Health Problems of the Endurance Athlete (Medicine in Running Part 2)

We are all familiar with the classic model of an injury: finger is bleeding. What happened? I cut it.

This model however very rarely works for endurance athletes. Instead health problems and sports-related injuries are almost always the result of many factors working together, often over a long period of time.

What athletes and recreational distance runners should be aware of is doctors are not trained in the health problems of endurance athletes. They see a young, "healthy" person with a disease or injury and assume the problem and solution are straight forward. For example: "you have anemia"  - "you must have heavy periods" (I will get back to the anemia example). Or your knee hurts - you must have IT band syndrome - but the why and the root of the problem eludes them.

When a runner writes to me via email or Facebook about a health problem they face that the problem is rarely, if ever, straight forward. Let's face it, I also know this from my own battles with health problems over the last many years.

In other words, when I see a runner, triathlete or someone who trains hard - a lot, say "I finally found out exactly what my problem is!" Before I know more details, I generally won't believe the solution to their problem is as simple as they think.

Take for example exhibit A: cytomegalovirus (CMV). This virus has come to the fore due to (Salomon) athlete Neal Gorman. He is an ultrarunner who was trying to figure our why he was feeling so tired and sluggish. He is NOT an athlete who contacted me for advice so I feel I can safely use him as an example without risking a breach of doctor-patient confidentiality. He was diagnosed with CMV. Normally this virus does not cause symptoms in healthy adults. He however had 1. elevated liver function tests and 2. the specific type of antibody which indicated active disease. He was given what appears to be the correct diagnosis by a very astute clinician who knew to look for this illness.

However, the underlying question is why. Why should a young, otherwise healthy adult get active disease (symptoms) from CMV when adults with normal immune systems who are exposed to the disease and don't react? He discusses openly his lack of sleep leading up to it. We can only speculate how much months of years of hard training led to a compromised immune system. (we already know the immune system of ultra runners is compromised following ultras - aka the "window" for infection of 3-72 hours, but what are the more long-term effects on the immune system?).

Read this article on Irunfar about the importance of sleep. Read these articles about overtraining: 1., 2, 3. I can not emphasize enough though that overtraining is far from simple itself. There are so many things that can predispose to it - or push a person over into having symptoms, but training is the one necessary component. (November 2012 when I went to the Urgent Care with lymph nodes and spit glands the size of fists, of course the doctor had no clue what he was dealing with - so we endurance athletes need to help care for each other and create awareness within our sport/s - and if it is our field of training and interest, contribute to high quality, non-biased research)

2. Take basically any viral or bacterial illness: pneumonia, mono (which, for some unexplained reason my 38 year old husband has - again, normally this is a disease of college students), sinusitis, any upper respiratory illness. The list goes on and on. Ultrarunners are NOT just exceedingly unlucky.

Let's face it: if we want to train to run ultramarathons, we have to get 1. adequate sleep (preferably 8 hours a night) 2. variation in our training and 3. avoid overtraining - ie, not just getting miles in for the sake of miles -or running too many ultras so we fail end the year with excess energy. (for once I AM ending this year with excess energy!) - that is the whole POINT of running: to get energy, to feel better!

3. Anemia (lack of red blood cells): I am including this because it seems almost every female runner I know suffers from it.

There are so many reasons for anemia in runners (and non-runners). Especially females. Sure, the ladies bleed regularly, but there is a small amount of bleeding from the GI tract every time you run and probably small amounts from muscle (that would escape through the urine). Then there is the increased need for iron, often not met with adequate dietary intake. Finally, there may be an element of gluten sensitivity (the amazingly complicated "story of wheat" and it's role in human disease remains to be fully elucidated, but I have a suspicion, though no proof it is contributing to anemia). I would be amiss if I did not also mention alcohol, which is toxic to the bone marrow. Finally if you add to this upper GI distress, ulcers, GERD, there is probably microscopic bleeding due to that as well.

I have previously been hospitalized with anemia (I was a 70 mile/week runner at the time). The thing that really confused the doctors was that I did not menstruate (how can a female who doesn't menstruate be anemic?). I learned a lot about anemia through this hospitalization. Normally they would have sent me home saying "sorry about your heavy periods", but a critical level of hemoglobin in a female who didn't menstruate was- well -freaky.

They sent me to get an upper endoscopy and colonoscopy and there was "nothing wrong". I almost got a bone marrow biopsy - and they might have muttered the word "cancer". At 23 years of age, it seemed wild.

I have now not been anemic for years. And what I have done is - improve my diet (increased protein & iron), given up gluten and take probiotics daily. (I am NOT saying this is your solution, but it was mine and it took years for me to find this solution.). And by the way, I DO menstruate now - barely, but it's there.

4. Depression. I am not sure if depression, fatigue or recurrent viral illnesses is the most frequent problem among endurance athletes, but the big D is certainly the most important one to discuss.

Depression also scares doctors (like it scares everyone). I am going to go out on a limb and say that ultra runners in particular may have depression tendencies (or mood disorders) to begin with. One of the most amazing things about running is it is a mood stabilizer/improver. And by the way, I just read that "dirt" - just breathing it in - can be like a dose of prozac. Nice.

I have on multiple occasions been forthright about why I started running - and that was because I could not sleep. And no sleep = depression no matter what kind of genes you have.

There are so many reasons a person can become depressed. There is no doubt that there are genetic tendencies towards depression. But there are also clear triggers and aggravators.

