Covid Recovery - Slow but Steady

I hope I am not jinxing myself by saying this, but I believe myself to be 100% recovered with no lingering symptoms. In my previous post, I said that this would either be a "normal" recovery or it would turn into my mono-like illness, taking months to recover from. 

In retrospect, it seems like it has taken me slightly longer to recover than the average person, but not abnormally long. Here's a recap:

Days 1-2: Mild sore throat
I noticed that my throat was slightly scratchy. It was more of an annoyance than anything else; I had no other symptoms and was fully energized. Thankfully, I didn't run during this time because I was on vacation and was planning to take a few rest days anyway. I took the required Covid test to fly home from Mexico and it was negative.

Days 3-5: Severe sore throat, loss of voice
These were the worst days. I was moderately fatigued but I couldn't eat whole foods and I couldn't speak. I was continually spraying throat-numbing solution down my throat and using NyQuill to sleep. My at-home Covid test was negative on day 3, but positive on day 5.

Days 6-12: Body aches, coughing fits, skin rash, fatigue
My sore throat lessened in severity but I had coughing fits about 8-10 times per day and it kept me up at night. I had tiny bumps all over my back, butt and stomach, and a few on my legs. Not loads of them; maybe 20 total. I started to feel more energized by day 11, so I walked on the treadmill on days 11 and 12.

Days 13-17: Lingering fatigue, body aches
It turns out that the treadmill walk was too much and I woke up the next day feeling totally wasted. I did, however, test negative for Covid on my at-home test. At this point I think I was rid of the virus, but I was now suffering from post-viral illness, which felt similar to my mono episodes. The big difference between this and my mono episodes is that I was never tired in the sleepy sense. I didn't nap. The fatigue was more of a bodily fatigue and not a head fatigue. I also did not experience dizziness like I had with my mono.

I decided not to engage in any physical activity at all during these 5 days. I just rested. On day 17, I decided to take one of my Turmeric supplements. I had read an article about post-viral fatigue and it said that some researchers believed it to be caused by brain inflammation. Turmeric is a natural anti-inflammatory so I figured it was worth a shot.

Days 18-22: Major improvement
The day after I took the turmeric I noticed a major improvement. If I was at 65% on day 17, I was at 85% on day 18. I felt almost normal the very next day. I decided I could go ahead and resume walking, but very slowly and only for 15 minutes. 

By this point, I had only slightly noticeable throat congestion and the sore throat was totally gone. I didn't have body aches any more. I continued with the turmeric plus the other vitamin supplement I had been taking all along (Zinc, D3, C + lots of other herbs). 

Every day from 18-22 I felt better and better, with my legs feeling stronger as I walked. Previously, they had felt like jello. 

Day 23-Today
By day 23 I was 100% symptom-free and feeling like my normal self. No lingering fatigue. No weakness. No throat congestion. I continued my walking regimen and got up to 2 miles walking before I attempted to run. My first run back was a run-walk on the treadmill because it was pouring rain outside. I did 6 x (3:00 walk, 2:00 run). And I kept the runs very easy. 

Everything felt great during the run and after the run. So I continued to progress my workouts, shortening the walk breaks and increasing the overall duration of each session. My most recent run/walk (today) was 8 x 1:00 walk, 4:00 run. This is 32 minutes of running. I didn't feel like I needed the walk breaks, but I kept them in any way as a chance to "check in" with myself to make sure everything felt normal after each run. 

I can't stress enough the importance of walking multiple times before attempting to run, and waiting to be  100% symptom free. I felt 100% symptom free for about 4 days before I started to run, and when I did run, it was a run/walk. 

While there is a protocol for returning to run post-Covid, everyone is unique and it also depends on how long you were sick and how severe the illness was. Because I have so much experience with illness, I know my body pretty well and I can tell when I am ready to walk and when I am ready to run. My rule is to always wait a few extra days after feeling ready! I probably could have run on day 22, but I waited an extra 5 days to be absolutely sure. I would much rather have a slow and steady comeback instead of a rollercoaster of ups and downs from doing too much too soon. 

