Pulled top runner from the race today after one mile today....need help diagnosing...

Coach Cookie wrote:

donearun0 wrote:

I'm with you. Never ask for help, suggestions, ideas, thoughts, advice.....

He can ask for help, but it needs to be to the right people. For example, I'm a world-class coach with several Olympians. Of course there's no way to tell here between my advice and the advice that jamin might be giving on this thread under another name.

Once again, Coach Cookie, thank you for your input.

I understand what you'really trying to say, sure, but I'm not afraid to admit when I'm out of ideas. Frankly, for this kid, I don't even care if I look stupid or ignorant, I just want him to come back from this. I want answers. I have tried so many things over the last year. I've been searching high and low, asking doctor friends, PT friends, other coaches in my network. Why do you think it took me a year until I posted on here?

If he doesn't seem to get any better this fall, I'd even be willing to resign and let someone else more knowledgeable take over for track. I just want him to run well. In my 10 years of experience, I honestly cannot draw from anything that might help from past experiences. So yes, maybe he needs a better coach - I'm trying to be that better coach. If you have the number for Alberto Salazar, I'd be happy to call him up and ask him questions, but all I have is this forum full of experienced runners. I figure with all of the unique perspectives and experiences somebody has to have gone through this before.

Coach Cookie, there might be a job posting in a month out my way if you want to take over.

Coach Cookie wrote:

donearun0 wrote:

I'm with you. Never ask for help, suggestions, ideas, thoughts, advice.....

He can ask for help, but it needs to be to the right people. For example, I'm a world-class coach with several Olympians. Of course there's no way to tell here between my advice and the advice that jamin might be giving on this thread under another name.

Who cares where the advice comes from as long it's sound and constructive. My point your here, and state you a 'world class' umm coach, yet answer to this thread.

Also again with the iron thing. I went and got my iron tested and the doctor told me it was normal so told that to my coach. About a month later I still felt crappy and my coach asked what the number was. I was oblivious, went and asked my doctor then told my coach that my ferritin was a 7 like it was high and something to be proud of, which is what my doctor basically told me. I don't think my coach has ever looked at me like I'm such as idiot.

Adrenal fatigue?

Maybe (exercise induced) asthma? Worth checking....

Aren't you supposed to get your iron levels checked regularly? Like every 6 months if you've had a history.

But if it's not that it's most likely mental. Is he really spooked about pushing hard now? You say he's been training well - maybe have him race some shorter distances like the mile or even the 800 to get his confidence back. He'll start to see there's no logical reason he can't hit those paces in a 5k. Either that or boost his mileage by 10-20 miles easy. But I doubt that he shouldn't be hitting those times as it is on that kind of mileage given his youth.

You were right to pull him from the race seeing as it's likely a confidence issue.

hey

i don't know if someone has also mentioned it but you could also check on "infectious mononucleosis". i experienced the same symptoms as your athlete and this cost me one your of training. Especially his feeling - the one you described - fits really to what i felt back then. like as if someone had pulled the plug.

i wish your athlete all the best !

HobsJog wrote:

Aren't you supposed to get your iron levels checked regularly? Like every 6 months if you've had a history.

But if it's not that it's most likely mental. Is he really spooked about pushing hard now? You say he's been training well - maybe have him race some shorter distances like the mile or even the 800 to get his confidence back. He'll start to see there's no logical reason he can't hit those paces in a 5k. Either that or boost his mileage by 10-20 miles easy. But I doubt that he shouldn't be hitting those times as it is on that kind of mileage given his youth.

You were right to pull him from the race seeing as it's likely a confidence issue.

Also, something from left field, is he drinking? I had embarrassing finish in a mile race once after not being aware of how badly alcohol affects performance. I didn't drink in the race, it was the hangover.

+1 For the iron/ferritin issue. When I first had mine tested, my doctor said my ferritin levels were "normal." I looked at the normal range and it was 11-300. Mine was 11. Plus runners need more than sedentary people because we don't just want it to be enough to classify as healthy. We want to be able to feel strong when we run and race. I have friends in the medical field who also run and they say the number should be closer to at least 50. After 3 years of taking liquid iron, the last time I had it checked, I was only at 35, but felt way better than when it was 11.

My daughter had a similar situation. I believe her ferritin level originally (meaning first time checked) when she got tested was low 20s-high teens and eventually dropped down to 9 at one point. She doubled up iron supplements for awhile but what really helped was getting iron in her diet i.e. Nuts, red meat, canned oysters (she was desperate she would eat anything) and eventually she started feeling better. Took awhile, she probably lost one season of racing well but started doing better by her senior.

