Tuesday, October 28, 2014


So! Breathing! It's a good thing, I highly recommend the practice. Especially while running.

The Monday after Kettle, I knew I needed to make an appointment and I still didn't feel quite right. The problem, of course, being that noone is going to feel quite right after 50-something miles and three hours of hyperventilating. Anyway, my doctor is awesome and she was able to fit me in right on Monday, just in case something serious was going on. Crew extraordinaire Lisa agreed to come with me, which was super helpful since she can speak doctor talk and had been there to witness what was going on during the race. The consensus there was that it sure sounded like asthma. A bizarre form of exercise induced asthma. So I was prescribed an inhaler and we scheduled a spirometry test to confirm.

I went in for that in the middle of a day. There was lots of breathing into a doo-hickie that measured the amount of air being moved. Pushing air out fast, pushing air out long, taking a quick breath in, etc, etc. Then they had me inhale a bunch of Albuterol (what the inhaler is) and do some of the tests again to see if I had better results. A fascinating side effect of a boat-load of Albtuerol is becoming super hyper and shaky. And by super hyper and shaky, I mean, can't-really-type-hands-are-shaking-so-hard shaky and super-hard-to-concentrate-on-doing-just-one-thing inability to concentrate. Needless to say, it was an amusing rest of the day at work and I made my coworkers giggle at me a lot. So the results of that test came back and . . . negative for asthma. Hm.

A couple weeks after this test, I did a 42 mile run with friends. It was not a hot day at all (chilly and foggy) but it was rather humid. I brought my inhaler along just in case and was super paranoid about increases in breathing around the 30 mile mark (oh my god! I'm breathing awfully hard! Oh, right - I'm going uphill) but ultimately had no need for an inhaler. Which meant I must need humidity AND heat for 30 miles for this to kick in.

Next up was another test called a methacholine challenge where I did some basic breathing tests and then they tried to induce an attack. I was a little nervous about this at first just because the idea of inducing an asthma attack didn't sound like fun. Then I remembered, oh yeah, I spent 3+ hours stumbling down the trail in what appears to be a full on asthma attack, what is there to be nervous about with inducing it in a doctor's office? Apparently, this test is generally not the first one ordered because a positive result doesn't necessarily mean you have asthma but a negative does generally mean you don't have it so it can help to rule things out. This was right before Voyageur so I was hoping for results before the race. My doctor gave me the green light to do the race as long as I was comfortable so I was planning on doing it, regardless. The test itself involved some baseline measurements and then inhaling increasing amounts of irritants several times while repeating some breathing tests. Then they had you take Albuterol (though happily, not as much as the first test) and repeat tests. I didn't notice any sort of difference throughout the test which I decided was a good thing but then decided maybe they didn't mean to really induce something and it was all going to be measurable but not noticeable different. Happily, results came back fairly quickly as . . . negative for asthma. Hmmm, again.

So, Voyageur time. I do still plan to do a brief race report but - my breathing issues started right on cue around mile 27, on my way back to Magney. This time, I noticed that my fingers were going tingly BEFORE my breathing was picking up too much, which I filed away as interesting. I suffered a bit through the next section, moving quite slowly and walking most of the way down Skyline. When I came into Beck's, my breathing was high but not Kettle level hyperventilating yet. I decided to try my inhaler. It wasn't supposed to work, since I was testing negative for asthma but I figured it wasn't like it was going to hurt and I was super frustrated. Lo and behold, it worked. Almost instantly! Double hmmmmmmmm. I also decided during Voyageur to not run Sawtooth until I had some sort of a handle of what was going on. Voyageur did at least help me know for sure that this isn't a weird psychological thing since I had no reason to be stressed/worked up/under pressure at Voyageur. I knew going in that I would treat it as a test of things and that it was a good race to do so at since it had lots of aid stations and I would know people at every one of them.

Next up was a echo stress test to rule out any sort of heart related cause. This was SUPER neat since I got to watch them do an ultrasound on my heart for a good 20 minutes straight. SO COOL! Then they put me on a treadmill and increased the speed and incline by bits while hooked up to an EKG, the goal being to go until you couldn't keep going. The guy getting things started mentioned that a normal athletic 30-something women goes for about ten-twelve minutes and that it would max out after 16 minutes. Now I had a challenge! I did in fact make it to the 16 minute mark, which I felt oddly proud about. Then it was back to the ultrasound to take some more images while the heart was fired up to see if anything was functioning differently. The EKG girls told me they didn't see anything abnormal but the ultrasound woman was rather nonverbal, which I know they're supposed to be but I was so hoping to come out of the test knowing something without having to wait for the cardiologist to read everything and report back. In the end, there was nothing abnormal there, which was fabulous.

Then it was to a pulmonologist, who wasn't super helpful. He said there was another test I could do but he figured I would test normal on that too. I mentioned that the breathing tests I had done before had specified that I couldn't eat/drink x number of hours before the test. I questioned if he knew how necessary that was since it would be great if I could run 30 miles and THEN come into the lab for tests. He thought that was a great idea. So now the lab is willing to schedule me late in the day and have me come up the back stairs, skip the registration, and head right in. The problem with this (beyond needing to time a 30ish mile run to end at an exact time, oi!) being that this was in mid-September, they need at least a week notice to schedule the appointment (which is totally reasonable), and I need a hot/humid day to assure this isn't a waste of time. So that's not going to happen until next year if I decide to do it at all.

The last test of the year, then, was Wild Duluth 100K. It was gorgeous day out. Not hot, not humid, but it was a long race, so that would give me some data. I carried my inhaler just in case but I had no breathing issues, huzzah! Which means this isn't anything to do with something I might be doing differently on race day vs training. Though, another long race in nice conditions would be good to solidify that.

So! It requires heat AND humidity (though, to what degree, I don't know) and it needs around 30 miles to kick in. I'm calling it a bizarre form of exercise induced asthma that just has very specific conditions it needs to kick in. It makes sense to me that it's not showing up on lab tests because the lab tests aren't replicating the conditions (which is why doing a test post 30 mile run would be great). So for now, I'll carry around the inhaler just in case and go from there. I would like one more hot/humid run where my issues kick in so I can test the inhaler one more time before deciding for sure that's what I'm dealing with. I'll keep you updated if I learn anything new, though I don't expect much over the winter.

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