Long Covid – 80/20 Endurance

The last time I tried to run it did not go well. It was May 2021, four months after I stopped running in the hope that doing so would heal me from long covid. Alas, my symptoms showed no improvement in that time, but neither did they worsen, so I decided to try to ease back into a light jogging routine for the sake of my mental health.

My first run was a single 10-minute mile on a fitness club treadmill. It went okay, giving me the confidence to jog another mile the next day, and the next. I was on my way!

Until I wasn’t. With long covid and other post-viral syndromes there are two barriers to exercise. The first is exercise intolerance. That’s when you feel like shit while you exercise. The other is post-exertional malaise. That’s when you feel like death after you exercise.

On day four of my return to running I discovered that I was unable to rise from bed. Words cannot begin to describe the agony I felt. Imagine your body is a burning building and your soul is trapped inside, desperate but unable to get out. I Iay in bed the entire day hyperventilating, curled into a tight little ball of misery, wishing for some quick and final means of ending my suffering.

When this is the price you pay for trying to run, you’re in no great hurry to try again. Hence, I waited an entire year to do so, and even then, it was more a matter of necessity than of choice. In May 2022 I got caught in a snow squall while walking toward a hotel I’d booked in Boulder, Colorado. By this point I was so fully detrained that I felt like an arthritic centenarian as I slogged some 300 meters to lobby door wearing street clothes. The price I paid for this two-minute shuffle was several weeks of exacerbated long covid symptoms, including exhaustion, shortness of breath, brain fog, and paresthesia.

Happily, by the time New Year’s Day 2023 rolled around, all of my symptoms were in abeyance, my only remaining complaint being a touch of general malaise (or as I like to call it, “chemotherapy feeling”) in the morning. I had recently moved to Flagstaff, a place where I had felt comparatively well during each of my prior post-covid visits, which is a major reason I choose to move here. Although movers were hired to do the grunt work, I wound up chipping in a fair amount of lifting and carrying, and I noticed that I felt okay in the days that followed. I’d been waiting on a gut intuition that it was safe to try to run again, and on January 1^st, I got it.

On the advice of my friend and fellow coach Jessica Schnier, who was staying with my wife and me at the time, I structured the session as a run/walk: 30 seconds on, 30 seconds off—that’s it. I grant that a person has to be in a really bad way to find himself struggling in such a modest session, but I was actually pleasantly surprised by how decent I felt, considering that, long covid aside, I am a sedentary fifty-one-year old man. I suppose low expectations had something to do with it, but still.

The real test, though, was how I would feel the next day, and the next. The answer, it turned out, was fine. So, I ran again on the 3^rd, progressing to six times 1 minute on, 1 minute off. Again I felt okay during the session, and as I write these words 48 hours hours after run number two, I feel fine, and am planning to do five times 90 seconds later today.

There’s no telling where this process will lead. Even in the best-case scenario, where my progress continues unimpeded, I doubt I will ever compete again. I say this in part because, four months into my battle with long covid, I was diagnosed with heart disease, which in my case was likely caused by decades of punishing my body in training and racing. But I say it also because my time away from the sport has given me a different appreciation for what running does for me.

I wasn’t speaking loosely when I said above that my abortive May 2020 comeback attempt was motivated by concerns for my mental health. When I was running, I was happy. I woke up each morning excited for what lay ahead, brimming with passion and confidence. Now my days are peppered with little internal pep talks I give myself in an effort to muster a minor-key enthusiasm for life. So, while I truly have no clue whether I will still be running one month from now, I am certain that if I am running, however slowly, I will be as happy as any man on earth.

Pray for me.

“Life is full of little ironies,” he said.

This wry observation was spoken by my father during a recent phone conversation between us. He’d called me to inquire about my health and to ask how my newly released book ON PACE: Discover How to Run Every Race at Your Real Limit was doing so far. The irony he pointed out was that, despite their disparateness, the two subjects—the state of my body and the status of my book sales—shared a common theme, which was pacing itself.

