Thursday, June 19, 2014

Girl talk

I love bad joke eel...sorry.

One of my friends recently posted a recap of her Ragnar relay experience. She commented that was on her period during the race...which made things that much more challenging. I bet! Logistics, pain, just yuck.

Another one of my friends was running a marathon and passed out. She was on her period.

This got me thinking about running and periods. Just Google menstruation and running and a ton of blog posts pop up. This is a big topic. For women. Men, you can be excused.

So what's a woman runner to do?

In my practice as a PNP, I do physical exams on kids of all ages up to 21. With girls, starting at age 9-10, I always talk about periods. Pre-puberty, I get to do a lot of what we medical folks call "anticipatory guidance", and we talk about changes to their bodies and what to expect. Most of the girls are pretty receptive, and I'm always surprised how much these young girls already know! I try to keep the discussion positive, but let's face it, who looks forward to bleeding every month? Periods are part of life but something that women love to hate. One thing I always say is that every woman gets their period and it's a club that no one really wants to be in. Truth!

I mean look at all the nicknames for it: Aunt Flo, Flo, on the rag (hate that one!), my friend (with friends like that, who needs enemies?), that time of the month, the blogger called it "riding the crimson tide", but she's from England and I'll excuse her for that! Anyways, none of them were really positive. Because really, what is so great about bleeding for 5-7 days every month? Some lucky women have a really easy time with their periods. But I have found over the years that is the exception. Most women have pain, fatigue, nausea, diarrhea, and mood swings with their periods. It's tough for women because advertisers really stress how their products can help you take your period in stride and go about your everyday activities as if nothing was bothering you.

Full disclosure: I always had bad periods. When I did get my period (every 6 weeks if that), it wasn't heavy but I had terrible cramps. Sometimes I vomited from the pain. Luckily, ibuprofen came out around that time, and once I was able to choke down those giant pills, I had some pretty good pain relief. It wasn't perfect, but I could function. I tried oral contraceptives and that definitely helped but I didn't like the idea of taking daily medication, and after several years, I stopped taking them. For several years after I gave birth, my periods weren't too bad. They were regular, and I could get by with ibuprofen on the first day. But in my 40s, everything changed. My periods became more and more painful again. Running became difficult, and I started having trouble even running 3 miles most days because I was so fatigued. I was diagnosed with a uterine fibroid and about 6 years ago, finally had a partial hysterectomy to remove it when it became so large I had trouble urinating. 

Eight weeks after that procedure, I ran 5 miles pain free and haven't looked back. I feel like a different person. Not only do I not get a period anymore, I have so much more energy. I'm running faster and farther than I have in years. I packed up all my pads and tampons and gave them to my friend, the mother of 2 girls. We laughed about it, but she told me how lucky I was not to have my period anymore. I completely agree.

I don't advocate such an extreme procedure for horrible periods, but for me it was life changing. Many of my friends who are in their 40s who have had similar issues have also undergone a procedure called uterine ablation, which basically compresses the uterine lining and reduces monthly bleeding. If you're done having kids, why not? Quality of life is a big deal here.

Jenny Hadfield wrote a great blog post on running and menstruation. Being an elite runner, she was really concerned how her cycles affected her training. She began keeping a symptom log and found that there were some key changes to her HR and pace during certain days of the month. Typically, the last 2 weeks of the month were more challenging due to cyclical hormonal changes. Interesting, because although I no longer get my period, I do still have my ovaries and so I do go through a monthly cycle. I just don't notice the extreme ups and downs that I did prior to my surgery.  She also talks about a "cut back" week if you are one who experiences bad cramps and /or heavy bleeding. Which is a great idea unless you are training for a race or your race just happens to fall at "that time of the month". Since women bleed 1 week out of the month, there's a pretty good chance that a race may occur during your period.

Another great article was published in Competitor magazine earlier this year. The article (written by a man, I should add) is more technical but talks about the physiology behind the cycle and why women should train differently than men. Turns out that depending on what time of the month it is, your heat tolerance could be lower due to fluctuations in hormones. Women are more susceptible to heat related illness than men. The author states that training helps improve a woman's ability to tolerate hot conditions. Anemia can be an issue in all runners, but especially women who bleed heavily during their periods. Anemia can contribute to fatigue because red blood cells carry oxygen to the brain and if you have less of them, well, it just makes sense. Glucose metabolism is also affected and he advocates a high carb diet. Hooray for carbs!


