster.

Rocks and mud are hard. But runnable. I was in running love. Not overdoing it this week was going to be difficult.

Beat, in turn, had been quite ill since we returned to Colorado, and had to languish in bed. He finally went to the doctor and tested positive for strep throat. This is generally highly contagious, and since I hadn't been careful around him at all, I assumed I'd wake up one day with a throat on fire. But I never did. This reminded me of an interesting conversation with a friend in Alaska, who also has autoimmune diseases, and almost never becomes conventionally sick (cold, flu, etc.) Her reasoning was that because her immune system is constantly attacking her body, it manages to kill all the invaders as well. I'm not sure what science says about this, but it would be interesting to research.

Sunday and Monday brought pleasant temperatures in the 50s and 60s, along with intense April sunshine to make quick work of the snow. On Sunday I climbed up Bear Peak and again felt strong, which brought memories of many dizzy ascents in the recent past. It wasn't that long ago that I pushed myself hard enough to become unnervingly lightheaded, my vision flickered, my throat burned, and I'd gasp for air until I had no choice but to stop and rest. Steep hiking ascents are the only aspect of mountain "running" where I consider myself reasonably proficient, so this is the area where I always strived most to improve. I began to wonder how fast I could push this climb ... but no ... easy pace, steady breathing. I'm not going to overdo it right now.

So I went into a Monday Mount Sanitas loop with every intention just to saunter along at a conversational pace. The first mile ascends 1,300 rocky feet, and then there's a buffed-out runnable descent for four miles — the best of all worlds, in my book. The whole stress-free run seemed to go fairly fast, so later that day I caved and uploaded my stats to Strava. 

See, I sort of "quit" Strava a month ago, recognizing that the self-comparisons were an unnecessary source of angst. In truth I lost an old GPS watch during the first week in Alaska, but it was an opportune loss, and I didn't miss it. I swore that I wouldn't go back on Strava until my health was better and I was actually training for something again. Still, old habits don't go away easily. I guess I'm back for now.

Strava indicated I'd actually set a PR for the one-mile climb, even though my previous Sanitas runs were gasping efforts of striving for exactly that. This effort had been nothing more than a brisk hike, with calm breathing and a clear head. I looked back at the other recent Strava stats — more PRs or near-PRs on segments that I worked hard at during the winter. It was interesting to compare the actual numbers to perceived effort — as though suddenly, after a month of not running and being all over the map in terms of energy, I'd become considerably more fit. In reality, I think my thyroid levels are closer to normal. I'll know more about this next week. 

Tuesday brought more snow — 8 inches by dawn, and still coming down hard. You have to love spring in Colorado. I grew up in Salt Lake City, which has a similar climate, so 65 degrees one day and snow the next doesn't strike me as strange. But I could hardly ignore an opportunity for what might be the last snowy run of the season. Tuesday was a busy work day and I had to go in to town for a blood test first thing in the morning, but I still carved out a couple of hours for something resembling a run on the Ranger Trail of Green Mountain.

Okay, it wasn't even close to a run. The trail had only been "broken" by one person wearing snowshoes, which I did not have, nor did I have trekking poles or gloves. I went anyway, trudging through four laborious miles and sweating profusely even after I wrapped my puffy jacket around my waist. Four miles in 1:45. I didn't care. I love a good slog.

The morning was gray but lovely, with frost-tinged branches and thick flakes of springtime snow falling from the sky. I could have slogged along happily all day if I had the time.

By Wednesday morning, more than a foot of snow had fallen at our house. It was as lovely as an April 5 can be, 21 degrees and clear.

But the heat was coming. I knew it, so I opted for one last hike in the snow. I set out figuring this would be a hike instead of a run, but I was banking on somebody breaking trail on the West Ridge. It was not to be. High winds overnight had deposited drifts that swallowed my thighs. The snow was regularly knee deep, condensing quickly in the 45-degree sunlight. My lower body was entirely soaked; I felt like I was marching through a knee-deep Slurpee. Two hours of this became my most taxing effort of the week by far.

You gotta love spring in Colorado. I know I do. I really am happy to be home. A part of my heart will always reside in Alaska, but to be honest I think it becomes a little bit smaller with each passing year, each experience in a new place, and each connection with the familiarity we call home.

A visit to my endocrinologist next week should reveal how much of this (relatively) high-flying fitness is thyroid-related. It's interesting how many aspects of myself I question now — my moods, my thought patterns, my attention span, my fitness, some of my more extreme emotions. How much of this is "me" and how much is "Graves Disease?" Could I really be on a fast road to normalcy, or was this week just another spike on the long rollercoaster of recovery? The latter is much more likely, but it's encouraging all the same. 

