Have you ever run a marathon, half-marathon, or any long distance race? The amount of training and dedication that leads up to a race is, for lack of better words, intense. I spent most weekends clocking in a long run that lasted up to 3.5 hours and I was running, at the most, 9.5 hours (~65 miles) per week. So, with those miles and training under my belt, I found it extremely difficult to consider foregoing the marathon, even with lasting negative effects from my first (and only) 3 TMS sessions. I was motivated to push past my cognitive problems, as I was told by the doctor and staff that the adverse symptoms of TMS would subside within mere hours after treatment. But, that didn't happen.
To catch you up, the first post I wrote on this topic My Experience with Transcranial Magnetic Stimulation (TMS) discusses what led me to seek TMS, my experience with the psychiatrist and staff, the three sessions, and the resulting effects. This post is the story of how I tried to run a marathon after those three TMS sessions. It is about how TMS denied me from achieving my healthy year-long goal.
Please Note: I am in no way bashing candidates that had successful TMS results. Rather, I am spreading awareness about possible adverse effects to counter the overwhelmingly positive internet search results. TMS did not work for me. In fact, I had serious consequences after only three sessions, and I believe these need to be discussed, studied, and readily available to those considering it as a treatment option.
If you are unfamiliar with TMS, please read: TMS is a procedure in which a technician uses a device, containing a magnetic coil, to send electromagnetic pulses into a specific area of the brain. The idea behind this is that electromagnetic stimulation of brain cells will encourage neural rewiring. After an initial brain "mapping" session, the typical time commitment for treatment is about 56 sessions over 6 to 9 weeks. During each session, 3,000 electromagnetic pulses will be sent through the brain in under 20 minutes. These pulses are broken up into pulse pattern groupings with several seconds of rest between pulse groups. These electromagnetic pulses have a frequency of 1 Hz (1 pulse per second) or high-frequency pulses at 5 Hz to 10 Hz (5 pulses per second to 10 pulses per second) depending on the settings. The strength of these pulses also vary from 1.5T to 2T (T = Tesla).
During my treatment, the staff placed the device on my left prefrontal cortex about 5 cm superior to my motor cortex (the area of my motor cortex which controls finger movements).
If you are curious about what I am calling a "TMS utopia", please refer to this article from BMC Medical Ethics which discusses the difference between how academic and print media portrays TMS.
Okay, let's get to the topic of this post: How My Marathon Went Post-TMS
Since my last blog post finished with the third day of TMS, I will start there. I was planning to run a marathon three days after my third treament. I was assured by the doctor and technicians that my now-constant headache, feeling of depersonalization, and other ailments would be completely gone by the day of the race, July 4th.
In fact, if you research TMS online, there is an overwhelming amount of information that says that lingering symptoms such as twitching or unusual feelings in your head only last a few minutes after treatment, but even these symptoms are extremely rare. Other symptoms that are mentioned are:
Headaches
Pain in scalp or neck
Dizziness or lightheadedness
Tingling in muscles
Sensitivity to sounds
Other sources like Healthline or Cleveland Clinic or even the Mayo Clinic also suggest that these symptoms disappear after several sessions and can be mitigated through use of pain medications.
So, with the information I found online and with advice from my psychiatrist, I believed that my brain would adapt to the treatments after three days of recovery before the marathon.
For me, this was not the case.
The days leading up to my race, I had a headache. But it was not normal. It lasted all day and varied from wrapping around my head like an anaconda squeezing its prey, to sharp violent pain around the TMS treatment site (left prefrontal cortex about 5cm above the motor cortex).
On Saturday (July 1st), the day after my third (and final) TMS session, I woke up with flu-like symptoms. My body felt as if a mack truck slammed into me, and then had a WWE wrestler peel me off the asphalt and body slam me. Ibuprofen didn't help. Additionally, I found it difficult to recall words. It felt like my brain had words and letters scattered, like scrambled eggs, but I was unable to assemble them for cohesive thoughts. My husband and stepdad observed that my verbal communication was noticeably impaired. Despite these symptoms, I was still determined to run. After all, I had trained for 5 months for this one race! My biggest hang-up was the flu-like symptoms, though I stubbornly ignored the constant head pain. I secretly told myself that if these persisted, I would not run.
On Sunday (July 2nd), my symptoms had not improved, save for the body aches which were less intense. The head pain remained. I tried another over-the-counter painkiller, with no success. My hubby and I spent the day distracting me with race preparations. We went to the craft store and got an American flag towel, plates and napkins for post-race snacks. I laid out all I would need before, during, and after the race, from sunscreen to homemade oatmeal banana cookies.
On Monday (July 3rd), the day before the race, there was no improvement. My husband and I jogged together for a couple of miles very slowly to focus on blood flow and gentle movement. Afterwards, we spent the rest of the day trying to relax by distracting me from the pain with movies and snacks, since every painkiller we bought failed to provide relief.
