Out of Shape

The other day, one of my partners requested me to supervise a cardiopulmonary exercise test (CPET) that he ordered on a patient that he saw in our clinic. Since I would be in the hospital all day that particular day, and the exercise test would be done in a lab in the hospital anyway, so I obliged.

CPET is usually a test that we request if the cause of shortness of breath remains unclear even after initial evaluation. Most of the time when we request a CPET, we have already done lung imaging (like a chest x-ray), a pulmonary function test, and basic heart evaluation to rule out gross cardiac problems. Definitely we don’t want a patient having a heart attack and keeling over while we are performing the test.

During CPET, a patients walks/runs on a treadmill or pedals on a stationary bike, while having all these body monitors to measure the heart rate, blood pressure, and oxygen saturation level. Then they also wear a mask, like the super villain Bane in the Batman movie, that is attached to a breath analyzer where we measure not alcohol content, but the volume and gas content (oxygen and carbon dioxide) of the air they inhale and exhale. At the peak of the exercise, we also draw a blood sample to measure the level of oxygen, carbon dioxide, and lactic acid. We may not be experimenting on Captain America, but it is an intense test regardless.

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cardiopulmonary exercise test (image from BMJ journal)

By the way, lactic acid is a byproduct of “overstressed” metabolism. It is produced when there’s not enough oxygen supply to the contracting muscles, so the muscle switched from aerobic to anaerobic metabolism. The build up of lactic acid in the muscles is one of the cause of having pain in your muscles few hours or few days after a viogorous exercise. I hope I am not bringing back bad memories from your high school physiology teacher.

The exercise test is usually ended in several possible ways: a patient cannot exercise anymore due to exhaustion, or we have achieved the maximum target heart rate (which is: 220 minus patient’s age), or we have reached the end of the designed exercise protocol, or the patient developed an alarming symptom, like severe chest pain.

The information we gather in this test help us delineate what is the limiting factor causing the shortness of breath, whether it is a heart problem, a lung problem, a muscle problem, or plain deconditioning. Sometimes elite athletes undergo this test to gain data on how they can improve their performance. I’m sure Gatorade lab performs lots of this.

Perhaps the most common diagnosis we reach considering the group of patients we deal with, is deconditioning, or in simple term, being out of shape. Definitely this is a scientific way, albeit expensive, to say to a patient that he is too lazy or is too fat.

The duration of the CPET is mostly less than 15 minutes, and with our patient population, it rarely last more than 10 minutes. Not a big deal for me to supervise the test, as it is short and quick.

I was busy that day so I was not able to look beforehand at the chart of the patient whose CPET I would supervise. What I just know was the time I needed to show up in the lab, the name of the patient, and his age.

I knew that the patient was in his early 50’s, a couple of years older than me. Even before meeting the patient, I already have a diagnosis in mind, as I was expecting a middle-aged man who is overweight, maybe a couch potato, and perhaps cannot accept the fact that he is way out of shape, and instead blames something is wrong with him, thus we are doing this CPET. Since I have a few half-marathons under my belt, I thought I could show him how to “exercise.”

When I came to the lab, I met our patient who was already sitting on the stationary bike. He looked fairly trim, and to be honest, he looks younger than his age. I introduced myself and explained the test that we will administer.

To get some idea of his condition, I asked him about his symptoms. He told me that he felt this “disproportionate” shortness of breath when he is running.

Sensing that he is a “runner” like me, I asked if the shortness of breath happens early, or during the latter part of his run. He answered that he experienced this shortness of breath relatively “early” in his run. I asked him then to be more specific, like how many minutes after he started his run.

Then he said, “I have this ‘unusual’ shortness of breath after running 20 to 25 miles.”

What?! Who considers 25 miles as early? Most people are not short of breath, but may not be even breathing at that point!

That’s when I learned that he was an ultra-marathoner, and runs 50 to 100 miles or more when he competes. He said that after 25 miles of running, he usually catches his “second wind” and feels good the rest of the way through.

All my preconceived notion flew out the window. Life is never short of surprises. Another lesson learned. Never assume.

I just told the lab staff to commence the exercise, and brace for a long, long test.

