Pumping Iron

Today is iron infusion day! Here's the play by play.

11:50 AM: checked in at the infusion center. Each patient has their own curtained area with a recliner or bed, TV, headphones, even a partial view of Elliott Bay. Settled in to my own big blue vinyl recliner.

12:05 PM: met my nurse, also named Mel. Checked vitals & inserted the IV cannula in my left hand - very painful! Sadly for me, the vein blew and we had to try again at the inside of my elbow. I should have a stellar bruise on the back of my hand by tomorrow. I get a little hot pack to rest my hand on.

12:10 PM: started off with some Benadryl and a steroid (in case of an allergic reaction), then a small test dose of INFeD - iron in a dextrose solution - to see if I'm one of the lucky few who has a severe reaction. Mel asks me to let her know if anything feels weird or odd, but doesn't seem to want to tell me more about what can go wrong. Maybe people get scared or imagine side effects they don't have? Some people do have anaphylaxis from this, but that's not in my plan today.

12:40 PM: no problems with the test dose, so Mel hangs the next bag with the full dose: 1 gram of iron in a 1 liter bag of solution. Now I just chill for the next 3 hours.

1:05 PM: someone's pump is beeping, LOUDLY. Cecil is all done - yay, Cecil! The infusion center is in the oncology/hematology department, so most of the folks here are getting chemo - and I'm here so I can run (better). Well, and not be anemic, but still seems trivial in comparison. 

1:30 - 3:30 PM: read a bit, nap a bit, gotta pee! Unplug the pump & walk the IV pole across the hall to the bathroom. Settle in again in my recliner, repeat: read, nap, pee.

3:42 PM: whoops, pump stopped. Mel resets it & says I have about 20 minutes left. Time enough for another nap, I think.

4:00 PM: nope, read the internet instead. But the infusion is all done and I'm out of here. 

6:45 PM: so afterward, I feel really good - I guess some folks get pretty fatigued after these but so far, so good. Trail runs on deck for Saturday & Sunday, then head to Mazama next week for a running & yoga retreat - really hope the iron starts helping by then!

Two Weekend Runs: A Study in Contrasts

Two completely different workouts this weekend - so different that I felt like two separate runners. Saturday's workout turned out to be the kind of workout I don't like to talk about, or write about, or acknowledge beyond briefly noting the data in my training log and looking away. Even though Saturday's run followed 4 migraine days in the preceding week and started with nausea + lingering head pain, I still intended to attempt the assigned workout: 65 minutes with 30-60 second pickups each 5 minutes starting at 15 minutes in. Perhaps my brain was still addled from the migraines.

Perhaps I'm just stubborn. I set out from Gasworks Park, running clockwise around Lake Union and managed all of two :30 pickups at 15 and 21 minutes before admitting to myself that I really did not feel well at all. By the time I got to Fairview, I was walking, dry-mouthed and stomach churning. I walked all along the south end of the lake, past the park and crowds of charity walkers. Was I done? Was I willing to log just 2.3 miles for the day when I'd already missed 2 workouts due to migraine?

I was not. Once I reached Westlake, I started running again, and made it all the way up the west side of Lake Union before needing to walk again. By this time I think I'd decided to log the damned 65 minutes, however many hours it actually took. (I do not, in fact, know how many hours it took to do this workout - at least two, but I really, really hope not three.)  And that's how it went. Walk along the Ship Canal trail till just before the SPU track. Run to the mini park, turn around, and run back under the Aurora Bridge, up Westlake, across the Fremont Bridge, and down 34th. Cross the street at Stone Way for water at the new Brooks building. Cross back and run to Gasworks - only 58 minutes. Keep going along the trail for another couple of minutes, then walk again. Turn around and run back to Gasworks and, finally, stop. Ugh. 

Sunday morning, though! So very different. Up at 6:00 for coffee, out the door at 7:00 to drive over to Discovery Park, aka The Disco. Cool, a little misty over the meadow, a touch of sunrise on the horizon. Assigned workout: 45-80 minutes of completely relaxed trail running. My goal: three comfortable laps of the Loop Trail.

So off I went on lap one, heading out clockwise on the Loop Trail from the south lot. Steady and relaxed through the meadow, around the sand hill and up to the south bluff, then onward. Very quiet, very peaceful, quite relaxed - easing up the hills and cruising the rest. And just like that, lap one done. Stopped at the car to grab a water bottle and gel, then out on lap two - wash, rinse, repeat. At around 4 miles in, I began to feel noticeably better - not so chilly, legs happy, still cruising the hills. Gel at 45 minutes, then back through the south lot. Knocked a rock out of the sole of one shoe and out again on lap three. 

By this point in the run I began to pay more attention to the other walkers, runners, and dogs out along the trail than to the effort of running, cresting a hill before noticing the extra work. I began to think about why this run was so different - cooler weather, no migraine symptoms, yes - but also the comfort of knowing this trail inside out, in either direction, knowing exactly what comes next, exactly where to relax into the pace and where to push.

The last push on lap three came on the steep uphill just past the turnoff to the Visitor Center, then a cakewalk back to the south lot. Still short of 80 minutes, so why not cruise down the road behind the lot & back to finish out the run? 

This is the kind of run I want more of. This is the kind of running I'm working for, and the kind of runner I strive to be - relaxed, optimistic, joyful. I don't want to be Saturday's runner any more, struggling harder for lower-quality running. The iron infusion scheduled for this Friday should help get my body there - but there's some mind-work to do, too. 

Tomorrow's workout is 40 minutes easy & meditative; I think I'll be meditating some more on Sunday's run.

Not So Iron Mel

The good news is that I'm not anemic. Yet. The bad news is that even though I've been taking iron supplements twice a day for months, my ferritin level has fallen from 6 in June to 4. That's not quite as low as it was in 2009 - the first time I ever had it tested, at 2 whopping ng/ml - when I actually was anemic. As my doctor told me earlier this week, my body seems to be really good at making red blood cells even when my iron is low.

What it seems to be really terrible at is absorbing & storing iron, especially when I'm training, even with supplementation. I don't get much from my diet to begin with, as a vegetarian, and non-heme iron (from plant sources) is poorly absorbed. Fortunately, I don't have the added depletion of monthly bleeding, as do many women with low iron - I can't even imagine how bad my iron status would be if I were bleeding every month.

There's increasing evidence that low iron affects athletic performance, training, and recovery, even when there's no anemia. In my case, running is harder, slower, and more fatiguing when my ferritin is <12 or 13 ng/ml, the bottom of the normal range - though it's never actually been measured any higher than this). So even though I'm enjoying my runs & workouts, they feel far more effortful than they should. Trail running is especially hard right now - steep uphill efforts are simply draining; if I push through the fatigue & keep going up, I get dizzy. Last Saturday's trail run at Cougar Mountain included unscheduled resting-against-a-tree intervals.

On Friday I'll see a hematologist to discuss my absorption & storage issues, and to ask for iron infusions - here's hoping he's receptive to the idea & doesn't want me to wait till I'm anemic again.