WEEK ONE OF MTX TREATMENT

I'm basically giving my immune system ritalin and hoping it
will start paying attention in class.

I thought maybe I'd start posting weekly updates with how I'm feeling. The medication I'm on (methotrexate, herein referred to as "MTX") usually takes a few weeks to start being effective and about six weeks before it's in full swing, so I think recording my status on a week to week basis might be a helpful exercise to look back on later.

The main side effect of MTX is digestive distress. Upset stomach, cramping, that sort of deal. From what I read it was mainly in the first 24-48 hours of taking the medication. In some people it is bad enough that they switch to an injectable form of the drug to avoid this side effect. In some people they just have a slightly upset tummy once a week. And in about a third of people they don't really experience anything. So I was feeling pretty cocky when after two days of taking my first dose I didn't have any stomach issues at all. Maybe a slight rumble the night I took it but nothing super noticeable at all.

While I might have avoided tummy issues, you have to remember that MTX is an immunosuppressant and what do you know, I come down with a minor cold a few days after taking it. Nothing major, but annoying. And then yesterday, as I still had this cold, I felt like complete shit. Just no energy or anything. Yesterday, after feeling like complete garbage, I was a little discouraged. However, today I am feeling much better and I can tell my cold is starting to clear. Just in time for another weekly dose. Hah.

I think my immune system has always been "supercharged." The last time I remember getting sick enough to miss school or work was 8th grade when I had whooping cough. Otherwise, I've gone 7.5 years of my professional life without a sick day. Sure, I've gotten colds and stuff, but I've worked through those. Food poisoning a couple times, really bad diarrhea from Mexico... but overall, I remain pretty healthy. I've always credited that to a good immune system. But, my immune system is hyperactive and bored and starting to attack my own body now.

I'm hoping taking MTX will knock it down to an immune system of a normal person. So maybe I get sick a little more often, but in exchange my psoriatic arthritis (PsA) more or less goes into remission. That would be a fair trade off that I could accept. I will not accept being one of those people who is constantly sick, especially during the winter. So hopefully once my body adjusts to the new normal with MTX I won't be a constant sniffling mess. I don't think I will be, but after getting hit by a truck yesterday I'm putting it on notice.

As for my PsA, I don't know if this is a placebo effect at this point or what, but it feels like it is getting slightly better. I swear I am able to sit up from chairs without hoisting myself with my upper body like before. I can bend at the knees and pick stuff up easier. I don't feel as creaky and stiff in the morning or after sitting for a period of time. It's still definitely there, but I want to say this is the best I've felt in regards to the PsA since initially seeking treatment. I know the drug isn't really supposed to kick in for a few weeks, so maybe this is just me being optimistic. I'll keep an eye on it.

Wish me luck tomorrow. Hopefully I don't curl into a ball from G.I. distress and then follow that up with the flu.

REPORT BACK FROM THE RHEUMATOLOGIST

Snapped this picture of the waiting room while I was there.

Well, it turns out my web sleuthing was correct. I do appear to have psoriatic arthritis. It’s funny how I started down this road, it was all sparked by a TV commercial for a drug treating psoriatic arthritis. As soon as I heard those words there was a spark in my mind that led to reading all about it and pretty much diagnosing myself. Of course, I also diagnosed myself with a tight hamstring as the cause, so my batting average is still pretty shitty.

I would have eventually been passed along to the rheumatologist. I think the orthopedic doctor would have tried a few more things before referring me along, but I basically told him to do the MRI before the end of the year just in case (that sweet, sweet deductible) but then to pass me along because I had this hunch and he agreed. So off I went to into the world of auto-immune joint inflammation.

First of all, I was the only person younger than 70 in the waiting room. So that was a huge confidence boost right there. Not. Eventually I see the doctor and she asks some questions, does some poking and moving of joints, and comes to the psoriatic arthritis diagnosis. I’m not a classic case, but she still was pretty confident that’s what it is based on all the other work I’ve had done and the way my body was reacting.