Again, I know this first hand. It probably would be a really difficult subject to write about depression if I didn't.

Two years ago at Christmas, I had lost a lot of weight. I had also run a lot of long races post-partum. I am well aware that setting a marathon PR 2½ months post-partum is not "normal", but it was so dang gratifying to me. I had no clue the cycles of mania and depression it would send me on (I had experienced them before, but never so rapidly or to that extreme). I don't even know if it was the post-pregnancy training alone - probably that in combination with hormonal swings, weight loss, lack of sleep and the stress of constantly moving between countries and doing a PhD. But it is clear that 1. overtraining and 2. rapid weight loss/low BMI are triggers for my "bipolar". I do not even know if it can be called "bipolar" with these as triggers, but I do not doubt that everyone has triggers for their depression (or mania) and that mood and other psychiatric disorders can be to a certain extent managed by identifying triggers.

I also noticed that depression tends to be worse around Christmas. Two Christmases ago I was in a hopeless state. Last Christmas I felt I was getting better, but could not stop crying at two Christmas parties in Denmark--- I had to go hide in bedrooms. I was even diagnosed with major depression but then went back to the doctor a few weeks later and it was - gone. (I have to mention my sister in law, Beverley, a psychologist, who helped me enormously at this time last year).

There are a lot of things around Christmas that lead us to depression (the expectation of being happy, low Vit D, fatigue, loss of control) which is why I chose to write this post today.

And that brings me to the last health problem of this post: injury. In ultra running or long-distance triathlon, injury is so rarely  "if only I hadn't stepped in that pothole". Injury is repeated misuse of the body without adequate rest, cross training, healthy diet and sleep.

I can not encourage you all enough to get into a good pattern that you can stick to the rest of your life.

The last two weeks I have been on constant cross training (I have only run twice). I absolutely love cross-country skiing, snow shoeing - and you throw swimming and yoga in there and I am as happy as a clam. I thought today - if there were beautiful powder snow all year long, I might never run again. (of course I would)

Over the last year, I have been the healthiest I have been since I can remember. As far back in my memory as I can go as a child, I suffered from stomach problems. I have been injured every year  -except this one - since I was 22. This year, no injury has lasted longer than a week. I have the old hip problem, but it is improving. Folks, this is not just luck. I even stopped at Desert Solstice 24 hour in time (after 50k) before doing any permanent damage. I know that it was not my achilles per se that was acting up, but a long season of hard ultras (and improvement I never dreamed of) and a body that needed a break.

Here is a brief list of a combination of things that led to a healthier, happier (and faster) year:

1. Giving up wheat and taking probiotics and well as generally cleaning up my diet (no artificial sugars, no high fructose corn syrup) has apparently helped.
But it is not just this.

2. I have changed my running style to pose - so the stress is more on the muscles than the joints. I may land on my heal some (most) of the time, but at least my knee is bent so my hips and back aren't taking the brunt of the stress. And it is a more efficient style with more rapid cadence.

3. And it's not JUST running style, it is respect of the body and knowing when it is time to rest.

4. It is also prophylactic rest. Don't run every day. Take at least a day off a week. Some people say do nothing, but I say cross train. Nothing super hard, but just get out there are use your muscles differently. And I am really feeling great with this couple weeks of cross training. I know Chrissie Wellington, Kilian Jornet, etc. recommend an "off-season"

5. Sleep. (and sleep well- no caffeine in the afternoon or night. And NO BABIES ;-)) There is a Flaming Lips Song that says - "you have to sleep late when you can and all your bad days will end". I love this song, but the real truth is, you have to sleep early when you can. If we had not gotten an au pair, I never would have started achieving this!! (hard to underestimate the importance of this on my health these past 6 months!)

On that note, my family and I should probably sleep. But I have to say how thrilled I am to for the first time in 3 years to NOT be depressed on Christmas.

SLG, Mattias, Meow, Christian. Christmas Eve.

Grandma Joyce, Mom, Christian, Emily, SLG, Mattias &; Meow

Nashota Park today. 15k skate ski. The thing I didn't know about skate skiing was how awesome it is as a workout of core stabilizing muscles. I actually didn't know what it felt like to have sore core stabilizers before beginning skate skiing. Will I be ready for the 50k Birkie on Feb 22nd? (I doubt it!)

Snowshoe running + sled surfing with Christian on North Lake.

Out skate skiing with SR before he knew he had mono! We miss you SR and wish you weren't working seven 12 hour shifts in a row!

Final note: if you are interested in learning about advancements in health-related research in ultra running, you may consider attending the Medicine & Science in Ultra Endurance Sports conference in Squaw Valley June 24th-25th. I will be there and this is one of the few (if not only) venues for discussing heath as exclusively related to endurance exercise.  I only hope that I can run Western States the weekend after (that will require placing in the top 3 females at the Ice Age Trail  50 miler).

Running/Skiing Song of the Day: so happy to run across an old fave "Stutter" by Elastica.

National Identity, more on Desert Solstice and the simple goal of running well

I am the type of person who spends an inordinate amount of time thinking about things like which national jersey I should wear to the Desert Solstice 24 race on Saturday. In reality, I don't have a Danish national jersey, I am not Danish and most likely will never be unless the important people of the government decide to allow double citizenship (yes, the US, along with almost every European country, allows double citizenship - and it would make our lives a lot easier if SR and I didn't have to hold jobs and addresses in each other's countries to follow the rules of our residency cards!). Of course I could write a lot more about this, but I won't. I don't have a passion for writing about laws even though I have a passion for being both Danish and American. To solve the clothing dilemma, of course I will wear Salomon. They are a company I believe in, make products I love and trust and they have supported me and their athletes in both good and challenging times. Salomon is a company that transcends national boundaries and is simply about the joy of trail running, skiing and hiking out in the amazing nature of our planet. In fact, part of what I love about Denmark is what Salomon has helped do for trail running there!

