A Need For Speed

How fast do you run?

I’ve been asked that quite a bit lately. Whether it’s nonrunning friends or acquaintances asking for curiosity sake, a race entry form requesting this information so they can place you at an appropriate starting corral, or a member of your running club wanting to know before he decides whether you can be training buddies, everybody wants to know your speed. But the funny thing is, speed is relative. As such, the answer to this seemingly simple question will inevitably be varied as well.

By ‘how fast’, do you mean my 5K time, my 10K time, my half-marathon time, my marathon time, or for shorter distances like 400 meters or a mile?

If you want to know my mile time, do you want to know my mile time during interval training, in a group run or in a race?

And if in a race, do you want to know my mile time this year, last year, in a past life, or if I were to spontaneous drop this bottle of beer and start running?

Although this internal monologue always seem to play itself out whenever the question is posed, my curiosity is never satisfied because it would be the equivalent of committing social suicide. As such, I often have to guess the sort of response my interrogator wants to hear. Some of the answers I’ve given are: “Well, I’m not fast, but I finished the New York City Marathon in a little over 3 hours last year.” “If we were to all start running right now, I’d probably end up somewhere between Lance Armstrong and Katie Holmes.” “Oh, I’m slow. I can’t even run for one mile what the Kenyans average for the whole marathon.” After offering a quick answer, I always wait in eager anticipation for a followup question. But none ever comes, as if they know if they were to ask, they’d open the floodgates to a full blown running discussion.

Those of us who have been in this business for a little while know that running for speed is but just one small aspect of the racing experience. As such, it would be inaccurate for me to assume that just because I ran a few seconds or minutes faster than some guy in a race we both entered some time ago, I’m a “faster” or a “better” runner than he is. There are so many variables inherent in running and racing that trying to judge the competency or skill of a runner based solely on speed would be a little like trying to determine if Tiger Woods or Alex Rodriguez is the “better” all-around athlete based on their statistics in their respective sports . It makes good fodder for debate, sure, but in the end, there really is no objective basis of comparison.

I believe it is enough that we all intuitively know our own speeds in our own terms. No matter whether we run 5, 7, 10, or 13 minute miles on a sunny day or a winter’s night, we are in competition only with ourselves, in so far as we strive with every race in every year to run a little better and finish a little faster than the year before. As long as there are people in front of me and people in back of me, and I’m finishing my race at a respectable time for me, I’ll be happy because ultimately isn’t this what life is all about: To live and run the good race. No one asks, Yeah, but what time did you finish?!

Having said all that, it still feels pretty awesome in the rare instance that I receive recognition (admiration?) for my speed. Case in point. I was struggling to finish up my long run yesterday, at mile 9 of an 11 mile trek, when I found myself at the foot of Harlem Hill with a biker about 40-50 yards in front. The weather was unseasonably warm, and both of us were having a difficult time running up the steep incline. As I started running and gaining on him, his breathing became audible and louder with each step. Initially, I had quickened my pace not so much to beat him to the top, but because I was nearing the end of my run and just wanted to get this over with as fast as possible. He continued to pant louder, as I continued to run behind and then next to him. He looks over at me and I could see he’s off his bike seat, trying to peddle as hard as he could, with beads of sweat trickling from behind his sunglasses onto his spandex shirt. Something about that visual bothered me, and I decided right then that I’d turn up the afterburners and take him to the crest of the hill, which was maybe a quarter mile away. Once I took off, I could hear that he knew it was on. But despite his loud grunting, his bike was still not moving very fast, at least as compared to me and my kicks. A short while later, I beat him to the top of the hill by a safe margin. Now, ordinarily, that would be the end of the story. But lo and behold, as we approached the top of the hill, there was a little girl in a ponytail crossing the street with an older woman, I assume her mother, holding her hand. And even though my heart was pumping hard, my chest burning, and globs of sweat stinging both my eyes, I had no trouble making out the words to the conversation happening right before me.

“Mommy, mommy, look, he’s running faster than the bike.”

“Yeah, he’s fast, isn’t he?”

“I wanna run fast too…”

I couldn’t resist, but waved to the little girl as I ran by. Looks like the Running Laminator Fan Club just increased its membership by one. Woohoo!