Overall, at the moment, my case is milder and I don’t have some of the symptoms of when it can get really bad. So that’s good. No sausage fingers for me. It’s also early enough where my joints haven’t likely suffered long term damage. Also good. With treatment, I should be feeling back to close to normal. She wasn’t willing to say I’d be 100% normal again, but that is where some people can get. Almost like a remission of the arthritis. You can’t cure it, but you can treat it. So I’m hoping I can get to that point.

She also agreed it wasn’t triggered by the running, rather, this was something that was going to happen regardless of that whole deal. When I first was seeking help, the running made sense, the dual marathons I did, the sore knees, etc. Unfortunately, that kind of sidetracked my treatment for a while as we were looking for a mechanical issue to diagnose and fix. However, I think you have to go down that road first to rule it out regardless. It just sucks it took almost a year to get an answer. And let’s hope this is the final answer! I think it will be though.

Until a cure is found (aka probs not), I’ll have to take a prescription for life if I want to keep it at bay. So that kind of blows. However, it is better than the alternative, which is the disease progressing and me being unable to walk by the time I’m 50. By taking treatment, I can pretty much proceed as normal and my joints should be no worse for the wear other than the typical aging effects.

The drug I’ll be taking is meth. Jay kay. It’s methotrexate. It’s the most commonly prescribed drug for arthritis. In large doses it can be a chemotherapy drug, like 100x what I’m taking, so if you search for it on the internet the results can be really scary. However, in smalls doses it’s pretty safe as evidenced by its huge user base. While it usually treats rheumatoid arthritis, it also treats psoriasis and psoriatic arthritis very effectively. So I’ll be taking a pill of that once a week! The most common side effect is gastrointestinal distress when you take the pill, however, I had almost zero discomfort on my first dose so hopefully I won’t experience that. One bonus is that it also treats psoriasis, so the little patches on my scalp that I do have should go away.

Sweet, sweet pharmaceuticals... that's actually what
they look like though!

The drug takes many weeks to reach its full effectiveness. I should have “relief” three weeks in and by six weeks the drug should reach its maximum effect. So hopefully, by mid-April, I’ll be feeling like a new man. If not, they can always tweak the dosage or try a different medication. If I’m also feeling awesome they can try to lower the dose a little and see if I could have the same result on a lesser dose. So I’ll be visiting with the doctor every three months or so to check in and adjust if necessary.

Overall, I am just happy to finally have an answer I truly can believe. All the other times I’ve just been like “okay, that makes sense, let’s try that” but never really was convinced we had the root problem nailed. I feel differently this time. I have a sense of hope because I think we’ve figured it out and there is relief in sight! It sucks to have to take a pill, but hey, overall it’s not so bad. It could be a lot worse and I should be grateful for being alive and generally healthy, minus this little deal.

I’ll let you know how I’m feeling in the coming weeks! I decided to sign up for the Shamrock 8k with Brandon in three weeks, so that should be interesting. I think I can run about four miles right now without stopping, so I’m close to being able to shuffle along for five that day. We’ll see!

POST MIAMI REFLECTIONS

I had a great time in Miami this year. Even though I wasn't trained for the race, I actually enjoyed it. During the race towards the end I just wanted it to be over, but looking back I had a great time so it was no surprised when I registered for next year the day after. Hopefully I can be in better shape in 2018!

As for my knees, they responded really well to the run. There was no "flare" in sight! They are still weird and screwed up, but they didn't change much from their generally inflamed/sore baseline due to the race. Maybe a little more sore, but that was minor and only lasted a few days. About like how my knees would feel like they were normal. The thing that really bugged me was my hamstrings. Those were sore for DAYS. No surprise there, longer, slower runs always impact the hamstrings the most and I wasn't trained for this thing at all.

I'll see the rheumatologist on the 21st, so hopefully I am close to some answers. I still think the psoriatic arthritis is the best bet. I'm just hoping that whatever it is, it can be treated. I know you can't cure psoriatic arthritis, you basically have to take a pill the rest of your life, but that would be better than not being able to be active and having my joints damaged. So we'll see. I'm eager to just get an answer instead of having this be such a mystery. It's been almost nine months from when I decided to seek help and I still don't have an answer! Grrr!