Do you notice changes in your running related to your period? What do you do to alter your training, if anything? Do you plan your races around your cycle?

Tuesday, June 17, 2014

Summer Running

"Summer running, had me a blast....
Summer running, happened so fast...
I ran a race, crazy for me,
Ran a PR, look and you'll see..

Runner days, runnin' away....but oh, oh those finish times!"

What about those finish times? Who likes to run in the heat of the summer? Does anyone get a PR in the heat and humidity?

We midwesterners complain all winter about the weather. After last winter and all its brutality, I promised myself I wouldn't complain about the heat of summer. Personally, I love the heat. But I won't lie. I hate running in it. If I had my choice, I'd rather run in the cold. Last March, I ran a half marathon in Florida. Remember that recap? The heat and humidity just about did me in. I wasn't acclimated for it. And now, that weather has arrived in Chicago. Time to excuses.

This morning, I set out to run 6 miles. Like any good runner, I checked the weather forecast before I headed out the door. At 6 am, it was 77 degrees and 67% humidity. In spite of calling for thunderstorms, the radar looked clear. The wind was whipping--what the weathermen call "breezy". I decided to take my chances. Anything but the treadmill!

Before I headed out, I applied BodyGlide to some body parts that had the potential for chafing, drank a big glass of cold water, took one last look at the sky--nah, no storms--, and headed out the door. I almost left the Garmin at home, thinking that I didn't even want to know my pace...but my OCD won out, I turned on it, and pushed start as I headed down the street.

I started off at a fairly easy 9:00/mile pace. Felt pretty good with the wind at my back. At mile 1, I headed into the wind. I hoped the wind would cool me, but it was so humid that I did not feel any relief. Interestingly, the wind didn't affect my pace. I took that as a good sign.

But by mile 2, my heart was calling for mercy. I didn't need my heart rate monitor to tell me that I was in the red zone. I also started getting a side stitch. Woo! I stopped to catch my breath and stop the nausea in its tracks. "This is not happening", I told myself. My intestines churned. After about 30 seconds, I started running again, albeit very slowly. Before heading out, I had promised myself I would complete this 6 and I decided no matter what, I would get it done. As I moved forward, I saw one of my neighbors out for his morning run. He started running a few years ago, lost a ton of weight, and left his wife, a friend of mine. Boo on him!

"Hey Wendy", he called. 

"Oh, hey," I said and kept moving, a little spring in my step. 

A little while later, I saw the high school boys cross country team. Most of them were shirtless. Not that this affected me in any way at all. But to be friendly and encouraging, I waved and called out to them. "Hi boys!", I said. I got a few greetings back but was mostly ignored. They probably thought "eww, it's somebody's mom". Yeah, somebody's mom who's KICKING YOUR ASS!

I saw them again as they looped around a second time. Tried again and said hi. Got a few more waves this time. Yep. Badass mother runner here. I kept moving forward. Who's old?

At the 4 mile mark, I approached the park fieldhouse and stopped to drink water. Trying to make that side stitch go away. The maintenance guy greeted me. "It's hot out there!",  he said.  A little bit. Understatement of the year! I sucked up a ton of water and headed back out. Two miles to go.

I saw the guy who walks his Eskimo dog. I see this guy all the time. The one with the dog who lunges and barks at every car that goes by. Raised my hand in a wave. 

One mile to go. That side stitch was getting pretty intense. But I kept going. Rounded the corner onto my street. Saw the guy with the Ironman license plate bracket walking to his car, heading to work. I picked up the pace, tried to look like a strong runner as I passed his house. Seriously. WTH?

Finally at my destination, I stopped when I reached my driveway. 6.11 miles, 58:09, 9:31min/mile. I'll take it. According to an article I read in Runners' World, every 5F above 60 degrees can slow your pace by 20-30 sec/mile. I think I did ok.

I have Zooma in August. Hoping that the weather then isn't like this morning. Could be a long 13.1. Or not. A couple more runs like this heat? Makes me feel unstoppable.

