A couple years ago, I thought I had it all figured out. Marathon training was simple: just do 2 big workouts per week (15+ miles), an easy long run, and fill the rest of the days with easy doubles until I hit 100+ miles for the week. It was a formula that took my marathon time down from above 2:30 to under 2:20. And I expected it to work into the future.

Getting hit with ankylosing spondylitis (A.S.) has changed everything. My body’s old limits are no longer valid, and the disease has imposed on me new limits. Through trial and error (most error), I’ve figured out that if I go over 50-60 miles/week, I start to break down. Mostly it’s the tendon injuries that sideline me.

I had been holding out hope that I would be able to at some point resume my old high-mileage training, and get back to marathons. But just recently I’ve finally accepted the fact that A.S. and marathoning don’t mix, and my condition will likely prevent me from ever running how I used to again. Yes, it was a bit of a sad realization, but it was actually more liberating than anything. Once I accepted that as a fact, I felt like a weight had lifted off my shoulders, and I was free to look at and pursue running from a different perspective. The pressure of being what I once was is gone, and now I can look forward to running becoming something new.

Clearly hard marathon training is now out of the question, but I had proven this past year that I could still successfully train for and run quality races at the 5K through half marathon distance. So that is where my focus will now lie. If anything, it’s getting back to my roots, as I was a 5K/10K specialist long before I had even dreamed of running a marathon. I’m excited at the prospect of the shorter distances, of different types of training, and of potentially even setting new PR’s that I’ve neglected over the last several years.

So in essence I need to relearn how to train. I had figured out marathon training, but now I need to figure out 5K/10K training, and specialize it for running with A.S. with the training load I can handle. For now, the centerpiece of my training will not be running, but the elliptical machine. I’ve found over the last year that it is possible to get an excellent workout on the elliptical, and my heart rate elevates to levels similar to running while on the machine. When I push hard on the elliptical, I often get my HR up to near 180, which is 90% of my max. Seems good enough for most types of training!

My new staple elliptical workouts are 10×3-minutes hard, with 1-minute recovery, and 2×15-minutes hard, with 5 minutes recovery. These are designed to simulate CV and MP workouts. As I get stronger on the elliptical, I plan to extend the time of the “tempos”.

Perhaps the best aspect of cross training is that since there is no pounding, I can recover faster and work out more frequently. Rather than doing 2 hard workouts per week, I will be able to do 3 hard workouts per week. I firmly believe that I can achieve a high state of fitness from cross training like this, and that it will translate to good races.

Of course I will need to run too, but for now I’m just doing 2-3 miles/day on the weekdays, and a 9-miler or so on Saturday. Once the weather warms up, the snow melts, and I get more daylight to work with, I’ll add a second 4-5 mile run with the jogging stroller in the evenings after work. Adding doubles will give a total running volume of 45-50 miles/week, along with a cross training volume about 5 hours/week. This cross training volume I convert to 30 “miles”, based on the approximation of 10 minutes on elliptical = 1 mile running (Jack Daniels suggests 1 unit of cross training = 2/3 unit of running) . So the end result will give me up to 80 “miles” per week of total training volume, which is certainly sufficient to run some nice 5K/10K/half marathon races.

Some of you readers (assuming I still have readers) may wonder, why isn’t 70-80 miles/week good enough to run a marathon? Simple: I’m not doing any long runs or big workouts. Everything is short and sweet. A huge part of marathon-specific training is geared to adapt the body to handle of pounding and fueling of a race longer than two hours. It is that type of training I’ve determined I can no longer handle. No more 20-milers, no more huge tempo runs or interval workouts, no more runs over 60 minutes in duration. Dropping those kinds of runs, I believe, will keep me healthier, but they will also prohibit me from really doing any race longer than a Half.

So marathons are out, but other races are in. And I’m excited about it. I feel like it’s a fresh start and a new challenge. And is this to say I won’t ever run a marathon again? No, it’s just saying that I won’t ever train for a marathon…in the near future. I could easily see myself taking this training plan, adding one longer run (16-18 miles), and then jumping in a marathon for fun. But it would have to come at the end of the season, and would have to be dialed back with lowered expectations.

But who knows what the future will really bring? I’m just grateful for everyday out there I have to run and be active. I look forward to trying to PR at the Indy Mini Marathon in May, and to perhaps running the USATF LDR Circuit again this summer.

