I like to think of myself as a strong person, and a relatively smart one. After all, I managed to run a marathon after having had back problems (and issues with type 2 diabetes during training). I came back after a knee injury. I managed physically and mentally navigate through all that so I thought I was pretty set and had medical issues well in hand.
But sometimes my mind plays tricks, and sometimes what I think is well in hand, isn't. It is interesting too, how a step out of the ordinary every day flow of life, can bring struggles into focus as you get messages you didn't even know you needed.
So here is my recent story. Earlier this year (in mid-April) we were headed to Boston for Glenda to run the marathon, and incidentally for me to run the BAA 5k. Because we were going spend a few days anyway, we decided to go early and visit with friends in Rhode Island where I lived and taught at URI for 4 years. We toured the old haunts and ran that Thursday evening with my old running group...the NRA (Narragansett Running Association). We then went to the traditional Thursday night dinner at the Mews Tavern with the group, and there an amazing thing happened.
One of the guys started teasing another about "all that crap you are eating." They went on to explain that the other fellow had high cholesterol and taking statin drugs had really messed him up. I knew statins could cause muscle aches and assumed that was the problem, but in the course of conversation asked anyway how they had messed him up. He told me it messed with his running, he was so sore and his pace fell off, etc.
A lightbulb went off in my brain. You see, I've been on a statin for a while. When I went on it I was building mileage for a half marathon, and I chalked up the soreness I felt to the extra miles. I had a couple of halfs in that period that I had trouble finishing because I was so sore. But as I reduced my miles, the soreness did not go away. I didn't ache all the time like my mother had on statins, but the aftermath of a 3 miles run felt more like I'd done 10. I chalked it up to being older, or muscle imbalances or weight or .... it became the new normal to the point that I didn't really report it to my coach. Or if I did I'd say something like was a little more sore than I should be after the run, but it seems to be recovering. Maybe, I thought, this is a side effect, I'll ask my doctor the next time I have occasion to see her.
Whether fortunately or unfortunately, my body, and another medication, made that occasion sooner...
You can't really tell from this picture, but I had an "interesting" thing occur on Saturday at the BAA 5K.
I was on lisinopril, an ACE inhibitor and common blood pressure medication, not so much for my blood pressure but as a kidney protector since I am a type 2 diabetic. People do develop allergies to these drugs, normally in the form of a dry cough. I can't be that simple. I normally would take that drug in the morning, but not workout until a few hours later. This day I took it and headed out to race. About 2 miles in, I noticed that my left lower lip had started to swell. My thought was, "that's weird, I didn't have any cold sore warning signs...and there's no sign of a bite or sting." At first I thought it was probably just a cold sore...but it was weird.
By the time we got back to the hotel, I looked like the selfie below.
At first I thought it was some sort of weird cold sore, but I posted something on social media about it, and a physician friend suggested that it could very well be angioedema and if it spread to tongue or throat, or did not reverse to see someone. I took benadryl and we developed a plan if that did not reverse things (fortunately it did).
Clearly I was going to have to see my doctor sooner rather than later. So when I came home, I made an appointment and I set about planning for it. I wanted to be very clear about what I wanted from this appointment. I clearly wanted off the ACE inhibitor, and probably the statin. But more than that, I determined that I needed a "reset" and decided to ask for a referral to the diabetes educator for a brush up and a referral to PT in case the soreness problem was not the meds (or in case I had developed imbalances in compensating for it). This seems to me to be a lot to ask in one appointment, because doctors are so limited in the time they can spend, but I thought...."if I really have my ducks in a row maybe I can do this." And after all it is my body, I have an opinion and I know what I am motivated to do. So I armed myself with my swollen lip picture, brief versions of the stories above and a list of what I wanted.
The upside: Preparation pays. After a good conversation with my provider, I was taken off the ACE inhibitor for the time being as my recent tests showed no kidney involvement (we will deal with further when the statin situation is completely figured out). I was taken off the statin and put on a different one for which a much smaller dose is effective. I was totally off any statins for 2 weeks, so that I could get a baseline for soreness. OMG, the difference is amazing! I don't know how I didn't realize that this could be the problem. Interestingly as soon as I said to the doctor about the statin, "I'm very sore, and I didn't realize that it could be the med as I was building mileage when I started it, but now a 3 mile run feels like 10 afterward." She nodded and told me that was a typical description of this particular side effect...soreness or aching that is out of proportion for the activity level. I just started the new statin (fingers crossed!). And she was all about giving me the "reset" I wanted too. As a healthy, active lifestyle beats any medication alone for the control of diabetes and its repercussions.
The downside: As I understand it the statin side effect not only causes soreness, but slows the natural muscle adaptation. So all the miles of running and soreness did not result in the improvement one would expect. In fact I got much slower, and less likely to do all the miles, besides. So in a very real way, after 12 years of running, I am starting over. It is a bit daunting. I have chosen to do some things with no expectations other than to finish, and I have backed down the distance on a few events. But I'm determined. Nowhere to go but up.
A side note: As a library/information professional (recently retired), I have to point out that I googled side-effects of statins and running after my conversation with my friends. The first thing I found was an article from Runner's World written when statins were first being widely prescribed. They were of the opinion that statins did not affect running. (Not a bad article... just outdated). This is why you never stop at the first source...and you go to the scientific work directly if you can. When I did that, I found there were many articles, much newer that suggested (once you slogged through all the scientific verbiage) that this was indeed a documented problem for some people.
The moral of the story, Trust yourself, do your homework, and be proactive.
Onward!
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