This week was 52 miles of running and 9 "miles" of pool-running -- training log is here.
I was still recovering from being sick at the start of the week, so I did Iwo Jima hills (500m to the top, 90 second jog, 100-200m downhill stride, and 45-60 second jog to bottom) as a form/gait workout. This meant that I kept the effort very limited - instead of trying to run hard or fast, I focused on good form while only picking up the pace slightly.
By Friday I was feeling better, so I returned to the track with tempo intervals. These were much faster than I expected, despite the fact that I felt (and am) out of shape. I suspect this is because I recently (post-marathon) changed my meds slightly.
By way of background, Parkinson's is essentially the brain's inability to produce enough dopamine. Dopamine is the neurotransmitter that sends signals to muscles, telling them when to contract and when to relax. Without sufficient dopamine, your muscles get weak, confusing, intermittent signals - this results in weakness, slowness, shakiness, and poor control of your muscles.
So...you replace that dopamine through oral medication. This is obviously not going to work as well as the original - basically you are dumping chunks of dopamine into your brain a few times a day instead of your brain producing on demand when you need it. And if you have too much dopamine in your brain, it doesn't always sit there and wait until it's needed - instead it starts sending additional and unwanted signals to your muscles. Which results in (again) poor muscle control - things like muscles contracting unexpectedly.
Ideally you hit the perfect not-too-much/not-too-little dose, which has to be adjusted according to activity - when you are more active (or stressed) you burn more. It's a bit tricky. What has made it more tricky for me is that I am very small, very active, relatively young, and female. Your stereotypical Parkinsons patient is bigger, less active, older, and male. And the medications are manufactured with that patient in mind.
Rytary is essentially extended release dopamine - it comes in four different strengths (95, 145, 195, 245), and most patients - older, bigger, inactive men - take 3-4 pills of it at each dosing (generally you take a dose 3-5 times a day). Because they take 3-4 pills each time, they can mix and match the different strengths to fine tune the dose to their needs.
However, I need a much smaller dose than the average patient - I take just one pill each time, with one of the strengths (the 145) being not enough and the other (the 195) being too much. Ideally, I'd be on a "175" but they don't manufacture that strength and the pills can't be split.
So, I've been swapping back and forth - taking a 195 pill before working out in the morning and dropping to 145 for the other three doses that day. It's worked OK, but not great. Basically, running on the 195 means that I'm constantly working really hard mentally when running to keep my leg muscles from contracting at the wrong time in each stride cycle. And the faster I try to run, the harder it is to control things. Effectively, my speed is limited not by my fitness but by my ability to manage my legs.
So....the change that we recently made was to add another medication, called a COMT-inhibitor, which basically boosts the Rytary (it's more complicated than that, but you get the point). The thought was by adding the COMT-inhibitor and then dropping back to a lower dose of Rytary, we'd get closer to the ideal amount of medication for me.
And...so far it seems to be working. While things aren't perfect, I have a lot more control of my legs now. And better coordination means that I move more efficiently, with less mental effort. I have a little less power/energy - which also corresponds to less dopamine - but the tradeoff is overall a big positive, running-wise. I'm fighting my own muscles less, so I'm running faster.
One of my big frustrations during track workouts over the past year is that my lack of coordination has been the upper limit on how fast I can run - I am (or was) limited to slightly faster than tempo pace. Which has made it really difficult to improve my VO2Max.
This held until Friday - my first track workout on the new medication regime. On Friday, for the first time in what seems like forever, I was able to run hard enough to really elevate my heart rate during the workout. That itself was a shock to the system (and highlighted how unsurprisingly out of shape I am), but it was a pleasant shock. Not coincidentally, I also ran my fastest 1600 on the track in about a year despite the fact this was my first track workout after my post-marathon break.
If I'm now capable of running faster than tempo effort during track workouts, then that's good news - it means that the door is open to improve my speed, and maybe get a bit closer to where I used to be.
Monday: 7 miles very easy (9:24) and upper body weights/core. Foam rolling in evening.
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