See Sarah Run

I wrote an entire blog post on why I chose to run the Philadelphia marathon so I won’t re-hash that here. There’s no denying that it’s been a really tough six months. A really tough year, if I’m honest. I am working on recovery. The weekend before the race, I had a Kintsugi party with a close group of friends. Kintsugi is the Japanese art of repairing broken ceramics with gold. Kintsugi celebrates imperfection. Kintsugi pottery is stronger and more beautiful, not in spite of the repair, but because of it. Perhaps I can become a piece of Kintsugi.

The marathon was well timed, but I also love the city of Philadelphia. When I ran the half marathon here in 2019, I wanted to make a return trip with the family to visit the Christmas markets and soak in the city. It was too late to plan anything for December 2019 and well, December 2020 wasn’t the time for a quick trip to Philly. This year, though, we enjoyed the city in spades.

When planning the weekend in Philadelphia, I knew I wanted to make it a special visit for Rose.  We left home right after lunch. Despite hitting traffic, we were only four minutes late for our dinner reservations Friday night! We went to a restaurant called Spice Finch, upscale Mediterranean. The restaurant was wonderful. We got a trio of spreads, amazing “berbere chips,” fancy cocktails, mushroom pasta, chickpea wedges, and a tahini brownie for dessert.

After dinner, we went back to the car and grabbed our stuff. Our AirBnB had a great layout and a lot of space. That said, it also had a dishwasher full of other people’s dirty dishes. Yuck. We thought about going to CVS for a few things, but ended up reading the reviews of the nearest CVS and laughing hysterically instead. “The minute clinic is psycho!” had to be our favorite. We got successfully settled in and had a good night.

The following morning, I set out for my shakeout run. I was missing being with other runners. The entire weekend was going to be cold and blustery and it was a little hard to get going on my own. In my previous post, I wrote about calling on grit and grace for this race. Whatever the issues with the AirBnB, the entryway told me that we were clearly in the right place.

Once I got out the door, I quickly ran into the half marathon, which was already underway. Cool! I ran out Benjamin Franklin Parkway, got a look at the starting and finishing area, and jogged back. It was cold but I felt pretty good, probably the best I’d felt all week. It’s always weird to think – the next run will be the big one!

I got cleaned up and we set off for our tour of Independence Hall. It was a lovely sunny morning with lots to see. Independence Hall was a *huge* hit! We had watched National Treasure as a get-ready-for-Philly movie so we were all primed. It was surprisingly moving to see the actual place where the Declaration of Independence was signed.

Of course, we also checked out the Liberty Bell.

From there, we Ubered to the Convention Center in an effort to save my legs. We met Nurse Runner at the expo. It was great to catch up. I miss running with her SO much! We got some swag for Rose and I picked up a pint glass and a magnet. The expo was still quite a lot smaller than it was pre-Covid. I hope we can get back to pre-Covid expos at some point.

We were getting hungry and it was time for lunch at Reading Terminal Market. Luckily I’ve been here enough that I’ve got a game plan because this place is crazy! I stationed Mervus near Molly Molloy’s to watch for a free table. I took Rose to scope out what she wanted for lunch. Chocolate butter cake and a pumpkin cupcake from the Flying Monkey Bakery. Good choice! I waited forever to get a pile of food from Molly Molloy’s. YUMMY. Plus, I got an extra biscuit, which came in handy later. Rose and I both love Reading Terminal Market, but it is a bit overwhelming.

Next up was the Love statue, which we could walk to. A quick glimpse of the Christmas market, but we were getting weary and there was one important stop left. Off to the Rocky Statue! So funny that in a city full of statue of famous historical figures, I suspect Rocky is the biggest tourist draw. Rose and I ran up the steps of the Art Institute together. That was probably my favorite moment of the entire weekend. Such joy to leap up the stairs with my girl just one step ahead of me! The view of the beautiful city from the top!

Then back to the AirBnB to relax a little. We still needed a pot for cooking pasta so Mervus went to fetch that. A former student came by for a visit, which was really nice. I love it when students stay in touch. She’s one of a very special group that got through the pandemic together.

We headed back out to hit the Christmas markets before dinner. That was also just so joyful! We rode the double carousel! We got some fresh Stroopwaffels fresh out of the press. So delicious!

Then back to the AirBnB again. Mervus got the pasta ready while I did a little last minute race prep. I taped a Tums tablet to each Maurten gel and laid out Flat Sarah. All the various meds at the assigned times. One last text to Coach Maverick. One last look at my confidence resume. We had dinner and went to bed.

When I learned I had to have thyroid surgery in May, I initially assumed that a fall marathon was off the table. Surely recovery would take too long and there wouldn’t be enough time for adequate training. But then my coach-at-the time suggested I might be able to fit in a late fall marathon. Driving the hospital for surgery, I discussed racing plans on the phone with High Power Running Mentor #1. That turns out to be an amazing distraction technique and also an excellent way to toss a grappling hook of hope into the future.  HPRM#1 normally opposes my habit of frequent marathons but he also thought a fall race wasn’t a crazy idea. I started to think about CIM. Obviously, recovery has turned out to be much more complicated than expected. But by mid-summer, it seemed that running easy miles was going better than running faster miles. Marathons love easy miles. Then CIM sold out. But Aidan’s girlfriend goes to school in Philadelphia. He could fly into Philly for Thanksgiving and we could pick the two of them up and drive them home. Was it a giant coincidence that the Philadelphia marathon is the very weekend we planned to go fetch the college kids? I’ll let readers draw their own conclusions.

Back in August when we made this plan, it was hard to say how things would look in November. I certainly hoped that I would be done dealing with calcium and voice issues by now, which I am not. But back in August, I was also really scared. That’s when the marathon called to me most clearly. I don’t always subscribe to the old adage “Life is uncertain. Eat dessert first.” But in this case, it fits. Given that it was extremely hard to predict how training would go, train for the thing you love the most. For me, that’s the marathon.

By early September, training started to fall into place. I’m loving working with Coach Maverick. I love the routine of marathon training. I’ve loved fall long runs with friends through the gorgeous New England autumn. One of my main goals for the training cycle was to re-establish a regular training routine post-surgery. No matter what happens at the race, I’ve accomplished that. More than any training cycle in a long time, this one has been about process. I’ve trained almost entirely by effort, barely looking at my watch, just showing up every day and doing the work. I’m hugely grateful that this turned out to be possible.

You can run without racing. But a race provides some direction. It gives a purpose to the training. It’s true that the race is the celebration of the training, but in this case, it’s more than that. I’ve thought a lot about the first marathon training cycle after my epic bout with plantar fasciitis. That was my first marathon with Coach Mick. Like now, I ran every run based on effort rather than pace. Like now, some long runs were ventures into the unknown more than they usually are because I didn’t know how my body would hold up. Like now, I made it to the starting line, which is never a guarantee.

This training cycle also reminds me of my first research trip abroad after Rose was born. The entire family went to Berlin so I could do field work. Aidan was four and a half and Rose was just five months old. The plan was that Mervus and I would both work while the kids napped. I am not sure that either of us got a lot of work done. But I proved to myself (and my department? Other political scientists?) that I could still do field work, even with two children. In many ways the trip was ridiculous. But I’ve never regretted going. More than anything else, I needed to know that I could still do research abroad.

That’s a lot of what this marathon is about. I need to know that I can run 26.2 miles without a thyroid. Unless something very weird happens, I am going to make it to the starting line on Sunday morning. I am also really good at getting to the finish line though that is never a guarantee either. I’ve run a couple of exceptionally hot marathons. This one is going to be the coldest yet. It might or might not be marked by severe cramping due to calcium deficiency. The marathon is a very long race with a lot of opportunity for the wheels to come off the bus.

