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Mid-century Runner
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Many of you who read this blog probably know by now my love affair with running -- both as a leisure activity and a tool for weight management. I ran through my aging process, through full time and part time works, through sickness and health, through schooling for a second college degree, through disease-free status and then diabetes, through becoming overweight and then achieving appropriate BMI. I don’t have a single regret about it.
But it is one thing to praise and worship running as an enjoyable activity and another thing to face its ‘not-oh-so-awesomeness’ and contradictions . Running is both good and bad; it can lead to pain and relieve pain at the same time. Running can help your heart if done moderately and damage it if done extremely. Running can help you escape depression but skipping it for a couple of days might lead to depression albeit temporarily. People will talk about running all the time : how to do it correctly, how it should be avoided, how it should be embraced, how it could lead to one’s healthy life and how it can ruin it too.
Through all these multiple and conflicting claims and theories, what do I think about running?
My answer is based on my personal experience so there is nothing scientific and evidence-based in what I’m about to say. This is a blog and not a peer-reviewed article meant for scientific journal publication. This is actually a mere story. And it is very subjective.
Running for me was not some activity I picked out randomly somewhere to accomplish a certain objective. I chose running as a component of my quest to save my body from damages resulting from smoking, borderline obesity, carelessness with food choices, stress and being overworked. Running doesn’t require special skills as it only requires me to advance one leg after the other, or special equipment (except for good running shoes). It doesn’t involve targeted training, no need for a team play and best of all, I could indulge in it for personal leisure or competition (even if only beating my own running times). Running helps me control-alt-delete my brain and reboot it with fresh ideas on the business of the day. I believe that my running have mitigated the destructive complications of diabetes and helped me continue with my work as a PT without injuries, disability, or failures.
Now that I have reached my not-so-young age of 54, I have noticed that the baby boomer wolves who ran alongside me on my trails in my younger years have gradually vanished and were replaced by much younger x-gen and millennial wolves. I unhesitatingly slow down when my body tells me no matter how much these young ones lure me to keep up with their paces. In being left behind, I often wonder where the old runners went. Did they retire their running shoes to better and more enjoyable brisk walking or golf or swimming? Did they abandon the sport due to injuries or fear of injuries or in compliance to the advice of their primary care physicians? Am I the lone aging wolf left behind while the others have wandered to greener and more interesting trails? I entertain these stupid thoughts at times while I plod my feet on the road.
But one thing is true about me: I have matured gracefully with the help of my running.
Have I been injured? Of course I have but I recovered without disrupting my life. There were a few days or weeks I skipped regular running due to pain or very busy work schedule but I returned to it quickly. I have likewise gone through running technique experiments, committed mistakes, wasted time in over-analytics, unnecessary obsessions, frustrations, infantile knowledge and raw ignorance about running. I used to be the first one to buy new gadgets, latest shoes based on current fads - shoes for supinators, shoes for pronators until I realized the best ones for my feet were the neutral. I talked my ass off about running like a parrot, to the point of perseveration. Every day I shared unsolicited info about my running distances or improved times or improved endurance as if expecting some applause or expressed admiration from listeners who were, deep inside, rolling their eyes in utter boredom.
Yet my running persisted. But like anything else, time has the ability taper us all down. That unwelcome phenomenon called aging soon got a hold of me, and unwittingly crushed all my confidence and feeling of invincibility. At fifty I was diagnosed with diabetes and concomitantly its twin siblings of high BP and high cholesterol. You can not imagine how shocked I was. Me? How is it possible a man who had run at least 11 half marathons be positive for diabetes? I felt betrayed by running that I considered as my armor and shield against all form of maladies. I felt embarrassed when I came face to face with my non-runner friends who were actually much healthier than me.
But that did not stop me from running even when the kids ‘round the block yelled ‘Run Forrest run!’ at me at 6 am while they waited for their school bus. Diabetes did not stop me from tying my Mizuno shoe laces in early mornings to challenge my legs to cover the distance from point A to point B. I am just glad to listen to my Pandora and occasionally peek at my running app for a feedback on my distance, pace, frequency.
Through the years I developed my own personal running rules, revising them constantly, depending on current evidence-based studies. Here are the personal rules that I keep:
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I still believe that running too fast, on elevation, covering a longer than usual distance done at the same time is a sure way to sustain running injuries. This can be solved by breaking them down, one day for speed, another day for elevations, another day for long distance with lots of resting days in between.
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I still believe that abrupt increase of weekly mileage is akin to inviting injuries as well. One should not increase mileage more than 10 percent each week.
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I also believe that modifications to running, whether incorporating intervals, increasing speed, lengthening/shortening strides, changing footwear, any experiment with running techniques should be done gradually paying close attention to how the body responds and responding appropriately to what it tell me.
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It goes without saying that any sign of discomfort, especially the localized type of pain anywhere in the body should not be ignored, it should in fact be acknowledged quickly by stopping before it gets worse.
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As I get older, I am getting more and more acutely aware of emerging indications, contraindications, trends, warnings on exercises and running. For example, having a medical check up is absolutely indicated before trying any form of intensive exercise. There is also a contemporary belief (by no less than cardiac specialists) that heavy-duty cardiovascular activities are increasingly associated with heart damages suggesting that moderation is the key to healthy and longer life. On a personal level, my aging process and diabetes are slightly affecting my muscle girth (atrophy ) and balance thus strengthening and balancing are also some activities I should indulge on top of my running.