A Gray Day to Run a Marathon

It was time for my annual participation for the half marathon. As always, I can’t run without taking photos. I could have played Pokemon Go and capture Pokemon creatures too, but I settled in just capturing pictures.

It was a foggy and an overcast morning. Though for runners, there’s no “bad” day to run. As you can see, hundreds of runners showed up on race day. Here we are waiting for the run to start.

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And here we go! Crossing the official Starting Line.

img_3577Weaving our way through downtown Des Moines.

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Passing the Pappajohn’s Sculpture Park.

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We’re away from the downtown buildings now. The visibility remained a few hundred yards due to the fog, as shown below.

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Circling around a lake. Where’s the lake you may ask? I know you can’t see it, but just believe me, that’s a lake.

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Crossing a foot bridge in Gray’s Lake. It was really gray indeed!

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Even if it’s foggy and cool, we need to keep hydrated. Below are the paper cups thrown aside by the runners just past the water station.

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Running around the Capitol building. The golden dome is barely visible due to the fog. It was about this time that I felt my legs starting to cramp. So I started to intermittently walk and run.

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I almost crawled the last (13th) mile. But to look good for the spectators at the finish line, I ran fast for the final 0.2 to 0.3 miles to the Finish Line. As they always say, finish strong! Even if it just for a show.

Finally, me approaching the Finish Line! Look, a medical personnel is waiting.

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(*all photos were taken by me, except for the last photo which was taken by my wife)

Not Running

The annual Des Moines Marathon is less than 3 weeks away. And I am in no close form to run it.

For the past 5 years, I participated in this yearly event, running the half-marathon (13.1 miles). This year I learned that a classmate of mine from medical school who is also now living in the US, but in another state, is participating in this run. Even out-of-towners are joining this event, not to mention some elite runners as well.

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(photo taken during Des Moines Marathon 2013)

Participating in this annual race keeps me committed on my running and hopefully this keeps me fit and healthy, which is the ultimate goal anyway.

I know it is not hard to find a hundred reasons to stop running and it is so easy to fall off the wagon, and stop exercising at all. Doing this half-marathon at least once a year keeps me motivated. Or unable to button my pants, or an innocent yet honest remark from my kids about my bulging belly, will also do the same.

If I follow the running gurus’ advice, like the Hal Higdon’s training schedule (click here) on how to prepare for the half marathon, my long runs should be at least 8 to 10 miles by this time. Adhering to these recommended training schedules assure you that you cross the finish line on race day without killing yourself. But I loosely follow those schedules anyway.

Yet, even if I am not on track in my training for the half-marathon, there’s no urgency for me to train hard. The truth is I was not even training at all. I have not run a distance of more than 3 miles for the past couple of months. I am indeed slacking.

Why? Have I lost the motivation? Have I resigned and accept my bulging midsection? Not at all!

About 3 months ago, I learned that on the weekend of the scheduled Des Moines Marathon is the date that my kids will have their piano competition. And I will not miss the world for that. So we will be out-of-town at that time, and thus I cannot do the run.

So I forgo on my training.

However last Sunday, just to challenge myself, I push to run 5 miles in less than an hour, and I felt good about it. Next weekend, if I can run 7 or 8 miles, then it is as if I am ready to run the half marathon, even if I am not doing it.

Just because.

Old Man Running

I ran the Des Moines half marathon (13.1 miles) this morning.

Compared to my previous runs (this is my 5th half marathon), this was my least prepared race. I usually start training around 3 months prior to the race. I gradually increase my run and by the time of the race, I should have at least run a 10-miler or more.

But due to interruptions in my training this year, like my unscheduled trip to the Philippines, my extra weekend calls, and other lame excuses, I never really had my training up to par. Though I don’t want to waste altogether the effort I placed on this for the past couple of months, so I still decided to participate anyway, and just have fun.

I never ran more than 7 miles this year. Well, until this morning.

While I was standing in the starting line among the throng of runners (it was estimated that there were about 10,000 participants – for the marathon, half marathon, and 5K), I saw a familiar face. It was one of the cardiothoracic surgeons whom I worked with in the hospital.