I am running the Philadelphia marathon to prove that I can do it – to prove it to myself and to the numerous doctors supervising my care. It’s more than a bit audacious. It has not yet been six months since surgery. When I made this plan, I did not know what a big deal that was going to be. The past few months have been marked by a lot of fear and not a small amount of despair. But there’s also a little bit of iron that lives inside me and that bit of iron is still very much there.

When I thought the plantar fasciitis might take me away from running forever, I got up each morning and looked at my workout clothes and thought about whether it was worth it to cross train or not. Every single day, it was worth it, because I wanted to get back to running.

When I cramped so severely at the end of the 22 miler in West Hartford earlier this month, I thought about turning back early. But I didn’t. I ran 22 miles even though the last few were incredibly painful.

When the insurance company called twice during my 20 miler, I fielded the calls and finished the run.

Sometimes you just run because it’s on the plan. Because following the plan brings order to disorder. Because I can’t control my health, which is one of the most frustrating things I have ever encountered in my life. Because it’s terrifying to think how close I might have come to having a condition that can be incapacitating. Because I am going to have to work every day to get my voice back to normal – damaged through absolutely no fault of my own. These really bad things have happened to me and I can’t control them. I can control showing up and doing the work.

On a podcast I heard a professional runner talk about being able to control effort and attitude. I like that. That’s no different for a professional runner or for me. Ultimately even Kipchoge can only control effort and attitude.

Coach Maverick told me last week that I was showing strength and grit, but I misremembered that as grace and grit. I like that even better. In a lot of ways, strength is easier than grace. I have a lot of grit. I’ve showed that many times. I’m also really strong. But this experience is helping me find grace. What does that mean? It means discovering a deep well of kindness within myself, kindness for myself and for others. I am not perfect and I do not always manage this. Just ask Mervus. But to run simply because I can. Because sometimes, often, the world is terrible, more terrible than we could imagine. But learning to run through the terrible helps us overcome it.

So, that’s why I am running the Philadelphia marathon. To prove to myself and others that I can do it. For the chance to practice controlling effort and attitude. To demonstrate strength and grit, but most of all grace. As the City of Brotherly Love, Philadelphia turns out to be the absolutely most perfect place to run a marathon.

Progress is still progress, right? I am in a crazy-making zone right now where the overall trajectory is definitely improvement. However, things have been so bad for so long that I am really scared to hope for anything for fear of jinxing myself. Hope feels too dangerous because it seems that it will inevitably lead to disappointment.

I want to acknowledge that I am probably difficult to talk to at the moment even though I also need people to reach out. When someone is struggling, we naturally want to comfort them. We would love to say “It’s going to be ok” – but what if it isn’t? We might try something like: “Things are getting better!” – that’s accurate in my case, but that can feel like it denies the very real suffering that is ongoing. A few people are getting regular updates on all this health crap. One friend sends a prayer and a joke every single morning. Friends from church have sent me things like an amazing thyroid-calcium poster and a dragonfly to symbolize transformation. I am beyond grateful for these acts of compassion. My inner circle has had a massive lesson in the endocrine system. Kevin has been an absolute rock. Sometimes I am scared and furious, but I try to remember that I am not alone.

All right, so here’s the update. We checked thyroid levels again on October 13 and THS was 2.1, basically the same as the previous test of 1.94. We are looking for that to be a bit lower so I am now taking 150mcg of levothyroxine a day, plus half a pill extra once a week. Hopefully that brings TSH down just a tad. Free T4 and Free T3 were within range. We will check thyroid levels again in early December, but I’m feeling good and I expect them to be fine.

The biggest news (and stress, as usual) is about calcium. From mid-September to mid-October, I was able to reduce calcium and calcitriol at the pace of dropping one daily pill a week. YAY YAY YAY! Calcium remained stable throughout and PTH (parathyroid hormone) came up! YAY! I got down to ZERO Tums per day and .75mcg calcitriol per day. Hallelujah!

Then we I tried to go to .5mcg calcitriol per day and my calcium dropped too low. That was disappointing. I also felt crappy. No real tingles but a severe backache and just general body grouchiness. When I returned to .75mcg calcitriol/day, those symptoms disappeared so it’s no mystery what was going on.

My endocrinologist characterized our process of dropping meds as “aggressive” and I agree. I was able to drop a pill every week for four weeks straight before my body said no more. That said, I was on a roll and having to go back on the higher calcitriol dose was a bit of a heart breaker. It’s been a major mental balancing act. On the one hand, weaning off that much calcium and calcitriol that quickly is pretty damn awesome. On the other hand, no one likes a setback and there’s no way to predict when a setback might become permanent. The plan for now is to let my body re-group for a couple of weeks and then try again. We can also tinker with things like dropping some calcitriol but adding some calcium back in.

Just to clarify, if my parathyroid glands don’t start working again, I have permanent hypoparathyroidism. That is a really shitty outcome. We are trying to discover if it is in fact my personal shitty outcome. This condition is often transient. If I can reduce and eventually eliminate the medication and my body takes over regulating calcium on its own, then I am good to go! If my calcium levels drop every time we try to reduce calcitriol, then I am stuck with this bullshit, probably for life. Calcitriol is a high power prescription strength Vitamin D that carries with it long-term risks of things like kidney stones, cataracts, and calcification of the brain. That’s why I want to get off it. Let’s hope and pray that my hypoparathyroidism is transient! The process of weaning off the meds is stressful because the stakes are high.

In terms of my voice, I’ve been able to get voice therapy appointments close to every other week. That’s much better than once a month! I’m making clear progress. At my first appointment, my range was only 17 semi-tones. At my most recent appointment, it was 28 semi-tones! Now a lot of those tones are squawks but the voice therapists assure me that that will improve. I am currently pretty hopeful that with time, I will get most and maybe all of my voice back. I have a new and deep understanding for how much our voices represent our selves. I am grieving the fact that six months after surgery, I very much doubt I will be able to sing Christmas carols.

That leaves the pesky little basal cell carcinoma as the last health issue. Because the last time someone cut my neck, things did not go so well, I had been hoping to treat this skin cancer with radiation therapy. Cigna has approved the radiation, but not the ultrasound guidance. I guess the idea is that the doctor would just wave the radiation wand in the general direction of my neck and call it good? I am running out of energy to fight the insurance company so I may just go for the surgery.

I am kind of stuck between hope and fear. It’s often hard to think about topics other than my health. After five months, I am getting quite tired. Yes, I am still running. I am in fact training for the Philadelphia marathon and it’s going pretty well, all things considered.

These updates are a way for me to process all of this stuff. Today is a tough day mentally but I need to get this post off my chest in an effort to move on so here it is.

Photograph by Jennifer Schulten

In a lot of ways, the story of Hartford 2022 begins way back in August 2013. I was training for my first full marathon and I ended up with an Achilles issue. As I’ve told the story many times, I showed up in the Maestro’s physical therapy clinic with my training plan in one hand and two small children dangling off the other. Rose would have been five and Aidan was nine. The Maestro put SpongeBob SquarePants for them, which they objected to. Then he got on with the business of healing my Achilles, but more importantly, helping me understand that even though risk can lead to injury, injury can lead to recovery. The injury is not the end of the story. That’s such an important lesson and here I am nine years later, still learning it. The Maestro started running himself earlier this year and I have the enormous honor of acting as his coach. Watching him cross the finish line of his first full marathon was by far the best moment of my day! I’m happy about how my own race went, but I am OVER THE MOON about his!

My training leading up to Hartford went well. Coach Maverick and I are settling into a groove. I am currently training by effort, which makes a lot of sense because pace is so hard to predict during recovery. Effort is probably the best metric anyway, but it takes a big leap of faith to rely on it exclusively. Since the Surftown Half, we’ve extended tempo segments, my pace has dropped, and I haven’t once looked at my watch during a workout. The weekend before the race, I ran 16 miles with some half marathon effort segments and the Tuesday before the race, I had 20 consecutive minutes of tempo. Most days have been a happy surprise when I looked at pace after the run.

