Park Ave: unrelated, but lovely

But the person I can’t forget about from last week was one I met at my other job – the standing Sunday running store gig. Sometimes I wish I had a full “weekend” of no work, but for the most part I like working on Sundays. This past weekend, on Mother’s Day, a small family came in to buy shoes. The little boy was probably about 6 or 7, thin and completely bald. His mom needed new shoes, and while she and the boy went to the bathroom the dad and I started chatting. They were from Indiana but hadn’t been home in months due to cancer treatments at a hospital here for the little guy. The doctors had just found something new and he needed more radiation as soon as he was healthy enough. I told the dad what I did for a living and we talked about what his son eats and doesn’t eat (dietitian mode, what can I say), and what a long road it’s been for them. And then the dad said, “But you know, even after all this time and all of the treatments, he hasn’t complained once.”

Tears sprung to my eyes as the little boy and his mom came back to try on shoes. While we tried to find her the perfect shoe I became totally mesmerized by the tiny, little guy who sat quietly by his parents’ side and confided to me that while he didn’t like ice cream, he loved chocolate chip cookies, and that they had plans to go to the playground for a little bit after his mom got shoes. I couldn’t help but wonder how often he didn’t get to play or have friends or do normal kid things because of his cancer and treatment. I had such an urge to hug this little guy, feed him some cookies and PediaSure (dietitian mode) and take him to the park myself. Both of his parents had a weary look in their eyes that said “we’re exhausted and so worried, but if he’s got a good attitude about this then we better have one too,” and I kind of wanted to hug them too. Needless to say, by the time the family left my heart was a little broken and I asked myself a question that now pops into my head all too often - “Why does life seem so unfair for some people?”

I think one of the big reasons why I haven’t talked or really thought much about my injury lately is because it doesn’t seem like a big deal compared to all the other things I see on a daily basis. It’s a bump in the road, and that’s all it is. Now more than ever it makes me crazy when people whine and complain about the most ridiculous things (especially via social media) “ruining” their perfect day(s). Sometimes we all need to take a step back and be thankful for what we have, realize we are being ungrateful assholes, and get on with life (which is pretty great).

I had to take the day off work today to present my final research project this afternoon at school. After that, I’ve got one final tomorrow night. The light at the end of the tunnel is blinding

The LE doesn’t hurt at all during spinning and elliptical, but still gets pretty sore from walking and if I make a random quick move. I’ve set a secret-but-not-anymore goal of being able to run by the time my marathon happens, even if it’s just a few miles. This just so happens to be pretty close to my birthday too, and I can’t imagine starting a birthday without a run, even if I have no interest in celebrating whatsoever (#old). Aside from the occasional yearning for the bridle path, I’ve been dealing with the injury pretty well. I think it helps that I’ve been super busy finishing school stuff and working, and that I really, really love my job. Every day and every patient is different, and I feel constantly busy, challenged and fulfilled. It’s awesome

the air cast totally matches the lab coat, yeah?

I’ve also been trying to keep things interesting at the gym, because I pretty much hate the gym and it pales in comparison to running in the park. I downloaded the Nike Training Club App to find some things to supplement the usual spin/elliptical routine and it’s awesome. I may not be a fan of their shoes, but I like Nike for developing this app and making it free. There are tons of workouts to target specific body parts, and they are HARD. Or maybe I just think they’re hard because I’ve been primarily running for God knows how long and not exercising other muscles. I’ve made it a goal to do at least one of the targeted workouts every day, so hopefully when I do get back to running I will also be beastly strong (heh).

Last weekend I also spent a little time in the kitchen. After seeing this delicious-looking recipe in the most recent issue Runner’s World I had to make it (also almost made up for the multiple pages devoted to “color runs”).