Thursday, June 12, 2014

More, more, more

When I started running, about 20 years ago, I ran to help me deal with stress and anxiety which was taking over my life. I began running with a friend I met at the health club, who was also training to be a personal trainer. She was really athletic and decided to train for the Chicago Marathon. Back then, I didn't know anyone who ran marathons. It really wasn't a common thing. I ran a lot of 5Ks and 10ks, which were really popular, but still so small, and certainly not the spectacle they are today. There were no color runs, no tough mudders! Half marathons weren't even heard of. A full marathon seemed overwhelming and out of reach to me.

As I eased back into racing, about 5 years ago, I found that the racing scene had changed dramatically. Half marathons were growing in popularity. I decided to run my first half marathon in Door County Wisconsin, a beautiful peninsula where I had spent my childhood summers. This was at the urging of my mother, who I am sure wanted bragging rights that one of her daughters ran this "hometown" race. And there's nothing better than making your parents proud, no matter how old you might be! The Door County half marathon is a pretty big deal up there, and the year I ran it was only the 3rd year for the race. I cried when I crossed the finish line, because it was the farthest I had ever run in my life. But instead of feeling content, I wanted to do more. I fell in love with long distance running.

The following year, I ran several half marathons and the Chicago Marathon. I was anxious from the moment I signed up for the marathon. Every time I thought about the marathon, I felt panicked. I carefully selected my training plan from Hal Higdon's vast selection of training plans, choosing Novice 2. I followed the plan religiously, which really helped boost my confidence and reduce my nervousness. I promised my husband (and myself) that with the marathon, it was one and done. But is was important to me to run it. I just didn't want to go through my life as a runner, without running "all" the distances.

Well, as you well know, that marathon wasn't exactly a success but I did finish and got my medal. I had bragging rights. I was a marathoner! And I never had to do THAT again. Right?

But then I started to hear about people running multiple marathons. Apparently, running one marathon wasn't enough. I saw people wearing Marathon Maniac shirts, which meant they ran multiple marathons within a short time frame. And ultras.

When did running an ultra become "a thing"? I worked with a woman who runs ultras, who one year actually was one of 2 women from Illinois who qualified for Western States, a 100 mile race. She's several years older than me. I asked her how she trained for her races, and she told me she really didn't, that she just ran a lot of marathons and long races throughout the year. I always had this perception of ultramarathoners as a little bit out there. She's really quiet and soft spoken, humble, actually. However, there is another woman who lives near me, who also runs ultras. She runs in a sports bra and short shorts all year round. It could be 20 degrees and snowing, and I see her scantily dressed, running down the street. Maybe on those days, I've seen her wearing arm warmers. I've met her at a couple of my yoga classes, and she's what my mom would call "a character". This is how I viewed ultramarathoners.

Until recently. Now on my facebook feed, I have posts appearing regularly from friends who are training for ultras. Who have completed ultras. Normal, everyday moms and dads. And I ask myself, when did this happen? When did the marathon distance not become far enough? And what if a 50K (31 miles) isn't enough? Then what? A 50 miler? When do you decide to do 100? And finally, what kind of toll does all this running take on your body?

I've been running for a long time, and I've chronicled some of the problems I've had with my feet over the past couple of years. Marathon training--my one and only--took a huge toll on my feet. I can do strength work to support my knees and hips. But my feet? My most recent injury to my foot was caused by a well meaning podiatrist, who I sought out after the marathon, and who put me in orthotics. Those orthotics directly caused the injury to my big toe due to the stiffness in the midfoot, which forced me to land on that joint. This is an injury that has become chronic and most likely will plague me for the rest of my life. I've been thinking about another marathon. That's no secret. But could my feet survive the training?

And an ultra? I have to admit that I have absolutely no desire to run that far. Even another marathon isn't all that appealing to me. But as much as I'm not one to succumb to peer pressure, reading about everyone's accomplishments makes me sort of wish I was younger...had fresher legs and feet...and could push my limits a little bit more.

For now, I have to be content with what I can do. After all, I'm still running! I also have to put it all in perspective. When I saw the orthopedic surgeon, who sorted out my whole foot injury thing, he reminded me that the amount of running I actually do is a lot. When I talk with people at work, and they ask me how far I ran, "just 4" always makes them laugh. To people who don't run, 4 miles sounds like a lot. But in the company I keep, my friends, the runners who post on my facebook feed, and those whose blogs I follow, 4 miles is a warm up.