On race day (July 4th), I woke up with the same lingering headache that felt like a pressure cooker, but not as severe as the anaconda wrapping itself around my skull. Along with the slightly reduced headache, I no longer had body aches and a sore throat, so I took this as a good sign to run.
During the drive to the race, I tried to stay in good spirits but my husband and I chatted about the very real possibility of not being able to accomplish my goal time, or not even finishing the race at all. I was well aware of the possibilities, but I did not want to quit before giving it a shot. Running has always been my outlet to let go, escape, and feel most like myself. I felt that if I didn't try, I would be worse off.
Because I was cautious of my head pain and wanted to avoid burnout, I started off slower than I originally planned. I knew that my head had the potential to be an issue and I didn't want my body to hit a wall. After the first 4 miles, I felt great. I was so focused on pace and running steady that I didn't notice my headache as much as at the starting line. Despite the runner's high, I tried to be disciplined and made a goal to break up the marathon into bite-sized, manageable chunks of four 6.5 mile sets. I would gauge myself every 6.5 miles and, if I felt ready, adopt a faster pace. I would not increase my pace unless I felt my head was ready.
For a breakdown, I aimed at running 8:45/mile the first 6.5 miles. Then, the next 6.5 miles to complete the half-marathon, my goal pace was to play with my goal race pace of 8:15/mile for one or two miles, but average 8:30/mile over the second set. For the most part, I stuck to this plan. Then, my third set of 6.5 miles I planned to ease back into an 8:45/mile to gauge my head. My hope was to finish the final 6.5 miles with an 8:20/mile average or even my goal race pace if I felt up to it.
At the half-marathon point (13.1 miles), my head started pounding a bit more and I tried to refuel with pickle juice, pineapple, and honey every mile or half-mile for an extra boost. My standard practice was to fuel every 40 minutes with electrolytes and small bits of food. However, 13 miles in, I felt I needed more energy and couldn't determine if my head was aching from TMS or from lack of calories (which has never been the case for me).
Around mile 16, I decided to grab my honey packet (Three Peaks Manuka Honey). The boost kicked in at mile 17 and seemed to do the trick, so again I reached into my running vest and grabbed my honey, but it slipped from my hands. I did not notice any severe pains in my body and my slightly-more-intense headache felt manageable, so I bent over to pick up the honey...and that was the catalyst.
My headache soared in intensity and it felt worse than ever.
I took small breaths of air and kept my eyes on the turnaround as a goal, hoping that the downhill would shake off the pain. Instead, the pain intensified.
My skull felt as though it was being stomped on by an elephant. I could feel my cervical spine compressing to the point of snapping at my twisted vertebrae (I have a twist around C3).
From mile 16 to mile 18, I only thought about my plan going forward - walking to the finish, stopping and trying to regroup, or quitting. I pushed myself to keep going and gauged my pace each mile. Downhill I was running a 9:40/mile, so I figured the last 6.5 miles I would slow to a 10:00/mile or more. I was fine with throwing out my goal time, and thought finishing would be solid enough. I kept taking small gasps of air, since a large inhale and exhale only seemed to aggravate my head and neck. I kept my eyes forward and kept jogging. I couldn't turn my head from side to side without making my headache worse, so I just tried to pick a goal ahead of me on the course and make it there.
At mile 19, I saw my husband and two dogs sitting on our patriotic beach towel and decided that it was a sign to quit. I didn't want to give up, but I feared that my headache was something more serious and shouldn't be played with lightly.
You know, marathoners always talk about the last 4-6 miles as a pure heart-and-head challenge because your body begins to break down muscles and tendons after 20 or so miles, and this is true. But for me, I didn't reach the body shutdown phase. I felt like my body could still run and finish if only it was attached to a different head. The headache level was certainly severe, but the fear of not knowing what TMS did to my brain, plus the fear of not knowing what additional damage I could incur should I have kept going, was all the motivation I needed to quit.
There are a lot of lessons in running and I am thankful for them all, but one thing that this race taught me over all other past ones was that no race is more important than my current and future health. That feeling of crossing the finish line and receiving that finisher's medal around my neck, while insanely satisfying, is no way more important than my ability to heal and run well into my old age. So, I walked away from that race disappointed, but hopeful that future Jordan will thank me when she is safely and healthfully running marathons later down the road.
This was the point when I realized that TMS "treatment" had actually harmed me, and was potentially much more dangerous than the psychiatrist and technicians led my husband and I to believe. It's a scary realization, but by mile 19 I knew I needed to focus on healing and seeking help in understanding what happened to me.
Now, it is time to heal from TMS. Please keep a look out for more updates on my blog as I plan to continue to share my TMS journey and healing from adverse effects of this "treatment".
All my light. All my love. Namaste.
Jordan
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