Quinoa Kale Salad with Fresh Apricots (via Runner’s World)
Makes 3 large servings or 4 normal servings

Ingredients
1 cup quinoa
2 cups water
2 cloves garlic, minced
1 teaspoon ground cumin
1 1/2   tablespoons course-grain Dijon mustard
1/3 cup plain low-fat kefir
1/8 teaspoon ground black pepper
Pinch salt
1 tablespoon olive oil
4 cups finely chopped, washed kale
1 can (15 to 16 ounces) kidney beans, rinsed and drained
1 1/2  cups pitted and diced fresh apricots (about 4 medium) or 1 cup dried apricots, diced
1/4 red onion, coarsely chopped
1/4 cup fresh cilantro

Instructions
Heat a large saucepan over medium heat. Add quinoa and toast until fragrant and slightly darker in color, about 2 minutes. Add the water, cover, and bring to a simmer. Reduce heat to medium-low, and continue to simmer until water is absorbed and quinoa is cooked, about 20 minutes. Cool quinoa to lukewarm. Make the dressing by whisking the garlic, cumin, mustard, kefir, pepper, and salt. Slowly whisk in the oil. Place remaining ingredients—kale, kidney beans, apricots, onion, and cilantro—in a large bowl. Add quinoa and the dressing. Toss to coat and serve.

I followed the directions pretty closely for the most part, but reduced the amount of olive oil and probably included more kale (obvi). This made three big servings for me, but you could also get four smaller servings and have something else with the dish like a piece of fish or chicken. The good thing about the recipe is that it has a good amount of carbs and protein via the quinoa and beans, so it makes a decent entree for vegetarians/vegans or side dish for meat eaters.

This weekend is the last one I will ever spend doing schoolwork EVER IN LIFE. I’m pretty sure that a week from now, I won’t know what to do with myself.

Tell me: What do people do when they have free time? Also, do you do core or targeted exercises in addition to running? What kind of stuff? Ever tried the Nike app?

Obviously I love sports nutrition, and one topic I have a keen interest in is lady athletes and menstruation (if you’re one of the maybe three dudes who reads this blog, sorry but this has little to do with you!). A lot of female athletes – especially endurance athletes like runners – experience menstrual irregularities, which can range from skipping a period here and there to complete absence of a menstrual period (called amenorrhea). This may not seem like a big deal, or even a good thing (no tampons! no cramps!), but the truth is not having a period isn’t normal. It not only means you will have trouble conceiving when and if you want to, but also puts you at a higher risk for things like fractures and osteoporosis.

There are many theories as to why athletes have problems with their periods – low body fat and eating disorders being the top two – but I’ve always wondered whether there is more to the story. Very lean professional athletes have successfully gotten knocked up and had kids, and some regular everyday athletes haven’t had a period in years.

Biologically, low estrogen levels are what cause athletes to miss their periods. Sometimes they are put on the birth control pill to increase estrogen levels and restore menstruation, but it is basically like putting a bandaid on the problem and not really fixing the underlying issue. This is why I excluded you from the survey if you answered “yes” to the question about oral contraceptives.

I’ve always been curious as to whether dietary fat can positively influence estrogen levels since some of our body’s estrogen is made in fat cells. It has been shown in a number of studies that reducing fat intake can lower estrogen levels in overweight women at risk for breast cancer. SO, if reducing fat intake can lower estrogen levels, then can increasing fat intake raise estrogen levels? Or is it really more about overall body weight/body fat? That was basically my research question, but because I obviously couldn’t test estrogen levels in my subjects I aimed to see whether there was a difference in animal fat intake among the people who said they had irregular or no periods and those who said they had normal periods.

animal fat can be delicious

I present the results next week (spoiler alert?), but in a nutshell I didn’t find any significant difference in animal fat intake among all of the people who took the survey. Kind of a bummer, but the sample size was pretty small and there are a bunch of other limitations to my “study.” I did find that the ladies who reported having no periods or irregular periods had a significantly lower body weight that the ladies with regular periods. This is pretty consistent with other research, which suggests that increasing overall energy intake (eating more calories) and gaining a little weight (~5 lbs or more) can restore menstruation in those who don’t have periods.

