You can also view Dr. Dave’s blog at http://driversseatpatients.blogspot.com to find out how to better help your doctor help you.

Remember – your body is a like a Ferrari. Drive carefully!

Last weekend, I completed my second marathon - the Mercedes Marathon in Birmingham, AL. Despite an unfamiliar course, more hills and a concussion three days before the marathon, my official finish time (chip time) was 3 1/2 minutes faster than my previous marathon time. Only in Alabama can you fall and hit your head on the ice and three days later, run in 60-degree weather during a marathon:)

Best of all, I felt much better during the race and afterwards!  The recovery was shorter and I didn’t have dehydration and potassium loss issues.  Ongoing training obviously helped, but I really think that tweaking my hydration and electrolyte plan accounted for most of the improvement.  For the Mercedes Marathon, I made two changes:

• I used Nuun tablets (available in Fleet Feet) instead of water and gatorade. The Nuun tablets (mixed with water) offer quicker absorption and a higher sodium content. I used four of them before and during the marathon, filling my water bottle at most aid stations.
• Instead of salt tablets, I used S!caps.  These capsules provide the major blood plasma electrolytes – sodium, potassium, chloride, bicarbonate, and phosphate – needed to get through a grueling long-distance run.

If you are struggling with distance runs, don’t give up.  Keep trying different hydration and electroyte options, along with recovery (ice baths vs. warm epsom salts baths) and running shoes. What works for you at one level, may change as you add mileage or speed. I had to change running shoes and inserts when I began training for my first marathon. One of the best ways to find what works best for you is to do your long training runs with others to see what works for them.  If you have a running specialty store in your area, the employees can be a wealth of helpful information. I couldn’t function without our local Fleet Feet staff! 

Running Web sites provide great information ranging from upcoming races to training to gear and hydration. My favorites include:

http://www.runnersworld.com/

http://www.active.com/running

http://www.runningtimes.com/

So what are you waiting for…get out there and get moving!  Before you know it, you’ll be sporting a 26.2 plaque on your car:)

How many of you have made New Year’s resolutions for 2011?  How many of you have already broken them?  Fear not, successful New Year’s resolutions are within your grasp!

One year ago, my New Year’s resolution was to grow as a runner and to complete a half-marathon in 2010.  As it turned out, I completed two half-marathons, a full marathon, and I attempted my first 50k (31 miles) on New Year’s Eve (completed 25 miles.)  It may sound daunting, but it wasn’t difficult at all when I followed these strategies:

1. Select a resolution that will give you a tremendous sense of accomplishment.  It can be something as simple as organizing your closets. It doesn’t have to be impressive to others, but it needs to add value to your life.
2. Make sure your resolution is achievable.  If it is not, you are setting yourself up for a feeling of failure.  Be prepared to make adjustments if you find along the way that your original goal is not going to be achievable, after all.
3. Focus on the journey, not the destination.  Celebrate each milestone and don’t beat yourself up when you falter – just get back on track as quickly as possible.  Larger goals may need to be broken up into smaller segments.
4. Rally the troops. You need support from those who will hold you accountable with encouragement, not nagging.  Your supporters should encourage you to continue your successes and to get back in the saddle whenever you do fall.
5. Find sources of inspiration.  Let others know that they inpsire you – this is a great way of paying it forward!  And verbalizing your inspiration helps you move towards your own goals.
6. Visualize the rewards awaiting you upon your success.  If your goal is to lose weight or stop smoking, visualize yourself healthy and energetic.  If your goal is to further your education, visualize yourself in a higher-paying and more satisfying job.  Right now, I am trying to get motivated with visions of a clean house:)

2011 is a new year, a new chance to reaffirm your most powerful relationship – with yourself.  The one person guaranteed to be with you the rest of your life is YOU!  Be good to yourself!  You owe it to yourself to enjoy the best that life has to offer.  It all starts today, with your hopes and dreams for 2011.  Happy New Year!

Last Saturday, I completed my first marathon – the Rocket City Marathon in Huntsville, Alabama. What an adventure!  My goal finish time was 4:30 – 4:45 and I finished in 4:47:35.  Not bad, considering it was 26.2 miles!