When I approached the surgeon, he told me that he was running the half-marathon as well. He asked me what pace I usually run, and I said to him that I’m just going to “go slow” this time, due to lack of preparedness. He then asked me if we can run together. Of course, I obliged.

I told him that I commend the fact that he as a heart surgeon, have the credibility to advise his patients that he performed cardiac bypass on, to live healthy and exercise, for he himself follows that advise. I wish we doctors will all practice what we preach.

So we ran together the whole 13.1 miles. As we ran, we shared stories of our lives and our families in between gasping breaths. It was my first time to run with somebody the entire race, and I enjoyed it. We even finished with a decent time: 2 hours and 35 minutes. Not bad. Not bad at all.

After crossing the finish line, and when I was walking back to my car, I suddenly felt my age. How many more years would I be doing this?

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But did I tell you that the heart surgeon that I ran with was in his mid-60’s and has recently retired from his practice? He’s almost 20 years older than me but still in very good shape. I just wish I can still run when I’m his age.

Although honestly, he kept me going on that race. If I was running alone, I would have run more slowly, or even walked part of the course, or who knows even stopped and quit. But I was too embarrassed to slow down, given the fact that I was much younger than he was.

After getting home and getting some rest, I felt good except for some soreness in my legs and feet. I just moved “slowly” the rest of the day. Just like an old man.

Hanging up my running shoes

Yes, you read the title right. I’m hanging up my running shoes.

Though it does not mean I am done with running. What I mean is I am retiring my old beat-up running shoes.

I got this particular running shoes about 2 years ago, and I even wrote about it (see post Heart and Sole here).

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from my post: Heart and Sole

After only a couple of months of having it, my new running shoes was stolen. Somebody swiped it, right in my garage! We had different service crew and repairmen visit our home that day, and I don’t know what happened. But the next thing I know, my shoes were gone. I just hope that whoever it was, he had put it to good use.

I like that shoes very much that I replaced it with exactly the same kind. Since then, that shoes had taken me to many places.

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Iowa State Fair, while riding the sky lift

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Badlands, South Dakota

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Vail, Colorado

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Grand Teton, Wyoming

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Sedona, Arizona

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Chicago, Illinois

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Boston, Massachusetts

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Hamilton, New Jersey

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Arches National Park, Utah

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Grand Canyon

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Metro Manila, Philippines 2014

It also served its purpose, as I used it for my regular morning runs. It even let me finish not just one, but two half marathons. Is that equivalent to doing the full marathon?

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Des Moines Marathon 2012

“Hindi lang pang-pamilya, pang-sports pa!”

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Des Moines Marathon 2013

Now the shoes has way more than 500 miles under its belt. Experts on running recommends replacing your shoes after 300 to 400 miles of running. This is to prevent injury, as old shoes loses its stability and support.

Over the past two years, it gotten worn-out, got dusty from running on the dirt road, and even got muddy. Though taking me to the above places and finishing marathons were not the only accomplishment of these shoes.

These shoes got seriously dirty when they walked the muddy streets of Tacloban, and gave service to people affected by the typhoon Haiyan (local name:Yolanda) in the Philippines.

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Tacloban airport, after typhoon Haiyan

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ACTS World Relief Team, Tacloban 2013

Here’s a video I took in one of our helicopter medical mission, showing the devastation of Tacloban. But I also inadvertently focused on my shoes at the end of the video:

 

In that regard, it went beyond it’s purpose of a running shoes.

I’m hanging you up now, my old and faithful running shoes.

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Oops, I Did It Again

No, I did not suddenly become a fan of Britney Spears. What I meant was I finished the Des Moines marathon again. Well, half marathon (13.1 miles). And it’s not really oops, but rather “whoopee, I did it again!”

This year I decided to keep away my camera phone and just concentrate on the running. Though I still took pictures before the race started.

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photo taken at the start line

I planned to run at around 11-minute mile pace, which is what I trained for, so I followed the 2:20 pace runner. That is if I keep the right pace, I’ll finish the half marathon in 2 hours and 20 minutes.

I was doing great in the first two miles that I even overtook the 2:20 pace runner. However on the 4th mile the 2:20 pace group caught up with me. I must have been slowing down then.

