The Bethesda-Chevy Chase High School track team filed off the cheese bus into an overcast Saturday morning at Middleburg High School. The heat wave that had singed DC for much of early May had finally lifted, and the 70-degree temperatures felt chilly enough to keep our vinyl blue-and-gold track suits on.

‘Damn!’ David exclaimed as he stepped off the bus, removing his headphones and pointing at a large dome structure ahead. ‘What the hell is that?’

‘It’s a silo,’ Alpha said tersely.  ‘Welcome to Middleburg.’

‘Say wh-at?’

Alpha did not respond. A senior, this was Alpha’s final 2A West Regional Track & Field Championships, and she could not be bothered with David’s unfamiliarity with rural Maryland.

Maduba lifted her beaded braids from her eyes as she scampered off the bus. ‘Man, looka all dem white kids!’ Maduba could get away with saying things like that because (a) she was from South Africa, (b) she had a black mom and white dad, and (c) she could run 400m in 60 seconds.  Maduba was also known for getting away with eating three hotdogs before running her 400m race and still outkicking the field.

We ambled to the track as a disorderly herd that bothered Alpha far more than our coach, Mike Flemming. Coach Flemming had been a star runner for Nebraska some forty years ago, and his coaching style was defined by a strong emphasis on calisthenics. In the next months, my parents would stage a coup that would remove Mr Flemming as our fall cross-country coach after twenty-odd years on the job. They had a legitimate complaint, as the girls cross country team didn’t even have the five runners required to field an official team. But little old Flemming had such cute twinkly blue eyes I still felt bad.

There was a lot of commotion on the track, and enough banners and streamers to look  like a state fair.  I watched a giant shot putter, bursting through his ill-fitting singlet, dip into a deep squat and hurl a metal ball across the field, much farther than anyone on our team could throw.  Someone was speaking over the loudspeaker, but there was too much background noise to make it out.

The metal bleachers were cold and reeked of IcyHot. Assistant Coach Smart handed out the order of events. Thankfully the mile came early so I didn’t have to wait around all day on edge.

Dave bounded from behind and grabbed me by the shoulders gleefully. ‘It’s do-or-die today! You ready, Min?’

‘I think I would rather just die.’

‘M-in!’

‘Regionals is the worst.’ I sighed. ‘There’s no glory, it’s just something you have to get through so you can go on to States.’

‘Hey, not all of us are guaranteed to go on.’

‘I know, I know. Last year qualifying was super exciting.’

‘Martha. Go warm up.’ Coach Smart was in full clipboard/cap/perky ponytail organization mode.

‘Already?’

‘One hour til gun.’

‘I don’t need an hour to warm up,’ I protested.

‘You’re always whining. Go.’

I unzipped the insides of my blue track pants with gold and white blazes on the sides, and reluctantly extricated myself from my giant grey hoodie. Underneath I had a mesh white singlet with scratchy blue and gold trim and B-CC in block letters, and the flimsiest petals of shorts, cut high on the leg and the trim coming undone at the bottom. We had no evidence, but I’d have bet all my lunch money that our uniforms dated back to the 70s.

I warmed up alone in the parking lot. The last time I had been to Middleburg was the regional cross country meet last November. Cross country was so much better than track. I missed the course walks, where we had 3.1 miles to stroll the course as a team, ostensibly learning where it went so we wouldn’t get lost in the race. But we goofed off so much I could never recall where the course actually followed, and my mother could always tell when I got that deer-in-the-headlights look when I came around the turn with absolutely no clue where I was supposed to run.

I trotted around the high school, right by the spot where seven months ago Tripp O’Connell had recounted his traumatic regional cross country race. Tripp had arrived at the race wearing spandex shorts under his uniform. But the power tripping race official had ruled that every team member’s uniform had to match exactly and made Tripp remove the spandex. Everyone wears spandex under their uniform in soccer and lacrosse and other sports. I don’t know why running has to be so fascismo. Especially when there is no physical contact. I mean, it’s understandable that you can’t wear a big chain around your neck in soccer, when you could whip someone in the face with it going up for a header. But running?? Besides, have you seen the kind of jewelry Gail Devers wore at the 100m at Sydney 2000?  God, track officials are the worst.

Apparently the inside liner of Tripp’s thirty-year old uniform shorts had worn out the elastic, and Tripp had to run most of the race with his hand in his pants holding it all from flopping out. He confessed that early in the race there had been some major slippage and was certain that some of the other racers had gotten a good show. With neither our boys nor girls cross country teams qualifying to go on to states (just three of us qualified as individuals), that was the last day we all spent together as a cross country team, howling over Tripp’s story.

I returned to the bleachers, where my parents had arrived. I checked in with them and then scurried to the track to get in a few last strides in. I was much more confident now than a year ago when I ran my first regional meet as a gawky freshman in clunky Nike sneakers.  Now, in my featherweight track spikes I knew the drill. But at the same time, everyone knew me.

My jittering intensified as the track officials walked us to the starting line, and my right leg shook uncontrollably. As always, I would let the pack burst out and then reel them in gradually over the next laps. I just had to finish top-4.  I would let the race unfold and let my finishing kick pop into a Q spot, just as I had at last year’s regionals.

‘Ready.  Set.’

The starting gun shot and the air smelled like gun powder. Nearly twenty girls jockeyed for position. On my second step I felt a chain around my neck clunk against my collarbone, and I realized I had neglected to remove it before the race. I stopped dead and jumped into the infield, all the girls flying by. I fumbled desperately with the clasp, finally got the chain off and threw it in the grass, while everyone else disappeared around the first turn.

By the time I hopped back onto the track the leaders had already completed the first turn. I tore after the pack with a panicked adrenaline, at least 50 meters behind. I trailed the pack alone for the first lap and a half , not seeming to make up much ground.  The only good thing about the mile is that you’re running so hard that you don’t have time to think or get demoralized.

