Thursday, September 13, 2012

How Sick Is Too Sick?

It’s that time of the year again. If you listen closely, you can hear it everywhere. Coughs, sneezes, the occasional gag. I was at the high school the other day and some kid left the health office with his mom and proceeded to throw up all over the front of the school.  Welcome back germs!

We are moving into it: the sick season.  Flu shot clinics and warnings about the whooping cough epidemic surround us (26,000 cases just this year). Don’t even get me started on the number of people walking around with strep throat and stomach viruses. I’m just hoping to escape the measles this year.

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Illness and running don’t always mix. But, we runners are a stubborn bunch and sometimes it takes nearly aspirating forty gallons of phlegm before we’ll back down from a planned training run. I’ve always heard that the guide for running or not running while sick is the “neck rule”:

“Symptoms below the neck (chest cold, bronchial infection, body ache) require time off, while symptoms above the neck (runny nose, stuffiness, sneezing) don't pose a risk to runners continuing workouts.” {source}

Makes sense to me. Apparently, if you run with a fever, you can actually make yourself much sicker because you elevate your body temperature even more. I would also add the obvious – no running until the vomiting and diarrhea have completely left the building. No one wants to see that.

One tough thing about getting sick while training is knowing where to pick up after you’ve taken off from running due to illness. A reader (who is one month out from her first marathon and has been suffering from pneumonia for the past 10 days) brought up this question:

“I wanted to ask about people's experience with time lost due to illness (vs. injury) and getting back into training.  I unfortunately can't even cross-train at this point.  Should I expect that it will be hard as hell when I get back out there?  I think that by the time I get back to running, it will be taper time, and I may need to defer my scheduled marathon and find another to run the next month.”

Yes, it will be hard as hell.

I am not a doctor and have no clue what I am really talking about, but some of this seems to be common sense. That said, probably a good idea to ask Meredith Grey or someone like that.

My two cents:

I think deferring a marathon due to illness depends on the severity of the illness, how much the sickness will set you back and where you are in your training plan. If you are in the middle to end of marathon training and are going to miss more than two long runs, maybe you should postpone your race.  I think with more severe illnesses, you have to be careful to not set yourself back even more by doing too much too soon. Certainly pneumonia affects breathing and that’s not to be messed with.

Ultimately, you have to decide what kind of a race you want. Know that if you run and are still recovering, you will likely be slower and weaker than you’d like. It may be a better idea to wait until you can run the way you really want to. It’s cliché, but there is always another race.

Bottom line: ask your doctor. Hopefully he/she is a runner and “gets” how much running means to you.

Have you ever had to take major time off or miss a race due to illness?

Would you advise this reader to run her race or to postpone?

SUAR

30 comments:

  1. I was supposed to run MCM next month, but was diagnosed with pneumonia almost 4 wks ago. I still have the cough and am just getting back into running. There's no way I could properly train after losing this many weeks. It totally sucks, but I set my eyes on a new goal for February and deferred MCM until next year. This pneumonia completely knocked me on my ass. :(

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  2. This is a topic that will bring me to high anxiety!!! Most of us sign up several months in advance of races (fear of some selling out, etc) and then as you get closer, you realize you are getting sick, getting a raging period, or whatever other obstacles of life intervene. My two cents - if I were SICK, regardless of upper neck or below neck, and really just not feeling well, I would postpone. Sure you eat the cost, but as long as it wasn't a ridiculously high priced marathon cost, it's not the end of the world. There are always many more races to do! Plus, a full marathon is no picnic. Perhaps running a tad under the weather for a half isn't as disastrous, but I can't imagine being sick out there for 26.2 miles!

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  3. I'm a big believer in not running if the crud is below the neck--I've learned the hard way from this. Ditto on fevers--don't mess with it. As to what to do if you're sick and it's a big race--this is a tricky one. We can always slog through if necessary but potential long-term damage might not make it worthwhile. Tough question!

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  4. I think that once the reader gets over the illness and goes out on her first post illness runs she will know how much it has set her back. I guess I would be in the wait and see camp. Without knowing the reader's goals or pre illness running fitness hard to say. I agree though, there is always another race.

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  5. I definitely fall into the stubborn category. I know the neck rule, but I have been guilty of not following it.

    I had bronchitis when I ran my first half marathon. To top it off, the antibiotics gave me very icky tummy troubles. 24 hours leading up to the race, I had only been able to keep down one slice of bread and a little Gatorade.

    Should I have run that race? Absolutely not. But I did. It was the toughest race I've ever run. It hurt like hell. And I ended up taking 3 weeks after with no running at all. I know I prolonged my recovery by simply being stupid.

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  6. I'm currently debating deferring my mcm ... my hip flexor is giving me hell. Thanks for this. :)

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  7. Ugh. I sympathize with anyone in this situation as I've been there myself. At one month prior to a marathon, you are usually in the peak of your training. It seems like missing 5 or less days and you could still salvage your race (and goal time). More than 5 days and it would probably start to impact your level of readiness. Although 5 days is arbitrary, it just seems like 10 days would be hard to recover from without seeing lasting effects.