To the OP, first off don't beat yourself up about your athlete. Sounds like you have tried to do what you can for him and I'm sure you're a great coach. I would definitely have him get a full blood work up to rule out any other underlying issues and talk with his parents (if you haven't already but I'm sure you have) about your concerns. Best of luck.

Thanks everyone for the responses. Again, at first we thought it was a mental/anxiety thing, but it does not seem to be the case. I'm sure his confidence has taken a hit from not feeling right, but he definitely is a tough racer normally.

Can anyone shed some light on what adrenal fatigue is? I'll probably Google the infectious mononucleosis as well.

I'm going to look into this iron thing again.

He's definitely not drinking either, the kid goes to bed at 9 every night, his parents said.

Why the adjective "white" suburbia family?

They have issues in suburbs too.

Good luck to your special runner. Keep buying him by pulling him from a race to avoid a poor finish and he'll never learn to fight through a bad day. Look for your runner to fade in adversity if you keep that up. You are not helping him that way

My first thought is that he's still overtrained and in the hole. 2 months off may not have been enough if he was really burned out, and though he improved slightly, he's still walking a fine line.

As for the physiological specifics of why he's feeling like crap, I also suggest taking a closer look at the iron/ferritin numbers. Also, now that he's had a few tests, you can look at trends.

I've dealt with fatigue (training and just every day life sucking) and autoimmune issues for years and have pieced together some of MY causes, which I'll state as possibilities for him to investigate:

low B12 - can be related to iron as pernicious anemia

low D

thyroid (and other, more complicated endocrine issues)

mono (I had mono in 2005 and I swear I've never been the same since)

lyme (ask for western blot test, not lyme titer)

poor QUALITY sleep

Best of luck, hope you guys figure it out.

It could be mono/EBV. Fatigue illnesses can fly under the radar. Research monolaurin and have him supplement monolaurin 3x3 grams a day for three weeks. If it doesn't work you can rule out mono and EBV, no harm done.

Make sure he is having fun. If he isn't having fun, he isn't going to race well.

Why cut down mileage? Overtraining usually stems from too much intensity, and easy mileage is generally a solution. Just curious why he would cut back on the amount he runs.

OP, perhaps allergies of some kind?

I think the best bet would be to ask folks here to recommend physicians who have worked with distance runners. Good luck and don't beat yourself up.

This is by no means medical advice, and I continue to urge for him to get follow-up with his physician for exhaustive examination and laboratory studies as warranted. A couple of thoughts, not medical advice:

1. You mentioned abnormalities in creatinine. It would help to know whether you meant creatinine or creatine kinase. Increases in the former generally indicate kidney malfunction, dehydration, highly muscular build, and a few other both normal and abnormal states. Increases in creatine kinase generally indicate muscle breakdown - heart or skeletal. Mild elevations can be expected following strenuous workout. Persistent elevations, however, may indicate rarer causes of muscle breakdown (issues with heart, such as viral illness with coxsackie virus causing mild persistent dysfunction - the episode of 'overtraining' deserves more looking into; rare disorders of muscle wasting, inherited and acquired). In short, it is important to ensure that levels of creatinine and/or creatine kinase have normalized.

2. Regarding tests for anemia. The first test to look at is the hemoglobin or hematocrit. If this is and always has been normal, the discussion of anemia of any kind may be moot - but that is something his physician should verify.

The second test to look at is the MCV (mean corpuscular volume), as this can give insight into possible causes. MCV is most often reduced, and sometimes normal, in iron-deficiency anemia. If MCV is increased, other causes (eg. B12 deficiency) are more likely.

Regarding iron studies: A comprehensive panel of studies includes iron itself, ferritin (great marker of body-wide iron stores), transferrin/TIBC (carries iron in blood), and transferrin saturation. In iron deficiency anemia, ferritin is low, transferrin/TIBC is high, and transferrin saturation is low. Further confirmation of iron deficiency anemia comes from an increase in RDW - red cell distribution width. I agree with a prior poster that low-normal level of ferritin may not be ideal for a runner. For anatomic reasons, adolescent males do not have as high a rate of iron deficiency anemia as females - it is common in females, and not that common in males.

In summary, the kid should talk to his physician. Consider discussing the episode of overtraining and related symptoms at that time, as well as the laboratory abnormalities you mentioned previously. This is not medical advice but just a few thoughts about general topics. Hopefully he discusses his concerns, and possibly other issues, with the appropriate professionals.

Just a shot in the dark here, but could it be compartment syndrome? I went through the whole heavy legs no speed thing in college and that's what ended up being the issue. Might be worth getting him evaluated.