Looking Ahead
Overall, this illness took about a month of training from me, plus the 2-3 weeks it will take to get back to where I was. With the Boston Marathon coming up in the middle of April, I certainly have my work cut out for me. Thankfully I was in pretty good shape before I got sick and my body adapts to workouts relatively quickly. I don't plan on doing any hard running for another week; I first need to wean myself off of walk breaks and then increase the duration of my runs. 

I'm not at all worried; I know I will be able to finish the marathon and I wasn't planning on trying to run a PR anyway. My original goal was to run a course PR and I think that's still possible, but I will re-assess as the race gets closer. 

Focusing on Form

I've now been running for 3 weeks after taking 8 weeks off for my Osteitis Pubis and torn adductor. As I said in my last post, I am using the run-walk approach to gradually get back into my normal routine. So far my longest run has been 5 x (9 minutes running, 90 seconds walking). That adds up to 45 minutes of running total.

I'm probably at a point where I can start to get rid of the walk breaks but I like them because 1) it's crazy hot and humid and I need my heart rate to come down and 2) I'm 100% focused on my form and stride and I need a mental break from that. It's also good to check in to make sure everything is feeling good and nothing is hurting. I would hate to finish a run and realize I made the injury worse but didn't get that feedback immediately.

I went to the doctor last week and she was pleasantly surprised at how quickly I was recovering. She gave me and exam and tested my strength as was impressed that I had made such progress. It wasn't a guarantee that this adductor tendon would heal on its own, but thankfully it's most of the way there and I won't need surgery or any other kind of procedures. Just the dry needling which I stopped about a month ago.

A note to subscribers
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Issues with my running form
Back to the topic of this blog. Fixing my stride will not only prevent this injury from coming back, but it will make me a stronger and more efficient runner. 

I have always been a "shuffle runner". I wouldn't pick my feet very high off the ground and drive forward with the knee. My stride was short, partially due to limited range of motion in my ankle. In order to offset

Drills before running

this and still run fast (like a 5:52 mile) I adapted by having a very high cadence. Most runs would average 200 steps per minute and speed work would sometimes average 210. My feet would stay super close to the ground and move very quickly. Like shuffling!

Another form issue was that when I landed on my left foot, my right hip would drop down, making the pelvis unstable and uneven. This is a common issue with runners and can lead to injuries. It indicates instability and lack of glute activation. I also had this issue on the other side, but it was not nearly as pronounced. It makes sense that I tore the left adductor because I wasn't activating the left glute when I landing -- the right hip was dropping.

I have known about this hip drop issue for over a year now and have been working on it with my strength training coach. I have strong glutes! The problem is that my body doesn't naturally tap into that strength when running. It prefers to use the adductors. If I were able to access that power, I would be a more efficient (faster) runner and be protected from re-injuring my pubic bone.

Changing movement patterns
Working with my Osteitis Pubis specialist in Australia, live video feedback or mirror feedback has been essential. The focus is on doing all the PT exercises 100% correctly. It's not about doing them to get strong (although some of them build strength). It's about teaching my body to have a stable pelvis when put under different types of stress. There are literally over 100 exercises. I am not exaggerating. When I say "literally" I don't mean it like a millennial. I mean literally over 100 exercises. It would be overwhelming to do them every day, so the point is to progress through them one step at a time adding more stress and complexity while keeping a stable center of gravity and a pelvis that is controlled.

There is a huge focus on deadlifts, bird dogs, downward dogs, and side planks. There are many variations of each that challenge pelvic stability in different ways. Being able to see myself on video or in the mirror has enabled me to ensure I am doing the movements correctly, which ultimately translate to running. 

