24hours post diagnosis: Feeling Kinda Lucky

Mulling over the news these last 24 hours doesn't leave me feeling any less fearful of what it means to not be able to put any pressure on my knee for two months including walking. But I do see that I am really lucky in the timing. I feel like I tend to get incredibly lucky. When I tore my right ACL playing soccer four years ago, it was 9 days before my mom's fall break. So I was able to arrange everything and have my mom fly out to take care of me for a week after surgery, which I pushed the insurance company, doctor's office, etc, etc to arrange only nine-days post injury. That way my mom was able to wake me up every four hours to take narcotics and change out my recirculating ice container and I healed very quickly.

The cartilage in my knee could have been torn as long ago as when I tore my left ACL thriteen years ago and was just a ticking time bomb, waiting to fall away. The back of my knee first felt loose last April. It didn't become painful until around the time of the Chicago half marathon at the end of July. At that point I couldn't squat down without a lot of pain, but I thought it must be a pulled muscle or something. My leg muscles have tightened up since then to protect or 'guard' it. It feels similar to when I tore my ACL in terms of how tight my muscles have become and that guarding response.

So if I hadn't run enough miles to get it to start falling away now or whatever else I did, then it could have fallen away at any other point during my career. But this is the year where I need to sit still on my butt and study. It is perfect! Next year, actually beginning in July, through my residency (the next 6.5 years) I will need to be up-down, on my feet, running around the hospital, beating attendings to the meetings. Having surgery and being unable to walk would not be an option. Which would mean that I would have to let something that is 100% fixable for the rest of my life go. Then I wouldn't be able to run without tremendous pain for up to 7 years at least! And the pain would get worse due to increasing damage to the bone without treatment.

When my mom got sick I got incredibly lucky as well. I had great support from Montana State, unreal even, as I took off the semester at the drop of a dime to go be with my mom. Also my background was perfect between a year in biochemistry and two years studying neuropharmacology of stroke treatment. So the teachers there let me put together a research project on the neuropharmacology of glioblastoma treatment (though glioblastoma was not the type of brain tumor my mom had) AND allowed me to finish my classes at a distance. This gave me time to put my 100% into researching my mom's brain tumor and e-mail the top people who were publishing about treating my mother. When I brought her to the National Cancer Institute to meet with Howard Fine's group, who by far had the most experience in treating gliomatosis cerebrii type II (my mom's type of brain cancer), I was offered a job in radiation oncology by the head of the department based on how informed I appeared on my mom's case... in the middle of a recession!

This meant that I got to have a job with understanding people while taking care of my mom, who had taken care of me when I couldn't walk. I got to have a job while being there for my mother in the middle of the night the way she had taken care of me! Once again, despite misfortune, I have come out incredibly lucky. I can get treatment AND do my job... sit on my butt and learn all day. Wow, I am lucky the cartilage broke off now instead of half a year from now, so I can get treatment and make a full recovery. Plus I now know that I can run a 1:22 half marathon without cartilage in my knee.... I can only guess what I will be able to do once I have full capabilities again. Now I just have to get through the next 2 months of not being able to put pressure on my leg while living in a second story apartment....

The Almost-Worst News Imaginable

So I need surgery to run again. The surgery will take some cartilage from a non-weight bearing region and place it in the weight-bearing region that is missing the cartilage. At some point a chunk of cartilage was traumatically knocked loose from my knee and must have just fell away sometime recently. Who knows where it is, probably attached to some soft tissue somewhere. The surgery usually has a high rate of success, meaning no complications for the rest of my life.

This is a view of the back of my left knee, with the right side of the picture being the left/lateral portion and the left being the right/medial portion. On the lateral side of my knee where the femur articulates with the tibia, the lucent space under the femur is where there is a rectangular chunk of cartilage missing. The light area in the bone above the chondral defect is from bone marrow edema as the bone has been breaking down over time due to the chunk of cartilage missing.

In this view of the lateral portion of my knee, you can see the lucent area on the posterior portion of my knee showing the cartilage is missing on the back of my femur. You can also see that the bone marrow edema/lighter portion of my femur goes up pretty far. Apparently this is why I have been betting bone pain on my medial knee and above my knee on the femur, because the bone is affected pretty far from the injury. Once again, the bone should all be dark.

The downfalls. I will not be able to bear weight on that knee, meaning no walking for a fairly significant period of time (possibly up to two months), as the part that is going to be fixed is directly where I bear weight on my knee. Apparently I should be able to swim about 2 weeks following the surgery. I will apparently not be able to bike for ~3 months following surgery because of no weight bearing. I will not be able to run for 5-6 months following surgery, once again because it will be on the weight-bearing portion of my knee. The upsides include that I will be able to run again because this isn't one of those overuse injuries i.e. from running. Many forums I have viewed the people are never able to run again. But if I get the surgery in january by june or july I will be able to run :)

I'm trying to arrange to have the surgery Marthin Luther King Jr weekend, that thursday to be exact. But this will take a lot of planning and I don't know how I will get to class the following week, hopefully I will be able to crutch and be off narcotics by then. My goal will to be able to run by the time I take the USMLEs in June. That way I can run during my next vacation before rotations start and I will really have no time to call my own for many years to come.

To people in the Norfolk area, I will probably need some help following surgery. I will probably look incredibly pitiful as I did following ACL surgery. I will try to line up a handicapped sticker for the time right after surgery so I don't have to crutch to and from school. I have distinct memories of trying to crutch to and from class following ACL surgery in Montana and they aren't pretty. The narcotics made me dizzy so I would regularly do what I called crutch-by vomiting. I didn't want to stop crutching to where I was going, so I would just lean to the side and vomit as I mosied along my way to and from class. This is going to be an unpleasant experience. But that's life, sometimes you just gotta roll with it.

Making a Comeback

Tomorrow I meet with an orthopaedic surgeon about my knee. It seems from the MRI that I do need surgery after all and until I have surgery it will be incredibly painful to run. But nothing will be sure until I meet with a surgeon. Something that has been interesting is how everyone says but you are a medical student, you should understand what is going on. My knee has multiple ligament tears, some appear healed from the previous surgery. It also has a cyst, "densities," and a large chunk of cartilage missing in a manner that looks as though it must be "traumatic", not an overuse injury... meaning I was hit by something and I'm not sure what. Oh, and also a bit of bone missing with bone marrow edema. I had surgery on that knee thirteen years ago after tearing my acl from a sideways hit while playing girls' "powder puff" football. The acl snapped the rest of the way while I kicked a ball during a soccer game the next day. Every doctor that has looked at that knee since has said that acl is loose, meaning the surgeon probably didn't do a great job of fixing up the knee.

