Friday, December 4, 2015

Post-Marathon Wrap Up from Dr. Larkin: The Pain of Plan B

Going into a marathon, a runner must have multiple plans.  You never know how a race may go.  Plan A is your perfectly run race—feeling good, optimal weather—the race of your dreams.  Personally, I’ve never had Plan A come to fruition.  It’s that unreachable star, that ideal situation for which you strive, but won’t be horribly disappointed if it doesn’t happen.

Plan B through Y are varying finishing time thresholds.  Depending on the runner, this may be a Boston Marathon qualifying time (not me), or it may be a sub-four-hour finish (that’s in there somewhere). 

Plan Z, by the way, is simply to finish.  Walk or crawl, no runner sets out on race day to get scooped off of the course before the finish line.  It happens, but it’s not the goal.

My race was the Monumental Marathon in Indianapolis, and I crushed Plan Z.  I even smacked around Plan C a little bit.  And I knocked on Plan B’s door.  Sadly, though, Plan B had just stepped out to run an errand.  And I missed him.  By seconds.

I have no delusions that I am a competitive runner.  I won’t ever win a race, unless it’s against my six-year-old.  (Lately, my nine-year-old is starting to take a little effort to vanquish.)  Unless I’m running when I’m sixty, my marathon time won’t qualify me for Boston.  And I’m totally fine with that.  I run for the exercise, and I run marathons for the personal accomplishment.

With that preface, I will admit that I am a competitive individual.  A little part of me hurts when I let my kids beat me in checkers.  I can’t turn it off when I run, but I’m not very fast, so I have no choice but to become competitive with myself.

The ultimate goal in every race is to improve.  To better that Personal Record, or PR.  I’m not putting in hours of training over five months to get worse at running a marathon.  So as long as there are smaller numbers on the finish line clock than there were the last time, I’m happy.  Point me to the bananas and the mylar blankets and we’re good.

So far, this hasn’t been a problem.  I’ve gotten faster with every race.  By a pretty wide margin.  Going into Monumental, my goal was simple—to get better.  I had a number in mind (Plan A), but if I didn’t hit it, it wasn’t a big deal.  As long as it was faster than last time.

The conditions were perfect.  It was chilly at the start.  Already an improvement from last year, where heat was an issue later in the race.  I took off slow and steady, sticking to the strategy that had been successful in the past.  After a few miles, I found the groove and picked up the pace.  If all went well, I’d have a nice cushion at the end and could coast in to pick up that PR.

As you’ve probably deduced, all didn’t go well.  Pretty well, but I wouldn’t go so far as “well.”

Because of a couple of visits to the facilities during the race, my cushion was gone and I was struggling to make up time.  I didn’t feel significant pain until about mile 23, which was an improvement from previous races.  Unfortunately, as much as I wanted to pound through it, my grumpy hamstrings made a speed burst at the end of the race a non-option.  As hard as I’d push, they’d push back even harder.

By mile 24, the negotiations began. 

“Okay, just get through this, and you never have to run another marathon again.“

“Don’t quit.  At this point you’d just have to walk all the way in anyway.”

“If I walk for a few steps, will I be able to get my legs moving again?  Better not chance it.“

And then, from the depths of self-doubt and despair, out of nowhere, an angel appeared.  (Not a real one, although I wouldn’t have been surprised at that point as there was very little blood pumping to my brain.  In fact, I think I might have seen fat Elvis pass me about then.)

Remember Rachel, who was previously featured in the “St. Charles Hot Hot War is Hell” run earlier in the training season? Well, she pulled the same magical appearing act.  At mile 25, she sidled up next to me to bring me in.  And it worked.  She pushed the pace to the edge of my limited possibility.  There was no way I could have finished as hard as I did without her steely encouragement.  As the finish line came into view, I overpowered every mutinous muscle cell in my legs to ensure I left nothing on the course.  I looked over to thank Rachel.  And just as was the case in St. Charles, she was gone.  Shifty one, that Rachel.

So I finished the race.  Plan Z: Check!

The immediate post race euphoria at the finish was somewhat lost on me.  I was trying not to pass out, and my legs were stubbornly refusing to bend at the knees.  It was reminiscent of a zombie searching for brains, except that while I probably looked the part, I was really just looking to score a Gatorade and to find a central place to collapse where my family would be able to find me.  My time was not of concern.  At that point.

Of course, my dear wife, the Boston Marathon Finisher, was curious.  When she discovered my quaking body, “What was your time?” was her second question, after a mildly concerned “Are you okay?”  I really didn’t know the answer to either. But I knew I had worked really hard to convince my body to bend in such a way to allow me to sit.  I didn’t care enough to try to figure out how to get back upright to find out my time.

When I finally trudged over to the results tent some minutes later to find out, it was a stomach punch moment.  I had missed improving on my best time.  I had failed Plan B. 

By five seconds.

Do you know how many five-second moments there are in a marathon?  It’s in how you cut the corner on a turn.  It’s in a few steps of walking through a water station.  It’s in stopping to give my kids a well-deserved hug and high five as they held up their homemade signs to cheer along the course.

And in my case, it’s the four minutes I spent in line waiting to use the Porta-Potty.  And it’s the three steps I was behind the guy who beat me to it, then evidently fell asleep in there for a little bit while I danced around outside the door.

That’s all it was.  Three steps and a place in line at the john between success and failure in an agonizing 26.2-mile journey.  Between replying flatly or with a smile when someone asks, “How was your race?”  Between a PR and a “Wait ‘til next year!”

Next year? 

Well, yeah.  I can’t go out like this. 

Anybody got an Immodium?

Friday, November 6, 2015

Marathon Update from Dr. Brandon Larkin; "Leave Me Alone, I'm Tapering!" (Race Day is TOMORROW!)

June 20th.  Four and a half months ago.  That’s a long time.  June 20th was the start of the marathon-training season.  That’s 18 weeks.  18 long runs.  18 nearly barf-inducing speed training track workouts.  I don’t know how many miles in total—but a lot.  (You know I actually do know exactly how many miles, and minutes, and calories burned, but I’m not writing that here because it’ll blow my reputation as a low-key, laissez faire type of runner.  And don’t judge me, because I know you all know your data, too.)

