The Parkinson’s brain, pain, my 4x4x48 challenge, and Type 2 Fun
With only four miles to go my body wanted to give up. Miles 43 and 44, out of a planned 48, were a struggle. And those were downhill miles. They should have been easy. I stopped and doubled over to catch my breath. My house was just a few hundred yards away — best not to collapse on the concrete in full view of neighbors — get home first and crash in discrete comfort.
I felt spent and wretched. How was I to finish this?
I had a little more than three hours to figure it out.
David Goggins (the “Can’t Hurt Me” guy) conceived the 4x4x48 challenge during the pandemic when nearly all traditional endurance events were canceled. It is a test of physical and mental toughness that anyone can tailor to their particular situation.
The idea is to run 4 miles every 4 hours over 48 hours for a total of 48 miles. Most runners can readily complete a 4 mile run in under an hour thus leaving more than 3 hours of recovery time before the next 4 mile leg. That part doesn’t sound so bad. It gets nasty though during the nighttime legs when the body expects sleep. And the cumulative toll of run, wait, run, wait, run, etc. over the course of two days is significant.
I decided that it shouldn’t be that hard, really. After all, in 2021, I ran the Boston Marathon the day after running the Chicago Marathon. That worked out to be 56.4 miles in 34 hours, which included a flight from Chicago to Boston. With no logistical issues and anchored by the comfort of my home in Seattle, this 4x4x48 thing should be a relative walk in the park.
And it just might have been if not for the painful sciatica flare-up two weeks prior that put the kibosh on my training.
The signature feature of Parkinson’s disease (PD) is a deficit of the neurotransmitter dopamine, which is critical for a person’s motor functions. Typical symptoms are uncontrollable tremors in the arms and legs, slow movement, balance issues, stumbling, and falling.
PD is progressive. As time goes on, symptoms worsen. Medication helps by replacing the lost dopamine thus reinvigorating some motor functions but it does not affect the progression. To compensate, a Parkinson’s patient typically must increase their dosage of medication over time to manage the symptoms.
In the worst cases, the disease progresses beyond the point that medication has any positive effect. The latter decades for a person living with PD can be excruciating for them and for their caregivers.
Despite much research on the disease, there is no cure. Vigorous exercise, however, to the tune of at least 150 minutes per week, can slow its progression. Yet, there is no limit. The more exercise, the slower the progression.
That is why I run as much as I do. It is also why I test the limits of what my body can endure.
Indeed, how much exercise is needed in order to reverse Parkinson’s? That is a data point worth exploring.
Many of my running adventures are best classified as “Type 2 Fun”. Unlike Type 1 fun — which is, simply, fun — Type 2 is only fun after it’s over. Type 2 activities are not enjoyable at the time but stir feelings of pride and accomplishment upon completion.
That positivity is critical for maintaining the proper mindset for living with Parkinson’s. I get that positivity by taking on nutty running challenges.
Besides the lost dopamine, there is evidence that Parkinson’s disrupts the workings of the autonomic nervous system (ANS) via damage to a part of the brain called the hypothalamus.
There is a vast array of non-motor symptoms that a Parkinson’s patient may experience. Constipation. Excessive sweating. Muscle cramps. Sleep disorders. The list seems endless. All due to a defective ANS.
Pain is also managed by the ANS. In an act of self-preservation, the brain triggers a painful sensation when it is necessary to prevent the body from harming itself.
My interpretation: The damaged ANS in a person with Parkinson’s can create a heightened pain response even in situations when the concern is not warranted.
For example, in response to the signals from my pinched sciatic nerve, my brain has decided to make my right butt cheek hurt and the pain radiates down to my ankle. That’s sciatica and the pinching is probably being done by my piriformis muscle. It’s often known as piriformis syndrome.
I know that sciatica is not a “real” disorder. Although there is pain, it is not like that of a torn tendon or broken bone. Continuing to exercise in disregard of the pain, assuming that I can endure it, won’t destroy tissue as would a stress fracture or muscle sprain.
Performing stretching exercises designed to open up the channels where the sciatic nerve traverses — thus preventing the pinch — is a potential therapy for sciatica. My runner friend, Dudley, suggested this via some online videos after we compared notes on our sore butts. When I performed the routines that Dudley sent me, the pain, although still present, diminished greatly. Ibuprofen helps a bit, too.
Thus one part of my plan for dealing with the sciatica pain was to just live with it. In addition, I’ve noticed that running up hills doesn’t bother me as much as on the flats. Possibly that is due to an imbalance between my stronger quads and my weaker gluteal (butt) muscles (i.e. quads dominate on the hills.) Gotta fix that imbalance eventually.
I decided to make the first part of my 4 mile loop uphill (~400 feet) to give my butt a chance to ease into it. That had the added psychological advantage of knowing that once I got to 2 miles in to a loop it was all downhill from there.
Another questionable choice I made was to begin the first of the twelve 4 mile legs at midnight Saturday morning. That way, the entire effort did not stretch into a third calendar day.
With 4 hours between legs, there was no time pressure for each running segment. I started each leg off tentatively, attempting to ease into the pain and to overcome the awkward gait that sciatica was causing.