If we consistently don’t eat enough calories to replace what we burn through all of the miles we run, the body goes into something like “emergency mode” and the reproductive cycle is one of the first things to shut down because it’s not considered essential. But this doesn’t have to mean we are consciously starving ourselves (although this obviously is the case sometimes as well). One of the most interesting things I learned from reading through the research is that it’s possible to maintain a normal weight while at the same time be in a chronic energy deficient state. Sometimes we don’t know we’re not eating enough. Missing a period here and there (or every month) is a red flag to take a look at the bigger picture and make sure you’re getting enough calories. Here’s a cool formula I found from a recent Running Times article written by an RD/elite runner:

Women formula:

Step 1: Predicted Daily Energy Expenditure =

(10 × weight in kg) + (6.25 × height in cm) – (5 × age in years) – 161 = base number of calories

Step 2: multiple your base number of calories by an activity factor based on how active you are throughout the day. Don’t count running/working out. Activity factors can range from 1.4 – 2.5 or more, 1.4 being extremely sedentary. If you work in an office job, I would pick 1.4-1.6.

base number of calories x activity factor = total calories (not counting running)

Step 3: Here’s where you add in calories burned from running. Take the number of miles you run per week, multiply by 90 (an average amount of calories burned per mile) and divide by 7 to account for the seven days of the week.

#miles run x 90/7 = additional number of calories

Total calories + additional calories from running = daily caloric goal

Here’s an example for me assuming I am running 45 miles per week (to get your weight in kg divide pounds by 2.2; to get your height in cm multiply inches by 2.54):

(10x 58kg) + (6.25 x 167.6) – (5 x 30) – 161 = 1317

1317 x 1.6 = 2107

45 miles x 90 = 4050/7 = 579 + 2107 = 2686 total calories needed per day

When I did that I was pretty surprised at how high the number was, and while it’s probably not 100% accurate all of the time, it definitely prompted me to make a few changes to my diet.

Ok, whew. This was kind of a long one. As always, I’m curious to hear your thoughts on any of the above, and thanks again for taking the survey

I’ve said it before, but having friends/family/crazy runners on the sidelines cheering their heads off for you can make all the difference. Am I right?

Hope everyone has a great weekend filled with lots of miles. Or in my case, ice packs and stuffy spin studios with repetitive playlists…

But I’m frustrated. It comes from both missing running and still not really knowing what’s going on with my foot/leg. After an X-ray on Saturday it was a probable stress fracture to the fibula. On Monday, it was a maybe stress fracture, maybe peroneal tendonitis but we “can’t say for sure without an MRI.”

To make a long story short, MRIs are expensive, not totally covered under my current insurance plan and my confidence in the MDs I have to use is less than optimal. So at this point, I feel fairly stuck between not knowing what’s really wrong and wanting to know, but tired of getting frustrated with the healthcare system and trying to avoid ridiculous out-of-pocket costs. I like having a plan of action, but without an official diagnosis it’s kind of tough.

will I ever use these things again??

I go back and forth to never wanting to think about running ever again to wanting to run 12 marathons in the fall. This injury is happening at such a weird time – super busy finishing school, getting settled in the new job – and you’d think it’d actually make things easier to not have to worry about running. In a way it does, but I also don’t totally feel like myself. I like having tough goals to work towards, I love waking up to run before dawn and I live for that feeling you get after finishing a hard 20 miler, workout or race.

THAT feeling.

I know I’m not ever going to win anything or turn pro (HA!), but running is still a big part of my life. When it goes missing all of a sudden, everything else gets all out of whack, almost like all of the balls I’ve been juggling fly out of my hands and fall to the ground. Maybe that’s a little dramatic, I don’t know.

It’s only been 2.5 weeks since I last laced up my Brooks/Saucony/Asics/New Balance, but I already miss running a whole lot, and it’s hard to think about a longer, more extended break from my beloved bridle path.

I know, I know, things will get better eventually. The world will keep on turning, yadda yadda yadda. I just need to figure out how to make the best of the situation and move onward.

So tell me: Best strategies for coping with an annoying injury? Advice? Anyone have access to a free MRI machine/radiologist? (<– yeah, I work at a hospital but they aren’t free and I’m pretty sure sticking myself in an MRI unannounced would be frowned upon. And I like my job).