Return to the Whites

It was late March and the weather was a manic rollercoaster — 20 below in the mornings, sun, wind, heat. By the time Beat's plane landed at 4:45 p.m.,  the temperature was 19 above. Beat was fresh from balmy Colorado, bundled up, and giddy about the upcoming White Mountains 100. I had stripped down to the one T-shirt I owned in Alaska, torn somewhere in my travels. Worn ragged and weary. 

Forty-eight hours had passed since the avalanche debacle, and although my head was finally switching to its normal settings as hormones settled, I had no energy for much of anything. I'd slept in the car during a break from my commute between Denali and Fairbanks (30 minutes, alarm set) and dozed off again while sitting at the airport. Beat was a bundle of excitement and I tried to absorb some of that energy as we went through the usual pre-race motions. The WM100 is my favorite race of all. Even though I couldn't be a participant this year, I'd be in the midst of the excitement while volunteering at checkpoint 1. I wanted to support Beat as he tried to recapture his mojo after leaving the Iditarod Trail. 

All of this I reminded myself, but in truth I was just weary. I wanted to go home. 

"Home is in the Whites!" I reminded myself as I packed my bike with the same gear I'd been hauling around for a month. Pieces were missing after all of the back-and-forth: Some clothing, straps, an old Garmin watch. The bike — Beat's old 2010 aluminum Fatback — made its own long journey from Canada to Fairbanks with a kind French woman who was planning to run the White Mountains 100. The frame was still coated in grit from a sloppy thaw during a miserable commute through Whitehorse, several parts were creaking, and had its own weary feel.

The plan was to leave Fairbanks after the pre-race meeting Saturday, drive to the trailhead, and ride 17 miles into Moose Creek cabin, where I'd meet four other volunteers to set up our checkpoint early the following morning. I planned to spend two nights at Moose Creek, then ride out a cutoff trail early Monday to greet Beat near the end of the course. It was a low-stress trip of minimal miles that would allow me to spend two-plus days in my beloved White Mountains. It was great to have one last adventure in Alaska, I told myself. But I was weary.

Although the pulled quad muscle was improving rapidly, my right leg was still sore, and neither leg had any spark at all. At 7:34 p.m. I finally trundled onto the trail, balking at the steady incline, stopping several times to adjust things on my creaking bike. Trail conditions had improved quite a bit since I was here two weeks earlier, but there was still a layer of sugary fluff that had been stirred up by snowmobile traffic, and the base wasn't quite "late March bomber."

Churning and churning, I thought, "I'm tired of pedaling a bike in the highest resistance setting," and "I wonder who else is going to be riding out this trail at four miles an hour tomorrow morning?" Just as I pondered the speed of White Mountains cyclists, a friendly Anchorage racer who was out for a shakedown ride approached. I'd chatted with him at the trailhead; he seemed relaxed there, but here he sped past me as though I was standing still.

"You okay?" he asked.

"Yes, just a heavy bike," I replied as I watched him race up the next hill.

"He'll do well tomorrow," I thought. Ultimately he would arrive with the lead pack at checkpoint one, then return two hours later to inform us that he'd blown up so he was heading back to the start.

After sunset, temperatures plummeted again. I guessed it was -10 or -15. Frost collected on the fuzzy blue fleece things that have become as much security blankets as they are cold-weather gear. I saw the tracks of the other checkpoint one volunteer who was riding out on a bike. He walked in many of the places I wanted to walk, which made me feel a bit better.

The trail undulated over steep hills populated by toothpick trees. Hints of green aurora swept over the northern horizon. To the south I could see the yellow aura of Fairbanks, and three headlights approaching me. The other volunteers were hauling gear out by snowmobile, and also told me they were getting a late start.

"Yay, I can catch a ride," I thought as I trudged up a mushy incline. The headlights disappeared into a dark valley and emerged again, seemingly on a different ridge. Minutes went by, miles went by, and they inexplicably never caught up to me.

"Maybe they're all riding bikes," I thought, imagining someone hauling out tables and snacks and 25 gallons of water via bicycle. Ultimately the lights were the three volunteers on snowmobiles, moving slowly across a deceptively expansive ripple of hills.

We all crammed into the new but diminutive cabin — me, four dudes, and three dogs, one of which barked through the night. We stayed up until 2 a.m. chatting about races, laughing, and drinking beer (I had a virgin hot chocolate.) One guy had stopped by Sams Club to pick up an army's worth of breakfast foods — two pounds of bacon, 18 eggs, 40 tortillas, a gallon of orange juice, a pound of shredded cheese, at least five pounds of ground beef, and two big jars of salsa. There were five of us. I looked at my little bag of oatmeal and laughed.

We woke up at 6 a.m. and headed up the trail to set up our trailside checkpoint — this would be the first checkpoint racers reached at mile 17. We provided warm water, drink mixes, chips, cookies, granola bars, soda, and fruit snacks. There was a small tent for a bucket toilet, tables, five chairs, a propane heater, ten liters of Coke, and only 15 gallons of water for this checkpoint — anything more would have to be generated by melting snow. The minimal offerings at this spot necessitated a surprising amount of stuff. I managed to pull a muscle in my lower back while yanking a snowmobile trailer to a different spot. This injury ultimately proved more annoying and longer lasting than my pulled quad muscle.

