Yawn

Got up at 7:30am. Woken by my phone reminder alarm. The sun so bright and hot now at 7:58am. Not gonna do any run now. Besides I'm so sleepy after returning home at 1:35am from Segamat, Johor attending a wedding of an ex-colleague. Hopefully, this evening can run a bit. But my hamstring does feel a little tight when I woke and even now :(

Aiyoh, guess what. My phone reminder was that SCSM 08 is 1 week from 7:30am, 7 December 2008.

The Lab Says Heart Attack, but the Patient Is Fine

November 27, 2008
Personal Best
The Lab Says Heart Attack, but the Patient Is Fine
By GINA KOLATA

THE man was 40 years old and seemed perfectly healthy — he had just run a 10-kilometer race. But he fainted after the race and was rushed to a hospital. There, in the emergency room, his blood was tested. His levels of a heart protein, troponin, were sky-high. It looked as if he was having a heart attack.

The runner ended up in the coronary intensive care unit at Hadassah-Hebrew University Medical Center in Jerusalem. He was in the hospital for four days, undergoing test after test. Yet nothing appeared to be wrong, his doctors — Lior Tolkin, Beth Goldstein and David Rott — report in a recent issue of Cardiology. He had no other symptoms of a heart attack; every test of his heart’s function was normal. And his soaring troponin levels, which can be an indicator of heart muscle damage, went down to normal.

A false alarm or a heart attack averted or maybe a lab error? Researchers say the most likely explanation is that the man had been caught up in a poorly understood but surprisingly common phenomenon: blood tested shortly after a long or strenuous bout of exercise is likely to show abnormalities, maybe even indicators of a heart attack or liver failure. But usually the patient is not in danger. Instead, those results are normal and are not a reason for concern.

While it is unusual to find such effects after a race as short as 10 kilometers, researchers say they are well aware of the general problem.

“I can tell you several stories like that,” said Dr. Fred Apple, a professor of laboratory medicine and pathology at the University of Minnesota School of Medicine.

In one, in fact, he is the center of the story.

Dr. Apple likes to experiment on himself, so one day, when he was a medical resident at Washington University in St. Louis, he drew his own blood and sent it to the hospital lab for routine tests.

The next thing he knew, he was being paged and escorted to the coronary intensive care unit. His blood test results were terrifying, with levels of an enzyme, creatine kinase MB, 10 times higher than normal. Like the runner in Israel, it looked as if Dr. Apple was having a heart attack.
His heart was fine. But Dr. Apple had just gone for a long run (he was running 50 to 60 miles a week in those days).

That experience, in the 1980s, made Dr. Apple curious about lab tests after strenuous exercise, and led him to systematically study the problem, documenting the exercise effect.
“I’d say that 5 percent of people who stress their bodies with exercise could bump up some of these levels above the level that signals a heart attack,” Dr. Apple said.

To avoid false alarms, he suggests that patients avoid lab tests within 24 hours of exercise. If not, he said, “you are asking for abnormalities to be detected.”

Dr. Malissa Wood, a cardiologist at the Massachusetts General Hospital who is a marathon runner, goes further. “I think it’s a really bad idea to have blood work unless something is wrong,” she said.

Dr. Wood and her colleagues have studied runners in the Boston Marathon, testing their blood before and after the race for proteins that can indicate a stroke risk or a heart attack.

“Almost everything we looked at went up,” she said.

And it may not take hours of exercise to do it.
Rob Shave and his colleagues at Brunel University in England recently reported in the Journal of the American College of Cardiology on nine young men who ran a marathon distance on a treadmill. The researchers took blood samples from the men every 30 minutes while they ran and periodically for 24 hours afterward. All had marked increases in troponin within one to two hours after they started running. Everyone’s troponin levels fell within an hour after the run, but in eight of the runners the protein’s levels rose again over the next hours, and five runners had elevated levels 24 hours later.

Yet, Dr. Wood noted, this study involved healthy people. They were not having heart attacks. “Their hearts were fine,” she said.

It is not known for sure why exercise can elicit such strange lab results, researchers say. But part of the explanation is thought to be immune system responses involving inflammation, and part is thought to be effects of temporary skeletal muscle injury.

For example, some studies biopsied the muscles of runners before and after marathons. After the race, muscle fibers were broken and dying. But skeletal muscle is very different from heart muscle. When heart muscle dies in a heart attack, it never regenerates. Skeletal muscle does. Within four days, those runners had repaired their skeletal muscle, growing new muscle fibers to replace the ones that had died.

