Now that you’ve trained properly after having a medical exam and clearance to run, you are nearly ready for the big day. Prudence should keep you upright for the next 26.2 miles. Some have said “Start slow, and finish slower”. But that may not be your plan. Make sure you run within your means. Be certain to taper for 3 weeks. And let’s make another list:

• 3 training runs of 18 – 20 miles should have you set for your marathon.
• Taper and run much less for 3 weeks.
• You may gently carbo load. Don’t “deplete”. Don’t gorge. And don’t eat new or spicy foods for the 4 – 5 days before the marathon.
• Sleep well the nights before the marathon.
• Don’t drink too much the night before. Don’t use drugs. (In Woodstock the word was to avoid the brown acid.)
• Don’t take herbal diet or stimulant mixes. They are not checked by the FDA and may have unhealthy contents.
• Hydrate wisely. You may hydrate before the race. Don’t drink till you slosh. Don’t overhydrate. For the slow marathoner, hyponatremia (low blood sodium) from taking in too many fluids is a bigger danger than dehydration. Some races have scales for you to weigh yourself on. If you weigh more as the race goes on, you are drinking too much.
• Wear a medical condition and allergy bracelet or have the information attached to your shoe.
• Eat your regular long run breakfast.
• Warm up gently.
• Don’t start out too quickly.
• Pay attention to your body. Dizziness, faintness, chest, shoulder, jaw pain or tightness should be checked with the medical team immediately.
• Drink and eat foods you’ve used before on your training runs.
• Don’t sit down abruptly at the end of the race. Walk around a bit as a gentle cool down. If you sit, your muscles will likely tighten up and you may not get back up again easily.

General Tips

• Wear shoes that you’ve had good success with and shoes that are broken in.
• Make sure the rest of your clothes are also comfortable and broken in also including your sports bra or other sports underwear, shorts, singlet, sweats and socks.
• Use broken in Coolmax socks or another “wicking” fiber for all of your runs and  on race day.
• Try to get adequate sleep over the last month so your body can be as well recovered as possible from all the training you’ve been doing.
• Eat healthy throughout your training. Don’t overeat  or drink much alcohol  on the night before  your  race. Do eat a carbohydrate rich meal for a few evenings before the marathon.
• Wear outer layer clothes you can throw away as the race goes on and you warm up. If you are going to be at the race line early, dress warm for the morning chill, and be prepared to ditch your outer layers as the race draws near or as you go along and warm up.
• Use the same fluid replacement and  gel that you’ve practiced with on your long runs. Beware of under hydration and over hydration. If you are running for longer than 4 hours, consider using weighing stations if your marathon has them available to attempt to avoid hypernatremia.
• Remember to go out slower than you think you should so you can have a negative split and  not burn out somewhere before mile 20.
• Figure out where some of those cameras will be taking your photo so you can  look  good for your marathon portrait.
• Don’t forget after the race that you should rest about one week before running again and then “reverse” taper.

Things To Bring:

1. Race number  and safety pins. Pin this to your clothes two nights before the race.
2. Running Shoes and all your racing clothes
3. Clothes to toss, if it is cold. Long sleeve teeshirts, sweat clothes.
4. Change  of clothes for after the race.
5. Money for emergencies.
6. Body glide, if you’ve used it for areas  that rub on previous long runs.
7. Your own food for after the race  in case the race runs  low.
8. Plastic  container of water  or sports drink to drink before the race
9. Toilet paper to carry in your carry-along, in case of emergency.
10. Very light  weight, miniature camera if you don’t expect to win.
11. Throw away reading material for the  long  wait before the race.

For post marathon recovery, I have some tips on recovering from the marathon and a reverse taper program.

I just came across the following “tips” video performed by Toby Tanser via Mark Remey at RW

Last Minute Marathon Tips: shot with Nikon D90 from Mike Kobal on Vimeo.

Health care reform of some sort is in the making for this year. The shaping of it probably should not be a political issue, but should be instead an informed decision made with wisdom.

