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.

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.

local rock band

Mile 6 marker

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

water station

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.

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(*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)