Sunday, June 8, 2014

Motherhood melancholy

Yesterday I was seeing one of my patients for his 2 year old check up. This child, who was an adorable baby, has turned into THE CUTEST little boy. The first thing he did when I sat down to talk to his mom was take off his shorts and diaper. Then he sat on the exam room couch. He took his mother's blue sunglasses and put them on, and then sat back and relaxed. "Are you all set now?", I asked. "I want milk," he said. His mom gave him a sippy cup with milk and he sat there sipping, as if he was pondering the meaning of life. Buck naked, blue sunglasses, drinking milk. I mean REALLY. I thought I was going to die, it was just so cute. I'm so lucky I work in pediatrics. I have encounters like this all day long. Of course, I do see those 2 year olds who are so terrified of me that they scream during the entire visit. So there's that...

Knowing that I have a 14 and a 16 year old, the patient's mother asked me, "do your boys still want to be with you?"

March 2014 Anna Maria Island

I stopped and thought about that question before answering her. I told her that I don't believe they mind being with me, but that they would rather be with their friends. Because that is the hard truth about motherhood.

Prior to becoming a mother, I had always been a runner. This type A personality that I have been blessed with needs an outlet. And while I was able to juggle the demands of motherhood and a part-time career, I learned after becoming a mom that I needed my outlet--running--even more than ever before. I didn't do races when the boys were little, it just wasn't a priority for me. But I always got in my runs--at least 4-5 time per week. Because my husband left for work before 6 am, for several years those runs were done at 430am. Me, the newspaper delivery men, and the skunks. But I did it. That hour on the road was my me time, the only time of day that I was alone. It was so important and I made sure those runs happened. It actually worked out well, since my boys went to bed at 8--I didn't stay up much later than that!

I never complained about having to get up early to do get my runs in. I actually looked forward to them. What I believed is that being able to run, to have my me time, made me a better and more patient mom. I had more energy to play with my boys. I wanted to be able to keep up with them--I didn't want to be one of those moms who sits on the bench and watches them. I wanted to be in there. And I have been.

But all of a sudden, or so it seems, I look at my boys, and they're big. Taller than me, my oldest has also passed up my husband. Oh, and that yummy baby smell? Replaced by a not so pleasant male odor. Which they was away with Axe shower gel. That smooth baby skin is now sprouting hair. Sigh....

They are hardly ever around. One minute they're home, the next minute, the door slams before I can even say goodbye and be careful, and they're gone. All the free time I longed for when they were little is mine. I read and finish books before they need to go back to the library. Phone conversations with my sister go uninterrupted. I go to the store alone and come home with only the things that were on my list. I can run whenever I want. I can go on a 30 mile bike, and not think twice about it.

But there's a price you pay for that free time. I miss those little boys. When they needed me--sometimes it was overwhelming! Not that my boys don't need me now, but it is usually to drive them somewhere or give them money. Hugs? "Disturbing", my oldest proclaims. Forget kisses! I always tell them I love them when they leave for school, but I don't get a response anymore. Oh, and they know everything! Apparently, I don't.

Is this wrong?

Friends who have older children tell me that they come around again, once they leave home for college. Yikes! I don't even want to think about that!

I'm so glad I have a passion, an interest outside of my family. Something for me. Running has always gotten me through so many rough times in my life. And I believe, running will get me through this too. Letting go is so hard, but it is part of life. I'm starting to pull away a little too, I think--running more races, getting more involved in the running community. I could throw myself into my career, but that isn't what drives me. Running is my motivator. Running has always made me better at everything I do.

“But kids don't stay with you if you do it right. It's the one job where, the better you are, the more surely you won't be needed in the long run.” ― Barbara Kingsolver, Pigs In Heaven

Thursday, June 5, 2014

Good news

You know what they say about opinions--everyone has one. I've certainly been the recipient of multiple opinions regarding my foot since my injury 7 weeks ago. To recap, I was running my usual 6 mile neighborhood loop and came down funny on my left big toe, causing me to have excruciating pain. By the next morning, the pain had calmed down, and several days later, I ran my 10 mile race and PR'd.