Before medical procedures are performed a consent form called “informed consent” is read, (mostly) understood, agreed to, and signed. All speakers at medical conferences and authors of articles appearning in medical journals are required to disclose conflicts of interest before speaking or publishing. These declarations are made in public, in clear and open view of all. The declaration appears on the first page of each journal article and in programs and from the podium prior to each lecture, by the lecturer.

Our discussion of these issues both in the media and among members of congress and others with specific axes to grind and political preferences are not obligated to make any disclosures. From the democratic congress person receiving mega bucks to the republican senator receiving similar funds for campaigns, there is no requirement before making a statement to announce how much financial support they have received. Former members of congress do not make these declarations nor do they state what boards they sit on or organizations they’ve founded.  The news media does not state what their interests and conflicts are.

Yet, this debate should be beyond conservative and liberal. It should be between sense and nonsense. It should be what will be the best possible system in all regards versus a system of appearances that serves only those with the most money to spend lobbying and the most money to make. The debate between single payer and traditional insurance is over. We do need to consider though including a public option within the reform we will be making.

The obvious necessities will be in this plan. Elimination of prior existing condition clauses, better control of health care savings programs, and a wider, geographically based,  more inclusive amortization of costs will likely be implemented. These could have been implemented years ago. The usual recent buzzing issues that will be included are electronic record keeping, decrease in over utilization of tests and radiology services, and decrease billing  and other fraud within the healthcare system. This year physicians are required to make sure that their patients do not appear to be committing identity theft. We’ll see what next year brings.

A public insurance option be made available would set a minimal standard and put some pressure on the insurance industry to conform to at least this minimal standard and  to do so without deception in all of their plans. Some have declared that a government plan will cost people little but provide bad care. People don’t want bad care, although they would like less expensive care. Many have learned that cheap and bad care are not worth much at all, and would  be happy with something that works, is trustworthy, and isn’t necessarily at a rock bottom price. Newt Gingrich is now a prominent spokesperson on health care reform. He is one who has often stated that a government run health care program will be too expensive to the nation and provide miserable care for patients. He has recently amended that to also declare that it would drive insurers out of the market place.

Appearing recently on MSNBC  Gingrich said, “I think when the average American looks at the idea that we’re going to have a government bureaucrat decide whether you get, or your daughter, or your granddaughter gets the treatment you need, if you look at the death rate from breast cancer in Great Britain and the death rate from breast cancer here, I don’t think that’s a model we’re going to accept.”

The reality is that there is no way that traditional insurers will be eliminated. There is much they can do to make their programs attractive and have sufficient value added service to make them desirable for many. I do have a fair number of ideas on what they can do to be more attractive than a government run system, and I’m sure they have others making suggestions. They also have considerable power to market and to lobby and to even join the organization the Newt Gingrich founded the “Center For Healthcare Transformation”. The corporate members and even the existence of this organization is not often mentioned, if ever, when Gingrich is quoted in the media or appearing on a news show. The corporate members are not an absolute secret. A list is available online.

There is no need for traditional insurers to fear for their existence. They will survive, live long and likely prosper.

But for many people another option is required and that option is a public health care option. It shouldn’t and won’t be free but some will feel more comfortable within that system than what they have experienced within the current traditional system. The next area of concern is how to pay for it. Certainly part of the cost, and perhaps much of it may be borne by those who buy in to the plan. And that is how it should be. Do we need to increase taxes elsewhere? Do we need to tax other peoples health care plans? To me taxing others health care plans does not make sense.

A public option for health care does not have to follow any other model precisely. It doesn’t need to follow Canada, Switzerland, Sweden or the U.K. We have a specific set of expectations from our health care system that are different from our friends and neighbors. And “Freedom of choice” is a resonant slogan. We can work in freedom of choice, carefully defined benefits, prescription drug coverage, and choice into a plan.

How else can we cut costs? One way is to decrease the cost involved in caring for chronic disease. But, let’s save that for an upcoming blog. And, I’ll bet fitness and healthy lifestyle choices come into play. In the meantime, ask not what your health insurance company can do for you, ask what it will take to get some more options.

June 3, 2009 is the day for the celebration of National Running Day. This is a fine day to rededicate yourself to your fitness program. A day to set up your schedule to complete your first 5 K race or to solidify your marathon training schedule. We’ll be adding information to help you with both. In the meantime you can visit Runner’s World for a wide variety of information, programs, and inspiration.

