Ugen derpå and continuous experimentation in physiology

Jeg overvejer stærkt at begynde at skrive bloggen på dansk da hele mit daglige live foregår på dansk og jeg kan mærke, jeg har lidt svært ved at finde ordene når jeg skriver på engelsk. Jeg føler mig dog lidt fanget mellem to stole da jeg bliver nok aldrig så "god" til dansk som jeg er til engelsk. Nå- men jeg imidlertid bare på engelsk da langt over halvdelen af mine læsere ikke kan forstå det flotte danske sprog :-). Men måske lige pludselig en dag er bloggen på dansk.

Marie Sklodowska Curie was a mother of 2 girls. She was born in Poland, but educated in Paris. Basically, she studied rocks in an old shed and discovered that radiation does not come from the interaction of molecules but instead is due to an intrinsic property of the elements' atoms. As long as I have been an adult, she has been a person I have looked up to and the a number of Swedes did see it fitting to give her a Nobel Prize in both Chemistry and Physics.

My hematologist husband, SR, may be interested in knowing that Marie died of aplastic anemia. She had such an intimate understanding of radioactivity, yet, ironically, she did not know it could kill her.

Perhaps a good, albeit dark, segué to discuss ultrarunning. 

Many (especially new) ultra runners may be surprised to know that running ultramarathons appears to affect the right side of the heart. Whether not it is strain (and dangerous) or an adaptation (and advantageous) is not known (Heidbuchel, Oxborough, George, etc); it may be an adaptation that in the short term is good, but in the long term causes arrhythmias. In running longs distances, we experiment as we go. Humans have always run, but races this long? 

Post ultra fever

3 days after the Fyr til Fyr 60k, I developed my usual post-ultra fever. I felt terrible and had to force Mattias to go to bed early with me. It seems most reasonable to me that this is a result of a cytokine storm (in response to high levels of adrenaline +/- muscle breakdown) rather than an infection (see Pedersen, 1997), but studies of blood work multiple days after an ultra are difficult and expensive so they are few.

The most recent fever was nothing compared to the fever I had 3 days after 3 days of Syllamo where I was so delirious that I had to call 911. It got so high that I could not watch a newborn and SR ironically was on call at a different ER and couldn't leave. There have only been a few moments in my life where I wondered if I would survive and they have all been following ultramarathons (I don't drive much).

Then there is my diet experimentation: low carb, high fat

Our kitchen is at all times filled with pots, pans, cutting boards, loads of veggies, nuts, cheese, eggs, fish and tofu.I have never been one to get into cooking, but anything in the name of science! Burners and blenders constantly going, it is kind of fun, though time consuming. (by the way, it is nearly impossible to be a pesco-vegetarian and eat a truly high fat diet, but again, I think it is the low carb, no added sugar that is the most important part).

My newest discovery is ground flax seed in unsweetened soy milk.

This is the version Amy Sproston referred to as "cat getting sick"

Then I made it prettier with more soy milk and a few pure corn flakes

Again the reason for all of this is to 1. eat naturally, 2. keep my blood sugar more constant and 3. teach my body to rely more on fat as a fuel source.

My experince at Fyr til Fyr was evidence for me that my body is better at using fat for energy than before (evidence was needing to eat way less during the race). Additional evidence is Zach Bitter's continued ultraruning success (did you guys see him break the course record at the Mad City 100k? (I'm not saying it is not ALSO his training) - he is also on an all-natural, low, carb, high fat diet.

BUT- after I ate the above for breakfast AND lunch (very high fat and high protein), I got up quickly after Bikram Yoga and actually fainted in the locker room. As I stood there, feeling sick, knowing I was about to topple over, I had the wherewithal to think: "this is what happens when you experiment too much!" (it was probably because I got dehydrated from digesting a super high fat, high protein series of meals). 

Have I mentioned that I have lost over 4 kilos since starting this diet? As I stood there giving my "Runner's Diet" talk to Sparta, I talked about how I loved the fact that I never weighed myself and, on this new diet, just went by feel. Well, after two months, I figured I had better step on the scale--49 kilos!?