Greg has been recording videos of my running so that I can analyze my stride afterwards. He records some of them in slow motion so I can really see where I need to pick the legs up higher or keep the pelvis more stable. Drills have also been important in reinforcing the correct movement patterns, provided that I am doing the drills correctly. 

Here is what my hip drop looked like last summer:

Here is what it looked like yesterday:

And here is a back view, which is much more noticeable, taken last summer:

This was taken on Saturday - notice the difference:

My knees still come together, but that's just my anatomy. When my feet are pointed straight ahead, my knees go in. When my knees are straight ahead, my feet turn outwards. My PT said that was fine and you can't fix your anatomy! The important thing here is that the line of the top of my shorts is straight across rather than slanted down, like in the green shorts from the previous photo.

What I think about
As I said earlier, I need the walk breaks because focusing so much on my form is mentally exhausting. There are only so many mental cues you can give yourself at a time. Here are a few of them:

• Feel the glutes working
• Engage the core to keep stable
• Keep the spine elongated
• Shoulder blades down
• Lean forward from the ankles
• Drive forward with the knee
• Use gravity to fall forward
• Most of the weight in the forefoot
• Stable foot "tripod" when landing
• Remember deadlift form

I hope this way of running becomes automatic. I honestly have trouble running slowly when I do this. It's easier to open up the stride when you are running fast. This normally wouldn't be a problem but I don't have the cardio fitness to support the faster paces, and it's crazy hot and humid! My heart rate has been averaging in the 170s for the run segments because I am out of shape and it's hot. My paces range from 8:10-8:30 once I get going. That used to be my easy pace but it's not my easy pace right now, and it's definitely not my easy pace in the heat. So hopefully I will get the hang of it and be able to run in the 9:00's so I won't be dying in the heat. 

I'm on track with my plan to build a base in July and start marathon training in August for Richmond!

Getting There: Recovery from post-viral syndrome

I haven't provided an update on my running (or lack thereof) in a few weeks, so here it is.

I came down with a virus on May 31st, so it's now been 6.5 weeks since the onset of this whole thing. A few days after getting sick, I realized that it could take me a long time to recover, because I had a similar illness in 2012 and 2016. Both occurred in the summertime. Both were the likely result of too much physical exertion in the heat. Being the planner that I am, I made a comeback strategy, which I outlined in a previous blog. Below is the same plan, with actual dates:

• Return to about 90% of my healthy energy level: June 25
• Ease my way back into work by going in for half-days: June 28
• If I tolerate the half-days and feel 100%, start working full days: July 2nd
• If I tolerate full days and feel 100%, wait a few days and then start taking walks around the neighborhood: I started walking sooner, on June 21st, because my doctor advised to. 
• If I tolerate the walks around the neighborhood, wait a few days and then run: July 4th

All of this worked out fine, but I think I made a mistake by increasing my running volume by too much too soon. For my first run back, I ran 11 minutes non stop. Two days later, I ran 25 minutes nonstop. And the next day, I ran 27 minutes, plus a 2-mile walk. Apparently this was too much too soon, because by Sunday July 8th, I felt tired most of the day and didn't do any running or walking.

This frustrated me greatly because I had thought the illness was completely behind me. But then I chose to look on the positive side, remembering that my doctor quoted a 6-8 week recovery time, and I wasn't quite yet at 6 weeks. I also remembered that recovery is not linear, and just because I felt bad last Sunday, didn't mean I wasn't progressing overall.

On Monday, I did a short walk (1.5 miles) with two 3-minute jogs thrown in, and decided that run/walking would be a better way to get back into it instead of trying to run for 15-20 minutes at a time. I still didn't feel all that great, but I remembered how walking in the earlier stages of my illness made me feel better. I went to work, but came home feeling so exhausted that I got into bed at 7:00, immediately following dinner.

On Tuesday morning, I woke up feeling totally wiped out, even though I had slept for 9 straight hours. I did not run or walk. I debated going to work. It was a difficult morning for me emotionally because it was a reminder that I was not done with this illness yet. But, after taking a shower and getting dressed for work, I felt better. And by noon, I was feeling almost back to normal. What a relief!