Recent articles have highlighted the significant dangers involved in being sedentary. An article by Katzmarzyk et. al. published in MSSE May, 2009 indicated that the death rate was much higher for those who sat for longer periods of time in their jobs. This was found to be “dose” related and independent of fitness activities.

Other studies have found that sedentary behavior leads to weight gain.  Television  watching for extended hours is unhealthy. The specifics are readily found in the literature.

It is important to have 30 minutes of moderate intensity exercise 5 days per week or 20 minutes for 3 days per week. And this is a bare minimum. More is required to assist weight and fat loss. A healthy diet most, if not all of the time, and strength (resistance) training at least 2 days per week for 8-10 exercises 8-12 reps is also helpful for most people.

So get out and move today, think and plan your next moves. Don’t just sit there, get out and  celebrate motion!

For more information on running and running injuries: Running Injuries (http://www.drpribut.com/sports/)

References:

1) Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer. Katzmarzyk PT, Church TS, Craig CL, Bouchard C Med Sci Sports Exerc 2009 Apr 3

[PubMed]    http://www.ncbi.nlm.nih.gov/pubmed/19346988

2) Too much sitting: a novel and important predictor of chronic disease ris
N Owen, A Bauman and W Brown

2009;43;81-83; originally published online 2 Dec 2008;
Br. J. Sports Med.

The District of Columbia (Washington, D.C.) has been declared the fittest of the 50 largest cities in the  United States. The American College of Sports Medicine (ACSM) using their American Fitness Index (TM)  AFI  has found that the overall health and fitness of Washington, D.C. ranks first nationally. The index is a composite which includes personal health information such as eating 5 fruits or vegetables daily, exercise regularly, non-smokers, and a variety of community level rankings. Available parkland, primary care providers, number of those insured all went into the community ranking. If the mayors of the U.S. were ranked for fitness it would be noted that Mayor Fenty would be among the fittest mayors in the country and D.C. would deserve bonus points for his efforts. He regularly participates in triathlons and marathons demonstrating to those in the city the significance and value of regular exercise. By swimming, running, and biking, Mayor Fenty shows that there is more than one way to get your workout in.

DC is previously held the number one position for the American Podiatric Medical Association and Prevention Magazine’s “Best Walking Cities”.

With the current epidemic of obesity and the resulting increase in chronic diseases, disability, and mortality, it is important for everyone who can to get the recommended amount of exercise and have healthy lifestyle habits. It is likely that one day many primary care providers will have multiple health consultants within their offices including perhaps a fitness consultant such as a certified trainer, nutritionist, and a motivator perhaps a psychologist to help with dietary and fitness lifestyle changes.

For more information on the ranking of cities and the programs supporting this undertaking visit: http://www.americanfitnessindex.org/

The ACSM is undertaking a push to have fitness and encouragement for lifestyle changes that dramatically lower the risk of chronic disease. The message is being delivered to the U.S. Congress, the President, and Health and Human Services. In addition to organizational messages, it is important that individuals contact their representatives to indicate how important they feel this is to decreasing healthcare costs and improving overall health.

In the upcoming days and weeks I will try to detail some of these issues and should have brief discussions of “sitting disease”, place a 5K beginners schedule online, a guide for beginning runner’s long run schedule for marathon training, and rationale for a program I call “Think, Stop, Think”. Think, Stop, Think is what we all should do. It is important to take a break from our daily work, particularly those with sitting down jobs and do something else. That something else is ideally exercise and movement. 30-50 minutes of moderate exercise 5 days per week will meet your requirements for aerobic exercise and is great for a mental break which refreshes in many ways. My fellow running friends and many exercise walkers already understand this.

The top 15 cities ranked by the AFI are:

1. Washington, DC
2. Minneapolis-St. Paul
3. Denver
4. Boston
5. San Francisco
6. Seattle, WA
7. Portland, OR
8. San Diego, CA
9. Austin, TX
10. Virginia Beach, VA
11. Hartford, CN
12. Sacramento, CA
13. San Jose, CA
14. Cincinnati, OH
15. Atlanta, GA

Whatever your politics are, wherever you live, not just in the United States, but all over the world, people are hoping for change. And there is a lot that needs to be changed. In fact some things have been so bad that any change will have to be for the better.