I never sleep all that well. That’s typical of Parkies. I rise frequently through the night to pee and often I experience a few hours of insomnia. However, I am a champion napper, and I regularly take an hour long mid-day siesta. This skill worked well for me. Between segments, I found it relatively easy to get one to two hours of deep sleep and usually woke up before my alarm went off.
So as not to disturb my wife, Lynn, I set up camp in one of our guest rooms. I settled into a regular sequence. Run, cool off, hydrate, eat, change clothes, sleep, rise, pee, repeat.
As one might expect, hydration and fueling were critical variables. Temperatures were high throughout and I know from experience that this is my kryptonite. I sweat a lot and I have a high concentration of sodium in my sweat. Without appropriate replenishment, I get horrific leg cramps. It is another one of those Parkie things — the ANS does a poor job of core temperature regulation. Sweating is excessive and that deprives the body of sodium needed for proper muscle contractions.
After each leg, I drank at least two liters of water and consumed roughly 2000 mg of sodium through a combination of Tailwind Endurance Formula, Zym tablets, and SaltStick electrolyte capsules. With this protocol, leg cramps were minor.
To most runners, that amount of sodium replenishment would seem excessive. I would agree except that I recently bought a hydration meter to wear while running and I have data to support my strategy. Since acting in accordance with the data, I haven’t had serious cramping issues. I do often have nausea after a hard run on a hot day but the nausea subsides with adequate sodium intake after the workout.
I chose to avoid any conventional meals for fear that the digestive burden would bring on nausea. Rather, I stuck with snacks of Tailwind, Untapped Maple Syrup gels, cookies, lemonade, potato chips, and Ritz crackers for my caloric needs. Carbs all the way.
Many runners with PD modify their medication schedule to take best advantage of their effects. Some experience “OFF” time when the meds wear off and dangerous symptoms emerge (read: stumbles and face plants). It can be tricky to get the timing right because “ON” duration can decrease during exercise — i.e. the well dries up faster while running.
For whatever reason, that doesn’t happen with me. Some of my bonks during a race or long runs may be due to inadequate meds. It’s hard to say. But I’ve never experienced a performance boost by taking a pill mid-race earlier than usual. Therefore, I decided to stick to my normal med cycle of Sinemet every four hours (6 am, 10 am, 2 pm, and 6 pm) and Selegiline at 6 am and noon.
I chose segment start times of midnight, 4 am, 8 am, noon, 4 pm and 8 pm. That made the 4 am segment the least medicated of them all and I was curious how that might work. Interestingly, during the 4 am leg on Saturday my running was stiffer and more sluggish that usual but these feelings did not return on Sunday at 4 am. Hence, I have no data to suggest a better optimization of my med cycle.
I should note that the 4x4x48 was the first of three running challenges I set for myself this summer as a fundraiser for Team Fox of the Michael J. Fox Foundation for Parkinson’s Research. If I survive them, I will report on the other two in future posts to this blog.
A month or so earlier, I told Lori, one of the owners of my favorite running store, West Seattle Runner (WSR), of my plans and she spread the word to the local running community. Lori thought that some runners would want to run some of the legs with me. Hence, I chose my 4 mile loop to pass by the store a little beyond the half way mark.
As I approached WSR on my third (8 am Saturday) leg, a group of runners were waiting for me. Though Lori said this was likely, I didn’t expect it but was very happy to have them join me for the rest of the leg. I nearly always run alone but having company for this challenge was an enormous emotional lift.
Among them were Sarang, Shawna, Luis, and Brian. Brian and I are in the same age group and compete in local races. He always beats me. I met Sarang earlier this year and we both ran the Tokyo Marathon in March. This was my first time meeting Shawna and Luis. We cruised downhill and chatted about upcoming races and Sarang’s newborn daughter, snapped some selfies, and then parted ways at the Puget Sound shoreline near my house. As I headed home, the rest of them ran off to complete their planned 11 mile workout.
My segments at 4 and 8 am were the most tolerable with the temperature at about 60 degrees both days. By noon, the mercury reached the 70’s. Difficult but not too bad. But the 4 pm legs were in the 80’s and those were dangerous. I wore my hydration meter on the Saturday 4 pm and it reported over 3600 mg of sodium loss or about 900 mg/mile, which was a record for me.
Each run segment left me a bit wasted but I soon found that I regained my senses within 20 minutes or so by dousing with cold water, hydrating, and downing some carbs. To keep the pain level tolerable, I did the prescribed sciatic nerve stretches after each segment. I also needed about 20 minutes of just puttering around after the nap in order to get back into running mode.
The 8th leg was at 4 am Sunday. I was happy to complete that one because that meant that the nighttime ordeals were over and I no longer needed to wear a headlamp while running. Sidewalk trip hazards on the route were prolific. Falling at night was a real concern of mine and might have ruined everything.
At 7:30 Sunday morning, my friend Andrew (also a Team Fox member) texted me to ask if I wanted company on the next (9th) leg. Of course, I was delighted to have him along. He’s a good story teller; chatting with him allowed the time to fly by.
