Half a Half a Marathon

What a beautiful day! I can't imagine better weather for all the runners who ran the Brooklyn Half Marathon today. I hope all my friends who were aiming for a PR achieved it. Wish I could have been with them.

I didn't miss the party completely. I got up at 7 to prep for a morning run and got out the door about 40 minutes after the race had started. This being my second run post-exacerbation, I figured I'd take the subway to the park and do two leisurely loops and that when I got there, the leaders should be just about entering the park and I could do my run as a show of solidarity with all those poor suckers brave, intrepid runners who had just finished 10 miles and had three more to go in the park.

I didn't take the subway. With a powerful sun shining down, it was plenty warm if I stayed out of the shadows, so I just headed for the park on foot, changing my plan from 6.6 in the park to 6.7 in my up-around-down loop. I was pleased that on the way uphill to the park, I managed to run most of it, with only one steep section slowing me to a walk.

I arrived at the park at a most opportune moment. As I stretched out my now-warm muscles at the Pritchard Square entrance and surveyed who all was in the park today, I was approached by two gorgeous women who inquired about the location of Ocean Parkway. I said it was at the other end of the park almost - about 3/4 mile down the loop, and were they there to cheer for a friend running the half? They smiled and said yes. I pointed out that being at the Ocean entrance is a good spot, since the runners come around a bend there as well and they'll have plenty of opportunity to spot their friend, but that since the route loops back on itself in the park, they could set up on the north side low down on the main hill and cheer their friend on TWICE. Then I took off.

Almost as soon as I got on the main loop and got a slow jog going, I looked to my left and the very leader of the pack came zipping by - he was really moving! He was followed 15 seconds or so later by another, and then a third runner in a minute. The loop was clogged with runners, not only racing but just casual, like me. A lot of people also turned out to take up stations and cheer their friends on - that was really nice to see.

As I made my way around the loop (sometimes walking, but not too much) I took water from the tables. Hey, I pay my dues to NYRR! I had meant to bring a bottle of HEED but somehow felt I should do this run weighed down by as little as possible, so no HEED, no powersnot, no tunes, just me and the mighty, mighty wind. (And indeed the wind was pretty strong at times and cold in the shadows, which made for a little more challenge for the racers this year than last, when it was a little warmer and not as windy.) It was not always my lungs I had to walk for; half the time it was my legs. I have pains in places I haven't felt before, but they're not major and they went away after four miles. I think breaking in my new 992s is causing these pains, even though I'm still running in the old 991s.

It was at the water table at the top of the park, just before I exited, that I was standing near a lamppost, leisurely sipping a cup of slightly-frozen water and catching my breath, that a very familiar face approached in the middle of the pack. NYFlyGirl was making her appearance! She looked great, running strong at a steady pace. She looked like she was working hard, and threw me a wave as I toasted her. Great to see you out there!

I didn't manage to catch a glimpse of either Derek or Beast; but I know they were out there. Beast emailed and said he's happy with his run, ran negative splits the whole way, which is a solid indicator of being well-prepared for a particular race.

I finished my water and headed home, and only walked one block in that last 1.7 miles. (Though my exacerbation is under control, the asthma still rears its ugly head and I really, REALLLY must remember to carry albuterol with me!) Along this final leg, I realized that the racers today had run twice as far as me, but that I ran a little over half of a half-marathon distance. And that any distress I had during the run was not distance related, but health related, which makes a quarter marathon a perfect re-training distance! This distance will start the training-up process again, will force my lungs to breath deeper, force my legs to build-up glycogen-storage capacity, use less glycogen for the work they do, take longer strides. I was pleased that while in park, I was easily able to keep up with the racers who were at about a 9:40 pace (at least until an incline).

I took my time and really stretched after the run, like I haven't done in a couple months. I've lost some flexibility, but not as much as one would assume. Since I was lying on my bed using a strap to help stretch my IT bands, I was not surprised to find myself waking up after a solid 90 minute nap! And though I had a pounding headache, the rest of my body felt truly great.