So in summary yes, I am a medical student, but I am NOT an expert or even a doctor. One very important aspect of medicine is that expertise means something. I will be better every year that I work and every case that I see and contemplate. That is why I chose the field. So no, I cannot diagnose myself. Further, I am going to try to see at least two surgeons so that I can prevent the knee from getting worse.... because every doctor's opinion is formed by the cases he or she sees and my case is complex. Different surgeons may have different opinions and capabilities. The more complex the case, the more different doctors' opinions will vary on how to  best treat the problem(s).

In the meantime I have been learning how to swim and doing a lot of spinning classes. This has put a huge hamper on my writing, so I apologize for going missing. But when I run my mind and heart are free. I used to compose poetry and songs while running, using the beat of my feet as a metronome. Not having that outlet really changes the way I process information and in a way who I am.  I want to write about swimming, which really is so very very very different than running, but still similar. Mostly I want to disprove the notion that if you are a runner and haven't been a swimmer that means you have pegged yourself into a hole and can't adopt a healthy balance of a sport into your regimen. It frustrates me every time people tell me they don't swim, they are a runner. I am a runner who stinks at swimming. I was never on a swim team and I never competed. Also I was chubby growing up so I didn't want anyone to ever see me in a bathing suit if I could avoid it! I played soccer and occasionally went rafting.

But I'll tell you what I am not. I AM NOT A GIMP! When I am fifty I am going to have kids and take them skiing. I'm going to laugh with them as they beat me down the mountain. I'm going to kick the soccer ball around with them and run after it. If swimming = long term happiness then heck yeah, I am going to keep being a swimmer, even if I suck, don't enjoy it very much, etc, etc. Also when I am 70 I am going to be in those old lady pool workout classes. I'm going to jump around in that water and enjoy it. Because I am not a gimp and never will be! So cheers to swimming and being a runner and don't tell me you aren't a swimmer but a runner because I will roll my eyes and work my hardest to beat you in a running race as soon as I have surgery and can run again! Because I used swimming to keep in cardiovascular shape and strengthen my hamstrings, quads, hips, back, stomach, and lungs so I can be all I want to be!

Dedicated to my Dad: "Athletes aren't normal people"

Is what my new triathalon coach Dai Roberts said to me when we met for the first time on Friday (11/2). He was recommending that I go see a sports medicine doctor. who, unlike the orthopedic surgeon I saw about my knee, will understand my absolute compulsion to run.

For me my compulsion started as a little girl studying the religion of "soccer" with my dad. By high school practically every Saturday and Sunday morning I didn't have a team-game I would be up playing pick up soccer with my dad; usually out on the pitch by 6:30. I loved the feeling driving home and seeing almost no one else on the road, just me and my dad. And we were covered in sweat from running our hearts out for the last 2-3 hours.

When I would come home from college breaks (especially when I lived in Oregon with a 3-hour time difference), my mom would make my dad promise not to wake me up to go play soccer because "I would need my sleep". But he would come by at 6am (3am my time) and whisper "Courtney, are you ready, you sure you don't want to go play?" And I would get up and go.

My dad runs through every injury and always has. Growing up, he was always injured or had a black eye, or something else. Every year he would mention something about giving up soccer because it was hard on the body.... In fact, we were told that if it weren't for our bad knees, we wouldn't be here. My dad had played semi-professional soccer. Then the first lottery he ever won was the Vietnam War draft. His birthday was the first number picked. When he reported, he was rejected because of his knees. As he walked into the reject room, a football player looked up and said "what sport do you play?"

Now he still goes out there and gives it all he has got. He can't see peripherally or when someone sneaks up on one side because he has glaucoma (for which the dutiful man would never try marijuana :) and he is virtually blind in one eye. He also can't see depth because that needs two eyes. But he is out there giving it what he has got because he isn't a normal person; he is an athlete!

My Saturday morning Coaches league

Coming home to take care of my mom I played pick up on Tuesdays and Thursdays nights with one group and Saturday mornings with another. People played through all kinds of muggy, hot Virginia summer weather, and this normal/fun activity with these guys gave me a happy place which helped buoy me through the hell I was experiencing inside. Because of their strange athletic compulsion, I could trust that they would be out there trying their hardest despite whatever injury they were working through. These are my people.

Love this shot, note the head in the hands on the right :)

My dad made me into a Crazy Athlete long before I became a runner with high hopes two years ago. Now I have sustained another serious knee injury. This injury really scared me as I have already torn both my ACLs. But I will cross train and get healthy because I am an athlete, a part of this strange group of people with a crazy compulsion to play. Once healthy, I will put my all into working to qualify for the next Olympic Trials. What makes me crazy? Every day when I get up I think of running for as long as I can for as fast as I can. After that I want to ski, jump, climb, play soccer, kayak over waterfalls, and more! And some day I want to have children and get them up before dawn to go play soccer with other crazed athletes from around the world, showing them the beauty and fulfillment of having drenched their shirt with sweat hours before before there are any other cars on the road. I will make a great comeback because am an ATHLETE, eager to be on the pitch, and a little insane. It *runs* in the family. Tee hee, RUNs in the family!

Me, my sister, and my Dad

Family canoe trip when I was 5

       

My dad in my boat, life jacket, and paddle looking at the leaves  this past month

Me two summers ago going off a waterfall 2.5 months after I started kayaking

Me competing in Missoula a year after starting kayaking; lol, somehow I came in second :)

Survival...through an injured knee or vibrio cholerae

So I just swam my first mile in two years. While my mom was dying, before I ran my first competitive marathon time, I had a badly sprained ankle from soccer and was confined to swimming and biking.... I actually got recruited to be a spinning teacher because I'm so dang perky and excited at six in the morning. Strange... I know....  I was excited to do my first triathalon, but then I found out that I was really good at running. So decided to put my 100% into running. And then I decided that I could make the Olympic team trials for Brazil and swimming and biking suddenly seemed bleak. But then 2 weeks ago, I got injured, and I still can't walk down stairs without excruciating pain in my left knee.

So today I joined the YMCA and I swam my first mile, not using my left leg because it hurts to kick. With about 500m left to go a fat bald man got in next to me and passed me doing freestyle while I was doing backstroke. So I decided to race him. It was so much fun because we were both pretty pitiful and slow and he didn't know I was waiting for him to finish so I could race him for another 50m. And neither of us could do flip turns, so there were a lot of pauses.

But I left feeling like a hero because I was back to the mindset I had when I was taking care of my mom. My hero mindset, where I am my own hero. Where I can go swimming in the morning, work a full day, go home and be with/take care of/read to my mom, and get up and do it all over again. Where nothing could stop me, not my anger with the world that would mercilessly destroy my idol (my mother), and not an ankle that I couldn't really walk on.