Note and disclaimer: I am not a doctor. I am not associated with Padma Basic or Euconugenics. I am just a guy with ankylosing spondylitis, trying to find any and all treatments that can help control the disease. My statements below are not authoritative, but rather reflect my own experiences with Padma Basic, and nothing more. Please consult a rheumatologist when implementing any change of treatment to your own disease.

Well, it’s been a month since my Part 1 Review on Padma Basic. I have finished my supply of the product, meaning I’ve been taking 6 tablets/day for 30 days in an attempt to suppress my ankylosing spondylitis. Time to discuss results.

Frankly, for the first three weeks I experienced no change whatsoever. I wasn’t exactly disappointed with this, as my expectations were not that high to begin with (given my lack of faith in alternative therapies). However, during the final seven days of using Padma, my neck and shoulders became noticeably less painful and stiff, especially in the morning. Pain levels went from about a “3″ to a “1″ or even “0.5″.

At the same time, pain and inflammation in my feet and toes subsided somewhat, probably from a “3″ to a “2″. I experienced no change in my lower back or my bothersome left hip. I also noticed no change in my chronically cold hands while running outside.

So it’s safe to say that results were mixed. Yes, my neck feels better right now, so it could be because of the Padma, or it could just be the natural ebb and flow of my ankylosing spondylitis. Simply put, with A.S. some days are better than others, and some weeks are better than others. My final week of taking Padma was certainly a “good” week.

My own conclusion: I will not continue taking Padma, simply because I can’t afford the $85-$100/month pricetag, and the results weren’t sufficient to justify the price. That’s still a lot of money in my world for something that is not proven to work (especially in today’s economy). Fortunately or unfortunately (depending on your view), prescription medication combined with insurance costs much less, and is proven to be effective. Even the biologic medications, such as Remicade and Enbrel, can often be obtained with less than $100/month, with insurance and financial aid from the respective drug company.

But to bring up the biologic drugs brings up a reason to try Padma Basic or Padma 28: through my own experience or through my literature review, I have not found any discernable side effects. Many side effects of the immuno-suppressant drugs or NSAIDs are downright scary. With Padma, I experienced no gastro-intestinal discomfort, no orange skin, no sensitivity to sunlight, no compromised immune system. This all observational; I did not have any testing done (liver, kidneys, etc.), so please take my lack of perceived side effects for what it’s worth. I also encourage readers to go through the literature review and links from my first posting; I have yet to see mention of side effects from the studies I’ve looked at, but that does not mean that don’t exist. So in a nutshell, my own experiences were positive, but please be responsible and be cautious when trying any new medication or any especially any non-FDA regulated supplement.

But pushing aside side effects (or lack thereof), Padma’s benefits to me were subtle at best. Perhaps Padma could be a viable option for people with very mild auto-immune diseases. Also, I think to truly test Padma better than I just did, a person would have to use it for 6-12 months. One month was probably not long enough to get the full effects. But then again, most of us with ankylosing spondylitis simply do not have 6-12 months to fool around, as permanent joint damage can occur in that kind of time frame. That is reason enough to go with a form of proven medication prescribed by a rheumatologist as front-line treatment; there is simply too much at stake to bank on an alternative therapy as the main treatment.

So to summarize, I took Padma Basic for 30 days to help suppress ankylosing spondylitis. I found:

• No side effects
• A small but noticeable reduction in neck/shoulder pain and stiffness
• A very small reduction in foot/toe pain
• No change in lower back/hip pain and stiffness
• Not convinced that improvements were necessarily directly from Padma
• Found the cost prohibitive
• Feel that a longer term of use would be more conclusive

I would love to see some real studies done with Padma Basic/28 on various auto-immune arthritis’s. How does it really compare to the anti-TNF drugs? Let’s see some real numbers, double-blind trials, and other methods that will hold up under scrutiny.

I would also love to hear back anecdotally from other people who use Padma to inhibit TNF and control rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Chron’s disease, and others. Does it work for you? Please leave your comments, questions, and experiences. I hope this blog can be used as a resource for auto-immune sufferers who are investigating Padma and looking for real-life experiences about it.

Note and disclaimer: I am not a doctor. I am not associated with Padma Basic or Euconugenics. I am just a guy with ankylosing spondylitis, trying to find any and all treatments that can help control the disease. My statements below are not authoritative, but rather reflect my own experiences with Padma Basic, and nothing more. Please consult a rheumatologist when implementing any change of treatment to your own disease. 