But, as the expression goes, all politics is local. And right at home is where you can get your goal list out, review it, and see how those changes are going. That’s the list of things you want to accomplish this year. The list you made a few weeks ago. And if you didn’t get that list made, do it now. Some people have been working on change for years. Some have been working on how to express the changes they want for months, if not years. We are bound to hear some inspiring phrases this week. But you have to get inspired to get that list made, plan how you’ll accomplish your list, and consider it done. Fitness goals, weight goals, body composition goals, life goals: figure them out, write them down, and plan to get things done. Most of the things you want to accomplish will not happy overnight. Some things will take months or longer. Patience will be important. So will a plan. And short term, intermediate term, and long term goals need to be determined, followed, evaluated, and checked off.

And one more thing, it is time to evaluate what is standing in your way of your goals. Clean them up and move on. If it is not enough sleep, bad food, too much alcohol or cigarettes, give those up and move on. For the example-in-chief, who’ll be inspiring many this week: Yes you can! You can give up those cigarettes. Then those gym trips, or that personal gym in that right in the middle of DC home will feel even better.  Yes you can and yes we can! We all can and should.  Change starts at home. Be The Change. 

David Bowie: Changes (Ziggy Stardust version)

Each year the calendar starts afresh, but hangovers linger from the last year. What you are right now, you’ve been building to, or fallen to by virtue of what you’ve done over the last year. This holds for you as an individual, and for bigger things like the economy.

Many say it is not good to make resolutions at the start of the year. And it is true that most resolutions are broken. In fact, many may be broken before the sun sets at the end of the day, or within a week at best. But, this is a fine time for re-evaluation, for setting a plan, and for determining your goals. So off we go, we’ll set goals and not make any resolutions.

Goal Setting

This year then, rather than resolutions, we will be setting goals. Then we’ll go for those goals. If you don’t achieve them, re-evaluate and reset your goals. Evaluate your goals regularly and set up weekly and monthly reviews.

Goal setting is an excellent concept. Set near term, intermediate term and long term goals. You now have something to measure and chart and can observe your progress. Make certain to set short term, achievable goals also.  If you only set long term goals, you are likely to get discouraged and give up. Start now and set up achievable short term goals, so that when you accomplish them within the next 4 weeks you’ll be encouraged to continue.

In sports and fitness, this holds for both the experienced, well conditioned athlete, and for the lapsed out of shape, determined to come back one. It is important for both, but definitely more important for the out of condition athlete. The experienced athlete likely already has goals. The experienced, well conditioned athlete must be prepared to modify their goals based on daily and weekly changes that they need to carefully monitor. They must guard against injury, as in reality we all must do.

The beginning athlete, or those of you starting up, determined to whip yourselves into shape need to exercise caution and realistic goal setting. Your ideal, dream fitness accomplishments and body weight and composition can be a long term goal. Realistic improvement, changes in activity level by increasing 5-10% per week with drop backs every third week  can be a short term goal. Setting up a plan with a trainer, or following suggestions from the many helpful websites, books, and plans available can help you get started. Of course the usual caveat applies, if you have or have had a serious medical condition or if you are over 40 years old, have a physical before starting a vigorous physical fitness program. But realize that sitting on a couch watching tv, or sitting on a comfy chair surfing the web can also be dangerous activity.

As you start off the year, make plans to improve in all of what I call the 3 Pillars of Fitness: Cardiovascular (CV), Musculoskeletal (MS), and Physiological (PY).   There is overlap within these categories.

Goals 2009:

Cardiovascular Exercise:

Walking: Increase amount to ___________ steps per day. (Goal – minimum of 10,000)
Running: Weekly range _____ to ______ miles per week
Other: Elliptical

Racing: Event 5K, 10K, 10 mile, Half-marathon, Marathon, Ultra

Musculoskeletal (MS)

Setup a strength (resistance) training , conditioning, and a gentle stretching program to do at a gym or at home. You can use body resistance, dumbbells, combination free weight, or machines.