So I left and thought of one of my old goals in life: to never have to drink my own urine. I made that a goal when I was 9 or 10 and read about a man who got trapped under his house during an earthquake in India. He drank his own urine to stay alive. My goal made me never want to live in California, or anywhere near a fault line (it may seem ridiculous, but the desire to not drink my own urine was actually a factor in me turning down some california colleges to which I was accepted). Recently this goal has been modified to never having to drink my own urine or my own diarrhea to stay alive. One of my professors mentioned how in third world countries if someone has a bad bout of cholera, you can feed them their own diarrhea to give them to fluid and electrolytes necessary to keep them alive through the bout of diarrhea**.

I realized today what it means that the goal  of never drinking my own urine has influenced my life decisions... It means that if necessary to stay alive (i.e. if I were in that situation), I would drink my own urine (and maybe diarrhea). That I am strong enough that I will do almost what is necessary to survive and thrive and be the best that I can be. Fortunately, in my life that has meant joining a swimming pool at 26 years old because I sprained my ankle and can't walk. Hence, I know that my knee injury will help me become as strong as I was became when I hurt my ankle and within months became an elite runner. This injury will help me become as strong as I was when I had to be strong for my mother and figure out a way to get her to smile even when she was crying. Because she could die at any second if her tumor felt like making that her last.

** Note that I will never endorse Urine Therapy: http://en.wikipedia.org/wiki/Urine_Therapy
This is NOT endorsed by the medical establishment. But if someone wants to get back to me on what spreading urea on their skin does to help prevent wrinkles or help get rid of their hemorrhoids, I am ALL EARS! Though I may giggle a little while listening.

Beckley Half Marathon 2012: My first injured race

As this is my boyfriend's birthday weekend, I flew out to visit him in Fayetteville West Virginia, home of the Gauley & New Rivers. There just happened to be a half marathon ~1/2 hour away in Beckley, so I figured I would try it out.

There were a few factors against me from the start. First of all I have runners knee and have barely been able to walk down the stairs this week. My knee started to ache after my 21 miler last weekend and got pretty bad after my monday workout, so I did crosstraining on the bike or eliptical for the rest of the week. As I lay in bed this morning, just the act of raising it made my knee hurt.

So if I can't walk down the stairs without limping, what kind of course is Beckley. Well it is an out-and back course that is up or downhill the whole time, except for ~1 mile loop around some soccer fields and a .75 mile loop around a school. Ha!

It was so steep that at ~mile 7.5 I was running down what I thought was a fairly steep hill, I realized while I was running up the other direction I had thought I was running on flat ground because it was so less steep than the rest of the course.

My knee gave out soon after this point. My quad starting cramping up painfully on my knee the way it hurt to walk down the stairs. I had to stop and stretch for the first time in my life during a race. This is also soon after the temperature dropped from 60 degrees to about 50 degrees with a cold rain and brutal wind. Also there was a complete dearth of powerade, electrolytes, or sugar along the course. Lots of water set ups with everyone having a big smile on their face cheering you on. At some of the water stops people even jogged along with you to give you water (so wonderful and adorable!!!!) But when doing this hilly of a half marathon in cold rain and having your quad cramp up on you, all you want is some sugar and salt... and there was none anywhere along the course.

At about mile 10 on a downhill my knee gave out on me again and I prayed that there would be some sugar and/or salt as I stopped to stretch my quad & try to elminate some of the pain in my knee. After that, I couldn't run down hill, it was just too painful. I had to kind of hop-skip down, but I could still run the uphills! so it was a weird kind of speed workout :) I was passed by men #3&4 at ~mile 12 and one of them turned around as I was hoping down the hill in pain and said "you can do it you're almost there." Just one more example of the great personality that pervaded this rural race.

I came in 5th overall and 1st for women with a time of 1:25:?. My boyfriend was there to help me limp to the car because I couldn't walk without support my knee was so angry and painful. I cried a little from cold, hunger, and pain. And then I laughed at how stupid I was for running the hilliest half marathon I have ever seen with a hurt knee. I hope to come back next year and reap revenge on the course that destroyed me. I will have lots of goodies and electrolyte pills in my back pocket though! The support was great, the route was beautiful and challenging and strength-building. There were lots of cops to direct you were to go and to make sure traffic didn't hit anyone. Other than having gotten my butt handed to me, it was an amazing race! But that's why I will be back next year without a hurt knee and lots to prove!

Heart of Ghent 10k

This was a great little race and win this morning. The weather is perfect and sunny (though as normal a bit humid for my taste! :) And I was up at 5:30 eating my oatmeal and studying.

I jogged over to register, only 1/4 mile from my house and then watched pathology lectures while rolling out my legs until ~20 minutes before the race, when I jogged over and met up with Aric Martinez, a new running buddy for ~10min warm-up.

The gun went off and I started out fast, but I was so nervous. I think I went to the bathroom about 20 times before the race because it has been so long since I raced and I just didn't know how it would go. This is my home turf and I wanted to do my best... could I? Despite having gained my medical school 10 pounds? Oh, the nerves!

I dropped back from the first group of fast guys to a second group of two somewhat older fast guys and let them get ahead of me. I passed them baack at ~ mile 1.5 and~mile2, pulling of a 5:27 second mile.

Then right before mile 3 I got off course when a police officer was talking to a homeless man instead of giving the runners directions. Fortunately the man that I had passed yelled me back and I only added on ~.17 miles. I also got called back at ~mile 4.5, meaning I had to stop twice :( so I don't know how fast I could have gone if I had kept my stride!

The best moment of the race was the first time I passed the guy that called me back when he said "oh crap, I'm going to get beat by a girl aren't I?" And I replied "yep" and thought of my good friend Renee High, who just demolishes men with egos all over the place.

I came in having first with 6.48 miles in 38:09. A solid first race back on my feet around my flat and diverse neighborhood. I won with the hometown advantage :) Now I'm off to do a cool down jog with my new friends from Hampton Road Runners! Yay!

***As an aside when waiting for the medal I heard "Courtney Chapman will you please come up here." I ran up there and said I'm Courtney Chapman. And they said Oh, just making sure you are a girl. You finished so fast we thought you were probably a guy. I was #5 of 632 finishers, #1 for women. Kind of neat! Now if I can only pass my pathology exam on Monday, my life will be complete!

Getting owned by a surgeon: adductor myotomy,

I got owned. I was headed to a surgeon's office because I want to continue my research from the summer as to whether a questionnaire filled out be parents can adequately reflect a child with cerebral palsy's treatment needs and whether they will benefit from surgery.