But anyway, that’s a long time.  There aren’t many activities in my life that I have spent that many hours working on that didn’t result in some kind of financial gain or earned credit hours or half of a baby.  (Maybe I didn’t do the actual work on that last one, but I was very supportive for at least 7 of the 9 months.)  

There’s usually a reward for that much sustained effort, right?  So what’s the reward for marathon training?  The actual marathon?  Scant days before the event, the race sure doesn’t feel like much in the way of reward potential.  In fact, the butterflies I get just thinking about it threaten to provoke even more barf induction.  My reward for 18 weeks of lifestyle-altering, family-alienating training is that I get to punish myself by running 26.2 miles and having to go down entire flights of stairs backwards for two days afterward?  How can an activity serve as a reward if I have to write the mile markers of every Johnny-on-the-Spot on the course to successfully and hygienically complete it?  It feels wrong somehow.

I’m sure I’m in the minority among seasoned distance runners, but I think a little bit of the reward for the long hours and monotony of training is the taper.  Yes, the dreaded taper.  Most of my counterparts utter those two syllables with a long sigh of disgust.  But honestly, I’ve never understood what’s so bad about it.  The taper is the two weeks of lower mileage and intensity before the race.  It’s the point after the peak in training when you allow your body to recover so you’re as fresh as a daisy when you cross the start line on race day.

Experienced marathoners suffer through these weeks with crankiness and general dislike for other humans.  Because they’re not running 40 miles a week anymore.  And they view that as a bad thing.  Don’t get me wrong, I like running.  But after four months or so, I’m kind of beat down by it.  So don’t tell anybody this, but I welcome the taper.  Because it’s less time for running, and more time for sleeping.  I no longer have to get 8 or 9 miles in before work in the morning.  This morning, I ran for twenty minutes.  Twenty minutes!! And then I was finished!  For the entire day! That’s an hour less than some weekday runs a few weeks ago.  I’ve got so much time on my hands, I’m doing crazy stuff like emptying the dishwasher before work.  And even crazier things like actually getting to work on time.  

So I don’t get the grumbling about the taper.  Seems like a good thing—a reward, even.  That’s my take on it.  There’s my reward.  Doing significantly less of the thing I’ve been voluntarily doing for the last third of a year.  Man, running is weird.

Full disclosure: I know the reward is crossing that finish line.  I’ve felt that swell of emotion before, so I get it.  It’s just that as I get ever closer to race day, I feel like that mountain I’ve been climbing for the last several weeks has been topped, only to reveal another taller mountain.  A 26.2 mile high, snow-capped, imposing mountain right in front of me.  One more mountain to scale to cross that finish line and experience that pride (relief?) that I’ve risen to this challenge.  And as long as there’s a Johnny-on-the-Spot on the mountain every couple of miles or so, I’ll be just fine.

Monday, October 12, 2015

Marathon Training Update from Dr. Brandon Larkin; May the Force (and good health) be with you!

Marathon season is upon us!  We’ve banked hundreds of miles over the past several weeks.  It’s a bittersweet time, as every week we lose a few more of our training team buddies to their respective races.  Well, we don’t really lose them, but they finish their training and step up to the start line in St. Charles or Chicago or Chattanooga.  

It’s somewhat of a sad bit of attrition.  We all still start our long runs together, but because the folks with earlier races are tapering their miles to ready their bodies to handle 26.2 miles, they fall off after ten or so.  They leave the rest of us, those suckers whom are either bad at math or at reading calendars.  Those of us who thought, “I know! I’ll do a race in November! The weather will be more predictable.”  Never mind that means five extra weeks of training to maintain our fitness after our peak mileage weeks.  I’m such a dummy.

So while they are busy finalizing travel arrangements and stuffing their suitcases full of GU, I’m left planning the next five weeks of runs.  Or rather, planning how to avoid getting hurt this close to the race.  

And this doesn’t just mean getting hurt while running.  Real life is a dangerous place.  You have never seen a grown man move as fast as you will when my five-year-old stomps within 18 inches of my left second toenail.  I’m like a toenail Jedi.  When it comes to my feet, I can sense a potential disturbance in the Force from as far away as….well….a galaxy far, far away.

So this far into training, injury prevention is paramount.  But here’s the deal.  I hurt.  I’m sore.  If I drop something on the ground the day after my speed work run, it’s pretty likely to stay down there unless it has a picture of Andrew Jackson or Ulysses S. Grant on it.

How do I know if what I’m feeling is just the “normal” soreness of training or something more concerning?  It’s not always easy, but there are a few tips to remember if that question is causing you some anxiety.

If you roll out of bed, pull on your shoes, and trudge out the door to face the early morning street lamps and startled raccoons, and you have some pain as you get those legs going, it’s probably fine.  BUT, that pain should improve as you get warmed up.  That’s what muscle soreness does—it decreases as you repeatedly lengthen the muscle unit.  If the pain doesn’t decrease, or gets worse, you may have an injury.

Realize that you don’t have to have one traumatic event to sustain an injury.  Distance runners are at high risk of overuse injuries like tendonitis, stress fractures, and bursitis.  They result from repetitive stress to tissues without adequate time to heal before the next episode of stress.

DING DING DING!! That’s marathon training.

If the pain increases to a point where you are changing your gait, or how you run, you need to get things checked out.  At a minimum, you are placing stress on other structures to compensate for the pain and are risking a second issue.  Worse, you may be overloading the injured tissue and making a mild injury more severe.  Think of it this way. You may be growing a one or two week injury into one that puts your race in jeopardy.  Even if it is five long weeks away.  In November.  Ugh.

Lastly, if you are having pain at rest, get to the doctor.  You aren’t moving.  It shouldn’t hurt.  Not being able to sleep or being awoken from pain is no good.  That deep achy pain in your shin you can feel throbbing while sitting on the couch may not be shin splints.  So get it looked at.  You’d hate to find out you have a stress fracture when your leg actually breaks during a run.  Makes it hard to finish the miles.  