Race day went something like this:

• Miles 1-12- I stay with the 4:15 pace group, averaging 9:15-9:30 per mile. I know better than to run the first half of the marathon at half-marathon pace, but I got overly ambitious.
• Mile 12 – I need to use the porta potty and can’t wait another second!  There’s a line and that delays me about three minutes.
• Mile 13 – I start to hit the wall. No actually, I slam into the wall!  The headwind is rough and we have a steady mile or so uphill. My ambitious plan to finish under 4:30 unravels quickly.  Legs are starting to cramp so I take half of a salt tablet.
• Miles 14-16 – Okay what is going on? I need walk breaks?!!!  This didn’t happen during my training runs. I’ll get a second wind any minute.
• Miles 16-20 – I’m still waiting for that second wind and still needing walk breaks. I have consumed two GUs and I grab a third at an aid station around mile 19.  I can’t get very much of it down, because the nausea is setting in, so I discard it, knowing I haven’t had enough fuel.  Leg muscles are on fire and I take a whole salt tablet.
• Miles 20-24 – I’m feeling nauseous and lightheaded, wishing I could still get my finisher medal after finishing most of the marathon.  My training coach Mona runs with me for awhile and offers some badly-needed encouragement.
• Miles 24–25 –Yay! Volunteers are handing out peppermints!  Peppermint oil helps with nausea and boy do I need it!  I make a second porta potty stop, not caring if I make my goal finish range of 4:30 – 4:45.  I’m almost too exhausted and lightheaded to leave the porta potty, but I know something special is waiting for me at mile 25….
• Mile 25 – There he is…the most beautiful golden teddy bear in the world!  My precious German shepherd Beau is cheering me on at mile 25 with the help of “Aunt Susan,” his doggy sitter.  I give Beau a hug and kiss and walk a short distance with him and Susan until he stops to sniff and hike his leg.  I know…TMI with his potty stops and mine:)

Beau

• Mile 25.1-26 – I’m on the home stretch! For the first time in 12 miles, I feel like I can actually finish this!  I know I won’t come in under 4:45, but that’s okay, I’ll be close. I am determined to do whatever it takes to get across that finish line, preferably running.
• Mile 26 – The crowd is cheering and I feel exhilarated!  Just a few steps to go…and I will have marathoner bragging rights!
• Mile 26.2 – Amazing! I did it! As I cross the finish line, my running buddy Kristin is there to give me my medal, blanket, hugs and congrats. (Her first marathon is in a couple of weeks!)  My dear friend Steve is there with hugs and congrats and then I see my running buddy Carol at the finish line!  The same Carol who told me last summer “I’ll never run a marathon”:)

The best part of the marathon experience was the support from the Huntsville community. The race directors Dink and Suzanne Taylor, Fleet Feet staff, Huntsville Track Club, Huntsville Police Department, HEMSI rescue squad, Huntsville Amateur Radio Club and numerous volunteers were amazing!  Everything was carefully orchestrated to keep us safe and hydrated.  Aid stations were abundant every 2 or 3 miles, with plenty of volunteers to hand us water or Gatorade, or even pour it in our water bottles.  GUs were available at two aid stations and we even had people meeting us with trays of cookies and providing tubs of candy. 

The volunteers and local citizens provided tremendous help with cheers, bull horns, music, cowbells and high fives.  They displayed signs that gave us inspiration and determination to continue.  A number of signs had inspirational scriptures that gave us strength.  My other favorite signs include: “Toenails are overrated,” “Chuck Norris never ran a marathon,” “Free high-fives!” “Free hugs!” and “Because 26.3 miles would be crazy!”  One guy met us every 3 or 4 miles with his “Good job!” sign.  One of my favorite moments was when a little girl who looked to be about 4 years old stood at the curb saying softly, “Good job!”   Most of us could not have finished the race without all of the wonderful encouragement we received.  Good job Huntsville!

My first marathon is just 2 1/2 weeks away! Right now is the hard part – tapering.  Three weeks before a marathon, runners should gradually reduce mileage to be as strong and recovered as possible on race day. Most marathon training programs recommend the completion of two 20-mile runs at least three weeks prior to the marathon. Because I completed the two 20-mile runs ahead of schedule (impatient!) I opted to complete a 24.5 mile run this past weekend. It was my last long run before the taper and I wanted to make it count!  I also wanted the confidence of knowing I can break through that formidable 20-mile wall. Not that it was easy. I had to repeatedly play the theme from the movie Rocky on my mp3 player to get through the last few miles.