A certified trainer can help you get started. But don’t be ignorant of what they are doing. Learn the exercises, learn good form, learn how to modify your program. Check your budget, but at least get started and have a form check with a certified trainer. Make sure your trainer understands your medical conditions. Discuss your goals. If you have osteoporosis, osteopenia, and a history of stress fractures, you don’t want your trainer starting you off with jumps onto and off of high objects. If the trainer is aware of this and leads you down a dangerous and high impact path, for your medical condition, your best exercise will certainly be running. Running away. There are many good certified trainers around. Seek them out.

Physiological

Physical examination for evaluation of blood pressure, blood chemistry, lipid measurements, etc.

Make certain your blood pressure and cholesterol and lipids are at good levels. Make certain everything else that needs to be controlled, corrected also is acted upon.

Improve your diet.  Evaluate it thorougly and realistically. Determine to eat healthy 95%, if not 100% of the time. Follow a rationale and balanced plan. Avoid fads. Understand that caloric balance is the key to successful weight loss.

Set your goals for body weight and composition changes (fat loss, muscle gain, etc.) if needed. Short term, intermediate, and long term. Most authorities recommend losing 1 pound per week, with some allowing more than that for a limited time period. Start working on it immediately. You should have been working on this one already, but yes, most people do put weight on over the holidays. In fact, most put weight on, and more than the need over their lifetimes. All of these areas of fitness complement each other. By improving your cardiovascular fitness, getting aerobic exercise, and improving your muscular strength and fitness you’ll also be assisting your diet. In fact they are all connected. Eating properly will improve your workouts also.

Get Going Now

In short, now (and always) is a time to set goals, evaluate progress, and move ahead. Have hope and a plan for the future. Reach for it, run for it, train for it. Get there, where you should be!

]]> http://www.drpribut.com/blog/index.php/2009/01/getting-off-on-the-right-foot/feed/ 0 http://www.drpribut.com/blog/index.php/2008/12/genetics-a-part-of-the-big-picture/ http://www.drpribut.com/blog/index.php/2008/12/genetics-a-part-of-the-big-picture/#comments Wed, 31 Dec 2008 03:42:14 +0000 pribut http://www.drpribut.com/blog/?p=67

Training, dedication, and hard work (along with a good diet and a bit of rest carefully added) will go far in helping you improve your conditioning and body composition. Your performance will increase. But for most of us, we will not become world class athletes, or even national class athletes. That is no reason not to work at improvement and in many cases where it is needed very dramatic improvement. You should not accept or provide yourself with excuses that without trying hard you’ve reached the point where you are all you can possibly be.

from Wikipedia (Clopidogrel molecule)

In the future, genetics will be used to help determine the best possible training methods for each of us, the best diet, and even the best medications to take.  The FDA is now considering changing the label on the anti-clotting medication Plavix in view of several recent studies that indicate a genetic variation may make the medication ineffective for up to 30% of those taking it to prevent heart attacks and strokes. This is a dramatic step and an obviously important one based on the currently available research.

Genetic variants and mutations will become increasingly important in pharmaceutical development, design, prescription and use. Plavix is a new and developing case in point. Ultimately research will lead to the development and determination of improved training, diet, and even legal supplements. Until then, other studies, experience, and just changing things that are obviously wrong can and will go a long way in helping us all improve.

More information at the Wall Street Journal: http://tinyurl.com/g3n3ticDru7gs

Science, Numbers, Journalism and Critical Thinking

I believe it was on a Merlin Mann podcast, where someone jokingly mentioned the concept of an iColon website which in typical Web 2.0 fashion people could share the images and films of their colonoscopy procedures. This week the New York Times managed to demonstrate where their heads were at regarding simple mathematics and statistics. An article by one of their most popular reporters reviewed a new study that showed that colonoscopies were not all they were cracked up to be as far as picking up colon cancer and in their ability to prevent future cancers from developing from detection and removal of polyps.

The American Cancer Society still strongly recommends the colonoscopy as a useful  screening procedure. and the physicians I know who both perform this procedure and recommend it all strongly feel that it is one procedure that can actually save lives. We will however take a quick and simple look at the use of math and see a lack of simple math skills and the failure of editorial checking at the New York Times.

