Fighting the fatigue--I think I'm winning

I've been gradually returning to normal after my horrendous 3-week illness which set me back and ultimately caused me to forgo AFC's 1/2 marathon last weekend. It's been a slippery uphill slope. On a day-to-day basis, I can't gauge my improvement. But on a weekly basis, I can see I have more energy and am feeling better and better. I think a combination of overtraining causing a weakened immune system and an ill-fated gastric infection from the dairy farm (plus another virus to boot) caused me to fall flat on my back. However, it's been unusually difficult to beat the fatigue and get back to my perky self. It could be the virus in my system plus the stomach bug just took a large toll that my body will need a few months to reover from (many viruses can cause fatigue in patients lasting several weeks).

Just to be safe, I went to the doctor and had some tests done. My blood tests came back normal (almost). Turns out, I may have low thyroid (see below for more info on low thyroid). At age 28! My whole family has low thyroid and though I don't display some of the more common symptoms (weight gain), I do have a hard time keeping warm and have been extremely tired lately. So the doc ran a simple blood test. My thyroid hormone was on the low side (0.8) but not out of the normal range (0.8 to 1.6). But my TSH was almost 30. What? Off the charts! Anything over 4 "merits treatment." The doc wanted to start me on a high dose of daily thryoid medication. However, it's a pretty serious drug with some potentially adverse side effects (erratic heart beat was the one that caught my eye) so I went and got a 2nd opinion from a more conservative doc. This one will probably recommend thyroid treatment as well but he'll probably start me off on a lower dose. Plus, he's comparing these results to results 2 years ago (normal), and he's redoing the lab work (yea! needles!) in a few weeks to make sure. Hey, I'm a scientist. I need something more than an n of 1 to confirm off-the-chart results before getting excited. 29 just seems too high to be believable. Plus, the 2nd doc said illness could cause fluctuations in thyroid levels. Hmmmm. Did the illness cause the thyroid issues or the other way around. Hmmm.

I like the 2nd doc much better than the first one. The first one just wanted to get me on drugs and out of the office. Not acceptable. You really have to be your own health care advocate these days. Do the research. Know your body and your symptoms. Don't be afraid to get a 2nd opinion. Take the time to find a doctor you trust and can work with. Your doctor should respect your symptoms and your previous knowledge of your body. You know it better than anyone else. But I digress...

Anyway, I'm addressing my ridiculous fatigue. I'm doing all the right things, and I'm getting it figured out. I figure, if it's low thyroid, I've probably been developing it for some time and can hold off treatment for a few more weeks (zzzz) while I take the time to do the lab work correctly to confirm that is actually what's wrong.

In the meantime, I've been addressing my fatigue in other ways. I avoid caffeine late in the day. I go to bed early. I avoid naps like the plague, even if it means I'm a mega-bitch in the afternoons. I try to eat small, healthy meals frequently throughout the day. I make myself take breaks and restrain myself from going overboard on any one activity, which I'm prone to doing. I exercise almost every day but don't overdo it. Sigh. This level of discipline is tiring in and of itself but it does seem to keep me productive and functional as I get my fatigue figured out.

Another possibility is chronic fatigue syndrome (CFS), which is basically overwhelming fatigue and symptoms similar to the flu without having any indications otherwise (that can be detected) that there is anything physically wrong. Experts believe it could be due to a poorly functioning immune system or triggered by a virus but no one is really sure.

What struck me in reading about CFS was its similarity to overtraining syndrome. Indeed, in some articles about possible triggers for CFS, overtraining was actually listed. Interesting. In addition, in reading about overtraining, some articles stated that if overtraining was not addressed (by rest), symptoms could become chronic. I don't think I have CFS because my symptoms are not persistent enough and have not lasted for long enough. But it's just another illustration of what could happen if I ignored what my body is telling me. I think all the racing and hard training days I did back-to-back this summer took its toll. It's just another warning to myself to pull back, take it easy, and let my body recover. I'm amazed at how easy it is to trick yourself into overtraining mode in triathlon.

Overall, I feel really good about this week. 1. I found a doctor I like and who I can work with, and 2. I think I found a solution to my long-lasting fatiuge. 3. I've been able to control my fatigue somewhat through more rest, pacing myself, and nutrition and 4. was able to have a productive week both in lab, at home, and in training. 5. I did a workout almost every day--ran on Monday, swam on Tuesday, biked on Wednesday, did a club Aquathlon on Thursday, rested (smart) on Fri and Sat, and did the Imperial Beach Tri on Sunday. Tonight, I'm resting, eating, doing a little housework catching-up, a little reading for lab, and a lot of petting the buns.