As those who read my blog know, I’m been dealing with an auto-immune disease called Anklyosing Spondylitis (A.S.). In a nutshell, A.S. incites my body’s immune system to attack my own cells and cause inflammation, most notably in the lower back, hips/SI, and neck. These are all distinguishing markers for A.S. In addition, it has also caused swelling and painful inflammation in my toe joints, as well as a variety of tendon-related injuries.

And reportedly it only gets worse over time. This is certainly bad news for a 29-year-old guy like myself, supposedly entering my physical prime. It almost makes it worse being a competitive runner. I felt like I was finally coming into my own and making real progress as a marathoner over the past couple years. The 2:18:09 at St. George and 2:22:34 at the Olympic Trials four weeks later were real high points, and I felt like I had the ability to break 2:18:00 or even 2:16:00 on an unaided course. All I needed was time and continuity of training.

When the A.S. diagnoses was revealed, a lot of my hopes went down the drain. But I did keep a mere fragment of hope: If I could find a way to control the A.S. (and the tendon injuries that go along with it), then I would be able to resume training at an elite level, find my body’s true limits, and achieve my goals. Thus began my search for the treatment(s) that would work for me. I am open-minded: drugs, diets, herbal remedies…my main interest is in finding something that works.

Do date, the most effective treatment I’ve tried (and still use) is simply NSAIDs. Meloxicam has been effective in reducing pain and stiffness, and has not caused any gastrointestinal damage (yet). I take the tummy-protector Omeprazole to reduce acid and help out my gut with the NSAIDs. Also, I am doing the No Starch Diet (NSD), which supposedly reduces disease activity through eliminating all starches (wheat, rice, potatoes, legumes, processed foods, etc.). NSD indeed has helped dial back my pain levels by a couple points, but so far has not been a panacea. Right now, I view it to as a complement to traditional drug treatment, and not the primary treatment in itself.

I have also tried fish oil, ultrasound, and various supplements. They all basically did nothing other than make me wary of alternative treatments and throwing my money away. With NSAIDs plus NSD, my pain levels most days are around a “2″. I have daily stiffness in my neck, and intermittent stiffness in my lower back. My left foot has been constantly inflamed and sore for the past year, and I have experienced numerous tendon-related injuries. I am doing “okay”, but would like to do “better”…and I would also like to reduce the amount of NSAIDs I need to take, in order to preserve the long-term health of my gut.

So that is a rather long intro, but it lays the foundation that:

1. I suffer from A.S.
2. I have several ways to treat A.S., none of which are perfect
3. I am constantly looking for new treatments to try. Anything that can take off a point or more of pain and inflammation levels is worth trying, especially if there are no side effects.

A couple months ago I read a press release on the Spondylitis Association of America (SAA) website. It was about an herbal supplement called Padma Basic. The press release stated:

First, we look at an “exotic supplement” called “Padma Basic”. The “Dear Pharmacist” column in Tulsa World reports, “It works for rheumatoid arthritis by calming an overactive immune system that is bent on destroying cartilage and bone. The destruction occurs thanks to TNF (tumor necrosis factor), which signals the attack. Padma contains an herb “Pterocarpus santalinus,” which inhibits TNF and T-cell proliferation in a similar way to prescription drugs like Humira, Remicade and Enbrel. It could improve inflammatory conditions among them, Crohn’s disease, MS, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.” 

Whoa! That’s an eye-catcher to me! The release states that the herb has potential to inhibit TNF (and therefore slow or halt A.S.) similar to the very powerful biologic drugs available. These biologic drugs work very well, but they have many side effects and are very, very expensive. The press statement gave me a great interest in Padma Basic, so I started googling for anything I could find on it.

Padma is an ancient Tibetan herbal formula manufactured by Padma, Inc. in Switzerland under international pharmaceutical standards. It is sold in Europe as an OTC drug known as “Padma 28″, but in the U.S. it is distributed by EcoNugenics as a herbal supplement not regulated by the FDA. The only difference between Padma Basic and Padma 28 (beside their name) is the presence of 1 mg/tablet of aconite in Padma 28. This does not really affect the formula, and the function between the two is exactly the same.