    I'd say you can still recover and run the race but you just have to adjust goals, which is so hard and frustrating after putting in so much time, effort and miles...

    Personally, one thing I will NEVER do again is start a marathon knowing I will likely drop out. I had IT band issues when training for the NYC marathon one year. But the trip was all planned and I still wanted to experience the start of the race, etc. I started it knowing I couldn't finish it and ended up hobbling off the course at mile 7. It was SO HARD to have to leave the course and then see everyone at the finish line wearing their medals proudly...while I was hobbling around with a bag of frozen peas on my leg.

    I would advise her to run it only if she really thinks she can finish and if she is okay with possibly adjusting goals. Good luck to her!

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  8. Tough call - I had to give up my first half marathon this coming weekend for a torn ligament in my ankle, and I keep asking the ortho doc if I can still do it. I don't know if I would chance it with pneumonia. I might pull up my big girl panties and do the race with a head cold, but bring tissues and nasal spray in my bra. I think knowing I could make myself worse by trying to perform if I were that sick would be enough to sideline me.
    I think the mental aspect of sacrificing our time off, family time, sleep time and getting in all that training to get to the point where we can perform and do what we set out to do is what calls into question our inability to call it quits and take care of ourselves.
    I use the simplest method possible. If I am sick enough that I would've stayed home from work, I am too sick to run/train/laundry/grocery shop/dishes/vacuum/clean.
    Amy P.

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  9. I once got pneumonia a few weeks before a 74 mile bike race. I was starting to feel better but my Dr. said "NO RACE!!" Did I listen? No, I did not! To be honest the first 15 miles or so I was having a hard time breathing...no big deal ;) After I got past those first miles I felt great. It's always hard to know when to take off and when not to. I probably could have caused myself some serious issues but I had warned my husband that I could be calling for him to pick me up. I will say thst running is much harder than biking, at least in my opinion it is. When it all comes down do it, you know your body and you know what you can or can't handle. I knew I could do the bike race and I did it and was fine.

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  10. I ran my first marathon this year. I was completely healthy, but it was still hard. I've also had pneumonia in the past. I cannot imagine trying to run a marathon afterwards - I remember running through LAX while still recovering and it about killed me!

    My 2 cents - I wouldn't run my FIRST marathon in these conditions. I think the first one is very hard mentally, and if you DNF, you may never want to run another one again.

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  11. I'm currently postponing a 10-miler due to an injury (not quite the same as an illness), but as someone who normally runs through illness and injury, I'm going to go with you on this one.

    Reader: Listen to your body. If you're not able to do it, see about switching to a half or 5K (if available) that day so you can still participate. Take care of yourself. There are always other races!

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  12. "…we runners are a stubborn bunch…" hahaha! Don't candy-coat it…let's go ahead pull out the "o" word… obsessive :)

    Pneumonia is nothing to mess with. I'd suggest she postpone…even beyond the following month. But then again I don't know her sports history other than this being her first marathon. Knowing her training habits would factor into a recommendation.

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  13. While your thoughts on this matter are insightful (as usual), the part that struck me was the way the post shows up in my Blogger Reader thingy :

    "How Sick Is Too Sick?" Shut Up + Run.
    lol. It looks like you're asking and answering the question all at once...

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  14. Hmmm I am not a good person to ask about this one. I ran a marathon with walking pneumonia and PR'ed but I am stubborn like that. What I usually do is go to the doctor and tell them my intention is to run and that there is not much that will stop me. But if they can come up with a reason that I really shouldn't I won't. Stubborn much?

    Really though, I think it is what you feel you can do. Just the way you are feeling should be a good measure as to whether you are capable of running or not. With walking pneumonia I was still going to work and commuting in and out of the city, so I knew I still had the energy.

    Know your body and know that there are always other races out there.

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  15. Does she have speed or strength work as a component of her marathon training? If so, and she isn't able to maintain her previous pace, it will be tough both physically and mentally. Results that are far short of what you anticipated (been there) are difficult enough when you are neither ill or injured.

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  16. I really follow the neck rule! I find when I have something above the neck and run/workout, I feel a million times better. That said, my 10k PR was run with a brutal chest cold. I felt AMAZING until about 3 minutes across the finish line when I wanted. to. die.

    Illness hasn't kept me from a race but I did postpone my first half marathon due to some Achilles/heal pain. I slowed my training substantially, stretched more and started using tape and it got better fairly quickly.

    My experience with pneumonia is bad. The two times I had it were near-fatal. For me, I probably would be out of commission for a long time and the marathon would be the least of my worries. If I were her, I wouldn't chance it. Especially not for my FIRST.

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  17. Depends on her goals for the race. If she is out to kill a PR then I would definitely defer. If the goal is simply to finish and be ok that the time will not be what you trained for, then she can do it. Although bronchitis, pneumonia ain't nuttin to truck with! I ran a half marathon with bronchitis and it was literally the worst thing ever.