When runners think of pacing, they think of the skill they use to find the right intensity in workouts and to reach the finish line in the least time possible in races. Scientists define this form of pacing as “the goal-directed distribution and management of effort across an exercise bout,” and in my book I offer this less formal definition: “the art of finding your limit.” So, what does pacing have to do with health?

Fair question. I saw no connection between effort distribution and physical well-being either, until I developed long covid, a chronic illness that affects a small percentage of COVID-19 survivors. Long covid is a type post-viral syndrome that closely resembles chronic fatigue syndrome/myalgic encephalomyelitis. Although some people do recover from CFS/ME, at least partially, there is no cure and there aren’t many treatments. Indeed, the primary treatment for CFS/ME—and now also long covid—is (you guessed it) pacing!

According to the MEpedia website, this therapeutic form of pacing “is an activity management strategy to helpME/CFS patients limit the number and severity of relapses while remaining as active as possible. First described by health psychologist Ellen Goudsmit in 1989, it gives patients the advice to: ‘do as much as you can within your limits’. Pacing recognizes research showing an abnormal metabolic and immunological response to exercise in ME/CFS and offers patients a middle ground between post-exertional malaise and the negative consequences of inactivity.”

The differences between these two forms of pacing—the one runners do and the one chronic illness sufferers do, or as I like to call them, micropacing and macropacing—are obvious. If you push too hard too early in a marathon, for example, it’s game over (with rare exceptions). Having depleted your immediate energy stores, you can’t possibly replenish them in time to salvage a good race. With CFS/ME and long covid, however, you’ve got the rest of your life to bounce back from the often devasting consequences of doing too much (days or weeks of near-total incapacitation) and try again.

The similarities between micropacing and macropacing, though, are not to be overlooked. Both skills are cultivated through experience, for which there is no workaround. Simply stated, trial-and-error is the only way to get better at either. As I often say with regard to running, “The road to pacing mastery is paved with running mistakes,” and I can tell you from bitter experience that the same is true of macropacing.

I was a very slow learner when it came to pacing longer races. I was reduced to walking in each of my first two marathons, lost more than a minute in the closing miles of my third, and didn’t really nail my marathon pacing until ten years after my debut. So, I should not be surprised that I’m also proving to be a slow learner with respect to pacing for health. The biggest mistake I made in the first 18 months with long covid was failing to respect that mental exertion is still exertion. As an athlete, I was quick to recognize the necessity of curtailing my physical activity, but instead of conserving the energy spared by this concession I redirected much of it into my work as a writer, coach, and entrepreneur. The result was that my body forced me to slow down in general by ceasing to function. In particular, the symptom that many of us covid long-haulers refer to as “brain on fire” made it impossible for me to work, regardless of will.

The other big mistake I’ve made is getting greedy during periods when I’m feeling and functioning getter. It reminds me of something my wife, who has bipolar disorder, used to do. When she was going through a rough patch, she dutifully resumed taking the medication she’d been prescribed. Months later, feeling better, she stopped taking it again, thinking she didn’t need it anymore, only to come crashing down. Similarly, when I’m doing poorly, I slow down. After taking it easy for a while, I feel somewhat better, so I start doing more—a lot more oftentimes. It’s more than I can handle, and as a result I come crashing down, just like my wife. Indeed, as I write these words, I feel like death warmed over, having ridden the wave of a recent remission in my symptoms by launching myself back into the work I love.

That’s bad pacing! But I figured out the marathon eventually, and I’m confident I’ll get better at pacing long covid too. It sucks to be unhealthy, but I must say there is a compensatory satisfaction in embracing the irony of depending now for my very well-being on a skill that I previously took such great satisfaction in developing as an athlete.

Interested in learning more about the art and science of pacing? Click here for a free sample chapter of On Pace, and here to purchase a copy.

Even before long covid scrambled my brain, I was absentminded. It sounds like such a benign foible, but absentmindedness can be deadly. For example, it nearly killed my dog in a Kansas hotel one time.