Hopefully I can get back to jogging soon. I don't know if I'll be "running" again... the days of 1:40 halfs and 3:35 marathons might be over. I had my run. If I can just become a hobby jogger I'll be happy. I used running to keep me in shape and socialize, so if it can continue to serve that need, then perfect. Some of the most fun I've had at races are races where I just ran them for fun. Miami this year, the Rum Run last year, the Detroit Marathon once I blew up... all good times.

Anyways, we'll see where this all goes. For now, nothing until I see the rheumatologist!

2017 MIAMI HALF MARATHON RACE RECAP

My Miami journey this year. I went ahead and shaded periods of walking in red. As you can see, it was at least 80% jogging.

Well, against all odds, there I was again, toeing the start line in Miami. Despite not running more than four miles since May (eight months), I was about to embark on a thirteen mile adventure. And you know what? I was kind of excited! I was able to fight through whatever knee stuff was going on and get a minimum baseline of fitness back, enough that I hoped would bring me through the finish. I had a total green light to walk if I had to and absolutely no time goal. Just finishing would be a huge accomplishment.

I flew into Miami on Thursday, as usual, but didn't get in until almost midnight as my second flight was delayed. I went to bed shortly after because we were going to wake up at 6am to drive up to the Kennedy Space Center. I ended up getting only about four hours of sleep (after four hours the night before the flight) but surprisingly I wasn't too exhausted. We had an awesome time at the KSC and it was very cool for a space enthusiast like me! The Saturn V was unbelievable!

The Space Shuttle Atlantis!

Saturday was lower key. I was able to sleep in and get my eight hours before we headed off to the race expo at Marlins Park. This was really cool. Instead of the typical convention center, it was held in the new baseball stadium, which was REALLY nice. The expo itself was all around the concourse, so by the time you had walked through it all you had lapped the field. Very cool. Too bad nobody goes to Marlins games. Anyways, other than that novelty, you've been to one expo, you've been to them all.

After the expo we went to Kurios, a Cirque Du Soleil show. That was very cool. I was disappointed in the last Cirque Du Soleil show I went to, the Michael Jackson one, but this one was really neat. A steampunk theme and, as usual, a lot of amazing stunts. We had really good seats too. The only thing I didn't like was spending $5 on a cardboard box of water. Their concession prices were ridiculous. The show is going to be in Portland later this year and I would highly recommend it!

Once the show was over we headed back to my friend's house and stayed low key until we went to bed. I got about four hours of sleep, like last year. With the good rest the night before it was enough though. We left his place about 4:30am and were near the start line by 5:10. Instead of taking a shuttle, this year we parked in a lot right by the start line. It was actually much slicker than the shuttle and cheaper too. So maybe we'll shoot for that again next year.

OVER THE CAUSEWAY (11:19, 11:13, 11:41, 11:01)

MacArthur Causeway

Like other years, I was placed in the "C" corral. Since there was no way I was running anything close to justifying being in that corral, I hung with my friends in the "I" corral. In fact, I decided to run the entire thing with my friend who was going to shoot for 2:30-2:45ish. That would be about 12:00/mile and perfect for the fitness I was in. I have to admit, it was kind of annoying waiting for corral after corral to go. It was almost 40 minutes by the time we started off. Normally I'm out of the gate within minutes of the first gun!

Anyways, this first part is always easy. The adrenaline of the race and the atmosphere of the start line really gets you pumped up. We made a plan to run to the bottom of the hill of the causeway and then walk up the incline. That's exactly what we did and when we were walking, it was a power walk to be sure. The walking parts toward the beginning averaged about 14:00/mile, while the running parts were more to the tune of 10:30/mile. We wouldn't be able to maintain those paces by the end of the race.

For the first five miles or so my friend was trying to stay ahead of the 2:30 pacer. We did a good job for a while, at one point probably opening up a 100 yard lead, but it just wasn't sustainable. It was good motivation for a while though. Also, I should mention the weather. About 56 and pouring rain. Felt like home to be honest. It was actually near perfect race weather, it just sucked when waiting to start and once we were done running!