Two nights ago I dreamt I was running this Saturday's Desert Solstice and was in terrible pain. Today, I feel no pressure and only hope I can run for 24 hours without getting injured. It is an exciting opportunity, this. I'm not really sure how I feel about the fact there is a webcam. I'm not really sure how I feel about the fact that I am interviewing for a residency spot on Friday at University of Minnesota and on Monday and UC-Irvine (okay, I'm nervous)! This is all a lot to take in. By the way, I would not be able to do any of this without our Au Pair, Nanna - not to mention SR, who just tossed a Danish jersey singlet on my lap.

Here is the startlist for Desert Solstice:

2013 Desert Solstice Entrants

Name	Notable PR	Other Highlight	Nationality
Jennifer Aradi	128.1 Miles (24 Hour)	2012 Heartland 100 Winner	USA
Zach Bitter	5:12:36 (50 Miles)	2012 50 Mile National Champion	USA
Eric Clifton	13:16:02 (100 Miles)	Former JFK Course Record Holder	USA
Anthony Culpepper	82.39 Miles (12 Hour)	2013 Beyond Limits 100 Winner	USA
Ed Ettinghausen	135.7 (24 Hours)	52 Lifetime 100 Mile Finishes	USA
Anthony Forsyth	16:03:47 (100 Miles)	2013 Beyond Limits 50 Winner	UK
Connie Gardner	149.368 Miles (24 Hours)	Former American 24 Hour Record Holder	USA
Tracy Høeg	43 Miles (6 Hours)	2013 Salomon Hammer 100 Mile Winner	USA
Deb Horn	134.45 Miles (24 Hours)	Multiple Time Team USA 24 Hour	USA
Carilyn Johnson	130.92 Miles (24 Hours)	Multiple Time Team USA 24 Hour	USA
Olivier Leblond	14:33:25 (100 Miles)	2012 Old Dominion 100 Winner	USA
John Maas	15:37:23 (100 Miles)	2013 Kettle Moraine 100 Winner	USA
Beth McCurdy	122.55 Miles (24 Hour)	2012 North Coast 24 Runner Up	USA
Padraig Mullins	8:42 (100 KM)	2 Time Lake Waramug 100k Winner	Ireland
Kristina Pham			USA
Roy Pirrung	154 Miles (24 Hours)	World Age Group Record Holder	USA
David Ploskonka	134.3 Miles (24 Hours)	2010 Beast of Burden 100 Mile Winner	USA
Pam Smith	15:01:40 (100 Mile)	4th Fastest North American 100 Miler	USA
Jay Smithberger	13:49:13 (100 Mile)	3rd Place 2012 Desert Solstice 100	USA
John Ticer	16:35:45 (100 Mile)	2010 24 Hour AG National Champion	USA
Victor Vella	34:29:40 (Spartathlon)	National Age Group Record Holder	Malta

The race director, Nick Coury, wrote a very informative piece on irunfar as a lead up to this Saturday's race, which includes an interesting history about 100 mile and 24 hour American records. Of course it will be exciting to see what Pam Smith can do (if she can break the track 24 hour American record) and if Zach Bitter can run a 100 mile American record. Pam, her husband and I will be staying together then night before and I hope at least some of her aura (don't be freaked, Pam) will rub off on me. Of course I can not be better than I am; I can only be the best I can be at this time. And that is pretty low-pressure and purposely vague, which is fine with me. No one is watching me and no one knows me. (Let's keep it that way)

Back to Nick Coury. He has been emailing all of us about exactly what he can buy for us to have at the aid station. If we are cold- they have extra jackets, if we need pacing, they are there to calculate, if we want Thai food at 2am, they'll get it- or something like that. And now we are all invited out to dinner the night before.

By the way, I love Duluth in the cold. On the way back from Virginia, driving with SR, Nanna and the kids, we saw amazing northern lights.

The nothern lights we saw looked like this. They were green because the wind from the sun was blowing through the weak spots in the magnetic field at the north pole and reacting with the oxygen in the atmosphere. Had they been reacting with the nitrogen, the northern lights would have been bluer/purpler and higher up in the atmosphere. It's intuitively obvious, really. What I never knew about aurora borealis is the lights and pattern change constantly (mostly it gets brighter and dimmer)! It is incredible. Like a sea of sun spot wind (an analogy we can all relate to).

Yesterday it was -5F/-21 C

And today's photo from -10F/-23C is the new header. Spectacular. Nothing makes Lake Superior look more beautiful than the dry, clear air, bright sun and steam from the warm water.

One more thing.

I read this article last night by Dr. Nicholas Romanov and it made so much sense to me! Why would you have a goal of running a marathon before you have learned to run well? I was exactly one of those people who never learned to run and was convinced to sign up for a marathon before I had even run a 5k. Sure it was fun and I had a runner's high at the end, but then I was injured for months afterwards. And for what? To tell people I had run a marathon? Pointless.

Would you try to play a concerto before you had learned the notes of the piano? Before you have learned to play chords and each scale? I don't know. Maybe. But you are sure making your life difficult. Plus it will sound like crap. And when it is not just your fingers, but your entire body, you are risking injury if not worse. Just something to consider.