In the second lap I caught the first straggler, then another, and something clicked. Runners were coming back to me, and by the third lap I had pulled myself to the middle of the pack. Entering the final lap, I slipped into my kick. The beauty of the mile is that your lungs are heaving so hard, you’re not registering anything else around you.  People might have cheered as I gained on the girl in the last qualifying position.  But all you hear is the thumping in your head, the gasping of your breath, and the wind whooshing by your ears.

I stumbled to a stop and rested my knees on my hands after crossing the line, lungs still heaving. Panting over my knees, I grinned ear to ear.  I had rallied to overcome what seemed an insurmountable deficit, and I had qualified.

There was a tap on my shoulder and I looked sideways to see an obese man busting out of the front buttons of his official’s uniform and donning an ill-fitting cap. He carried a large clip board.

‘Um, missy. I am afraid you are disqualified.’

I still hadn’t caught my breath yet. ‘I’m sorry?’

‘No jewelry permitted,’ he said flatly.

‘But I took it off.’ My throat constricted. ‘I only ran like four steps in it.’

‘Rules are rules.  Sorry.’

‘But the only one it hurt was me.’  My eyes were wide.

I sat down in the grass and placed my head in my hands and sobbed. Coach Flemming and Coach Smart quickly arrived and began discussing the matter with the official, but to no avail.

I’m sure the meet continued and other races were held. I’m sure my friends Rob and Dave ran. I’m sure Alpha demolished her competition and screamed at her relay team for sloppy baton passes. I’m sure the relay won anyway. But honestly I recall nothing else from that year’s Regional championship. Nothing but several hours of crushed sobbing that was met with extraordinarily sympathetic, consoling words from my coaches and teammates. Even Alpha.

After the final race of the day was run, the 4 x 400m relay, I said my farewells to the B-CC track team for the year and followed my parents to our Honda Civic.

As we walked through the parking lot, a thought entered my father’s head. ‘You know, if you had really been thinking, you would have run back to the starting line and taken your necklace off there. That way, you would have just technically started the race late. I’m sure there’s nothing in the rule books that says you can’t start the race late.’

‘I doubt you can start the race late.’

‘I bet there’s nothing in the rule book.’ He thought he had hit on something. ‘I mean, why would they have a rule against starting a race late?’

‘Whatever.’

‘I mean, just if you had really been thinking.’

I had finally stopped crying a half hour ago, but the tears began to well again.

‘Or, I bet if you had just left the chain on, no one would have noticed.’ He had concocted another plausible alternative. ‘I mean, it was just a tiny chain. You brought attention to it by taking it off. You could just have not touched it.’

‘Oh, Bob!’ my mother exclaimed.

But the economist in him was on a roll.  ‘You know, what you really need to have is a mental checklist. Before each race you go through your checklist of places where you might have jewelry: wrists, ankles, neck, ears, fingers.’

‘I never wear jewelry.’ My hands fumbled with the chain in the pocket of my hoodie. I had eventually retrieved it from the field, but I couldn’t bring myself to put it back on.

‘Well, clearly you wore it today.’

‘I don’t even know where it came from. I don’t wear rings, I don’t wear earrings, I don’t wear necklaces. For some reason I put on that chain last night.’

‘When you went out with your friends last night,’ my mother added.

‘Yeah, I guess.’

‘Well that’s it. It went against your routine,’ my father explained. ‘Routine is very important in sports. That’s why tennis players bounce the ball the exact same way before each serve.’

I had not taken to tennis as a child, much preferring sports like soccer where it was harder to identify discrete errors.  But I begrudgingly picked up a racquet from time to time.  Probably the last time I had played tennis was in Los Angeles, during what had been billed as a friendly game of doubles with my father and I teamed up against my uncle Jeffrey and his friend David. Jeffrey loves retelling the story about how my dad yelled at me to get off the court when I hit the ball in the net too many times.

My head hung low and I stared at the pavement of Middleburg’s parking lot.  Running was the stupidest sport in the world.  But as the defending state champion in cross country, I could not quit.  My grip on my emotions faltered, and tears streamed down my cheeks again.  I would never be a state champion again.

 

 

TickWarningSign

Question:  Should I be freaked out about Lyme disease?

Answer: (a) It depends on where you live.  In the 1990s there wasn’t much Lyme reported in Virginia.  But in the last decade Lyme has been spreading throughout the Northeastern US, and increasingly into Virginia and parts of West Virginia (a trend that is only likely to continue).  In 2012, 95% of Lyme disease cases were reported from 13 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia, Wisconsin.  A number of VHTRC runners have had nasty long-term Lyme infections that knocked them out of commission for long periods of time, highlighting the need for knowledge and awareness of Lyme in our running community.

For years, the CDC has reported around 30,000 cases of Lyme in the US a year.  Last year the CDC reported that the methods it has relied on has under-estimated Lyme in the US by a factor of TEN and more like 300,000 Americans are infected each year.  I interpret this as an admission that we really don’t have a clue how many people are infected with Lyme (a 10-fold difference in estimate is HUGE), and reflects how methods of reporting, diagnosing, and estimating Lyme prevalence in the US remain as much art as science.

2001map

2011map

 

Answer: (b) It also depends on the time of year.  The spirochetal agent of Lyme disease, Borrelia burgdoferi, is transmitted to humans through a bite of a nymphal stage deer tick Ixodes scapularis.  The highest risk for disease transmission to humans occurs during April – September (peaking  in June-July) when the activity of deer tick nymphs is highest.  However, adult deer ticks are still active in cooler fall months.