An echocardiogram also might be misleading. Vigorous exercise can bring on transient abnormalities in the functioning of the left ventricle.

Further complicating the picture is the huge variation from person to person.

“Everyone responds differently,” Dr. Apple said. “Each person is their own little experiment.”
Enzyme levels also soar in people with larger muscles, men as compared with women, blacks as compared with whites. Enzyme levels in a black man after a marathon can be twice as high as those in a white woman, Dr. Apple said.

“I’ll often get a call from a clinic,” asking about lab test results for a black man who recently raced, Dr. Apple said. “I’ll say, ‘That’s normal for a black man.’ ”

Dr. Wood said that athletes and doctors should be wary of blood tests that seem at odds with clinical findings. All too often athletes end up in emergency rooms after races because they are breathing hard or they fainted or their chests hurt (typically because their stomachs are upset). Often, she added, those athletes are just fine.

“We recognize that after a long-distance endurance event the body is going through some sort of adjustment,” Dr. Wood said. “Most of it is a blip on the radar screen.”

Some SC BKK 2008 photos

42km, 10.5km and 5km finishers' medals

The Standard Chartered Bangkok Marathon 2008 event tee

(New Balance Lightning Dry)


Water points - all plain ice water from Pepsi and served by army boys (no 100Plus)

Me in front of the Grand Palance and in front of the start line.

Every finisher collected a medal and then given 2 MacDonald's burgers (2 fish fillets)

Shouting from BKK

It's 11:44am Spore time but 10:44 BKK time.

Run is over. Completed the 10.5km in 1:18:26 my watch time. The gun time was 48secs later at 1:19:06. Pretty good time but injuries all over both legs. Ha ha ha.

Pre-race, I noticed that people bring their dogs - and each dog got their own bib with number. Wah...ha...ha...ha. Won't see that happening in Singapore since the rules usually forbid it. Quite a number of expatriates working in BKK, Asians and Europeans were also at the start line for the 10.5km. One 'farang' guy even had a camel-bak for the 10.5km - serious stuff.

Ran up and down highways and bridges, some were quite steep. Saw a mobile toilet (where the piss came through the floorboards of the bus) onto the road. So spoilt in Singapore with energy drinks. The route had 4-5 water points and it's just ice water by Pepsi. End of race had MacDonalds 2 burgers from choice of 3 (pepper chicken/ beef hamburger which many locals rejected and fish fillet), iced (thick but very sweet) ovaltine and more ice water courtesy of Pepsi.

Saw quite a lot of Singaporeans just from the way they speak English, SCSM 06 vest, GE Women 10k 2008 red vest, Spore Nike Runaholics, Sundown Marathon and even Saucony PAssion Run 08 green vest. Am surprised so many Singaporeans ran 10km in BKK.

Not many photos and I wished I knew where I ran so I can mapped but I think with all the twists and turns, that's quite an impossible task.

Now waiting for my 150BHT 1 hr bus ride to airport at 11:10am Thai time. Will pass the internet session to my room mate slow_runner.

BKK here I come

Leaving for BK today. 3:30pm flight via AirAsia.

Short prep run

Did a quick 4km today. 4.15km actually using MapMyRun. Ran too fast over the last click. Finished in 30mins:10secs (Avg pace of 7mins/16secs per km).

Tough run

Yeh. Woke up late. Was 7am. I drank water. Splashed sunblock cause the sun's usually up at 7:20am.

Set off at around 7:30am. Surprising, it wasn't rally sunny at all as the sky was overcast.

What a tough run. Was breathless at 4km mark. My sniffles came around before the 3km mark and I've always found breathing through the mouth a thirsty and more tiring affair than breathing through the nose. I brought a running cap but no tissue (!!). Might be unbelievable but at around 5km under Rumbia LRT, I saw a plastic bag with empty MacDonald's fries pack + a tissue. I scooped it and blew my nose clear. It helped but little. I was already breathless. Stopped and walked quite a few times during this run. It was tough. I really was thristy. During the last km, my saliva tasted acidic, like the phelgm in my throat or the acid from the stomack creeped up my throat into my mouth. Yukky.

At the end, I walked 3/4 of the last km. More than I wanted. Completed the 8km in 1 hour, 4 mins and 45 secs (Avg pace of 8mins 6 secs per km). My knees were okay but my right ankle felt slight discomfort. The stretching does not seem to help. I target doing a 5km next Wednesday night before the Sunday 10km run, if possible.

Ran but it drizzled...

2 weeks with flu and rains causing havoc. Not sure what is my fitness like now and there's a 10km race in 1 wk+ followed by another 10km race on 7 December.