With my wariness of herbal supplements in mind, I needed to be convinced to even try Padma Basic. But as it turns out, quite a body of objective research exists that validates using Padma for a variety of applications and ailments, including:

• peripheral artery disease (Atherosclerosis. 2006: Nov; 189(1):39-46)
• angina (Herba Polonica. 1986: 32; 107-114)
• stroke (Europ J Neurology. 1998: 5(suppl1); p. S9)
• hepatitis (Phytotherapy Research. 1993: 7; 224-247)
• arthritis (Int. Journal of Immunotherapy. 1991: 2(3); 143-147)
• ulcers (Nowiny Lekarski. 1992: 2; 40-44)
• AIDS Related Complex (Internation Congress for Infectious Diseases. 1988. Rio de Janeiro)
• multiple sclerosis (Phytotherapy Research. 1992: 6; 133-136)
• dental root canals (Forsch Komplementarmed. 2006 Feb; 13 Suppl 1: 28-30)
• recurrent infections (SchweizZschr fur Ganzheits Med. 1992: 7/8(Suppl 1); 22-23)
• inflammation (Inflammopharmacology. 1999: 7(1); 47-62)
• antioxidant (Redox Rep. 2000: 5(1); 17-22)
• antimicrobial (Research in Complementary and Classical Natural Medicine. 2002:9; 346-351)
• immune modulating (Inflammopharmacology. 2004: 12(4); 373-89)
• TNF / IL-inhibiting (Eur Cytokine Netw (0) 15: 203-9)
• 

I perused many of these journal articles (see links for yourself), and became even more interested. Although there was nothing directly studying the effects of Padma Basic/28 on ankylosing spondylitis, there were indeed many studies that indirectly stated that it could help in a variety of ways, including reducing inflammation, improving circulation, and inhibiting TNF.

The results of the Bernacka et al. (1991) study on juvenile rheumatoid arthritis, published in the Journal of Imunotherapy, were particularly encouraging to me. The group of children who were given Padma improved in both symptoms and laboratory tests without side effects during the six-month clinical trial. It was a very small study, but enough to stir more interest and hope in me that Padma can help dampen my overactive immune system.

So I believe it is worth a try. I plan to take Padma Basic for 30 days, and report my findings in a full review on this blog. Of course I have no delusion that this is some sort study; rather, it is merely my own personal experiences with Padma. Everyone’s form of A.S. is different, and different treatments will help different people. But my goal is that through this review and the followup review that other A.S. sufferers can find pertinent information, and be exposed to the option of Padma.

The kind people at EcoNugenics were gracious enough to supply me with a 180-tablet supply of Padma Basic. It arrived yesterday (January 2nd), and I have begun to take it. My dosage is two tablets 30 minutes before each meal (6 tablets/day). I am still taking meloxicam and omeprazole, and will continue to do so unless my pain drops down to a 0 or 1.

I plan to be as objective as possible when reporting the effects of Padma. My hopes are that it will:

1. Reduce or eliminate stiffness in my neck
2. Reduce the pain and swelling my left foot
3. Allow me to take fewer NSAIDs
4. Help the circulation of my hands and feet, which are constantly cold

So come back in 30 days for a full report of results!

It is officially winter now, but up here in northern Utah we’ve been in the throes of winter for several weeks already. Sub-20 degree temperatures, icy roads, and snowy hummocky sidewalks have quickly become the norm. Back when I skied a lot, this would have made me jump with glee. But at this point skiing is an aside, and I am focused on being a husband, a father, and runner. And all this snow is very, very bad for running.

I managed to get through my shin injury in October, and had a great November and early December. Mileage crept back up to the mid-60’s, and I was throwing in a weekly tempo run or two at about 5:40-6:00/mile pace. All in all, I was feeling good and fit, and excited to slowly increase my mileage over the months. Then winter hit. And motivation dwindled. And my body began to ache in various spots.

Some of the aches and pains are due to A.S. Others are due to running on slippery, snowy surfaces. And others are a combination of both, ever reminding of the fact that I cannot train how I used to, that once I hit 70 miles/week I’m an injury waiting to happen.

So far I’m still healthy enough, but I can feel protesting in my left knee. And I constantly worry about my shin flaring up again, or my foot flaring up again. If only it were spring, then things would be better…but unfortunately today is only Day 5 of winter.

Deep breath. Whew. It really doesn’t matter. That’s what I remind myself. There are no races of any importance until May or so. There is absolutely no reason for me to push into higher mileage; there is no reason for me not to back down and relax; there is no reason not to take days off or cross train when I feel my body protest the rigors of training. It will all come together in due time.