A Boy Name Wally

Note: Although this is my contribution to Take It and Run Thursday on the topic of Hydration, you might not learn anything that would teach you how or what to drink on your runs. If that is what you’re looking for, I suggest you check out all of the other posts that are not only educational, but well worth reading. Instead, what you will find here is some complicated human physiology, a story about me, and a boy name Wally.

Everything I know about hydration and water balance I learned because of Wally. I first met Wally (not his real name, of course) when I was a first year house officer, or intern as we’re known in the medical community, rotating through the pediatric emergency room. Even on our first encounter, Wally made it quite clear that he would not soon be forgotten. “Hi, Wally, what brings you here today?” “I’m fine. I’m here to teach you everything about MY condition.” “Really? And what condition is that?” “I have DI.” And with those infamous words, spoken with the same tone was if he was introducing me to his best friend, I was introduced into Wally’s world.

DI, or diabetes insipidus, is a disorder of water balance, whereby the body loses the ability to regulate the loss of free water from the body. In the majority of cases, it is caused by a deficiency of the anti-diuretic hormone (ADH) that is normally produced from the posterior pituitary gland in response to dehydration. Rarely, it can also can be caused by electrolyte imbalances, medications, or kidney disease. The role of ADH is to bind to receptors in the kidney and reclaim some of the water that would otherwise be lost in the urine. So in a normal person who is dehydrated, ADH levels are high, allowing more water to be reabsorbed by the kidney to be returned back to the blood, and causing the urine to be very concentrated. (Anyone still here?) People who have DI, like Wally, lack this hormone. As a result, they cannot reclaim any water from their kidneys and become severely polyuric (meaning they produce massive amounts of urine) polydipsic (meaning they have to drink massive quantities of water to keep up with their frequent urination) and is at high risk for severe dehydration. Fortunately, the ADH hormone can be replaced pharmacologically. However, the medication, called DDAVP or vasopressin, must be given at the right dose and at the right time to maintain the water level in the body at a safe and stable level.

By the time I met him, Wally was 12 years old and has had DI for 3 years. For the first 1.5 of those years, no one knew why Wally had DI. But then, someone found a small speckle of something on his brain MRI. Two lumbar punctures and a few lab tests later, it was confirmed that Wally had a brain tumor called a germinoma. Because germinomas are exquisitely sensitive to chemotherapy, Wally was started immediately on a regimen with three different chemotherapeutic agents. Although most cancer patients nowadays often receive chemo as outpatients, because of his DI, Wally always received his chemo in the hospital.

Over the next six years, Wally and I got to know each other very well because of his frequent admissions for chemo, and he taught me many things about fluid management that I would not have learned otherwise. For example, he taught me early on, that unregulated water input leads to hyponatremia, which can be just as dangerous as unregulated water loss leading to dehydration. He taught me that the most sensitive indicator of the body’s water status is the sensation of thirst. He also taught me that carbonated drinks, especially the caffeinated ones, actually cause you to be more dehydrated an hour later than you were before you drank it. For a kid so young, he actually knew quite a lot about himself and his condition. But just like any kid, Wally had a wild side too. At times, when he was frustrated with how a particular doctor was not nice to him, he would purposely not drink or drink too much just before his daily blood draw so that his labs would be all out of wack, and cause his doctor to freak. My favorite was when he would correct medical students during rounds when they were forced to give a synopsis of his condition. “I only drank 100cc yesterday, not 120. I gave the other 20 to the kid next to me when he wanted a sip of my orange juice…” Ah, he was something.

Sometime last year, during my second to last month of fellowship training, Wally passed away. The tumor in his brain, which had initially responded to his first course of chemotherapy, had recurred and eventually became resistant to all other treatments. I remember one of the last conversations I had with Wally was when I asked him who’d teach me what to do the next time someone came in with DI and I couldn’t figure out what fluids to give him. “Don’t worry about it, Doc.” He said, with his usual candor and honesty. “Just ask yourself. What would Wally do? You’ll figure it out.”

I have figured it out, thanks to you, Wally.

