Sunday, October 19, 2014

I want my body back... and I think I'm finally on the right track!

I have been feeling "off" all year and have talked about it a little bit on this blog as I've visited with doctors and attempted to find solutions as to "why I feel absolutely awful when I train and race"... Of course, I know that when training hard, it doesn't always feel good, but this year it has been much more than that... a feeling that I was always stuck in second gear, and this feeling manifested itself most of all in the run. However, I also struggled with breathing in the swim and had many bike sessions where I would cover or remove my SRM as I really didn't care to know what the power was.

People, including my own husband, offered me many reasons as to why I might be feeling off:
- I was overtrained
- I didn't get enough sleep
- My nutrition must be off
- Allergies
- Anemia
- I need more recovery than others
- Too much stress

Standard CBC test results - "I'm totally fine"

Iron, B12 and ferritin values - "highest values I've ever seen"

I consulted with my coach, Matt Dixon, I had three sets of blood tests, I visited an allergist, I consulted several different specialist sports doctors and they all had ideas to treat my symptoms (take B12 and folic acid supplements, use a nasal spray) but no one offered solutions that were comprehensive or demonstrated a true understanding of my health situation. By *normal* standards, I was just fine and the fact that I could no longer run a mile well under 8 minutes (never mind 13 miles) is not considered cause for alarm.

From the outside, things probably didn't seem all that bad. I podiumed a few times this year, my race times were only off by 10 or so minutes here and there, I qualified for 70.3 Worlds. It would appear that I was doing just fine. But I know how much I invested in training, nutrition, strength all while going backwards in training. After 13 years of calling myself a triathlete, I know what it feels like to be training and making progress, I know what it feels like to have gears in training and racing... this year I was always in survival mode, trying to chase fitness that my body was not permitting me to accumulate. After yet another mediocre race at Mont-Tremblant, I just broke down in tears to my husband, saying: "I want my body back, I don't recognize any of these sensations".

The return from Mont-Tremblant coincided with catching up with a long-time friend, Kiki Silver. Kiki and I met while running at Kezar track with SFTri Club in 2003... we go back a long way! She's a super smart doctor and a kick-ass triathlete, having placed 2nd at Ironman 70.3 worlds and 6th at Ironman Hawaii over the years. She's also the sweetest and most caring person you'll ever meet. She and her husband relocated to Boulder, Colorado about 3-4 years ago but we've kept in touch via email and occasional visits. She updated me that she was leaving the general practice where she had been working since arriving in Boulder in order to open up her own practice... my immediate thought was "can you be my doctor? I need help!" After a quick legal check (since I'm CA-based), she confirmed that she would be able to help me and we could do everything remotely. She would order a bunch of labs that I could get done at my local LabCorp office, and she'd also send me some other testing kits.

Kiki's practice, Boulder Peak Health, opened on October 1st so I scheduled a phone consult for October 3rd, the day before I flew to Kona. I completed the first set of bloodwork and a very detailed questionnaire beforehand so Kiki had some preliminary results for us to review over the phone. Here are some excerpts from the blood tests.

Testosterone is zero 
Thyroid, while in normal range is NOT optimal for an athlete, progesterone is zero

The first thing I noticed in our hour-long phone consult is the much broader range of tests and results that Kiki had ordered compared to other doctors I had visited. She also included an awesome summary discussing both the test results and aligning them to the symptoms I had reported in a very holistic manner. See the excerpt below:

We discussed all of the explanations in detail with Kiki pointing out that the BCP was probably contributing in large part to many of my symptoms... and had probably been affecting me over the last five years... From what I understand, my body has slowly depleted many of the hormones that I need for normal functioning... in particular what I needed to function as an endurance athlete. The largest culprit is the BCP... and while I appear to only have minor symptoms on a monthly basis, I was unaware of the long-term damage it had been doing to my body, in particular as an endurance athlete. Few people talk about it... in fact no one had ever told me and no doctor (before Kiki) had even suggested that this might be the culprit. Note that Angela Naeth had conducted a survey earlier this year and many other women reported issues on the BCP, though I had dismissed this thinking it was merely bloating or headaches as the key symptoms fellow athletes were reporting.

My lesson here is that it's hard to know exactly what's going on "under the hood" unless you have a doctor that is committed to you and your health for the lifestyle that you choose to lead... running 9 minute miles was not good enough for me :)

Another particularly interesting part of Kiki's assessment that the allergy symptoms that have become increasingly worse in the past 5 years (having never had hay fever before in my life) are likely due to "estrogen mediated mast cell degranulation of histamine". Basically, the low level of estradiol and progesterone in my body due to being on BCP have been activating mast cells and causing allergy/hayfever-like reactions. What's even worse is that the Afrin and Nasocort that the allergy doctor had been recommending offered merely temporary relief and were in fact exacerbating my symptoms.

Kiki's detailed "treatment plan"
I just returned from Kona and I found it really hard to be out there feeling very unfit relative to how I felt just twelve months ago, running loops around our house at Hualalai and seeing the difference on the Garmin in 2014 compared to my Kona-fit self in 2013. But I could finally sense that I was beginning to feel a little bit stronger... not great but getting there. I even managed to hang on for 75 bike miles with the studette triathletes in the picture below.

Witsup ride with Chrissie Wellington, Mel Hauschildt, Emma Snowsill,
Belinda Granger, Stef Hanson, Beth Gerdes, Laura Siddall

It's now been just over two weeks since I consulted with Kiki and have been following her plan and advice and I'm happy to say that I threw down a couple of 7:4X min/miles in today's easy run. I also didn't feel like I needed to stop and sit on the curb 3 miles into my run. That's huge progress! The testing is not yet over as I still need to complete some saliva, urine and more blood tests, but I am beginning to feel that "I am getting my body back"...

It was fun to be in Kona and I was very happy to be spectating and not racing... that was always the plan. However, a part of me would like to return at some point and I can only do so if I fully resolve the issues I've been dealing with this year. I have a good feeling that I am finally on the right track and for that I owe Kiki, aka Dr. Silver, a huge thanks!

If you need help and are searching for an athlete-minded doctor to do a thorough review of your state of health, I cannot recommend Dr Silver more highly. She can be reached via her website: Boulder Peak Health

Betty Girls at the Underpants run

In Kona to cheer and support Pia!


  1. OH I AM SO GLAD you got some answers! What a relief! I hope you are on the mend and start to feel more like yourself.
    FWIW, I was on the BCP for 20 years. Yes, 20 years. From the age of 20-40. (only went off to get pregnant w/ the twins). I did not notice anything except the bloating and lack of super moodiness - but I know it was not good for me. Once I got off, I was SUPER regular - to the day with my period - and felt like I was in control of my body. Best thing I did - So glad this Dr has been so great. Wish she was here in IL to help some people here!!

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