Lyme disease is associated

June-July is peak Lyme time

Answer (c): Ultra runners are particularly at risk because they spent so much extended time in the woods, are often too exhausted after 24+ hours of activity to bother with anything amounting to a thorough tick check, and are tough, indepedent buggers who are more likely to wrestle with chronic symptoms than to seek medical treatment.  Some well known runners have had debilitating and long-term battles with Lyme, including years of symptoms and misdiagnoses by doctors, including Dusty Olson and Burt Yasso.

 

Question: I got bit by a tick.  Should I freak out?

Answer: If you got the big fatty dog tick you’re in the clear — they don’t carry Lyme.  It’s the smaller deer ticks (and the tiny deer tick nymphs, which are approximately the size of the head of a pin) that are less likely to be detected while engorged and of greatest concern.

ticksIDcard

 

Question: I think I got a nymphal deer tick.  Am I screwed?

Answer: Only if the tick has been attached for over 24 hours.  Infected nymphs begin to transmit Lyme approx. 36 hours after attachment. The nymph increases in size as feeding progresses (see below), so you can estimate the duration of feeding and probability of transmission based on the tick’s appearance and size.

time

 

Question:  This is complicated.  Can’t I just wait and see if I get a bulls-eye rash?

Answer: An estimated 70-90% of Lyme cases present with a distinct bull’s-eye rash (called a ‘erythema migrans’ (EM)) that emerges after a delay of 3-30 days (average is about 7 days).  But this truism has made it much more likely for cases with rashes to be diagnosed by physicians and cases without to go undiagnosed, so this estimate is biased.  Rashes may also appear on one’s back or in an area that is not readily visible.  Aaron has no recollection of a rash from his case.  Other clinical signs of Lyme include: facial or Bell’s palsy (loss of muscle tone on one or both sides of the face), severe headaches and neck stiffness due to meningitis (inflammation of the spinal cord), pain and swelling in the large joints (such as knees), shooting pains that may interfere with sleep, heart palpitations and dizziness due to changes in heartbeat.  Even without a rash or any of these symptoms it may be prudent to take a prophylactic regimen of doxycycline antibiotics if you think you have been exposed to Lyme.  

EMforWeb2

Question: Why are doctors (like the infectious disease doc Aaron visited) sometimes reluctant to test for Lyme?

Answer: If you have the bull’s-eye rash, you’re in good shape — even a dolt doctor will know to order a Lyme test or even just put you straight on antibiotics.  But if you don’t have the rash or swollen joints, it can be hard to diagnose Lyme clinically, as other symptoms tend to be variable and non-specific and could be caused by a host of other pathogens (there are even other tick-borne illnesses in our region) or conditions (chronic fatigue, fibromyalgia, etc.).  Lyme falls into that grey category of illnesses with non-specific chronic symptoms like fatigue that are hard to pin down.

Furthermore, there is no ‘gold standard’ culture test for Lyme that actually isolates the pathogen.  Instead, docs have to rely on indirect measures of Lyme infection based on human antibody immune responses to the pathogen found in the blood.  But these immune responses aren’t detectable immediately and may take several weeks to develop.   ELISA are cheap and easy first screens, but aren’t reliable due to their high false-negative rate (may miss over half the true cases), and a more rigorous Western blot array that tests for multiple antibody proteins in the blood (if you’ve ever taken Molecular Biology in college, chances are that one of your first lab assignments was to perform a Western blot using gel electrophoresis to separate proteins based on the length of the polypeptide).  The interpretation of the Western blot is based on an algorithm of how many antibodies come up positive (i.e., one positive protein is not enough for a diagnosis of Lyme).

Doctors that are not in high-risk Lyme areas that aren’t used to performing these tests might not know quite how to interpret them (and may therefore be reluctant to administer them).  Your best bet is to seek out a doctor in a high-risk Lyme area who has seen lots of test results and has developed a feel for distinguishing a positive from a negative.  In Aaron’s case, his test ‘lit up like a Christmas tree’ and there was no ambiguity.

Question: Will use of insecticide help keep ticks off me?

Answer: Use of DEET is recommended as a deterrent for ticks.  A chemical called Permethrin is stronger, but is highly toxic to cats.  It’s recommended to wear long pants and stay out of tall grass, and that recommendation holds for non-running activities when possible (ie, volunteering).  Thorough inspection for ticks post-woodland adventure in all parts of the body is the key.  When I run with someone through a tall grassy area I typically call out Tick Check! at the end to inspect the legs.

Question: Why is there no vaccine for Lyme?

Answer: I will try to contain myself here, as this question is an excellent one but the answer makes my blood boil.  There actually was a vaccine LYMERix that was licensed by GSK in 1998 in the US that was nearly 80% effective after three doses.  Between the time of its licensure in 1998 and July 31, 2000, about 1.5 million doses of the vaccine were distributed.  But anti-vaccine lobbies are extremely strong in this country, and the media loves a good scare story.  Although science showed that all claims of arthritis caused by the vaccine were bogus, headlines like “Concerns Grow Over Reactions to Lyme Shots,” “Lyme Vaccine May Cause Problems,” and “Lyme Disease Vaccine’s Safety Is Questioned” all appeared in 2000 and 2001, and the vaccine manufacturer discontinued production in 2002, citing insufficient consumer demand.  Following this experience, it is highly unlikely that another vaccine manufacturer will try to enter the US market for a Lyme vaccine.  A Lyme vaccine for dogs is available, although its effectiveness less certain and tick control practices are encouraged even with vaccination.

Question: So, should we just shoot all the deer?

the culprit!

the culprit!

Answer: Even though it’s called a ‘deer’ tick, the ecology of Lyme is complex, and smaller rodents like the white-footed mouse are thought to be key reservoirs.  It’s thought that suburban sprawl has increased rodent populations by removal of predators (like foxes) and replacement of old continuous woodlands with meadows and patches, increasing Borrelia prevalence.

