Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Thursday 26 December 2013

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.

Thursday 12 December 2013

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

NameNotable PROther HighlightNationality
Jennifer Aradi128.1 Miles (24 Hour)2012 Heartland 100 WinnerUSA
Zach Bitter5:12:36 (50 Miles)2012 50 Mile National ChampionUSA
Eric Clifton13:16:02 (100 Miles)Former JFK Course Record HolderUSA
Anthony Culpepper82.39 Miles (12 Hour)2013 Beyond Limits 100 WinnerUSA
Ed Ettinghausen135.7 (24 Hours)52 Lifetime 100 Mile FinishesUSA
Anthony Forsyth16:03:47 (100 Miles)2013 Beyond Limits 50 WinnerUK
Connie Gardner149.368 Miles (24 Hours)Former American 24 Hour Record HolderUSA
Tracy Høeg43 Miles (6 Hours)2013 Salomon Hammer 100 Mile WinnerUSA
Deb Horn134.45 Miles (24 Hours)Multiple Time Team USA 24 HourUSA
Carilyn Johnson130.92 Miles (24 Hours)Multiple Time Team USA 24 HourUSA
Olivier Leblond14:33:25 (100 Miles)2012 Old Dominion 100 WinnerUSA
John Maas15:37:23 (100 Miles)2013 Kettle Moraine 100 WinnerUSA
Beth McCurdy122.55 Miles (24 Hour)2012 North Coast 24 Runner UpUSA
Padraig Mullins8:42 (100 KM)2 Time Lake Waramug 100k WinnerIreland
Kristina PhamUSA
Roy Pirrung154 Miles (24 Hours)World Age Group Record HolderUSA
David Ploskonka134.3 Miles (24 Hours)2010 Beast of Burden 100 Mile WinnerUSA
Pam Smith15:01:40 (100 Mile)4th Fastest North American 100 MilerUSA
Jay Smithberger13:49:13 (100 Mile)3rd Place 2012 Desert Solstice 100USA
John Ticer16:35:45 (100 Mile)2010 24 Hour AG National ChampionUSA
Victor Vella34:29:40 (Spartathlon)National Age Group Record HolderMalta

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.

Saturday 7 December 2013

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?

Tuesday 3 December 2013

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.

Gotta have it! :)  CoreFX Black "Running for Two" Racerback Tank
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