Wow - this is long. Maybe I should blog more often so I wouldn't have as much to say at one time. I'm impressed if anyone actually reads the whole thing.
So I think I am learning the hard way that being sick can bring me back to square one with POTS. I'm not entirely sure that is what is going on, but it seems to be the case. How awesome is it that I can finally recover from 6+ weeks of bronchitis only to be slapped in the face with POTS all over again?
I have had no heart rate issues since maybe July, and that was my recovery month from IMCDA and it was 100 degrees outside, so understandable that it was harder to keep my HR under 85% max then as opposed to April or October. I remember I was a bit worried on a few runs then, but any issues I may have had faded as the temperatures slowly dropped and my mileage slowly ramped back up for IMFL.
Not including July, it has been a good 10-11 months since I have had major POTS issues. I cannot even tell you when they really started to go away, but I think it would probably have been around the end of March or so last year as I was getting into the meat of ironman training. I also cannot tell you anything I did or didn't do that made the symptoms fade. I did mass amounts of salt for maybe a month, and wore compression socks off and on, but could never see a definite difference in my heart rate when I wore then vs. when I did not. I have still had brief "episodes" over the last 10-11 months, but nothing ever lasting longer than a day or two, and certainly nothing lasting the ~6 months that round 1 of POTS did.
Even after IMFL I did not have any heart rate problems. I did get sick and had bronchitis forever, but also had some awesome long runs between IMFL and the Houston half. I didn't have many other runs period, so that has plenty to do with not doing great at Houston, but that is totally understandable. So I guess I'm basically trying to say that my runs leading up to and including the Houston half were definitely plagued by asthmatic bronchitis, but did not seem to be plagued by POTS.
Fast forward to a week after the Houston half, my second run after the race, and "it" is back. My heart rate was absolutely awful and it got to where I could not run more than 2 minutes at a 12 minute pace without hitting the top of zone 2 (173bpm). That is my self-imposed limit and from all the reading I've done, most of your workouts should be done in zone 2 or lower as it is, unless you are doing a speed/tempo type workout. In other words, I shouldn't be nearly that high on any of my long runs, and spending too much time above that level can be counterproductive. I also know for me that if I'm hanging out at that heart rate for any pace slower than about 10 minutes/mile, something is off. My heart should not have to work that hard to plod along at a 12-something pace. So my planned 8 mile run that day turned into a 4.5 mile run/walk/cry/repeat. I was mortified to be wearing the hat from my 12:47 Ironman just 2.5 months earlier and now was not even able to run 2 minutes at a time. I wanted to hide but was right in the middle of the running mecca of Houston. I feared everything was coming back and I did not know what to do about it. I do NOT want to go through all of this again. Heart rate training is about as lonely as it gets because everyone's heart rates are different and no two people would have the same workout. I have also found that talking, unfortunately, but not surprisingly, raises my heart rate while I am running too.
I was not 100% convinced the POTS was completely back though because my run the Wednesday evening before the awful Saturday mid-morning run was just fine. Maybe a tiny bit slow, but no heart rate issues. It was just a loop of the park, but that is plenty of time for any red flags to appear. One thing though is the weather was nice that Wednesday after the half marathon, and that Saturday after was one of the grossest days we have had in forever (68-70 degrees with 95% humidity when I set out on my run).
So I cautiously set out on my run Monday night, with one okay run and one awful run under my belt in the previous week. I knew I'd have to do a few more workouts before I could tell if I was really having problems again, or if it was just a complete fluke of a day. The result? A very fine 5 mile run where I only hit 173 one time, and averaged in the low 160s for the run. A normal run. Nothing spectacularly fast, and maybe 10-30 seconds/mile slower than I had been running in December, but not much to complain about, and plenty of room for improvement.
I went back out Wednesday night, and had the same result - no identifiable POTS issues.
By the end of Wednesday's run I was breathing a sigh of relief, believing Saturday to just be a fluke.
Not so fast. I had Friday off from work and ended up running in Seabrook around 11am after lounging around all morning. I hit 175 within twenty feet of starting my run. Seriously? Not again. It could have been quite the adventure of a run but instead was spent listening to the lovely heart rate alarm go off over and over and over again. I ate some clif blocks and took 2 salt tabs hoping maybe I could salvage part of the run. It was pouring and in the 50s at the start of the run, so high temps definitely were not to blame. I was the only person on the entire trail down there. It was awesome, except in the "Alligator and Snake Habitat." Try running through there when you have heart rate issues. I always have my eye on the chain link fence that runs alongside one side of the trail (fencing off a cemetery) when the marsh is on the other. I've convinced myself I can hop the fence into the safety of the cemetery if I ever do happen to disrupt the alligator habitat! I splashed in puddles and marveled at the fact that it turned out to be a pretty awesome run day despite my stupid heart rate. The coast side park at the back of the trail was closed to car traffic (presumably because the weather was so bad), so I had that all to myself as well. The bathrooms were still unlocked though, so that was a double score!