 I should make the disclaimer that Monday, the day before, I was owned by a final exam on immunology, on a textbook of over 800 pages that was 90 questions in 105 minutes. And the questions were hard. I believed a failed it due to a classmates joke that other people didn't take seriously (found out Friday that I actually passed by a good margin). I have not reviewed anatomy and was studying for a pathophysiology quiz (Wednesday) pharmacology quiz(thursday) and pathology exam (next monday) so anatomy was not on my mind.

I was meeting the surgeon I would work with at EVMS for the first time. I was late. I showed up at 7:07 and should have been there at 7:00. I couldn't find my ID badge, I couldn't find the office, etc, etc, etc.

Then (surgeon): what muscles lift the thigh? The iliac, the psoas (iliopsoas)... this is as much as I remembered.
Surgeon: "What else?"
 Me:Blank. Blank. Random guess#1...#2....#3...

We go in to see a little boy who has broken his arm above the elbow and will need pins and should be operated upon asap in order to correct location. He also has a bronchitis for which be was put on antibiotics a week earlier, but his parents only gave him one antibiotic pill because they don't like medications, so we can't operate until the internal medicine doctor comes and sees the boy to give him IV antibiotics and ensure that he can be operated upon hopefully later that day without dying. Call the internist and pneumonologist.

Back to the elevator, where a fourth year med student is standing... great, now I get even more of an audience for my wrong answers...

 Surgeon: What else lifts the leg?
Random guess #4: Rectus Femoris
Surgeon: "Where does it insert"
Me: (thinking facial sheath, but now completely discombobulated) the femur?

 This continues...
Surgeon: And what else lifts the leg?
Me:......... (correct answer, the tensor fascia lata)
 Where does the iliopsoas insert?
Me: The femur below the acetabulum (this is the head of the femur)
Surgeon: There is a specific place
Me:......... (right answer is lesser trochanter)
Surgeon: Time to put on your scrubs

In the operating room. Three year old boy who is under anesthesia. Surgeon shows me the limited range of motion at three joints despite no possible residual tone: ankle (foot permanently pointed, can't go to 90degrees), knee, (can't extend knee past 90degrees, not even close to straight), and hip.

 He cuts open the hip right under the boy's scrotal sac on the right side. Grabs a muscle with a hook-type tool...
 Surgeon: What muscle is this?
Me: An adductor (it is an adductor myotomy, the point is to cut the adductors so that the kids spastic adductors stop pulling the hip joint out of socket).
Surgeon: Which adductor? Me: ........RG (Random Guess)....#1Gracilis....#2adductor longus#3...adductor magnus....
Surgeon: adductor brevis
 Surgeon repeats this process with all other adductor muscles.
Surgeon shows random white stringy thing. "What is this?"
Me: Obturator nerve. (Ding I got one right!)
Surgeon: Which branch?
 Me: ........fml.....mental cursewords

Surgeon: what important structures are here?
Me: Everything in the femoral triangle.
Surgeon: What is the medial boundary of the femoral triangle?
Me:......
Surgeon: It starts with a P
Me:.... Pectineus? I can only think of muscles in the knee like popliteus....
Surgeon: It's the pectineus. ***I got one kind of right***

 This continues as he performs the hamstring myotomy and opens up the side of the back of the knee, visualizing it. He showed me the muscles, and I correctly guessed the biceps femoris long headand the short head.
Surgeon: So why do we open up this area?
Me: Because there is an important structure you want to save?
Surgeon: And what structure
Me:.....fml....
Finally an audience member intervenes! Note that  this is all infront of the entire OR team of 6 people + Me + The Surgeon
Nurse: It's a nerve
After many more hints...
Surgeon: it's the peroneal nerve. (this means he gave up on me. darn.)

 He opens up the medial rear of the knee. I am watching this and not paying attention. He continues to ask me questions, me not realizing it. Then I zone back in to him talking to me.

 Surgeon: Too nervous? Me: No, I was just interested in what you were doing, what did you ask?
Surgeon: What muscles are here?
Me (not thinking, not nervous, distrcacted by watching him): Semitendinosus
Surgeon: And what's underneath there?
Me: Semimembranosus.
Surgeon: and what important structures are there?
Me: I don't know any.
Surgeon, that's right, there aren't any, that's why we aren't invasively opening it up.

This process continued through the other leg as well.

So I got owned by a surgeon and left knowing how utterly inadequate I am. He reminded me that he took anatomy in 1985, not last year. Why did I choose to do this for fun? And why have I arranged to go back asap? That will be discussed in Part 2: How I have no ego and it has made me able to achieve a lot AKA what it means to be a little sister.

High Cholesterol in a Runner

So whenever I eat and worry about fat content, I am told that people are just sure that I don't need to worry about cholesterol. Well let me tell you how WRONG you are! At 11 I had a total cholesterol level of 250. This would be of concern in a middle aged person. My mom was a health nut and I played sports. I still had a level of 250. My doctor put me on a diet where I could eat nothing with over 25% fat including cheese, egg yolks, ice cream, etc. and my cholesterol dropped down to a level of 180. Turns out cardiovascular disease runs in both my mom's and dad's family. Seems to have skipped both my mom and dad, but hit me somehow; my grandfather died at 45 while taking a dump.

I have tried to adhere to a low-cholesterol diet and I haven't gotten my cholesterol checked in over 10 years because I didn't want to go on medications and I didn't want to change my diet.

I finally got my cholesterol checked this past week and the verdict is: 205! I am so relieved, this means with making my diet just a bit more rigid, I can go back to the optimal range. I have a VERY VERY high LDL and an okay (not great) HDL level. LDL is what tends to deposit oxidized cholesterol into one's vasculature and HDL can have the capability to remove oxidized cholesterol from the vasculature.

Apparently what happens with me according to this test is I have a very high absorption of fat. This means that what I eat, I absorb. There are many people with low fat absorption. So the amount of nutrition someone else gets from 1 egg yolk, I can get from 1/8 of an egg yolk.

The way this test shows this is with sterols, which are plant-based cholesterols. Mine are through the roof!!! There is a condition called sitosterolemia that I probably have. It is genetic, autosomal recessive meaning my parents were heterozygotes (each containing one normal and one mutant gene). This also explains why my parents and sister all have normal cholesterol, but I have high cholesterol. The genes responsible are the cholesterol transporters that absorb cholesterol from the gut and also pump bile into the gut to assist with fat absorption.

In summary, mutation of these receptors means "defective secretion into the bile of dietary sterols, increased intestinal absorption of plant and dietary sterols, hypercholesterolemia, and early-onset atherosclerosis". The best drug for this specific (uncommon) reason for high cholesterol is one that decreases absorption of cholesterol, ezetimibe.