And so what if my breakdown point with A.S. is now 60-70 miles/week, rather than 100+ miles/week?  I must make do with what I’m given to work with. It’s in my nature to push whatever limits I can find. And I will continue to do so during the near future with running. I will run the most mileage I possibly can in search for the next P.R. and in search of a 2012 Trials qualifier. But if that limit is lower than what I would like, I just need to accept it and make the most of that volume of training. The keys are patience and adaptability.

Next race: The Painter’s Half Marathon in St. George. This race is mostly an excuse to for my family to get out of Logan and get some warmer weather down in St. George. But at the same time, I would like to run well, perhaps in the 1:10:-high range or so. Hopefully this race will keep me motivated enough to keep hitting the roads, treadmill, elliptical, and weights…but still keep it all in check and stay healthy.

It’s been a short but sweet racing season with a little symmetry to it, as I ran my first and last races in Moab. Last week I completed The Other Half, the sister race to the Canyonlands Half Marathon.

This was an interesting race, primarily because I had not run more than a few miles over the last 3 weeks. My shin issue, which was later diagnosed as Tenosynovitis (inflammation of the tendon sheath), kept me confined to the elliptical for the preceding weeks. Although nothing is as good as running, my 60-90 minute sweat sessions in the gym kept me fit. However, I didn’t appreciate this out until around Mile 8 of the race, as I was quite nervous before the race and during the early miles that I would just utterly bomb, or that my shin would flare up and make me drop out.

But the outcome was quite good: a time of 1:14:02 and 1st place overall. Can’t complain, especially given the circumstances. I knew my initial goal of sub-1:12 was out the window, so I went out at 5:40-pace the first couple miles, and pretty much held that effort the entire way. You can read my full race report with gory details here.

And I loved the course. The first six miles feature small rolling hills in a redrock canyon along the Colorado River. This stretch is pretty fast. But then the canyon opens up to Castle Valley, and displays amazing views of the LaSal Mountains in the background and large sandstone monoliths in the foreground. Very inspiring. However, the terrain also changes from here to the finish to large rolling hills, and the course gets considerably harder during the second half.

Fortunately, every uphill had downhill on the other side, and I actually thought the more challenging second half of the race was as fun as it was beautiful. The race finishes on a nice downhill into Sorrel River Ranch, a resort spa nestled along the Colorado River. The race had a lot of “frills” (which I don’t care much about), but it was also well-managed: the expo was easy, they started the race on time, and it was a closed course. The jacket, pint glass, finishers’ medal, and beer garden were just gravy, but a nice touch I suppose. But really, the course and the scenery were the stars of the show. I may be back next year, hopefully in better health, to try to get my 1:12:00.

Little Seth proudly wearing daddy’s finishers’ medal

But that’s it for me for 2008. Despite being injured to laid up with with an A.S. flare for most of the year, I did manage to squeeze in 5 races, most of which were pretty good considering my fitness. What’s next? Well, my shin has greatly improved since the race, and I’m starting to run again. If things go well, I’d like to build a big base throughout the rest of the fall, all winter, and into the spring. If I’m going to do another marathon, I’d like to do things right! Reading “Once a Runner” and “Return to Carthage” has inspired me to be patient, as the main character Cassidy was patient. Staying cool and calm, building a big base over a period of many months, will make my next marathon a great one. No sense in jumping the gun.

Right now I’m about 75% sure I’m going to sign up for the Indy Mini Marathon. My next big race will be the Indy Mini Marathon. Registration is in, so now it’s a matter of good training and praying to stay healthy. The Mini is a flat, fast half marathon course near sea level, plus I will be in town that weekend to visit my family, so it would be a shame not to go for a PR. Beyond that, if things are firing on all cylinders I would like to find a good marathon in late May, and perhaps make a run for the Trials.

With having ankylosing spondylitis, it is so hard to plan far ahead into the future. As a “normal”runner, it is hard to stay healthy as it is, but A.S. greatly increases my chance of tendon injuries, not to mention the background back and neck pain. Yet, dreaming and planning is something that makes me love running and love life. I don’t think I can give that up. So while I eagerly make plans and scope out potential races with one half of my mind, the other side duels with it and tries to prevent me from too much disappointment and letdown. It’s a hard transition, but I don’t think I will ever truly give up dreaming.