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  18. Pneumonia, yikes, nothing to mess with. I'd go with postpone. Short term pain and frustration but too much risk in doing it. 9 years ago (yikes) I was training for a mid/late October marathon, training hard, and flew to a job interview in September. Yep, I came back with what I thought was a cold but that had me coughing up green gunk out of my lungs. Took me several weeks to get over it. My sister had to work hard convince me to downmode to the half - and after that, when I got to the location, I talked myself down to the 5k (still my 5k PR and 2nd in AG) but I finished knowing I couldn't have done more even though I'd been healthy - I shudder to think what I'd have done to myself if I'd gone further. (and a word of warning - the next year, I REALLY pushed my training because I wanted to run THAT marathon, darnit! I trained myself right into posterior tibial tendinitis, or at least that's what I found out it was AFTER I was on great pace till mile 20, stepped down and was in so much pain I thought I broke my foot....then I walked/jogged the rest of the way (dumb) - still working my way back from that 8 years later, trying to get solid and faster at halfs before going back to fulls).

    It's so disappointing and frustrating - and kind of depressing - to step away when you've worked so hard. But you want to be healthy and able to run the next race, and the one after that....hang in there.

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  19. Easy call..she needs to postpone. Marathon running takes a huge toll on the body, including the immune system, which can last for a period of time after the race is completed. Since she is already taxing her immune system, fighting the pneumonia, she is already behind the eight ball, so to speak. Even if she successfully completes the marathon--which I expect she could--she is risking putting herself at risk for more serious illness.

    Is it worth it?

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  20. Just my personal experience here: I got very sick twice while training for my very first marathon. I missed 3 key weeks of longish runs. I tried to ramp training back up quickly, and I almost immediately got sick again, a vicious secondary infection with a 105 F fever. I ended up with a very abbreviated training cycle with just one long run of 20 miles. This left me extremely undertrained and still a little ill on marathon day. I had a very rough race (try running a marathon with a hacking cough. Not fun) and I got sick AGAIN the next week! Make sure you are totally healed before stressing your body again, and if you missed key runs or two long runs, adjust expectations or defer.

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  21. I almost postponed a trail half-marathon this past February because I was under the weather for about 3 weeks with a cold that progressed through every part of my body. Fortunately, it moved in reverse from how I normally get sick - it was bad at first, then eased up to just a head cold - so in the last week of being snotty I was able to start getting some tempo runs back in to build confidence for my race. Basically, you have to just go by how you feel. If you try a run or workout and feel WORSE afterwards than when you started, that's a cue that you need to wait at least another FULL 24 hours before you try it again. Drink tea, rest, and if you go stir-crazy, try just going for a walk in the fresh air!

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  22. OK let us see, there are a lot of things one needs to know before you can make that call...

    How much was she running before she got sick?
    how long was her taper planned for?

    with that in mind, If she can put in a full weeks training / running before the race, I would go for it and run the marathon... Forget about the taper, train hard for that week ending 3/4 day before that race, I don't think you would need a longer taper (rest period) than that after having 10-14 days off...

    Good luck.

    As of me, if I was walking again I would run!!!

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  23. Greetings from the UK! Great blog Beth.
    Paris Marathon 2010. Training was great all the way through until 2 weeks to go.....flu and fever. Hotel and flights booked for ages so decided to carry on. Finally finished puking two days before the race. Putting one and a half hours onto my previous marathon time has left me with unfinished business so we're heading back in 2013, fully fit hopefully!

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  24. I've heard of the "neck rule". If my head is pounding, I can't bear the thought of running.

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  25. So glad I found this...I'm running Berlin marathon in 10 days and right now am suffering from bad diarrhea, sore throat and a rather horrible snotty nose, headache etc. Basically I feel real bad :-(

    In a way I'm glad it happened this week and not next but will I be recovered in time? And how will it effect my race?

    I'm feeling so weak and sorry for myself :-(

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  26. So glad I found this...I'm running Berlin marathon in 10 days and right now am suffering from bad diarrhea, sore throat and a rather horrible snotty nose, headache etc. Basically I feel real bad :-(

    In a way I'm glad it happened this week and not next but will I be recovered in time? And how will it effect my race?

    I'm feeling so weak and sorry for myself :-(

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  27. I ran a pb at limerick marathon with pneumonia. Really sick for 9 weeks. Bed all week prior and after. Vomiting and coughing on course all around but got there.
    Ironman in a few months time. Trying to train but finding it difficult. Second time with pneumonia. Sick of being sick.

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  29. I have this problem. I am racing in 2 days, my first half marathon. I have a cold, which has lasted 5 days and I just cannot breathe at all right now. I have just trained myself out of getting a stitch, by controlling my breathing. I am worried now, if I do run, how will I be able to focus on the correct breathing. Any tips?

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  30. I would just like to add something which now makes me think twice about training with a virus. A very good friend of mine caught a cold virus last year, went to the doctor who said he should not do any strenuous sports activities until the symptoms have cleared up. Being a stubborn runner, he ignored the advice and went for a run the next morning. The virus had, unbeknown to him, attacked his heart muscles and he died later that day from heart failure. Whether he would have survived had he not gone for a run is uncertain, but I think it would have put the heart under added stress. My advice is that if you are unsure whether you should run or not, take a break until you feel good again.

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