Andrew was the first companion runner to experience the steep hills of the first two miles and suggested that maybe I didn’t really need to be so hard on myself. By then I had already come to doubting that strategy but figured I was locked in. Besides, after that leg I only had three more to go. What could go wrong now?
Afterwards, Andrew took off to finish the rest of his 9 mile run. At the beginning of the Sunday noon segment I saw Ty, another local running friend, passing by my house very quickly. He, too, offered to join me. He had tracked my progress on Strava and was sprinting down my street because he thought that I had already left for the next loop but slowed down when he saw me.
Ty is very fast. We both ran the Boston Marathon this year and he finished more than an hour ahead of me. Boston was hot this year, about the same temperature as this 10th leg, 73 degrees. Ty apparently does not have as much difficulty with heat as I do. I warned him that I would be very slow but he brushed that off saying that he was good with whatever pace I set.
Running with someone significantly faster can be off-putting. They look as if they could comfortably walk at that slower pace. I got that impression with Ty. My leg was an 11 min/mile detour of his otherwise sub-8 minute paced long run. But Ty is polite. He maintained a “running” posture while I trudged alongside him on that opening uphill. Ty works at Boeing. We had a lot to talk about given the very public struggles of that once venerable company.
After some more selfies, Ty ran off and I headed home with only two more segments to go. I was feeling pretty good having had wonderful company on both of the two previous legs and I already had heard from two other friends, Erica and Erika, that they would run with me on the final leg at 8 pm. 40 miles down and a lovely end to this ordeal was in sight.
The temperature rose to 85 degrees by 4 pm for the start of the penultimate leg. At the top of the hill that joyful feeling of “It’s all downhill from here” I had grown accustomed to was absent. I have run in extreme heat before so I knew the feeling: utter depletion and with every step a struggle. I knew that I could just walk it in if necessary but I refused. This was a running challenge, damn it.
At the 4 mile mark, I was light-headed and weak. Walking to my house I was unable to keep to a straight line. It occurred to me that this was potentially serious. Heat stroke was a possibility.
Fortunately, prior experience and research prepared me for this scenario. In fact, I have written about it on this blog.
I was at an early stage of “heat exhaustion”, which features dizziness, nausea, fatigue, weakness, irritability, muscle cramps, and unsteady gait. It is not as bad as heat stroke but is a step along the way. Treatment must be rapid and decisive. As I entered my house, I chirped a cheerful “Hi Lynn!” to my wife and headed straight to the bathroom for a cold shower.
My first priority was to bring my core body temperature down, which was probably dangerously high, at least 100 degrees. But I didn’t want to shock my system with very cold water. I got in with the water lukewarm and gradually dialed down the temperature. After about 10 or 15 minutes the fog lifted and I knew I was in the clear.
Still a bit weak I started in on hydration. For the first time in the challenge I felt some muscle cramps but eventually they dissipated as I executed my hydration plan.
The body amazes me with its adaptability. We are all capable of so much more than we might think. After a 75 minute power nap I felt strong enough to go for it. And the outside temperature had cooled off some too. Good thing. I did not want to disappoint Erica and Erika.
The ladies showed up just before 8 pm and Lynn took some photos of us. Both of them are faster than me even on my best days. I warned them not to expect too much. Like everyone else, they dismissed my objections and let me set the pace, which was becoming comically slow on the initial uphill. They also suggested I needn’t have selected such a hilly route. Erika wondered why I didn’t pick a flat out and back.
“I could have,” I quipped, “if I wanted to do this the easy way.”
The leg went by happily and without incident. We talked about upcoming races and injuries. I told Erica, who is Dudley’s wife, how his suggestions helped me to tame my sciatica somewhat thus allowing me to follow through on the challenge. She chuckled a bit when I referred to Dudley as the “Sciatica Whisperer”.
Erica reported that she recently came down with frozen shoulder — a baffling and painful ailment that can come on after age 40 and is most common in women. The two of them discussed the condition although I didn’t have too much to add other than the fact that Lynn has had it and it takes a godawful long time for it to heal.
Once again, having company made the leg fly by and the lower temperature meant that I did not suffer much. Though the challenge was intended as Type 2 fun, the thrill of having friends join me brought it delightfully close to Type 1 fun.
The next challenge is coming up soon, August 18. For that one the format is modeled after a Backyard Ultra wherein each leg of 4.17 miles must be completed in an hour at which time the next one starts. I am attempting 12 such loops for a total of 50 miles in 12 hours. I’ve never run that distance in a single day.
Erica, Erika, Andrew, and others have committed to joining me on that one too. They expect to take turns accompanying me on the loops and so I am anticipating a lot of Type 1 fun.
Pacing will be key as will be managing the heat. I intend to run at a 11–12 minute per mile pace, which would allow 10 or so minutes of recovery prior to the subsequent leg. Although the route I am considering is different than the one I used for the 4x4x48, it is still front-loaded with a steep climb.
It threatens to be more difficult than the 4x4x48 and I have my reservations. But I will give it a go. The current forecast calls for cooler temperatures than what I just worked through. And perhaps my sciatica will heal some before then. And maybe I go with a less strenuous route.
The worst that can happen is that I fail. I can live with that. I don’t think that I would be happy with not trying.