Question: What about those people who never get over their Lyme?

Answer: Lyme remains poorly understood on so many levels and I’ve only begun to delve into the many factious Lyme issues of the day.  Some of the biggies are whether Lyme disease also occurs in Southern US regions and is hugely undiagnosed and whether a form of chronic Lyme can persist following antibiotic treatment.  These issues have yet to be resolved, and there’s not enough science for me to have an opinion yet, but if you’re curious, there’s a lot of information on the web:

CDC Lyme info

NIH Lyme info

American Lyme Disease Foundation

NY Times section on Lyme Disease prevention

Lymedisease.org

History of Lyme Disease Vaccine

Mayo clinic

More on Lyme Vaccine

 

[Note – this is a blog written by Aaron.  I pilfered it directly from Aaron’s secret blog]

____________________________________________________________________________

“You HAVE to go to a doctor!”

“Yeah, I guess.”

“Seriously… I’ll make an appointment for you. Your fever was 101 yesterday, and it’s 102 today. A 102 fever is a legitimate, doctor-worthy fever.”

“Alright.”

Martha was right. I needed to see a doctor. It had been several days since Highland Sky 40 Miler. Martha and I started the race together. After 10 miles, I was struggling to match her pace. After 20 miles, I told her that there was no way I could keep up with her, so she should go ahead. After 40 miles, I dragged my feet across the finish line, spent, as exhausted as I’ve been after 100 milers. And while I should have started to feel better in the following the race, my condition declined day by day as my fever rose. By Wednesday, I hit 102. I was able to get an appointment for Thursday afternoon.


“Are you going to be able to make it to your doctor’s appointment this afternoon? I think my mom can take you if you can’t drive yourself.”

“No, I can make it.” I was starting to feel better. I even considered cancelling the appointment. “I’ve been thinking, though… This illness… I’m not snotty or coughing, and my stomach feels fine. There’s no respiratory or gastrointestinal component. That’s sort of odd, right?”

“Yeah, it is,” she agreed.

I was looking for some validation for a wild theory. Since she is an infectious disease researcher, I could defer to her judgement. “I was thinking about the last few months. Remember a couple of weeks ago, when we did that long run? Remember how much I struggled? You could hardly run slow enough for me to keep up. All of our runs have been like that recently.”

“I don’t know why. It’s so weird!” It was a sentiment that she had expressed many times in the past, as I had found it harder and harder to keep up with her.

“And not just recently,” I continued. “The last few months have been really bad, but I’ve been struggling for longer than that. I really haven’t been able to run long for a couple years. Everything over an hour reduces me to a shuffle.”

“Right.”

“What if this fever is related to all of that? I mean, the obvious assumption is that I’m just sick because I was immunocompromised from the hard effort of the race last weekend. But what if I was sick before that? All of the difficulty and fatigue I’ve had over the last couple of years could be the real thing, and maybe this fever is just a new symptom.”

“That could be,” she agreed.

“So I looked at my race result, you know, for my entire race history — all the marathons and ultramarathon and everything over the last decade. Every year, I was getting faster and faster, winning and placing in more races every year through 2009. Then, I ran well in the Spring of 2010, and had a good race at Massanutten 100 Miler. I remember pulling a few ticks off of me at the end of the race. And I remember some other racers did the same. That was the turning point. After that, I had a couple of good races, but overall, that was a turning point. After the Spring of 2010, I was nowhere near the runner I was before then. Maybe I have Lyme disease, and it’s been progressing slowly over the last three years.” It made sense to me, but Lyme is a hypochondriac’s delight. It can present as a wide variety of symptoms; any sort of malaise or general achiness could be falsely flagged as Lyme. If Martha was skeptical, I’d drop it, and leave the diagnostics to the professionals.

“Hmm… That’s interesting… You should definitely ask the doctor to test you for Lyme.”


My fever broke an hour before the appointment. I arrived at the doctor’s office feeling like the trip and my concerns had all been wasted effort. Despite feeling like it was a long shot, I did request that the doctor test me for Lyme. She declined, dismissing my self-diagnosis with barely a second thought. As it seemed that I had made an abrupt recovery, there wasn’t much to do, other than send me on my way. I did try to get some conjecture about what sort of illness I might have had — what could have made me so sick, with no respiratory or gastrointestinal symptoms. I knew that aside from my own curiosity, Martha would be interested in a firm diagnosis. But the doctor was unable or unwilling to provide an answer. So drove myself home, where I promptly started shivering, and my temperature returned to 101.

The doctor called me the following day. “Hi, I know that you wanted a diagnosis. I was thinking about your case last night. I think I know what the problem was.”

“Great!” I was thoroughly sick once again, and I was happy that the doctor was giving me some attention. “What is it?”

“I think you are suffering from heat exhaustion from the race you did last weekend.”

“Heat exhaustion?”

“Yes,” she explained, “when you work very hard, you body’s ability to cool itself sometimes…”

“No, I know what heat exhaustion is. I’m just not sure that that’s the case. The weather during the race was fine. It was overcast, and in the 60s for the whole day.”

“That may be,” she continued, “but it was 40 miles. That’s an extremely long distance to run. Even on a cool days, it is a tremendous stress to your body.”

“I mean… You know… I know it sounds like a long way. But in the grand scheme of things… You know… The big picture… Like, I’ve done a lot of races that long. And longer! I don’t think that that’s anywhere near my limit.”

“What you need to remember, though, is that now you’re 36, not 16. I’m not saying that you’re ‘old’ by any means. However, you are at an age where perhaps you need to dial back your expectations of what you can do. People just aren’t made to run long distances like that.”

There was only one possible response. “Thank you,” I told her, “I’ll keep that in mind.” I needed to find a new doctor.


