Doc Sarah: Mysterious Condition, Miraculous Race

Doc Sarah

I live in a very rural area, so I can see mountains and streams. And just being out when the sun was rising, being alone with my thoughts, I can just run and run and run.

Valerie Wencis (co-host)

For thirty years Sarah ran religiously. It was her constant companion. The thing she always returned to.

Doc Sarah

It was really a place for me to find peace.

Robert Pease (co-host)

And for all those decades, Sarah ran without so much as a sprained ankle. Then, when Sarah was in her 50s but still quite fit, she starts getting injuries. In fact a whole series of them. Bunch of them.

Doc Sarah

I had gone for 30 years with no injuries and then all of a sudden I’ve got IT band, and I got plantar fasciitis, I’m tearing my hamstrings, I had back pain. I mean, I was never a national caliber athlete, but I mean I was a decent local runner. But over the years I just got worse and worse and worse.

Robert Pease (co-host)

The tipping point came when Sarah signed up for a 5k a few years ago.

Doc Sarah

It was the most incredibly painful thing I had ever done. I finished the 5k and just wanted crutches. If someone had been willing to amputate it, I would have taken them up on it.

Valerie Wencis (co-host)

Suddenly, this lifelong runner was thinking about hanging up her running shoes.

Doc Sarah

And I was like, you know what? Everything needs to come to an end. I’ve been running for 30+ years but my time is over. It’s done, it’s finished.

Robert Pease (co-host)

This is My Body Odyssey. A podcast about the rewards and challenges of an active lifestyle. I’m Robert Pease.

Valerie Wencis (co-host)

And I’m Valerie Wencis. Our bodies are always changing. We have days where our bodies feel great, then days where they feel completely broken and we just want to trade them in for new ones.

Robert Pease (co-host)

As we get older, doesn’t it always feel like there’s something a bit wrong? Tweaked knee. Stiff neck. And because we’re all aging for the first time, we don’t know how much we’re supposed to push through all those aches and pains.

Valerie Wencis (co-host)

And when we can no longer endure, we go to the doctor. And the best doctors are great listeners and great detectives, piecing those symptoms together towards a diagnosis. Sarah had always prided herself on being one of those doctors. But in this episode, she struggles to diagnose her most challenging case yet: her own.

Robert Pease (co-host)

Doc Sarah lives and practices medicine in New Hampshire.

Doc Sarah

I’m a pediatrician, athlete, and mom of four. Probably should have put mom of four first but…

Robert Pease (co-host)

She’s warm, affable. Full of interesting facts.

Doc Sarah

And actually one just landed in New Zealand right before we started talking. There is a Dunkin Donuts at the airport in New Zealand. Who knew?

Robert Pease (co-host)

Apparently the whole planet runs on Dunkin. We first met Sarah at the Pumpkin Man triathlon in Maine in 2019. We found her just past the finish line.

Doc Sarah

It wasn’t as hard as I thought. I came in a little underprepared. But really this race to me is a miracle.

Valerie Wencis (co-host)

We didn’t know it then, but we found Sarah at a very special moment. She had just done something that, to her, was miraculous after a medical odyssey of many years. Sarah grew up running, cycling, all kinds of exercise. It was just part of her upbringing.

Doc Sarah

Growing up we did a lot of exercise, especially with my dad. We were doing long cycling trips pretty early on.

Robert Pease (co-host)

But running was Sarah’s main event. She continued to run in high school and college. She says the hardest part of med school was no time to exercise.

Valerie Wencis (co-host)

Over the decades, Sarah used running to decompress, de-stress, and clear her head.

But running was also much more than that. It was the way she organized her thoughts and made sense of the world.

Doc Sarah

It’s how I process things. When my mother died, I processed that through miles on the road. I had four small kids at that time. And so there wasn’t a lot of peace and quiet at home, but it was also just being out when the sun was rising, being alone with my own thoughts. I could just run and run and run.

Robert Pease (co-host)

So when Sarah started getting injured and running became more painful – that is, when she could run – it was really hard on multiple levels.

Valerie Wencis (co-host)

Let’s start with Sarah’s first symptom: a strange sound coming from…her foot.