I managed my way through six miles and things did seem to get a tiny bit better on the second half. Maybe that is because I told my heart rate alarm where to go and turned it off. Oops. I guess that kind of defeats the purpose, but I did keep an eye on it and backed off when it started to creep up. So that run was a success on the "fun run in the puddles on a beautiful trail with no one else around" but was still quite a failure on the POTS front. I averaged 12:30 pace. Not fun, and 2 minutes/mile slower than earlier in the week. I had hoped to run 8-10 miles, but lose patience very quickly when the run is going so bad.
So that was all a very long way of saying in the past 10 days I have had 3 normal evening runs and 2 awful mid-morning runs. Do we see a pattern here? I will have to do a few more runs to know for sure, but so far it is looking like my body is not interested in mornings. That is not necessarily surprising because everything I have read about POTS says mornings are awful for most people with POTS, presumably because you have not been up and moving around very long and the blood has not been flowing like it is supposed to for a while. Next Saturday will be the next time I run in the morning again, so I will try a few things different beforehand to see if they help. I will take salt the night before when I go to bed, and might try to do as much as a mile walk/warmup to see if that gets the juices flowing any better. This is a new view of POTS for me because there did not seem to be any difference in mornings and nights last year. The other new view of POTS, as I said at the beginning, is that I think being sick for so long brought this bout on. My only question now is how long will it last? Unfortunately only time will answer that. Grrr. One big issue with this, if it does stick around, is that virtually ALL races/long training events are in the morning. I hope I can somehow figure out how to manage all of this. There is no way I can race anything in the condition I have been in on my last 2 morning runs.
People often ask me "are you sure your heart rate monitor is working right?" and "do you feel bad when it happens, or just see a high number on your heart rate monitor?" Yes, my heart rate monitor is working right and I generally feel pretty in-line with what the numbers have to say. When it starts to blow up, I feel like I'm going to blow up. My chest gets tight and on the really fun days I get pain in my left shoulder. I get lightheaded and sometimes dizzy and get a headache. Walking usually makes all those things go away, but they come back quickly after I begin running again when I'm having a bad day.
On a non-running related note, I have had a headache for I don't know how long and I just read that is pretty common with POTS too. Awesome. I don't remember that the first time around, but I am similarly tired this go 'round. My stomach has also started hurting again after any big meal - i.e. every meal I eat with Jon. On the weekdays I usually eat pretty small portions and eat throughout the day. On the weekends with Jon, we usually eat real meals, and larger portions than I eat during the week. That is another symptom of POTS I do remember having last time. (With POTS, blood ends up pooling in your stomach when it is trying to digest a large meal)
I just pray that this goes away as quickly as it came on this time. I wish I knew what made it come in the first place, and what made it go away last time. I don't though. I can do what I think might help and just hope and pray it does. I also realize I am fortunate that I have what seems to be a very very mild case of POTS and know there are people who struggle to get out of bed each day because they faint as soon as they do. There are many teenage girls who have had to withdraw from school because they are too sick to go. I'm the one who did two ironmans the year I was diagnosed, so it is safe to say I do not have it nearly as bad as most others.
So I think I am learning the hard way that being sick can bring me back to square one with POTS. I'm not entirely sure that is what is going on, but it seems to be the case. How awesome is it that I can finally recover from 6+ weeks of bronchitis only to be slapped in the face with POTS all over again?
I have had no heart rate issues since maybe July, and that was my recovery month from IMCDA and it was 100 degrees outside, so understandable that it was harder to keep my HR under 85% max then as opposed to April or October. I remember I was a bit worried on a few runs then, but any issues I may have had faded as the temperatures slowly dropped and my mileage slowly ramped back up for IMFL.
Not including July, it has been a good 10-11 months since I have had major POTS issues. I cannot even tell you when they really started to go away, but I think it would probably have been around the end of March or so last year as I was getting into the meat of ironman training. I also cannot tell you anything I did or didn't do that made the symptoms fade. I did mass amounts of salt for maybe a month, and wore compression socks off and on, but could never see a definite difference in my heart rate when I wore then vs. when I did not. I have still had brief "episodes" over the last 10-11 months, but nothing ever lasting longer than a day or two, and certainly nothing lasting the ~6 months that round 1 of POTS did.