I have been blessed with an amazing marathon training program provided by our local Fleet Feet staff and volunteer coaches and I have taken away the following lessons:

• Running is both a physical and mental sport. Ten days ago, I ran in my second half-marathon and finished it nearly 12 minutes faster than my previous half-marathon seven months ago. Better conditioning and a faster pace helped, but I also found a very powerful mental aid. I purchased a Pacetat, a tattoo that helps runners stick to a desired pace  http://www.pacetat.com/. I kept track of my mileage with my Garmin Forerunner watch and saw that I was ahead of schedule. This provided such an adrenaline boost that I finished well ahead of my goal.
• Long runs are like hiking, only faster. Long runs have to be planned carefully with proper hydration (water belt with extra water, aid stations), fuel (GUs, electrolytes), gear (Garmin GPS watch, Spibelt to hold items, lights, sunglasses) and mapping the course.
• Warm weather extended exercise results in significant salt loss. Post-long run, my running buddies and I have salt crystals on our skin. I keep salt tablets with me while running.
• Running doesn’t mean that we can eat whatever we want. Runners need to be conscious of food choices and fueling while also dealing with “rebound hunger” that causes out-of-control ravenousness. Even with 35-40 miles per week of running, I still have to watch my weight.
• Endorphins are addictive!
• Runners have ugly feet. Yes, we show our black and missing toenails like badges of honor!
• Runners get bigger calves. My running friends and I call ourselves “Calfzilla.”
• Asthma gets better after mile 3, but the first three miles in cold weather are rough.
• Running can get expensive! My last pair of running shoes had to be replaced after eight weeks! But we can afford to buy the necessary clothing and gear, because running is our entertainment and our social life. Vacations are destination races.
• Runners are very friendly, compassionate people, but also very goal-oriented and committed to excellence. We don’t compete with each other – we are all competing with ourselves. We are all bonded by our love of running.

As you can see, running builds character and promotes personal growth. I am not the same person I was 15 months ago. I feel much stronger, both physically and mentally. But this is not the end of my journey – it is just the beginning. After the marathon, on to a 50k!

Think of your body as a car. If you put low-quality gasoline and oil in your car, do you think it can run as efficiently? What happens to your car when the gas tank is empty?

The same principles apply to our bodies. If our gas tank gets low or if we fill our tank with low-quality fuel, our performance will suffer. Objectively, I have always known this, but I didn’t fully comprehend this principle until I became a distance runner. Never before have I seen the correlation between my body’s performance and its fuel level and quality as I have now. Proper fueling for my body used to be an option I didn’t exercise consistently, but now it is no longer optional. Proper fueling is now a necessity. Running is such an important part of my life that I am willing to do anything to run faster and for longer distances.  

As part of my marathon training program, I recently attended a seminar on proper fueling, led by Tammy Beasley, RD, CSSD, LD, author of Rev it Up: The Lifestyle Diet That Puts You in the Driver’s Seat. Tammy’s discussion confirmed what I was already learning – there is so much more to running than just running! I’m sure this is true for any intense exercise program. Proper fueling is almost an art form; it has to be done very carefully and to some degree, customized to the athlete. What works for one person may not work for another. We all vary according to weight, gender, food preferences, tolerances (i.e. lactose, wheat), GI issues, etc. But here are some of the basics recommendations from Rev it Up:

• Eat every four hours to avoid an empty tank.
• Eat the right combinations and amounts of food. Hunger is an indication that your tank is empty – either too much time has elapsed or you didn’t give your body the right kind or proper amount of fuel.
• Fuel properly for heavy physical activity.  The night before a long run or similar activity, eat a carbohydrate-rich meal with fruits, vegetables and lean protein. Skip the fat content and keep fiber lower for this meal.
• You need fuel just before and during physical activity, but you cannot have large amounts of food in your stomach. Aim for low-fiber foods that are easily digested and provide quick energy, either in gel form (i.e. GU) or in the form of bread, a banana, or cereal. For more extensive activity, such as longer runs, you may need to add a small amount of protein, such as peanut butter.
• Your recovery meal/drink should equal 3 parts carbohydrate to one part protein. Studies have shown that chocolate milk is one of the best recovery drinks, due to the perfect carb/protein ratio and electrolyte replacement benefits. Your recovery meal or drink should be consumed within 30 minutes of completing your high-intensity activity to replace muscle energy stores and help your muscles recover properly.

As I continue to increase my long run distance, I see a greater need for proper nutrition and just as important, the timing of these nutritional choices. This is where proper marathon training is important, because good nutrition and timing require practice, including trial and error.  Last Saturday was my first 20-mile run and I learned that a carb-only pre-run fuel choice will not provide adequate energy for such a long distance. Tomorrow, I will go back to my banana and peanut butter combination that has worked well consistently. I also find GUs to be very helpful when ingested slowly for sustained energy. 