Doc Sarah

I don’t run with any music, which is good. And I noticed that my feet sounded different. My right foot would sound like I would expect it. And the left would just kind of shuffle.

Valerie Wencis (co-host)

The sound in the foot turned into a pain in the foot. Then a pain in the knee. She started getting terrible rashes on her arm. Were these symptoms connected? They just seemed random. So Sarah did what most of us do and just pushed through the pain.

Doc Sarah

I mean I’ve never aged before, so I was like, yeah, I have aches and pains, but you know, everybody talks about having aches and pains.

Robert Pease (co-host)

On top of aches and pains, though, Sarah was exhausted.

Doc Sarah

I’m a doctor, I have four kids, I’m running marathons, of course I’m tired, who wouldn’t be tired?

Valerie Wencis (co-host)

Everybody’s tired. But Sarah was really tired.

Doc Sarah

I mean it truly was exhaustion. I’d sit outside before the day started and go, how am I going to get through the day? And then I’d get home and go, how am I going to get through, how do I do what I need to do for my family?

Robert Pease (co-host)

It was kind of sobering to hear from the doctor that they’d had trouble diagnosing themselves for many years. So what hope do we have then?

Doc Sarah

I will say that doctors are the absolute worst patients. I mean, we don’t listen to anybody, anything. If you want to see what not to do just follow a doc!

Robert Pease (co-host)

Diagnosis is one of the most difficult yet critical skills in medicine. We spoke to a general practitioner about the rewards and challenges of medical diagnosis– Dr. Diviya Muthappa, who runs a general family practice with her husband in Southern Texas.

Dr. Divya Muthappa

So absolutely there are patients that I am just 99% sure that I know what their diagnosis is and it ends up being something else. And so it just makes me remember, oh yeah, I need to look out of the box and outta my routine to make sure that we’re catching all of these various illnesses. So it’s 100% a challenge everyday.

Valerie Wencis (co-host)

Regarding the particular challenges of self-diagnosis, Doc Sarah was stumped for several years. And her symptoms were building towards a crash, a medical crescendo. And that crescendo arrived at the Disney World marathon in 2017.

Doc Sarah

Well, in 2017 at Disney World, my knee just blew up. My leg just wouldn’t move. I wasn’t sure, like, did I have a stroke? What the heck happened? So I did what any good athlete would do if I went to the expo, and looked for a brace that would help me to get my run in. So I was able to do the half marathon, but it wasn’t pretty. And the next day my knee blew up. So I got back home and they drained a ton of fluid off. They put some steroids in and kind of sent me on my way and they said this happens sometimes. And then another couple of weeks later, blew up again. It’s just going in the wrong direction.

Robert Pease (co-host)

Sarah tried another 5k – the one she mentioned earlier – but the pain was unbearable.

Doc Sarah

After that 5k that I did, I was in the pool because that was the only exercise I could really do.

Valerie Wencis (co-host)

No running, no cycling, no hiking in the White Mountains near her home.

Doc Sarah

Finally I talked with someone that I swim with who has rheumatoid arthritis and I said, how, how did your rheumatoid arthritis present? And she said, kind of like yours.

Valerie Wencis (co-host)

At last, a clue, a hunch, and she was back on the case – her own case…

Doc Sarah

So, I’m a physician. So I went to my friend, I said, look, these are the labs I need. And she ordered them.

Robert Pease (co-host)

Sarah had started to connect the dots of all the injuries she’d had. And arthritis did seem to be the logical culprit.

Doc Sarah

Rheumatology is just tricky. Now I look back on some of the things, some of the injuries that I had and in reality, they weren’t injuries, and this has been going on a lot longer. I just didn’t notice it. It’s partly, it’s not until you go get the big picture. Like if you go in with any individual injury, you know, no one’s gonna be able to get it. If it’s part of a big process, it’s you really just gotta put everything together.

Robert Pease (co-host)

Mystery solved, but only after an odyssey of many painful years.

Doc Sarah

They ended up with a diagnosis of psoriatic arthritis.

Robert Pease (co-host)

Psoriatic arthritis is a chronic inflammatory condition. Joints, tendons and ligaments will swell up. Particularly in the lower limbs. Knees, ankles, toes. It can be incredibly painful. It’s also incredibly hard to diagnose

Dr. Jeffrey Sparks

There’s an endless amount of detective work to do when you’re talking about the immune system.

