The Curious Case of the Clumsy Legs - Calling all SLUETHS!

The Clues:

1. Being sick often. Perhaps I've developed allergies because my sinuses seem to continually be congested. I've literally been congested the last 4 weeks. No lie. Not with actual stuff, just inflamed (or whatever happens to them) enough to make me sound really stuffy. Before Chicago I was super stuffy, but after a day in Chicago I was almost completely clear. That would point to allergies. After I returned to MN, stuffiness that lasted until NY (THREE weeks). I also swear I had two actual head colds in there, but it's hard for me to tell the differece between a day or three where allergies might just be overdrive or I have a head cold. I'm pretty sure I had two head colds in there, though. 

That means that I've been sick at least 5 times since the ER visit. I think that's about twice as many times as between starting with Jerry in 2011 and this summer.

2. Extreme sleepiness. Two nights last week I either fell asleep on the couch (I think I lasted 10 minutes through a movie one night, if that...  sorry, Nate) or needed to go to bed at 9:30 because I just couldn't stay up any longer. Another day last week I slept HARD for 14 hours. I woke up and looked at the clock and did the math, immediately forcing myself out of bed. 14 hours? The problem was... I was so groggy for the next two hours... I probably could have used 15+ hours that day. Yikes. I am normally a good sleeper, but that means a norm of 9-10 hours/night, and that's when my mileage fairly high. Anything lower than 60, I am okay to operate on 8-9. Last week I think I did 15 miles leading up to the marathon. And I think I probably averaged 12 hours/night. Or more. I remember another 11 hour day where I then laid down for a nap and didn't wake up for 4.5 hours. Wow.

Thank you, Nate, for being supportive during this. I felt so unbelievably lazy and like a complete pile sleeping this much, but you were nice enough to go with it and tell me "I needed it". Probably just being nice, but I appreciate it :). *Best Husband*  



3. Most prevalent symptom is clumsiness of the legs, leg-lock, and straining to hold paces after about 3-5 miles into an easy run

The clumsiness/harder time controlling the legs started after the ER visit this summer. It was officially diagnosed as colonitis, but I swear there was something wrong with my uterus since that was where the intense cramping and pain seemed to be coming from. And now that I've officially lost every guy reader...

Then it turned into persistent straining on easy runs. I would feel great for the first 25-35 minutes of a run but then all of a sudden my legs would be working super hard to keep going. Most of the straining was in the hamstrings. If I stopped and stretched and started again, I'd be good to keep going  for another 10 minutes or so. I just realized how much starting and stopping happened during my runs during the last 6-8 weeks. Hmm, no wonder Chicago and NYC didn't go well...

On the 2 mile T segments I had, I'd do fine for the first mile and then REALLY struggle to stay upright during the second mile. It was as if the legs weren't firing right or I was just fighting to keep them turning over correctly. I literally couldn't go any faster, not because my lungs wouldn't let me, but because my I couldn't get my legs to turn over any faster because they were fighting coordination issues. 

The clumsiness seemed to come on earlier and earlier as time passed. Right before Chicago and then again between Chicago and NYC, I remember struggling at mile 4.5-5. Closer to NYC it was at mile 4, then 3... and during NYC, before mile 2. Yikes.



4. Headaches. Nothing super often or bad, but I don't typically get headaches.


Things I've thought about:

1. Overtraining/Exhaustion - probable. But I also think  I've been overtrained before, and it hasn't been like this. Usually it's just a feeling where the legs have no spring, I can't bound of the ground as far, paces slip, etc.

I'm disappointed in myself here. I know the signs of fatigue/overtraining and would catch it in my athletes right away and correct it. Instead, I continued to fight through. Part of that was Jerry's coaching style - to get me to push harder than I thought possible & hit aggressive target times. Once I wasn't able to hit those times post-ER visit (and start of this decline), we didn't edit anything. Instead, everytime I went out I tried even harder to hit those paces. In doing so, I know I was working outside of my correct "zones" on nearly every hard workout from about July & on. I know better than this! (hanging my head)

Chris thinkgs it's just extreme overtraining and said that it usually takes months to come out from under. Super.

