Running from my Cough
I was feeling unusually slow and weak. It was exactly one week until the 2019 Surf City Half Marathon, and I was aiming for a new personal record, hoping to break my earlier personal record from just a few months before at the Long Beach Half.
The previous weekend I had comfortably matched my earlier pace, and thought that I had probably just pushed myself a little harder than I should have. I was also trying a new route, with a friend, so possible explanations seemed to abound.
A few days later I came down with pretty unpleasant cold symptoms. I thought I’d take my rest days to try to quickly recover, and bounce back for the race. Instead, I developed body aches, a persistent low grade fever and a fairly insistent cough. These symptoms may sound familiar now, but this is 2019, almost exactly a year before the arrival of the novel coronavirus and the COVID-19 pandemic.
At the last minute, I decided to drop out of the race. It was disappointing to miss out on the opportunity to beat my old record, but I figured I would recover quickly. I’d achieve that new PR in the spring in Hawai’i where I would be working with Hawai’i Opera Theatre, and where I figured I would have ample opportunity to train in the hills in and around Honolulu.
My symptoms didn’t clear up. My cough became a constant presence, day and night, and my fever hung on right around 100 degrees. I actually began to believe that our digital thermometer had some glitch that resulted in slightly elevated readings. It became normal in the house to hear me comment about how the thermometer was mis-calibrated, without considering whether that were even possible. What didn’t seem possible in the moment was that I was experiencing a long lasting low-grade fever and persistent illness. I’d been basically healthy since I had mono in the eighth grade, anything like a serious illness seemed inconceivable.
Almost two weeks later, having seen little improvement I went to an urgent care clinic, thinking I probably had some bacterial infection that could be knocked out quickly with a round of antibiotics. I have a deviated septum, had some sinus infections in college, and was used to occasional upper respiratory infection. This seemed like a natural, if somewhat delayed extension of that earlier experience.
I was diagnosed with bronchitis, and prescribed a Z-pack as treatment. After the five day course, I felt better, but my cough persisted, keeping my wife up at night and making me tired to the point that I had to take breaks during the day to lie down, something I had never done before.
I was a late adopter to running, starting just before I turned 30. However, over about ten years I had gotten progressively more involved, increasing distance, then entering races. Though I doubt most people would characterize me as highly energetic, I’ve not been a person prone to napping, before February 2019, when it became a necessary daily activity.
Rather than go back to the clinic, we decided it was time to go to a GP to check me out. Fortunately we live in a fairly small city, and even though we didn’t already have a family doctor, we were able to find a doctor who could see me the same day.
It turned out that the doctor herself had just gone out on maternity leave, so I was seen by a Nurse Practitioner. She said it was likely that given the length of the illness, that I had some kind of pneumonia, and sent me to the local lab (yes, there’s only one here) for a chest X-ray and prescribed me a course of antibiotics used to target respiratory infections.
In the meantime, the date of my departure for Hawai’i had nearly arrived. On top of this, I was in the middle of a highly involved project that needed to be completed before my departure, and that occupied me for 6–7 hours a day.
I adopted a routine adapted to my illness: Get up between 7:00 and 8:00; work, take a nap, work take a nap, work; go to bed between 7:00 and 8:00.
Needless to say, I hadn’t looked at my running shoes for almost about three weeks.
After a few days I felt better, but my thermometer still indicated a low grade fever (glitchy thermometer!) and, more important, I still had my cough. Concerned that my primary symptoms didn’t seem to be changing as quickly as anticipated I called my doctor to check in.
Their response was not exactly a surprise, but still unexpected. The diagnosis at that point was probable coccidioidomycosis, better known as Valley Fever.
Cocci, as it is also called is a fungal infection that often manifests as a cold, passing unnoticed. But, in some cases it develops into pneumonia, and in some rare but very serious cases can develop into meningitis.
As an unknown number cases go untested and unreported, there’s sadly very little known about the prevalence of the disease. It is common in places like California’s San Joaquin Valley and parts of Arizona and New Mexico. The CDC reports on its page covering the illness that:
“The number of Valley fever cases reported to CDC likely underestimates the true number of Valley fever cases. Tens of thousands more illnesses likely occur and may be misdiagnosed because many patients are not tested for Valley fever. “
I was sent back to the lab to get a blood test that would confirm the infection (by testing for antibodies — sound familiar?). They said they would have a preliminary diagnosis in about a day, with final confirmation within ten days. It turns out there’s only one lab that tests for cocci, at the University of California, Davis.
The preliminary test results came back the next day. Positive.
I was prescribed a daily dose of fluconazole to help my body fight the infection, and a steroid inhaler to help my breathing. They said I should start to feel better in about two weeks. That is, about twelve days into my trip.
My wife and I had to decide quickly if I would still travel to Hawai’i for work. Not only was it far from home, but doctors outside the Central Valley are not often familiar with Valley Fever. If things got worse, I would have to find a doctor in Honolulu who would feel be comfortable treating me..
I consulted with my doctor’s office. Their response was that I could still travel so long as I took it easy.
We decided I would still go.
My work schedule for the first two weeks wasn’t too intense, and I would be able to rest a good amount.
My departure day was more emotional than usual. Not only was I traveling longer than I ever had before, thirteen weeks, but I was feeling very insecure about my health and nervous about possible serious negative outcomes. After all, I had only received my diagnosis two days before.
One massive breakdown in the car later, I was on my way to Hawai’i.
My first day in Hawai’i I quickly learned the degree to which my physical condition had deteriorated. I was trying my best to appear to be well, having ensured my contact with my company that I was not contagious (which was true, you contract Valley Fever by inhaling spores from the soil) and ok to work. One thing opera singers don’t want to have to deal with is pernicious and exotic fungal respiratory infections.