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Finally, life is not all about exercising and running alone. I also need to focus on relaxation, rest, proper nutrition, spirituality, financial stability and social interactions especially in my community. I must also work on challenging my brain constantly to keep a sharp memory, solve problems. I am not exactly thinking of Sudoku and crossword puzzles. Hey, this is the age of technology - people like me should code in advanced computer languages, create killer apps, design awesome graphics and blog like there is no tomorrow.
Pain: Pills versus no-Pill
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Yes Virginia, there are two ways of treating pain in this world. Pill versus no pill. And where do I stand on this?
Obviously I am partial to no-pain-pill approach or I’d be out of a job as a Physical Therapist if pain management rely on drugs alone. It’s undeniable, however, there are conditions when pain pill is necessary. Surgery is one. Or Cancer. Or toothache. Or hospice care. Or palliative care. These are conditions that will make someone suffer immensely without some form of medication. I will be dealing with very angry, screaming, crying, uncooperative patients who are deprived of legitimate pain meds. It can be human abuse and cruelty in fact, if that is the case.
Pain pills depend on the stage of the condition. Acute pain is that period immediately after an injury or malady onward to its resolution. Usually administration of pain should be tapered off as the full recovery is approached. Chronic pain lingers beyond 90 days and the sufferer begins to ask for more doses. Weaning is a hellish nightmare for them. We are talking of addiction. And addiction can have devastating consequences. Let us review some actions and side effects of most common pain meds:
NSAIDS such as ibuprofen (Advil, Motrin) can lead to heart problems in prolonged use. It is worse with Diclofenac (Voltaren). These medications block cyclo-oxiganase(COX2) enzymes that cause pain and inflammation due to overproduction of prostaglandins. Problem is, the inhibition of COX2 is known also to cause stomach problems, indigestion and heart conditions. They also have the ‘ceiling effect’. That means no matter how much dosage you increase the medication, the pain relief will stay the same but the side effects increase. To those who take these mostly over the counter pain pills, please start weaning as soon as possible and try other pain relieving approaches: movement is the best approach. Yoga, meditation, music, heat packs, massage, psychotherapy, PT (of course) are very useful. Better yet, keep moving, nothing can beat movement in the prevention and relief of pain.
Opioids, i.e. Morphine, Oxycodone, Methadone, Codeine are narcotics that can become addictive. Overdosage can lead to respiratory distress, hypotension, dreaded constipation, bowel obstruction, ileus. Opioids work by targeting the root cause of pain in the brain and they don’t have ‘ceiling effect’ which means the higher the dosage, the lesser the pain symptoms (improved analgesic effects). In other words, people can develop high tolerance to these meds which may require higher dosages in future. And that can lead to addiction. It becomes more dangerous when withdrawn - leading to drug withdrawal symptoms. The side-effects alone are enough to frighten anyone using these meds. And though some people legitimately need them at least during the acute phase of their painful conditions, it is imperative to be very vigilant in dosages and time-frame of use. I have had patients who became instant ‘drug-addict suspects’ when they knew more about pain meds than pharmacists :) or when the intensity of their pain is a 10 while laughing or having a pleasant conversation over the phone. Yup - I have no right to treat them differently from my other patients but one should be careful in over-prescribing with inconsistent or non-reliable symptoms. And these are not only limited to patients. They could also be friends and family members. Prescribing pain pills is outside the scope of my practice but these patients should immediately be referred to Pain Management professionals before it’s too late.
Finally, there are drugs that can ‘harness’ the impact of a pain pill. They are antidepressants, anticonvulsants, local anesthetics and corticosteroids. Together with opioids, they provide a maximum analgesic effect. These ‘harnessing’ drugs have side-effects of their own combined with pain meds. Mostly drowsiness, irritability, slow movements and in case of corticosteroids - kidney and liver side-effects.
There are always legitimate conditions that require pain pills. Unfortunately, the current trend points to their overuse and the victims mostly likely did not intend to become drug dependent in the first place. Someone does not wake up in the morning with that goal in mind. The most likely scenario is that he had a pain he needed to address. Temporarily. But the pain becomes chronic (about 90 days) and only the prescription with increased dosage (ceiling effect) would help him make it through each day. When he tries to wean himself off it, he goes through withdrawal. In no time, he would revert back to it to avoid the withdrawal symptoms. The cycle continues. That is addiction.
That prescription pill addict could be me or you or someone we both know, or a parent, sibling, friend co-worker. Pain does not discriminate and there are situations and environments that render one person more susceptible to pain than another.
[The following is copied from PT in Motion] Here are some statistics via The Centers for Disease Control and Prevention (CDC), which released guidelines in March 2016 encouraging health care providers to try safer alternatives like physical therapy for most pain management:
1. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every American adult to have their own bottle of pills.
2. As many as 1 in 4 people who receive prescription opioids long term for noncancer pain in primary care settings struggles with addiction.
3. Sales of prescription opioids have nearly quadrupled since 1999.
4. Deaths related to prescription opioids have quadrupled.
5. Heroin-related overdose deaths more than quadrupled between 2002 and 2014, and people addicted to prescription opioids are 40 times more likely to be addicted to heroin.
6. More than 165,000 persons in the United States have died from opioid pain-medication-related overdoses since 1999.
7. Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.
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