I was still at par with the 2:20 pace group after 6 miles, when “nature” called me. I needed to pee! So I stopped at one of the many portable toilets lining the race course.

By the time I got out, the 2:20 pace runner was too far away already. Damn nature call! I didn’t want to burn too much energy to catch up with the group, so I ran on my own. Yet I was still keeping up with my training pace.

After passing the 10-mile marker, I was happy that I was still feeling great. Yeah, my bunions may be hurting a bit, but I could run through blisters and pain. Even though I never ran more than 10 miles during my training for this race, I knew that the sheer excitement and adrenaline rush could carry me through the last 3.1 miles. Just like in the past.

On the 11th mile, the motorcade with the lead marathon runners passed me. (Even though the course of the half and full marathon diverge at some point, the start and finish point are the same.) It was amazing to think that they have already covered 24 miles. That was way below 6-minute mile pace! Those athletes are really freaks of nature. And I said that in a good way.

Not too long after the lead marathon runners passed me, when trouble began. Leg cramps! It was not so bad, but I have to stop running. But I can still walk. I was still determined to finish this race, cramps and all, even if it means I have to crawl the last 2 miles.

On the 12th mile marker, the 2:30 pace runner and group passed me. I thought to myself that given the circumstances, I was still not so far from my projected time of finish.

I was working on my last mile, when the lead “physically challenged” marathoner passed me. He was “rolling” strong on his wheelchair to finish the 26 miles. That gave me renewed inspiration.

On the last stretch of the race, in front of cheering crowds of people lining up near the finish line, that I really wanted to finish strong. But whenever I tried to break into a run, my legs would cramp again. Certainly the spirit was willing, but the flesh was weak. Or more aptly, the flesh was cramping! But I plodded on.

Finally I crossed the finish line. Time: 2 hours 35 minutes. Maybe not to the condition I wanted, but it was still sweet regardless.

I know I will be sore for a few days. Was it worth it? Definitely! Every single step (and cramps) of it.

*******

Related Posts:

Take the Photo and Run

I Did It!

Running the First Mile

Not too long ago, I saw a patient that was referred to me for pulmonary evaluation. The complaint was “shortness of breath.”

Me: What’s going on?

Patient: Doctor, I cannot run a mile. I ran out of air. And I use to run before.

He is in his 40’s and is on the heavy side. OK, overweight. I already reviewed his chest x-ray and pulmonary function test (it’s a stress test of sort for the lungs), and both were normal. My nurse has tested and recorded in the chart his pulse oxymetry (measure of oxygen saturation in the blood) at rest and on walking, and it too was normal. You see, I have all the information I needed even before I lay eyes on the patient.

Me: Do you have chest pains, wheezing, or cough?

Patient: No, no, and no.

Me: When was the last time you were able to ran a mile?

Patient: 25 years ago.

I almost fell off my chair!

You may snicker at him, but I took him seriously. I told him that I do not believe he has anything wrong with his lungs. Although I cannot rule out conclusively any other diseases, like heart conditions, but I am almost certain of the diagnosis.

I told him that his shortness of breath is from being overweight and deconditioning. In more simple terms, he is way out of shape.

I coaxed him that it’s not easy to run that first mile. But I reassured him that with more training and persistence, he should be able to run a mile, and more.

I will be riding a 50-mile bike course tomorrow, as part of the RAGBRAI (Register’s Annual Great Bike Ride Across Iowa). In three months it would be the annual Des Moines Marathon, which I hope I can participate again.

Even though I consider myself fit and have been exercising somewhat regularly, there are days that I struggle to run the first mile. What I am trying to say is, it is not always easy to run a mile. No, let me rephrase that. It is hard to run a mile.

Running a mile and beyond, is not like a faucet that you can turn off for a long time, and then when you turn it on, you expect it to be flowing freely again. No, it is more like a pump, that you need to prime first, before it flows again. Running or any other endeavor for that matter, takes time, training, and dedication.

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For all of you out there, who are struggling to run a mile, don’t lose heart. Many times the hardest part of a long run is the first mile. But the good thing is, it can be done. And it must be done. For your health sake.

As a popular Chinese proverb says, ” A journey of a thousand miles, begins with a single step.” If I may add, that single step will eventually lead to the first mile.