So now that I’ve totally freaked you out and convinced you that your leg is going to fall off, make sure to take a breath and keep these tips in mind.  I know I will be while I’m finishing up those last few long runs.  By myself.  After everyone else has run their races.  After the World Series.  With no leaves in the trees. In the same month as Thanksgiving.  

Such a dummy.

Wednesday, September 16, 2015

Marathon Training Update from Dr. Brandon Larkin: Diet, Exercise, and the Coca-Cola Conundrum #WorkoutWednesday

Last week, we talked about a runner’s (and by extension, any active person’s) propensity to overeat after a prolonged bout of exercise.  For me, it’s the Saturday long run that inspires gluttony.  And for me, and others, the reasons are numerous: a reward for a job well done, a misinterpretation of an acceptable amount of replacement calories (see: poor math skills), or simply insatiable hunger.

But as we discussed, pounding the donuts and ice cream all weekend after completion of a long run probably doesn’t make for the best nutrition strategy, especially if you are using running (or any exercise) as a method for losing weight.

So this begs the question: “What is the correct balance between diet and exercise for losing (or maintaining) weight?”

There is A LOT of controversy about the answer to this question.  Many think the rise in sugar and fat intake is the biggest cause of today’s obesity epidemic.  Others insist it’s the ever-increasing amount of time we spend being inactive every day. Which is more important, diet or exercise? Or is it both?

Thankfully, you just happen to be best buds with a well-read, intelligent, charming sports medicine physician. (Who, you ask? Really funny.  It’s me.)

So I’m going to fill you in on the secret.  The answer to this all-important question of health is this:

“It’s complicated.”

Most studies point to a combination of appropriate diet/calorie control with regular moderate-intensity exercise as the best strategy.  New research comes out all the time on this topic, and I like to keep abreast of the current thinking to counsel my patients (and you).

So I was particularly interested about a presentation at one of my national meetings this year about the Global Energy Balance Network.  This is a group of scientists who believe that the best intervention to fight the obesity epidemic is to promote exercise.  Activity, they believe, is the single most important predictor of who will actually keep weight off for good.  They contend that sedentary behavior sets the body’s metabolism at a different level than it would be if a person were an active exerciser.  That means that caloric balance (calories in = calories burned) is more effective in losing or maintaining weight in someone who exercises than it is in one who doesn’t. 

Put another way, you can eat more calories if you burn more calories by exercising regularly.  If you don’t exercise, you have to eat less food and be much more restrictive, and this is harder to maintain in the long term. 

It really isn’t that simple, they say.  While exercise is super important, lots of other variables go into it, like genetics, body physiology, and behavioral factors.  Some of those you can control.  Some you can’t.

But here’s the thing.  I control one of those things a lot.  I exercise like crazy.  I’ve run a few marathons.  And the amount of miles I’ve logged and calories I’ve burned during training have never really resulted in any weight loss.  I got hungrier during training.  I reasoned that I deserved a reward for completing my long runs.  So I ate.  And ate big.  (See last week.)

I’ll burn close to 2000 calories on some of these runs.  But if I don’t watch what I eat, I can put that much and more back on by the time I’m pushing back from the table at lunchtime.

So the “Exercise is King” argument seemed to fly in the face of my reality.  I only began to lose weight when I became very aware of the caloric content of what I put down the hatch.  Only once I realized that my previous diet had me taking in vastly more than I was burning did I start to trim down.  Even with this knowledge, I wasn’t militant.  I ate gluten.  And ice cream.  And a little scotch.  But I paid attention to how much I was eating and was careful not to throw my energy balance out of whack.  And it worked.

Maybe I’m not like everyone else.  Who am I to argue with the science of the Global Energy Balance Network?  I may just be special.

Turns out I’m not.  Last month, the New York Times published an article that exposed the major source of funding for the GEBN.  It was Coca-Cola.  Coke supported much of the research performed by the scientists I heard speak about the importance of exercise.  And it was Coke’s dollars that might have biased the opinion that what you eat isn’t as important as how much you move. 

So maybe diet has something to do with it, too.

The answer lies somewhere in the middle.  Both are crucial.  I don’t think a researcher’s funding source automatically negates their findings.  Exercise is incredibly important.  It makes weight loss easier by burning calories and revving metabolism.  Even if Coca-Cola pushes that belief.  Doesn’t make it wrong.  You just can’t forget the other side.

In my opinion, based on personal experience and professional training, the best strategy for weight control, as with most things, is moderation.  Despite vigorous preaching about the dangers of what we eat, it’s pretty likely that there is no one single evil nutrient.  You can probably eat fat.  And (gasp!) carbs. You probably want to stay away from foods and drinks with high refined sugar contents, like donuts.  And Coke.

But then again, one Coke or two donuts probably won’t make or break you.  You just have practice than magical dogma: moderation.  Just don’t let two donuts become four because you ran ten miles this morning.

And you know what? Get up and move!  Walk around a little.  Run a marathon. Or a half.  Or a mile.  Flip the TV off.  Hey, Facebook will be there when you get back.

So after you run this weekend, sit back and be satisfied with a job well done.  Heck, have a Coke and a smile.  Just make sure you take that 12-ounce calorie bomb into account with your choices later on.

Wednesday, September 9, 2015

Marathon Training Update from Dr. Brandon Larkin; Hungry? Donut Musings for your #WorkoutWednesday

Solve for x: 17 Miles = x Donuts

Anyone who trains for a distance race with a group knows there are some weird conversations that occur.  (Thank goodness, because they serve as fuel for my musings in this space.)  Invariably, the subject of food always comes up.  A new restaurant here, a guilty junk food pleasure there.  A lot of times, especially as the minutes and miles click by, the subject of the post run meal comes up.

I’d love to tell you my chosen provisions reflect my healthy runner lifestyle.  You know, high protein Greek yogurt and kale and such.  But as mile 5 becomes 10 and on to 15, the thought of kale just doesn’t seem to push me along as much as that of a juicy glazed jelly donut.  And a chocolate custard filled donut.  And maybe just a bite of the old-fashioned.