(either this is the weight my body wants to be - I still feel great, actually better than ever - or I need to blend and boil a bit more in the kitchen)

Training by Menstrual Cycle
This is not much of an experiment, but I love getting regular periods (this is the first time in my life I have) and the sure sign that one is coming is I write to coach Ole "I don't feel like running" - and then 1 to 2 days later, there it is. Estrogen levels drop dramatically (the female equivalent of testosterone) right before menstruation so it makes sense training (or racing) is not optimal at this stage of the cycle. A study I read recently in Medicine and Science in Sports and Exercise found that women who are on birth control pills don't have the same physiological changes during their menstrual cycles, but those not on hormonal contraceptives actually get significantly stiffer when their estrogen level is lower. (Casey, 2013) I am sure other "things" happen, but stiffness was the endpoint of that study.

Vitargo

My next experiment will be with something quite different before and during my runs: Vitargo. It is a Swedish-made carbohydrate source for athletes that is made with maize, maltodextrin and sugar. No, this is not part of a low carb diet, but will give you quick energy while training. Pia Joan, Jesper Noer and I have been asked to test it while ultra training. Jesper had a great experience using Vitargo at Fyr til Fyr. Thanks to Mikkel Halkjær of Sport4Fun for delivering this to Fysium today:

Vitargo products a plenty. But take note of "Free Style" in the left hand corner (not tampons). That is a a glucose monitor with strips. The bar with "ENERGI" written on it promises stable blood sugar during competition in 3 hours and 20 minutes. We will see! 

Yeah, so I plan on using the blood sugar monitor regularly to see what is really happening with my blood sugar. One thing is "feeling" a certain a blood sugar, another is getting a reading. I will keep a Stata spreadsheet; don't worry.

By the way, that green couch was hand-made for me when I was 18 years old. It has travelled a lot.

So, the glucose measuring is just to point out- you don't need a lab to experiment: you can get away with a Marie Curie shed or a tiny apartment in Næstved.

Another thing I look forward to experimenting with (Thomas said I could :-)) and following other peoples' experiences with is the Alter-G treadmill at Fysium. There are only 10 in Denmark.

The Alter-G treadmill effectively lowers gravity from the waist down and can be used in rehab from neurological or athletic injuries. That's Tomas from Fysium, who was telling me about the experiences people with stroke and spinal cord injury, etc had while using it. In my mind, it is a lot like water jogging, yet a lot MORE like really running and you can increase the gravity the stronger you get.

Now some pictures from a great pre-Easter week

Mattias following his first sub-18 min km.

I have started training with the fast women of Køge Atletik and we hope to win the Danish Championship in team 10,000 meters on the track on April 26th. Huge thanks to Erling for talking me into this. It is fun to run with 1:16 and 1:19 half-marathon women!

With family med doc, Rikke, of Køge Atletik (and 1:19 min ½ marathoner... you would not guess her age). Thanks to Jørn of MarathonSport for my new track shoes; I had sewn my old ones together again multiple times.

And with Sylvia the Kenyan braider, who went on to run a 1:16 ½ marathon the weekend after she ran a 1:20 marathon at Griseløbet (that fun race where I set my PR). You would probably guess her age and it is young!

But today was home on Herlufsholm home track.

Today's workout was simply 200 + 6  x 800 meters at "moderate" pace. I could feel I wanted to go faster and that my legs are doing well again after Fyr til Fyr.

Sometimes I wonder if the simple design of Danish furniture is inspired by the simple lines of the landscape (lovely bike ride-- I often dream of getting back into triathlon, but I refuse to buy an expensive tri bike). By the way is this young barley (byg)?

Everywhere we go the sky is different. Today's sky over Næstved. The colors in Scandinavia are much bluer than in the US where everything has a more yellow tone. Funny how only people of our generation can make observations like this.

Some pictures from our back yard 

Mattias and misakat

Happy Easter, everyone!

Toujours et encore une fois - la musique...

For my intervals today:

Fyr til Fyr 60k - The Epic Battle for First Female

It has been nearly a month since my last entry and there is a lot to tell!