It was a raw, gray Friday at the tail end of March, stubborn winter turfing out nominal spring. I’d just returned to the pet-friendly Best Western Wichita Northeast after walking Queenie and was, as usual, lost in thought, paying no mind to the twenty pound ball of fluff trailing behind me as I strode across the lobby, stepped into a waiting elevator car, and pressed the button for the third floor. The doors closed. It was then I realized Queenie was still in the lobby, her leash caught between the sealed doors. The car began to move. In the ensuing panic, I overlooked the big red Stop switch located at the top of the control panel and instead jabbed the Lobby button repeatedly, frantic as a cornered cat. The elevator kept rising.

I knew Queenie’s leash was less than two floors in length. My mind pictured the horrible scene that would unfold below as the elevator ascended. The leash line would fully unspool. When there was no play left, Queenie would be dragged to the door, then yanked off the ground, levitating like pulley freight until she hit the ceiling, at which point she would be either strangled to death or decapitated by her own collar.

After a seeming eternity, the car came to a juddering halt and the doors opened. Third floor? Second floor? I couldn’t tell. Making no assumptions, I hastily stuffed the leash handle into the narrow gap between the elevator floor and the landing and tried to jam it through. Maddeningly, the width of the handle exactly matched that of the gap, a perfect wedge. I pounded it with a fist, heedless of pain, and when that didn’t work, I stomped it with the heel of my right shoe. At last I succeeded in driving through the stupid pink plastic thingy, holding my breath as it vanished soundlessly into the void.

I hit the Lobby button again. The doors closed and the car sank. I prayed. When the doors opened again, I saw a boy of twelve or thirteen years with a stricken look on his face. Saying nothing, he made a tentative movement with his right arm, proffering Queenie’s leash handle. The leash itself was snagged in the door frame in a complicated way. I lowered my gaze, and there sat Queenie at the boy’s feet, unharmed and unconcerned, smiling that endearing openmouthed canine smile that made everyone around her smile too, whether they wanted to or not. A woman with big hair, probably the boy’s mother, appeared behind him.

“Your dog sure didn’t want to go in the elevator!” she drawled.

I stood blinking at her for an awkwardly long time.

“That could have been a whole lot worse,” I croaked.

Quick to forgive, Queenie maintained full faith in her daddy’s omnipotence despite the near-tragedy I’d inflicted upon her. In truth, I was a superhero of sorts back then, absentmindedness notwithstanding. The events I just described took place during a fifty-day cross-country road trip in which I drove 7,000 miles, ran eight marathons, did seven book signings, and published a daily blog, all while somehow keeping up with my book writing, coaching, and other normal duties. It was a limit-testing experience, to be sure, but I felt wholly equal to it throughout, in the zone and unstoppable.

Matt and Queenie

Dogs are more perceptive than even most dog lovers give them credit for. Not much escapes them. Queenie couldn’t have failed to notice her daddy’s sudden diminishment a couple of years after the elevator incident—how he no longer left the house twice a day every day wearing running or cycling clothes, or with a bag of gym or swim gear slung over his shoulder; how he paused to catch his breath while climbing the stairs; how his forehead sometimes dropped to his desktop for no apparent reason, and stayed there. And yet, like the elevator incident, these signs of weakness did nothing to dim Queenie’s faith in my omnipotence, as became evident when she too got sick, drawing the short straw of congestive heart failure.

How fitting that my sweet little pup’s cause of death was to be a heart that had literally grown too big! So big, in fact, did Queenie’s fluid-bloated ticker become in her final days that it pressed against her trachea, restricting her breathing, slowly suffocating her. Periodically in those awful last days she would fix me with beseeching eyes that betrayed a heartrending trust in my power to make it stop. But of course I couldn’t—not without taking her on a one-way trip to the place she feared more than any other, and I was determined to spare her that ultimate trauma until and unless it became unavoidable.

Among the peculiarities of Queenie’s breed is wind intolerance. Bichons have sensitive eyes, so you will never see one sticking its head out the window of a moving vehicle as other breeds do. When I walked her on blustery days she would scuttle along with her belly close to the earth, head down and eyes slitted. Sometimes she’d refuse outright, stiffening at the threshold in a posture that said, “No, thanks. I can hold it a little longer.”