So I hammer the donuts after a long run.  And its okay, right?  Because I just ran 17 miles, for goodness sake.  And while the sticky sweet raspberry artificially sweetened jelly drips down my chin on late Saturday morning, you know what question never comes up that I tend to ask myself almost every other day of the week?

“Why don’t I lose any weight while I’m in training?”

Never enters my mind after a long run.  But presented as it is here with next to the shame of my weekly donut intoxication, it doesn’t take a nutritionist to come up with the answer. 

Let me tell you a secret. Throwing 2000 calories down the hatch takes a lot less effort than the 15 miles it takes to burn 2000 calories.  Especially because the brain’s ability to perform the mental math of calories in vs. calories burned goes dark all weekend after a long run. 

Donuts? Yep, I ran a long way today.  Pizza for lunch (and afternoon snack)? I earned it! A few beers?  Yes, please!

I make decisions about my diet on Saturdays that I would never make on the other days of the week.  But something about that long run makes me crazy.  And all the caloric benefit of the effort and sweat I left on the course for three hours that morning, of all the achy groans when I get out of a chair the rest of the day, all of it goes for naught.

Admittedly, I don’t run to lose weight.  At least not primarily.  But I wouldn’t mind getting a little leaner as a reward for all of the miles I’m putting on the tires.

So here’s the lesson:  “GET AHOLD OF YOURSELF, MAN!”

Or put another way; continue to make the wise choices you make during the week, even though you feel like you could destroy a dozen Krispy Kremes when you walk in the door after your long run. 

The same rules apply.  Portion control.  Eat slowly.  Avoid food as a reward.

When my mind’s right, I try to use a strategy of taking a portion half the size of what I think I want.  Then reassess.  If I want more, fine.  But slow and steady, buddy.  Otherwise it’s like Kobayashi at Coney Island on the Fourth of July.

Balance is key.  You can have a donut.  Heck, you can maybe have two.  But it’s probably not the best choice to use “I ran this morning” as justification for feeding every craving the rest of the day.  If you do, you’ll be packing on more pounds that will have to be carried across that finish line on race day.

Everything in moderation, right? Which is hard for us.  We’re distance runners.  Nothing moderate about that. 

So everything in moderation, except for distance running.

And donuts.  I’m pretty sure donuts get an exception.

Monday, August 24, 2015

Marathon Training Update from Dr. Brandon Larkin; "Choose Your Own Adventure--The Long Run of Doom!"

Do you remember the “Choose Your Own Adventure” book series?  Huge in my life as a child.  I read every one of them.  Several times.  (That was the point, you know.)

Just in case you were not a purveyor of children’s literature in the eighties and have no idea what I’m talking about, CYOA was a collection of books in which you determined the plot.  The stories started out harmless—a regular kid having a regular day.  Heck, it could have been you.  In fact, it was you!  Some crazy sequence would occur and you were smack dab in the middle of a volcano.  And you drove the plot—“Choose option 1 to hike up the stairs to get away from the smoldering lava, turn to page 25.” Or choose option 2 to jump over the liquid fire, turn to page 44.”  Eventually you’d either win the day….or get killed.  But the beauty part was that if you got killed, you just start over and make a different pivotal decision.  And if you were in a pinch, you could just peek ahead and look for “THE END” on your chosen page, then flip back because those two words were pretty much a death sentence.  But you would only do that if you were a big ol’ cheater.

So let’s play “Choose Your Own Adventure—Long Run of Doom”

You’re on a 16-miler around the hills of beautiful Queeny Park.  It’s beautiful scenery, but as usual, it’s hot and humid.  Kind of like running in the Mekong Delta.  (See what I did there?)

You’re half way around your fourth four-mile loop, and your running buddy, Suzi, is starting to sag a little.  She’s been cramping for the last couple of miles, but now she’s starting to get dizzy and confused, and she’s throwing up.  She looks rough.

Do you:

1: Start pushing fluids.  She’s been drinking the whole run, but it’s hot and she’s sweating something fierce.  It must be dehydration.

2: Try these salt tabs you bought last week.  And how about an ambulance?

Suzi’s been drinking Nuun and Gatorade non-stop for two hours, so more salt probably isn’t the answer.  She needs more fluids, right?

You choose option 1.  (Just do it.  The story works better that way.)


Nice job. Some friend you are.


Fortunately, especially for Suzi, I’m going to let you turn back and choose option 2.  But wait, why does she need salt? You would have thought she would have had plenty of salt from the sports drinks.  Turns out you were wrong. 

Suzi is suffering from exercise-associated hyponatremia (EAH).  Because of the steamy forecast, she prehydrated all day yesterday and this morning with water and sports drinks.  This caused the concentration of sodium in her blood to decrease and the continuous drinking during the run made it even lower—dangerously low. 

So where did Suzi (and you—you’re not off the hook yet) go wrong?  She followed the dogma of overhydration.  The one that tells athletes to drink and drink and drink.  And then drink some more.  Gotta keep hydrated to replace the fluids lost by sweat, right?  And that means drinking like a fish, right?

Well, wrong.  In fact, too much water during exercise can be incredibly dangerous.  And even replacing fluids with an electrolyte containing beverage like Gatorade or Nuun isn’t safe.  These sports drinks are more dilute than your blood, so they’re considered “hypotonic.”  That means that drinking them will not increase the sodium concentration in your blood.  Rather, it makes things worse.

Too much water or sports beverages over an extended period can cause hyponatremia, or low sodium concentration in the blood.  We replace lost fluids when we drink it, but not enough of the sodium is replaced, and the blood in our body becomes diluted. Hyponatremia can be incredibly dangerous, even deadly. 

So there needs to be a balance, but do we really know how much to drink and what to drink and when to drink it during a prolonged bout of exercise?