2. Iron/Ferritin - my first reaction so I was tested. Things actually looked great. First number is my value, next is the normal range.

WBC6.94.0 - 11.0thou/uL
RBC4.353.80 - 5.40mill/uL
Hemoglobin15.212.0 - 16.0g/dL
Hematocrit43.935.0 - 47.0%
MCV10180 - 100fL
MCH34.927.0 - 34.0pg
MCHC34.632.0 - 36.0g/dL
RDW12.811.0 - 14.5%
Platelets401140 - 440thou/uL
Mean Platelet Volume7.27.0 - 10.0fL

Ferritin was 121 (wow!)

Two things that stick out:
MCV - a measure of the average red blood cell volume. Calculated by dividing the total volume of packed red blood cells (also known as hematocrit) by the total number of red blood cells.

Mine is higher than normal and I've been tested to figure out the cause - apparently, it's just genetic. I have a lot larger RBCs than normal. Think that's a good thing. Thanks M&D.

MCH -  the average mass of hemoglobin per RBC. Calculated by dividing the total mass of hemoglobin by the number of RBCs in a volume of blood.

So not only do I have large RBCs, but I pack a lot of hemoglobin onto each of them. Again, I think that's a good thing. Thanks again, M&D.

I've never had ferritin tested, so no idea if 121 is really high for me? I was surprised at the number, though. I know I'm a healthy eater and good meat-eater, but still! I've been told that if it's too high there can be negative effects... need to research...

Last time I had hemoglobin tested I was 13.9 (before Fargo). Same test had WBC count at 5.7 and RBC count at 4.10. So looks like everything is a little higher (better?). The only other thought was that maybe a little dehydrated and things are just concentrated? I asked Chris that question and he said maybe, but that dehydration shouldn't be affecting my performance THAT much, if it truly is a little dehydration.

I don't think it would be anything else nutrition related. I've eaten well throughout this cycle, and have been diligent about taking my Nutrilite Double X vitamins which are THE best vitamins out there. Can't imagine that between the two I'd be missing much of anything [Thank you, Nutrilite!!].

3. Thyroid- also tested normal. TSH was .8
4. Being "too" lean?  My body fat % before Chicago was lower than it ever has been.12 days before the race I went up to the U of MN for a running economy test and they also let me re-test body composition. At 110.3 pounds, I was 13.8% body fat, which is about 2% lower than the last time I was tested (results here). But then, over the next 7-8 days, I dropped to 107. Doing the math, that means I was at a BF % of ~11. (They say the "average" elite female marathoner is 10%). I think I am genetically pre-dispositioned to have a higher than normal BF %, so I wonder if this just wasn't natural for me. It wasn't like I was starving myself to get down to this (in fact, not at all), so it's weird. I just think I've changed what I burn in workouts enough that I don't need to fight as hard to lose weight (thanks, UCAN) and my metabolism has changed a little in general so even if I'm not using UCAN pre and post workout, I've taught my body to burn a little more fat vs. entirely carbs.

The other clue that this was that I missed my period before Chicago. Since I'm on birth control, it takes a bit to miss it (I haven't missed one since starting on BC in college). Probably a sign :).

TMI? Perhaps. But I'm all about logging everything and trying to be completely real. Missing periods in competitive female athletics is common (all too common), and I know it is NOT a good thing.

Because of this thought, I allowed myself to gain a bit before NYC. Problem is, that didn't help. Not sure how much I gained (haven't weighed myself and don't really care to), but it's noticeable.  Problem is, things just got worse in between Chicago and NYC. I know underfueling is something that takes a while to come back from... so still perhaps a contributing factor?

5. Just plain falling apart the day after I turned 30. Ha. Gee, I can hardly wait to see what 31 will bring!

Potential tests?

I've talked a bit with Kelly Brinkman, an AMAZINGLY fast runner that has struggled with something similar starting this summer. Same leg problems, but also some GI issues. She's had a zillion tests done to figure it out and thinks hers might be a gluten intolerance.

