On I went, out of the wood, passing the man leading without knowing I was going to do so. Flip-flap, flip-flap, jog-trot, jog-trot, curnchslap-crunchslap, across the middle of a broad field again, rhythmically running in my greyhound effortless fashion, knowing I had won the race though it wasn't half over, won it if I wanted it, could go on for ten or fifteen or twenty miles if I had to and drop dead at the finish of it, which would be the same, in the end, as living an honest life like the governor wanted me to. -Alan Sillitoe, "Loneliness of the Long Distance Runner"

Wednesday, April 10, 2013

I could have been a contender

A few weeks ago, I woke up with terrible joint pain. It was weird and uncharacteristic and it sent me promptly to the doctor. The test results weren't good, and I was sent for follow-up with an endocrinologist and a rheumatologist.

I didn't blog about it because it turned out to be nothing. My normal doctor asked some probing questions that had me convinced I was a goner ("have you been tired lately? have you been thirsty?" - the sorts of questions that immediately have you saying, "YES! YES! I am tired and thirsty! Do you have any water and can I lay down here for a minute?"). The specialists did an ultrasound and told me not to worry about it - fluctuations in the thyroid um something medical yeah blah blah blah totally normal. I'm supposed to go back again in six months or so.

Still, for a brief second in between "Will I die?" and "I hate being in chronic pain," I'll admit - a sneaky, sneaky thought snuck in... "Will thyroid meds make me magically lose weight and will that make me a better runner?"

This man needs more cake, fewer thyroid meds

I'm not alone in my line of thinking. If you haven't already, read this article in the WSJ about a doctor in Texas who is becoming notorious for prescribing thyroid medicine to elite runners (including Galen Rupp) who are borderline (read: completely normal by most assessments) for hypothyroidism with amazing results.

You didn't think I'd mention Galen Rupp without a picture
of the Galen Rupp Mask, did you?

The article (full disclosure: it was written by a friend of mine) is neutral in tone, neither condemning nor condoning the diagnoses and treatment. And, truth be told, I'm not sure how I feel, either. On one hand, cheating is bad. It's against the rules, by definition. On the other hand, where is the line? Thyroid drugs are performance enhancing, male enhancement drugs are performance enhancing, heroin is banned. Personally, I've come around to the idea that we should just have it be a free-for-all. This goes for cycling, too. Jack yourself up. Use whatever drugs you want. No more testing, just an amped up, drug fueled race to the finish.

15 comments:

  1. I believe the American Academy of Endocrinologists says TSH above 3 is a sign of hypothyroidism. I started getting mine treated at 3.3 because I was highly symptomatic. Anyways, it's an interesting article, but I definitely have more questions about the diagnostic methods Brown uses. I'm also wondering what his monitoring criteria is since TSH is supposed to stay above a certain level, which is wouldn't if he's over medicating these athletes. I guess you could start mandating a TSH level above 0.5-1 if you wanted to treat Synthroid as a controlled substance in sports, but that seems a little excessive to me.

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    1. I'm not sure what they say, but my endocrinologist (and my lab results) all said that 5 was the high end of normal, and mine were just above 4 - and they told me not to worry. I think there obviously must be a fair margin there. I don't know what Galen Rupp's symptoms were, but I've seen shirtless pictures of him and weight gain was NOT one of them!

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    2. My endocrinologist maintains that one person's "normal" might be different than another's... and your baseline is the best proxy for figuring that out. I know that when my TSH get into the 4s, shit is NOT right. I guess some docs think above mid-3's actually starts getting above normal for some people. Unfortunately, you don't necessarily know a baseline unless you're symptomatic to begin with... or something. Also, we figured out that vitamin D has a lot to do with it, for me at least, since I also had my parathyroid glands removed. (I had thyroid/parathyroid surgery due to a tumor, so I kind of have to take the medication anyway. I hate when it comes up in running circles because then I feel like... MAYBE NONE OF MY PRs COUNT. And I'm a fake human. :( )

      Sorry, been Wednesday night drinking, no coherent comments from me.

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    3. TOTALLY none of your PRs count. I knew it. You're not actually like 4 minutes per mile faster than me; you're only like 3:45 per mile faster. I'm curious about my situation now. I feel like the doctors kind of dismissed my symptoms - and I think it's my fault for downplaying them a little bit. But am I sluggish and have I gained weight because I haven't been running (maybe)? Or have I not been running because my thyroid is making me sluggish and prone to weight gain?

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  2. I'd be leery any doctor fond of comparing himself to House. Endocrinology is incredibly complicated, and there is not likely to be any medical consensus on the exercise/hyperthyroid correlation for a long time. The PED implications don't bother me yet, either. Just too little hard data.

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    1. I think sometimes the idea of an advantage is psychological as well as physiological. I promise you, had my doctor given my thyroid drugs, I would be running harder and faster right now (and probably losing weight). When you're Lance Armstrong and blood doping, you know you're doing something wrong. When you're taking caffeine or using an inhaler or thyroid meds, I don't know. What about ritalin or other ADD drugs? Are those PEDs - they're basically meth?

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  3. Agreed! I'm not all Libertarian-lets-get-rid-of-traffic-lights-and-meat-inspectors (tell me you saw Bill Maher's New Rule on that), but I've always thought one of the stupider areas of government regulation was that of pro sports and doping. We've all seen enough after-school specials about steroid use to know that if you abuse them, you're going to self-destruct eventually anyway, is it so bad if you set a world record with a 1-minute mile in the meantime?

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    1. BRB looking up Bill Maher's New Rule

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  4. I think it should be a free for all. Everything is performance enhancing on a spectrum from the food you eat to the technology you have available to the drugs you take. Drawing arbitrary lines (and then subsequently moving them) seems ridiculous to me. I just want to see super juiced up athletes accomplishing amazing feats of strength, speed, and dexterity.

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    1. I agree. And then I want to read the tell all memoirs written by their girlfriends about their small genitalia.

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  5. There was something on Facebook awhile back about Lance Armstrong... I can't remember the exact wording, but the gist of it was "Lance won the Tour de France while on drugs - when I'm on drugs, I can't even find my couch!" It's a valid point. =)

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    1. Obviously we all need to find different drugs ;)

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  6. This makes me paranoid that I have a thyroid problem. BECAUSE I'M SO TiRED.

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    1. Welcome to my world. I'm writing this from my pyjamas, in bed, at 4:45 on a weekday. Because that's normal.

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    2. I'm so jealous. I regularly sleep 8 hours a night (okay, sometimes 9) and I feel like shit most days. I know if I sleep less I usually feel better, but who wants to sleep less??

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