Tonight reached home it was cloudy, as in very dark clouds. I was hoping that it would not rain or will only rain later int he night. Around 6:45pm I set off. Wanted to do a 4km or 5km loop. Not sure which. Finished my 1st km in 8min 14 secs. Real slow. But it was okay.

Before 2km mark, light rain started dropping. Sigh. I was already on the 5km loop. Was thinking where to cut short since I was still having my flu/sniffles. Before 3km mark, my nose started a little drip and had to breathe through the mouth/throad which I don't like cause it makes my throad dry very quickly and there was no water station unlike during a race. Anyway, I turned off and completed 4.26km. {Click the MayMyRun button link below}.



I completed 4.26km in 33mins. Quite a good average pace of 7mins 45secs. Short distance but it meant I started going at a faster pace after my 1st km. But was glad to get out of the rain as my nose was wet. Was thinking just now that hopefully Sunday morning I can clock 7km. See how.

12 November 2008

I didn't see doctor today. Day started quite well though by lunchtime the thick mucus in nose returned and it was yellowish. :(

Almost whole day I told myself I want to run 5km, whether the flu gets better or not. I think God decided I should not kill myself and send heavy rain + lightning in the afternoon which is still drizzling now. :)

Quite unwell

For those who noticed I've not run for 2 weeks. I got runny nose (sinus) since 1 November which has developed into thick mucus, blocked nose + phelgm high up the back of my throat. The mucus was yellowish since 2 days ago and turned greenish today. I went to company's Raffles Medical clinic last Thursday and they didn't have a few medicines like Zyrtec-D and Piriton to clear my runny nose. So, get gave me generic Delcogen.

Now I have little choice. Will have to go back there tomorrow morning. Sianz.....

No run after so many days liao

Today is 8 November and no run since 30 October 2008.

I been having runny nose which has developed into a cough and phelgm stuck at my throad. I went to company doctor, Raffles Medical clinic at Oglivy Centre around lunch time on Thursday. Would you believe the clinic has no (a) Zrytec-D and (b) Piriton. The doctor only gave me a generic version of Delcogen. After taking three, incl this morning + piriton at night, I wonder how long it will take for me to fully recover. I actually spent almost $40 of my own money to but (a) 1 box Zyrtec-D, (b) Piriton and (c) Mucloslavan. Disappointed with the clinic. Last night, one of my colleagues said I should have walked to the Raffles Medical clinic at OUB Centre. See how, next week.

SC BKK 08

Just to keep a record before I forget. I'll be going BKK with slow_runner from 21 - 23 November 08. We're flying Airasia and staying in Royal Hotel. We're doing the 10k for the experience of it. We're sharing the costs which should all come below our estimated $500 budget.

Thus far:
Hotel (2 nights, twin share): THB 2480 (S$105.88)
Airasia return: S$544.00
Race Fee (10km) for foreigners: THB 1400 (S$59.80).

Thus far, total cost per person is $$384.74.

Race Pack collection is near the hotel and we'll collect on Saturday morning at 10am and then head to the shoppping district where MBK and Paragon is. Hope it is a nice time of relaxing, fellowship, shop and makan.

Running Shoe FAQ [Runners World US]

Running Shoe FAQ

Our experts solve your shoe conundrums.

When is it time to retire my running shoes?—Ken Becker, Phoenix
Between 300 and 500 miles. Why the range? Because how quickly a shoe wears depends on you. If you land hard on your heels with each stride, for example, you're going to wear through shoes more quickly than more efficient runners. Go by feel. If after a normal run your legs feel as if the shoes aren't providing you adequate protection, they probably aren't. Give your legs a week to make sure it's really the shoes and you're not just tired. If the shoes still feel dead, replace them. We can tell you that the vast majority of runners replace their shoes too late. When you can see white midsole material poking through the outsole or when the sole under the heel looks crushed, the shoes are long past their prime.

I'm new to the sport, and when I went to buy my running shoes, the local running-store owner explained that training in two or three different shoe models is better for your feet. I bought her story and walked out with two different pairs. Any truth to this?—Rachel Setton, Brooklyn
Good advice, but the up-front cost can seem pretty high. Running in more than one pair will help your biomechanics adapt ever so slightly to each shoe. These adaptations are a good thing because they help prevent overuse injuries. In addition, midsole foam requires as long as 24 hours to fully recover from a run. So if you run at night and then need to get an early workout in the next morning, a different pair will give your body more protection.