(*photo from here)

For the Love of Marathon

I love marathons. It epitomizes the human grit and endurance. 26-mile long of pavement-pounding and grueling run. Though I have not run a marathon yet, I hope that someday I will be in one. I have run in three half-marathon in the past three years, so maybe I’m due for the full one next time.

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photo taken during my visit to Boston last year

The Boston Marathon is one of the more famous and elite races. You need to run a qualifying race just to even participate on it. For my age group (45-49), in order for me to be eligible, I need to have a previous time of 3 hours and 25 minutes or less. Really? I will be happy to finish it in less than 24 hours. Or maybe just to finish it, period!

But now this. The bombings in the recent Boston Marathon had saturated our news in the past couple of days. A day of celebration turned into a dreadful one. What a tragic event. What a senseless act of violence. My thoughts and prayers goes to all the victims and their families.

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Boston bombing (photo from CNN news)

Will this horrific acts of terror forever change our love for marathon? Certainly not! We will not be deterred. We will not slow down. We will not back down. And like the fallen runner in the photo, we will rise up on our feet, and we will finish the race.

I will continue to run. I will continue to train. I will continue to participate in the races. We will continue to have marathon events. We will continue to live our lives and pursue the things that we love. Running the marathon will not only symbolize our perseverance. It will also signify our defiance.

Run. For the love of marathon. For the love of freedom. For the love of life.

Take the Photo and Run

It was a perfect autumn day. It was clear and cool, with early morning temperature in the high 40’s but expected to warm up to 70’s Fahrenheit. Excitement was heating up the nippy air. Beautiful day to run the marathon! This was my third half-marathon race. And I even took pictures while running it.

Waiting to start. This was how far I was from the starting line.

There was a sea of people that day. Nice to be in this good company of athletes and wannabe-athletes. This was the annual IMT Des Moines Marathon (which also includes the half-marathon and 5K run). I learned that there were more than 8,000 runners that morning, and perhaps thousands more family and friends who were there to support and to cheer.

It took a few minutes after the official time begun before I even cross the starting line.

Iowa Capitol in the distance. I was trying to follow the pace runner with the red sign 2:20 (that is the goal time I want to finish the half marathon)

Court house building ahead. Can you still see the 2:20 pace runner?

I kept on taking pictures to amuse myself. I also took photos of all the mile markers as motivation for myself of how much distance I already covered. Somehow I missed the mile 2 marker as I was oblivious of other things, like keeping up with the pace runner that I wanted to follow, while watching other runners and not stepping on their toes, for it was crowded.

Mile 3 marker. Where’s the 2:20 pace runner? I think I fell behind already. O well, I’ll just enjoy the run.

After running through city streets we entered Water Works Park, and it was a change of scenery.

Mile 4 marker

Mile 5 marker

I was in mile 5 when there were several runners going the opposite direction, meaning that I was still on my way further and they were on their way back already. Are you kidding me? I must be running slow! The eventual winner of Des Moines half marathon was a Kenyan with a blistering time of 1 hour, 3 minutes and 18 seconds. That was really more than twice faster than my pace.

I was still going upstream, while others were already heading back.

There were several water stations along the way. They offer water and Gatorade. There were even different stations that handed out pretzels, candies, gummy bear, energy gels and power bars. I stopped on most of them and took whatever they offer. Hey, they’re free.  And I don’t even have to say trick or treat!

Gatorade station

Along the route were signs that kind of encourages the runners to go on. There was one that said “Run as if you stole something.” Maybe I should have stolen the prize money for the winner when I passed the starting line and I could have run faster. Playing in my head was the Steve Miller Band song “Take the money and run.” Hoo, hoo, hoo! Here are the other signs.

Why can’t they hand them now in the water station?

I am a Filipino, and I can run fast too. Specially if I am being chased by a rabid dog! (see previous post here)

Besides the spectators on the side of the road cheering the runners, there were also several singers and local rock bands playing, boosting our moods and electrifying the air.

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Mile 6 marker

I need a break. This kind of break. A breath-holding break, if you know what I mean.

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A different kind of station.