The next doctor was an infectious diseases specialist. Due to factors out of my control, it was a week before I was able to get an appointment. By then, my fever had mostly subsided (though on any day, I might be running a slight temperature). Unfortunately, an array of new symptoms started to present. I was extremely tired and occasionally dizzy, I developed severe skin sensitivity and I would drench the sheets with sweat every night. Martha wanted to come to the doctor with me. I was happy to have her as an advocate who could talk to the doctor with more authority than I could.

The infectious diseases doctor performed a routine examination, and ordered some standard blood work. He confidently declared that I would be better within a week. Martha pushed for a specific diagnosis. “Enterovirus,” he said. But Martha didn’t buy it. She tried to debate him, explaining why she didn’t think that was a likely diagnosis. She asked him to test for Lyme. We brought a copy of my race results in the hopes that we could quantify my decline. The doctor glanced through them, and declared that while my times are a little slower than they once were, I’m still faster than most people. “If you had Lyme, you wouldn’t be able to run a three hour marathon!” We tried to explain that a three hour marathon is a world away from the 2:35 marathons I had been running fairly regularly before 2010. Still, though, he refused. “It’s an enterovirus. You’ll feel better in a week.”

As we left the office, Martha ranted, “He doesn’t know! He has no idea! We’re supposed to respect the doctors, like they have all the answers. But he just felt your lymph nodes and made a guess! It’s… It’s… I’ll tell you what it is: It’s medieval! He might as well set some leeches on you! He might as well say that your humors are out of balance! We need to make an appointment with Dr. H!”

“You think we’ll get a different answer? I’m not sure it’s worth making an appointment with yet another doctor.”

“Dr. H will listen to you. You’ll need to be assertive, but he’ll listen.”


Dr. H was on vacation, so it was yet another week of fatigue and illness before I could get an appointment. At some point, I started tracking my symptoms. Each day was a different set of symptoms: fatigue, night sweats, rashes, skin sensitivity, dizziness, nausea, and most concerning, arrhythmia. Some days were better than others, but even on my best days, I was in a constant fog, napping several times a day to stay functional.

When the time for my appointment arrived, Martha briefed me on Dr. H. “You need to be assertive. He’ll listen to you, but you need to be assertive.”

“Assertive. Got it.” But I didn’t have it. I wasn’t entirely prepared for his line of questioning.

I happened to be having one of my better days when I saw him. He started the consultation by asking, “What symptoms of the illness you called about are you experiencing right now?”

“Right now? Right now I’m not experiencing any symptoms.”

“Okay, then what symptoms were you experiencing on the day that you called to make the appointment?”

“Well, on that day, I believe that I was a little bit fatigued, but I was generally alright.” I spoke from the perspective of someone who had spent the previous month waking up in the morning not knowing whether I would be able to get out of bed during the day, and grateful for the days when I felt relatively normal.

Dr. H, however, was approaching the problem systematically, with the assumption that I was a patient looking for a diagnosis of an illness that was proceeding in an arc of several days or weeks. Growing impatient, he sighed. “When you called to make the appointment, there was some reason, right?”

“Yes. Absolutely. Maybe I should just describe the situation from the beginning…”

“No, no, no,” he cut me off. “I think I know how to get the information I need. Let me ask you several questions, and we’ll figure this out.” He proceeded to ask me a series of questions that did allow me to describe the range of symptoms I had experienced in the preceding month. I described my progression from what seemed like a standard, febrile illness to one that involved a strange array of ever-shifting symptoms that might present or not on any given day. By the end of the interview, he had received a fairly thorough picture of the month since I first started experiencing acute symptoms. “So,” he was ready to conclude, “at this point your primary symptom is the extreme fatigue you described. You are starting to feel better than you have, but you want to know of there is any treatment that can help your recovery. Is that a fair statement of the problem?”

I took the opportunity to respond to the first open-ended question he had posed. “No! The real problem is that for the past decade I’ve been a fast, competitive long distance runner. I was getting faster and faster every year until the Spring of 2010. I had several good races in the Spring of that year, then I did a long trail race. At the end of the race, I pulled several ticks off of me. I thought I got all of them, but ever since then, I’ve been struggling with my running. My race standings dropped precipitously. I’ve been getting slower and slower. By this summer, every run would leave me exhausted. It was only due to this past month of severe, acute illness that I finally took a look at the larger picture to put everything together. I think I got Lyme disease at that race in 2010. I want you to test me for it.” It had all come out in a single breath, blurted without a pause or break.

Dr. H paused for a moment, in case I had any more to say. “Well why didn’t you tell me that earlier? We’ll test you for Lyme and babesiosis, for Epstein-Barr and Cytomegalovirus…” He probably listed a few others, but I don’t recall what they were.


A week later, the doctor’s office called. “Your test results came back. Everything was negative except for the Lyme test. Dr. H wants to start you on three weeks of doxycycline as soon as possible.” (In a follow-up visit with Dr. H a few weeks later, he insisted on showing me my lab results. He assured me that while the raw results aren’t of interest to most patients — they require a bit of interpretation — mine were noteworthy because they, “lit up like a Christmas tree.” Apparently, according to the test, I was as clearly and thoroughly infected as someone could be.)

Many people who receive delayed treatment for Lyme experience prolonged or chronic symptoms. I was tremendously fortunate in that the antibiotics had an immediate effect. Within two days, the acute symptoms had disappeared. Within 10 days, I was feeling better than I had in at least a year. Within a month, I was an entirely new person.