Oops, I did it again. During my Monday tempo run, a slight pain in my lower shin transformed into inflamed, swollen mess. Why did I bother finishing the workout? Why not just jog it in? Did I seriously think it would just “go away”? Well, apparently I did. D’oh!

Regardless of my delusions and mistakes, I am left with what appears to be a moderate case of tendinitis in my shin. I’ve had tendinitis in my upper hamstring before, and it was not fun. But this already seems to be way better than my hamstring injury, or the groin strain I had a couple years back. It seems that injuries that occur higher up take longer to heal (groin, hamstring, etc.). Walking with this shin injury is not too bad, and I can already run a little bit after only a couple days. With the hamstring and groin injuries, it was a couple months before I could run.

So how to treat this? The past two days I have been religiously:

• Icing, with both stationary ice packs and with ice massage.
• Scraping, with Gua Sha tools.
• Massaging, by just putting some oil on my shin, and then using deep strokes with my thumbs from the top of my shin down to my foot.
• using my TENs unit, a little device that reduces pain and perhaps increases circulation through electrical pulses.

On Sunday, I am seeing my massage therapist, and hopefully she can work some magic. Also, I’ve ordered a Zensah compression sock. I don’t know how much compression will help, but it’s worth a shot. Anything that allows returning to running without re-injury is a good thing.

My worst fear is missing The Other Half, or just limping through it. I figure I can supplement a full week of training with cross-training and still run at full potential in Moab. If I miss two weeks, I could probably still run so-so at Moab, but would miss too much “real” training to continue entertaining ideas of a December marathon. Basically, I would be done for the year after the half marathon. If I miss three weeks or longer, then Moab will become just a vacation, and I’ll have to be happy with the three races I was able to run this year.

But I am optimistic. In order to keep fit and keep my edge for the upcoming half marathon, I’m trying to get an hour of cross training in every day, and will attempt some interval and tempo type workouts as well. For cross training, I use my mountain bike, the elliptical machine, and the arc trainer machine. The arc trainer in particular is a fantastic workout. I get gassed on it after about 10 minutes. But nothing beats running.

The question I always ask myself when I get an injury: is if it is purely a running injury, or if it is because my Ankylosing Spondylitis? A.S. has a tendency to attack muscle insertion points, thus A.S. sufferers are more prone to “injuries” such as plantar fasciitis and tendinitis. In my case, yes, I think there is a good chance that A.S. set the stage for this bout of tendinitis, but if I were not a runner it would certainly not be inflamed to its current extent. So the two work together as a one-two punch. A.S. weakens the tendons, and running blows them up. I imagine this is just something I will have to deal with as long as I run.

New rule: if I feel any sort of new pain, I abandon the workout. This a basically a repeat of my hamstring tendinitis from earlier this year, so strike two on me.

Back in June I thought this year for racing would be a complete wash. In fact, I did not know if I would ever run competitively again, due to the plethora of arthritic ailments brought on by Ankylosing Spondylitis (A.S.).Fortunately, things have turned around for me a bit, to where I’ve been able to run again, and even get into some semblance of shape.  I am not pain-free yet, but am “good enough” to train and do some speed work too. My key challenge was to learn how to manage the A.S., which I have done so far through diet and occasional use of the NSAID meloxicam. Right now I am taking 2-3 meloxicam (brand name: Mobic) per week, and that is enough to make me feel pretty good when I get out of bed in the morning.

Thanks to eliminating all starch in my diet (the “No Starch Diet”, which will be a blog topic of its own soon), the pain in my hip, SI joints, and low back stiffness have basically disappeared. The swelling in my foot and stiffness in my neck (particularly in the mornings) is all that remains, and that is what I take the meloxicam for. If the diet continues to work over time, I hope to eliminate all NSAID use completely.  But for now I’m thankful that I’m taking it a few times per week rather than everyday. I’m sure my stomach will thank me as well.

So despite a horrid first half of the year, I’ve been salvaging a short racing season after all.  I’m not nearly in the form I was last year, but I’m still having a lot of fun, and thankful to God for the opportunity to run again. On August 2nd, I ran a local 10K (for $5!), and placed 3rd with a time of 34:55. I was quite happy with this considering that I had about a month’s worth of training at 30 miles/week at this point (plus the birth of my first child three days prior).

My second race of the year was August 23rd, the Top of Utah Half Marathon. I won this last year, so it was a little humbling to be completely out of contention, but I still enjoyed myself immensely, taking 6th overall with a time of 1:12:12.  Mileage was around 50 mpw at this point, with some speed work.