Where I am right now-- my goal is simply to be good at running. This is a very satisfying and understandable goal. It has intrinsic value. Like, I want to be a good painter (okay I don't really) rather than paint 100 enormous murals before I have really learned to paint. (Maybe I should learn to write before writing this blog?!)

I leave you with some pictures of First Landing State Park in Virginia Beach, the site of the first landing of Jamestown Colonists in 1607.

Spanish Moss on the trees, plant identification by Pam Smith

I gained an understanding of why it was called the "tidewater area"

On my way to the plane, I showered at the Zen hot yoga studio in Virgina Beach- one of the nicest showers I have ever experienced! Yogis are such awesome people. And they like nice shampoo and soap.

Interview Report: State of the American Health Care System 2013

Let America be the dream the dreamers dreamed— Let it be that great strong land of love Where never kings connive nor tyrants scheme That any man be crushed by one above. (It never was America to me.)...I am the immigrant clutching the hope I seek— And finding only the same old stupid plan Of dog eat dog, of mighty crush the weak. Langston Hughes - Let America be America Again


Aren't we all really Langston Hughes? As I walked out of hot yoga and ran back to my hotel in Virginia, I saw my white woman afro in my iPhone and it was good.

Yes so here we are- back in the US, 5 years later. Me, the American and my Danish husband and boys.

Here I am- applying for a residency position again - to be a doctor (with a specialty, which I can use to get a job in both the US and Denmark). Denmark recognizes US degrees but not vice versa. 6 years later. I've been through this before, matched at my first choice, got pregnant had to drop out to live with SR (living alone with a baby while working 80 hours a week with only15 days maternity leave seemed wrong in every way)- never thought I'd be granted another chance but I was.

8 interviews. That's the minimum they say you can go on to guarantee a residency position in "the match" - and how I'm spending my fall and winter (we all learn where we will go in March based on how we rank the programs and how they rank us). I am applying to Physical Medicine and Rehab - a small specialty and a field of medicine that by its very nature fights the "throw surgery at it as first line therapy, always go for the most expensive procedure (before trying to change your life)", that I am and so many others are fighting in American medicine. Only businessmen want that model, but doctors are fooled into thinking expensive is best because it is tradition and large clinical trials are funded by pharmaceutical and medical equipment companies. 

Capitalism never did much for human rights.

And even "not for profit" hospitals use their millions of dollars of extra money to build fancy new buildings and buy expensive, inspiring art, etc - rather than entering it into a shared pool of money that could provide medical care for all. 

BUT, let there be no doubt that doctors are good people. Heck, they sacrifice their lives - voluntarily work 80 hours a week at less than minimum wage (during residency) to have the privilege to heal (as one very prophetic vascular surgeon with a great sense of humor once said to me - "in residency, they break your spine, then you stop caring about your own life".) And it is a huge privilege to care for the sick and dying. We all think it, otherwise we WOULD become yoga instructors, coaches or professional athletes (to name some random examples). I think about it as I spend our money and my vacation time going from interview to interview (I just drove from Pennsylvania to Virginia yesterday) and one hour ago took my first shower in three days (don't ask me how I got out of the four feet of snow in Duluth). And I think - what are the boys doing now? How I want to just hold them. And couldn't this interview system be a bit simpler? Like couldn't I just go to an interview and then they decide whether or not I am hired like any other type of job???

On the interview trail, I have seen a sad trend: the hospitals and administrative buildings are bigger and more awe-inspiring than they were 5 years ago. There is more "state of the art" care everywhere. The rich get tailored, expensive, very expensive, often futile medical treatments, while the poor die from cancer that could have been cured - but they had no health insurance. Or the poor GET the health care and then end up spending the rest of their lives paying for it. IT IS WRONG AND I AM NOT IMPRESSED.

Is this America? Yes.

Is this what American doctors want? No. Is this what Americans want? No.

Day in and out I am struck - by how caring and passionate the young (and not so young) physicians are I meet. Healing is an art as pure as music and painting and dancing. I can't remember the last time I met a physician who went into it "for the money". I, for one, am still paying off my medical school debt.

As I asked the other residents I interviewed with today: Is medical care a human right? Well, we all agreed. Yes, yes, yes. How can America deny its citizens of a basic human right? Is America a first or third world country?

Well, in case you were wondering i HAVE the answer (and think it is better than Obamacare): extend the VA system (for veterans) to cover every American. Basic and preventive care. It works. Its cheap. Call me a socialist, I don't care. I have been a dedicated socialist since I was 19 years old. But more than this, I can't forget being in Denmark where medicine was about figuring out how to treat everyone. I can't forget it and why should I? It was the right thing to do. Medicine shouldn't be about impressing (and getting money from) the rich. It should be a basic human right. It's kind of incredible that none of the medical students interviewing with me could afford their own health insurance.

Medicine is not the flashy job it maybe used to be - but it is more competitive than ever - because at least it gives you the chance to get a job with health care. And a job where you can change peoples' lives for the better. Provided you truly care about healing and not throwing expensive bandaids at everything. And we all learned in medical school (and kindergarten) to care about the first.

Pasty mom on the interview trail - sad to see the closed and broken down Virginia Ballet Theater.  

Boonsboro, Maryland with Muktar, the fastest Ethiopian gas station attendant along the Appalachian trail to ever give me training advice and true stories of Haile. 