I received the following opinions about my injury:

Dr Sport: arthritis flare up. Gave steroid injection in the joint.

Dr Foot, sports podiatrist, seen previously: arthritis. Built up my orthotics.

Becky, corrective exercise specialist: hip imbalance/glute weakness. Exercises and strengthening. Boo to the orthotics.

Dr Rad, radiologist #1: avulsion fracture L MPJ

Dr Sunshine, radiologist #2: non-healing avulsion fracture, old fracture, cortical avulsion fracture L medial sesamoid

Dr Peds, medical director of my practice: whatever it is, you need to take time off work. And definitely no cycling.

It just keeps getting better. What's a runner to do with all these opinions?

And if that weren't enough, I saw Dr Ortho today.

An orthopedic surgeon, Dr Ortho's specialty is foot and ankle. His wife roomed with one of my partners during medical school. Dr Sport talked with him prior to my appointment. I felt like I was in good hands.

When I apologized for not seeking help sooner, he laughed. "Runners are like that," he said. "You are so used to running with pain that you try to fix it yourself. And you only come when you can't run."

Hello? This guy gets me! What a breath of fresh air.

He looked at my xrays and told me he didn't think the fracture was recent. He told me that if I had fractured that joint, I wouldn't have been able to run at all. He also thought that I would have had some significant swelling. I nodded in agreement.

The proof! A 10 mile PR 3 days after the initial injury.
He examined my foot. Made me stand on my tippy toes. No pain. Pressed on the joint. No pain. Took a few more xrays, while I was standing. Those views did not show a fracture. He told me that maybe there was an old fracture, but what he was seeing was....arthritis. His opinion? Something I did aggravated the joint. The treatment? Rest, immobilization aka the boot, ice, antiinflammatory medications--steroids. Everything I had done. Oh and by the way, cycling was fine.

He wants me to- gasp!-try running on it and see what happens. Nothing crazy, but start out slow. He told me to take the boot to work, but to try wearing my shoes and see how it feels. No need to come back, unless the pain returned. Oh and by the way, trash the orthotics. He looked at them and showed me how stiff they were in the midfoot, causing me to land harder on my toe. Probably leading to some of this pain.

Shocked? Yes. Surprised? Yes. Happy? Yes! And a little confused. I did call Dr Sport after the appointment and he had the same reaction as I did. So we're back to our original opinion. Why such differing opinions? Here's the thing. The radiologists read the xrays. But the orthopedic surgeons are the experts. My only regret? Not going to see this guy sooner. Although it sounds like it wouldn't have changed anything. Maybe that radiologist did me a favor by giving me the doom and gloom report. I might not have sought out the ortho. But I'm glad I did. I'll keep you posted on my progress.

Tomorrow, work all day. Saturday, I plan to test out the foot. 2 miles. I have to also wean myself from those orthotics. Running without them is going to change my body mechanics. It was hard getting used to them. I wonder how long it will take me to get used to running without them. Prior to all this, I had a plan to take it easy for the next 6 weeks and let Becky push me on the weights. That plan is still in place--the only difference is that I'll be easing back into running instead of cutting my miles.

My opinion about all this? I'm cautiously optimistic. For now, the boot isn't going back into the closet.

Wednesday, June 4, 2014

Riding in the rain

As I runner, I've always been really flexible about running in all kinds of weather. This past winter was a perfect of example of my willingness to take it outdoors, no matter what the conditions. I don't ever remember a winter as cold and snowy as this past winter. So what's a little rain? Meh. Getting wet never bothered a matter of fact, running in bad conditions makes me feel...shall I say, a little more badass than usual?


But in the past, as a cycler, I've been pretty reluctant to hit the road in anything but perfect conditions. Some would call me a fair weather cycler. The broken foot has changed all that. I need my endorphins and have started pushing past my comfort zone to get them. I've ridden in cooler conditions that I would have in the past. This morning, I rode in the rain.

I didn't plan it that way. When I checked the forecast, the weatherman was all optimistic. "The rain is moving out and the skies are going to clear," he declared. I looked at his radar and all that green on the map, indicative of rain, was moving east. I looked out the window at my deck, and while it was wet, there were no raindrops falling into the little puddles out there.