Hydration is also critical during intense exercise, and one bottle of water is not nearly sufficient during long runs. If aid stations are not available with proper hydration, then water belts (hold extra water bottles) are a must. Plain water is fine for shorter distances, but long runs often result in electrolyte loss. For longer runs, water should be supplemented by electrolyte replacement sports drinks such as Gatorade or even electrolyte supplements, such as Endurolytes. Some runners swear by salt tablets or loose sea salt. Electrolyte balance is another area that requires trial and error – what works for one runner may not work for another. Be careful with caffeinated drinks because they can contribute to dehydration.

Although pre-exercise and post-exercise nutrition is important, your ongoing nutritional needs are important, too. If you put junk into your body, it will not function properly. Think of your body as a Ferrari. Would you put trash in a Ferrari?  Serve your body well and it will serve you.

Hooray for cooler weather! What a difference 20 degrees makes! 

My marathon training group has a short run together (5 – 7 miles) on Wednesday night and a long run on Saturday morning. This past Saturday’s run at 17.5 miles was much easier than the previous Saturday’s run at 16 miles, 90 degrees and probably 100 % humidity.  I finished the 17.5 mile run in 3 hours, 3 minutes and 12 seconds – and that included a potty stop and aid station stop!

 Many people ask, “Do you run the whole time?”  I did run the entire 17.5 mile course, aside from the two brief stops. Ironically, it is easier to keep running, rather than slowing down and trying to speed back up.

Hydration is vital, particularly during warmer weather runs. It is important to run with a water bottle and to drink often even if you don’t feel thirsty. Dehydration symptoms tend to hit later, suddenly and without warning. Dehydration often goes hand in hand with loss of electrolytes such as sodium, potassium, calcium and magnesium. Electrolyte replacement sports drinks help with both hydration and electrolyte loss. But longer miles require greater fluid and electrolyte-loading.  During Saturday’s 17.5 miler, I didn’t have any muscle cramps, so most of my electrolytes were good. But post-run, I was caked with salt – a sign of sodium loss. I guess that one bottle of Gatorade (with three bottles of water) and one salt packet were not sufficient!  Distance running is an exercise in experimentation. As distances change, nutritional and hydration needs also change.  That’s why this middle-aged, clueless novice runner needs a marathon training program:)

My running friends have noticed the same issues, particularly those who are female and over age 40.  We’re not sure if the problem is age, hormones, ravenous runner’s appetite or all the above.  Regardless of the cause of my middle-aged runner’s spread, I’m determined to nip it in the bud immediately!  That means keeping careful track of everything I eat, along with calorie, fat, carb and sodium contents.  I have developed a spreadsheet that automatically calculates these counts, by meal. I have posted it on my Web site at http://theproactivepatient.com/page14.php and I am happy to share!  The numbers can be replaced each day, or you can create a new sheet for each day by copying and pasting into a new sheet.  Bon Appetite!

In our training program, we will gradually build our miles to include several 20 miles runs on Saturday or Sunday.  Our shorter group run is on Wednesday night, in conjunction with a seminar on valuable information such as nutrition, proper form, stretching and sports psychology.  We are also encouraged to participate in several local races to help the coaching staff assess our speed and distance.  The coaches will then design a customized training program for each of us.

Yesterday, most of our training group participated in a local 5k to give our coaches the opportunity to evaluate our performance.  Although I’m weak at shorter runs/faster speeds and stronger at longer runs/slower speeds, I finished with a respectable time and managed to win my first racing medal!  Third place in my age group – whoo hoo!

Today, I did a longer run – 10 miles, and I hope to log at least 32 miles this week.  Last week’s total was 31 miles.  I still can’t imagine 26.2 miles in one day!  But I have almost 4 months to get there.  Anything is possible.  One year ago, I began my running journey with 2 miles of half-running and half-walking.  At that time, I couldn’t imagine running even five miles.  What a difference a year makes!

If you are thinking about beginning en exercise program, check with your doctor first.  Once you have the medical all-clear, seek the best guidance and instruction possible for the exercise of your choice.  If you are using improper equipment or form, you not only risk insufficient results, but also injury. Regardless of which exercise option you choose, the important thing is to get started! Imagine where you can be one year from now!