It’s been 10 days now, and the ankle isn’t feeling much better. There is still some swelling and pain when I walk, and the thought of trying to run pretty much makes me want to cry. The pain is still localized around the outside ankle bone and behind the fibula, and it just feels like things aren’t quite right in there. I’ve avoided going to the doctor and getting it checked out because I still have crappy graduate student insurance that involves high out-of-pocket and shitty doctors, but I have been seeing Dr Levine to at least help with the inflammation and surrounding muscles. I’ve never had an injury with such obnoxious pain and swelling last so long without much improvement, and it sucks.

Spinning with a little standing doesn’t cause any pain, so that’s what I’ve been doing to stay sane. But let me tell you, it’s no bridle path. Still, in light of everything that has happened in the past week, this injury is small potatoes. I know it’ll heal eventually and I’ll be able to run again, and in the grand scheme I’m pretty lucky.

Thanks to everyone who commented about having a similar injury – any more advice? Was yours this painful for so long??

But! Jack Rabbit Upper East Side (Lexington Ave. between 85/84th streets) is providing the perfect excuse to congregate amongst our people and having a Ladies’ Night. From 7-9 p.m. tonight, they’ll have a nutritionist (ME!), a physical therapist, and a yoga instructor to answer questions about women’s health and all things running/triathlon/fitness related. Representatives from Sparkly Soul and Moving Comfort (the maker of the best sports bras known to runners) will also be there, complete with bra fittings.

If that’s not enough to get you to come check it out, there will also be free food, booze and goody bags. Hope to see you there – I can’t promise I won’t be in a hugging mood.

Needless to say, as the news unfolded it just got worse. Even though all of my friends and sister are thankfully safe and unharmed, I have never felt such an intensely personal connection to a tragedy of this magnitude. It’s not just that extensions of my (our) runner family were targeted, but so was my former city and that race. That one race that means so much to those who have run it, those who strive to run it and those who come out year after year in support. People who meant nothing but good, whether by running or spectating, were targeted and most will never be the same.

I’m struggling to find the right words to describe how I feel about the fact that all of those who lost their lives and probably most of the injured were spectators. All I can think about is the people (my mom, sister and friend Meghan, in particular) who have stood outside in the cold for hours just to see me run by for a few seconds and then deal with my sweaty, sore and hungry mess in the aftermath of 26.2 miles.

It also gets me that Boston is where I became a runner. It’s where I ran my first double digit run, explored the Charles River paths at sunrise, got my first overuse injury. It’s where I stood on the sidelines for countless Marathon Mondays to get inspired, cheer until my voice was hoarse and fall back in love with a city that sometimes drove me crazy and a sport that could be pretty unforgiving.

A lot of my thoughts are still jumbled on this whole situation, but my sister wrote a pretty great post recently. If I learned anything from living there for 6 years, it’s that Boston is pretty resilient and a little stubborn. Not unlike most runners. And because of that, we’ll all be ok. My thoughts are with the injured and those who lost lives on Monday. Check out what Erica is doing to raise funds for the victims, or visit this page on ways to help.

worn under my lab coat on Tuesday <3 

I already know where I’ll be on Monday, April 21, 2014 (in one way or another), and I wouldn’t have it any other way.

marathon training in a nutshell

This is a feeling I should know to pay more attention to by now, but even in my old age of 30 I can be pretty dumb. Saturday’s long run plan was 20 miles with the last 7 at marathon pace, and I woke up early wanting it to be over before I even left my apartment.  Not the best way to start a run. I tried desperately to shake the whole “negative Nancy” attitude, but some serious intestinal troubles and lingering sluggishness remained as I hit mile 10 along my favorite stretch of the Hudson. I started the MP miles half-heartedly and couldn’t keep the pace as the first split ticked off. Oh well, it’s still a good effort, I told myself. Keep going. It was an undeniable beautiful morning and I started to feel a little better.

Once I neared Riverbank State Park with the GWB looming closer, this weird, sharp pain appeared in my left ankle. Ok, run it out and it’ll go away. A few minutes later and my ankle felt like it was going to explode, so I stopped. What the fuck? I have a high tolerance for pain and it takes A LOT for me to actually stop a planned run and throw in the towel. But this was something I knew would be stupid to run through and the pain was showing no sign of letting up.

the green pin is near my house. the red pin is where I had to stop. not anywhere near each other at all.