Fortunately, new guidelines about this topic are hot off the presses, having been published in the July 2015 issue of the Clinical Journal of Sports Medicine.  It’s an 18-page article that I’m going to distill down into one sentence for you. (It’s OK.  I like reading this stuff. You’re welcome.)

Lean closer. Here it is: “Drink when you get thirsty.” 


Now, some believe that this strategy is a sure path to dehydration, but based on the research, we know that the thirst sensation is a finely tuned mechanism for maintaining normal fluid concentration.  It does a pretty good job of protecting against excessive dehydration.  And while controversial, most of the research supports that mild levels of dehydration (up to 2-3% of body weight) are tolerable and don’t overly affect performance.  The only concern here is in extreme environments or with especially aggressive prolonged activities that may lead to rapid dehydration.  In these cases, drinking to thirst may not be enough.  But situations like this are pretty rare.  (Think ultramarathons and Ironman Kona.)

If you want to be a little more scientific about it, pre- and post-exercise weights are a good way to determine the total amount of fluid to replace.  The goal should be to replace enough fluid to maintain a consistent weight or to come in a little less after exercise.  You should NEVER weigh more.  This method is relatively involved, as we don’t often have a scale readily available after completion of a run.  And it doesn’t account for the weight of the non-fluid nutritionals you put in your body during a long run or of the, ahem, other substances that leave your body during pit stops.  (Insert your favorite poop joke here.)

If you’re technologically inclined, there are apps into which you can feed the ambient temperature and humidity, your weight, and other important data to get a handle on your fluid requirements.

But here’s the deal.

Your body already does this.  Really well.  Without wifi.  The body is filled with receptors that monitor your fluid volume and electrolyte concentrations—in real time.  And these receptors give constant feedback to your brain about the situation on the ground.

And you know what it does when your internal fluids start to drop too low?  Your body, supercomputer that it is, says to your brain, “Hey! You know that water bottle sloshing around on that belt down there?  Use it, dummy.”

Your body makes you feel thirsty, so you drink.  And that’s that.  If you drink according to thirst, you stay hydrated in a safe way. 

So if our buddy Suzi had just been drinking when she was thirsty and not freaked out about the heat, we wouldn’t be in this mess.  (So, let’s blame her.)

Now, I mentioned salt supplements as an option above.  A quick note: Salt supplements can help replace depleted sodium.  In fact, oral sodium is the treatment for hyponatremia out in the field before an affected athlete can get to the hospital.  Studies recommend 4 bouillon cubes in a half-cup of water for anyone exhibiting signs of mild EAH. (Yum.) 

What they don’t recommend is more sports drinks.  The benefit of the sodium in these beverages is far outweighed by the volume of fluid it takes to deliver it when you drink.  So Gatorade isn’t going to fix anything.  And if you still overdrink while you’re taking salt supplements, you can still get EAH.

At any rate, overhydrating by constantly drinking during a prolonged bout of exercise increases the risk of hyponatremia and is potentially disasterous.  So stop doing it.  Drink when you’re thirsty.  And don’t forget to pack your bouillon.

Suzi will thank you.

THE END, for real. 

Tuesday, August 11, 2015

Straight from the trenches! Dr. Brandon Larkin talks marathon training and the "Platoon-St. Charles" in this week's #trainingtuesday blog!

Humans are tribal animals. They seek others for support and survival, especially in times of great stress.  That’s why groups of people who live through trauma together tend to be bound to each other for life.  They’ve shared the same horrible experiences and feel as though only those who were there with them can truly understand the emotional toll.  We see this during famine and wartime.  And we saw it this past weekend on the harsh burning trails of the St. Charles Riverfront.

I have never been in the military, and I’ve never faced a situation in which my life was truly in danger. But I’ve seen a lot of war movies, so I’m pretty sure that makes me an expert on the interpersonal relationships of a basic military unit.

Welcome to Platoon—St. Charles.

Let me set the scene.  While war takes soldiers to some of the harshest terrain in the world—the jungles of Vietnam or the dusty deserts of Iraq—our environment was almost just as treacherous.  In striking similarity to the Mekong Delta, the weather at the start of this 17-mile run was 75 degrees with 83% humidity.  5 brave souls headed northeast on the rocky Katy Trail along the Missouri River.  Not all five would make it back.

The cast of characters is usually pretty much the same, whether in the movies or, I’m assuming, in true wartime conflict.  So let me introduce you to our players—the 9:30 minute/mile pace group.  During my weekend long runs, these folks are the ones with which I spill blood, sweat, and tears on the pavement as the miles tick by.

Sarah:  “The Commander” AKA “Coach”
Sarah serves as the leader of the cadre, both logistically and inspirationally.  She’s an experienced marathoner and knows how to get the most from her men.  And women.  And while she’s the spiritual leader of the crew, she is prone to operational errors, like losing track of the correct course or forgetting gear that is vital to mission success—like her pacing watch.

Lisa: “The Grizzled Veteran”
With over 25 years of distance running under her belt, Lisa does things her own way.  And she’s respected for it.  She doesn’t have patience for things like “rules” and “schedules.” If you don’t like how she does things, too bad.  She’s been around too long to take any lip from you, Buster.  “Good luck, kid.  See you on the other side.”

Leslie: “Pancake”
Whether it’s a distraction technique or simply a quirky preoccupation, Leslie’s the one always talking about food.  Pancakes for breakfast after the run.  New restaurant for dinner that night.  She forces you to fantasize about the comforts of home while you’re trudging through the hell of war.  Or in this case, marathon training.  Think Bubba in Forrest Gump.

Brent: The “Go On Without Me” Guy
Brent sweats.  A lot.  Hydration in these high heat, high humidity situations is always a concern.  As the temperature rises, Brent starts to drift behind.  But as a good soldier, he doesn’t want his personal struggles to jeopardize the success of the mission.  So he urges us forward, often at his own peril.  There’s always this guy in the movies.

Me: “Pollyanna”
I try to stay positive, even in the face of massive hardship.  “C’mon guys! It’s a character building exercise!  We’re fine!”  In the movies, this guy usually gets killed in the first 30 minutes.  Sometimes by his own men.