After a few tours as an Army fitness trainer stationed in Iraq, I've developed plantar fasciitis. I am a high-arched runner, so what should I look for in a shoe to help curb the pain?—Staff Sgt. James Moore
You should run in neutral-cushioned shoes, since your foot doesn't roll inward enough at footstrike. Adding an aftermarket insole to your shoes will help distribute the pressure and curb your plantar pain. Or try a heel lift, such as Spenco Gel heel cups, which takes some pressure off your plantar fascia by shortening the length your calf has to stretch. Sadly, rest and ice—two things undoubtedly in short supply in Iraq—are key to getting over plantar fasciitis.

Does the surface you run on affect how your shoes break down?—Chris Kuemple, Spring, Texas
Road running will make your shoes wear faster than trail running, for sure, but the way you run is an even bigger factor. A 200-pound heavy heel-striker who runs exclusively on trails will most likely wear out his shoes well before a 100-pound biomechanically efficient road runner. If you're worried that your shoes are ready for retirement, take a close look at them. If the upper appears pulled or stretched so that the foot is sliding off the midsole, or the grooves on the outsole are worn smooth, it's time for new running shoes.

I notice that during long runs in my motion-control shoes, the balls of my feet hurt. Does this have anything to do with my shoes, my gait, aging, or all of the above?—Aidan Lee, Brentwood, Tennessee
As we age, the natural cushioning of the foot starts to lose its resiliency, which means shoes with good cushioning are especially important for older runners. To address your sore feet, look for a shoe with good support but better RW Shoe Lab cushioning scores. If you're lighter weight (under 160 pounds), consider moving from a motion-control to a stability model.

The wet test confirms I have flat feet, but my shoes wear along the outside edges. Also, I experience pain along the outside of my knee eight to nine miles into my runs. What type of shoe should I wear?—Bill Ritz, Salinas, California
Chances are your shoe's giving you too much support or you're running in worn-out trainers that are stressing your iliotibial band (ITB). Either way, you're supinating, which means your foot is not rolling inward enough at footstrike. To determine the type of shoe you need, go to a specialty running store to get feedback on your gait. You're likely one of the few runners with flat feet who do not overpronate and need a less-supportive shoe.Is there any harm in someone with normal arches wearing motion-control shoes?—Joseph Rose, Modesto, CaliforniaIt depends how much you weigh and how much you pronate. If you weigh less than 140 pounds (120 pounds for women) and overpronate, you'll get plenty of support in a moderate stability shoe. If you weigh 160 to 180 pounds (140 to 160 pounds for women) and overpronate, then go with motion-control shoes. Bigger runners who wear stability shoes will not get the support they need and can actually bottom out the cushioning, negating the shoe's ability to protect the foot from impact.

My shoes wear along the outside, and I have low arches. What type of shoe should I wear?—Michelle "Mimi" Brice, Hayward, California
If that wear is in the heel only, you're one of the 80 percent of runners who are heel-strikers, which means your shoes should offer plenty of impact protection in the heel. Just keep in mind that women often see wear along the outer edge of their shoes because of the greater Q-angle (quadriceps angle) from the hip down to the knee. Shoes with a durable outsole material like carbon rubber will help minimize the wear. Because you have low arches, we recommend going with a more supportive shoe.

I have flat feet, and my arches always get sore after long runs. Why is this, and how can I stop the pain?—Lynne Wekerle, Cincinnati
You most likely have either post-tibial tendonitis or plantar fasciitis. Oftentimes, injuries to the post-tibial tendon are seen just above the ankle, so we're thinking it's plantar fasciitis. We recommend getting properly fitted into a supportive shoe by a specialty running shop. To help the plantar fascia heal, wear shoes with plenty of support even when you're not running, and stretch and massage your arches when you get up in the morning as well as before and after you run. If the pain persists or gets worse, see a sports-medicine doctor.

Is it possible to have flat feet but not overpronate?—Bryanna Johnson, Salt Lake City
It's possible, yes, but uncommon. People with flat feet usually have flexible joints that cause their ankles to roll too far inward at heel-strike. If that's not happening to you, you're compensating somewhere else in the foot, knee, or even hip. Compensation isn't necessarily a bad thing. Your body has found a way to disperse the impact forces that can cause injuries. So you really only need a firm neutral-cushioned shoe.