I write these race reports partly for everyone’s amusement, but also for my own record keeping. I never published the Hartford 2016 race report because it’s too damn dark. I was really struggling and in that report I note that it was the Maestro who made me confront my mental demons. Tough Guy Trainer helped me figure out how to seize the day and run well even in the middle of a lot of doubt. These two have been on my team, by my side, and in my head since 2013 and I am beyond grateful for their continued support. Hartford 2017 was a different story entirely. I had recovered from the PF. I had started working with Coach Mick. He convinced me to run the race without looking at my watch. I worried “What if I go out too fast? Or too slow?” He said “What if not looking at your watch allows you to find just the right pace?” Wise words from a wise friend. Hartford 2017 was the beginning of a glorious comeback.

Fast forward to Hartford 2022. Coach Maverick also suggested I run by feel. I knew this was the only sensible choice. I would absolutely be running slower paces workouts if I had been looking at my watch because I would have been scared of blowing up. Racing by effort is scarier because the stakes feel higher but Coach Maverick helped me remember that there are no stakes here. I have everything to win and nothing to lose right now. He even convinced me to change my watch face to remove pace entirely. No temptation to peek.

On the Friday before the race I had planned to meet the Maestro at the expo for bib pick up and lunch. He ended up having car trouble so I picked up our bibs by myself. Full service coaching! [I was crossing my fingers *really* hard that he figured out transport to the race, but he did, no problem.] I went to Goodwill for throw away clothes. I even talked to Coach Mick while driving around. We are still good friends. I don’t think I would have been brave enough to drop the watch this time around if I hadn’t already done it once so huge thank you to Coach Mick!

The other pre-race day activity was going to the lab for blood work. I’m a regular at this point. I was up in the night a bit checking for results, but they arrived on race morning. No red exclamation point! The red exclamation point marks abnormal test results. It has been there all ten times we have checked calcium and parathyroid hormone levels since surgery. At first, I thought there was some kind of error, but no. Calcium and parathyroid hormone IN RANGE!! Both of them! For the first time since surgery! That is seriously the best news EVER on race morning. Truly incredible. I woke up Mervus to show him, but then let him get back to sleep.

Downstairs, I made my oatmeal (opting for a compromise of ¾ cup dry this time) and coffee. There was a bit of texting back and forth between me and the Maestro, with images of our race kits, last minute nutrition tips, all-around getting amped.

I got to the race very early and secured some seriously Rockstar parking. For free! I was so early that I did a Headspace meditation to get in the right frame of mind. I had the Maestro’s bib and some gloves and some Gu for him so we agreed to meet in front of the Bushnell Theater. I jogged around a bit and ended up at the theater on time to hand off the Maestro’s stuff and hop in for the Manchester Running Company team picture. Then the Maestro and I did some strides, made a last minute port-a-potty stop, and headed to the start.

The Maestro and I were running different paces – his first marathon, my zillionth half marathon – but the course is the same for the first mile and we decided to stick together. So incredibly exciting! It went by too quickly, though we were running pretty slowly. Then I made the turn and he went straight and I thought, I’ll see you in about four hours!

It was time for me to find my pace. I tried to feel it. Faster than easy. Nothing like a sprint. Something like what Coach Mick calls “sentences pace” and what Coach Maverick calls 7 on the perceived exertion scale. I know about what this should feel like, but it takes some confidence to just go for it. Too fast and you die later. Too slow and you blow your race.

In 2017, I wrote about how even without my watch, I still had a lot of chatter in my head. My mind was constantly assessing my effort level. I was talking out loud, pretending to say things to Snarky Girl. I know better now. A quiet mind is the way to go, at least in the early miles. I managed that a lot better this time around. Miles two through five passed uneventfully. I enjoy running under the overpass that says Parkville and that’s about all I remember.

For fueling, I had decided to combine taking Maurten and Tums at 40 minutes and 80 minutes into the race. It’s just too complicated to put the Tums and the gels on separate schedules. I also had a Tums at my car before going to find the Maestro. Fueling mostly went fine except at the 80 minute mark, I dropped the damn Tums! I considered just skipping it, but I knew that wasn’t smart. I took out another one and dropped that one too! At that point I just stopped and stood there at the aid station eating the Tums. A friend with my same calcium issues compared extracting the Tums from plastic wrap during a race to solving a Rubik’s cube and he’s got that right. I must have looked a little ridiculous, but who cares – I got it down and I had NO calcium tingles throughout the race! My right quad was extremely cramped at the end. I suspect some of that is because of low calcium, but that right quad is a long-time problem child so who knows. I had one more Tums when I finished the race just for good measure, making four total. Last weekend I went straight from my long run to the lab for a blood draw so I know this schedule of Tums gives me plenty of calcium. I can not WAIT until the Tums is gone from my routine entirely. Fingers crossed that that is sooner rather than later.

The race had a big arch up at the 6.2 mile mark and unfortunately I saw the clock there. It said something like 55:xx minutes. I knew I was a minute behind the clock so did that mean I was running 9 minute pace? Except what about the .2 miles, how did that factor in? Whether it was seeing the clock or just being about halfway through the race, everything felt harder after that. Just like at Surftown, this wasn’t a gradual onset. One minute everything felt pretty much okay and a minute later everything felt really difficult.

The next few miles felt slow and they were in fact the slowest miles of the race. At a few races this year, I’ve actually stopped for a minute (or longer….) to collect myself when things got hard. But at Hartford, I had committed to myself before the race to not doing that. Miles eight through ten felt pretty rough and I walked a short uphill segment, but I forced myself to keep going. No stopping for a mini-meltdown. YAY! I think this might be a significant breakthrough. When I came out of Elizabeth Park, I was able to pick it up a little. My breathing was okay. I didn’t have the same issue I did at Surftown where it felt like my chest was constricted. My legs would not go faster, but luckily I was also able to keep them from going any slower. The last two miles I was just counting and counting. I did take one little peak at the watch with just over half a mile to go and I saw 1:50:xx. That helped me kick it into gear! Final time of 1:55:54! In 2017 I ran 1:55:39. That’s pretty crazy.

I was incredibly happy to be finished. I hadn’t planned on having anyone at the finish line but the Librarian popped up! She had finished a few minutes before me in a great run! She made sure I was ok and got me some water. I hung on the fence for a moment or two and then stumbled through getting a heat sheet and my medal. I found a bench to sit on and collect myself. Somebody I had seen in the race sat down next to me. It was kind of nice to just sit next to each other quietly. Somewhere in here I texted the Incredible Mervus and Coach Maverick to let them know how it had gone. I wandered back to my car and called my mom. I was excited to let her know about the race but even more excited to let her know about the calcium results. It was so great to be able to share the good news! Then I got a shower at the YMCA and wandered over to the beer garden staged by the race.

I was only there a couple of minutes – not even long enough for a beer! – before it was time to head to the finish line to watch the Maestro come in. I got to the line with about 3:55 on the clock and the Maestro cruised in a couple of minutes later. He ran 3:58:04!!! His first marathon!! And my first time coaching a runner to the full distance! He ran a monster race, negatively splitting and staying mentally tough the whole time. The Maestro is an all-around great athlete, but he’s clearly got huge potential at the marathon if he decides to stick with the distance.

The rest of the day was for celebrating. A big gang went to Parkville Market for food and drinks. The Maestro’s family came by. It was a perfect day for racing and a lot of people had run good times. We are having a beautiful October here in Connecticut.

True confessions: The next day, I had some mental struggles. Calcium within range!!! Running without Tums!!! Those were not goals I set down on January 1^st, not even close. It can be really hard to adjust to the pace of recovery when it’s a lot slower than I would prefer. Mostly I’m celebrating progress as it comes. It was certainly awesome to be back racing on the streets of Hartford.

Here’s another update on the various medical fronts. I’ve had a couple of people tell me these missives are useful for friends and family who might be dealing with similar issues. That means so much to me! There’s a lot going on and some good news for a change. I am just going to bring this up to speed – for background info, please read previous posts.