I put on one of my favorite running shirts, which really motivates me to move, and headed out the door. A cool, east breeze was blowing but I knew I'd warm up quickly. I clipped my shoes into the pedals and away I went.

I'm all dry and feeling optimistic today. I wanted to get in about 20 miles.
As I rode on, I started to feel a few drops of rain. No biggie, I thought, it's going to blow over. As I headed down the hill towards the tunnel that would take me onto the bike path, the raindrops began to increase. I took it slow, because I wiped out once on wet pavement, and it is an experience I don't care to repeat. 

It happened a few years ago. A crabby old man who was walking on the path yelled at me because I didn't call out to him that I was passing by. I hit my brakes and my back tire fishtailed underneath me. He laughed and told me I deserved to fall. I asked him what his problem was as his wife came over to help me up. She told me to ignore him, but that I really should alert people as I approached. I thanked her and told her I felt badly for her. I was pretty banged up, but I felt much worse about such a negative encounter, and now I always shout out to walkers and runners as I pass by.

Anyways, as I pedalled on today, I saw a few runners! The rain steadily increased but I pressed on. Because that is what I would do if I were running, right? My Garmin beeped to let me know that a mile had passed and I looked down to see a 4 min/mile pace. I was surprised, because I felt that I was moving pretty slowly. I had heard that using the shoes and toe clips would increase my efficiency, and now I wonder if that is what was happening, even as I tried to proceed with caution.

I made it to the forest preserve and the 3 mile loop. The wind picked up and the rain came down pretty heavily. It wasn't a downpour, which would have been painful--I've experienced a few of those as a runner--but it was enough to make me pretty uncomfortable. I could have used windshield wipers on my glasses! I felt safer on the loop than I did on the forest preserve path, and so instead of heading back on the path, I decided to make a couple extra loops around, heading home on the neighborhood streets. As I increased my speed, I passed a few walkers and runners. On my second loop, I passed another woman cycling. We smiled at each other. Yep.

I made it home after completing a total of 18.5 miles. My hands and feet were numb. I dried off my bike. When I took off shoes, my socks were soaked. It was then that I noticed all the debris up the back of my legs, shorts, and shirt. Kind of yucky, but kind of satisfying--I felt like I did something pretty awesome today. Some might call it pretty stupid. But it's what I needed.

The good thing about riding in the rain is that I had the path pretty much to myself! Silver lining....

And the post ride shower felt great!

Average mile time 4mins/mile. Not bad for a rainy day!

Tuesday, June 3, 2014

A healthy addiction and a trip down memory lane

Today in my clinic, I saw one of my newborns for a weight check. Although this wasn't a first baby for these parents, their other child was 18 years old and mom was trying to breastfeed, so I wanted to check in with them sooner rather than later. The baby looked fabulous, had gained 9 ounces in 5 days (!), and the parents were definitely more at ease than the last time I saw them.

At one point in the conversation, I began to wrap up the visit. I don't recall exactly what I said, but it prompted the father to lift his shirt and show me a long scar that extended the entire length of his sternum. "Aortic aneurysm," he said. "I also have COPD and emphysema." Which are the same entity, by the way.

I knew it! He had one of those "smokers' voices", that deep, raspy voice that is so distinctive, I was certain he was a smoker--but at the last visit, when my medical assistant asked about secondhand smoke, both parents said no. I asked him if he was currently smoking.

He told me he quit a few years ago, but looked embarrassed and admitted to recently "sneaking a few". He told me not even a pack a day, and he didn't smoke around the baby. I chose not to focus on that, but instead talked about his health. Both parents used to be heavy smokers, he told me, but the mom quit a few years ago. They had been trying for a second child for years, but it wasn't until she quit that she was able to conceive. The dad was convinced that quitting smoking was the reason she got pregnant.

Ok, so why "sneak a few"? He couldn't answer me when I asked him that very question. We talked about how addictive cigarettes were, I get that, but with his health problems, why start back up? I asked him if he's tried the nicotine gum, the patch. He told me he tried everything, but he still wanted to smoke. I empathized with his addiction. I've shared stories I've heard about big tobacco putting substances in cigarettes to make them more addictive and he nodded in agreement. He seemed to think, though, that since he survived the aneurysm, that he dodged some sort of a bullet. I didn't use the "C" word--cancer--or go into a discussion about the progression of emphysema/COPD. Clearly, he'd heard everything I said before.

