Thursday, March 27, 2014

Pancreatitis and Endurance Running

Pushing Past Pancreatitis Pain:
A Misapplication of the Ultrarunner's Skillset 

photo by Kathy Vaughan
By Kathy Vaughan

     For months, my focus and energy towards a big goal of the season has been to thruhike the 800 mile Arizona Trail, starting at the Mexico border and ending at the Utah border. Due to the desert nature of much of the terrain, and in order to avoid the worst of the heat, April is the best time to do the trip.

      I've made arrangements to have a house sitter stay here while Ras and I are away for a month. I've poured over maps and passage information. I've made supply lists and organized my pack, piling gear next to it on the window bench.  I've studied the gateway communities along the trail and figured out where we can resupply and which towns have coffee shops with Wifi, vegan food options and grocery stores with natural food sections. 

     I've trained in a fun, yet disciplined way, averaging 40 mile weeks and running or skiing an ultra distance at least once a month since September. I started joining Ras for his “Fartlek Friday” sessions 2 months ago, and have been having a lot of fun with it. I've stuck with a yoga home practice, realizing the importance of keeping stretched out so I remain injury-free.   I signed for up for the Pigtails Challenge 100 mile trail race, held within the month after I would return from the AZT, figuring I'd be ready to knock that one out, finishing faster than last year and setting a 100 mile PR. I have put lots of energy into all of this preparation, an important aspect of accomplishing this goal.

     Several weeks ago, a few days before a 40 mile run with my friend Lisa to celebrate her 40th birthday, some crazy cramping started in my abdominal area, radiating around to my back. Having a history of pancreatitis, I should have seen this as a red flag that maybe I was having some inflammation in this organ again. But instead, I convinced myself that my “change of life” years were upon me and I was having some intense cramping related to being a 47 year old female. I had been having some of the other tell-tale signs of this including waking up sopping wet with sweat a couple times a night every few months, the dreaded hot flashes, and a couple of missed cycles.

photo by Julie Ashmore

     Lisa's birthday run went better than any ultra distance I've ever done. It was all on forest service road and county dirt road. The first half had some snowy uphill climbing on icy snow mobile track, but transitioned to forest service road after about 8 miles. After 5 miles on this road, Lisa and I were able to stop at Shona's house and refill our water bottles, munch on salty potato chips and make a few adjustments. Shona joined us for a few miles before turning around to head back to her house. Lisa and I stopped at the bottom of my ½ mile long driveway, where we had an aid station set up in my car. We changed into fresh, dry layers.  I changed from my Lone Peaks into my max cushion Olympus for the section of the run that would be mostly dirt road with some sections of pavement. We ate a quick lunch. We restocked our packs with more snacks to sustain us for the next 22 miles and hit the road again. We had two more homes to stop at along the way. They were both log homes, spaced a good distance apart, welcoming and accommodating to our needs. It broke the run up perfectly and it was fun to share Lisa's birthday with some of her other friends.

     After stopping at the second of the beautiful log homes, Lisa and I had 6 miles to go. The early evening light had begun and the almost full moon became brighter in the sky. We started a downhill run now, with only a few more climbs before we would reach the car we had left parked alongside the road early that morning. The run still felt cruisy, the miles continuing to go by pleasantly, even though we were now hours and miles into it.  I had never felt stronger on a run and the endorphins were helping me to feel invincible. This was the furthest Lisa had ever run (22 miles being her furthest distance so far) and it was exciting to reach her car, knowing that she had accomplished a huge feat by running 40 miles on her 40th and that I was feeling a big growth spurt in my ultra distance running. 

     We had tofu scramble for dinner and chocolate birthday cake for dessert back at my house. Ras was away on his Issaquah Alps 100 Mile Unsupported attempt. We had a quiet time, unwinding from the run and enjoying the delicious meal. I was unaware of any pain creeping back. I had not felt any discomfort on the run.  

photo by Julie Ashmore

     Ras and I continued planning towards our spring thruhike and what adventures we would pursue when we got back. In hospitals these days, pain is measured and described on a scale of 1-10, a good way to let the doctors and nurses know how intense it is at the time. When I woke up one morning writhing in pain that was now registering at an 8, I realized I should take some action if I still hoped to do the hike. Ras suggested I call my insurance company 24 hour nurse hot line number and I in no way wanted to do that. I did it only because he insisted and it wasn't very helpful. I ended up calling my local small town clinic to set an appointment, knowing it might be hard to get in that day. Sure enough, no openings until late the following day, so the nurse told me to go to the ER if my pains increased in intensity. I held off as long as I could and finally two hours before the appointment, Ras drove me the half hour into town to check in at the small town hospital emergency room. 

photo by Ras

     I was immediately greeted by the staff who had been expecting me and I felt like I was in good hands. The ER doc was a woman about my age, very sharp and thorough and a University of Washington Medical Center Alumni, the home of the specialists whose care I'd been under since having pancreatic surgery seven years ago. She told me she had written her doctoral thesis on pain and personality type, and said she knew that as an endurance runner I trained myself to compartmentalize pain and ignore it. She also told me this was not a good way to handle the distinctive pancreatic pains with which I was so familiar. After drawing blood to check my lipase levels, it was clear I was in full blown pancreatitis with the levels over 800, far from the normal range. I would be hospitalized while my pancreas “cooled down”.