After years of playing soccer, I recently started running with my dad and developed shin splints. Is there a shoe that will help with this?—Chris Weglein, Sebastopol, California
"Shin splints" is a catchall term for pain that usually occurs to the outside of the shin and is common in new runners. A soft, stable shoe can help manage your discomfort. Softer shoes will help absorb the impact that occurs when you run on hard surfaces. A decent amount of stability is also important, as this will slow the rate that your feet pronate, which reduces the stress on your shins.I'm experiencing discomfort in my heels. Can you recommend a particular shoe for my situation?—Nancy Morales, MiamiWe're thinking you may have plantar fasciitis, which is an inflammation of the band of tissue (the fascia) on the underside of your foot that connects to the heel. Either your current shoes aren't supportive enough or they're worn out. Plantar fasciitis can be exacerbated by overpronation because the fascia helps realign the foot as it moves through the gait cycle. Therefore, more stable running shoes will help relieve some of the stress on the fascia. We also recommend you do some rehabilitation. For simple tips on relieving plantar fasciitis, click here. If your heel pain persists or gets worse, see a sports-medicine doctor.

I saw a Spalding running shoe offered at a Payless shoe store. Have you guys seen it? What's your take?—Donna Belitza, Greenbelt, Maryland
You probably saw the $35 Payless Spalding Amp. We tested these shoes recently at the RW Shoe Lab. Our verdict? It's not a bad basic running shoe. We put more than 300 miles on some pairs and they held up well—better than you'd expect at this price. We categorized the Amp as a stability shoe, but it's lightweight and offers less support than other shoes in that category, so it's definitely not a good match for all stability-shoe wearers. Bottom line: While it's better than running in high tops, at Payless you will not get the same expert fit advice you will at a running specialty-retail store. Stick with the experts.

I'm a heavy-framed runner and a significant overpronator. Am I chained to motion-control shoes for life, or is there any way to move into a pair of lighter shoes?—Chad Meli, Middletown, Connecticut
You're not trapped, Chad. For your lower-mileage runs, buy a pair of stability shoes and add a rigid over-the-counter orthotic. This combination will give you the stability you need in a lightweight package. If you weigh north of 170 pounds, look for firmer stability shoes, above. These shoes will be less likely to overcompress when your heel hits the ground, which jeopardizes the amount of protection the shoe offers. For your longer runs, however, stick with motion control shoes, because your biomechanics are more likely to break down, and you'll be happy you have the added pronation control.

My heel slips out of my running shoe with every pair I buy. Does this happen to other women, and what can I do to prevent it?—Krista Huskey, East Lansing, Michigan
Unfortunately many women's running shoes are still basically the same as the men's, except for the color. This means they are generally wide in the heel on most women. Many major running-shoe companies are starting to offer gender-specific lasts (the forms shoes are built on) instead of the unisex lasts they currently use, resulting in better-fitting shoes. For immediate relief with your current shoes, try adding a flat over-the-counter insole underneath your sockliner to make the fit narrower without affecting the overall length. Also experiment with different lacing patterns to more securely wrap the top of the shoe and lock in the heel. See runnersworld.com/lacing for our best suggestions.

After a nine-month battle with plantar fasciitis I am pain-free. What features should I look for in my shoes as I start to get back into running?—David Brandriss, Dallas
Look for a stability shoe with a good fit in the heel and arch. Manufacturers strengthen a shoe's arch support with upper overlays that help the shoe better wrap around the midfoot. But in order for any system to work, your shoes need to be tied properly. We see wear-testers slip out of tied shoes all the time—a sure way to eliminate any benefit. If you can slip them off, your shoes are too loose. Also, make an effort to strengthen your feet, which will help your plantar fascia by working the small muscles in the foot. A great way to do this is by walking barefoot in the grass or on the beach, but start slowly, and at the first twinge of discomfort, put your shoes on.

Is there such a thing as a running sandal? If so, what should I look for in a pair?—ean Belman, East Lansing, Michigan
Companies such as Merrell, Bite, and Teva all make running sandals that cost the same as running shoes. You should use the same criteria for fit with sandals as you do with shoes: They need to provide ample room for your toes and forefoot, wrap the arch securely, and fit snugly in the heel.

Halfway through my runs, my shoe inserts tend to slide forward. Can you tell me how to fix this?—R. Patrick Concepcion, San Francisco
If they're slipping only after you run for a while, maybe you just need to lace your shoes more snugly. If you can kick them off without unlacing them, your shoes are too loose, which is allowing your inserts to slide around. This is definitely going to compromise the support you're getting from your shoes. To check that your inserts fit properly, bring them with you when you go to a specialty retailer to buy your shoes. And be aware that your inserts may fit better in one shoe than another, because manufacturers all use different lasts, or foot forms, when constructing shoes. Also, your feet may be different.Is it possible that the exact same pair of shoes (same manufacturer, model, and color) can fit differently?—Heather J. Brown, Charlotte, North Carolina
Yes. Though shoe companies put huge resources into quality control, no two shoes are exactly the same (kind of like snowflakes). Most running shoes are handmade, and up to 50 operators may handle a shoe from start to finish on an assembly line. The same shoe can be made in different factories with different levels of quality control. Sometimes even a minor update, such as a change in upper pattern or materials, can affect fit. Our advice: Always try on the shoes. And because foot lengths also vary, fit your longer foot. If one foot doesn't feel right but the other does, that's not good enough. Ask to try another pair.