 1. I got a residency training position at the University of California-Irvine in Physical Medicine and Rehab starting July of 2015. We are quit excited about this new adventure and I am thrilled to have matched in a field that suddenly has become among the most competitive in the US. Like so many other things in life, it was much more about knowing people (especially through my work with Western States) than any other factor. I really owe Kentaro Onishi and Marty Hoffman for their help with "the match".

2. SR finishes his job in Duluth in September and will move back to Denmark to work again in Næstved before we head to California for 3 years. The long term plan, as described earlier, is to try to start a Physical Medicine and Rehab training program in Denmark after I finish. And the most important part of the plan is- our family will actually live together again! (it is so hard with both SR and Christian in the US right now)

3. I have had my most exciting and productive training cycle leading up to the Fyr til Fyr 60k yesterday, including one training PR after another and a ½ Marathon PR on the rather hilly Griseløbet route of 1:26:51 (header photo from this ½ marathon). I am curious whether it is my change in diet (2 months and going strong of a natural low carb, high fat (LCHF) (still gluten free), which isn't really that high fat, my "off season" with skate skiing over the winter or the realisation that all of my step classes in Næstved were the source of my vastus lateralis tendonosis in my right hip. Probably a combination of all of these with my recent ability to sleep up to 10 hours a night (oh, and I may give my coach a bit too little credit!).

Fyr til Fyr 60k

Very unique point to point race route from Dueodde (the southern tip of Bornholm) to Hammerknude (the northern tip) - literal translation of fyr til fyr = lighthouse to lighthouse (fyr is not fire, I know what you were thinking. "ild" is fire, so just stop thinking and then Danish will come. Oh, but if you want "to fire" someone, you can say "fyr".See. Perfect nonsense.)

Yes, I was cold before we started, but I think I was one of the only runners who didn't overheat. Then again, I think I have an unusually low threshold for getting too warm. 

Photo from the start of the race from the southern lighthouse on Dueodde. The sand is truly this white. There were nearly 400 participants this year. Photo: Stine Sophie Winckel. 

Whether or not I wanted it, there was a lot of hype leading up to Fyr til Fyr. Pia Joan Sørensen is pretty much unanimously considered the best ultra runner female in Denmark. She can run close to an 8 hour 100km and hopes to go under that at the IAU World Championships. She is a recent addition to the Danish running scene despite being in her 40's. We have both been signed up for the Fyr til Fyr 60k since last year and both have been training with the same coach, Ole Stougaard of Multitesta.

We have been comparing training times and, as the race drew near, it seemed inevitable that we would be battling it out for the win. I told her the day before the race that I could not let myself have a "goal" of beating her, since I wanted us both to run our best race. And frankly I am probably more interested in her getting fast than me because I think she has a lot more talent and potential.

But SR kept saying "it is going to be really close". And I was getting that impression from Ole, too.

The start is so dramatic and lovely with a sprint over the sand dunes. I passed Pia here, but she soon caught up again and we ran the first sandy, rocky 10k in 46 flat. We were both winded, both wondering who would slow down first. I have never been in a neck and neck ultra race with a woman before and it is exciting and hard. But we talked and had fun, too.

Pia was right on my heals here (about 8km) before we entered a more rocky, technical section. She stayed with me there, too. As did Anders Hjortlund, who is a professional Danish triathlete (cool to run with him!.. I'm thinking he's ever so slightly faster than me on his bike and in the water).

At 17km, I skipped the first aid station pulled away from Pia here with a solid lead. I had planned out my energy so I would not stop at either of the aid stations during the race. With 2L of fluid, I was probably actually transporting too much.

Above was the next section we entered. Danes have an inferiority complex about their ultra trail races, but I want to say that THIS race has the most varied terrain of any ultra I have run and it must be because it is on an island where there are so many microclimates affected differently by humidity, wind, waves, sunlight, etc.

Here Pia had run about a marathon and I learned from a friendly bystander that she was about 4 minutes back. This is a hilly section in the woods along the coast with spectacular views. It is called "Helligdom" (the shrine).

At around the marathon distance, I knew I was having a great race. No energy lows and by the end, I had only eaten a half a Clif Builder's bar. I drank under 500 mL of fluid (½ natural tropical juice ½ water) the whole race. I was quite astounded since at this same race last year I ate 5 Clif Builders bars and drank 2 L of fluid. I can only deduce that my new diet has improved my ability to burn fat over sugar/glycogen and this decreased need for sugar, which also meant less stomach problems and a nice, constant energy level.