They even have an ambulance ready. But not for me. Not today.

Mile 7 marker. I am more than halfway!

Another music band

Mile 21 marker. Huh? Oh, that’s a marker for the full marathon.

Here’s the right one for me, the half marathon marker.

I am not Dave, but I’ll take the motivation. Thanks doggie!

Downtown Des Moines in the distance. That’s how far I need to go still?

Mile 9 marker

Gray’s Lake in downtown Des Moines. A beautiful day indeed!

Still in Gray’s Lake

Mile 10 marker. That’s the farthest I ran training for this half-marathon. It would be sheer determination from here on.

I was on my 10th mile, when a motorcade passed, alerting us to give way. It was the lead runner for the full marathon. He already ran 23 miles in the same time period that I was running! The next marathon runner that passed me was almost 5 minutes behind the leader.

The lead runner for the full marathon.

I learned that this was James Kirwa (#1), a Kenyan runner. He eventually won the race with the time of 2:16:54. It was his third consecutive year winning the Des Moines Marathon.

Mile 11 marker

Mile 12 marker. The next marker will say “FINISH”

This band was blaring heavy rock music when I passed by.

Finish strong? My legs were like jelly. The spirit is willing but the flesh is weak.

I can smell the finish line!

Finally! Finish time was 2 hours 29 minutes. Still close to my goal,while taking photos to boot.

I think I deserve one of those, please.

wearing it proudly

See you again next year! For now I need more ibuprofen.

******

(*all photos taken with my iPhone)

Marshmallows and Delayed Gratification

It is hard for us humans to purposefully delay a pleasure, that we know we can possibly have now. We live in a day and age that we want rapid results, immediate benefits, and instant gratification. We want everything and we want it now. Pronto! ASAP! And we don’t care about its future consequences.

Studies have shown though, that the ability to delay immediate gratification is link to a successful life. In one experiment conducted by psychologist Walter Mischel years ago, he offered marshmallows to a group of 4-year old kids. He told them that if they want a marshmallow they can eat one now, but if they could wait several minutes, they can have two. Some of the kids immediately grab the treat though some were able to hold off. Mischel followed these kids until they were adults and he found that those who were able to wait were generally more self-motivated, more successful in school, and more emotionally stable. I just wonder though if the kids who ate two marshmallows got to see the dentist more. Sorry, I digress.

Looking at the things that we do now in our everyday routine, I know that some of the benefits from our efforts, we would not rake until much later. At least that’s what we hope for. There may be grinding days that we ask ourselves, what’s the point of doing all of this? But let’s keep reminding ourselves that someday we will have our gratification. So hold off gulping down that marshmallow, for someday you will have a whole bag all for you. What? Sorry, I digress again.

In four weeks, I will be running the half-marathon. This will be my third. And I am up to par with my training schedule. Last weekend I ran 10 miles, the longest distance I ran for this year so far. Training experts say that if you can run 10 miles, you can finish the half marathon which is 13 miles (21 km). I hope so. For that’s what I’m training for, right? That’s also the reason I’m not eating marshmallows. Huh?

So as I make the final push for my preparation for the half-marathon, I wonder would it be worth all the efforts – the early morning rise, the long, lonely and grueling runs, the buckets of sweats, and the muscle sores. Would the medal (which is probably worth $2) hanging on my neck, signifying that I finished the 13-mile run, the ultimate prize? Would having my name in the list of finishers the final goal? Would finally cooling off my heels, hanging up my running shoes, and just taking it slow after the half-marathon, and eating all the marshmallows I can eat, the delayed gratification I am alluding to? Heck, no! I don’t think I will stop running anyway even after the event.

By keeping on running today, what I am hoping for is in 15 years, when I am 60 and my son will be 24, that I can still play basketball one-on-one and keep up toe-to-toe with him. Or in 25 years when I am 70, and my grandson is 7, that I can still teach him how to dribble and shoot the ball, or show him how to do a lay-up or even a forceful dunk. Or in 45 years when I am 90, and my great-grandson is 1, that I can still guide and support him as he take his first steps, or perhaps just witness him bite a marshmallow.

That will be gratifying. Really gratifying. And it will be all worth it.

(*photo from here)