What runner-friendly features should I look for in a dress shoe?—Jon Baylor, Prescott, Arizona
Runners set themselves up for injury by wearing nonsupportive casual or dress shoes all day long. As with running shoes, dress shoes should have a snug, supportive heel, a good feel through the arch area, and no pinching or restriction in the forefoot. Look for shoes that have form-fitting removable sockliners, or consider buying an over-the-counter insert for added support. Replace your dress shoes regularly, because—as with running shoes—they lose their cushioning and support features over time.

I recently had foot surgery, which left a sizable indentation on the bottom of my foot. Some of the padding was removed from my foot. What type of shoe insert do you recommend that will increase my cushioning?—Donald Modder, Danville, Virginia
Consult with a sports-medicine physician or running podiatrist about what exactly has been removed from your foot. If the person who did your surgery doesn't normally work with runners, get a referral to someone who does. When you go, bring your running shoes with you. You will likely receive a well-cushioned orthotic, or insert, for added protection. Depending on where your indentation is, an extra pad can be placed under the ball of the foot or below the heel for improved cushioning.

What are the pros and cons of wearing a lightweight training shoe versus one with more stability?—Nathan Usher, Gregory, Michigan
Most runners benefit from wearing a training shoe with stability features that control the inward collapsing, or "rolling," of the foot after it lands. This is called overpronation, and it can lead to injuries. If you don't overpronate, you'll be fine in lightweight trainers most of the time. But even if you're a heavier or less efficient runner, you can wear lightweight training shoes for speedwork and shorter races without worry.

I've heard you have to lace up your shoes tightly in order for them to perform the way they're supposed to. Is this right?—Paul Nelson, Kailua, Hawaii
Yes, it is. The laces of your running shoes should be pulled relatively tight. If they're not, the shoe won't "wrap" your arch properly, which will compromise the shoe's stability features. Here's a test: Try prying one shoe off using the other foot. If you can do this easily, they're too loose. But shoes can also be too tight. How to tell? You'll feel tingling or binding on the top of the foot or discomfort in the forefoot.

I lose my middle toenail every time I train for a marathon. How do I find running shoes that won't do this?—Jeff, Katz, Wellington, Kansas
Ouch. You're probably buying shoes that are too small. Amazingly, studies have shown that 80 percent of runners wear their shoes at least half a size too short. The reason? Most runners have one foot that's slightly longer than the other, and they don't buy shoes to fit the longer foot. When you buy your next pair, stand with both shoes on and have the store attendant check that there's a thumb-nail's space between the tip of the shoe and the end of your middle toe. Also, depending on the shape of the shoe, the ball of your foot can sometimes rest too far forward in the shoe, which will cause toes to jam against the front. Ask the store attendant to double-check this aspect of fit.

I'm a vegan, and I'm looking for running shoes that contain no animal products. Can you help?—Shamira Meghani, Las Vegas
The good news for you is that running shoes these days are about as natural as a Twinkie. Most manufacturers rely completely on synthetic material when they build their high-end shoes. So there is little chance—if you're paying $90 or more for a running shoe at a specialty running store—that you'll encounter any natural material. If you pay less, you may get a shoe with overlays (reinforcing strips) made of leather, suede, or pigskin. The adhesive used in low-end running shoes may also derive from animal byproducts. Obviously street shoes are a whole different story; they're much more likely to contain natural materials. Call the manufacturer to double-check.

Do orthotics change the type of running shoe I should wear?—Sandy Kinkade, Fort Worth
Yes. In most cases, adding a customized orthotic will increase the amount of motion-control you get from a shoe, which normally means you can go with a shoe that provides less control to start with. But every runner is different. A 100-pound woman needs a different amount of support in her shoes than a 200-pound man, for example, even if their biomechanics are similar. So here's what to do: Next time you buy a pair of running shoes, bring your orthotics and your old shoes to your local specialty running store. The salespeople will have suggestions based on what they see. If they don't, find a shop that does, or seek out a footwear professional such as a pedorthist or podiatrist, either of whom will give you advice on how to make your shoes and orthotics work together.