But already at 35 km I started noticing my right hip and knew I was running with a limp (for those who don't know me, I always walk with a limp, but only limp when running in long races). The changes in terrain really helped keep any pain at bay. As I have discussed with Ole, anything that makes me take shorter steps helps prevent the pain and problems from developing. I focused a lot on technique from 35 km on. It helped as always.

I looked at my Endomondo file and I came through the marathon in 3:33 and the 50k in 4:18.

I learned from Kim Rasmussen (mastermind of the Hammer Trail race route) with 5k to go that Pia was "at least 4 minutes behind" me and looked "very tired." I guess you could say I thought I had the win, but not 30 seconds later, Pia came sprinting past both me and Kim.

Susan Bargholz captured the point in the race with 4km to go when the female winner was decided (in front of Hotel Romantik). When I tried to sprint to keep up with Pia, my right calf started cramping. I have never had calf cramps before -ouch! Despite a high level of energy, my right leg wouldn't cooperate and I watched her disappear over the horizon to the final ascent up to Hammerfyr. As you can see, my running technique fell apart here and my steps were way too long. There are oh so many factors that come into play in a perfect race. My race was almost perfect; but when the right leg doesn't cooperate at the end, there is room for improvement. 

Pia looked so strong as she ascended the dunes and rocks to the final lighthouse. I had to give it to her- she won fair and square. But I was not disappointed because we both had an awesome race, greatly exceeding our expectations, mostly because we were there to push each other. We both finished well under Dorte Dahl's course record from last year of 5:47. Pia came in in 5:12. My time was 5:14. This is neither here nor there, of course, but I ran 12 minutes faster than SR's time from last year on the same course, same temperatures; we had the benefit of the wind being at our backs this year and it came from the side last year. I ran 47 minutes faster than I did last year. How could I not be thrilled? And I was!! 

From within the lighthouse at Hammerknude at the northern finish. Photo: Stine Sophie Winckel.

Goal! 59.2 wickedly wonderful km in 5:14. Photo: Moses Løvstad

The winning man was Jesper Noer in an amazing 4:15 (new CR; race report). Second was Kenneth Kofoed (pictured below) in 4:45. Pia was 5th overall and I was 7th. Kind of cool in a race with nearly as many participants as Western States! Results here. I am ok they added an extra "h" to my last name. Høegh sounds like an even faster hawk to me.

Just after race finish, Pia was offering me wipes to clean off my blood. It was fun sharing this adventure with her. I am in my usual duck-footed position (or at least with the right foot)

What a fantastic weekend. The ultra running community in Denmark feels like my family. I love the way people who are injured or not running travel all the way to Bornholm just to volunteer,to support and be with their ultra running friends. There were people cheering all along the route. Huge thanks to Moses Løvstad, Thure Kjær, Ravn Hamberg, Maibritt Skovgaard and Peter Riis. There are so many other helpers I wish I could name. Thank you all! And thank you to SR's parents, Beth and Asger for watching Mattias who now has chickenpox :-). And thank you to Salomon Denmark --- I don't feel there is much room for improvement in my running gear or clothing. It is nice to not even have think about that and just enjoy the race.

And I don't think I was the only one who had fun! (photo- Stine Sophie Winckel; jumper ??)

And I probably had a bit too much fun traveling with Christian, Per, Dan, René, Martin and Pia. The above picture is from Brazz restaurant in Rønne the next day where I treated myself to my favorite fish- herring. Christian and Per pictured here.

And the other side of the table at Brazz: Pia, Dan and Martin.

And we all survived the car ride in my SUV Porsche (does Porsche make SUV's? Oh, I guess they do - the Cayenne?!); thanks Christian Bering for that unexpected gift ;-). I don't think it's too early to say "see you next year!"

As always, you can see my races and training in detail on Endomondo- here.

Running song of the day ...because someone at Bikram yoga asked me if I was Medina :) ... if you want to make my day, just ask me if I am Medina.

One more, since this weekend made me feel like a kid on the beach and this song is the essence of Denmark, not least of all the strange English lyrics.