By the Spring of 2013, before my symptoms had become acute, I had come to accept that I could no longer run competitively, that at the end of the work day I would only have the energy to make it to the couch to collapse with exhaustion, that every morning, no matter how much sleep I got the night before, I would wake up dizzy and exhausted and never feel fully rested. Over three years, I had aged three decades. The process was so steady and gradual that I never quite noticed it. Then I took three weeks of antibiotics, and then another three weeks (which I requested after hearing the consensus among many long-term Lyme sufferers that three weeks is not enough), and in the following three months — from the middle of August to the middle of November, I gained back those three decades.

As I write this, in the first few days of 2014, I’m excited about the future. If there are lingering effects of the Lyme, they are small. I have run one race post-Lyme — a 100km race I run every year. I felt better at mile 60 this year than I felt at mile 10 last year. Looking back, it’s hard to believe I dragged myself through that distance last year in the state I was in. I haven’t yet regained all the fitness I lost, but I’m on my way. And now that I’m healthy again, everything feels just so much easier.

 
pileated

the nearly 30-inch wingspan of the Pileated woodpecker

When Aaron and I started running together, it became clear that we would never get anywhere if I kept stopping every few minutes to look at birds.  But it seemed implausible that we would spend all those hundred of hours running in the woods and never stop to appreciate the beautiful and varied avian fauna that could be found even in the heart of the city.  So I proposed a compromise: we would only stop for woodpeckers.

I believe the Red-bellied woodpecker was named by someone who was anatomically confused

The Red-bellied woodpecker was named by someone who was clearly anatomically confused

Woodpeckers have several advantages as a family (Picidae) to key in on.  Most importantly, the distinct thump of the woodpecker beak on rotting wood is easy to hear, even over the sounds of running and conversation, so we wouldn’t have to rely on sight for identification (much better to keep those eyes pealed on the roots and rocks one is apt to trip on).  Woodpeckers also have very distinctive calls (the Woody Woodpecker imitation is not as absurd as one might think).  Secondly, the medium-level abundance of woodpeckers in Rock Creek Park and Glover Park falls perfectly at the sweet spot of the spectrum.  In our woods we could reasonably expect to spot at least one woodpecker per 1-hour run, on average, not so many that we would be continually bombarded with stoppage (the original problem), but not so few that we would often come home empty-handed.

The harlequin Flicker is actually quite common in our woods

The harlequin Flicker is actually quite common in our woods

The third advantage of woodpeckers is that they are relatively large, charismatic birds with striking bold patterns (e.g., distinct crests, black-and-white striking, large beaks, bright red patches, unique vocals), which would make them not only exciting to see, but plausible for Aaron to learn to distinguish.  The fourth major advantage of woodpeckers is that there are five main species of woodpecker found in our woods, enough to have a good diversity and range of shapes and sizes, but a relatively small number for poor Aaron to learn to identify: Pileated woodpecker, Red-bellied woodpecker, Flicker, Hairy woodpecker, and Downy woodpecker (Yellow-bellied sapsuckers and the majestic Red-headed woodpecker also can be found but are not so common).

Sean and I almost strangled each other on an Eagle Run when Sean was convinced that a Red-headed woodpecker was a Pileated woodpecker.  The bickering only stopped when I could Google-prove it on my cell phone

Sean and I almost strangled each other on an Eagle Run when Sean was convinced that a stunning Red-headed woodpecker was the more common Pileated woodpecker. The bickering only stopped when I could Google-prove it on my cell phone.

And the final reason to stop for woodpeckers: they EAT BY BASHING THEIR FACES INTO TREES — how can you not stop to witness that.  So, if you want to start to appreciate the feathered friends that serenade your runs, I suggest the woodpecker, for the reasons above, as a good place to start.

Aaron has now become a full-fledged Pecker Master.  At this time he can even distinguish the Hairy woodpecker from its nearly identical but slightly more petite Downy woodpecker cousin.  Find the Pecker is now our favorite running game.  He’s even ventured into learning other unusual bird species like the Rufous-sided towhee.  I think Aaron’s true crowning as Pecker Master happened when he identified one while we were biking.  Granted, I am not a fast biker (this was the first time I’d ridden a bike on a road since college).  But still, that’s some skill there.

downy-hairy-woodpecker

Aaron’s response to the anatomical differences between the Downy woodpecker (left) and the slightly larger Hairy woodpecker (right): pshaw!

 
puke-buddies

puke-buddies

Bull Run 50 miler

Manassas, VA

April 12, 2014

*warning: this report contains graphic descriptions of bodily fluids*

‘I had calculated that our team could win even if we all had cruddy days,’ I told my teammate Robin as we strolled into the Do Loop around mile 30 of the Bull Run Run.  ‘But it never occurred to me that we’d hit this level of cruddy.’  Robin had been dragging me along since Fountainhead, where I had collapsed into a chair and made no signs of getting up.  My race had been going fabulously for the first 20 or so miles, but I was horribly nauseated by the time I got to the Wolf Run Shoals aid station, and spewed vomit and diarrhea shortly thereafter.  Trying to run made me sick to my stomach, and trying to eat made me gag.  But I knew that the major aid station at Fountainhead was just a couple miles away.  When I reached Fountainhead I plopped into chair, immobilized,  and was ready to throw in the towel.  I still had 20+ miles to go, and I couldn’t see any direction for my race to go except down into that death spiral where you’re too sick to eat, and without any food you ultimately lose all energy to move.  Twenty miles is a long way to do the sad walk.

