Friday, August 13, 2010

POTS Test update

 I heard back from Dr. Joy today, my POTS test came back positive, which means I for sure have POTS. The way they test for it is by having you lie down for 30 minutes and drawing your blood, and then having you stand up for 30 minutes and drawing your blood while standing. Drawing my blood while standing nearly made me pass out, which is a POTS response, not a fear of needles but an androgenic response. What happens, and what they test for is a change in norepinephrine levels when drawing the blood in the supine position vs. standing. If you have POTS your levels will be higher while standing due to an androgenic response. If you test positive then you for sure have POTS, if you test negative, then you can still have POTS. I tested positive, and my standing noepinephrine levels are over 2 x the reference levels, which is very high.

What this means for treatment, I have no idea. Dr. Joy says I am a strange case because I have basically learned to self-manage most of my symptoms and prevent them from worsening intuitively. All of the lifestyle things they would have me do I am already doing, and have been naturally drawn to because I have figured out how to make things better. She doesn't want to put me on a beta-blocker because I am a runner and she says I would hate it. She is consulting with other Dr.'s to see what my treatment options are, but in the mean time my symptoms are generally much improved with the sodium and potassium increases, and I will be working with Elena to figure out if there are ways to improve the blood sugar fluctuation issues during endurance events.

Overall, I feel positive that we are going to figure this thing out and that my running and ability to finish races will improve as we figure out what works and what does not.

Not diabetic!

This is good news! The blood sugar issues I have been having are part of POTS. When I have a stress response I release high amounts of epinephrine which causes an insulin response. This is why during some endurance events, I have blood sugar issues.

So now I will be working with Elena on figuring out a nutrition plan to help minimize this effect, and hopefully be successful at Wasatch next month.

Part of what seems to probably help is getting a lot of sleep before a race, and reducing stress as much as possible. I guess I will be adding on more meditative moments to my life. This will be interesting to try and do this during my second year of grad school!

Sunday, August 8, 2010

Kactina Mosa and Speed Goat 50K reports

 Well, I am not feeling much like reporting, because I am discouraged a bit at the moment.

The positive, I am finding out more at each race what works with my body, and in many ways improving my situation. On the discouraging side, I am finding out more about my body and how weird it is, and in a phase of a lot of trial and error. The problem is, one error that I don't know about can kill a race for me. That is what happened at Kactina Mosa.

I DNF'd last year due to dehydration after leaving Windy Pass, and I was determined to finish no matter what this year. But it looks like I have to modify my expectation for the time being. I am still in an experimental phase trying to figure out what works with POTS. It seems like I have figured out how to stay hydrated, but it also looks like I am probably diabetic.

I am still undergoing different test, and it is probably early stages, but I think Dr. J is likely to start me on medication on Wednesday. She is also going to do a POTS test, but my blood glucose is showing wild patterns.

It was two bottles of Ensure that killed my race yesterday. So now I know one more what not to eat piece. I decided to start at 1am, and give myself 2 hours extra so that I could take time at every aid station to accurately write down all my intake, because that is part of what I am working on with Elena to figure my body out. I felt fine and determined when I started out, and decided to take the first section moderately. I was surprised at how much easier the hills felt this year. I have been doing a lot of conditioning, core strengthening, and balance exercise, and it has made a huge difference. When I am feeling perfect, it means theoretically my speed on all my races should be faster. Much faster! My running time is actually faster, what is killing me are these metabolic issues that I am still trying to get under control!

I was fine until I got to about mile 17, the turn off to climb the toughest part of the course, Lightening Ridge. It was there that I downed a bottle of Ensure and started the climb. I also figured out since than the the Nathan Catalyst tablets I have been putting in my water are the culprit of my GI problems. They contain fructose, and I am not handling fructose. Anyway, I didn't figure this out until later but basically the Ensure made my blood sugar spike so high that I started having vision problems, and my heart rate jumped to 200 bpm. I had to stop and sit down until it slowed down, and then I could move again. This is how I had to get up the ridge, and about two hours later, I finally felt normal again. This is what I am figuring out my problem is. When I eat something that spikes my blood sugar, it is at it's worse at 30 minutes, and then usually by two hours it is normal. Actually, when I did my 2 hour glucose test I was hypoglycemic at 2 hours, even though I felt horrible, and am pretty sure my sugar spiked in the same pattern. I probably have reflexive hypoglycemia.