Since a lot of our symptoms are the same (except for the stomach/GI stuff), I'm curious if that could be it...
Here were the tests that she had done. I'm wondering if any of them might help to figure this out?

Regular tests: vitamin D, mono, lyme's disease, food allergies (glucose, fructose, lactose, and gluten)... 

Testing for abnormalities: complete blood count, chemistry panel, urinalysis, auto-immune diseases (not sure which ones, it was a panel of them), EKG

Another blogger commented here and recommended adrenal gland testing.

Some of the elites at NYC suggested a torn hip labral (which apparently causes clumsiness, but no pain from the actual torn labral.

I'm not so sure about mono, since I don't have a sore throat or other symptoms other than extreme tiredness. Torn hip labral? I would doubt it? 


Help?!?

So, now I leave this open to the wide world of blogging - to you! If  you have any thoughts on what this might be, have had anything similar and found something you thought to have worked, please comment here. If any of the tests above would be fruitless, I also appreciate the comments (the fewer times I need to be poked or give blood, the better!).
Oh, and if there are doctor recommendations in MN, let me know. Kelly suggested Mayo and I'm more than happy to travel. Is there a doctor there that specializes in runners?

Also, if you'd be willing to forward this along to anyone else that might have an idea, I'd really appreciate it. Seriously, I really want to figure this out so I can make the most of this time off, get healthy again, so I can start running fast again :). 

THANK YOU, THANK YOU, THANK YOU in advance for all of your help. Already, there have been so many people that have reached out to me. Truly just awesome. :) 

(Oh, and if this is really just overtraining/exhaustion and not something else so I should just enjoy this time off and not worry about this, let me know. I think there is something else, but then again, I have a tendency to over-analyze and over-think! I don't mind a million comments just telling me I'm crazy and to stop thinking about it!)



Nichole Porath

Nichole is a blogger, elite level runner, and coach. She ran professionally for Brooks for two years after qualifying for the 2012 US Olympic Marathon Trials. During that time she founded TNC endurance, where she coaches and motivationally speaks to organizations large and small. This blog details her rise to national-level racing, and continues to follow her as she gets back into racing after starting a family. Read on, friends!

10 comments:

  1. Wow. That is a pretty hard-core blog post there. Nice work.

    Personally I think you need some extended time off. Get your hip/hamstring feeling good. Let your body recover. Rest does lots of good things.

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  2. I really wish I had anything to add medically. In my opinion the overtraining has to be a factor here. The gluten thing would bring on GI issues so I would doubt that is the issue. I would enjoy the time off. Sorry I don't have more to add.

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    1. Thanks Terry!! Yeah, you're right... without the GI issues, then gluten wouldn't be the cause. Don't be sorry - I'm just thankful you read it and scratched your head for a while!

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  3. There are a lot of things that could be going on, so if it was me, I would rest and find a physician who is willing to work with you to figure it out. It does seem like some dietary changes might be something you could do on your own in the meantime (gluten being the one that comes to mind, given how much it is in the media these days). I was thinking about Vitamin B12 deficiency, but unlikely given that you said you eat meat. Lyme disease and autoimmune disorders seem like good things to test for too. I hope they find something easy to fix!

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  4. Hi Nichole - So after reading your post, a few things jump out:

    1) I think the leg-lock issue may be separate, though it may be being exacerbated by the general fatigue/lack of energy. For the leg-lock thing, have you seen a good physical therapist to check your pelvic alignment lately? Or a chiropractor? They may be good sources for you on that. Another blogger (RoseRunner - http://roserunner.blogspot.com/) has dealt/is dealing with leg lock issues as well. She’s also speedy and might be a good person to talk to.

    2) Given the data you mentioned above, I’m going to guess it’s not gluten (especially given no GI issues), but I can’t be positive. You could always take it out from your diet for a few weeks and see if it makes a difference. Sounds like the allergies are just that (allergies), and your headaches may be allergy-related as well unfortunately.