The alternative is that I can just not eat cholesterol and be extremely conscious that I need to eat about 1/8 the total fat of that others need. I am willing to do this and stay of medications for a bit longer :) But PLEASE don't tell me not to worry about eating a burger with full fat. I need to worry about that. It means the difference between life and death for me.

            The problems that cause more people hypercholesterolemia are quite diverse and they include non-responsiveness to a high fat diet. So one's body continues to synthesize cholesterol despite eating too much fat already. This is not MY problem, as the markers of cholesterol synthesis are on the low end of the optimal range. For this group of people, statins would be more appropriate.

I will also begin taking Niacin (Vitamin B3) and omega-3 fatty acids, but I will discuss why after my next exam :)

A Medical Student/Runner/Psychologist's Take on Paul Ryan's Memory

So earlier this week Paul Ryan mis-remembered his marathon time as sub-3 when it was actually a little over 4 hours. There are very many ways to intepret this information.

First, it makes complete sense why he would mis-remember the time. In 1990 a 4 hour marathon time was a lot more impressive than a 4 hour marathon time today. Relative to his peers 21 years ago, he had a really high performance. Twenty years ago was the era of Richard Simmons and Jane Fonda. The first ladies were talking about not taking drugs (Nancy Reagan) and reading (Barbara Bush), not exercise and diet (Michelle Obama). We didn't have elliptical machines for cross training. And we didn't have the training groups we have today. Many marathons had just recently been started. In fact, it seems as though a conversion table could be called for so that we can compare racing times from years past the ways we do for monetary inflation. Then we could see how impressive a 4hr-1min marathon really was.

Second, as he did finish with an impressive time for twenty years ago, it is understandable that he would remember himself as being a relatively high achiever. According to my internal medicine mentor, who is a big Paul Ryan fan, Paul Ryan came from the working class to go to Harvard and was elected senate at a young age and is now a Vice Presidential candidate, along with several other very impressive achievements. This is not personally fact-checked (**Upon fact checking this information I received, it turns out that he went to Miami University of Ohio. This is the importance of Source Memory, another major source of Memory errors), but this story shows how in accomplishments that can be compared, Paul Ryan has outperformed probably 99% of the populace at what he has accomplished. Hence, when asked for a specific time, he knew that he had accomplished a lot relative to his peers in running, and substituted in a solid marathon time by today's standards, not by the standards in 1990. This is actually an understandable and normal memory mistake, the exact reason why eye-witness testimony is no longer taken for granted. Further, if he trained for a marathon with proper support, a personal trainer, he could probably at some point reach a sub-3 hour. He seems like a pretty fit guy and a lot of making a sub-3 marathon time as a man is just consistent training.

So what makes people uncomfortable about the memory mistake? Well it shows that he is not aware of how memories work and the common memory fallacies that everyone encounters. Memory is a reconstructive process. Every time we retrieve a memory it is altered by the context in which we retrieve it. Further, memory uses the same processes as imagination (which, by the way is one possible reason behind the strong correlation between reading fiction novels and improved memory at later ages). So Paul Ryan accurately remembered that 21 years ago he ran a time that was impressive relative to his peers and then spliced in a number that would be impressive for 21 years later.

This could be the Sin of Bias where we "often edit or entirely rewrite our previous experiences--unknowingly and unconsciously--in light of what we now know or believe. The result can be a skewed rendering of a specific incident." It could also be the Sin of Suggestibility which is when a memory is "implanted as a result of leading questions, comments, or suggestions when a person is trying to call up a past experience."  These are two of the "Seven Deadly Sins of Memory" that have wrought havoc on courtrooms throughout eternity (not to mention personal lives).

By insisting upon of the veracity of a false memory, Paul Ryan shows he is unaware of how memory works and how it plays tricks on people. Further he shows that he can asserted as fact an false memory based on circumstantial evidence. Thus, the scary thing (in my opinion) is his ignorance of how healthy cognitive and memory processes lead to false memories. Or his refusal to admit that his memory is subject to the same fallacies as have been proven in the vast literature on memory and especially memory and courtroom testimony.

Is this enough to demonstrate that Paul Ryan is not adequately humble to be a good leader? Or that he will be a poor leader because he will not account for how the mind and memory works? I don't know. Are the other candidates more aware of memory fallacies and more willing to account for memory fallacies to prevent mis-information from being disseminated? Once again, I don't know.

I do know Paul Ryan's memory made understandable mistake and thus he created a memory of a time he never achieved. I also know that being adamant about the veracity of a false memory is a dangerous trait to have in someone close to you or with power over you (Oh, I would NEVER let a boy get away with something like this). So let us all hope that he uses this as an opportunity to learn about how memory works and in the future be more aware of how the present circumstances affect one's memory of the past.

** For more information on memory in the courtroom see anything written by Elizabeth Loftus. For a layperson's book see the "Seven Deadly Sins of Memory" by Daniel L. Schacter, Professor of Psychology at Harvard and was Chair of Harvard's Department of Psychology. For a great textbook see Memory by Alan Baddely

Why I chose Not to race the Va Beach Rock and Roll Half

Hello everyone! So this weekend is the big half marathon in Va Beach. I ran it last year and got a PR for myself and I believe my first sub-1:30 with a 6:30 average. I believe I could do better this year, but we will never know because I chose not to race it. (Yes, there is a bit of agony in the tone of this statement).

There is a lot that went into this decision because I love racing and running. The first factor is my priority, which is medical school. Whenever I run and it is too humid, I get stomach cramps and diarrhea. This is proportional to how much I run. Last year after the race for the rest of the day I was in bed and running randomly to the bathroom. It was a bad experience. This year I am going into work at my mentorship for the day and don't have time to be running randomly to the bathroom or being unable to stand/walk around the office because I made myself sick from running in the humidity. Doing this would be irresponsible. And it is hotter and more humid than last year.

The next major factor is my physical condition. I have been getting slower at half marathons, not by much, but a little slower and more miserable each time. I need to focus right now on training and building myself up, not racing. After the last half my left knee was strained in the back so that it still hurts a little to squat, etc. And yesterday while doing a 5 mile tempo (6 min/mile for 5 miles) my right knee began to hurt, as I was diagnosed earlier this summer with tibio-femoral pain syndrome. Apparently my right quad and hip are slightly weaker than my left (hence why I strained the back of my left knee) and this is making my knee cap mis-track. While right now there is only a dull and achy pain and not too bad, I can't keep racing and expect it to get all better magically. I need to work for the healing!