Even after IMFL I did not have any heart rate problems. I did get sick and had bronchitis forever, but also had some awesome long runs between IMFL and the Houston half. I didn't have many other runs period, so that has plenty to do with not doing great at Houston, but that is totally understandable. So I guess I'm basically trying to say that my runs leading up to and including the Houston half were definitely plagued by asthmatic bronchitis, but did not seem to be plagued by POTS.
Fast forward to a week after the Houston half, my second run after the race, and "it" is back. My heart rate was absolutely awful and it got to where I could not run more than 2 minutes at a 12 minute pace without hitting the top of zone 2 (173bpm). That is my self-imposed limit and from all the reading I've done, most of your workouts should be done in zone 2 or lower as it is, unless you are doing a speed/tempo type workout. In other words, I shouldn't be nearly that high on any of my long runs, and spending too much time above that level can be counterproductive. I also know for me that if I'm hanging out at that heart rate for any pace slower than about 10 minutes/mile, something is off. My heart should not have to work that hard to plod along at a 12-something pace. So my planned 8 mile run that day turned into a 4.5 mile run/walk/cry/repeat. I was mortified to be wearing the hat from my 12:47 Ironman just 2.5 months earlier and now was not even able to run 2 minutes at a time. I wanted to hide but was right in the middle of the running mecca of Houston. I feared everything was coming back and I did not know what to do about it. I do NOT want to go through all of this again. Heart rate training is about as lonely as it gets because everyone's heart rates are different and no two people would have the same workout. I have also found that talking, unfortunately, but not surprisingly, raises my heart rate while I am running too.
I was not 100% convinced the POTS was completely back though because my run the Wednesday evening before the awful Saturday mid-morning run was just fine. Maybe a tiny bit slow, but no heart rate issues. It was just a loop of the park, but that is plenty of time for any red flags to appear. One thing though is the weather was nice that Wednesday after the half marathon, and that Saturday after was one of the grossest days we have had in forever (68-70 degrees with 95% humidity when I set out on my run).
So I cautiously set out on my run Monday night, with one okay run and one awful run under my belt in the previous week. I knew I'd have to do a few more workouts before I could tell if I was really having problems again, or if it was just a complete fluke of a day. The result? A very fine 5 mile run where I only hit 173 one time, and averaged in the low 160s for the run. A normal run. Nothing spectacularly fast, and maybe 10-30 seconds/mile slower than I had been running in December, but not much to complain about, and plenty of room for improvement.
I went back out Wednesday night, and had the same result - no identifiable POTS issues.
By the end of Wednesday's run I was breathing a sigh of relief, believing Saturday to just be a fluke.
Not so fast. I had Friday off from work and ended up running in Seabrook around 11am after lounging around all morning. I hit 175 within twenty feet of starting my run. Seriously? Not again. It could have been quite the adventure of a run but instead was spent listening to the lovely heart rate alarm go off over and over and over again. I ate some clif blocks and took 2 salt tabs hoping maybe I could salvage part of the run. It was pouring and in the 50s at the start of the run, so high temps definitely were not to blame. I was the only person on the entire trail down there. It was awesome, except in the "Alligator and Snake Habitat." Try running through there when you have heart rate issues. I always have my eye on the chain link fence that runs alongside one side of the trail (fencing off a cemetery) when the marsh is on the other. I've convinced myself I can hop the fence into the safety of the cemetery if I ever do happen to disrupt the alligator habitat! I splashed in puddles and marveled at the fact that it turned out to be a pretty awesome run day despite my stupid heart rate. The coast side park at the back of the trail was closed to car traffic (presumably because the weather was so bad), so I had that all to myself as well. The bathrooms were still unlocked though, so that was a double score!
I managed my way through six miles and things did seem to get a tiny bit better on the second half. Maybe that is because I told my heart rate alarm where to go and turned it off. Oops. I guess that kind of defeats the purpose, but I did keep an eye on it and backed off when it started to creep up. So that run was a success on the "fun run in the puddles on a beautiful trail with no one else around" but was still quite a failure on the POTS front. I averaged 12:30 pace. Not fun, and 2 minutes/mile slower than earlier in the week. I had hoped to run 8-10 miles, but lose patience very quickly when the run is going so bad.