I know running shoes have a certain life span for running (300 to 500 miles), but can I wear them for walking after I retire them from running?—Jeff Chapman, Marion, Ohio
It depends on the wear pattern of your shoes. If they are worn unevenly, we wouldn't even use them for walking. Here's how to determine wear: Lay your old running shoes on a table. If they tilt to one side or wobble easily from side to side when you nudge them, then they've worn unevenly and should be recycled . Another sign of uneven wear is if you see the white midsole foam exposed through the black outsole material. By the way, the reason you can get a few more miles out of old running shoes is because the forces generated by walking are about half those of running, so you don't need as much protection. After about 600 total miles, however, it's time to move on.

You frequently mention "EVA" foam in your reviews. What is EVA and why are so many shoes made of it?—Josh Dewar, Seattle
EVA is an acronym for "ethylene vinyl acetate." It was first used in a running shoe by Brooks in 1975. Brooks worked with the Monarch Rubber Company to develop a material that would combine lightness with cushioning. Result: A polymer with tiny air bubbles trapped inside the foam. EVA proved to be much lighter than rubber, and it had better shock absorption. These days, many shoe companies combine EVA with other nonfoam technologies such as Air, GEL, or HyrdoFlow, which retain cushioning longer than foam.

Not only are my feet big, but my left foot is a size 15 and my right foot is a 16. Any suggestions?—Burt Appletree, Gainesville, Florida
Most companies offer a full range of shoes up to a men's 15, and some, such as New Balance and Adidas, make specific shoes that go up to an 18 or 20. Since these sizes aren't always easy to find, call your local specialty running store before you stop in. If that doesn't work, check out oddballshoe.comor largefeet.com, which cater to bigger sizes. As for your different-sized feet, see if your local running store participates in the Books Mis-mates program. For an extra $25, you can order a pair of Brooks shoes in different sizes.

For money reasons, I try to make my shoes last as long as possible by adding Shoe Goo to the heel. Is this OK, or am I risking injury?—R. Patrick Concepcion, San Francisco
Shoe Goo, a clear adhesive that dries into a waterproof, flexible rubber compound, is quite durable, but it's not a very good shock absorber. So you are definitely sacrificing cushioning by using large amounts of it in one area. My recommendation: If you're going to use it, apply thinner layers more often, before things get too bad. This will extend the life of your shoes without compromising much cushioning. However, once you reach that critical 500-mile mark in one pair, you lose substantial cushioning, so retire it and buy another.

When I buy new running shoes, I toss my old ones in the closet. Is there anything I can do with them short of throwing them away?—Larissa Griswall, Yonkers, New York
You bet—there are plenty of ways for your old shoes to enjoy a second life. Check out our Shoe Donation page for several options.I have a half-marathon coming up in two months, and I just bought the shoes I want to race in. When should I start breaking them in?—Sarah MacIntyre, Wilmington, DelawareYou can start the break-in process now. Wear the shoes around the house for few days so the sock-liner—the thin insert on which your foot rests—can be begin conforming to the shape of your foot. Then run some shorter training runs or speed workout in the shoes so you get used to how they feel. I would also recommend that you run a 5-K or 10-K race in them, which is a good thing to do anyway in preparation for a longer race. Figure to do at least eight to 10 runs or at least 30 miles in your new shoes before race day.

I have a very narrow foot, so I need to lace my shoes really tight. Unfortunately, this can cause my feet to fall asleep. Can you recommend some supernarrow shoes?—Allison Best, Mattituck, New York
New Balance has had the best reputation for offering a variety of widths in their shoes, but now most of the major shoe companies do as well—including the narrow A, 2A, and 3A widths. Also know that narrow versions aren't always easy to find, but a good specialty running shop will order them for you. If you still can't find a shoe you like, try putting a flat Spenco insole (or another over-the-counter insole) underneath the conventional sockliner of the shoe. The insole will provide an extra later of cushioning, plus it'll take up space, so the shoe will feel and wear like a narrower shoe.

My feet get a mysterious rash after I run. The longer I run, the worse it is. What's going on?—William Morris, Atlanta
One of the most common fabrics used in apparel, especially in socks, is Lycra. It's what gives stretch to your socks and keeps them from falling down. This material could be causing your reaction. In fact, lots of runners suffer from this. To keep the rash at bay, put foot powder on your feet before putting on your socks—the powder will act as a buffer between your skin and the sock. There's also a silicone-based powder called Blister Shield (2toms.com) that should provide relief. Another option: Wear a very thin silk sock under your regular running sock. This will not affect the fit of your shoes or cause your feet to heat up on long runs.