    3) Definitely check into the “more iron than needed” thing – my first thought reading your post was “I bet her iron is low” but since it’s not…maybe it’s too high?? I don’t know enough about that, but I do know Camille Herron also had high iron and was looking into it. (http://camilleherron.com/2013/10/01/update-no-go-for-twin-cities-ferritin-check/)

    4) You mentioned you lost your period – I know you said you allowed yourself to gain a bit of weight, did that help bring it back? You may also want to have your doctor check for any cysts – I don’t know if you are prone to getting those but you mentioned cramping / uterus pain so you may want to check.

    5) Annnd…..speaking of that….you are positive you aren’t pregnant, right?

    6) Finally, if I was a betting person, I’d put some money on mono. I actually had it in college, and then had a reoccurrence (did you know you can have that? Neither did I!) when I was in the midst of marathon training a few seasons back. I had the exact same symptoms – extreme sleepiness, heavy/tired legs (but only after 2-3 miles), not able to hold pace, stopping after 2 miles and rest and then be okay for 10 more minutes until I had to stop again, etc. BUT I did NOT have swollen glands or a sore throat or any other symptoms. It was only after my doctor ran the Epstein Barr Virus panel and a CBC with differential that she saw that the virus had been “reactivated” – most likely due to a combination of overtraining and under fueling. I would DEFINITELY have them check for mono. If you have it, it would explain why you’ve been feeling this way for a while.

    GOOD LUCK, Nichole. I know this stuff is no fun. I was going nuts trying to figure out why all my runs were hard and yet I didn’t have any reason for it! As you said, you have had experience with overtraining and it sounds like there may be other factors in play than just that. Please keep us posted and best of luck – hope you find a solution quickly! (P.S. – I threw your questions over the fence to a doctor friend of mine – I’ll let you know if he has any thoughts!)

    Jenn

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  5. Hi Nichole, sorry to hear about your lingering struggles! Without having seen your blood tests, my first thoughts were, "This sounds like Vit. D and/or B12/folate deficiency." Then, I saw your MCV results and it confirmed it! Red flag right there. I'd recommend taking Super B Complex. Both Vit. D deficiency and the B vitamins are linked to ~getting sick frequently. I used to get ~seasonal hay fever all the time with season changes, and ever since I started taking Super B Complex it stopped! The B vitamins are needed for ~cell division and turnover, so they're very important to places of high cell turnover (throat, GI). Vit. D is important for both muscle and bone health, and because it drops in the winter the immune system becomes more suppressed. I blogged about both Vit. D and the B Vitamins on my website.

    The other thing was the iron-- funny enough, someone already pointed out my blog post about this. As I mention in this post, it could be caused by ~too much supplementing and/or inflammation in the body. You could get your cortisol checked as a sign of overtraining/inflammation.

    You mentioned the coordination issue. I was diagnosed with a labral tear in '10-- I had pain and "loss of coordination" in my right leg. You can have a labral tear or even ~hip impingement, without pain. We got rid of the pain and coordination issue through a diagnostic amount of cortisone in the hip joint. I didn't have to get surgery (although I had hernia surgery)-- I live with the labral tear, no problems. I've had a lot of ~GI issues and even the colitis/bleeding, for who knows what reasons.

    Anyways, hope I've given you some ideas to think about! You're definitely not alone in your struggles! It's good you're aware and trying to investigate all of it. Good luck!

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  6. Keep it simple...rest is needed. Take some suggestions from others, but the best is to do what your body wants and needs, listen to it and do your best to give it what it needs - it will and is telling you. It is good to think of things-all things, especially right now, but you also need to be able to just relax and know that what you are doing and what you are aiming to do soon is and will be the best, trust and believe that, always - no questioning - just do it because you feel it is right - in that way, it always is :) You know your body best! Rest and take time to do the stretching-rehab/eating what you crave/etc. and your body will bounce back, keep being smart and just listening and obeying your body is the best! Love and hugs to you and make sure to give Mesa some tlc too :) Power to some recovery!