Blow Street (it was 70 degrees in VA today) so I pranced around in a tank top while my husband and kids couldn't get the car out of 4 feet of snow in Duluth, in -20 F, not to mention the wind chill.

Well, Christian's hand says it all. It is too bad Kaj, the frog, has to sleep like that all night, though. (I wish I had seen this in real life.)

 Song that my hotel neighbor played tonight while talking with his girlfriend on the phone about free diving (seriously, we humans have so much in common).

Sweater Weather by The Neighborhood.

Fun fact- I interviewed with a young female doc today who ran track for North Carolina State and ran the 400 meter in 55 seconds. It is always exciting to meet someone who is (was) too fast for a treadmill and is a "real" runner :-).

Obligatory Nelson Mandela quote:  "Education is the most powerful weapon which you can use to change the world".

That's right. Education and health care. Two basic human rights. Can we agree on that?

Medicine in Running Part 1 and a 24 Hour Race

I have learned a lot about running in the past year. One of the most imporant things I have gotten out of my new training plan and the copious reading (and training) I have done is how much running is really about self-discovery and meditation and how little it is about arbitrary goals of distance and time.

I always knew there was something about those American bumper stickers that said 13.1 and 26.2, etc. that didn't sit right with me.

I want to write this post in a way that doesn't make me seem like a know it all. As always, this blog is a collection of stories and not a manual or textbook. When I gave my talk at Marathon Sport a few weeks ago about research, medicine and training in running, I realized that I am not very good a following templates or formulae. A lot of people strive to "think outside of the box" and I find myself asking "what the hell box are they talking about and how do I think inside of it?"

However, it is really hard to talk about medicine in a Jack Kerouac free-association, "I write to the beat of the contrabass" style. (as much as I would like to)

So let me at least attempt to organize my thoughts.(I have to point out that I was conceiving of this blog post while practicing free-diving today, so there may have been less oxygen getting to my brain)

Rule number 1: Running should heal you, not break you down.

12km with the NMTC at Bagley Nature Area

Listen to your body. I have run very few miles in the last week. My hardest run was 5km + 3km at 6:25/mile pace with 2 min break.
Longest was 12km with the Northern Minnesota Track Club.

Some weeks are harder for running and some easier. I love incorporating strength training into my weekly routine and lately have been more into this than running. I think my body needs a break after the 6 hour run and before the Desert Solstice 24 hour run.

This is the picture I like to call "I can kick your ass but choose not to"

My favorite move lately (not me) is getting into this position then putting my knees on my elbows, going up into a head and then handstand. Then if I am along the wall I do handstand pushups. It seems much less injurious than pull-ups (which Ole had on my training plan- and I couldn't do!). 

As mentioned above, I've also recently gotten into swimming under water for as long as I can without coming up for air. I am so fascinated with the sport of free diving (ever since reading about the tragic death of Nicholas Mervoli). It really keeps the lifeguards at the YMCA on edge.

2. If you learn proper running technique, you can run forever.

One of the biggest advantages of being able to read Scandinavian languages is I can read all of the discussions about running theory that never get translated into English. There is so much talk about the importance of running technique. Pose, chi, natural. If you shorten your step, quicken your cadence and actively lift your legs so you land on flat feet/mid foot, you will take the pressure off your hips and knees and shift the stress to your muscles. You'll avoid serious injuries. Why this is not catching on more in the US, I'm not sure, but no doubt the money involved in surgeries for runners has something to do with it. Running technique is a skill, just like in swimming or piano, that needs to be learned if you want to turn running into a life long sport. I'm so glad I learned better tecnique this from Ole. I had been hearing about it for years but didn't understand the importance of it or how to do it.

Want to see the runner with my favorite technique? Here is Haile Gebreselassie being analyzed by Dr. Romanov (father or the pose method):



If we have another son, his name will be Haile.

3. The most important rule about surgery for runners is there is no good surgery for runners.

See number 2. Just don't get into the situation where you need surgery. And if someone tells you you need surgery, try to change your running technique.

4. Few joys in life can be compared to running (or doing kick-ass exercises) while pregnant, but after the baby is born, you are an injury waiting to happen.

I was totally amazed at the workout Jessie HP took us through (note the sweat). She wore me out and she is in her second trimester. She had initially been told to stop teaching her yoga shape class by her Ob-Gyn, but went for a second opinion. During her first trimester, she was told to monitor her temperature. (She never got over 99 in the heated room --- vasodilation in pregnancy keeps women from experiencing a rise in temperature while exercizing. I was happy she did this experiment, though). Now she is supposed to monitor her pulse. There is no reason for this, as far as I have read. Much better to listen to the body and if you get Braxton Hicks contractions to just back off. But nothing dangerous here. Just cool.

After pregnancy, the hips and pelvis are moving back into place and it is such a set-up for injury. Look at me with all of my post-partum hip problems. Well, again, see number 2. Running technique. And develop a smart training plan, with a good balance of distance, strength, speed, cross-training and rest.

I love this shirt. But is she wearing a bra?

So, yeah, I'm running the Desert Solstice 24 hour with Pam Smith. She is seriously the coolest. She just offered to go shopping for me! And she talked me into this. This is the equivalent of Usain Bolt convincing pathetic 200 meter runner buddy to toe the line with him. How could I say no? :-)

Pam Smith: Will she set the AR in the 200k or even the 24 hour race at Desert Solstice?

Alright you guys, even though I know music tends to slow me down in races, I think I might enjoy it during those 24 hours. Any suggestions?