Saturday, July 14th: Run/Walk

Because of this setback, I decided that I needed to stop running and return to walking only. I did that and felt energized for the next few days, so on Friday, I did 4 x (4 minutes walk, 4 minutes jog). I took the jogs very easy, all at a 10:00 pace or slower. By contrast, when I had tried to run initially the week prior, I was running in the low 9's, and not taking walk breaks. This 32-minute "workout" left me feeling good, so I repeated it yesterday, and again today. There's no need to increase the distance/time every day. It's better to find something that works, stick with it for a short while, and then make a very small increase. It's all about finding the right balance between giving the body enough stimulation to continue to recover, but not so much that it causes a strain.

If I continue to feel good, I plan to run-walk for another week, with slight increases in the run time. I'm registered for a 5K one week from now, and it would be nice to jog the whole thing without taking walk breaks, but I am not going to do that if it's too hot or I don't feel ready. At the very least, I would like to run/walk it with Greg. Hopefully one week from now I will be blogging about how well the 5K went and how great it felt, regardless of the run/walk proportions!

Even though I've felt like my normal, healthy self for the past five days, I don't think I'm out of the danger zone. There's a small part of me that worries I will never be out of the danger zone and that running for an extended period of time will always cause extreme fatigue. My running career could be over. I don't believe this will happen, and I don't worry about it happening, but I realize it's a possibility, called Chronic Fatigue Syndrome. The difference between Chronic Fatigue and Post-viral Fatigue, is that Post-viral fatigue goes away.

In any event, I'm still very grateful that I'm healthy enough to go to the work and do the "everyday" things that I couldn't do during the first four weeks of illness. I have my life back now, all except for the running piece of it. 

Weekly mileage: Week of July 9th

Running After Mono

I think I am finally coming out of this illness. I've had many ups and downs throughout this experience with mono, but I devoted the entire month of August to resting in the hopes of preventing relapses and returning to my normal, pre-mono self. With the exception of two weeks in July when I thought I was recovered, I was suffering from this thing for the entire summer. I've never had an illness last this long and I've never had a summer when I was indoors for the majority of it.

Getting Healthy

This illness basically came to me in 4 phases: initial sickness (severe sore throat), temporary recovery, relapse with original symptoms, and then dizziness + general weakness and fatigue. The 4th phase lasted the longest and I am still not completely out of the woods. I still occasionally get dizzy and feel tired, but these periods don't last for longer than a few hours. 

August was tough. I worked from home for the first three weeks, logging sick hours here and there when I needed to sleep or get away from the computer. August 17 was actually my worst day of the entire illness in terms of fatigue. I woke up, got out of bed, and felt like I couldn't even walk to the bathroom. Even sitting up in the bed was exhausting so I took conference calls lying down and logged the rest of the day as sick. It was the only day of this entire illness that I asked Greg to bring me breakfast in bed. I did make my way downstairs for lunch, but it wasn't easy. Thankfully, I woke up the following day feeling worlds better. The illness is so unpredictable that way. Since then, things have been progressing in the right direction. 

When I returned to work, I did nothing aside from work. No running. No going out to dinner. No errands. Just to work and home so I could make sure I had the energy to continue going to work. I ended the week feeling decent so I gradually started adding in normal activities like going out to eat and doing the laundry. A very experienced runner advised me to not start running again until I had a sustained period of feeling good and healthy. I resumed my strength training during the last week of August and I seemed to handle it well. Nothing too intense-- just some planks, push-ups, and working with dumbells.

The First Run Back

On Saturday, September 1, I thought I would celebrate the new month by trying to run. I had felt great all week, and the week before had been pretty good, although not perfect. I set out to run three miles. Goal: three miles, keeping heart rate in zone 2. 