Race Report from the Scotland 10K RunPart II – The Finish and The After-Math

After winning the Battle At Harlem Hill, I relaxed a bit, knowing that the worse part of the race was behind me. I pushed the pace back up to a fast but comfortable level. There were definitely people who did not survive Harlem Hill as well as I, because the general pace of the runners around me slowed down by quite I bit. As I passed them by one-by-one, I imagined how I used to be so much like them last year.

Mile 5 was essentially one fast flat track, followed by a long descent down Cat Hill. I love running this mile because it allows you to gain tremendous speed heading towards the finish. As I ran down this time, I succinctly remember not even caring what my pace was or who was around me, but rather being thankful that I was running and racing again. Still, I was pretty psyched that the mile 5 marker passed by at 6:26. I felt so great at that point that I felt I could’ve kept that pace for another loop around the park.

The finishing drive wasn’t as eventful as it could’ve been. Partly, it was because I was still enjoying the pure exhiliaration of running fast, partly it was because I was somewhat tired by this point and didn’t really feel like spending the extra energy required to shave a few seconds. After all, I did run a 6:52 back in the first mile, so what’s it matter if I ran a 6:20 or 6:30 now? But while I was having this internal monologue, I saw a few runners who I had passed at miles 4 and 5 quietly slip by in front of me. I was slightly annoyed at their intrusion of my rightful place in the standings, and was eventually forced to pick up the pace for the final finish. I eventually crossed the finish time at a cool 40:27.

After walking off the initial exhaustion, I grabbed my stuff from baggage claim and headed over to a park bench to put on some clothes. (For some reason, I felt so much colder after the race than I did before, even though the sun was out and it was obviously a few degrees warmer…weird!) In between this impromptu dressing change, I took my glance at my Garmin and saw that I had registered 6:27 min/mile pace. I was initially happy because although I didn’t remember my exact 10K PR, I knew it was somewhere in the 6:31-6:35 min/mile range. Really?? I PR’d. But then I realized that Garmin had me running 6.33 miles instead of the 6.2 and so I was not so happy. I then proceeded to spend the next ten minutes trying to figure out what 6:30 min/mile pace for a 10K would be. That turned out not to be such a smart move (well, I guess if I was smart I would’ve figured out the answer already…) because it gave me the biggest headache like you wouldn’t believe. I finally had to ditch the effort when I realized that even though I took Advanced Multivariate Calculus in college, my brain was not in the mood to do simple arithmetic while hypoxic and hypoglycemic.

After a quick stretch, I grabbed an apple and a bagel from the refreshment table and walked back over to the finish line to watch and cheer some of the other runners cross the finish line. It was fun to see all the different facial expressions people make while gunning for the finish. (I believe I’ve already touched on this topic previously, so I’ll spare you the commentary here.) Still, I felt especially sorry for a middle-aged runner who stopped and vomited twice in the last 100 meters or so before the finish. It took me back to my first race ever back in 2005 in this same park where I did the exact same thing. Definitely not pretty. I waited around the finish area, enjoying the sounds of the Red Hot Chilly Pipers and all the people dressed in Scottish colors until they were ready to announce the award winners and hold the raffle. Unfortunately, I didn’t win either and had to endure the 20 minute walk back to my humble abode in the cold without the warmth of a ribbon around my neck.

By the time I reached my apartment on the Upper East Side, I still hadn’t figured out what my pace was, and more importantly, whether I had PR’d or not. A few simple clicks on the PC later, I had my answer.

3/30/08 Scotland Run 10K Time - 40:27; Pace - 6:31

5/20/06 Healthy Kidney 10K Time - 40:34; Pace – 6:32 (Previous PR)

I proceeded to spend the rest of the afternoon, being completely exhilarated that I PR’d, yet also being completely dumbfounded as to how I had done it. Did this really happen? Did I really PR in my first race back…at a distance that I run 10 times before? How did I PR after running the worst first mile I’ve ever run in a road race? To be honest, I’ve had two days to think about it, and I still have no clue how to explain it to myself. This is scary!

Final Race Statistics

Overall Place: 204/6928 (2.9%)

Gender Place: 191/3644 (5.2%)

Age Place: 76/2639 (2.9%)