Here's a fun Danish song and video:

And a fun picture of Kenneth Andersen at the Winforce 100k by Martin Paldan

Tough Turkey

I really should know better than to write a blog post when I am feeling so rueful. Especially on Thanksgiving. Sometimes I wonder about this holiday with its diffuse "thankfulness" that is used as an excuse to stuff ourselves with generally unhealthy food. I don't want to say we shouldn't appreciate life, but maybe that we should think more about who we are thanking more than exactly how great our lives are. 

I was sitting in the sauna yesterday with two women with notably darker skin than myself and when they asked me what my favorite holiday was, I said, almost feeling guilty, Martin Luther King Jr. day. I like holidays that make us think about history (especially civil rights) and how the world could be better and how we as humans can make that change.

For months I have had the Tough Turkey 1 miler and Gobble Gallop 5k on our family running schedule. The plan was, I was going to run the 1 miler while Nanna watched the boys, then we would all run the 5k, me with the boys and she would go for a placing (and a pie).

The race is put on by Duluth Running Company. This store has held a very special place in the hearts of SR and myself ever since we deposited my unborn fetus in the trashcan outside of their store after my miscarriage between the two boys. We will always look at that trashcan and think of "Freja" in there. 

Ok, so the race. We ran with the babyjogger 1.5 miles in the deep snow and, with both boys in it, and a strong headwind, it took ages. My race was in just 20 minutes, so I went out to warm up and in the meantime, the boys and Nanna got colder. I knew this was happening so I encouraged Christian to run the 1/4 mile kids race as a warmup. That didn't go great and he gave up because it was too cold. I really felt I had dressed them well, but all of us had freezing toes syndrome. despite wool socks.

So 5 minutes to the 1 mile start and I hadn't really warmed up. It was so cold that the startline balloon deflated and fell on those of us closest to the front. I could not make these things up. So we froze while the balloon was emergently reinflated.

Ready -go! Of course there were 50 guys ahead of me at the start, but after about 400 meters, I took the lead for the men and women! It was such a weird experience to be behind the lead bike! I felt good until we were supposed to turn around and my legs were so frozen that I felt like I was stuck in place around the cone. Well, I got my momentum up again and was in the lead on the home stretch (super cool feeling!)

Tough Turkey 1 mile, in the lead (!), photo by Nanna Olesen.

 Gradually my feet became more and more numb until it felt like I was running on peg legs. (I always had trouble with my circulation playing piano where I would have to stop in the winter and warm up my fingers on the heater to keep going --- I am sad this same problem is affecting my running... silly me to think wool socks would help!)

With 200 meters to go, I slowed a bit and about 4 guys passed me at once. I crossed the finish right after them in unknown time.

By the time I found Nanna with the boys before the 5k, both boys were both screaming and crying at the top of their lungs. We retreated to the Duluth Running Company. None of them wanted to run the 5k.

I may appear here to be a decent mom, but shouldn't I have been baking a turkey or something rather than forcing my kids into the cold? Mattias looks exasperated and will one day need thousands of dollars of orthodontic work because I force him into these situations and give him a nuk to calm him.

After the 5k was done, we ran into friends and life was good and I knew I had won a pie for winning the 1 miler, but when they called up the top 5 women, they didn't even say my name. Ok, I was leading the whole way until the last couple hundred meters and they didn't even notice me? Darn chip timing system! Seriously, this is why I like small races and ultras because if you win, people aren't inclined to believe an electronic timer over their own eyes. Anyway, I went up in utter abashment, and said I was actually the winner. They got it all straightened out and Christian got to pick out our pie (apple).

Christian and I ran home. I had run to get the car for Nanna and Mattias while we were waiting for the awards.

 And I started thinking. All the goodness in life revolves around people. And today (and she does read this blog) I want to thank this amazing woman who has worked her way into my heart and the heart of my family and has made our life of constant change manageable. Maybe we as humans underestimate our powers, how much good we can do. Well, Nanna, you are a superhuman with constant positive energy and we are so, so fortunate to have met you.

I'll leave you all with a couple pictures.

Storm and cold coming from the north over Lake Superior.

Reunited after 4 weeks in Lester Park. I don't want to say "I am thankful" because to me it sounds like I am bragging about having a good life. Instead I will say, I love you, SR.

The Wasatch Mountains

"The Mormon looked toward Heaven, but his Heaven was a Heaven on Earth and he would inherit bliss in the flesh"

´- Wallace Stegner, Mormon Country

The first thing I should probably clear up is I am not a Mormon. I don't think anyone who has been reading this blog for longer than 20 seconds thought I was, but now there is no lingering uncertainty.

When you see the Wasatch Mountains from Salt Lake City, though, it makes sense that many Mormons believe the celestial kingdom will one day be on Earth. (The celestial is better than terrestrial and telestrial, by the way. Telestial is only for whoremongers)

Even more so when you are running in these mountians- in the middle of the night- you might even believe heaven IS a place on earth, or rather a place inside of you, you have accessed in the mountains.

 Ok, so let's rewind... WHAT am I doing in SLC when...

these boys are in Duluth? (picture from this morning from SR)

I am on the interview trail. I am applying for training that can't be found in Denmark: it is Physical Medicine and Rehabilitation and will allow me to apply for a Sports Medicine Fellowship and then I can practice this medicine and do research in this field anywhere in the world. It is exciting! This training program, whichever university I match to, will start in July of 2015.