So we set out on our mission.  It’s hot. It’s sticky.  There are a lot of miles ahead of us.  And for the first half of the run, we’re okay.

Me: “C’mon guys! It’s not that bad.  The sun isn’t even blazing yet.”

Assorted grumbles.

Brent’s already sweat through his shirt.  We’re a half a mile in.

At our first stop for provisions around mile 8, some of the squad starts to show cracks.

Lisa: “I’m not going out all the way for the second loop, whipper-snappers.  I’ve done this enough.  I don’t want to get out too far and get in trouble.  It’s about the effort, not the mileage.”

Doubt starts to creep in.  The crafty veteran has made her play.  She’s got a point.  Should we follow? She’s knows her stuff and she’s got a feeling.  Who am I to not trust it?  But Sarah’s in charge.  Follow the chain of command.

Now we set out toward the southwest.  The trail is crowded now.  The carnage is immense.  Marathon and half marathon trainees are littering the path.  Few are smiling.  Most show no emotion.  Steely determination? Or dehydration induced disorientation?

I should mention that at our resupply stop we picked up a new character—Rachel.  Rachel commands another squad, but she’s now running with us.  I can only assume all of her men have become casualties.  She plays the cinematic part of the new leader who takes over after the original one gets killed or wounded or sent back home due to mental breakdown.  Sarah’s still with us, but she doesn’t really seem to be truly “with” us.  We’re all scared.  Rachel tries to pick up morale.

Rachel: “Alright guys, we’re almost there.  Just a few more miles.  Oh, and by the way, I’m knocking off early.  I put enough miles in already earlier this morning.”

Dang it.  That didn’t help.

Brent starts to sag.  He hasn’t spoken since mile 9.  Lisa turns back for basecamp.

Lisa: “Good luck kid.  See you on the other side.” 

We urge Brent to a forward position.

Brent: “I’m no good, man.  Go on without me.”


Brent: “I’m only going to bring you guys down.  You have to go on!”

Brent softly, quietly, turns back and heads to basecamp.  We don’t go after him.

Now we’re down to three and our plus one, until Rachel mysteriously disappears for a few miles.  Captured? Worse? Just kinda tired of all the running?

We’re down to three.  We’re in bad shape.  No one is talking.  Except Leslie.

Leslie: “Pancakes.”

Rachel reappears.  Is she a double agent?  She’s got pep in her step now.  Is that even really Rachel?  I’m not well.

We reach basecamp.  Rachel bugs out with a smile.  I’ve never trusted her.  

We get a visual on Lisa (feet in the ice bath chomping on a cigar—total veteran move) and Brent (in the ice bath, surrounded by medics with two large bore IVs dropping liters of fluids into his thirsty veins).


Three of us set out for the last sortie—Sarah, Leslie, and myself.

Me: “It could always be worse!”

I’m pretty sure sniper fire just misses me.  I assume it’s from a friendly.

Me: “Okay.  This kind of stinks.”

No response.  We’ve hit “The Zone.”

In times of great stress, one often looks to his comrades to survive.  But sometimes he is forced to draw on his own strength to persevere.  The three of us had arrived at that point.  That’s “The Zone.” We had done all we could to help each other.  It was do or die.  Or call on the cell phone to get picked up and driven to the end of the trail in a car.

So as we limped back into basecamp, beaten and exhausted, there was no joy in finishing.  We had lost some good men. And women.  And while it was true that they were technically at camp stretching and drinking water and seemingly doing pretty okay, we knew we would never forget them or the sacrifices they made.  

We left a little of our childhood on the trail that day.  We were no longer the innocent runners we started as.  We did horrible things.  We left Brent behind.  You never leave a man behind.  But we did.  We had seen things that could not be unseen.  We saw some guy with both nipples bleeding through his shirt.  So I’m serious here.  

But we now were bonded together for life.  We had lived through that traumatic August morning, and come out stronger on the other side.

There was only one thing left to do.


Tuesday, August 4, 2015

Hot, Hot, Hot! Great tips for running and training in the St. Louis August Heat from Dr. Larkin

Hot, Hot, Hot.

My goodness it's hot in St. Louis in August!  We got away with a little bit of a cooler summer with all this rain and milder temperatures, but this weekend's run was what I like to call a "Character Building Exercise."

I am now training for my third marathon.  For each of them, I have trained with the Fleet Feet Training team.  It's a nice setup, as they are able to customize your training schedule based on your experience and goals.  My training encompasses a few weekday runs on my own, then a group long run on Saturday mornings.  These will range from 11 to 21 miles during training.  

This past weekend, to remind you, was pretty darn warm.  And humid.  Swampy, even.  But, 15 miles lie ahead of us, so we set out from the St. Peters City Center heading northeast.  And by 5 miles in, I looked as though I had jumped into a swimming pool along the way.  Much of the course was in full sun, and by 8 AM, it was like running in a greenhouse.  Except without the pleasant floral aroma.  Not even close to pleasant floral aromas.

So a few notes for running in the heat.  (Yeah, a teaching moment!)  

Look for these symptoms:

·         Cramps
·         Chills
·         Dark urine
·         Dizziness
·         Dry mouth
·         Weakness
·         Thirst
·         Headaches
·         Nausea and vomiting
·         Confusion

To prevent heat illness, stay hydrated before, during and after exercise.  Light, loose clothing should be worn and skin should be exposed as much as possible.  Train appropriately to be ready for the heat, usually starting with short, low intensity workouts that may gradually increase over 7-14 days.  This allows the body to get used to the conditions safely. Consider altering your workouts when heat and humidity are high

Hydration is the most important way to prevent heat illness.  Drink at least 16 ounces of water one hour prior to exercise.  During exercise, continue to drink regularly, about 4-8 ounces every 15-20 minutes.   If a run lasts longer than one hour, a drink containing carbohydrates and electrolytes should be used.  Most sports drinks will do the trick.  Otherwise, plain water is fine.