TCB IN MIAMI BEACH (11:23, 12:13, 11:59, 11:59)

We took our first "defeatist" walking break at the mile five sign. Until then it was just strategic power walking up inclines and through water stations, but by mile five we decided we needed a short break. I certainly could have gone farther, but when my friend suggested it, I was more than happy to go along. Remember, I hadn't ran more than four miles since last May, so every step was already more than I had done in a long time.

Somewhere in South Beach (the 10k mat).

At this point in the race I was still feeling pretty good. Tired, but the energy of the race was still good and I wasn't having any major problems. I was happy with the way my body was performing in terms of energy and pain level. My legs felt pretty good and my cardio was holding up due to the slightly slower pace. All told, the pace I was going was just about perfect... maybe if I really wanted to kill myself I could have done a sub 11:30 pace, but it would have been tough. For this race, I just wanted to cross the finish line, and at this point I was pretty sure I could do it without issue.

This part of the course is always a little boring. Sure, you get to run on Sunset Drive, but it is 7am in the morning and the whole place is kind of dead. You can't see the beach or anything so really you might as well be running down just about any street. There was a slight course change this year that introduced a short out and back section... I actually enjoyed this. Something about out and backs is just so much fun... seeing all the people ahead of you, and then getting to see everyone behind you. Just something to mix it up.

REVENGE OF THE VENETIANS (12:19, 12:42, 12:52)

Unconvincing thumbs up.

The Venetian Island section is three miles long and boy did it feel like it! About mile eight the energy in my body seemed to just leave and all of a sudden an overall fatigue racked my body. It felt a lot like the "20s" of a marathon. At one point there was also a pretty strong headwind. By now, my gaze was strictly focused on the ten feet in front of me.

The last mile of continuous running also took place on this stretch. At mile 8.5 my friend remarks "let's run and not stop until 9.5!" to which some other guy says "why not 10.5!" To which we reply, "I like your style! 10.5 it is!" Well, let's just say, it took everything we had to make 9.5. Without that exchange we would have been walking earlier for sure. My watch hit 9.5 and I mentioned that we could walk, but no, my friend's watch wasn't there yet. So an agonizing .05 miles later we finally got our break.

Overall the two of us took turns getting exhausted and trying to encourage one another. There are times where I felt decent and there are times when I wanted to quit. Again, a lot like the 20s of marathons I actually trained for. At one point I ate about 15 Honey Stinger gummies in about thirty seconds. No joke. I was eating them two at a time prior but I was so exhausted I got desperate tanked every last one I had. I did feel a lot better, but it didn't last. By the time I hit the end of the islands I was back to being exhausted.

DOWNTOWN DOS (12:39, 12:28)

These final two miles downtown always seem like forever. This year was no different. At least this year I was able to eat the pineapple they pass out. I never have wanted to eat it flying by at 7:45ish a mile and near the finish. This year however, this year it was a treat for the senses! And gave a nice little energy boost that lasted two blocks.

Because the finish line is so close, these last two miles are manageable. You know you are almost done. I was doing some quick math on my watch to see if we could get in under 2:40. My calculations told me that, yes, yes we could. As long as we kept up our mid 12 pace, we should be golden.

By the time the split came with about a half mile to go I was so ready to be done. My body was starting to falter at this point and my jog had become more of a animated limp. Once the finish line was in sight though... I forgot all about this. I let my friend finish a few seconds ahead and then crossed the line myself. It was over!

THE WET AFTER PARTY

Overall, running a half marathon is no joke. This was probably the hardest half marathon I have ever done and it's pretty easy to figure out why. I wasn't trained at all. I'm glad I had the baseline fitness I did though. However, every other half I've run I've actually been trained for that distance. Not here though. It made for an interesting run.

In the end, it felt a lot like a marathon. The lack of energy toward the end of the race. The limping in the finish chute. The inability to go up stairs or lift yourself off the toilet. Mad respect for people who finish these things without training. Running thirteen miles is no joke. 90 minutes, 150 minutes, 210 minutes... whatever... it's an accomplishment. What a world removed from when I was from running 1:37 and winning that half though!

OFFICIAL RESULTS: 2:39:19, 12:10/mile. 10,193/14,133 overall, 5695/6982 male, 798/936 M30-34.