Finally, I held up his beautiful, perfect baby boy and asked him if he wanted to be around to see him grow up. To see him graduate from high school, college. "And get married," he said.

Nobody said anything after that. I looked down at the ground. Trying to think of the right thing to say and not pass judgement, I caught a glimpse of my boot. As a distance runner, the idea of smoking is so foreign to me--I had a hard time figuring out what to say next. As an NP talking to a father who has experienced first hand some terrible health consequences of smoking, yet is still smoking--clearly, nothing I could say would stop him. I needed to wrap up the visit, so I let the silence finish our discussion and made plans for follow up in a month.


The quintessential smoking stud of the 70s.

This encounter really got me thinking. I will never understand smoking--I never had any desire to start. When I grew up, almost every adult I knew smoked. Even my mom smoked! My grandma smoked! We had ashtrays in our house for when smokers came over. Some of those ashtrays were prized pieces of pottery. There were candy cigarettes for kids, which we begged my parents to buy for us, and when we blew through the paper wrapping on them, a puff of powder came out of the end. Smoking was glamorous. At least that was what the American Cancer Society tried to tell us.

My high school had a "smoking lounge" outside behind the school. If you wanted to be able to smoke, your parents had to sign a permission slip. The idea was to deter students from smoking in the bathrooms. Which didn't work. I hated going to the bathroom during passing time--for sure, girls would be in there lighting up. My freshly washed hair, using "Gee Your Hair Smells Terrific Shampoo", was ruined. Every. damn. time.

This would never happen to me!

My mother-in-law was a heavy smoker. One time I rode up to my father-in-law's cabin in Wisconsin with her. A 3 hour ride, she smoked the entire way. One cigarette after another. I staggered out the car when we arrived, nauseous. My husband asked if I was ok. "You look green", he said.

When I was a new staff nurse, in the 1980s, I had a job working on a medical oncology unit. It was the only job I could find at the time. I learned a lot, and I learned that I didn't want to take care of adults. But when I look back on that experience, what really stands out was that patients were allowed to smoke while hospitalized! And they did--even while receiving chemotherapy. Contrast that with now--you can't even smoke on hospital grounds! One hospital I worked at said they would fire employees who were caught smoking anywhere on hospital property, even if they were sitting in their own vehicles.

As a home health nurse, I did take care of some adults. One memorable experience was a visit to see a man with tongue cancer. He was dying, and I was there to hook him up to a morphine pump for pain control. No one prepared me for what to expect, which would have been nice. When I walked in, he was sitting in a chair, blood dripping out of the corners of his mouth, his tongue the size of a steak. Not only was I completely nauseated after seeing that, I couldn't eat beef for weeks after that experience. But the best part of the visit? His wife was in the corner of the room, you guessed it, SMOKING!

And yes, I took care of a few people who smoked through their tracheostomy.

A few years ago, one of my neighbors, a mom who was my age, was diagnosed with stage 3 lung cancer. She called me to talk about a persistent cough that wouldn't go away. Her doctor kept prescribing antibiotics, which didn't sound right to me. Although I don't take care of adults, I recommended that she go to see a pulmonologist. After being diagnosed with cancer, she told me that both her parents were heavy smokers. She herself never smoked. She did not survive this illness.

So, so many stories about smoking. In my practice as a pediatric nurse practitioner, I do my best to deter adolescents from smoking. But they've heard all the health risks and since thinking they are invincible is part of adolescence, me talking about the risks doesn't do much. So I talk about the cost. Sometimes that makes a dent. Other times, not. A lot of kids tell me they get cigarettes from their friends.

Or as the dad today told me, teenagers get money from their parents for all kinds of things. Lunch money, whatever, if they want to smoke, they'll find a way to do it. Just like sex....

Today's visit made me sad. Smoking is such an unhealthy addiction that affects more than just the smoker's health. As runners, we joke about our addiction to running. Ok sure, I have a broken foot, and I've been joking about how exercise is bad, but in all seriousness, the other health benefits of running--lowered cardiovascular disease, diabetes, obesity...outweigh the risks of physical injury. Would it really be so hard to trade one addiction--smoking--for another, healthier option? Those endorphins sure keep me coming back for more. And I'm pretty sure I won't die from them.