As fate would have it, a storm type known as a bomb cyclone struck northern California last Sunday, by which time Queenie was in obvious distress, hyperventilating and unable to sit still. That evening, the San Francisco 49ers played the Indianapolis Colts in nearby Santa Clara in the same atrocious weather, which caused seven fumbles. Whenever NBC cut to commercial, I went looking Queenie, who kept moving from spot to spot in search of relief, comforting her as best I could with strokes and pats and sweet words and nuzzling.

During the 2-minute warning of the first half, I couldn’t find her. I looked behind the living room sofa (a favorite cozy nook), but she wasn’t there. I looked behind the headboard in the master bedroom (her nighttime nest), but she wasn’t there, either. In the kitchen, a cottony blur in the periphery of my vision caught my attention. I whipped around and there she was, on the back patio of all places, lying in her trademark Sphinx pose, facing directly into a 45 mph gale. I froze in slack-jawed wonderment. Queenie had gone fifteen and a half years avoiding breezes of all kinds, and now, in her waning hours, she’d chosen to squeeze through her doggy door and into a blow as powerful as any she had ever encountered.

Then, as if sensing my astonished stare from the other side of the sliding glass window, Queenie turned her head toward me. For a brief, everlasting moment, her milky old eyes held mine, and then she turned to face the wind again.

I found Queenie dead at the foot of the steps the next morning. But that won’t be the image that stays with me. Instead I will remember the peaceful, almost beatific way she basked in a force that had been her lifelong nemesis until then. I’m not quite fool enough to believe Queenie was sending an explicit message to her ailing, at times defeated, daddy. But I do believe dogs offer lessons to their human guardians just by being who and what they are. Lessons in forgiveness. In not sweating the small stuff. Other things.

Face the wind, daddy. It’s okay. Face it.

How helpful are athletic coping skills really in helping us deal with life adversity?

One year ago today—on October 6, 2020—I had a bad run. It was the type of run I would have really enjoyed had I been on my game: 6 x 1,000 meters at one-mile race pace on a minute’s rest. I hit my target pace (1:52) in the first rep, but it felt harder than it should have, and things went downhill from there. I don’t quit a lot of workouts, but I’m disciplined enough to do so when I need to, and after the fourth rep I quit this one, little knowing it was likely the last speed workout I would ever do.

It took me close to a week to figure out that my poor outing wasn’t just one of those days—that something was seriously wrong with my body. Many more weeks passed before I figured out what that something was: long covid. Scientists aren’t exactly sure what this debilitating chronic illness is, but expert opinion seems to be coalescing around the notion that it is an incurable post-viral autoimmune disease. One thing is certain: After one year, many of my symptoms—including fatigue, weakness, shortness of breath, paresthesia, insomnia, exercise intolerance, and cognitive impairment—are as severe as ever.

This isn’t the first bad break I’ve suffered in my life, nor the worst. Thankfully, being an endurance athlete has instilled in me some coping skills that come in handy whenever I get blindsided by hard luck. In 2017, during a brief interregnum between one life-changing calamity and the next, I summarized my mindset as follows: “One of the biggest mistakes you can make in a marathon is to expect to keep feeling great when you’re feeling great—to stop bracing for the worst. I won’t make this mistake in my life. There will be more bad days, I know. Days of loss and grief, if not of trauma and violence. I don’t want to face these days. But when they come, I want to face them like a marathoner.”

I confess that I did not see long covid coming when I put these thoughts down on paper, but it hardly matters. All personal tragedies are the same in the sense that each of us possesses but one set of coping tools to apply to them. For me, therefore, no special effort has been required to fulfill my vow to face my present ordeal like a marathoner. The question is, how useful have my athletic coping tools actually been in their application to this health crisis over the past year?