I believe this was the first skier to checkpoint one — a Swede named Christian. I would see him again the following morning after he bonked and slept for 14 hours at checkpoint four.

The first runners, Teri and Brian. Teri holds the women's record for this course, and was the overall winner this year. Even though I don't think I'll ever have the ability to run the White Mountains 100 in less than 24 hours, that's what I dreamed about for the rest of the day. Running over the snow in the same way one might float on a cloud, with none of the weariness or pain that my body was currently experiencing. That's what I want to do, I decided, if I ever recover my previous abilities — run, really run, the White Mountains 100.

Beat approached with a big group of runners about 45 minutes later. They were laughing and seemed to be in great spirits. I didn't tell Beat that in the minutes before they'd arrived, we had nearly run out of water. We were frantically shoveling snow into the big pot on the cooker in hopes they wouldn't arrive to a dry checkpoint. The Coke wasn't much help — even though I buried it in the snow for insulation, all of the soda was mostly frozen. Temperatures were still in the single digits.

I gave Beat some warm water and a kiss and waved goodbye. After ninety minutes, everyone else had come through the checkpoint. We had one cyclist drop out with frost-nip concerns, and the Anchorage rider who bonked, but everyone else made it through. My back ached as we packed up, and I bid everyone else goodbye. For my second night at Moose Creek, I'd be alone.

Although I planned to ride a ways out the trail, weariness took over, and instead I went back to the cabin and napped for two hours. By 5:30 p.m. there were still several hours of daylight, so I attempted to rally for a ride. Snowmobiles with massive paddle tracks had torn up the trail again — it really was mashed potatoes, according to Beat, it wasn't just me. I gave up after three miles, which still took me nearly an hour to "pedal." It was both a relief and discouraging to realize that I'm really not in any condition to be racing anything right now.

Dinner with a view. I was a bit relieved to be alone again. Still processing thoughts, still uneasy. Still ready to sleep as long as possible.

At 8 p.m. I stepped outside for a satellite phone call with Beat. Just after sunset, the northern lights erupted. Beat had the best views from Cache Mountain Divide. Despite my overarching desire for sleep, I still went outside four times that night to view the light show — standing on the porch in my underwear and booties at 5 below as the wind howled. The final time I finally suited up in my down stuff so I could attempt to capture a photo, but it didn't turn out at all. I preferred viewing the aurora in my underwear, with the exhilarating tremors in my body as light dances in the sky.

The following morning, I took a cut-off trail to pedal ten miles between Moose Creek cabin and the final checkpoint, a trail shelter at mile 90. The cut-off trail had only been recently groomed and there was no base. I could see footprints next to tire tracks from a rider who just the day prior found it not rideable at all (turns out that was Matt, the WM100 cyclist who dropped out with frost-nip concerns. He strangely decided to attempt to ride this trail back, even though the route is four miles longer and clearly in worse condition.)

Churning, churning, but it was a beautiful morning. I may be weary, but I'm always happy in the Whites.

Despite the soft trail, I found I really enjoyed this route — a scenic expanse of open hillsides and anemic spruce forests. Temps were again in the -10s, but warmed rapidly. Trail conditions also improved drastically once I returned to the main race course. I was able to ride six miles per hour, up gentle inclines! Then I hit the Wickersham Wall, the infamous ascent that gains 800 feet in less than a mile. At this point of weariness it didn't feel much worse than anything else.

I set up my "camp" at the top of the Wickersham Wall, boiled water for coffee amid the brisk wind, and walked around as it was too cold to sit still, even with a puffy coat. This photo is Christian, the fast skier who bonked, with his friend Patrick, who was one of the volunteers with me at checkpoint one. Because of his dismal performance, Patrick told him his punishment would be to double-pole all the way up the Wickersham Wall. I watched him do exactly this. I'm not a skier and don't even really know what double-poling entails, but it looked painful.

Twenty minutes later, Beat came up the hill, as limber and smiley as ever. He told me he saw temperatures as low as -28 overnight, and the northern lights were some of the best he's seen, which is saying a lot. This made me miss winter racing even more — the act of being up all night through that deep cold and darkness, watching the sky light up.

Six miles later, Beat sprinted into the finish. His finish time was 31:45, the fourth runner overall and third man. His mojo had returned.

We were both ready to return home to routine, comfortable beds, and springtime. I'm always grateful for the time I'm able to spend in Alaska. Even without the Iditarod, this March visit had been full of adventures, exhilarating highs and humbling lows. My body and mind were ragged, but my spirit was full, ready to pick up the pieces and sprint forward.