I arrived at the University Guest House last night, right next to the hopsital and the Skaggs (relation??) pharmacy buidling and - there was the trail- there were the mountains, a 5 minute jog away, and a 30 second jog from the hospital door. I'm trying to see a downside to this. It's strange, it's like I'm incapable of being negative these days. I feel so happy and in love-- or ready to fall in love-- with humanity, with life, with the beauty of the earth. It is like all of the vitamins and minerals in my body are at the right level (or maybe it's because I have slept the last 3 weeks without warm little boy bodies next to me? )  I am ready to enshroud my boys with love and kisses on Saturday when I get back.

So 4 AM, I charge up the Wasatch Mountains, alone with my headlamp, shoes and maybe some clothing. 

It is rare to find a more beautiful phrase on a sign than "interpretive mountain trail"

The greatest thing about Salomon Sense is they don't collect mud on their soles ;-)

 But conditions in the mountains change by the meter. And soon I was just running again,out of the mud, in the wind-still darkness, feeling the contours of the mountains in very much the same way you feel emotions. It is almost not an analogy; it is just true. The rocky sloping and diving and delicate snow become symmetric with your soul. Don't believe me? Just try it.

Here I sat down and took a break, at my turnaround, looking over the valley.

And it looked like this. Not in reality, because everything was covered with fog, but I could feel that it looked like this. And now I can't even find where I got this picture, but it is exactly where I was running.

 On the way back, I got into trouble. One section got super slippery and I was crawling on my hands and knees, digging my fingers in the mud so I wouldn't tumble down the ridge. I was scared and SR called at that very moment. It is weird to be in the throes of nature, fighting for your life, and your i phone rings.

Baptized in mud.

Not about to waste a free day in my hotel room, I headed down to Salt Lake Power Yoga for some hot yoga with a view of the mountains.

Here I was anxiously awaiting the moment we would do mountain pose--- and we did. And you should have seen the smile spread across my face when she said "now do the inversion of your choice" and I inverted into my headstand!! Who knew inversion in Salt Lake City could be a good thing?

 At this yoga class, I met not one, but two runners who had had surgery done for Femoacetabular Impingement (FAI). It didn't sound like either of them was doing that much better after the surgery. I couldn't help thinking--- if only they had learned to run correctly! Well, no one is touching my acetabulum with anything! Below is a nice intro video to pose running Ole posted today. I really looking forward to getting certified as a pose instructor this March!


How do you define "Running"? from POSEtv on Vimeo.


But back to SLC..

Free bikes - or $5 for 24 hours (just like in Copenhagen!). I got one to bike back up the foothills to the hotel.

I don't just have a bad aim when taking pictures of myself. I have learned that if I only include half of my face, I am less likely to look asymmetric.

Running song of the day:

Closer by Tegan and Sara (okay, the entire heartthrob album is awesome, except "Now I'm all messed up") and this song totally reminds me of Taylor Swift in a cute way.

Now it is out to dinner with the PM&R residents and a day-long interview tomorrow. I'm ready with my photon joke! :-)

Grenaa 6 Hour Run

Yesterday's 6 hour run was definitely one for the books. Not just the race itself, but the entire experience of travelling from Næstved to Grenaa, staying at a lovely home in Sangstrup and being part of the Grenaa 6 hour weekend. Honestly, had it not been this particular 6 hour race and the timing of it, I may have never run a 6 hour race again. I had this voice in my head that said I could never again run on such an unvaried surface for so long without getting problems with my hip. This was my chance to tackle my fear with a new running technique and new training plan.

At the start line (yes, you can see me in the white compression socks), I couldn't help thinking of being in the exact same place last year... and dropping out after running 42 km in 4 hours with severe hip pain. I had a much better feeling yesterday. For one, I felt energetic and ready to race.

The start was really interesting. Almost immediately I noticed I had forgotten to change my Garmin from miles to kilometers and staying on pace for running 70k was going to be a constant challenge of my math skills.

Shortly after that, a woman passed me. I entertained the notion of holding on to her, but she was going 6:30 min/mile pace. I did not recognize her and I doubted a woman out here could run 80 km in 6 hours, so I figured it was smartest to let her go.

Just before the marathon, I passed her and felt very good in my skin.

There were really no lows yesterday. I just enjoyed running. The joy of constantly lapping people doesn't get old. I had also forgotten that about 80% of the course is on forest trails and only 20% on asphalt, so really an ideal surface for someone like me to run a 6 hour race on. Not to mention all of the people cheering at the aid station and really all along the course. This is a big advantage of a compact route.

It was, to be exact, a 3.13 km loop, which had two really sharp turns that really irritated my right hip. And that hip was killing me between miles 10 and 20, but I had also experienced this at Superior and Glacial Trail and it went away. The same thing happened yesterday. The more I live with my dysfunctional hip, the more I realize, the femoral head is simply not attached to the acetabulum correctly. It probably never will be. As I run, the problem gets worse, but then my muscles tighten and get inflamed and the actual hip pain goes away. And, in all honestly, the length and severity of the problem keeps becoming less, so maybe it will actually go away.

I did run with a back pack, despite an aid station every 3 km. I am the picture of someone who should develop hyponatremia. I drank constantly. But I was also constantly thirsty. I have to say, I think I know my body's signals well enough and the principals of exercise-associated hyponatremia that I know how to avoid it.

The drink of choice was an all natural tropical punch (yum). Food staple was potatoes with or without salt (in little pink bowl). In the red bag were 4 extra pairs of shoes. Just in case. I guess I am one of those runners who feels you can never be too prepared. It's almost too much, though, isn't it?