All that said, I was going to use the Va Beach Half Marathon as a training run, jumping in with people doing 7:30/mile and park ~2miles from the course, so I would do a total of 17-18 miles today. Lol, and I was just intimidated by the crowds and the parking (the shuttle to the parking lot was actually ~12 miles!!!!! That means I would have spent at least half an hour commuting and would be late for my mentorship) or I totally would have done this. If anyone who has done this wants to share their opinion, please tell me how to do it legitimately in the future!!!! It is painful to miss out on such an exciting event! And I can't wait to hear about how it went for everyone else!

It was suggested that I put up this post because my friends and family will want to know why I didn't race. Really it is because my number one priority is medical school and this has made it so I have not done the training I need to be in top shape right now. I have to recover from my injuries and that means not just running, but also weight-lifting, stretching, icing... It means doing all the things I cut out of my schedule in order to study more hours. It also means that I will not run if it comes down between running and being sick/not being able to work in a day and being able to work for sure, but not racing.

If anyone has tips, feel free to give advice. I already feel quite guilty that I'm not studying more or volunteering more. But running is something I enjoy so much and it makes me healthy. I have hypertension and heart disease runs in my family (my grandfather died at 45 from a heart attack while taking a dump). Running means I will not only be happy, but will live longer, and be able to help more people over time. I do not want to give that up.

Back in Norfolk: the Homeless make the Best Fan Base

On a side note, I started this on 8/14. Now, 11 days later, it feels like NO time has past, even though it is been 1.5 weeks.

Monday 8/13 was the first day of class. I got up for a brutal morning run in the heat and humidity of the Virginia beach, with the humidity so thick in the air I think I can see it. A little more than half a mile into my run though I remembered what I missed so much about Norfolk: the homeless people cheering me on when I run. It is the greatest thing ever. I was running past a church garden and in general homeless people get kicked out of the church shelters at ~6 or definitely by 7am at which point they tend to sit at nearby parks. They looked up at me and smiled, so I made a pumping movement with my fist and they started cheering me on. When I came back by a miserable & difficult 6 miles later, the group had grown, and they all turned around and started cheering again, as though they had been waiting for me. This is not the first time I have gotten cheered on by homeless (or apparently homeless) people.

Whenever I run, I pretend that the world is cheering me on. Even if people look down and away, avoiding eye contact. In MY head, they are saying "go get 'em killer". Only in Norfolk is it actually true that the random people ARE cheering me on! Norfolk also has a high density of military population with the Naval Base and Navy Seals here, so the homed population tends to really value fitness. My favorite was when once last semester ~6.2 miles into a 7/5 mile run, a ~70 year old man with the appearance of a military-for-lifer pulled over his car with a Marine Corps sticker on the back as he drove and started cheering me loudly. Apparently he had seen me running ~2 miles earlier and thought that I could run like a cheetah. The combination of military and homeless/underserved population creates a very unique running support system. And that this group of impressive & struggling individuals are inspired by me really compels me to try my hardest... My consistency actually seems to be something positive in other people's lives! It made a group of homeless men stand up and cheer at 7:30 in the morning!

I wanted to go to medical school here because it is a community where the students can make a real difference due to the high HIV/AIDS rate and the high poverty rate. EVMS is also ranked as one of the top community-oriented medical schools, where helping the community is labeled as the top priority (I can go to medical school and become a better person instead of a more self-absorbed jerk!) Unfortunately, I haven't yet done much in terms of direct volunteer service as I have had to work so hard in classes.Last semester I was able to take a weekend class in doing rapid HIV testing and also work a couple nights in a homeless shelter. But that is really inadequate relative to what I could do to help the community. People find my running inspiring, but what made me best at running was spending time in a hospital with people who can't run. So I am in awe of my classmates who find the time to volunteer and truly build the community much more inspiring than myself. They show me how much farther I have to grow. Once I'm not struggling in class I'd really like to work with a run with the homeless program as the consistency can have really positive effects in people's lives like this one: http://www.backonmyfeet.org/

As one of my mentors said, we are all just a few bits of luck away from being homeless ourselves. I got lucky a lot in life. I really hope I can do more to support the best fan base I have ever had.

Running in Chicago: The Lakefront

As I prep to run my first 16 miler in Norfolk, I really miss the lake front path where I'd run my long runs south and my shorter (up to 11 miles) going north, so here is a photo summary of running along the Lakefront.

The John Hancock tower (shown in the back) was ~0.5 miles from my house, so as I ran up and down the lakefront, I could judge about how far I was from home by looking up and seeing the Hancock tower.

The best part of the Lake Front was the ability to jump in the water at the end of my run. In fact, after the Chicago Rock & Roll half Marathon I waded straight into the water and swam 0.5 miles very slowly back to my apartment. Then I climbed right out of the water with a convenient pool-style ladder and walked the last ~1/8 mile to my apartment.

This was also great for cross training, where my friend Connor joined me for a few aqua jogging sessions where we jogged along and gossiped. He even pointed out that it felt like we were two ladies pushing kids along in strollers; quite a wonderful time!

There was an underpass for me to go under Lake Shore drive onto the Lake Shore path so I did not encounter traffic on my way to my run. Many of these images were taken during my morning run. These two pictures show the beginning, looking out over the water just after the underpass.

If I ran down south, then I would come to the navy pier, a place of tourists where I could only run early in the morning. Otherwise it would be so crowded that it would be easier to play red rover with professional football players than to continue running through that crowd unimpeded.

 This is the North side of the Pier, looking back out over the city and out over the water in the morning sunrise. These pictures were taken ~5:30a.m. during a morning jaunt.










Then the end of the pier, looking over an anchor statue past many american flags towards the light house in the distance.

 The south side of the pier, looking over South side Chicago.













At the end of the pier, you continue south by this statue. Then over the bridge, where you could look back at the pier to continue down the path

Chicago's architecture if you chose to go back along the Riverwalk was spectacular. I really like this building with the rounded car parking below. Sadly, it also meant very long elevator commutes (It can take more than 5 minutes to get an elevator)

On Saturdays, the Rehab Institute of Chicago will take the kids out to go around the track in a big group. Many of these kids have CP and are recovering either from surgery, a seizure, etc to cause a prolonged hospital stay








Norfolk is great for flat, fast runs, but I will very much Lakefront path of Chicago and the track infront of my apartment (seen in the back).

I will also VERY much miss my morning workout team (as led by Tre, where we would do pull ups and other functional exercises next to the track to stay strong/ injury-free-ish).




And my support team of Jessica Bauer (who cooks the most AMAZING pre-race German meals).