Runner's Diet: low carb, high fat research and experimentation

First of all, I am not going to pretend I am an expert on optimized fat metabolism (OFM). It is a popular term in endurance running these days. Normally I would just kind of ignore it and think it was a fad. But I am not ignoring it (and in fact, I am obsessing over it) for a few reasons:

1. I have been able to fight quite a few health problems and improve my running with a radical, though gradual change in my diet over the last year and a half. The diet I have somewhat coincidentally ended up eating is nearly the exact same diet endurance athletes such as Zach Bitter and Casper Wakefield use to optimize fat metabolism. I have to thank both of them for being so open about their eating strategies for ultra training.

Since switching their diets, Zach and Casper have gone on to set amazing records in long distance running. And here is Zach's cholesterol profile before and after switching to a low carb, high fat diet.

2011 - high carb diet

2012 low carb, high fat diet (N/A next to LDL since it was undetectable)

I had heard in medical school that, despite all odds, some guy with a personality disorder in Scotland who ate 2 dozen eggs a day had a "perfect" cholesterol profile (details may have been exaggerated :-). But Zach's cholesterol levels indicate he is indeed very healthy.

2. I have been asked to give a lecture to Sparta Atletik on April 3rd entitled "Runner's Diet" and, while I feel comfortable with general physiological concepts, as well as eating and drinking before and during races, what runner's optimally should eat on a daily basis, is a topic I have not looked into extensively before.

My previously unhealthy relationship with food (just because you start out "bad" doesn't mean you can't change)

I used to have a very simple way of looking at food and calories. Burn more calories than you take in and you will be thin and fast. Candy is bad and why not try to follow the food pyramid and avoid getting deficient in anything?

Probably the lowest point I reached in my diet was getting over half of my calories from flødeboller and then drinking diet soda and chewing sugar free gum to stop myself from eating more, though I was constantly hungry. I also tended to eat white bread and butter for breakfast. I always heard this was unhealthy, but come on, "the proof is in the pudding"!

I replaced the flødeboller with chocolate (much better?!) and .. it's embarrassing to go into too great of detail, but the truth is, I ran really high mileage and even won the Mad City 50k in 4:09 on this very diet. Heck, things weren't really that bad.

But what started the change in my diet was, despite weighing only 49 kilos, I was too embarrassed to wear anything tight or go swimming without a big towel around me because I looked like I was 4 months pregnant. Also, I had been on PPI pills for acid reflux since I was 18 years old and couldn't survive a day without them.

An ophthalmologist friend of mine pointed out the connection between diet soda and big bellies over Facebook. I cut out artificial sugar and my belly shrunk - over only one week (check out the purple and green lines over just 8 days after stopping diet soda and artificial sugars):


Around the same time, I decided to see if I could give up my PPI stomach acid medications. I started taking probiotics instead and after about a month, my acid reflux had greatly improved.

I was so amazed by how much better I felt that I decided to give up gluten. Around this time, a rash I had had around my eyes for two years disappeared. I started gaining muscle and energy. I ran PR times in the 5k, 10, ½ marathon and marathon within 3 months. My reflux and irritable bowel syndrome are gone and it is no coincidence, but pointing to one change is hard when I changed so much at once. I will only suggest that people reconsider eating modern day wheat (the semi-dwarf GMO (edit: thanks Robyn and SR; it is NOT a GMO, but created by cytogenic hybridization), when it is theoretically implicated in many autoimmune diseases, at least one type of dementia and lymphoma.

About two months ago, Robyn challenged me to try the Whole30 diet. I didn't. But what I did was I cut sugar out of my diet, except two Clif Builders bars for breakfast - they are all natural, low sugar (Edit: thanks, Pam- not really low, 20 g per bar), high protein bars (also 20 grams per bar). You probably don't believe I ate that much sugar going into it, but try 3 packages of pålægschocolade a day on for size.



Suddenly I was on a very low carb, gluten-free, pesco-vegetarian, basically sugar free (no artificial sugars!) diet. It took a couple of weeks before I started watching my body change before my very eyes. I would not be writing this if it weren't for the changes I have experienced, mostly positive, some negative.