By the way, the Aquathlon on Thursday was great. As always, I saw lots of great people, which is one of the best reasons to attend these things. I also met new people, including, Paul, which was awesome. Always good to meet fellow bloggers! I had a good, strong swim and run. I wasn't fast but I was steady. My base is still there, and that's what matters. The water was very inviting and warm. I saw lots of sting rays and leopard sharks! They're harmless but they swim in such shallow water; it's kind of freaky to see these long, skinny fish zipping under your arm. Yikes! The run was tough--on sand and a 2-lap course, which is mentally tough. But I actually felt better and better as I ran. I think the first 2 miles for me always suck. I'm such a long, slow distance person now. Guess it comes from the training.

On Sunday, I woke up, rarin' to go for the Imperial Beach Triathlon. I felt well-rested and prepared. It was "just" a sprint, and I can finally say that I can do a sprint and it doesn't kill me anymore. I can actually go out there and relax and have fun and put forth a good effort. It feels good to reflect on how far I've come. There weren't that many people there, which gave it a laid-back, friendly atmosphere. The swim was surprisingly tough. Even though the water looked gentle and calm the day before and had felt warm, Sunday morning brought some rough surf and FREEZING cold water. I forced myself to warm-up, vital for a sprint when the swim is over before it begins. Hurried to the start and got completely pummeled by a wave coming in. I hate when a big wave sneaks up from behind and you get caught in just the wrong way. You get sucked under and don't know which way is up or down. I try to let myself go limp, and I can feel the force and power of the ocean taking my body and bending it forward and backward at its whim. There's always that terrifying moment when I'm not sure if the wave is going to snap me in two or bash my head on the ground (in addition to breathing in a ton of water). I stay calm and zen out, and sure enough, I always end up popping up like a drowned rat, with the ebbing surf giggling after me. After getting spun around and swallowing a good deal of salt water, I shook it off and lined up on the start. The actual swim itself was pretty uneventful after my traumatic warm-up. I had no problem jumping on the bike and pedaling off, although I had to yell twice at people (spectators) to get off the course. Oh, and another time when a volunteer waved a bus through an intersection that I was barreling through. Hello! I'm riding here! But I kept my road rage in check. The bike felt awesome. It was over so quickly. Then, I was off and running. Found my stride and felt myself relax into it. I ended up pacing next to another woman in my age group I introduced myself and we chatted the rest of the way. It's so nice to meet people like that at these events. Makes it a little less lonely. I had a great surge across the finish and met someone else in a tri club uniform afterwards. I'm constantly amazed at how friendly everyone is in this sport in San Diego and how easy it is to meet good people. It's very refreshing. Especially b/c that hasn't always been my experience.

The rest of the day has been sleeping and relaxing. I'm going to hang back and restrain myself now to focus on training and being healthy. I'm gearing up for the San Jose Rock 'N Roll 1/2 Marathon Oct. 8th. Already have done most of the training since I just missed the last one so I really just want to maintain my base and have fun. After that, it's season wrap-up time (even though the season never really ends in San Diego) and a little rest before gearing up for next season. I'm already writing up a list of races I want to do (I have to cut several. sigh. too many. a happy problem) for 2007.


Informative websites on low thyroid:
Doctor Yourself
Endocrine Web
About.com
Project Aware


Symptoms of Low Thyroid:

• lethargy and decreased energy
• cold intolerance
• muscle cramps
• muscle pain and stiffness
• constipation
• weight gain
• dry skin
• mental slowing
• course hair and skin
• depression

Informative websites on chronic fatigue syndrome (CFS ):
The Free Dictionary
Life Extension
CDC
CFIDS
Family Doctor

Symptoms of CFS:

Four or more of the following symptoms must have been present for longer than six months:

• Short-term memory loss or a severe inability to concentrate that affects work, school, or other normal activities.
• Sore throat.
• Swollen lymph nodes in the neck or armpits.
• Muscle pain or weakness.
• Pain without redness or swelling in a number of joints.
• Intense or changing patterns of headaches.
• Unrefreshing sleep.
• After any exertion, weariness that lasts for more than a day.

2. The fatigue must be severe as indicated by the following:

• Sleep or rest does not relieve it.
• The fatigue is not the result of excessive work or exercise.
• The fatigue substantially impairs a person's ability to function normally at home, at work, and in social occasions.
• Even mild exercise often makes the symptoms, especially fatigue, much worse.

3. The fatigue must be a new, not lifelong, condition with a definite time of onset. Often, the condition first appears as a viral upper respiratory tract infection marked by some combination of fever, headache, muscle aches, sore throat, earache, congestion, runny nose, cough, diarrhea, and fatigue. Typically, the initial illness is no more severe than any cold or flu.

4. The symptoms must persist. In ordinary infections, symptoms go away after a few days, but in CFS, fatigue and other symptoms recur or continue for months to years. Many patients experience symptoms as recurring bouts of flu-like illness, with each attack lasting from hours to weeks.

Note: Other symptoms reported with CFS but not part of the criteria include intolerance to alcohol, irritable bowel syndrome, dry eyes and mouth, impaired circulation in the hands and feet, visual disturbances, and painful menstrual periods in women.

Overtraining and CFS:

BMJ
Sports Injury Bulletin
Emotional Processing & Physical Health