The home nurse came after that to take out my mid-line, I've just returned from getting groceries, and I'm sipping my favorite "recovery"/reward drink, POM (this time trying the blueberry version). And after this posts, I'm going to take a long, long hot shower. So, all in all, B+. Next year I hope to once again run the Brooklyn Half; in the meantime, I'm getting serious about tackling Nashville's half in April.

medical update

All day I've been thinking about the Brooklyn Half. Derek Rose has written about looking forward to it, too. I even ran into an older runner this evening while getting to the 96th street station who was wearing a new-looking long-sleeve T with the NYRR logo on the back, among others. I caught up with him and asked him if he was running the Brooklyn Half tomorrow and he allowed as how he was. He was embarassed being caught in a faux-pas - wearing the run's t-shirt before the run itself. I didn't care, but I did notice the nice graphic for the front, and it dawned on me that since sometime mid-fall, NYRR has had the most awesome graphics for the race shirts!

So, basically, I feel like I'm missing the party, the social event of the season; like the little kid who's too sick (or been too naughty) to go to his friend's birthday party. And going for my own run tomorrow and cheering on the finishers as they come in just isn't going to be the same. Nevertheless, I am looking forward to a clean, simple, two laps of Prospect Park tomorrow.

I had a checkup today and my PFTs are much better. I am back in the low 40's for my PFT1 percentile, an upwards change of 15 points! The numbers back up exactly what I'm feeling: that while not the best I've had it in the last year, I'm way, way up from my low of a month ago. The numbers, too, are only average for me. Significantly improved from the last PFTs, but noticeably below my previous best. I think getting back to running will be just the ticket to get the PFTs up another few points.

The asthma remains something to be reckoned with and I guess that won't ever change. I did find out that I'm supposed to be on BOTH Spiriva and Advair. (I'd quit the former when given the latter.) So that might help. And, I've gained a whole pound and a half!

As I type this, the last of my IVs are dripping into my arm and tomorrow after my run, I'll meet the home nurse to remove the mid-line. Having full use of my right arm will be a welcome change.

Now, on a different topic, I bought some new running shoes last Monday and wore them the last two days. These new 992's are a half-size larger than my old 991s and I'm having some problem adjusting to them. I fear I might have purchased them too large and will have to drop more money to get the next half-size down. Size 8 is tight, sure...but that's what I currently have in the 991's and I really like the way the old ones fit. On the other hand, perhaps I could just lace a bit tighter and give them time to break in better, eh?

brooklyn half upcoming

To everyone going out tomorrow to run the Brookyn Half: good luck! Fast feet kids!

It breaks my heart I won't be running it this time, but I'll be with you in spirit. I'm going to go up to Prospect Park bright and early and jog two loops; see if I can't make it up the big hill without stopping, at least the first time around. I'm hoping to time the last of the run with the head of the pack coming in to the park, so I can watch a lot of people finish and cheer them on. Hope to see all my blogging friends there.

A triumphant return to neuroticism.

"The unexamined Life is not worth Living," Socrates solipsistically stated. Bloggers are undeniably the monarchs of this matter, making it a monomania. With their unique ability not only to set forth every detail of life, from the edges to the core, but also to entice others to re-examine these details and respond, it is perhaps not incorrect to state that bloggers are Neurotics and their readers Enablers. However much they have taken Socrates' advice to heart, they sometimes forget Balance. "Observe due measure," Hesiod wrote in Works and Days, "moderation is best in all things." Ninth century B.C., kids. We have not grown wiser as we have grown older.

Accusation set forth, I declare myself guilty as hell* and embrace this nifty little item, which will make me look brainy and hip at the same time:

*At which point you, Reader, respond with, "No, you're not neurotic at all!" And I say - Thank you, Enabler!
---
So. What motivates one to get up 5:30 a.m. on a Sunday? Warm weather, a pleasant jog in the park, sunshine, a certain zest for life, and an appreciation for the kick in the ass that a race represents, motivating me to evaluate (and get in gear) my training. Yesterday's weather was beautiful. 68 degrees, sunny, breezy; I took a long walk around Greenwood cemetary. Perfect.