I had a three week hiatus from test results which was DELIGHTFUL. Getting lab results back is quite stressful so simply having a break from that process was wonderful. I also did not change any medication doses for about five weeks – the longest stretch since surgery. I had a lot of blood work done on September 21^st, so much of this information is from then.

Thyroid levels. My TSH came back at 1.94, drum roll please, NORMAL RANGE! WOOT WOOT! That’s my first normal TSH since surgery. My energy level has been good and I have been feeling “normal” so I wasn’t surprised, but it sure was nice to see this one. I would also say, normal isn’t necessarily “optimal” but it’s getting closer. My endocrinologist and I would both like that TSH number to come down a bit, at least under 1.5 and maybe closer to 1.0. But we decided to let this situation ride for awhile and did not change the levothyroxine dose.

Calcium levels. This is the big one because low calcium is the one piece of all this that can actually be quite dangerous. Calcium was 8.7 on September 21^st and we decided we can start backing off on some of the supplements. YAY! The high level of calcium supplementation is something I find quite concerning. High calcium levels can cause all sorts of problems. Also, high calcium levels can suppress the parathyroids, the poor little glands I am desperate to have working again. We are trying to keep calcium high enough that I am symptom free and safe, but low enough that the parathyroids get the message that they need to kick into gear. We calcium at 8.7, we could start backing off the supplements. YAY YAY YAY! I have gone from taking three Tums a day to taking only one Tums a day. We plan to try dropping the last Tums next week.

Dropping the Tums is great in lots of ways. I’ve gone from 10 pills a day to “only” 8 pills a day. I’ve gone from taking meds at four different times a day to “only” three different times a day. Best of all, when we get rid of that last Tums, we can start dropping Calcitriol. Calcitriol is the prescription strength vitamin D that does seem to suppress the parathyroids. Maybe. There is some debate on that, but I want the Calcitriol out of my life, ASAP.

In addition to the standard 10 pills a day, I had also been taking Tums on an as needed basis while running. I am very happy to report that I have not needed Tums while running in about two weeks! It’s MUCH nicer not to have to stop every couple of miles to eat a Tums, believe me.

One last sort of amusing calcium note – yes, we are in the realm of calcium amusement, better than calcium despair, trust me. Last weekend I ran 16 very solid miles. I am still taking Tums on long runs because they are so taxing on the body and I ended up taking four Tums over the course of the run. I went directly to the lab for a blood draw to see how this regimen was working. Calcium was 9.7! I don’t need it anything like that high so I can clearly scale back on long runs as well.

Good news on thyroid levels and good news on calcium and MORE good news on my voice. The voice therapy sessions are great, but very hard to book. I had one in late August and one on September 30^th – once a month just is not a great way to approach recovery. However, it was clear to me that my voice is becoming stronger. In August we were able to measure an increase of 8 decibels! We didn’t measure volume on September 30^th, but we did start to work on pitch. I saw a new therapist who told me he is very optimistic that I will get my full voice back. The fact that I can make high-pitched squeaks is apparently an indication that the vocal cords are starting to stretch and just need more squawking and more stretching. I am starting to be able to sing passably as long as the song has a very narrow range. The loss of the ability to sing has been more painful than I could have imagined. I will be so grateful to get my voice back.

Last and in fact least, we have that pesky little basal cell carcinoma issue, aka fancy words for skin cancer. There are two ways to get rid of this thing, superficial radiation therapy and Mohs surgery. I have met with the two different doctors who would do each procedure. I’m waiting to hear about insurance coverage. I’m considering the pros and cons of each choice. Sometimes I am very very angry that in addition to my adventures in thyroid-land, I now get to choose between radiation burns and another cutting open of my neck. Both are shitty options. On the other hand, I am pretty sure that either choice will get rid of the skin cancer.

Thyroid surgery and its aftermath have turned out to be much more difficult than I expected. The mental toll and the sheer amount of time involved in managing appointments are the aspects that have been the most difficult. Just in the last few weeks I have started to feel like things are turning a corner, but the last four months have been so hard that it’s hard to trust this feeling. There’s still a long road ahead and the calcium issue remains the most worrisome. The potential long-term implications are truly scary so I am raising a glass to every Tums not needed. Luckily I’ve been able to work and run and bake so my life is full of good things alongside the medical nonsense.

It’s been a truly crazy few months with a lot of unfortunate medical developments. However, I’ve been able to keep running and I’ve even returned to racing. On September 11^th, I ran the Surftown half marathon in 1:57:44. I’ve run Surftown seven times now, including the inaugural version of the race. I last ran it in 2019 when the world was a very different place. It’s my favorite half and I was so glad to be back!

This year, I am coming back from thyroid surgery. This process is proving more complicated than expected because of various post-surgical complications (see previous blog posts). Surftown was my second race since the surgery in May. I decided if I could run a faster pace per mile at Surftown than I did at the Blessing at the end of July, I would consider it a success. Mission accomplished! I also very much wanted to run under two hours. Mission accomplished again! I remain a little shocked that sub-2 is my “mission” given my PR of 1:44, but at the same time I am incredibly happy to hit that mark. Adjusting expectations on the road to recovery is a tricky thing.

There were six weeks in between the Blessing and Surftown. During that time:

• I switched coaches (Coach #5 in 2022. I realize this is getting ridiculous. Hoping very much that this one sticks.).
• Our family took a two week trip to Boulder to drop Aidan off at college.
• I spent two weeks dealing almost non-stop with medical stuff.
• Rose started high school.
• Blissfully, Wesleyan’s semester started and life started to get back to whatever “normal” is going to look like right now. Whew.

My new coach, who really has to be known as the Maverick, does pre-race phone calls (YAY!) so we talked on Thursday. We are still getting to know each other, but we had a good talk. He recommended focusing on effort, which is of course the right approach and he reminded me that my family and friends would love me regardless of the time on the clock. I know that, but it’s still nice to hear.

He also helped me nail down a calcium strategy. At the Blessing, I took a lot of Tums before the race and then also one every 2.5 miles. This past week I seemed to be having fewer calcium symptoms so we agreed that I would try to take the Tums with a gel every 30 minutes. Of course if I got tingling, I’d have to take more. I ended up taking a Tums when we arrived at the race (an hour before start time), then right at the start, then every 30 minutes as planned. I had a little tingling around 1.5 miles, but nothing serious. The calcium situation is SO much better than it was six weeks ago. I’m still taking quite large doses of calcium, but my levels are stable now so I am a lot less worried about potentially ending up in the ER. I really really really really really hope I can back off the current calcium regimen eventually. Besides being a pain in the ass, taking large amounts of calcium can lead to all kinds of issues down the line, such as kidney stones and cataracts plus a lot of other horrible stuff. But stable calcium beats not stable calcium every which way so I’m super grateful for stability at least. And if Tums is offering any running sponsorships, I’m all ears.

The plan was to run this race with the Maestro, my good friend, physical therapist, and, since last spring, also one my athletes. He’s training for the Hartford marathon so Surftown is a perfect prep race. To my complete delight, he decided we should run Surftown together. I have no doubt that he is currently faster than I am, but he insisted we run together and I loved the idea.

With a calcium plan, a plan to run with the Maestro, a plan to run by effort – things were falling into place. The workouts I did in the two weeks leading up to the race made me think I could maybe handle an 8:30-8:45 pace if I was prepared to really suffer during this race. But I knew I was not. I’m pretty good at running hard when I’m mentally ready, but it’s been a hell of a summer. I’m just getting back my race brain and remembering how to work hard while running. I’m learning (again) that it’s a process and it doesn’t have to happen all at once. At the Blessing, I remembered how to stay in control and pace smart instead of running like an idiot. I also made a conscious choice not to run that hard because I didn’t feel like the calcium situation was sufficiently under control. At Surftown, I was confident in the calcium plan and it was time to start working on mental fitness.