Fat Oxidation/Metabolism

My understanding of fat oxidation is it is using fat for fuel. One can improve their ability to metabolize (use for energy) fat though lifestyle. Endurance exercise improves our ability to metabolize fat. And insulin sensitivity improves our ability to metabolize fat. This means that people with diabetes, who are insulin resistant (not type 1, but type 2) have a remarkable inability to oxidize fat. Their fat sits there, basically unused. The final thing one can do to improve their ability to metabolize fat is to eat less carbs and more fat. From the research I have read, medium-chained fatty acids work the best, rather than long (olive oil is long and butter is medium, for example). My personal theory is it is the lack of carbs and not the type of fat that matters most.

Through the above exercise and dietary habits, one can preferentially oxidize fats at a higher and higher percent of one's VO2 max, which means that one can run ultras at say 60-70% of VO2 max with very, very little reliance on carbohydrates and stored glycogen. This means you won't have to eat carbs constantly while running. This is a big deal since nausea and stomach upset is the number one reason people drop out of ultras.

All of this has been demonstrated through sound science. The real question is if it can improve performance.

For the last 7-8 weeks, on my accidental OFM diet I have noticed a lot of changes.

1. My cellulite has disappeared. I never thought I would write this. But (as kinky as this sounds) I have SR do the skin squeeze test on me often and he can't find any cellulite anymore. Though I weigh the same. I do indeed see this as proof that I am preferentially burning fat- at least more so than before when I had these cellulite pockets (on my thighs and waist) that wouldn't move regardless of my weight or training.

Ok, not that impressively muscular, but an improvement!

Here is Robyn at the end of the Whole 30 diet-- maybe I should have tried to follow those rules strictly after all :-)

2. My blood sugar feels constant. It is great to not lose energy during the day. Eating things with a high glycemic index (white bread has the highest... see below) causes wild blood sugar swings. The only exception to this is when I am out on my long runs, it takes very little time before I hit a sort of wall. The interesting thing is, the energy comes back once I get past that initial wall. I have not run a marathon or ultra since I started on this diet so I am really curious what is going to happen. I honestly doubt it will mean I have to drop.

3. I have been running some tempo PRs in training. Though my coach doesn't like me to, I go entirely after feel and not after pace. A faster pace feels easier than it did last spring. There is no doubt about that.

4. If I get a small injury, I recover within 1-2 days. A benefit of having a stable blood sugar and insulin sensitivity is inflammation (which is fed by sugar) is decreased and you heal faster. People with diabetes (similarly fluctuating blood sugars to people with a high carb diet) are notoriously slow healers and this is one of the reasons.

5. I can do pull-ups for the first time in my life and up to 70 push-ups at a time. This is a good guage to me that my muscles are growing.

I never thought I would do a pull-up. Here was number 3 (on our home bar, which once fell down when SR was using it. He claims he blacked out when his head hit the trashcan)

6. Low carb/low sugar food is insanely expensive. At some point I would like to do a blog post called low-carb, gluten free, natural eating on a shoe string. I think this will take years of research, though, and really depends on which country I live in. The WHO now recommends less than 6 tsp of sugar a day. They just don't mention how expensive this is.

7. I get irritable on my long runs (see number 2)

8. I smell and have acne. I could not figure out why this was until today, but after reading more about whey and how bovine products cause insulin production out of proportion to the amount of sugar they have, I do believe my increased cheese intake is to blame. I don't drink milk, but eat cottage cheese and other cheeses, which contain a small amount of whey. I suspect this is the reason for my increased odor :-) and acne. I did not know that milk had been so convincingly implicated in increased teenage acne. Milk and high carb diets. It is amazing how much whey is used as an additive in processed foods, by the way.

In summary:

My feeling right now is a low-carb, all natural, gluten-free, low sugar diet is the way to go for a healthy life, or at least a major improvement on where I have been. And once you start following it - at least after the initial two weeks, you don't want to stop. I just think the night before long races that it will be important to fill up the glycogen stores so I don't go into a race ready to go cold. Also, it is really important that when running at high effort for many hours that you replace the carbohydrates you lose otherwise you WILL go cold. So don't skimp on carbs if hungry while racing and probably not on your long runs either. Pam Smith does well with liquid carbs + fat + protein (ensure, white soda). I do well with potatoes and salt + juice + Clif Builders bars. I'm not about to change this race strategy until it stops working. I just think with an improved ability to metabolize fat that I will not need to eat as much while racing, minimizing stomach problems and maximize energy.