A Win at Bogus Basin Mountain Race :)

In coming into the Rockies, I was eager to find a race because having the energy to tackle mountains by yourself is a lot easier if you have the adrenaline and companionship that come with a race. The opportunity to really push myself in the mountains was one that I didn't want to miss as I have been running the past year in the amazingly flat Norfolk. This past summer in Chicago seemed hilly in comparison, though Chicago is still noted for its flat runs along the race. Further, I think that the lack of hills is causing my legs to be lazy, so I'm not lifting my knee enough as I run and instead extending my leg past my knee and thus hurting my knee when I run. No matter how hard I've tried to stop doing this, I just need to run up some hills to get that proper stride re-ingrained in my body.

Fortunately I was able to find a race through the mountains that Sunday, about 1.5 days after arising in the Rocky altitude.

The race was held at Bogus Basin ski resort as part of the first ever Bogus Basin Roundup. This opened the ski lifts to the mountain biking community for the day. Worked into the schedule  was a mountain bike race at 8:45 at a running race with either a 6mile or 11mile option at 9:15. I signed up for the 11 mile and my boyfriend, Bryan Kirk, not a runner, not having run since he ran the Rock and Roll half marathon in Va Beach for me without training last September, signed up for the 6 mile. My goal in the race was to gain strength/endurance by pushing myself in a different way, not to win the race. So my plan was to take it easy by pushing myself during the difficult parts like a regular workout. Thus, I planned to (and did) stop and drink water at every water station to 'pace' myself as though it were a workout with friends, not a race. I honestly thought I may come in last while driving up there, as I was up at elevation in the Rockies, running hills/mountains for the first time in over a year and I what it means to run that difficult terrain at elevation on a regular basis.

The runners (I think there were ~50 including 3 kids less than 10 doing the shorter course, so adorable!!!!) started at the lodge and ran ~2 miles downhill to the ski lift. The ski lift then took us to the top of the mountain. I was quite happy for this break on the ski lift because I could feel the elevation and was sore from my 10 mile 'hill run' the day before where I was so eager to run up a mountain, I neglected to consider the race the next day. I got to ride and make friends with Jake Jacobs, a fellow soccer player and medical person while on the chairlift as well, which just added to the feeling of camaraderie that pervaded the race. Jake Jacobs won the 6 mile race :)



At the top we had the choice of chugging a beer or root beer. While I started the race with the full intention of chugging a beer, the burning in my quads and feeling of dehydration quickly changed my decision to rootbeer (and root beer has NEVER tasted so good). Then I took off down the mountain's single track trails.

These photos of me and Bryan were taken just before the 6 mile group broke off I think ~ mile 4 or 5 to go down to the finish, while the longer group continued down the mountain, winding back onto single track. The single track especially on the second part was amazing. As I ran down it, I felt like I was flying and floating like a bird soaring past wildflowers. That feeling and type of experience is what makes running rewarding.


That trail ended about 2 miles below the lodge and the last two miles were a difficult uphill slog. True to my word, I stopped at every water stop and chugged multiple cups of water. Thus, I had a solid workout-race where I pushed myself hard on new terrain and was sore the next day.



To my surprise, in the end, I came in 1st for women and second overall. In my eyes, this is a huge success because I had no clue that I could be competitive in the world of mountain racing while living in Norfolk, Va and running on pavement for 23/24ths of the year. It is wonderful to know that the mountains are so much a part of me that I can be competitive my first race back in the mountains, less than 36 hours arriving at  elevation, and on sore legs :) Yay! I love running and try hard at it every day and that consistency and effort can show even when facing new challenges.


As is normal with a second place, I also wonder whether I could have gotten first if I had pushed myself harder to 'race'. And this I will never know, because if I had I could have gotten dehydrated or burned out of gas. Also if I was less than minute behind the winner Mark Austin (who finished a minute and a half ahead of me), he may have found extra gas in his tank that would have left me in the dust. But as is, I may have taken a bit too long at the water stations so I didn't give my competitor as good of a run for our money as I could/should have under the circumstances.


My boyfriend, Bryan Kirk, shown going over great falls, came in second for the 5 mile race. He is a professional whitewater kayaker who is a team manager for wavesport. The last time he ran more than two miles was last september for the Va Beach Rock & Roll half marathon (which he also did for me). This just goes to show what it means to be an amazing athlete and competitor. Some people (like him) are naturally good, and some people (like me) have to work every day to be good.

I would like to thank Pulse Running Store for putting on this wonderful race. Like I said, experiences like this are what make running, training, and trying your hardest worthwhile!

In Boise: The Epic Running Movie The Dark Knight Rises

The evening of Friday, July 28th, the last day of my summer externship at the Rehabilitation Institute of Chicago, I flew to the Rockies. I consider the Rockies my home because I LOVE the mountains. That feeling is why I chose to attend Montana State over Johns Hopkins and Georgetown for my graduate degree.

The next day, I ran through the foothills of the Boise National Forest for the first time.

 

Then I went to see the dark knight rises; an epic event for me because Batman is my hero.

In Batman they discuss how to use the force and strength of pain, fear, and the loneliness of deep alienation for the good of all. Earlier that week, another medical student on my team, a guy from Nigeria who had run track in college at Columbia asked if one day I just woke up and could run really fast. And I replied yeah, pretty much, the day before they removed my mom’s breathing tube and two weeks after I put my cat to sleep I woke up and suddenly I could run really fast.

When I gave up the Rockies and my PhD/schooling to move back home, I was not met with open arms. My presence symbolized that my mom was dying. My dad may love me, but he most certainly hated and resented me being there and made that well known. I also (like cat woman) have a long list of youthful 'indiscretions' to rise above in my parents eyes.

One day in March, I was sitting still for a second holding my mom in her hospital bed, watching “Kitchen Nightmares” (which my sister had put on earlier with my mom).  I had been running around the previous few days because my mom was finally getting discharged after her first seizure. She had been in the hospital for a month because it took over three weeks to get back the results of the biopsy. She couldn’t be released until the cause of illness was determined i.e. cancer, not meningitis/viral encephalopathy/etc. Once cancer was determined as the cause of her seizures, I contacted neurooncologists throughout the world. Saturday, four days earlier I drove 5.5 hours down and 5.5 hours back to consult with Dr. Friedman at Duke about my mom’s treatment. I had also had phone meetings that Monday with people from Sloan Kettering and Johns Hopkins. In touch with more neurooncologists and researchers by e-mail, I was exploring whether to get her treated in Germany or Italy, where the most research on gliomatosis cerebri (my mom’s form of cancer) was being done.

The neurooncologists at the National Cancer Institute would not meet with just me without my mom present. But if she was discharged from the hospital to a rehabilitation facility, she could not leave the rehab center and return. According to the insurance company, if my mother was adequately healthy to make a doctor’s appointment for treatment options, then this woman who could not walk, was on seizure precautions, and living in a house with stairs and no safety features, was perfectly safe to go home. So my role that day was to arrange that she be discharged early in the morning, make it to Bethesda Md in time for an appointment with the head of neurooncology at NCI, then make it to the rehab facility before the close of business so the insurance would never know she was ‘healthy’ enough to be evaluated by a doctor.