Justine was there with her two kids, and I announced to her that I was ready to drop then and there as I crumpled into a chair.  But dammit I was on the all-women’s team Wussies with Pussies (censored version: Wussies with Kittycats), and all four of us had to finish or our team would be disqualified.  Man, signing up for a team had seemed like such a good idea at the time.  I always loved running on the cross country team in high school and college, having a sense of camaraderie, working together, and running for something larger than yourself.  But for that the only requirement was completing a measly three miles — not fifty.   I was beginning to regret the hole I’d cornered myself into.  I sat in my chair watching blankly as other runners came and went — Keith, several women, and eventually my teammate Robin, who was also having some stomach problems.  Justine must be a marmot-whisperer, because against all inertia she was able to coax me out of my chair to just ‘get moving.’  I mean, what other option did I have?  I couldn’t drop because of the team, I was just delaying the inevitable.

robin my savior

robin, my savior

Robin was leaving Fountainhead as well, and the two of us agreed to just walk together for a bit.  Robin proposed a game plan where we at least ran the downhills but could walk the rest.  Otherwise we’d be out there forever.  The downhills were actually the hardest on my stomach, and I proposed alternative strategies (i.e., not running ever).  But Robin was determined to get to Hemlock before nightfall, and if I didn’t want to be left behind I had to oblige.  Every time we went down a hill I was hit with a wave of nausea and would gag at the bottom.  That white loop was awful, but at least Robin was very good at distracting me with good conversation.

It was kind of painful to see just how far back in the pack we had slipped when we started seeing runners already coming our way out of the Do Loop — Mario, Jack, Brad, the two ladies vying for the lead, and, to my great delight, Aaron.  I gave Aaron a good whine about my vomity state of affairs.  But he was running great, and we let him on his way.  After years of struggling with Lyme disease, this was really Aaron’s first smooth race where he felt like his old self again.  So great to him back on top.

Bull Run was my first 50 mile race, but I knew that if I had a good day I had as good a shot at winning as anyone.  Aaron and I had done a number of training runs between Hemlock and Fountainhead, and I was feeling very comfortable with the course.  The fibroma on my foot is still there and occasionally gets inflamed, but I knew it could go the distance.  I had executed my early race plan to a tee, running my own pace and letting the other women run ahead, settling into a very comfortable fifth place by Hemlock.  I had moved into third place shortly after the Marina.  I was eating well, and feeling great.

happy aaron sans marmot

happy aaron sans marmot

The night before the race I remarked to Aaron that I couldn’t wait to see who would end up being my running buddy.  Aaron and I had decided not to run together (i.e., Aaron had announced he wasn’t going to run with me).  But I had always envisioned that I would find someone along the trail who would be good company, like I often do in races.  It’s so much better for me if I find someone chatty like Zaruba at Potomac Heritage or Schuster at Holiday Lake or one of those colorful characters who make me forget that I’m in the middle of a race.  I initially ran with Robin, which was great, but her pace was a little quicker than I had in mind, and I let her go.  After the Marina I found myself in particularly unfavorable company.  No naming names, but even Sean doesn’t like this dude.  And Sean likes Hot Pockets.  He’s just always hyper-competitive even in really inappropriate contexts like MGM.  Today his absurdly booty shorts were particularly irksome.  I tried to step aside and let him pass me, but circumstances made us keep criss-crossing.  I can’t blame him for making me vomit (at least not literally).  But I was definitely riled, and the timing of my stomach ills was eerily contemporaneous.   And if he can mess with Seanie’s impenetrable karma, just imagine what kind of hole he can blast though mine.

pre-pukefest

pre-pukefest

It’s entirely likely that this disruption of my early relaxed pace contributed to the stomach issues that ensued shortly thereafter.  All of my good (ie, puke-free) ultras have been when Aaron stays with and we treat the event like we’re out for a long training run and there just happens to be a race going on around us.  I grew up doing short races, where the race was all you ever had on your mind, and when I don’t have someone doing a good job of distracting me, my mind tends to drift back towards racing mode.  In fact, every ultra that Aaron has accompanied me for I’ve had a great day (Promise Land, Iceland, Highland Sky – take 2, Catawba), and every ultra that I’ve run solo I’ve puked (Highland Sky – take 1, Holiday Lake, Willis River).  When I’m running with Aaron we make fun of those annoying competitive dudes, rather than letting them get under my skin.  I bet if Aaron had been running with me at Bull Run we would have laughed and swapped stories about the ‘unfavorable company’ and it wouldn’t have unraveled my race.  Not that I’m going to make Aaron to stay at my side every race, I just need to learn how to buffer myself even when when he’s not there.

All aspirations for the podium clearly were long gone by the time Robin and I ambled into the Do Loop.  But we were trying to figure out whether we still had a chance to vie for the team title, and the possibility of it kept us going forward, and even trotting down the hills against the objections of my stomach.  There were only two all-female teams: Wussies with Pussies and last year’s winning team of Kathleen, Kari, Stephanie, and Tracy (team STAKK), which made the rivalry particularly fierce (team STAKK had written on all their legs BIF for Bring It Fuckers).

I had given up trying to eat any gels or even my drink mix, but at the Do Loop aid station I was able to get down some watermelon and ginger ale, and over the course of the Do Loop my nausea began to subside and my spirits  heighten.  As my nausea relented, I was beginning to actually really enjoy walking along with Robin.  We hadn’t caught up in a long time — on my decision to stay put in DC, on Aaron’s Lyme recovery, Adam’s back, on Robin’s plans to take a bit of a break from the ultra scene.  It began to seem plausible that we could keep this up with another 10-15 miles.