The answer to this question varies based on which specific tool we’re talking about, as some have been more useful than others. Starting on a positive note, I have done a good job of staying in the moment throughout my waking nightmare, and I believe that doing so has tempered my misery to a degree. More than a quarter century of endurance training and racing taught me to always run the mile I was in, not getting ahead of myself mentally or drawing too many conclusions from present circumstances. If I hit a bad patch during a race and things weren’t looking good, I would remind myself that I had experienced exactly the same thing before and come out just fine. Just put your head down, keep putting one foot in front of the other, and see what happens.

The same coping mechanism has served me well during the past, lost year. I don’t waste time and energy looking back or forward, focusing instead on making the most of what my body gives me each day. I know other long haulers who have only amplified their wretchedness by looking backward, wishing what’s happened to them hadn’t, and looking forward, hoping for a miracle cure that might never come.

Other skills that endurance sports have taught me, and that I’ve leaned on heavily in this living death, are tolerance for discomfort and self-reliance. The importance of these coping tools in endurance training and racing is obvious. As former American 5000-meter record holder Bob Kennedy said, “One thing about racing is that it hurts. You better accept that from the beginning or you’re not going anywhere.” As readers of How Bad Do You Want It? and Life Is a Marathon know, I had a hard time accepting the pain of racing when I was young, but through dogged persistence I executed a slow, 180-degree turnaround, arriving eventually at a point where I regarded toughness as my greatest competitive advantage.

As for self-reliance, one of the ways in which I’ve always been best suited to endurance sports personality-wise is that I keep my own counsel and I like to figure things out for myself. Decades of experience as an endurance athlete have only strengthened this tendency. But long covid is different enough from a marathon that being tough and self-reliant hasn’t always worked to my benefit in my current situation. During periods when my misery level is especially high and I probably ought to seek medical help, I more often than not just try to ride it out the same way I do a bad patch in a race. This grin-and-bear-it approach to surviving long covid has undoubtedly resulted in missed opportunities for symptom relief through therapeutic intervention.

The athletic coping skill that has perhaps proved most maladaptive in the context of my ongoing illness is what I call mission focus. One thing I’ve always found appealing about endurance racing is its sheer simplicity. In each event, I did absolutely everything in my power to reach the finish line in as little time as possible. All other objectives were subservient to this overarching mission. If a certain nutritional product tasted awful and turned my stomach but got me to the finish line quicker, I’d use it. I didn’t give a fuck how I felt; only the clock mattered.

As you might imagine, applying the same mission focus against long covid and hasn’t served me particularly well. I should have thought it through, but instead I acted on reflex, responding to feeling terrible all the time not by taking measures to feel less terrible but by doing absolutely everything in my power to maintain the same high level of productivity I enjoyed in full health despite feeling terrible. On paper (so to speak), I’ve largely succeeded in this mission, having written three new books in the past year. The problem is I’ve had zero fun doing it. Driving myself to produce like a healthy man when in fact I am far from healthy has made my work joyless, and because work dominates my life more than ever (given my inability to exercise or do much else), my entire existence has become joyless in equal measure. The only times I ever feel any peace during the day are when I’m just chilling with Nataki and Queenie, and yet I keep failing to take the hint because, frankly, I don’t know how to take it.

So, what’s my point? My point is that, although life truly is a marathon, it’s also not a marathon. The coping skills that athletes like me cultivate through training and racing help us in many ways when we encounter adversity elsewhere in life, but they aren’t always the perfect tools for every job. While I don’t regret facing my latest challenge like a marathoner, with one year’s hindsight I do wish I’d been more strategic in selecting which specific tools to use and which ones to leave in the toolbox. I encourage you to do the same the next time something big goes wrong in your life. To the extent you can, avoid reflexively coping with whatever it is the same way you cope with a bad break in sports. Use only the tools that apply, saving the rest for the competitive arena.

Fortunately, adaptability is also a coping skill that endurance sports cultivate. Plan A never works out in endurance training and racing, so to succeed you’ve got to get good at falling back to Plan B or Plan C. My goal for year two of long covid is to do just that, specifically by working a little less and chilling a little more. Hold me to it!

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