Valerie Wencis (co-host)

Dr. Jeffrey Sparks is a rheumatologist at Brigham and Women’s Hospital in Boston and also an avid runner.

Dr. Jeffrey Sparks

Honestly, a lot of rheumatology diseases, in particular psoriatic arthritis, they present insidiously. So this is not like you wake up one day and it’s clear things are wrong. It’s not like you have chest pain and you’re having a heart attack. These are things that unfold often very gradually. It’s usually several years that patients have symptoms before they’re really diagnosed. So her situation is not that atypical.

Robert Pease (co-host)

Which was confirmed by Dr. Muthappa in her experience of diagnosing the many types of arthritis, all driven by autoimmune factors, yet all present differently.

Dr. Divya Muthappa

I think that psoriatic arthritis, of all the types of arthritis, is one of the hardest to diagnose because there’s no blood test for it. Like rheumatoid arthritis, it doesn’t typically show up well on x-rays like osteoarthritis. Oftentimes psoriatic arthritis patients don’t actually have psoriasis, which you would assume they do, but they don’t always. And so it is definitely difficult.

Valerie Wencis (co-host)

Psoriatic means that the arthritis can cause psoriasis – dry and painful rashes on the skin. Sarah had noticed this but never connected a rash with the pain in her knees.

Robert Pease (co-host)

The next thing Sarah did after those initial tests came back – she found a rheumatologist – a specialist in immune disorders – who took her symptoms and her ambitions seriously.

Valerie Wencis (co-host)

Even that awfully ambitious goal of getting back to marathons when she could barely walk.

Doc Sarah

My rheumatologist has been fabulous. You know, if I wanna run a marathon, she’s happy to help me get there. And she encourages me to move. There’s not one ounce of her that says, well, maybe you shouldn’t do this. Maybe you should take a little bit of a break from this. She’s there to help me accomplish my goals.

Robert Pease (co-host)

First order of business: Sarah adjusted her diet.

Doc Sarah

I call it the -ish diet. Low-ish gluten and low-ish dairy. I don’t have it much, but I did have a whoopie pie today and I enjoyed it very much.

Valerie Wencis (co-host)

Then Sarah’s doctor prescribed an immunosuppressant medication to reduce her inflammation.

Doc Sarah

I had to get over that I’m an athlete, I can power through anything. I can ride over mountain passes, I can swim across lakes. You know, you name it, I can do it. And so it was kind of tough. Like I need medication so I can bend my knee, but I’m very grateful because I can’t even imagine where life would be if I hadn’t started medication.

Robert Pease (co-host)

The medication helped with the flare ups, the swelling, and Sarah slowly returned to some light exercise.

Doc Sarah

I got the Peloton bike, which allowed me to go at my own level, to get back to sports. I dropped 50 pounds. Regardless of what’s going on in your knees, the lighter you are, the better your knees are gonna feel.

Robert Pease (co-host)

Are there going to be a lot of these Peloton placement ads in this interview, Sarah?

Doc Sarah

Hey, any chance you give me to talk about the Peloton, I’ll go for it.

Robert Pease (co-host)

Okay

Valerie Wencis (co-host)

Over the next few months, Sarah kept improving. Gradually and not without setbacks. Two steps forward, one step back.

Robert Pease (co-host)

Eventually she signed up for that Pumpkin Man triathlon in Maine. Which is back where we started – where we met her at the finish line.

Doc Sarah

This race to me is a miracle because those were some tough times.

Robert Pease (co-host)

And we spoke to Doc Sarah a few times more recently since that first conversation at the finish line of her first post-recovery event, the race that felt like a miracle.

Valerie Wencis (co-host)

What have you’ve been up to since we last chatted with you?

Doc Sarah

Well, since our last chat, the fall went pretty well. I went and did the Disney World marathon in January, and that had been my first marathon in a while. My times are better than they’d been in like 10 years. I could not be happier. And to be honest, I wouldn’t have done as well before, before I had been diagnosed with the arthritis, because I wouldn’t have taken the training as seriously, I wouldn’t have had the Peloton. Those things have made the success happen.