It turns out those hills I had looked forward to running in healthier days were destined to prove a much more immediate challenge than I anticipated. The house I was staying at was about a fifty yard walk from the street, all uphill. Really, it may have been less, but felt like a lot more. My luggage was heavy, but I was used to lugging around heavy bags. When I finally got in the house, I had to sit down and catch my breath for about ten minutes.
Over the next several weeks I lived a pared-down life, reduced to work activities, eating and sleeping. I slept frequently, almost every free moment, for a week. After ten days I felt well enough to try a walk. I walked for 1/2 a mile, without stopping, which felt like a victory.
A few weeks later when my wife visited, we walked from the house partway up the Diamond Head, also with no problems. So, I thought, I could try to return to running short distances. Very short, one mile or less.
I still had a cough, though not as severe as it had been, more an occasional clearing out of my lungs. What’s more, I’d stopped using the inhaler and was generally breathing pretty easily.
After a handful of weeks of very short, occasional runs I had an unsettling experience. In one of those lung-clearing coughs, instead of the usual greenish mucousy mess, I noticed some very visible traces of blood. That destroyed my ambition and my faith in my own sense of well-being, and I basically stuck to walking for the rest of my stay.
In May, after I got home from Hawai’i, I had a follow up test to measure my progress with the infection. My antibody levels had increased rather than dropped, so my doctor decided to refer me out to an infectious disease specialist.
When I finally got in to see him, he said it isn’t unusual for titer levels to increase during early stages of treatment. Since the test measures antibody levels, as your body fights the infection, levels increase before they drop.
I maintained the same routine of occasional walking through the summer, sometimes longer, sometimes shorter. Home a month, three weeks in Pittsburgh, a couple of days in New York, back home again in the end of July. Walking.
Through all this, I continued with the fluconazole. A typical courses lasts six to nine months.
In August, I was given the specialist gave me the all clear to start training again for races.
But returning to running wasn’t as easy as I’d hoped.
I was acutely aware of tightness in my chest, right where the doctor told my I have “minor scarring.” I’m still not sure how much is considered “minor.” I just know that it is inexpressibly more than “no scarring.” I was much less willing to push myself.
The first week of January, 2020. We were in Nara, recovering from fairly unpleasant colds that we had fought through to celebrate the new year in Japan. I was about halfway through a training program for my first full marathon, and being sick had resulted in the loss of a few days of running. I would be running Huntington Beach a year after the half that I had scratched.
We were lounging around our room at the hotel when we saw a story on the news about a new respiratory infection that had popped up in China. It vaguely reminded me of the 2002 SARS epidemic, which I had hardly taken note of at the time. This time, however, I felt a slight panic at the thought of a new respiratory infection. I was reminded of the coughing, the waking up in the middle of the night trying to catch my breath.
Back home, I watched the development of the Pandemic with an impending sense of danger. Yet, experts in the States seemed confident that it wasn’t going to be a major problem.
I called the infectious disease doctor to see if he had any recommendations. When I asked if I should be concerned he asked if I were concerned about the flu. “Yes” I responded, “but there’s a flu shot.”
In March, I was scheduled to return to Hawai’i again for another project. I was again working on preparations for several hours a day, and also training for the Hapalua Half Marathon in April..
We all know what happened in the ensuing months.
In my case, and in that of many of my colleagues, all engagements were cancelled. I was fortunate that the companies I was working with took great care to make payments to their contracted artists, regardless their cancellations and loss of revenue.
My wife, who is a professor at the local community college switched to online teaching, and I picked up some online teaching work as well. I did a small “show and tell” concert online for a festival on Long Island in July, but otherwise stayed home. I continued to run — Virtual OC Half, Virtual Long Beach Half, but always with that acute awareness of my lung, and the concern that the tightness I experienced could betray serious damage, or worse, early symptoms of Covid-19.
I had three follow up blood tests scheduled, all of which I skipped (only one lab in town. Didn’t want to take unnecessary risks with my lung.)
Over the Thanksgiving weekend I was out running again, my regular quarantine loop through the neighborhood. I’m training for the Surf City again, this time the half, this time virtual.
As I became aware of the rhythm of my footfalls, I was brought back to a sensation that I had forgotten. I found a rhythm in my cadence that felt confident and sustainable. I wasn’t thinking about whether my lungs were tight, about whether I was pushing too hard, about what could go wrong. I remembered what I enjoyed about running, after almost two years after being recovered from cocci..
I’m certainly not at my old speed or strength. Part of it may be some kind of long-term effect from Valley Fever, part of it may just be age. But, I have come to appreciate that recovery from illness has its own timeline. I was first diagnosed nearly two years ago, I spent a good half a year sick. Then, when I no longer felt sick, I spent another six months carefully testing the waters as I waded back into something like my former life. The year since then has been a more subtle progression of changes, mostly unnoticed by me until a couple of weeks ago.
Over these months at home, I’ve read the stories about the frustration some have experienced with their recovery from Covid-19. I’m not talking about long haulers, just folks who thought they’d be back to their old selves right away, but for whom those old selves remain locked in the past. Those for whom the recovery is not what they expected.
Recently I’ve been thinking of these stories off and on in relation to my own recovery experience. The only thing that eventually worked for me was time. Time to let my lungs heal. Time to work through my fears. Time to accept who I am and move one step at a time toward who I aspire to be.
Update: Last weekend (2/10/21) I ran a half on the usual Surf City Marathon day. Finally beat my old PR, by around fifty seconds. It’s not an official time, and I had to stop for some traffic crossings, but it still felt like an important step back towards recapturing my former self.