This morning was colder, 55 degrees, but that's just about right for a run. It wasn't sunny, though, the rain has come back and threatened to let loose on those of us gathering for an 8 a.m. start for the Pfizer Oncology 4 mile race. I ran this race last year, only it was a half marathon then. This year, they broke it up into a 4-miler, a 15K, and a 1.7 mile walk. I suspect that this was to increase the overall participation and raise more money for colon cancer research. Well, it worked: had the 4-mile option not been there, I would not have made the snap decision yesterday to drop by NYRR and sign up.

After two months of no running, I had a major goal this weekend: get my butt back on the road. About three miles would do it, I thought. My lungs are in better shape, though not fantastic, and the asthma is under some control. (Mysteriously, I have had more asthma the last two days than in the last couple of weeks; am I growing immune to the effects of Advair already? Or maybe more likely, have I begun to associate running with an asthma attack, so now I'm getting stress-induced asthma?) But then there was this 4-miler staring me in the face and it would count towards the nine needed for next year's marathon entry, so...

Getting up at 5:30 in order to do an infusion, therapy, my toilette, and get out of the house by 7 was like climbing up a ladder with a corpse chained to my ankles. But as I went through my routine, I found that even with a two-month hiatus from races, that getting ready for the run was completely automatic. I didn't have to think about it for an instant. I noted the temp and the weather and automatically grabbed appropriate clothes and layers from exactly where they should be. I gathered up HEED and powergel from exactly where they should be. Everything I looked for, I found, and I left the house with nothing missing. That might have been a first.

I was running a bit late, so I left the subway at 34th and took a cab the rest of the way. Having failed to note online where the start was, I made an educated guess and had the cab drop me at the 70th street entrance on the west side. Bingo! The main area was all set up right there. I had five minutes to drop my bag and hustle over to the starting line; I heard the horn sound and got to the starting line just as the last of the pack was crossing it. Perfect.

The run was OK. Not earth-shattering, not ego-building, but not ego-crushing either.* My confidence that I can get back in the game has been bolstered. I ran all but a few yards of the first mile, even managed to get to the top of Cat Hill without stopping. Realized early on that a mile feels like a looooooong way right now. Also realized that this route - the standard 4-mile loop - was all new to me: I just didn't recognize any of it until I'd passed over it. I was getting a very weird sense of deja vu.

As usual with a back-of-the-pack race, I played tag with other runner-walkers most of the time. The second mile was probably the hardest, as I had not digested breakfast or the coffee yet and it was all sloshing around in there. Plus, having had no time to use the facilities before the race, I was beginning to need the johns. But at each station, I didn't want to stop. I only stopped at the halfway point to heave into the grass and clear my stomach a bit; I felt better immediately. Mile three was tough, and I had to stop to stretch, but I was beginning to feel pretty good.** My breathing had settled into the pursed-lip mode that I had to use when I began running and I know I sounded like a steam engine to the people I was running near. But at least I was running. My few walk breaks were not emergency-type breaks like at the end of 2005, they were more akin to the walk breaks I took as a brand-new runner - so I guess that's where my body is again. I can look forward to the pains of training up, but also some of the joys that I discovered over the last year. At some point, it began to rain lightly, but it stopped before the end of the race.

Walked a few uphills, but overall, it was a solid race for someone who hasn't run in two months and is still on IVs and recovering from an exacerbation. (Made a bloody mess of my mid-line dressing, though.) Point is: I finished running! I achieved my goals on this race and look forward to the next one, where I'll keep the same goals, but the race will be six miles and will include the hardest hill. I hope to get out to Prospect Park a couple times this week and do some laps there.

Before I go, I want to say thanks to the anonymous NY Flyer who, while obviously waiting for the 15K to start, had wandered to the third mile marker and was giving encouragement to us BOTP-ers. It was nice to see him out there.

A check of the results page shows marked improvement over my last (miserable) four-miler. In fact, I squeaked in under a twelve-minute-mile, something I didn't quite expect to do. I was aiming for a sub-52 minute run and managed sub-48.
---
* I'd like to revise that, now that an afternoon and evening have passed. This more than an OK run, it was a GOOD run by fair standards. The most important sign of how good it was is that my mood has continued to elevate all day and I positively feel positive about being able to do the half in good form in Nashville!