The NY Times reported on a study that demonstrated that colonoscopy missed virtually all polyps on the right side of the colon. The  article stated that 40% of all cancers and polyps originated on this side. Of those on the left side of the colon up to 30% of those were missed. The article then went on to quote and conclude that rather than preventing up to 90% of colon cancer from devleloping it might only be useful in preventing 60% to 70%. Now, this seems to be a fairly simple math problem. And a quick glance by anyone even one with only minimal math skills just looks and sounds wrong on the surface of it all.

If 40% of the lesions occur on the left side but are undetectable, than you have remaining 60% of the lesions to deal with that you can find. If 1/3 of these ones are not found, by splitting them into 3 equal parts of 20% 20% and 20%, and you remove 1/3 you are then left with 40% of the lesions that you would be able to find.
Hence, it is clear that it is not 60%-70% number of lesions that you’ll expect to find, but a number significantly less than 50% and which clearly looks to be 40%. The physician interviewed in the New York Times encourages people to have the colonoscopy as a screening procedure, but to not necessarily expect to be safe for the next 10 years. It is strongly recommnended that you follow the colon cleaning procedures prescribed prior to undergoing the procedure.

There will be more studies in the future and likely ones that will be quite positive on colonoscopy. Techniques will likely be modified that also result in improved detection of right sided lesions. Until then, we now and always will need clear heads to do the math and keep evidence based medicine, based on evidence and not on an easily obtained quote.

Up soon we may dissect an article published within the last few months that looked at the longevity of runners and non-runners. If you know the study, here’s a hint: check out the disparate population groups studied and see if it looked like a well designed and controlled study.

New Math From the New York Times:

“In the new study, the test missed just about every cancer in the right side of the colon, where cancers are harder to detect but about 40 percent arise. And it also missed roughly a third of cancers in the left side of the colon.

Instead of preventing 90 percent of cancers, as some doctors have told patients, colonoscopies might actually prevent more like 60 percent to 70 percent.”

George Sheehan’s book “Running & Being” is one that every dedicated runner should read. George, a cardiologist, and one of the early, great running philosophers and gurus has been an inspiration to all old school runners.

Many years back, some people, Jim Fixx included, thought that running marathons would give an immunity to fatal heart disease. While running is certainly excellent for cardiovascular health, this has been found to not be so. The most recent studies seem to demonstrate that long distance running reduces your overall risk from dying from cardiovascular disease but that during running itself your risk is higher than while at rest. I still believe that this is a reason to run and not to avoid running. The overall benefit to reduced risk of cardiovascular disease, high blood pressure, depression, body weight, and many more benefits clearly and strongly outweigh the statistically somewhat increased risk of exercising.

It is important though to note and keep track of your own personal risks. Be aware of your lipid profile, your total cholesterol, your HDLs, LDLs, Triglycerides, and what you must to do make it as good as can be done for you. Be aware of your personal and family history of cardiovascular illness. Have your blood pressure checked, and as you get older have it checked more often. High blood pressure is a serious and by many an underrated, and undetected but major contributor to severe cardiovascular illness. Do not underestimate it or think you may be immune to it because you did not have it for the first 25, 35 or 40 years of your life.

Jim Fixx, author of one of the early and earth shaking popular books on running, died from heart disease while running. Today, Ryan Shay, a promising American runner died in the U.S. Olympic Marathon trials. At this time the cause of death has not been established. It was a very sad thing to learn. He is believed to be the first american elite runner to die during a running event. Earlier this year Alberto Salazar had a severe heart attack and was without a self-sustaining heartbeat for more than 5 minutes. Amby Burfoot recently wrote a great article about Alberto’s heart attack in Runner’s World, in which his personal risk factors were discussed. One of his grandfather’s died at 52 from a heart attack and the other at age 70. He reported that his father had had more than one heart attack. If I recall correctly Alberto was being treated for high blood pressure and an abnormal lipid profile. His lab tests and blood pressure were considered fine while under treatment. Serious heart disease ran in his family. This was pointed out as a risk factor that you can not alter. A few weeks ago I came across another article about Alberto Salazar in a section of the New York Times written by John Brant, an author who has written a book on the famous Salazar – Beardsley Boston Marathon race. Salazar related to Amby Burfoot that his doctor recommended an echocardiogram which would not have demonstrated cardiovascular disease. In the New York Times article something jumped out at me. Alberto, according to this article, had had significant neck and back pain that made him go to visit his physician. Normally, he endures pain stoically. His doctor did a resting electrocardiogram and some lab tests and it seemed normal. He was then given an appointment for some weeks later to have stress electrocardiogram.

