A spanner in the works

If I needed a reminder of how far I’ve come in the last couple of months, it arrived in the form of feeling like I’m right back at square one. Last Saturday, I thought I had a touch of ‘runner’s tummy’ on my long coastal run, but these things happen (to me, anyway) and I wasn’t overly concerned. The run itself went well and I was happy to make it up the final steep mile-long hill at something closer to a run than a walk.

That night, when my dinner defeated me and I poured a glass of wine down the sink, I suspected all was not well. The next morning I knew it wasn’t. Still, these things usually only last 24-48 hours, and a couple of days of streaksavers wouldn’t do me any harm.

By Tuesday, I was worse rather than better. I don’t want to put anyone off their food, so I’ll try and limit the details (but you’re probably a trail runner if you’re reading this, and you probably shit in the woods). I set off on another 5km streaksaver feeling drained and a bit dehydrated. For the first time, I couldn’t make it to 5km, and the symptoms were scaring me. I saved the streak with just over a mile and walked home whilst phoning the GP surgery. I explained I thought I might be contagious so would probably be better speaking to a doctor than making an appointment. I was told the duty doctor would phone me back.

Following the phone call, the provisional diagnosis was dysentery and the advice was not to risk passing it on by attending an appointment unless I had a fever or couldn’t keep hydrated. They would send a sample to the lab and I should drink lots of water, continue using Tailwind to replace electrolytes and try to eat if I felt able. So many of these bugs are becoming resistant to antibiotics that the lab results would be unlikely to make a difference. They would only treat me if the symptoms didn’t get better on their own, but they needed to confirm I definitely have an infection as otherwise something else is very wrong.

I won’t get the results until next week and the symptoms are beginning to ease. I suspect the culprit will be Shigella – the most common cause of dysentery in the UK and a definite fit with my symptoms. If you want to know, then feel free to google ‘dysentery’ and ‘Shigella’. If you’re of a sensitive nature or having your tea, then I’ve just been poorly. There was also a death in the family on Wednesday, so it’s been a rough week, and my illness is minor by comparison.

Yesterday was my first run of more than 5km in a week. A slow 4.6 miles and I pretty much hiked the hill. Gus was delighted to get out for more than the 10-40 minutes he’s been getting this week. I then walked Ned for 15 minutes whilst trying to focus on the training that’s been lacking whilst I’ve been ill.

Goathland Marathon is in three weeks. I haven’t run further than 20 miles since February. This weekend should’ve contained a confidence-boosting 22-23 miler. Under the circumstances, that would be silly even by my standards. The symptoms may be completely gone by Monday, but I haven’t been fully absorbing either food or my thyroid medication for a week. I am depleted and exhausted. Three weeks is plenty of time to recover, but not if I don’t put as much effort into recovery as I usually do into running. I may have to wing it at Goathland, but that has a higher chance of success than trying to train too far or too fast before I’m ready. Training has been ditched in favour of healing.

I am napping in the day again and back to feeling freezing cold all the time. I don’t know if that is just down to the illness or if some of it is because my thyroxine levels have fallen. It probably doesn’t matter – the treatment is the same. Both should resolve as the symptoms continue to improve.

Initially, I was focused on the stomach pain and unpleasant nature of the infection. Now that the lack of energy is holding me back more than the symptoms, I feel like I’ve regressed six months.

I haven’t regressed of course – I should feel better much more quickly this time. However, the reality is that I am always going to have to manage hypothyroidism. Most people have an inbuilt feedback loop. If thyroxine levels drop a little lower than normal or the body temporarily needs extra thyroxine, the pituitary gland uses Thyroid Stimulating Hormone (TSH) to tell the thyroid gland to produce more hormone. When things go back to normal, it produces less TSH again. My thyroid gland is dead – my pituitary is trying to prod a corpse. There will only ever be as much thyroxine as I take in tablet form. If my needs change over a prolonged period, a blood test will pick that up and my dose can be changed. But I can’t respond to immediate fluctuations. If I get sick and don’t absorb the medication, my thyroxine levels will drop. If illness or stress cause my body to need more thyroxine, it won’t get it.

I don’t know how this fits in with being an endurance runner. It’s not like there are hundreds of hypothyroid ultra runners queuing up to take part in research to figure this out. Untreated hypothyroidism clearly affects sporting ability. I’m less clear on treated hypothyroidism. I can find research that suggests exercise is helpful for people on thyroid replacement medication. However, the levels of exercise involved make the findings irrelevant to endurance activity.

The research on the impact of running on thyroid hormone levels and needs is inconclusive and also not conducted using endurance athletes. Exercise has a small and short-lived effect on thyroxine and TSH levels. It may be significant or negligible depending on which study you read.

Does that mean higher levels of exercise could have a greater impact on thyroxine levels or that they could alter how much thyroxine the body requires? I don’t know, but it seems possible. Thyroxine regulates metabolism, so there must be some interaction with exercise. I was told by my Bedford endocrinologist that running shouldn’t affect the dose of medication I need. However, I’m not sure blood tests are going to pick up on what happens to my body during and after a long or hard run. From reading the accounts of individuals, it appears there could be some impact. Anecdotal evidence isn’t scientific evidence, but it’s all I’ve got.

Plenty of hypothyroid athletes achieve highly. Examples include Olympian Galen Rupp (if anyone still thinks taking thyroxine gives someone an unfair athletic advantage, then they have never had a thyroid disorder). Hypothyroidism doesn’t have to mean you can’t achieve, but I suspect the journey to achievement may have to be adapted.

Steve Magness, a runner with Hashimoto’s writes ‘You are always on the edge of overtraining, even if your medication is spot on, and you are doing half of what your competitors are…Despite being extra vigilant on recovery, I would be wrecked after races…Is a pill taken once a day that just releases stuff all at once, the same as a normal person whose thyroid secretes hormones when it is called upon to?’. I guess the answer is probably not.

Most people on adequate thyroxine replacement doses live normal lives. But if we’re really honest, most people don’t explore the limits of their body’s capabilities. That is not intended to be in any way critical or patronising. We all choose our challenges. Society is full of people pushing their limits at work, at home or in whatever domains they concentrate their energies. A relatively small proportion of us choose to push the limits of our physical endurance and use our bodies as heavily as the activities for which they were originally designed. I think that might affect the experience of hypothyroidism. Treatment enables a normal modern (sedentary) lifestyle. Does it enable a physically ‘extreme’ one? I’m still figuring that out.

I am in no way writing myself off here. I am determined not only to get back my fitness, but to come back stronger. I may have to adapt in order to achieve that. Only once I’ve had a TSH level at 1.5 or lower for several months will I know if I can clock up the kind of miles I used to on a regular basis. I doubt I’ll ever be a low mileage runner, but if I need to train smarter and a little less far, then so be it. I will also never race as frequently as I did in 2017 and I may need to pay more attention to recovery. All of this is unclear at the moment. It’s likely I will be inconsistent – any bug like this one is going to have a bigger impact and there’s no point throwing a tantrum in the process.

I will continue to runstreak until I cannot. I will continue to get the balance wrong sometimes. I will progress from streaksavers next week, but I will allow myself to recover. I will not be beaten, but I will probably be frustrated many times. I will try really hard not to take my health and fitness for granted and to be grateful that my condition has a treatment and can be managed. I will probably fail sometimes and need a kick up the arse (but not today, my arse has been through enough). I will enjoy the beautiful area in which I now live and try to do it justice. I will probably also continue to write long and rambling blog posts every now and then. If you’re still reading them, then thank you.

P.S. Please don’t pay me a surprise visit in the next few days. You really don’t want to see me until I’m no longer contagious 😬