Sunday, June 1, 2014

Teaching an old dog new tricks...

So after getting the news on Friday that my foot fracture wasn't healing and that I actually had more fractures, I decided to take the plunge and buy cycling shoes and toe clips. Multiple cyclists have told me that this is THE WAY to bike, and that I really should do it. I was reluctant for a number of reasons. First and foremost, I'm a runner. I didn't want to invest more $$ into an activity that I considered cross training. Buying shoes and clips seemed like a commitment. I already felt guilty enough, not riding my road bike as much as I should. Getting the real pedals and shoes meant that I really needed to maximize my investment. Which meant more riding and less running. And I just didn't want to go there.

The other reason was that I was scared. Let's face it. I'm not very coordinated, and I've heard tons of stories about people falling over on their bikes because they couldn't get their shoes unclipped in time. I've already got a broken foot...I don't want more broken bones!

But since it looks like I'll be spending the majority of my summer in the saddle, I headed over to the local bike shop to make a purchase. I hobbled into the store in my boot and ignored the strange looks from all the cycling studs that were shopping there. When I told the guy at the counter what I was looking for, he asked me how I planned to bike wearing the boot.

"It comes off, you know", I said. What the hell?

He asked me how far I usually ride and when I told him, he looked surprised. Really dude, what did you expect? I gave myself a silent high five and followed him over to the shoes.

He showed me my options and I tried on the shoes. I asked him if they could install the clips for me and he told me it wouldn't be a problem. I also asked him if he could show me how to use them. He said they'd put my bike in the trainer and let me practice. That didn't actually happen, but the service department guys installed my equipment.

They also warned me about the "rule of threes". "Everyone falls", the service guy said. "Three times". He also cracked a joke: "what do you call people without bikes? Runners". Ha ha. Real funny.

This morning, I nervously approached my bike. Try as I might, I could not figure out how to clip the shoes into the pedals. I spun them around, stepped on them, and pushed on them. Frustrated and hot, I asked my 16 year old to come outside and help me. I asked him to take the clips off and put my pedals back on. I thought I'd try the clips another day. He patiently took the clips off the bike and examined them closely.

"Mom,'' he said, "put these on your shoes." He showed me how to clip them on the shoes. Then he took them off my shoes and reinstalled them on my bike. He told me I was going to have a lot easier time getting my shoes out of the clips than I was stepping into them. He waited while I clipped my feet in and out a few times. "You'll be fine," he told me.

Clearly, he did not get his mechanical skills from me. Nor his calm, patient nature.

He watched me nervously ride away. At first, hesitant, my feet felt funny as I pedalled. As I approached my first stop light, I kicked my left foot out, just like my son told me to. It worked! My foot released and I touched the ground with my left foot. I proudly waited to cross the street. Once I pushed off, I had a little trouble clipping my foot back onto the pedal. About halfway through the intersection, my foot snapped on to the clip and away I went.

My first 5-6 miles were like this. There are a lot of stoplights at the beginning of this route, and I got plenty of practice kicking out of the pedals and stepping back in. I found that my son was right about this. As I rode on, I became more confident and picked up speed. Rule of threes, my ass!

My ride was hot and windy. Probably one of my toughest rides to date. I was exhausted and couldn't wait to be done. As I neared the end of my ride, I headed towards the exit of the Arlington Race Track. A car with its right turn signal on approached me and thinking he was actually going to turn right, I rode ahead. But he decided to go straight and I slammed on my brakes to avoid hitting his car. My biggest fear came true, I couldn't get my foot out of the clip fast enough and I began to fall towards the ground. My left foot (the broken one) wrenched out of the clip at the last minute and I landed on that foot, avoiding a fall. I felt my hip tug as I righted myself and I gave the driver a dirty look and saw that his license plate was from out of state. Tourist! Actually, I had some stronger words for him, but kept them inside where he couldn't hear it...

31 miles done, 2:05, and I made it home safely. I cracked open a beer, my reward for going out of my comfort zone and pushing my limits. Plus I was just so darned hot and miserable.

Thankful once again for my drive and perseverance, courtesy of running. With a little help from my teenage son. Who knew?