On race day, our gang woke up at 4:15am to get ready. Mervus and Rose are really troopers! I had my usual oatmeal and coffee plus a banana. By 5:15am, the Maestro was at our house and by 5:30am we were all in the van heading out. Rose napped on the way – smart girl. We pulled into the parking lot at 6:30am and it was noticeably less crowded than in 2019. I checked later and the half marathon had 948 runners in 2019 and only 639 this year. I have no idea if that’s still a Covid effect or something else. Surftown remains a great race!

Allegro Fuerte also ran Surftown but he was already warming up by the time we got situated with the port-a-pottys. The toilet paper situation left something to be desired but post-Covid, I always have TP in the car so we were fine. The Maestro and I ran just over a mile and then did some strides. This was definitely NOT too much time – we actually started running the warm up at 7am and it would have been better to start 10 minutes earlier. The strides felt good, but I was also already pretty sweaty after the warm-up so I passed my singlet along to the Incredible Mervus. In my 2019 Surftown race report I note that it was only my second race in just a sports bra. Wow. That’s certainly changed in the last 3 years!

Keeping busy during the race

The Hartford Marathon Foundation switched up the course this year. Surftown is a double lollypop with an eastern and western loop going out from Misquamicut State Park. The old course finished with a loop around Watch Hill, which included a hill at the 10 mile mark, but also a nice downhill finish. The new course heads out to Watch Hill first and takes a different, less steep route up the hill. I probably have a slight preference for the old course, but Mervus says this version is better for spectators because there is a lot more room in the start/finish area. It doesn’t really matter. It’s a gorgeous place to run, whichever order the loops come in.

The Maestro and I lined up and I tried to ignore the 2-hour pacer. I *really* wanted to get under two hours at this race. Both because it would be a huge blow to my ego to run slower than 2 hours and because it would be a massive triumph for the Maestro to hit sub-2 for the first time. I didn’t want to see that pacer again and I tried to forget about him. They had wheelchairs this year so they started first and a couple of minutes later, away we went!

It was good to be back running in Westerly. It was great to be running with the Maestro. We easily found Mervus and Rose and waved to them. It was a little strange to be starting in the “wrong” direction. I fueled exactly as planned. One Tums at an hour before the start and at the start. A Maurten gel plus a Tums at 30, 60, and 90 minutes into the race. In addition to the cup of coffee at home, I had a caffeine tab at 6:30am. I’ve been a little gun shy about caffeine since overdoing it at Berlin, but I do think it helps. At most aid stations, I had a few sips of water and also dumped a cup or two over my head. It was in the low 60s at the start, fairly humid with not much wind. Those aren’t perfect conditions, but they are pretty good, especially coming off of summer running.

The first mile clicked off easily in 8:46. The second mile was 8:50 and the third was 8:49. At that point I said to the Maestro, well, my new coach is learning about me here. If conditions are decent and the course is pretty flat, I can run really even splits. The first seven miles ranged from 8:44 to 8:53.

One reason I love this race is that the course is so beautiful. Lots of views of the shore and pretty neighborhoods. We ran past a lovely little street with cafes that I think is a new addition. They looped us around slightly differently so we the ascent of Watch Hill was less steep. It’s just a gorgeous place to run. As we were nearing the end of the first loop a spectator called out “Just keep putting one foot in front of the other. You’ll get there eventually.” I remarked, “Worst. Cheer. Ever.” which got a good laugh from our fellow runners.

This first section of the race felt really good. I wasn’t working terribly hard. I knew I was running well. I was feeling proud that I was so controlled. Running with the Maestro was a delight. A great day! But, you never know when that phase is going to end. I had been hoping to get to mile 9 before things got really tough, but instead right around 7 miles, everything started to feel overwhelming and impossible. I glanced at my watch and saw the dreaded 9:xx for pace instead of 8:xx. Brains are powerful and in a flash, I was filled with doubt. Instead of crossing the finish line with the Maestro, I started to see myself walking the last few miles alone. I pulled off to the side of the road, stopped, and put my hands on my knees to collect myself. Very reminiscent of what happened partway through the 2022 Boston marathon.

But, it turns out, brains can be taught how to do things. I had talked about that moment in Boston with my sports psychologist last spring. We worked on developing a set of mental tools to have ready to go when things get hard. It worked! I am not sure how long the stop in Boston lasted, but this one was less than 30 seconds. I gasped to the Maestro “This is mostly mental” and then “I need to get to the lines.” He had no idea what I meant, of course, but I started running again, moving to the middle of the street so I could focus on the yellow lane dividers. That’s a trick I’ve used before, but this time, it was very conscious. Really, just like pulling a hammer out of a toolbox! I knew we’d see my family soon and of course I wanted to be recovered by then.

Before mile 7, this race was great. I was feeling good at my target pace (around 8:50). I very much enjoyed the feeling of being in control instead of being furious or incredibly sad. After mile 7, though, this race was straight-up work. I had hoped that the work wouldn’t start until mile 9. Writing this afterwards, it doesn’t seem like much difference but at the time, the difference between mile 7 and mile 9 felt huge. The entire causeway was going to be work now.

One of the best things I did at that point was to quit looking at my watch. I no longer knew how fast we were running but it didn’t matter. Now the point was just to keep running at a pace that seemed hard but sustainable. In my head I chanted “Look at the lines, look at the lines, look at the lines.” I wanted to keep my mind as quiet as possible. I was working, but I reminded myself that the work was the point. At the Blessing, I wasn’t ready to work – I would even say, it wasn’t appropriate to do the work. But now I was ready and I was working.

The best thing about the causeway heading east is that you pass the runners coming into the finish line. I was still running in the middle of the road to stay on the lines so I knew I’d see some fast friends. I tried to cheer but it came out “CRROOAAKKKK!!!” Oops. My voice is pretty much completely non-operational while running hard. Still hoping that comes back at some point.

As we came into the mile 10 water stop, I slowed to a near stop. I made sure to get a full cup into me and dumped a couple more on my shoulders. Then off we went again. The second loop of the new course is shorter, thank goodness. I gave myself permission to count with three miles to go. Up to one hundred and back down again, over and over, until we got through 11 miles. Holy shit, that was a long freaking mile. The clock at mile eleven said 1:40 and I knew as long as we didn’t slow down, we would run under two hours. Two miles to go and I just pushed.

Some part of my brain was still doing a little analysis. My legs were okay, but it felt hard to get enough air. I even got a side stitch (maybe caused by too little oxygen? – haven’t had one in years!). I suspect the skin around my neck and chest just isn’t quite back to normal yet so my breathing is a little constricted. Instead of feeling angry or sad, I felt hopeful. That will surely correct itself with time. Maybe more stretching will help. I got a massage the next day and I DO think it helped! Hooray for healing!

The last two miles felt pretty endless. They always do. Counting helps me because it ticks off the mileage. Looking at our splits, except for that mile 10 water stop, we barely slowed down in the second half of the race. That breakdown at mile 7 WAS largely mental. I COULD keep going and I did! I remembered how to push and I found the mental and physical energy to go after it. I did not end up walking and the Maestro and I did cross the finish line together! It was awesome! !

Photo credit to Rose

Mervus and Rose were there cheering. We got our medals and some water. I caught my breath and we checked out the beach. It was fantastic!

I also want to note the dark tunnel lurking in this story. I can see it in my mind – it’s always to my left for some reason. It looks like a train tunnel with large stones around the opening. This imaginary tunnel is the counter-narrative about this day. The tunnel focuses on how the last time I ran Surftown, I ran 13 minutes faster. I got a nice PR in the lead-up to the Chicago marathon. I felt strong and free. I didn’t think about calcium or carry Tums. My breath came without restriction. When I called to friends, they heard me because my voice was strong and clear. The tunnel asks, will I ever run like that again? I don’t want to know what else is in that tunnel and I have mostly avoided exploring it. That’s one of the things I am most proud of. The tunnel is so clearly there, but I am largely staying out of it. On this day, for where I am with my running right now, this race was a big victory. Maybe that’s part of the magic of Surftown and another reason to love this race. Victory is not always a faster time on the clock.