If you see any signs of heat illness in you or your running partners, you may be dealing with a life-threatening emergency.  Do not hesitate to call for an ambulance early on if somebody seems to be in trouble.  While you are waiting, get him or her to a shaded area.  Placing ice bags or cold towels around the neck, armpits, and groin will help.  Provide cool beverages if possible.  Act quickly, as these interventions may save someone’s life.

Hopefully, we won’t have many more runs like last weekend.  But if you do happen to see sweaty footprints on the pavement, it’s probably me.   (That’s right, I sweat through my shoes.  It was hot!)

Sunday, August 2, 2015

Nash-Vegas!! An update on marathon training from Dr. Brandon Larkin!


Runners are an interesting breed.  They are typically a pretty obsessive group, and that’s even worse during marathon training season.  It’s raining?  The training schedule says I gotta run.  Blazing sun and 105 degree heat index? Yep, I’ll just take a little more water.  But I gotta run.

Missing a group long run while out of town on vacation with the family?  13 miles?  Hmmm.  I can make that work.  The schedule says…..

We’ll leave our jobs and our house and our real life responsibilities to take a vacation, but we can’t neglect that run.  So this past weekend my wife (thankfully an accomplished marathoner in her own right, so she gets it) and I loaded the kids into the Family Truckster, heading southeast toward Nashville, Tennessee. 

Already, the 13 miler was on my mind—driving on the highway will do that. “I could totally run to the next exit if we ran out of gas.  It’s not that far.”  But my incessant thoughts didn’t last long.

Now if you have been to Nashville, you undoubtedly know the force that is “Hot Chicken.”  Worshipped around the city and celebrated on national television, hot chicken is just that—fried chicken prepared to varying degrees of spiciness.  And just for good measure, the flagship of the hot chicken armada, Hattie B’s, dumps spicy fried chicken grease on the bird as a final step in its preparation.

My insistence on trying local cuisine while traveling is just as strong as my desire to complete every run during training season as scheduled, regardless of location.

This turned out to be a mistake.  Hot chicken does not make for a good pre-run late dinner.  Nor does the local microbrew consumed to extinguish the fire.  But when in Nashville….

Still licking the spicy from my fingers, I returned to the hotel and planted the computer on the bed to map my route for early the next morning.  Nashville has a nice greenway trail system that runs into downtown that I could pick up just a couple of miles from the front lobby of the sprawling Gaylord Opryland Hotel.  

So here’s the plan: Up with the sun, knock out 13 miles and meet the family to refill the gut with biscuits and sausage at a highly Yelp! rated breakfast spot downtown.  What could go wrong?  I mapped the entire route, sent it to my phone, and clicked off the light. And that little access road that didn’t seem to connect all the way on Google Maps?  It’s fine! I crossed checked it with satellite imagery and it goes through—pavement the whole way!  No problemo! Nighty night.  Ooh, that was an interesting tummy rumble.

Passing the Opryland Hotel and the adjoining Opry Mills Mall consumed darn close to two miles of the run.  The complex is really a shining monument to commercialism and capitalism.  But would it kill them to have the doors to the restroom open at 6 in the morning?

Having made it past the Mills and now a stone’s throw from the greenway along the Cumberland River, I hit that little questionable spot on the map.  And while my satellite reconnaissance was correct—it was a through road—I neglected to notice the ten foot high locked gate surrounded by barbed wire lined fencing during my research.

So I started thinking about options to get to the trail:
  1. Climb it.  Sure the gate and fence are there for a reason.  And the barbed wire.  And what’s that strange car doing parked a few yards away?  I don’t want to break a leg this early in training.  And who am I kidding?  I wouldn’t make it to the top, much less over it.
  2. Quit.  It’s only one run.  It’s not going well anyway.  This is a sign.  And that hot chicken is starting to become a serious concern.  Oh, and YOU’RE ON VACATION!
  3. 7 loops around the Opryland/Mills complex.  But once this mall opens, people will happily run me down looking for ridiculous deals.
  4. Consult the map.  I can still get there, but I have to run on a highway.  But just for a half mile or so.  Tempting, but….
  5. Head back to the room, grab the car, and drive to the trail.  With no car, the family can’t meet me downtown.  OK, I’ll just do an out and back and we can hit breakfast together when I’m finished.  It’ll be a bit of a pause in my run to get there, but it’s better than snagging my Achilles on razor wire or being shot for trespassing. Bingo!  And there’s a bathroom in my hotel room!  Everything’s falling into place!

So I head back, and as it turns out, the rest of the run was perfect.  It was a beautiful trail with a pedestrian bridge crossing of the Cumberland River.  Lots of friendly runners and cyclists.  A few deer.  Just what I was hoping for, minus the little detour.  Long run—check.

The biscuits tasted a little sweeter later that morning.  Probably because they were topped with success and perseverance.  And extra honey, you know, for the effort.

Wednesday, July 22, 2015

#WCW What's Cookin' Wednesday: Endive Salad fit for a BBQ!

Looking for a great salad to take to your next backyard bbq? Try this, made with Endive—branch out and try a different type of lettuce this week!! Endive is one of the very low calorie leafy vegetables. It has Vitamin A, B complex and minerals like manganese, copper, iron and potassium! 

*3 medium endive heads-thinly sliced crosswise
*2 medium Gala, Fuji, or Honeycrisp apples-peeled, cored, quartered, and thinly sliced
*½ cup roasted and salted pistachio nuts-shelled and chopped(I buy them already shelled in the bulk section of my local store and then throw them in my food processor to chop)
*Ground black pepper
*Sea Salt
*¼ cup Honey Mustard dressing (here’s a much healthier alternative to the store bought variety!)
                        3 tbsp apple cider vinegar
                        2 tbsp extra virgin olive oil
                        2 tbsp honey(local is the best!)
                        2 tsp Dijon-style mustard
                        ¼ tsp salt
                        Freshly ground black pepper 
            Just whisk all that together in a bowl until combined. Use the dressing right away or put in a tightly sealed jar for up to 3 days-shake well before serving.