After a week of recovery from the half marathon, and then missing some time due to sickness the following week, I’ve finally boosted my mileage again, and will be sitting around 65 mpw for awhile. I’ve managed to catch a little bit of the old fire, and have the desire to train again, and to excel in races. This fire had been missing for awhile. I’ll reach 75-80 mpw in the next couple months, which I never thought I’d would even want to do again.

Upcoming races include the Top of Utah 5K on September 20th, The Other Half on October 19th, and another local 5K (The First Dam Run) on November 1st. The Other Half is a half marathon in Moab, and is a fairly big race. It is a challenging, rolling course, with no elevation drop (rare for Utah). The course record is a low 1:12, and I’ve made it my “season goal” to break that record. If I can run 1:12 or faster on that hard course, and if I am reasonably pain-free, then I will consider continuing to up my mileage and running an early December sea-level marathon, most likely St. Jude.

Several people have tried to convince me to run St. George, but I am not for several reasons:

1. I have nothing left to accomplish there, other than to win. I cannot win this year with the training I have done. Therefore I will not traumatize my body for no good reason.
2. The injury risk is too high on that course with the amount of training I’ve done.
3. By deferring a marathon for two months (December vs. October), I will give myself training time to race a much better quality marathon.  True, I could probably break 2:30 in my current condition at St. George, but I gain more by training longer (uninterrupted), and running under 2:25 on an honest course like St. Jude.

Much of this is speculation right now, but that is where my thinking and heart are at. St. George was tempting simply because I really enjoy being at the race with my friends and peers. But to actually race it would be a bad idea. Plus, I’ve always wanted to run The Other Half, which is reportedly a beautiful, challenging course.

I do not know what the future will bring, but I have enjoyed the races I’ve been blessed with doing already, and look forward to running more.

Alright, long time no blog. I figure it’s time for an update. Most of what is below was copied and pasted from my training blog, but I figure it might reach a different audience here.

So why haven’t I been blogging? Simple, I haven’t been running. The last few months have been one “injury” after another. What started with hamstring tendinitis morphed into a monster that included SI pain, hip pain, low back pain, mid-back pain, neck pain, swollen sausage toes, and a swollen, sore forefoot. The forefoot is what really knocked me out of running. And I hate to say it, but I lost the fire over the last few months. The cross training suddenly became not worth the effort. Fitness is all gone.

My foot problems was initially, and wrongly, diagnosed as a mortons neuroma. After the digits and top of the foot started swelling, I pretty much knew that was wrong, and so did the podiatrist. We did a battery of blood tests, and I came out positive for HLA-B27. Given my chronic SI joint problems over the three years, combined with the sausage toes, the blood test, and even the insertion-point injuries (plantar fasciitis, hamstring tendinitis), I knew in my mind that Ankylosing Spondylitis would likely be the fit to the puzzle.

This is not answer I liked. Who wants a chronic, degenerative disease? But I would not know for sure until I saw the rheumatologist, something that apparently takes a long time to do (I couldn’t get in for four weeks; some people tell me I’m lucky).

Okay, now for the copy and paste part.

Finally had my rheumatologist appointment today. Got the official diagnoses of Ankylosing Spondylitis. No big surprise, but I supposed it’s nice to get a dx in some ways.

No, ankylosing spondylitis (A.S.) is not the name of a dinosaur. “Ankylosing” means stiff or rigid. “Spondylitis” means inflammation of the spine. So ankylosing spondylitis is a chronic arthritic disease that causes the joints and ligaments along the spine to become inflamed. If left untreated, the spine can completely fuse, causing the person to lose mobility (hence, the “Ankylosing” part of it). A.S. is most common in men in their 20s. The cause is not quite known, but it appears to be genetics (HLA-B27 gene) combined with a trigger event (probably some sort of gut infection). Most people with A.S. have HLA-B27, but only about 10% of people with HLA-B27 have A.S. So the environmental trigger factor is a large role.