So that was all a very long way of saying in the past 10 days I have had 3 normal evening runs and 2 awful mid-morning runs. Do we see a pattern here? I will have to do a few more runs to know for sure, but so far it is looking like my body is not interested in mornings. That is not necessarily surprising because everything I have read about POTS says mornings are awful for most people with POTS, presumably because you have not been up and moving around very long and the blood has not been flowing like it is supposed to for a while. Next Saturday will be the next time I run in the morning again, so I will try a few things different beforehand to see if they help. I will take salt the night before when I go to bed, and might try to do as much as a mile walk/warmup to see if that gets the juices flowing any better. This is a new view of POTS for me because there did not seem to be any difference in mornings and nights last year. The other new view of POTS, as I said at the beginning, is that I think being sick for so long brought this bout on. My only question now is how long will it last? Unfortunately only time will answer that. Grrr. One big issue with this, if it does stick around, is that virtually ALL races/long training events are in the morning. I hope I can somehow figure out how to manage all of this. There is no way I can race anything in the condition I have been in on my last 2 morning runs.
People often ask me "are you sure your heart rate monitor is working right?" and "do you feel bad when it happens, or just see a high number on your heart rate monitor?" Yes, my heart rate monitor is working right and I generally feel pretty in-line with what the numbers have to say. When it starts to blow up, I feel like I'm going to blow up. My chest gets tight and on the really fun days I get pain in my left shoulder. I get lightheaded and sometimes dizzy and get a headache. Walking usually makes all those things go away, but they come back quickly after I begin running again when I'm having a bad day.
On a non-running related note, I have had a headache for I don't know how long and I just read that is pretty common with POTS too. Awesome. I don't remember that the first time around, but I am similarly tired this go 'round. My stomach has also started hurting again after any big meal - i.e. every meal I eat with Jon. On the weekdays I usually eat pretty small portions and eat throughout the day. On the weekends with Jon, we usually eat real meals, and larger portions than I eat during the week. That is another symptom of POTS I do remember having last time. (With POTS, blood ends up pooling in your stomach when it is trying to digest a large meal)
I just pray that this goes away as quickly as it came on this time. I wish I knew what made it come in the first place, and what made it go away last time. I don't though. I can do what I think might help and just hope and pray it does. I also realize I am fortunate that I have what seems to be a very very mild case of POTS and know there are people who struggle to get out of bed each day because they faint as soon as they do. There are many teenage girls who have had to withdraw from school because they are too sick to go. I'm the one who did two ironmans the year I was diagnosed, so it is safe to say I do not have it nearly as bad as most others.
Comments
Sorry to hear about your issues. If heart rate training wasn't confusing enough (as it can be at times), it sounds like your situation can take it to an entirely new level.
I suggest that you integrate pace into your run training, as an objective metric (ie, 10' run pace is always 10' run pace) against which you can bounce your highly subjective heart rate off of (ie, sounds like 145bpm on Tuesday does not always equal 145bpm on Thursday).
I suggest you pick up a copy of Jack Daniels Running Formula. He describes a system of training paces that you could easily line up with heart rate zones. For example, you could determine your E, M, T paces (don't worry, all explained in the book :-), assign heart ranges to those paces, as observed on a Kathleen-on-a-good-training-day day, and then use those heart rate + pace zones to track your progress and the severity of your symptoms.
Whenever possible we encourage our athletes to use both a subjective and objective metric (heart rate and pace) as the sum of the two tells us more about what's going on.
Good luck!
Rich Strauss
We often use VDOT values from Jack Daniel's tables for our tri club track workouts (http://www.runbayou.com/jackd.htm), but then again I haven't done much track in over a year, since before I got sick.
The heart rate ranges listed on our calculator don't completely correspond to my training paces right now, but then again I may be looking at max HR at that pace as opposed to average (i.e. on a run when I hit 173 several times, I still probably average in the mid-160s, which is closer to fitting into the L/R HR range).
I should read the book though, and have honestly avoided it in the past because of fear of information overload (and fear of feeling inadequate with my measley triathlon milage as compared to "real" runners!)
I have shyed away from hanging out at too high of a heart rate for too long because I initially thought my POTS was overtraining (and did not want to dig myself ever deeper into an overtrained hole), but recently I'm starting to think that since it was not specifically overtraining and because my heart rate is quite special, that I might not suffer as bad of consequences if I don't worry as much about it and train more by paces than HR. I guess the only way to find out is to try!
Please let me know if you ever come across any other athletes with similar orthostatic intolerance issues. Most people can't get out of bed with this stuff, so cases like mine are even more rare and no one really knows much about it, or what to tell me to do or not do.