To do this I had to have the appointment set up by 10 a.m. at NCI (not an easy task). I had to have the approval of the busy physiatrist at the rehab center, which I did not get until after six the night before the appointment. I had to have the approval for release from the hospital from the oncologist team, the neurology team, the internal medicine team, the primary care team, the social worker, and the psychologist from Fairfax hospital. None of which I had at that time. My family had also been worried about which rehab center, so the day before (Monday) I had spent driving around the rehab centers in DC and VA trying to make sure we picked the best one for my mother’s condition and for my dad to be able to visit her.

So as I sat there, still for a minute, watching a brief bit of Kitchen Nightmares, the guy owning the restaurant had every excuse in the book handy for why the restaurant was failing. My mom looked at me and struggled to get out the words “that’s like you.” I said “what mom?” She repeated “like you” and added “always excuses, you always make excuses.” And I thought for a second about how I was in the hospital, watching TV with my mom, not working on my PhD, not gainfully employed, making another excuse. During the visit the next day to NCI, which the insurance company never learned about, the head of radiation oncology, Kevin Camphausen, offered me a job and took care of me.

But still every night home I was alone, worried that my mom was dying, having a seizure no one would see, unable to breathe, falling out of bed hitting her head. I was worried that I was doing the wrong thing making excuses, not accomplishing anything. Every night I barely slept and every night my heart broke as I faced my mom’s death and my new life not as a graduate student nerd living and playing in the rockies, but as the person responsible for my mother’s life in the busy metropolis of DC. I listened to the Eminem song “Superman” to remind myself that no one was going to save me from the pain I felt. I had to rise to the occasion. I had no Superman. It was only me.

I identify with what it means to be alone and to work to transform that utter alienation into some sort of strength, some sort of character. Despite the fact that the world will always know you for your weaknesses, no matter how hard you try. I identify with and admire the Dark Knight. But it can be hard as Robin says because people get frustrated that you always have that pain, it will always be a part of you. Like Batman, I can’t just go to a party on a Saturday night and feel at peace. So I try my hardest to channel that pain into strength and commitment whether as a runner or as a medical student. And every once in a while when I think of having my mom and my cat with me and the strength of the pain I have experienced, I feel as though I may one day be able to be a superhero and save another person's life.

      

Rock n Roll Chicago Half Marathon

So the day for me began at 3:40 in the morning. I was so excited I couldn't sleep. I tried and finally when turning over a little too forcefully at 4:20, my pillow sent my water glass flying and I realized that I was being ridiculous, there was no way I could fall back asleep! Might as well get up and make some oatmeal and start the mass movements/stomach gastrocolic reflex for the day tee hee :)
*** for non med-school people,
mass movements: occur 1-3x/day and function to move the contents of the large intestine over long distances, such as from the transverse colon to the sigmoid colon and a final mass movement propels fecal contents into the rectum, where they are stored until defecation occurs. In many people these are strongest for about 15 minutes during the first hour after eating breakfast.

Gastrocolic reflex: A long reflex arc whereby distention of the stomach by food increases the motility of the colon and increases the frequency of mass movements in the large intestine.

I met up with my coworker Paul (awesome guy by the way, I want him to be my primary care doctor, he's super laid back and just puts everyone at ease around him. Everyone who has been paired with him at work opens up and is nicer to be around. He just brings out the best in people!) to jog over to the race. As we were in different corals, we split off soon after arriving there and I met up with my morning workout team. Below is a picture of Tre who runs his own fitness program, which is my weight training, and is just awesome! There is a team environment and all the people are so great that we have now become a team. Plus cross training is what keeps me from breaking :)

The elite start was exciting, with several great people around me (at least they looked impressive, I don't know who they are). The start was very fast and I started at a 5:00 pace, but was able to pull back majorly in pace within .7 miles fortunately! And I let all the other women go ahead of me.

The course was flat and fast. The only problem is that my GPS signal was cut off by all the tall buildings, so for the first time I had no idea what pace I was going. I had to go off of 'feeling', which was definitely not ideal! Especially because due to my sheer exhaustion with spending such long hours at work I have not done a single tempo run in at least 2 months. So I had no 'feeling' to go off of, ha!

But i tried to hold strong and tried to pick people off. A lot of people in front of me dropped out of the race, more than I have seen before. One guy said it was a bad day as I passed him and I said we can't think that way. Many of the miles were not marked (as far as I noticed, and I was looking as my GPS was not working, but I was still more focused on the race so they could have been there). I saw a girl infront of me get frustrated and throw up her arms and yell something towards people working the race near where I expected a mile marker to be located and I realized I had a lot of these people beat. While I may be stressed and under-training relative to ideal, I am learning how to funnel/channel my emotions. I too have many strong emotions and feel like I'm failing. But what happens when I am on rounds and talking to a woman with progressive multifocal leukoencephalopathy & MS who has in the last 3 weeks gone from being able to sometimes walk and be able to speak to being completely bed ridden and barely able to get a word out? I suck up my emotions and focus on her. I channel my frustration into the race and deal with the problem at hand. I do not waste my energy and that is what makes me a good runner. I hold strong where I can and vent where it is appropriate/useful. So I thought of my inner strength on rounds and beat the people who did not funnel their frustrations appropriately into the race.

While it was my slowest race of the season, in many ways it was my strongest and I am proud of my fifth place finish. It shows my emotional growth and that I have held steady despite having been put through the turmoil of moving to a new city by myself where I knew absolutely no one and starting a new job where I really wanted to do my best. I have to thank my new friends in Chicago and my morning workout team for helping me stay strong when I have felt very weak at many points this summer :) Below is a cupcake that my workout teammate Jimmy and his sister dropped by my house this evening to say congrats! I have never gotten a congrats cupcake before!

Oh, and the theme song for this race was Jay-Z Run this town. Cause we gonna run this town tonight!

Theme lines: Life's a game, but it's not fair. I break the rules so I don't care. So I keep doin my own thing, walkin tall against the rain. Victory's within the mile. Almost there, don't give up now. Only thing that's on my mind is who's gonna run this town tonight... We Are, yeah I said it WE ARE!

We did it! Thank you to my support team! Oh, and I promised my neighbor, Jessica Bauer, that I would tell everyone that if I did well, it was due to the 3-course german meal she prepared last night, as Germany and German food is amazing (or maybe just her cooking is amazing!)

A video from Chance & Jimmy from my am workout/crosstraining team lead by Tre :)