So I got to the top of the ridge feeling better, and made it down to Big Springs. I was hoping to make it to Big Springs by 8 or 8:30, but that first blood sugar episode cost me at least 1 hour. I started up the climb to Windy Pass, I had to be more conservative because I was not sure at that point what had caused my heart rate to go up so high, and I felt like I was near having a stroke. But my heart rate never spiked again. I felt like I was edgy with my blood sugar the rest of the race, but could manage it.

I got to the top of Windy Pass with Jeff, who had joined me at Big Springs, around 12:30. It was 2 hours later than I had planned on, but that is how much the Ensure cost me. The good news, at first, was that it started raining, and was cool, unlike the 100 degree heat of last year! So I was able to make good time coming down, until it started lightening and hailing! We had to take cover from the hail for a few minutes. When it passed I still was fine, but started to feel shaky again. I had stopped with the Nathan Tabs because I had figured out they were causing the GI issues, but I think I was not in taking enough Scaps. I needed to be taking in about 12-20 per hour, but was unsure of what was causing me to feel bad, so I was probably only at 8-10 per hour, and started to swell. In taking potassium water helped, and I got enough energy to get down to the aid station at Little Valley 20 minutes before the absolute cut off, and so I did the out and back after in taking another Ensure. I felt a little funny, but still not too bad, and left Little Valley at 4:30. I had 2:45 to make the cut off at the next aid, and would have been able to do it, but about .75 miles from the aid station, I started having problems again. I thought my blood sugar was low, so I ate a Honey Stinger, which probably spiked it even more, and caused me to throw up! My heart rate did not go up again, but I had a foggy head, and just felt horrible, and couldn't move fast. Again, at the 2 hour mark, I started to feel better again, but unfortunately I was still 1.75 miles from the aid station when I felt like I could go on again and it was 6:45.

A guy who is on Utah Valley Search and Rescue, and off duty, drove by me. He was just out exploring the road, and wanted to know where it ended. I said I didn't know, but if he would kindly take me to the next aid station, they probably did. I told him I thought I was having blood sugar issues, and he told me he is diabetic, and a nurse, and in school to become a nurse practionare and specialize in diabetes treatment. Wow, that was the perfect guy to come along! So he tested my blood sugar, and it was not super high, but it was at 136, and I had not eaten since I had puked about 2 hours before, and that is high for me, and probably was on it's way down in the same manner of fluctuation it has been showing.

By the time he dropped me off at the aid station I felt so great, I was helping them break down the station. My legs were not even sore, and they still are not. I know had I not been a victim of Ensure, I would have made it probably 2 hours faster, and been fine! I know I will be fine on Wasatch if I can figure out how to manage this blood sugar issue. It seems like I have the hydration issue under control, but now I need to figure out what works for my blood sugar.

Hammer Gels, and Perpetuem, EFS gel system seem to work OK. Honey Stingers spaced out seem to be OK. Anything with too much simple carbohydrates, corn syrup, etc is bad news!

So the good news is I figured this out before Wasatch, and am more likely to be successful. This is partly why I have done so many hard courses this last month, so that I can find out what is and is not going to work before Wasatch! I am encouraged that my legs seem ready to handle 100 miles, I am working very closely with my dietitian and Dr. to figure this out, and get my body working right. It is doing way better, but it is finicky, and sometimes I don't know what not to do, until it has already killed the race, like it did yesterday.

I at least made it 6 miles further than last year, and I will be back, and hoping that I understand my body better and have a successful finish next year! I am more hopeful that I can handle Wasatch today, I was depressed yesterday until I figured out that if I can avoid the wrong kinds of carbs, I will probably be OK. All of these issues are making running tedious because I have to be so scientific on my intake with everything, but it is better than not being able to run, so I will do what I have to.

Last week at the Speedgaot 50K, I did mostly fine, but Karl's course said the cut off was at mile 21.5, and it was actually about 2 miles longer, and all uphill! So I timed out, but I felt great at least. I didn't have any Ensure on that race! The only issue I had, was that I ran out of gels, and there was no drop bag where I needed more of them. So I got hypoglycemic and felt horrible until a girl behind me happened upon me and gave me some gels, my energy felt better after that.

So basically I am having to carry a ton of stuff on my runs, take in tons of sodium, potassium, and water, and eat the right kinds of carbs at least every 30 minutes. It is tedious and a lot of mental effort, but that is what I have to do if I want to get better at ultras, and keep doing them. That is what I want, so I will figure it out eventually, and when I do, I will also be running these courses much faster!