And then, it was six weeks later. I'm not sure how time got away from me, but I apologize for not updating my blog sooner.
To recap: Over the last 2-3 months, I have lost a lot of blood and become clinically anemic (low hemoglobin) because I have fibroids in my uterus. There are three of them and one is the size of a 16-week old fetus and the other 2 are about 6 weeks along. In fact, the big one completely fills my entire uterus! I got to see them in ultrasound pictures but decided not to get a printed copy to hang on the fridge. The main, troubling symptom is massive blood loss and the only way to recover from that is to take iron supplements and, well, stop bleeding.
Last time we met, my hemoglobin had tanked to a low of 9.7. Over, the past six weeks, I got it up to a high of 12.4. My goal is to be around 14. My running mileage and intensity increased steadily with my blood levels. I began feeling so much better with each incremental gain in red blood cells. I have also found that this is not necessarily a linear process. Some weeks, my blood levels rose in what appeared to be regular increments while in others, they didn't go up at all, even under the same supplementation regime and without any blood loss. Then, some weeks, like last week, I lost so much blood that I ended up losing ground and became anemic again.
Here is a quick record of my blood levels and corresponding workout milestones:
2/14/14
Hemoglobin: 9.7
Hematocrit: 29.3
Running workouts: Kept all workouts to short speed efforts. Ran about 3-4 days per week, ~20 miles/week. Felt very tired running. Had to stop numerous times to get through an easy run. Had to walk rest breaks when doing speed work.
2/18/14
Hemoglobin: 10.8
Hematocrit: 33.7
Running workouts: Still keeping to short speed efforts. Ran about 3-4 days per week, ~20 miles/week. Still felt very tired running. Still walking in rest breaks when doing speed work.
2/25/14
Hemoglobin: 11.2
Hematocrit: 35.4
Running workouts: Finally starting to feel better. Ran a long run at around 7:30 pace midweek and it was hard. Heart rate averaged 88-90% of max for the whole run (usual pace at that HR range is ~6:10). Did a short speed workout over the weekend and it was the first time I didn't have to walk the recoveries! 48 miles this week. Felt less tired running in general.
3/6/14
Hemoglobin: 11.7
Hematocrit: 35.7
Running workouts: Not much change here. Pretty disappointed that my hemoglobin didn't rise more over the last two weeks despite the iron supplements. I guess recovery from anemia isn't a linear process. I did some running on hilly trails and felt much better than I thought I would. However, I had to cut my first lactate threshold workout into chunks a few days later because I couldn't hold 6:15 pace for more than 800m:(.
3/12/14
Hemoglobin: 12.3
Hematocrit: 38.7
Running workouts: Had my first long workout with 9 miles at alternating marathon and lactate threshold pace. Ran all of it, but boy did I stop a lot. Averaged about 6:25 pace, but I did stop about 6 times during the course of this "continuous" workout.
3/21/14
Hemoglobin: 12.4
Hematocrit: 37.8
Ferritin: 35
Running workouts: Had my blood drawn on my own and decided to get ferritin checked too. Was happy to see that my iron stores are still up there! Ran a couple of lactate threshold workouts and stopped in at least one of the miles to complete at the faster paces (5:58-6:07). I don't recommend this, btw. It's not the way you're supposed to run them, but this is what happens when your brain is disconnected from your anemic body: you think you can run faster than you actually can and then you die during the repeat.
3/28/14
Hemoglobin: 11.9
Hematocrit: 36.8
Ferritin: 19
Running workouts: I had my blood drawn because I had experienced another major episode this week and was very worried about the effect on my blood levels. I had good reason to be concerned. Not only were hemoglobin and hematocrit low, but my ferritin took a nose dive because my body was really needing the stored iron to make new RBCs. I also changed my supplements a little this week from taking the liquid ferrous sulfate 3 times/day to taking it once and adding in a "gentler" product called "blood builder" with non-heme iron, folate, and B vitamins. I won't do that again. That stuff doesn't work for me.
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So, that was last week and I had a race yesterday. Maybe you can imagine the deflation I felt when I was making such good progress with my blood levels and then, BAM, I lose nearly a month's worth of progress and turn into anemia girl again. IN TWO DAYS!!! I had hoped I might be close to normal by the time the race rolled around.
I was a bit conflicted about whether or not to even run the race. I had missed two other races I had signed up for in March because of my health issues. The first race in early March was a 10 miler and I couldn't even run 10 miles at any pace without stopping to catch my breath at that point, so that was kind of a no brainer. Then, there was the hilly but beautiful Race across the Bay in San Francisco where I did so well last year. I was feeling better by then, but wasn't sure I could run without walking the hills. No go.