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  7. Hi Nichole - I heard back from my friend who is a doctor - sounds like he agrees with Camille as well on the Vitamin B12! Here are his thoughts: Though I am by no means an expert in sports medicine, I have a couple thoughts. First, mononucleosis is a possibility with the excessive sleepiness, etc, but usually there would be some elevation in the WBC count of the CBC (your friend's is normal). Typically there is an abnormal number of monocytes (a specific type of white blood cell) in the blood; this can be tested with whats called a cell differential (breaking down percentage of different types of white blood cells in the blood), but this is only done if there is an elevation in the total number of WBC's in the blood. Second, with the elevation in MCV (mean cell volume), B12 deficiency comes to mind. Usually this will also cause a decrease in the hemoglobin and hematocrit, but you can have a deficiency without anemia. B12 deficiency can cause some neurologic symptoms (clumsiness, numbness, tingling) as well. Her "abnormality" in MCV is very mild, and like she mentions, that could just be normal for her. Deficiencies can result from diet or from malabsorption if she is having GI issues. Lastly, overtraining is always an option. I am not an expert in training for marathons by any stretch of the imagination, but it seems to me that that could be the unifying thing here. It could certainly account for her being really tired and her leg fatigue. In medicine we frequently talk about the probability of different diseases in individual patients and we say that it is much more likely for a common disease to present in an uncommon manner than it is for an uncommon disease to be present. Rest might do her some good.

    I hope this helps. These are just some of my thoughts after reading her blog. B12 and mono might be a good place to start if she is looking for further medical tests, and of course seeing someone who is a sports medicine doc who works with runners.

    Hope this helps, Nichole! Keep us posted!

    Jenn

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  8. A few years ago I was working with a coach and was responding great to training until all of a sudden I felt like my legs just forgot to work right and would not allow me to go fast, I got PF, I was tired, depressed and my periods got messed up. At the time my coach and I had a hard time believing it was over training as I had previously been doing so well with the load and on the edge of a huge breakthrough. The event that seemed to be responsible was running a half marathon right after having a stomach virus. This had put me over the edge.

    I struggled through months of trying to train and then finally took some time off and was able to find a treatment to help my PF heal. I think during this time off my body/ hormones that were out of whack returned to normal. I think that a body out of balance chemically does not heal. Instead of running I aqua jogged everyday and stretched in the hot tub. The work in the hot tub seemed to really return my legs to normal. By this time my hormones and body were back in balance but residual pain from the PF made me cautious for the next year.

    This spring I was able to return to training hard and was doing great until my zero drop shoes injured me right before my goal half. It was summer before I was completely better and then I struggled to keep up my motivation and was a bit lazy. I drank beer and had fun. And then in September I ran a 12 mile race at 6:38 pace which was 20 seconds faster a mile than my previous 5 half marathons. Even though I was not even close to 100 percent fit at the starting line I was for perhaps the first time in a long time 100 percent healthy and well rested.

    So I would just like to advise you that as runners we underestimate the power of rest and being 100% nag free. We also need fun and laughter as this is when our bodies relax and the good hormones perk us up.

    Taking a few months off from hard training may seem like a huge deal but trust me you are still very young. Time is still on your side.

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  9. I saw your post about your clumsy legs and saw you were diagnosed with colitis/colonitis?

    The FIRST thing that would come to mind for me is your absorption rate for nutrients. From what I know about colitis, it's similar in response (but less severe) than Crohn's. Both having issues with nutrient absorption. Basic physiology, if you're not absorbing nutrients effectively...you can't store glucose, or adequate sustenance, etc. If you can't do that, you're only relying on what's in your blood stream to propel you...which might not be much if you're not absorbing enough. Would make sense if you're dying early on in your workouts, feel tired, sleepy, etc. Are you losing weight? I saw you were losing your period? Not too abnormal, but something to pay attention to if it doesn't happen that often. Main idea -- poor absorption = sluggishness, fatigue, delayed neuromuscular control, etc.

    Just a thought.
    -KM

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