I was sooo happy to be out there again. I was enjoying the run so much for the first mile. Greg was with me and it was good to be running with him. It was a snail's pace but that didn't matter to me. I was just happy to be able to run. The second mile didn't feel all that great. I had to slow down even further to keep my heart rate in zone 2. By the end of the mile, I knew I was done. I walked the rest of the way home. 

Initially I was extremely frustrated. I couldn't even run three miles at an 11:xx pace. I could accept that I had lost fitness, but what I couldn't accept was that I wasn't at a spot with my recovery where 3 miles was realistic. That run left me feeling extremely tired and crappy, so I spent the rest of the day on the couch. On the plus side, I did get out there and complete 2 miles without stopping. And instead of spending the day depressed, I just accepted that I wasn't ready to start running again. 

The Second Run

I explained to my sports psychologist that I had a crappy first run back. At this point, he suggested the run/walk approach, which I had considered initially, but I didn't want to accept as reality. He gave me a reality check and told me that I'm not on the same path I was before the illness. I would get back there, but I'm not there, and I have to first work through the illness before I can get back there. I have to deal with my current circumstances, and spending my time wishing I was my old self again doesn't do me any good. He urged me to make comparisons only to the recent past. I'm doing much better now than I was three weeks ago. Comparing to how I was three months ago doesn't help me.

I did the run/walk thing after my stress fractures and tolerated it well, so I accepted that it would be the best approach to being "out there" and feeling good for more than just 15 minutes. I arbitrarily decided on 8:00 running, followed by 2:00 walking. I figured that the walk breaks would allow my heart rate to come down so that it wouldn't be such a struggle to stay in zone 2. 

On Thursday (5 days after the first run) I felt well enough to test the run/walk approach. It worked! I felt good the whole time, and good for the rest of the day. I ran a total of about 2.2 miles and covered a distance of about 2.6 miles. This is slightly more running than the previous attempt, and I felt a lot better.

Runs 3 & 4

I woke up feeling good on Friday morning, which hopefully means that the Thursday run wasn't too much for me. However, I decided to save up my energy for my Sunday run, in which I would attempt to cover a distance of 4.8 miles. I joined Greg for the first 8 minutes of his long run on Saturday, and then turned around and came home. Today (Sunday) was a big day for me. My team was meeting at Burke Lake to run the 4.8-mile loop. They were all running multiple loops as part of their long runs, but my goal was to simply complete the loop, even if it meant a substantial amount of walking. 

4.8 miles completed!

I had my trusty Garmin programmed at 8:00/2:00 intervals, so I heard a beep whenever it was time to transition from running to walking. Greg was with me, even though he just ran 18 miles the day before. I was so grateful to have him there, because part of me was worried that my body wouldn't react well, and I'd need help. Thursday's run left me feeling pretty confident that I would be okay, but mono is highly unpredictable. 

It was a beautiful morning. 62 degrees with low humidity. And most of the trail was shaded. This was such an enjoyable run for me! Running somewhere that I don't normally go, with my husband, and feeling healthy. Such a nice feeling. 

We ended up doing 5 x (8:00/2:00) for a total of 4.1 miles. I had to really slow down on the last one to keep my heart rate down, so I decided I probably shouldn't try for a 6th one. We walked the rest of the loop for a total of 4.8 miles covered. Afterwards, we waited for the other groups to finish their second lap so we could say hi and talk to the coach.

Greg and I had a celebratory breakfast and then returned home. I felt good for awhile, but then I started to get a slight headache and some dizziness. I'm still a bit dizzy as I type this, and I hope it passes. Mono recovery is just so unpredictable. It's hard to know what's okay to do and what's not. And there is no established timeline for a full recovery. I've heard it can take up to a year. I've heard some people say six months. All I can do is try to get plenty of rest, stay hydrated, eat healthy foods and minimize stress.

No race plans for me-- I'm completely focused on getting back to 100% health. Once I get back into the groove of normal training, I will start to think about spring racing.