With yesterday's Sactown 10-mile race, I knew that the anemia was going to affect me, but I decided I didn't want to miss another race. There is this little thing called ego that tried to get in the way of my decision, but I decided to just suck it up and go for it. I'm really glad I did. I had hoped to run around 6:30 pace for the whole race and try to pick it up a bit if possible in the second half. I stuck to my plan and was at least able to even split the race. I ran 31:59 for the first half and 1:03:57 overall. I was very pleased with this given the fact that 3 weeks ago I couldn't hold that pace for 9 miles. What I have to forget about is that I was running 30 miles/week at less than 6:20 pace two months ago in training.
The good thing about being anemic is that I will feel like a freakin' rockstar once my hemoglobin levels get over 13. I still have a long way to go, but I am hopeful that the meds I'm taking to control the bleeding will eventually kick in. I have been able to keep my mileage up around 60 these past couple of weeks and will be gradually increasing as I get closer to the Eugene Marathon.
So what is the solution to my medical problem? Well, the "easy" answer is to have a hysterectomy. In fact, the two gynecologists I saw prior to seeing a surgeon a few weeks ago, had already written my uterus off. When I walked in to see the surgeon, she said, "so, you're done with your uterus and just want to take it out, huh?" I told her that I never said that and, in fact, had told both of the other doctors that I did not want a hysterectomy. I wanted to see if I could manage the problem with meds before yanking the thing out.
This doctor was very good. She told me I had a few options available before resorting to major surgery. She explained these to me and said that I could totally live with my fibroid babies as long as I could deal with the symptoms. She also confirmed that they were living off a diet of estrogen and that, decreasing that would make them shrink and die. This is why they go away in menopause. I am a few years away from that big change, but it at least gives me a timeframe to work with.
What I have been doing is looking for other alternatives to reduce estrogen levels in my body and to shrink the fibroids. Those of you who've been regular followers will recall that I had my blood estrogen levels tested about 2 years ago (on my own because my docs said it was not useful) and was shocked that they were in the 500+ range which is the ideal level for someone on IVF treatment (very high). The medical doctors I have dealt with think estrogen tests are useless because they change with the monthly cycle, etc., yet they prescribe hormonal pills to increase them in order to remedy problems like I am having.
I am operating on the assumption that my estrogen levels are high (well, I have tests to prove that) and that my progesterone levels are low (taking BCPs for that). I am taking a product called Myomin to reduce my estrogen levels. It takes about 3-6 months to see reduction in fibroids if it's going to work. This is a long-term strategy, obviously. I also believe that I can quash the Occupy Jaymee movement inside my uterus by taking systemic enzymes that help to break down fibrin. This is based on internet research I have done and there is some science behind it, but it is purely a trial. I am assuming it can't hurt me to try.
In making this choice to try these alternative treatments and give my body a chance to kill the little bastards I have chosen a tough option. I won't get quick relief from this route, but I will at least know that I exhausted my non-surgical options. It is so tempting to think about surgery on the days, like the two days last week, where I am bleeding uncontrollably and know that I am becoming anemic yet again.
I am seeing progress. My blood levels aren't dropping as much as they were over a month ago every time I have a period, and I have new ways of coping with the massive bleeding when it comes. Ladies, if you are in the same boat as me and haven't tried the Diva Cup or Lunette, you are missing out on a wonderful world of leak-proof protection! Gross, I know guys, but this little device has literally changed my life. I can do everything I want to do without worrying about the flooding interrupting the party. It is perfect for runners and offers 12 hours of protection (for me that's about 3 hours, but way better than the 5 minutes I get from the other options).
And, I do believe my fibroid babies are shrinking. They are big enough that I can actually feel them in my abdomen (be grateful I spared you the baby bump pictures). They are definitely smaller than they were a month ago. As my symptoms subside, I'll try to get in for another ultrasound in a few months to see how much they have shrunk.
I am happy to be able to share my story with all of you and add another anecdote to the interwebs about dealing with fibroids--one that is specific to athletes. I got confirmation of the educational benefit of my efforts from a fast guy runner yesterday who confessed that he has been reading my blog despite the warnings I have posted. He said, "I had no idea how much older women have to deal with!" I told him these problems are a lot more common than he could imagine, but most women choose to keep their stories private--and for good reason! I'm glad I didn't.