So what’s a runner to do when they find themselves limping in a very unfamiliar neighborhood a lot of miles away from home? Your guess is as good as mine. There was a subway nearby but not one that goes anywhere near my apartment and not a whole lot of cabs so I started to hobble towards the stop for lack of better idea. I’m pretty dumb bad about bringing money on runs but I did have my Metrocard. The idea of a long, cold ride on multiple subways was not very appealing though, and luckily a cab appeared and the driver ok with the fact that my wallet was at home.

I kept thinking the pain would subside as the day went on, but it got worse despite lots of icing and not a lot of moving. Some panicked texts to Coach John,  Googling and most importantly, a call to an old friend who happens to be an orthopedic surgeon pretty much confirmed some severe peroneal tendonitis.

The pain is pretty much exactly where the tendon is, around the outside ankle bone and behind the fibula. This makes it extremely challenging to walk, raise up on my toes or make any sudden moves. Not ideal for any job that involves being on your feet. Or running marathons. Or living in NYC where walking is usually necessary.

Even though some injuries aren’t very preventable, I should have seen this one coming a mile away. Instead of backing off when I felt consistently crappy, I kept going thinking that feeling shitty was part of the game and OMG, no pain no gain must BQ OMG. And now that I’m getting the “rest” days I fantasized about earlier in the week, all I want to do is freaking run. Be careful what you wish for, I guess.

So I’m not sure when I’ll be back up and running, but right now some serious healing needs to happen before I can even think about it.

It would be weird if I didn’t mention Boston in this post, since the greatest marathon of all time is tomorrow and for the first time in 5 or so years, I won’t be there cheering at mile 24 with my sister and a mimosa.

from last year’s race

Before yesterday, I would have told you that come 2014 I would be doing the running, not the cheering, along Beacon Street in mid-April. Hopefully I haven’t screwed up my chances for this dream to become a reality, and am trying to keep a positive outlook for my marathon in ~1.5 months.

In the grand scheme, I know this is only temporary and I will live to run another day (perspective). Good luck to everyone running Boston – enjoy every mile

Question: Have you ever had peroneal tendonitis???

I definitely like being busy, but having class Monday, Tuesday and Wednesday nights after work, lots of homework/assignments to do, private client(s) and working on Sundays at the running store sometimes makes my head want to explode.

Blogging doesn’t rank very high on the priority list, but I thought I’d share a few quick patient stories (without violating HIPAA guidelines, of course).

Patient #1: morbidly obese requiring the use of a motorized scooter to get around because of severe breathing difficulty (COPD, acquired from years of smoking). Wanted desperately to lose weight in order to breathe easier and engage in more physical activity. Suffered from depression and cried, literally cried, because of embarrassment experienced when trying to go for walks outside and being unable to breathe. Cried more when talking about unsupportive, disrespectful teenage children who offer no help or privacy. Sent the patient off with a nutrition plan and a big virtual hug.

Patient #2: paraplegic due to loss of both legs from an MVA (that’s motor vehicle accident), in for an additional surgery and complications. Needed lots of protein  for healing and agreed to down some Boost Plus along with regular meals. When asked how the patient was feeling and if I could do anything else, the reply was “Naw. I’m feeling pretty blessed,” along with a big smile.

another patient said he liked my shoes  

Now that I’m getting into the swing of things at the new job and seeing patients, I don’t think a day goes by where my heart isn’t broken for (at least) one of them. I like that I can help them, and for sure try my hardest to do so, but in the end they’re helping me too. A constant reminder that a). whatever it is, it’s not so bad and b). shit happens; attitude is everything. #lovemyjob

And because I think I forgot to do this earlier, here’s last week’s training recap:

• Monday: 3 miles super easy, 50 minutes yoga
• Tuesday: 11 miles total, 5, 10, 15, 10, 5 minutes on @ MP with 2:00 mins rest in between
• Wednesday: 8 miles easy
• Thursday: 8 miles easy
• Friday: 7.25 miles easy
• Saturday: 18 miles total, 3.5 miles warm-up, 10K race, 8.25 miles cooldown
• Sunday: 6 miles easy

Total: 61.25 miles. Less than two months to go. #BQorBust