Valerie Wencis (co-host)

Sarah’s odyssey is an example of how sometimes our greatest challenges can potentially lead to even greater rewards. Our weaknesses force us to slow down and look more closely. To analyze and understand. And to overcome personal and social barriers.

Doc Sarah

The saddest thing to me has been how negative people are about medicine and taking medicine. And like, if you spend any time in the Facebook groups, it seems like people see taking medicine for something as a weakness. I can’t even imagine where life would be if I hadn’t started medication. I don’t think I’d be a good parent, I’m not sure I’d be able to work, because I wouldn’t be able to move. And I certainly wouldn’t be able to do any of the things that I truly enjoy.

Robert Pease (co-host)

So do you think that experience may have helped you in some way as a physician diagnosing others?

Doc Sarah

100%. Now I do think I’m much better at listening to people and keeping an open mind and realizing that while I might not necessarily see the problem, I do see that the person is coming to me with changes and we need to figure out what that change is, where that’s going. And it’s definitely made me a better listener and like I said, more open to other things

Valerie Wencis (co-host)

Doc Sarah’s struggle with arthritis has made her a better doctor and better at self-care as well, listening to her own body much more carefully.

Robert Pease (co-host)

But arthritis is an ongoing issue that will continue to present challenges.

Dr. Jeffrey Sparks

Unfortunately these diseases, they’re tenacious.

Robert Pease (co-host)

Rheumatologist Jeffrey Sparks.

Dr. Jeffrey Sparks

And that can be really tough when you’ve been in a great spot for a while and to kind of feel back to square one.

Robert Pease (co-host)

Which means Sarah is going to have to carefully manage her symptoms and her running ambitions.

Valerie Wencis (co-host)

Have you had any major flare ups since last time? Or any other injuries?

Doc Sarah

There was a race this weekend. It was a half marathon on Saturday And I trained for the half marathon, although not as well as I should have, I’ll be honest. But I did the race and within 30 seconds of starting, it was just not gonna be my day. It was horrible, I felt horrible. I didn’t get enough sleep and I just felt bad. And so at mile nine I decided to call it. And in the old days, like when I was younger, I probably would’ve sucked it up and just destroyed myself. But nowadays I’m just like, you know, it’s not my day. Hopefully there’ll be other half marathons to have, it’s not worth maybe getting an injury, exhausting myself. It’s just kind of really enjoying the process and enjoying where I am.

Robert Pease (co-host)

Well, I think there was a good tagline in there somewhere for a sports company: Suck it up and destroy yourself.

Doc Sarah

Yeah, yeah. I definitely would’ve done that in the old days.

Valerie Wencis (co-host)

Doc Sarah. Pediatrician. Medical Detective. And mom of four.

Robert Pease (co-host)

And once again a runner. Sarah says she’s planning on more events this year, if her knee will cooperate. But more than that, just enjoying being able to move.

Doc Sarah

I gotta get back to it. So it’s looking at the racing season. The White mountain tri, maybe running up Loon again. A couple other halfs and just having a good time.

Valerie Wencis (co-host)

We will be checking in on Doc Sarah’s odyssey this fall to see if her return to running improves the underlying arthritis, or triggers additional flare-ups or injuries – because while medication can help manage the symptoms, there is no cure for the underlying condition.

Robert Pease (co-host)

Many thanks to Doc Sarah for sharing her story with us. And next up: Another running odyssey involving Erin, a Mom-on-the-run. She’s a high school chemistry teacher who suffered through a difficult pregnancy and the challenges of postpartum depression until running helped her find a way forward.

Erin

My body wasn’t good at being pregnant and my body wasn’t good at breastfeeding either. So once I weaned him after he was a year old, that’s when my husband and I sat down. I said, I need to do something. I need to get back to me.

Valerie Wencis (co-host)

We hope you’ll join us for that episode. And if you have an odyssey you’d like to share, go to our website – mybodyodyssey.com – or find us on social media and send us a message. I’m Valerie Wencis.

Robert Pease (co-host)

And I’m Robert Pease for the rest of the production team. My Body Odyssey is a Fluent Knowledge production. Original music by Ryan Adair Rooney.