Their is no cure for A.S., but it can be treated into remission. Exercise, NSAIDs, DMARDs, and anti-TNF meds seem to be all there is at this point. The exercise is important to keep the joints mobile. Move it or lose it. Swimming is best for obvious reasons, and running is often frowned upon because of the jarring (but for the record my doc said that running is okay if it doesn’t hurt). NSAIDs treat the symptoms by killing the inflammation, but does not stop progression of the disease. They also tend to tear apart the stomach and fry the liver if taken for a long time. DMARDs (Disease-modifying anti-rheumatic drugs) can slow down disease progression, but haven’t been shown to be terribly effective with A.S. Kind of a hand-me-down from big brother rheumatoid arthritis. Anti-TNFs (tumor necrosis factor, biologics) suppress the part of the immune system that is attacking the body. Biologics can repress or completely halt the disease, and seem to be the most promising for A.S. However, they also increase the chance of infection, and perhaps even some types of cancer.

Diet has also helped a small percentage of people deal with A.S. to varying degrees. Low-starch and No-starch diets are definitely on the fringe of the treatment, mostly (IMO) because there is no money for doing non-drug research, plus pharmaceuticals can’t make any money if people just stop eating bread. But the diet has a small but fanatical cult-like following among lay-people. In any case, it is proven that some foods cause inflammation, and some foods reduce it, so it is a safe bet to pursue that kind of diet just for general health and to help things along.

Anyway, this is long, but it’s as much for my therapeutic benefit as for anything. My symptoms aren’t too terribly severe on the grand scale. Judging by x-rays and flexibility tests, I have suffered no joint damage or no beginnings to fusion either. This is good. Since A.S. isn’t terribly well-known, most people can go over a decade without getting it diagnosed, and by that time they may have already started to fuse (once you fuse, you can’t go back). In my case, I think my hyper-sensitivity to what is going on in my body due to being a runner helped get me into a series of doctors and start asking the right questions and getting the right tests. I can track my A.S. timeline back to June of 2005, so it’s been going on for three years at the longest, which is pretty quick for a dx.

And it turns out that my clusters of “running injuries” may not be entirely from running, and are better explained as A.S. flares. It also turns out that A.S. often affects muscles and tendons near insertion points, so my plantar fasciitis and hamstring tendinitis would also be common A.S. symptoms. Of course, running didn’t help most of these things either. And A.S. also commonly causes “sausage toe”, which is what it sounds like, and is what I have going on with my feet (currently preventing me from running). Timeline:

• 1994 - June 2005: No injuries whatsoever. Nothing, nada. No back pain.
  
• June 2005 - November 2005: SI pain, lower back pain, patellofemoral pain (runners knee). Ran through most of it, then took a couple months off after St. George.
• December 2005 - February 2006: perfectly healthy, resumed running
• Feb/March 2006 - August 2006: SI pain, lower back pain, patellofemoral pain (other knee), groin strain, plantar fasciitis. No running for 5 months.
• September 2006 - December 2007: pain-free, blissful running
• January 2008 - June 2008 (ongoing): hamstring tendinitis, SI pain, sore/stiff lower back, stiff mid-back, neck pain, swollen toes, swollen forefoot.

So it’s been alternating healthy - flare - healthy - flare. I am now in my third flare, by my count. This is definitely the longest, although I don’t know that it is more severe than what I went through in 2006. So the A.S. may be ramping up each time (bad thing), but I am not sure. It would sure be nice if I left this flare and had another 15 months of quiet.

My rheumie thought it would be best to start with a prescription NSAID to wick out the inflammation. Everyone’s version of A.S. if a little bit different. If mine follows the pattern of flare - healthy - flare, then I can probably get by with taking NSAIDs as needed. However, if things don’t ever get better, and it seems to be progressing, then he will want me do go on an anti-TNF, such as Remicade or Embrel. I’d rather not do this, as it is very expensive (~$20,000/year). With insurance it is something like $100-$200/month, depending on the drug.

So now I am taking diclofenac. Ibuprofen is quite effective on me, so hopefully this will be too, and shrink my foot down to a normal size. My next appointment is in 3 months, so until then it will just be the NSAID (as needed), exercise, and a healthy diet.

Will I run competitively again? Maybe. If I can, I probably will, but if I can’t life will go on. I know I can be happy and fulfilled without running, and it is not my identity, but I do enjoy it, so I would obviously like to be able to at least go out and run 6 miles pain-free with myself or with my friends. But this whole ordeal has served to remind me that my hope is not in the present with this broken body, but my hope lies in God and in His promise of a future and an eternal life.

19“Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal. 20But store up for yourselves treasures in heaven, where moth and rust do not destroy, and where thieves do not break in and steal. 21For where your treasure is, there your heart will be also. -Matt 6:19-21