Monday, November 30, 2020

Coming Back from Muscle Damage, Rabdo and COVID

2020 has been a hard year for almost all of us. In the running community, it’s been a year marked by race cancellations, constraints on group running, etc.

For me, it’s been all of those things along with other forms of adversity that have brought me to the place of recognizing that health is not something to be taken for granted. By the time June rolled around, my training for the Never Summer 100K—the only race on my calendar as the others had been canceled—was going solidly. My Achilles heel still wasn’t 100% (and still isn’t) but overall my fitness was improving and I felt upbeat about the race. I capped off June with a backpacking trip.

When I came back from the trip, I noticed I felt tired and sore. I didn’t think much of it and after a few days of rest embarked on my biggest-volume week of my Never Summer 100K training cycle. It was a hard week, and I finished it with a fairly strong 23-mile run along the Colorado Trail up at Kenosha Pass. After completing my run, I drove home, experiencing delays along the way due to weather and July 4th weekend traffic. The protracted drive home, along with an urgent DIY repair situation I had to address when walking in the door, resulted in me going over 4 hours after my last long run with zero nutrition.

The next week, I felt sluggish, fatigued, mentally foggy and like my fitness had gone on vacation. The following week, which would have been my second taper week, my lack of fitness felt even worse as my legs were completely dead. I could barely run 3 or 4 miles. By race week, my fitness and legs had deteriorated further, causing me to pull the plug on Never Summer. It literally felt like my fitness had gone off a cliff.

I decided I needed some rest but when I saw no improvement I went to my doctor. My doctor ran a bunch of tests and the tests showed that my liver values—notably my ALT and AST—were very high and my protein low. Everything else was normal. My doctor worried about hepatitis. As he said, some kind of toxin hit my liver. I remember leaving the doctor’s office that day worried that my liver was sick.

Additional blood tests and an ultrasound revealed that the cause of my liver values wasn’t a sick liver; it was muscle damage. The muscle damage had hut my liver. This explained why my legs felt so dead. I had apparently experienced significant muscle damage in my legs, leading to elevated liver values. We suspected that I’d experienced some mild rhabdomyolysis.

I have no proof of how I developed rhabdo except so say I wonder if I didn’t push myself over the edge on my Kenosha Pass run and then my failure to take in calories—especially protein—immediately after my run put me in the hole. I likely went into the run already a bit overcooked from the insane stress this year has brought on all of us and then sent myself over the cliff when I failed to take in calories after my run to help my body recover.

On doctor’s orders, I didn’t run for two weeks after we honed in on the likely cause of my issues in order to allow my muscles to recover. No running, weight lifting, core work, etc. So I rested. After the two weeks, I started back up with running very gradually and noticed some improvements in my legs, though I felt a hit to my fitness. But I stuck with it and eventually started to feel fitter.

It was right then that my wife and I both came down with COVID! We both had mild cases but even mild cases can really do a number on you. I didn’t run a step while I was sick and after my 10 days started back very gradually. My fitness has been slowly coming back, and my legs are better than they were in the late summer, but between both of these setbacks I have quite a ways to go in returning to a level of fitness where ultrarunning can be possible again. Currently, I am essentially in the aerobic base-building phase, though I am mixing in some higher-intensity workouts, such as going up the Manitou Incline on Black Friday.

Because I had COVID in October, I was very delayed in going back into the doctor to get follow-up bloodwork to test my liver values. Finally, in November, I got in and they ran all of the same tests that they had before. The test results showed my liver values were back in the normal range and my protein, which had been below where it needed to be, was back in the normal range. What a relief! As I think about all of this, I am left with some takeaways that I want to share:

Training & Recovery
  • I am sure I went into the last long run of my Never Summer 100K training cycle a bit overtaxed but I feel I could have gotten out of the hole I was in had I refueled properly right after my 23-miler. I did not. I went 4+ hours with zero calories and zero protein, which my body needed after such an effort, especially at elevation. I believe this all resulted in significant muscle damage in my legs, which led to my very high AST and ALT values and my likely case of mild rhabdo.
  • At age 47, protein has taken on a new significance in my recovery. I simply can’t get away with sloppy recovery. I am now consuming Muscle Milk after more strenuous efforts (and sometimes even before) and have put more of an emphasis on consuming protein at the right times. With my protein level back in the normal range, I believe these efforts are paying off.
  • Stress is stress and your body doesn’t recognize what kind it is—physical, mental, emotional, etc. It has been a stressful year for all of us. I believe I entered my Never Summer 100K training cycle with elevated stress and, coupled with the training load, my body hit its breaking point. Stress can’t be compartmentalized. It all has the same effects and has to be taken into account when designing a training plan.
At this point, I absolutely do not know if I’ll return to form. Only time will tell. I am cautiously optimistic I’ll be able to race ultras again but there could be lasting effects.

  • I had a mild case of COVID but even then I was quite sick. I was very achy, had a cough, experienced bizarre stomach issues, dealt with severe headaches that wouldn’t go away, and was extremely fatigued. I didn’t run for the full 10 days they say you are infectious and when my 10 days were up started back very gradually and cautiously.
  • COVID can cause myocarditis, which is heart inflammation. I did check in with my doctor to see how I should return to running and he said to stop immediately if I felt off. I never felt off—only out of shape. Athletes with myocarditis from COVID face the risk of heart attack. Return to running must be done carefully. 
  • As I was recovering from COVID, I dealt with near-crippling brain fog, irritability and non-diagnosed depression. When you have an illness that has killed over a million people since March—a tragedy that is not getting the attention it should get—it really has an impact on you. 
As I think about 2021, I feel quite excited to race again. I feel motivated to get fit and enter some long races, including a road marathon and also the Never Summer 100K. In 2020, I discovered that I really love backpacking and so I will use that as a way to complement my training, while at the same time enjoying relaxing time outdoors. I honestly feel more motivated to get back to racing than maybe ever before. 

Health should never be taken for granted. In 2020, I have faced two health setbacks that reminded me of the importance of health. May you be well.

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