** It should be noted that I expected my legs to cramp, complain, and all that jazz. Nothing happened. They just did their job almost as if I'd taken no time off at all. In fact, the joint pain I was expecting never materialized either - so perhaps taking some weeks off was a good thing in the long run! My abs and obliques, however, are definitely feeling the burn; they haven't worked like that in some time!

"This blog needs an update even if you aren't running." OK, Mom, you asked for it, you got it.

Before I get to an update on me, though, I'd like you all to point your broswers to jerrycahill.com or download the video file at this link. It is a short video in which Jerry shows-and-tells about the equipment he uses when he jogs. Jerry lives just down the road from me and is a friend of mine. I knew he was hardcore, but this video really spells it out. As a runner, he is HARD CORE.

Also before the update, I'd like to give kudos to Fairway food store. I'm currently doing a show at 78th Street Theatre Lab, and I stopped by Fairway for some groceries before heading home tonight. The problem with Fairway is, you go in to shop for a $20 dinner budget and wind up spending twice that, not just because everything there is more expensive (hey, you pays for quality), but also because they've just got so many neat things that you can put in your mouth. For instance, I picked up a little chunk of port cheddar and a wedge of Spanish fig cake w/ assorted nuts, something I've never had before. You can find something new to try everytime you go in. And their fish department is fantastic.

So. Let's review: I've been sick for about three months. Back in late October or early November, something changed and suddenly I was experiencing a steady decline in my lung function, against which running was proving no defense. Before Christmas, I sought out my doctor's help and for the next two months, it was oral antibiotic after oral antibiotic - none of which had much effect. My lungs kept declining and I found it impossible to keep running. In fact, up 'til last week, even the five-block walk to the subway meant having to stop and rest once or twice and I was coughing the whole way. Climbing UP out of the subways was doubly-hard.

So I called the doc and laid it out: what if the lung infection isn't the only problem? There's also inflammation and asthmatic-reaction to deal with. Could we address those problems too? I asked because any effect the antibiotics may have had was probably being masked by the other problems. So she put me on Advair last week (I'm sure you've seen the ads) and I also have HS and Xithro coming, too. HS, or hypertonic saline, is a CF-specific treatment that started when an Australian researcher noticed that some Australian surfers with CF had great lung function and theorized it was due to inhaling all the salt-water. And the hypertonic saline does seem to work for a lot of Cystics, the secretions break up, clear out, and their lung function improves. Xithromycin is an antibiotic that is being prescribed for its anti-inflammatory effect and is a long-term, low dosage kind of treatment

I've already seen improvement in the last week in my ability to breathe. Seriously, within hours of my first dose of Advair, I was able to breathe easier.

More importantly, I am now on intravaneous antibiotics. It's been difficult getting results from the labs or even interpreting what they send, the doc says. One lab says I'm pan-resistant (borne out by the ineffectiveness of the oral antibiotics, IMO) and another lab says I'm pan-susceptible. I don't believe the latter for a minute. So my doc has me on IV meropenem and will be starting an as-yet-undetermined second antibiotic soon. (The double-punch is always better than a single med.) So here I sit, with a mid-line .... wait, you don't know what a mid-line is? Ah, time for more education...

IVs: A Primer.

There are four options: you may be familiar with the first, a peripheral line, which is a local placement with a short (perhaps 1") catheter, and is held in with a plastic butterfly taped to your arm. If you've ever had surgery, this is what you got. These come in all sizes, even for premies, and are quite comfortable. Unfortunately, they don't last long, as the smaller veins tend to break down quickly and the catheter part often clogs. (The first time I did IVs, they used peripherals only and I went through three in two weeks.)