This time around, victory was also 3^rd place in my age group! I’ve never placed at Surftown before and I’m mighty happy about that! It’s true that there were fewer runners this year so there was less competition. Part of a race is just showing up which can be really hard. I understand not racing because I considered that. But instead, I showed up and I won a bus trophy!!! Super stoked about that! We went to the Cooked Goose for brunch and it was just as good as it always is. This day was a BIG step forward!

When I scheduled the thyroid surgery for May 27, I lay down a series of markers in my mind. These were things I wanted to be able to accomplish by a particular time: March in the Pride Parade on June 4th. Attend church on June 5th. Go to Portugal for my scheduled conference the last week of June. Run the Blessing of the Fleet 10 Miler on July 29^th.

When I made that plan, I wasn’t sure if I would be racing the Blessing, but it seemed reasonable to expect that I would be able to cover 10 miles on my own two feet by two months post-surgery. In late June, I thought I might be up to racing, but then I got Covid while in Portugal. And the post-surgical complications arrived: Potential vocal damage and low calcium. But I made a pros and cons list and the pros list was longer. The Blessing would be a celebration of getting through the last couple of months and of working with a new coach. More on that at some point. I’d run 10 miles a couple of times and I was sure I could cover the distance. Plus, I really wanted to see Chewie and Allegro Fuerte and I wanted to get out of town for a bit. It really was a last minute decision – I registered the night before the race.

We did the same routine as last year – Mervus and I picked up Rose directly from circus camp and headed for Narragansett. We hit some traffic and I was nervous about getting there on time, but we more or less managed it. I nearly lost my bib, having left it behind at the table where I stopped to buy some Gu. The pre-race scene was a bit of a wake-up call in terms of my voice. My vocal cords sustained some damage during my thyroid surgery in late May. When I am having a one-on-one conversation indoors, my voice is quiet, but comprehensible. In fifteen minutes of walking around outside with a lot of ambient noise, at least five different people were unable to hear what I was saying. Oy.

Still, we found Chewie and Allegro Fuerte and it was SO good to see them. After a quick pit-stop at the porta-potty, we went and lined up. I sent them ahead, but stayed pretty far back. I spotted an Achilles International guide working with a blind runner and I even considered asking if I could just stick with them, but they were aiming for a 12:30 pace. I knew I’d be faster than that. My coach had advised to start the race at easy long run effort and then see how it felt after a couple of miles. If I felt like pushing, physically and mentally, I could go for it. That seemed like a great plan. Rose and Mervus got up on a big rock so they could wave at me at the start. This is currently Rose’s favorite race to spectate, though I sometimes think the most recent race is her favorite race. Anyway, they fired the gun and off we went.

I love running and I love racing! The joy of running in a big pack of people is incomparable. Last year the Blessing was my first big race post-pandemic and everything still felt a bit tentative. This year, some people wore masks inside, but there were many more spectators and a much more joyful feel to the race. I had decided not to look at my watch and except for one glance by mistake, I didn’t. It felt wonderful to be running with people and the pace was very comfortable.

After a couple of miles, it was decision time. Did I want to push? I realized a couple of things simultaneously. First, I got my racing brain back! This is huge! Even prior to all the medical crap, I’ve been struggling with racing for about 18 months. The pandemic made me SO angry. I raced a lot of stupid emotionally-driven 5Ks where I would start hot and just run as hard as I could until I was slightly less pissed off and then I would slow down dramatically. That felt awful. I worked with a sports psychologist last spring. She helped me let go of the anger (mostly). We also started working on remembering all the mental cues I’ve used for racing in the past and coming up with some new ones. My racing in 2022 has been better than it was in 2021, but except for the Run for Refugees 5K, it still hasn’t been stellar. The Blessing was stellar. I didn’t run especially fast for me, but it was like I remembered how to drive and that was marvelous. I can hardly express how marvelous it felt.

Anyway, after a couple of miles, I had to assess whether to push. My biggest worry was my calcium deficiency. I changed how I was handling that issue in the lead-up to the race. Prior to the Blessing, I had been taking a Tums while running when symptoms show up. For me, symptoms are either a pins-and-needles tingling in my feet and hands or cramping, usually in my quads. The afternoon before the race, I realized that I should be hydrating with electrolytes to prepare for a warm race. Then I thought, I don’t wait until I am thirsty before I drink. I don’t wait to be hungry to take a gel. I drink and fuel on a schedule because if you fall behind, it’s very hard to catch up. Why would calcium be any different? I decided to try pre-loading the calcium and I had a Tums at noon, 2pm, 4pm, 5pm, and 6pm on the starting line. I also decided to take a gel and a Tums at 3 miles and 6 miles. New plan!

The truth is, this calcium crap is scary. I get symptoms of low calcium and take the Tums and that raises my calcium levels. But if calcium levels get too low, that can cause extreme muscle cramps. As an endocrinologist friend put it, “Your heart is a muscle.” A heart “muscle cramp” is pretty much a heart attack. I don’t believe I am in any danger of that, but I would like to keep it that way!

I thought about my race car driving analogy again. Running the Blessing really did feel like I was back in control of my own race car. Allegro Fuerte is a huge NASCAR fan so maybe some of his analogies are rubbing off on me. Anyway, I figured the first race back in control of the car is not the time to go for it. Instead, I wanted to see how it felt to run 10 continuous miles at a pace a bit faster than easy, but not even close to how it would feel to race. Just remember how to drive the damn car. By mile three, I knew I’d be holding at the effort level I had established.

That’s when things got fun. Really fun. I was in a great summertime race. I had started almost all the way back so I was passing a lot of people. I was running just a little bit faster than easy. Fast enough to feel fast and smooth, but not like it was much work. A summertime race with a ton of spectators on a beautiful night and I was feeling really good. I waved to a couple of old guys. They smiled and waved back. I blew kisses to the next older gentleman I passed. He laughed. I started high fiving all the little kids. I was grinning like a lunatic, a really happy lunatic. People started yelling “Go Chicago!” because of the sports bra I was wearing. It was amazing! The one back-to-earth moment came when I tried to call out to someone. It came out as an incomprehensible croak. Right. My voice sounds normal to me inside my head so I am constantly forgetting that it’s not. Eesh. I resolved not to make any more noise until the finish line. I raced contemplating what it must be like to be mute.

The Blessing is an interesting course. You run along the water for a few miles. There’s a long somewhat unpleasant stretch up a hill on a more exposed road. Then eventually you turn right and head into some neighborhoods with more shade. It was hot. I dumped water on my head and stuffed ice down my sports bra when it was available. None of that mattered. I took my gel and my Tums at miles 3 and 6 and I didn’t cramp. Running with no cramping was the true Blessing of the night!

The course doubles back on itself so Mervus and Rose could move easily from the start to mile 7.5. I found them quickly and waved and smiled. I almost stopped to tell them how damn good I was feeling and how magical the race was, but I figured there would be time for that later. The last two miles are a little bit downhill. I pressed just a little bit and felt maybe the whisper of a cramp, but nothing serious. I pushed a little more and my last mile was my fastest: 8:21. For reference, last year my average pace was 7:53. But that’s okay. This year, I remembered how to drive my race car. I ran (pretty) hard at the finish and felt so good! Last year I ran 1:19:32, for my only PR of 2021. This year I ran 1:31:14. My slowest 10 miler ever by a lot, but also one of the top three most joyous races of my life.

After the race, we spent time hanging out with Allegro Fuerte and Chewie, which was wonderful. We got nachos, which turned out to be terrible. The next day, my coach closed his coaching business. Mervus says I was the straw that broke the camel’s back. Maybe. It didn’t matter. (I wish him well, of course!). I found my racing self again. It might not be an easy road back. It’s going to involve a lot more calcium than I had anticipated or would like. But I’m on my way, and that’s what counts.