We started to increase our ratio of running to walking ever so slightly.  But my stomach was still in edge, and after revisiting the Do Loop aid station I had to let Robin go while I went off to  ‘scratch some leaves’ .  But afterwards I felt a lot better, and was able to run with decent pace back to Fountainhead and arrive just shortly after Robin.  All the shitting had made my bum-hole really sore, and by good fortune Adam had a tube of butt cream on him.  But after the application my finger came out draped with blood.  It was a warm day, and the volunteers were very active about offering runners wet towels, which I used to clean off my red fingers.  But I refused to turn the towel back over when the volunteer wanted to rinse it off to reuse for other runners.  I implored her not to reuse a towel that was now covered in my rectal serum, and I tried to throw the towel away.  But the bag I found turned out to be recycling and the volunteers kept shoeing me away from everything that looked trashbag-like.  As the unofficial VHTRC epidemiologist, I really think there should be BIOHAZARD boxes at the aid stations for proper disposal of such materials.  Then again, it can’t be any more dangerous than whatever was served up at the annual Awards Dinner.  (I was planning as a joke to show up at an aid station requesting a crab cake, but I didn’t come across White House Tom or anyone who I was convinced would get it.)  I still wasn’t eating or drinking much, and didn’t take any of the stuff I’d given Adam as a drop bag.  But I was feeding off of all the support from the incredibly helpful folks at the aid station and other WUSsies along the way (Tom and Kirstin were especially good to see at the road crossing) and I was catching a second wind when Robin and I trotted out of Fountainhead with just a half-marathon to the finish.

the Pussies' competition

the Pussies’ competition

My original race plan had been to run easy until the last stretch from Fountainhead back to Hemlock, when I would cut myself loose and have a chance to hunt down the competition.  I clearly was no longer in the running for individual awards, but the team competition was still looking pretty tight.  Robin and I had been passed in the Do Loop by Kari, and Kathleen was way ahead and would ultimately win the race.  But our two other teammates, Alisa and Boots, were looking great and their performances were keeping us in the running despite our dismal straights.  Even though my race reeked of disappointment at an individual level, I felt spurred to crank it up for the Pussies.  Robin had done a spectacular job nursing me back from the grave, and we had really worked together as teammates through our rough patch.  But I was pieced back together, smelling barn, and felt I owed it to the Pussies to give everything I had left in me to the finish.

It was perplexing to me that I felt so energized even though I hadn’t been consuming anything except ginger ale and a bit of essentially calorie-free watermelon over the last hours.  Normally under such caloric deficit I’d be collapsed in a heap.  But I found myself mysteriously able to ride through the depletion.  I was still shitting diarrhea every 4-5 miles or so.  And not eating much of anything.  But my legs were thrilled to be free from the yoke of my stomach, and to have a chance to run.  I missed the company of Robin, and wondered whether the caloric deficit would eventually bite me in the ass somewhere along the way back to Hemlock.  But I ran with abandon, getting stronger and stronger all the way to the finish line.  Runners were perplexed how someone could be whizzing by so late in the race.  A couple asked me quizzically if I was even in the race.  A few called out ‘sandbagger’ and I felt the need to defend myself from such accusations and stop and explain that I had in face been puking and walking for 15 miles and had just caught a second wind only recently.  The highlight of the race was when I flew by the bad karma dude from earlier doing his own sad walk.

Wussies Chasing Kitties

Wussies Chasing Kitties

Aaron finished in 7:48 in 13th place, a fantastic Aaron-is-back-from-Lyme finish (see his recent recounting of his struggle with Lyme disease), and he and Adam were hanging out together at Hemlock wondering when Robin and I would be coming in.  ‘Running 9-minute-ish miles, they’ll probably come in around 9:30 or so, maybe 9:15,’ Adam estimated.  ‘I don’t know,’ Aaron doubted.  ‘Martha tends to smell barn.’  Adam looked at his watch, ‘Well, it’s possible she could come in closer to 9.’

Right on cue, I came up the hill to the finish area in just under 8 hours and 45 minutes.  I didn’t sprint in — that seemed like a tool thing to do at a 50 mile race.  Robin held tight and came in 30 or so minutes later.  Alisa struggled with her own bout of puking at the end but battled in for the team, and Boots managed to be the only Pussy not to succumb to stomach problems.  Bootsie’s clutch performance, beating out both the 3rd and 4th runners on team STAKK, secured victory and winners’ blankets for the Pussies (and confirming my theory that the slower runners are the real heros that make or break teams and it hardly matters what the faster runners do).  This year we had a WUS sweep, as our Wussies Chasing Kitties men’s team of Mario, Keith, Aaron, and Ryan also won the men’s team competition.  Mario had a great run, finishing 5th.  Robin made us awesome pink Wussies with Pussies (Censored) shirts that we all sported for the team photo.  Although I was disappointed that I hadn’t been able to compete individually, there was an overwhelming sense of redemption at the end as the Pussies celebrated our team victory.  And it was great to just hang out at the finish line party and catch up with folks — if I hadn’t still been feeling queasy I would have stayed out there for hours.

happy pussies

a happy pussy is a pussy who doesn’t have to run anymore

All in all, I’m glad I eked out my first 50 miler.  This was the first time that I have ever bounced back from the stomach ails graveyard — a valuable lesson that in these longer events you have to keep plugging on, because a 180 turnaround is always possible.  Going forward, I’ve decided that I really need to do more ultra events.  I’ve been racing so long (since age 14) that I feel like an old hat who knows what I’m doing, but I still have incredibly little experience at these long distances.  And the only way I’m going to learn how pace myself and balance hydration and nutrition is to simply do more races.  Now that running 50k or 50 miles doesn’t seem  like a big deal anymore, I should be able to do these events more casually.  I’ve got Highland Sky on the calendar for June.  And Aaron and I are thinking of going to Montana in August for Fool’s Gold 50 miler.  I only wish there were more ultra events that had team competitions.  In the end, it was being part of the Pussies that made BRR, even under trying conditions, a fantastic event and a race I plan to return to.  It was a beautiful day with flowers in bloom and waterfalls gushing and birds singing and friends around every corner.  But is there any reason why we can’t we add a team competition to Stone Mill?  Or the Women’s Half Marathon?  Something to keep my sorry ass going even when it wants to crumple into a chair.

Mario takes the best photos

Mario takes the best photos

 

 

 
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