I'm posting this picture to remind myself NOT to tuck in my shirt next time. Good Lord. It never ceases to amaze me how despite not actually having a pot belly, I always look like I have one. It's like the opposite of a corset. So cool. But both my feet ARE off the ground. Photo by Ib Stokkebye.

According to my Garmin:
 marathon in 3:30
50 k in 4:12
60 k in 5:08

Ok, but what was 70k?? I kept saying to myself it was 43 miles, but it's actually 43.5 miles! (this is where Garmins in the right units come in handy. Or the ability to do math in your head while running an ultra. It alwasy seems so easy to do this math once I am done!).

Then, with a half an hour to go, things took an unexpected twist. "You're in second" said the race director Ove. "What?!" I told him I thought I was in first. All day, people kept saying I was in first and suddenly I get this information!? On my next and final trip through the aid station, I learned that she was slowing down and "5 minutes ahead". What was the chance I could make up 5 minutes in 15 minutes?! I held onto the hope she was walking and SPRINTED the last 15 minutes, like my life depended on it. I passed woman after woman, but what did she look like? I had passed the woman who started ahead of me... (I thought!).

The horn blew. The six hours were up. I did not know if I was in first or second or how much I had run. My Garmin said 43.03 miles and I thought that was 70 km. Whatever happened I was satisfied! It was actually fun! I could not walk off of the course to save my life, but it WAS fun.

I know this is going to be confusing since I said my Garmin was in miles, but Endomondo automatically reads in kilometers, so above was the final reading.

How I managed to run almost an extra kilometer that was not part of the course, I am not sure, but next time I should not run off into the woods with the first guy I meet named Svendrik. This will be my number one strategy for improvement next year.

Below are the laps times for myself and the first woman, Gitte Sørensen, who ran over 4km longer than she ran at Grenaa last year, so that is awesome!

This is what lap times look like when you FEEL like you are running an even pace :.-) I should point out, I think the 22nd lap, though I didn't quite complete it, was faster than the first. The end result was still almost a 5km 6 hour PR.

Edit - Ok, this post would not be complete without a shot of this guy, Poul Petersern (sponsored by Asics), who won for the men, running 79.1 km (6 km ahead of the 2nd place Krisitan Birk). This shot, again by Ib Stokkebye, captures his essence. Notice how he calmly yet totally effectively has just tossed his cup into the trash WHILE both feet are off the ground and no pot belly. Throwing away a plastic cup - like a boss. :-) (honestly, it was fun to watch him run; he is good).

While we were waiting for the final results, awesome times with good friends. The open, interesting conversations you have after a race are unparallelled in life. Everyone was so relaxedand humorous.  Pictured are Alice Kristensen,  "kisser" Claus Christensen, Anne-Dorte Mahato and a fascinting guy from the German border (who was Danish, but LOVED Germans!)

Finally getting a good look at the woman I apparently ran right behind all day! How I wish SR had been there to give me information on her whereabouts (and existence). I thrive on competition and it just didn't happen!!

Here are the 500 kr. I won which covered all of my travel expenses, so that was awesome. Of course, I didn't know I would forget all of my swimming stuff in the locker room.  But then again, I didn't know that today at our local pool, "pool master" Carl would give me an awesome pink Speedo swimsuit since he felt bad for me (provided a did a dance in it on the way out to the pool.. small price to pay) Edit: it was of course only AFTER I was at the bank I realized the check was made out to Gitte Sørensen. I wonder if she has mine?! Thisis all very confusing since 2nd place prize was 500 kr.

In Summary:

1. I am now going to speak with a Jutland accent all of the time because it is much easier and people can almost not hear I am an American import.

2. When I got home I read the standard for getting on the Danish 100k national team was 70km in six hours. Bøøøøø. So close! But until Denmark allows double citizenship, it doesn't affect me. I just think... wouldn't it be better to have MORE women to choose from on the team so that every time Denmark goes to worlds they have more than 2 or 3 going?! There should ALWAYS be a full team and if there are women on the edge who are fresh and ready to go, they will do better than an injured woman who has previously met the standards and is only luke-warm about going. Just my thoughts. Bring back the alternates!

3. The way into the heart of a Dane is through running. This study was no surprise to me to read (http://loeberne.dk/studerende-laver-faellestraening-til-halvmarathon/) that a country with one of the worst reputations in the world for accepting foreigners, is much more open to foreigners who run races (competere: striving together). Perhaps that helps explain why this clumsy American bookworm has been disguising herself as an athlete :-). Well, no regrets. I am having the time of my life and have never felt so at home in Denmark or so in shape.

It's been a fantastic 3 weeks filled with work, running, time with friends, lectures, but my family is in the US (!) and Tuesday I head back to the states. January, we'll all be back.

I have SO many songs to recommend. Where to begin? Well, I took a 30k bike ride today, windless, sunny, in the 50's

Næstelsø in the background, fantastic photochromic glasses sponsored by Ryders, helmet that ... does the job.

and listened to - on repeat- too many times to admit--

"Ways to Go" by Grouplove. Nothing more than a kick-ass love song.

And I want to say thank you to all of the friends and family members out cheering in Grenaa, Ove Kvist and the many volunteers for a fantastic race, my coach Ole for a training plan that is working, makes me energetic and happy and to Team Salomon Denmark for always supporting me, even off the trails (I LOVE that vest!).