There is so much going on medically that I’ve decided to start sending periodic updates when I have important appointments or get new information. Just to give an idea of the volume of medical stuff I am dealing with, I had three appointments for myself last week, I have four appointments for myself currently scheduled for this week, plus Geneva’s annual check-up. It’s a lot. On more than one day I spent more than four hours just going to doctor appointments.

Just a summary to bring folks up to speed. I had thyroid surgery on May 27^th. I’ve been dealing with the “normal” stuff you expect after thyroid surgery, which is mostly getting the dose of levothyroxine correct (brand name Synthroid). But I also had two major post-surgical complications: damage to my vocal cords and damage to my parathyroid glands.

Now I have a brand-new issue as well, lucky me! One of the appointments last week was to have that weird growth on my neck removed. Given how my luck has been going this year, no surprise that it turned out to be basal cell carcinoma. My dermatologist is out of town so I won’t know how to proceed with that until he gets back next week.

Here’s how each of these issues is progressing. This is summarizing the doctor appointments of the last 10 days.

Thyroid hormone regulation. This turns out to be the easiest one. You can measure various thyroid hormones but the main one is thyroid stimulating hormone (TSH). My TSH has been up and down a bit since surgery, sometimes in stressful and mysterious ways. It was 8.38 on August 2. We increased the levothyroxine to 150mcg. On August 26, TSH was 3.88. This is GOOD NEWS! Increased levo is supposed to make TSH go down so at least the medication is acting properly. Much better than July and August when levothyroxine and TSH seemed to be more or less random.

We are looking for TSH to be 0.5-1.0 so it is still too high. But it’s really only been three weeks since we increased the levothyroxine dose and it takes 6 weeks for the medicine to take full effect. My endocrinologist said we could check TSH again this week or next week, but since I am feeling good, we can also wait and check after September 11^th. There are various reasons to wait, but most importantly, I am running the Surftown Half on September 11^th and I’d rather not deal with the mental stress of more lab work before then. We do not quite have TSH all sewed up, but I think my endocrinologist and I are both hoping that I am at the right dose now.

Vocal cord damage. This one is mentally and emotionally incredibly hard. I am so grateful to my Uncle Norman who cried with me while we were in Boulder, to my voice therapist Lynn, who is a miracle worker, and to others who have offered sympathy and understanding in various ways. My voice cracks a lot. I have about a three note range. I have limited power to project. If I am talking to just 2-3 people in a small quiet space, the issue is not that noticeable. If there is ambient noise, it’s immediately a problem. Geneva and I love to sing together. We just spent six days in the car, listening to music, enjoying it very much, but NOT belting our lungs out as we should have been able to do.

I am still getting the details on this issue, but it’s starting to sound like there was actual damage done to the vocal cords during surgery. That’s quite bad news. On the other hand, Lynn, who is my voice therapist, is incredible. I go see her again on Friday. Getting appointments with her is almost impossible so that’s a big win. In case you’re wondering, saying something like “You don’t sound all that different” is not a very helpful comment. It can feel like trivialization of the problem. Losing the ability to sing turns out to be an enormous deal. Having to constantly fight to be heard is also not a lot of fun. The voice stuff does not hurt at all. There is no physical pain. But the emotional and mental distress is quite high. I hope that with time and voice therapy from Lynn, I will recover most of my voice and maybe all of it. When that happens, look out, because it’s possible I will never stop singing.

Calcium and hypoPARAthyroidism. In addition to a thyroid, we all have four parathyroid glands, located near the thyroid. These little glands (about the size of a grain of rice) sometimes get jostled during thyroid surgery. They might get disconnected from their blood supply or they might just shut down. Usually this problem resolves within a month. My surgery was three months ago and my parathyroids are not functioning normally. That’s really bad news.

Hypoparathyroidism is not curable. You can manage it with various supplements. Severe hypoparathyroidism is often crippling and life changing. Many people with this condition can not work, let alone run or otherwise enjoy life. It’s quite scary. Luckily, my version is not that severe, at least not currently. Mostly I manage with various calcium supplements. But no one knows what will happen next. Maybe my parathyroids will recover. If you’re the praying type, please pray for that (and also my voice….).

I want to share my current medication regime, which is super boring for almost everyone, but will be critical information if another hypoPARAthyroid endurance athlete ends up reading this. When I wake up, I take .5 mcg calcitriol, 1200 mg calcium (Citracal extended release), and one Tums. I take another Tums at noon. At 6pm I again take .5 mcg calcitriol and another Tums. At 10:30pm, I take the levothyroxine (currently 150 mcg).

In addition to the above, I am experimenting with Tums while running. I usually get a fairly strong tingle about 15-20 minutes into a run and I take a Tums then. Sometimes if I am running longer or it’s a hot day, I get another tingle and need another Tums. Last Saturday for my long run, I just pre-emptively took a Tums every 2.5 miles. With the above normal regimen, plus Tums while running, I only experience occasional calcium symptoms and only while running.

I had blood work done on August 26 and I met with my endocrinologist on August 29. We agreed that the above medication regime is “good enough for now.” TSH needs to come down, but we need to wait and see how that develops. My voice NEEDS to get better, but hopefully time and voice therapy will help. The calcium stuff is wait-and-see if the parathyroids recover. In the meantime, we are going to do blood work once after a long run to see just how low my calcium gets and also on a rest day to see where it is when I am not running.

Because I can’t get enough of doctors, I also decided to have that growth on my neck removed. The pathology came back yesterday: Basal cell carcinoma. I expect I will either have to have Mohs surgery or have some kind of radiation treatment. The dermatologist is on vacation until next week so it’s just more waiting on that issue.

Some days I am more or less okay. Other days I am very, very angry. On the worst days, I am just sad. I am writing this for a few reasons. First, there is almost no information out there about hypoparathyroidism and endurance athletes. Zero research, zero guidelines. So I am putting my own experience out there. Second, this whole process is incredibly isolating. Maybe sharing can make it a little less so. Lastly, I guess it just helps to write it down.

Apparently there are three significant things that can go wrong after thyroid surgery: post-operative bleeding, voice impairment, and damage to the parathyroids. I’m not bleeding so I’ve got that going for me! But I managed to get the other two post-surgical complications, which is a huge bummer.

My first issue is problems with my voice. It’s raspy and I don’t have a lot of ability to project. I can’t sing at all, which breaks my heart. I’m also nervous about my ability to give 80 minute lectures beginning in early September. Right now, I can have a one-on-one conversation and I sound weird, but I can be understood. If I’m outside or in a larger group, it’s much harder for people to hear me. However, last week I was able to start voice therapy! Getting an appointment did involve crying in front of the receptionist, but whatever. The therapist I am working with is incredible. She played me recordings of people she has helped, including another professor, and their voices go from almost incomprehensible to perfect. Plus she is amazingly supportive and understands how frustrating it is when your voice is always weird. I am very hopeful about this issue.

The second issue is much more difficult. I currently have a condition called hypoparathyroidism. This condition is rare, serious, and hard to understand. There is no cure. We are hoping to get to a point where it is well managed, but we are not there yet. The parathyroid glands are near the thyroid. In fact, “para” means “with.” But the parathyroids don’t really have anything to do with the thyroid. Sometimes, though, when the thyroid is surgically removed, the parathyroids get upset or “stunned” and they stop working. That’s what happened to me. Because the term hypoparathyroidism tends to make people think the thyroid is involved (when it is not), doctors and patients often refer to this condition as “hypopara.”