“…in Indianapolis, Salazar was unable to sleep, had little appetite and felt perpetually tired. Stabs of pain rose from his neck and back, which he attributed to sitting awkwardly on the plane. As soon as he returned to Portland, his primary-care physician prescribed some tests, which were inconclusive, and referred Salazar to a cardiologist. An EKG stress test was scheduled for early July.”

Unfortunately, before he had that he had his near fatal heart attack. Or as some called it a fatal one that he survived. (Since he lived, even though his heart stopped, I do not call it fatal.). This is another extremely important item for runner’s to note. Do not ignore chest pain, neck pain, left side of the jaw pain, upper back pain and any other pain that makes you think something could be wrong. If you have risk factors or if a possible coronary atherosclerosis is suspected, you don’t need your stress test and or thallium blood flow study next month, you need it now. You should have that test as soon as possible. Salazar had serious signs of heart disease that were perhaps taken a tad less seriously and attended to a little slower than they should have been. His test should have been the following week and not the following month. Another, not quite as good a runner, David Letterman, did get tested early, and had a quintuple bypass. Salazar, was lucky to only need a stent. Happily, both have recovered and are running again.

The Runner’s World article by Amby was excellently written and gripping. Alberto is thoroughly quoted within the article. In trying to figure out why there was a difference in how he related his symptoms before his heart attack to the two authors I was at a bit of a loss. In a close reading though, Alberto clearly wanted to emphasize his spirtual beliefs in both, and perhaps even more so in the earlier interview with Amby. He viewed his heart attack as part of God’s master plan for him. I don’t know why he didn’t mention the symptoms he had. I’d suggest if you do hear a bit of knocking at the door in the form of unusual discomfort, pain, fatigue or dizziness you pay attention quickly.

Since most of you runners are doing all that you can to be healthy, let’s make sure you don’t ignore signs that you need just a little help to keep that ticker working. And don’t put off the stress test, if you need it.

Over the past several years the concept of well rounded young athletes playing 3 sports over the course of a year has died. Most want to be specialized in one sport. Whether the sport is soccer, baseball or running, we rarely see the child athlete playing football or soccer in the fall, basketball in the winter and baseball or track in the spring.

In fact, school centered sports is no longer the norm. Travel sports rules. Year long focus on one sport is it. This has resulted in more overuse injuries than there should be. It has also resulted in more teens having the “Tommy John” elbow surgery and even for parents to seek it to see if it may make what started as a normal arm, pitch faster. Read Fit Young Pitchers See Elbow Repair as Cure-All in the New York Times for a current journalistic perspective on the surgery aspects of this. The article neglected to mention the year long focus on pitching as the root cause.

…it is becoming more commonplace among teenage pitchers who are injuring their arms through overuse at what surgeons call an alarming rate.

Some parents and young pitchers, hoping for college scholarships or multimillion-dollar professional contracts, misguidedly view the surgery as a performance-enhancement technique instead of a last-resort corrective procedure, said Matt Poe, a speed and strength coach in Nashville.

Often, pitchers who are pushed the hardest and sustain the worst overuse injuries are the most talented, doctors said. In the late 1990s, Dr. Andrews said he performed 5 to 10 Tommy John operations a year on high school pitchers. This year, he said, he may perform 75. Last month, he operated on a 14-year-old.

And for two interesting pages the article goes on.

“I don’t think there’s as deep a talent pool anymore,” Dr. Petty said, because so many kids are coming out of high school with what he called “100,000-mile arms.”

It’s not the talent pool. Pitchers have always been in short supply. High schools have made do with very few pitchers for years. But, not until recently did they only pitch for most all of the year.