A mid-line is a second option. A mid-line is placed by an RN and involves setting up a sterile field. The RN must wear a surgical gown and mask. Once the subway-axle-sized needle punctures the vein, simultaneously introducing a plastic shunt, it is withdrawn, leaving the shunt in place. This allows one's blood to flow OUT. Copiously. The nurse must work fast. She introduces a 20-centimeter (or so) catheter and threads it into the vein. Once placed to its base, the plastic shunt is pulled out and peeled apart and only the catheter stays in the skin and vein. The catheter hub is taped to the skin and the entry site is protected with a sterile, clear plastic covering. The tip of the catheter ends in a larger vein that is not likely to break down, so this kind of IV tends to last a while. This is what I have right now. Other options include a PIC, which is an even longer catheter which ends very near the heart and its placement has to be done in-hospital, as the final position has to be checked by x-ray. A fourth option is a port-a-cath, which requires actual surgery and is left in for years at a time, with only a small bubble under the skin betraying the location of the port, which is then accessed through the skin with very small, very short needles. This is a good solution if you're on IVs near-continuously. This document describes the types very well.

Getting the mid-line was quite an ordeal this time. The same nurse came out who did it last time (two years ago) and that was a pleasant reunion. It helps that she has my trust. Unfortunately, I offered up my left arm and previous mid-lines and untold numbers of blood test sticks have left the veins there full of lumps and scar tissue. The nurse couldn't get the catheter threaded. We decided to try a vein on the side of my arm. She chose one I wouldn't have, but I wasn't exactly watching her stick me, so I was surprised to feel the needle going in where she chose. Problem is, it was a very small vein, and she not only went into the vein, but right through it! So after 45 minutes, I was left with a sore left arm (and the second stick site is still tender and is bruised). I offered up my virgin right arm and this third time was the charm. Catheter threaded right in. My only worry is that now I've been having some mild aching up along the catheter and I can envision this fresh vein clogging itself up with scar tissue...I hope we haven't just screwed up this vein for good now, too.

Anyway, here's the part where I get to some concrete physical evidence. Before the Advair started and before the IVs, my PFTs (two weeks ago) were the lowest they've ever been. My best FEV1 was 27%. I was not surprised by this - I could simply feel what the numbers were making plain to the doctors. My weight was down, too, to 116 pounds. So we started Advair. What a difference! Inflammation going down...great.

A couple of days later, however, a Friday night, I had my first bout of hemoptysis, and I'm not just talking a spot or streak of blood in my sputum, I'm talking a lot of blood. My shock at seeing what I coughed up being composed of roughly half blood stopped me cold and I looked at it quite a while under the streetlight. For the next four blocks 'til I got home, I continued to cough up blood, quite a bit and now it was all blood. I coughed up a little more at home, and it all tapered off an hour later. All told I probably coughed up 15 or 20 cc of blood. Very sad. I knew I needed some advice so I turned to...the internet. I posted to a CF list and got some immediate response, re-assuring me that while I should call my doc soon, an ER visit wasn't necessary if (since) the bleeding had stopped. OK. I called my doc Monday morning and told her about it. I've had some spotting since then, but no major bleeding.

(It's worth noting that there are lots of people worse off than me; LOTS. A Steve on the CF list has only 18% lung function; several of those listers deal with hemoptysis regularly, or have had embolizations. And there are people close to me who have their own health problems that make mine look simple to handle, by comparison.)

And now the IVs have started. I've been on them for five days and I tell you, what a pain in the ass. Could be worse, though, I could be on a 4x day schedule instead of 3x day. I've done the 4x day schedule and the problem is you can't get enough sleep! But this schedule suits me fine. And it's neater than shit to be sitting at the tech table or at my desk at Insight doing an IV treatment. I think it's weird for people to see, but they're cool about it. If all goes well, I'll be done with these before tech for the dance concert in late March.

But the biggest physical change of all is a positive one: after weeks of not being hungry, I'm finally getting my apetite back! Hopefully I'll get my weight back, too.

And this brings me back to running. I have eight weeks to train up from scratch for a half-marathon. This is not impossible, I reckon, but it'll be a stretch. I'm not promising a half-marathon in Nashville, kiddies. But if I can get out next week on some warm-ish mornings and try to get in a couple of continuous miles... and gradually work it up to a 10-mile long run before Nashville, then I'll take a whack at it. Whatever happens, I do NOT want to do it like I did my last half-marathon.