Copyright © 2008 Rodale Inc. All rights reserved.

Runners World (US) articles on why some drop dead during marathons

November 04, 2008

Is it safe to run a marathon?

So sorry, Doc, to hear one of your runners at the NYC marathon didn’t make it. It seems that every time I pick up the newspaper after a major marathon, I hear of a death. Is it really safe to run a marathon? - Jeffrey S., Chicago

Thanks, Jeffrey. This question already has my office phones ringing off the hook. (Actually, two runners died after last weekend's New York City Marathon.) It's a timely topic, too, as Amby Burfoot writes at length about this in the December 2008 issue of Runner's World; click http://www.runnersworld.com/article/0,7120,s6-238-244-255-12968-0,00.html to read his special report.)

On the days following a marathon, not only am I treating all the aches and pains associated with running this event, I am also answering this sort of question. Time to re-emphasize some important points I first wrote about in my post "Can I prevent 'sudden death' while exercising?" back in November 2007. See post at http://runningdoctor.runnersworld.com/2007/11/can-i-prevent-s.html

Marathon running is safe for those cleared by their doctors to compete. Although the worldwide statistic is about one death in 50,000 participants or one in 75,000 (depending on the study), and this is quite small, whenever you get a large number of people together in one place, there are “expected” demises.

All who experience “sudden death” have an underlying cause. This points out the need for everyone to get a stress test after age 40 or earlier if recommended by their physician and get checked if they experience chest pain, pressure, shortness of breath, or some other abnormal feeling while exercising. This also points out the need for everyone to fill out the medical information label on the back of their bib number so as to make it easier for emergency personnel to take care of you if needed.

Speaking of which, here's an example of the kind of story you don’t read about:
In this year's marathon, a man was resuscitated on the 59th Street Bridge (he had no pulse and wasn’t breathing; a med team and ambulance were there in two minutes) and rushed to the hospital. He was having a heart attack. The man had angioplasty and will walk out of the hospital to someday run again! With thousands of medical volunteers and an ambulance system tuned to caring for our runners, response time, the greatest indicator for survival, was dramatic. Had he been sitting in his living room, he may not have made it.

In other words: Assuming you have all the appropriate pre-race health screening, running a marathon is safer than sitting in your living room. If you do your part, the marathon course may just be the safest place to be race day.

Enjoy the ride.

http://runningdoctor.runnersworld.com/2008/11/is-it-safe-to-r.html

Medical exam

My office sponsor a full annual medical exam for every staff. At Alexander Hospital 'Health for Life' clinic. It's the works. Blood tests, urine, stool, ECG, lifestyle survey, history or background check, eye tests, doctor doing a review, check lymph nodes, heart murmurs, x-ray, etc. Nurse who did the initial measurements said my BMI of 19 is normal and I saw the machine calculated my fat as 12.3% (I wonder what is normal range...)

My resting ECG printout came with the "ABNORMAL ECG" wordings printed from the Philips machine which got me real worried. Later when see the doctor, she said it's quite okay. When I told her my High BP and Cholesterol history + diagnosis of mild LVH via 2D Echo 2 years back, she says it explains the ECG readings (some measurement of S and V and whatever). She did add that it is really very borderline normal and as long as I continued to keep the blood pressure under control, it should improve. Blood pressure reading by nurse was 128/88 and by the doctor subsequently during the review was 121/80 (which was better than I would expect). The bad thing is my eye sight. My left eye was ok. But my right eye was 6/18 and 6/12 (with assisted pinhole). [The 6/18 meant I need to stand at 6 feet to read what people could at 18 feet and that's bad cause I could not read the 4th row of the eye chart]. Doctor said it likely means I need glasses for my right eye. Later she use the thing with the light to check my ears and nose and another thing with lights to check the eyes. She said no cloudy discolouration or abnormal signs in both eyeballs, so no glaucoma or damage to retina. So, I wonder if I need to get glasses. Now that I have tested reading with my left eye covered and vice-versa, I do realise the difference. Reading with right eye only even at the notebook LCD at close range is slightly blurry. Sigh, glasses cost $$$. Wait for Christmas sale.....

Oh, I told the doctor about the pain at the outer left knee. Told her I think it's the ligament due to running. She asked me to flex the leg 2-3 times and then felt around the knee. She said it is more of muscle and she agreed it feels tight. She doesn't think it is tendons or ligament. She suggests I do stretching and warm up which I admitted is something I do very little of.

Well, I must say, she is a thorough doctor. Now I wait for the report to come.