Something for you all to chew on...

A few pictures from our weekend. SR ran a potential double baby jogger world record 5k in 18:01 (on dirt) and I took 27 seconds off my time on the same route from 4 weeks earlier.


and I took 27 seconds off my time on the same route from 4 weeks earlier (19:28, just as a tempo). I love free races!

But not as much as I love my boy!

Running song of the day... (so poetic the way she enunciates the "e" at the end of each phrase)

The big decision

I haven't exactly hidden the fact that I love living in Denmark. I annoy my readers with this opinion often. SR suggested I tone down the "double citizenship argument" since no one cares but me. Fair enough. 

What exactly is going on in our lives is weird and confusing. SR has a full time job in the US; I have a full time job in Denmark. 

A few weeks ago, the kids moved to Denmark with me and SR spent time alone in the polar vortex (Duluth). He returned to Denmark last week, to a warm apartment in (relatively) balmy country; to happy kids and home-made chick-pea pancakes and most importantly, biathlon on Eurosport. Oh and his wife. These days he says often that he wants to move back to Denmark. He says will quit his job in Duluth this summer.

But the night he arrived, I had to decide whether or not I would withdraw from or stay in the American residency match, to start a 3 year training position in Physical Medicine and Rehab in the US (place to be determined). We agonized over the list I had to rank of most desirable programs (only those I had been invited to interview at) over least-desirable. Rasmus agonized over my desire to rank Stanford higher than his desire to live in Palo Alto (he won). But what really mattered to me was we were saying we would move to the US for 3 whole years. The country that wouldn't give me more the 15 days maternity leave or any understanding or compassion as a young female soon-to-be mother physician. That culture of working 80 hours a week and thinking nothing of it. The culture of medicine that doesn't tolerate ... moms. Mothers who sign up and sign away their lives are asking for conflict. American society wonders how you can't be there for your kids at 2:30 PM when they get out of school and go to after school activities (and you wonder yourself) and your residency program expects nothing to trump working and learning. 50% of young American moms don't work ... America- why even educate women who want to have kids?

3AM Feb 26th was the deadline to decide- is it any wonder I was up until 3 AM?

If I were any other blogger, I would say it was "a privilege" to be able to make this decision, that I was "filled with gratitude" for the opportunity, but those are big empty words. I don't like them. 

Instead of being filled with gratitude, I was filled with tears. But I followed through on the plan SR and I had made together. And we will be closer to his kids starting July of 2015- for 3 years.

And then, I will bring the speciality of Physical Medicine and Rehab back to Denmark, where it currently doesn't exist. I'm excited about that.

Since the big decision, we have been enjoying the magical weeks of all being together again. 

Christian's running has suffered in American public schools and Duluthian snowdrifts, but his drive for accomplishment hasn't.

After the race, he became the king of Fastelavn by breaking the barrel with the poor cat in it. Or was it a giraffe? Actually these days there is no animal inside the barrel, only candy.

 This past weekend, SR and I went to Møns Klint, Denmark, which looks like this from a distance:

from campingmoensklint.dk

It is good to meet a husband who is willing and ready to discuss the pathways to gluconeogenesis and the genetic makeup of Trinidad on long runs.

And ask me why on earth I am panting while running uphill. (the explanation is not rocket surgery)

He says my running technique keeps getting better, which I am so proud of. I just can't figure out how he started out with proper running technique, but he did!

We like grimacing, or not.

We pretend he looks fast, but perhaps we are looking at the scenery?

One of the essential elements of being an upper class (respectable) mom in Denmark is the perfect scarf for every occasion. Buffs are not accepted in most circles- I learned at a Christian's pre-kindergarten meeting.

Sudden mist storm.

And trash.

No one every said life would be easy. They did say life would be beautiful, though, and they were right.


Running Song of the Day: Tom Odell's "Another Love" (Zwette Edit)