     Four days later, I'm still here. I have tried clear liquids, but my pancreas isn't ready to handle that yet. It might take several more days before I can eat without causing inflammation or an increase in pancreatic enzymes. 

     Sadly, this puts the AZT on hold. It can't happen right now. The window of time to do the trail before summer heat waves come on is limited and Ras and I will now miss this. I have to see my specialist again in April, to further explore what might be going on in my pancreas. This is hard for me and possibly even harder for Ras to accept. 

     I am coming to terms with this. I find comfort and a sense of excitement for the future if I can now turn my thoughts toward a new goal, a new plan and a future that includes more adventuring.

photo by Ras
Hospital Hill Repeats

     Spring forward to almost a week later as I sit now by the woodstove. I have been home for four days after having spent five and a half days in the hospital. It took that long for my pancreas to cool down enough to come home, some slight discomfort still present. I learned that I can help ease the work load of my pancreas by consuming little to no fats and no sugar. This is taking some adjusting, but now after being home a few days and being conscious of what I consume, I am able to put together meals that are satisfying and healthy.

     I have tried to get back into my normal routine as much as possible. I took a day to rest and get caught up on household chores once I got home. By the next morning, I was ready to go on a hike that would last at least 2 hours. Lisa came over and we ended up going on a 3 hour evening hike near my home. Early spring conditions gave us an exciting hike as we walked carefully over slick ice, hopped around large slush puddles and crunched through soft spring snow. I breathed in the fresh outdoor scents and appreciated every moment of being out in the fresh air. 

     Lisa and I got back to my house just when it turned dark. We had done this on many of our adventures together in the past, not timing it on purpose. We stepped inside to a warm house as Ras had kept the woodstove going for us. I made us coffee and we pulled off our sopping wet socks and put on cozy, dry wool socks to warm our feet. 

     While hiking, I had talked with Lisa about how my plans for the Arizona Trail thru hike had changed. I had not canceled the plans like I had thought I would have to, as I lay in a hospital bed, writing the words that begin the text of this blog. I feel better each day and I still have 2 weeks ahead of me to continue healing before Ras and I will hit the trailhead in southern Arizona. I have an appointment next week to see a specialist at the University of Washington Medical Center. I will have an endoscopic ultrasound that will reveal anything in my pancreas that needs immediate attention. If nothing pops up and I feel ready to go, we will continue with our plans to thruhike the 800 mile trail. If I am not feeling well enough for our thruhike but the imaging reveals nothing, we will still travel to the southwest, day hiking and enjoying ourselves all along the way. If something needs immediate attention and it is not smart to pursue this big endurance effort, we will then set our sights on the next goal. I already have many in mind and I can start planning any one of those adventures to keep my spirits up and my heart in the right place. 

photo by Julie Ashmore

     This morning, I joined Shona and Ras for our regular weekly fartlek session.  I focused on using good form and a strong effort during the intervals. I relaxed in between the intervals, during the warm-up and during the cool-down. I thought to myself, “There is nowhere I'd rather be.” I was glad I had worn my Altra Lone Peaks; snow & mud covering the road made for slippery conditions. I had wanted to wear my Olympus for speed work on the dirt road as they had felt so springy and fast when I tried them during fartleks 2 weeks prior.  The more aggressive lug of the Lone Peaks was just what I needed though. The March morning had met us with a wet snow and gusty winds. I was not bothered by the conditions at all and instead breathed in the air, rich with the scent of damp earth and the smell of ponds formed by melt water, in the surrounding pastures. The sweet songs of meadowlarks were leading us down the dirt road and the flitting wings of the mountain blue birds reminded us that these days of harsher runs were coming to an end. I felt better the rest of the day after this healing session in nature. Spring is a season of transition and I am welcoming the changes it will bring this year. 

1 comment:

  1. Ultra distance teaches to ignore the pain, which backfired in your situation, but it also teaches us to adapt, adjust, change plans, and succeed through the most unexpected situations. It teaches us that DNFs happen, it can feel terrible after long hours of training and planning, but then we turn our thoughts to the next goal. I love your positive attitude, your appreciation of the moment, that's one of the many things I like about your blog.
    I hope your exams will show that you're healthy. If not I hope you recover quickly and are ready for new adventures.