Symptoms of hypoparathyroidism include (from https://www.nhs.uk/conditions/hypoparathyroidism/):

• a tingling sensation (paraesthesia) in your fingertips, toes and lips
• twitching facial muscles
• muscle pains or cramps, particularly in your legs, feet or tummy
• tiredness
• mood changes, such as feeling irritable, anxious or depressed
• dry, rough skin
• coarse hair that breaks easily and can fall out
• fingernails that break easily

As might be imagined, none of that is very fun. The symptoms are produced when low-functioning parathyroid glands don’t send enough calcium into the blood. In that way, it’s a little bit like diabetes except it’s about low calcium instead of low blood sugar. However, diabetes is well known. Hypopara is rare enough that your average ER doctor may not have heard of it. That’s relevant because if calcium drops low enough, you have to go to the ER to get calcium intravenously. Also, not a fun idea.

It turns out that muscles need calcium from the blood stream to operate properly. When I run, I get the tingling sensation and the muscle cramps, which can be pretty severe. I’m incredibly grateful that I am able to run at all. Right now, I am taking a lot of Tums as an easy and cheap method of calcium supplementation. I am also taking fancy vitamin D. It’s nothing to do with calcium in my bones and everything to do with calcium in my blood. It’s very much a work in progress.

My doctors disagree about whether the hypopara is permanent or temporary. The only way to find out is to wait. Even if it is temporary, the best guess is that I will have 4-6 months of dealing with it and those months are not likely to be easy.

I very much appreciate prayers and good wishes, especially directed towards getting my parathyroids to wake up.

Oh, by the way, I had Covid. Which is pretty much how it felt compared to this post-surgical stuff.

It’s my blog so I guess the world needs to know whatever I feel like writing. I have pictures, but I don’t need to post those here.

I’ve had thyroid “stuff” since long before I was a runner. Way back in grad school, my doctor said, hey, we need to check out that lump in your neck. I’m surprised I even had a doctor in grad school. I did have a lump on my neck, thyroid nodules it turned out. We had it biopsied and the results came back benign and I forgot about it. I don’t remember being very stressed about this process, which probably tells you how stressed I was about grad school.

After giving birth to Patrick (aka Aidan), I struggled to lose the pregnancy weight. Eventually I joined Weight Watchers, learned something about nutrition, and the weight came off. After giving birth to Geneva (aka Rose), we went to Germany for the summer so I could do research. The weight fell off and I figured I had found the magical combination: breastfeeding, lots of walking, plenty of cake and beer. The perfect postpartum diet. Except that a few weeks after we came home, I was walking up our basement steps and I thought my heart was going to burst out of my chest. My blood pressure was beyond through the roof, at something like 240/160. I was put on beta blockers immediately and within a few weeks, we discovered I had hyperthyroidism, presumably brought on by pregnancy. Because I was breastfeeding, I went on a medicine called PTU. The hyperthyroid symptoms were well controlled. When I quit breastfeeding, I switched to methimazole. We’ve adjusted the dose a couple of times since then, but generally speaking, my labs have been good and I’ve felt fine.

I’ve had thyroid issues for so long that I’ve gone through three endocrinologists. My first one, Dr. Kort Knudsen, was a lovely Oberlin grad and I remember talking about Oberlin a lot more than my thyroid. After he retired and moved to Florida (the nerve!), I switched to Dr. Grace Lee at Yale. Dr. Lee was fine, but I hated everything about going to Yale. I hated the drive. I hated the parking. I hated having to put on a hospital bracelet. I hated it all so much that I sometimes let too much time pass between appointments, which was not very adult of me. Sometimes being a grown-up is hard.

Dr. Lee first began urging me to consider surgery years ago. The thyroid nodules had grown larger. But, we checked them periodically. They were always benign. I figured “If it ain’t broke, don’t fix it.” Eventually Dr. Lee changed positions and I switched to Dr. Christine Signore, who is, thank goodness, in Middletown. I changed doctors in summer 2020, mid-pandemic, which wasn’t simple. But we got my methimazole prescription transferred, I eventually met Dr. Signore in person, and I was trucking along again.

The first week of May 2021, I ran a really lousy 5K in Providence. That wasn’t surprising. I’d been running shitty 5Ks all spring, my running fueled by pandemic-inspired rage. What *was* surprising is that I almost feel asleep while driving to the race. I told myself I was tired from a lot of travel, a difficult semester, a weekend in Boulder in the thin air. But then my routine thyroid blood work came back out of whack. I had slipped into a hypothyroid state from too much medication. We lowered my dose of methimazole. Now I think those shitty 5Ks might not only have been due to poor race execution.

In January 2022, we did a CT scan of my thyroid. Dr. Signore had suggested this procedure to get a baseline of how large the thyroid nodules were. I work well with Dr. Signore because she doesn’t tell me what to do. I strongly suspect most endocrinologists would have recommended that I have surgery long ago, but I did not want to go that route. You can always cut, but you can never uncut. The CT scan showed that the thyroid nodules were pushing on my trachea though. We’d done multiple biopsies and countless ultrasounds and thank God, nothing looked like cancer, but the nodules were growing. Eventually, the thyroid would need to come out.

If you’ve ever raced a 5K or done a really hard workout, you know that feeling that there is not enough air in the world. You simply can’t suck it into your lungs fast enough. Now imagine running your hardest, sucking wind like crazy, with the image in your mind of a little lump pushing your windpipe closed. I scheduled a consult with the surgeon in February 2022.

Dr. Signore recommended Dr. Courtney Gibson at Yale and frankly, Dr. Gibson knocked my socks off. She was compassionate and smart. She took time to answer all my questions, and yes, you know there were many questions. She never promised everything would be perfect. These two doctors have unfailingly treated me with respect. They understood that as a professor, I talk and think for a living. A surgery that potentially impacts my voice and my mind is a big deal. They understood that being an endurance athlete is a critical part of my personality, not just a “hobby” and that I needed to know how surgery would impact my running. I talked with them, as well as coaches and mentors, about timing the surgery to minimize the impact on my job and my running. A late May surgery date meant I had time to recover from the Boston marathon and finish the semester. Hopefully I would be sufficiently recovered to attend a professional conference in Portugal in late June. If we got the meds right, I would be able to resume training once recovered from surgery.

Surgery was May 27, 2022, and everything went well. I was really scared beforehand. I did a pre-surgical meditation recommended by a friend and that was really helpful. Other friends brought in dinners and that was amazing. I spent a couple of days flopped on the couch. I was able to start walking for exercise about three days post-surgery. The first ten days or so I did a lot of walking. I was also able to see some students from the class of 2020 who returned for their make-up commencement and I was able to march in Middletown’s Pride parade. I did a short run/walk ten days post-surgery. By two weeks post-surgery, I could run five miles with a short walk break. By a month post-surgery, I was back to running just over 40 miles a week. Easy miles are coming along a lot better than anything speedy, but that’s getting better also.

At 26 days post-surgery, I had my first blood work checked. My TSH was 6.8. We are looking for it to be between .5 and 1.5, preferably around 1.0. I was officially in a hypothyroid state of mind (and body). I was not surprised by that result because I felt tired when I got out of bed in the morning and I was falling asleep watching TV at night. We adjusted medication from 125mcg of levothyroxine to 137mcg.

I find myself saying “we adjusted medication” the same way some runners say things like “we scheduled a 17 mile long run for Saturday” when what they mean is: My coach put 17 miles on my schedule for Saturday. “We” did not adjust the medication dose – Dr. Signore adjusted the medication dose. That’s hard for me to swallow because I hate not being in control. In the week when Roe versus Wade was overturned, I am thinking a lot about bodily autonomy. Who should get to decide how my metabolism runs? Shouldn’t that be my choice? My choice with medical guidance, sure, but it is my body. I should be the one to decide. I suspect many people with defective thyroids are happy to hand over the reins to a doctor. But I know that many people with defective thyroids also believe, usually with a lot of justification, that their doctors do not listen to them and do not take their concerns seriously. So far, I am happy with my medical care, but I actually do think it’s worth contemplating why we don’t have patients make these decisions rather than doctors.

More soon, because if life without a thyroid wasn’t interesting enough, fate decided to throw Covid into the mix as well.