So, after you’ve gotten all of your healthy ingredients and made your delicious preservative free, sugar free honey mustard dressing….you can make this delicious summer time salad!
Combine the endive and apple slices in a bowl. Add dressing, enough to suit your taste, and gently toss together. Season with salt and pepper, top with the pistachio nuts before serving. 

Tuesday, July 21, 2015

New Blog Series! Dr. Brandon Larkin Shares His Marathon Training Experiences!

As a sports medicine specialist, I care for athletes of all shapes and sizes and activity levels.  Some patients don't consider themselves "athletes," but in reality, if you're active, you're an athlete.  Some of my favorite folks to talk with are distance runners.  They have interesting personalities a lot of the time, and they never shy away from talking about their running with you.  (Just ask one about his last long run, and you're likely to get a blow by blow account of every hill, turn, and bathroom stop along the way!)  As much as I joke about the "runner mental pathology," I'm a runner too.  And I'm as guilty of boring my friends and family with the mundane details of my running life as the next guy!

So, as Fall Marathon training season begins, I'll be sharing the successes and heartbreaks (hopefully not too many of the latter) of my preparation for my third marathon.  I promise not to share too many stories about the restrooms (or lack thereof) along the way.  Though there are some pretty funny/frightening ones about that.  Feel free to comment with your interesting stories, as well.  We're all one big happy community, and if an aspiring athlete gets inspired to get going on their way to better fitness, it'll be well worth it!

Dr. Larkin, far right. 

Wednesday, July 8, 2015

#WCW What's Cookin' Wednesday: Refreshing Summer Salad Mint Vinaigrette!

I love using fresh herbs from my garden! If you planted fresh mint, then this time of year it is growing like crazy! Mint plants contain an antioxidant known as rosmarinic acid, which has been studied for its effectiveness in relieving seasonal allergy symptoms. Mint contains menthol, which is a natural decongestant. Mint is also thought to improve the flow of bile through the stomach, which helps to speed and ease digestion.
There are a lot of recipes that call for fresh mint—here’s one of my favorites!

¼ cup chopped fresh mint
3 tbsp lemon juice
1/3 cup extra-virgin olive oil
2 tbsp red wine vinegar
1 tsp honey
½ tsp kosher salt

Combine the mint and lemon juice in a small saucepan. Bring to a boil and remove from heat. 
Let steep for about 10 minutes. Strain into a large bowl, pressing on the leaves to extract all the liquid. (you’ll have approx. 3  tbsp of liquid after straining)
Add the oil, vinegar, honey and salt and whisk until well combined. 

This is wonderful on a summer salad. Get about 12 cups of the bitter greens, like arugula and watercress. Chop that up and put in a bowl, along with ½ cup of slivered fresh mint. Mix in your homemade mint vinaigrette. Add some ripe, sliced peaches or nectarines and some slivered almonds and enjoy!!


Wednesday, July 1, 2015

#WCW What's Cookin' Wednesday: Healthy Happy Birthday Treat!

Summer is in full swing! One of my favorite summer foods are peaches! In season from June-August! Did you know that China is actually the world’s largest peach producer!? Yup—of course here at home, California and Georgia are our biggest producers. 

Peaches are a stone fruit, like plums and nectarines, and they have this stuff called phenolic compounds. Studies have shown that those actually have anti-obesity, anti-inflammatory and anti-diabetic properties. They may also help to reduce bad cholesterol LDL which is associated with cardiovascular disease. HEY!! Hand me a peach! 

Since my husband’s birthday is this week, I plan to make him a delicious Peach Cobbler…the healthier version of course! First you must know how to peel a peach…here’s the secret(that I perfected when I used to make my own baby food!)

Make sure your peaches are ripe. If they are even a little bit under ripe, they won’t peel easily. Bring a large pot of water to a boil. Don’t fill it too high, since you’ll be putting your peaches in there. While the water is boiling, cut a little “x” into the skin in the bottom of the peach. Fill a large bowl with ice water. When the water boils, add the peaches and boil for 30 seconds. Remove with a slotted spoon to the ice water. When the peaches are cool enough to handle simply slide the skin off, starting at the “x”….super easy! This way you retain all of the delicious “meat” of the fruit for your pie!

So here’s a totally “Delia approved” version of Peach Cobbler-Real Ingredients/Nutrient rich/Gluten Free/Non Inflammatory/Healthy fats/ No processed white sugar!


Ingredients Filling:
8 Peaches, peeled & pitted
¼ cup Granulated Coconut Sugar(you can find at most grocery stores nowadays, but especially a health food store)
¼ tsp Ground Cinnamon
⅛ tsp Ground Nutmeg 
2 tsp Arrowroot powder(this is a much healthier option instead of cornstarch!)

Starch Topping:
1 cup Almond Flour 
 ¼ cup Granulated Coconut Sugar
½ cup Unsweetened Shredded Coconut(get in the bulk section of your health food store-avoid any with preservatives and additives-   the ingredients should simply say, “coconut”)
½ cup Cashews, chopped 
 ½ tsp Sea Salt
½ tsp Cinnamon
4 Tbsp Ghee(clarified butter) or Grass-Fed Butter, or Coconut oil, softened (not melted) 

Preheat oven to 425F. 
Slice the peach quarters into 2-3 thin slices, then cut those in half to make chunks. Combine all filling ingredients together in a large bowl and gently stir to combine. Pour the peaches into a 13x9 baking dish OR you could use a deep-dish pie plate. 

Bake in the preheated oven for 10 minutes. Reduce oven heat to 375F. 
While the peaches are cooking, combine all of the topping ingredients except the ghee/coconut oil. 
Mix together with a fork until evenly combined. 
Add the ghee/coconut oil into the topping mixture and mix in with the fork, pressing the mixture down and around to evenly incorporate the ghee/coconut oil. The mixture should resemble coarse crumbs but won't stick together. 
Sprinkle the topping on top of the peaches and bake in the 375F oven for 20-25 minutes, or until the peaches are soft and bubbly and the topping is browned (don't let it burn). 
Try not to eat it straight out of the oven! 
You must let it cool first.