Category Archives: medicine

Transitions

I am a day away from starting my General Surgery Residency. Gulp. I (and so many others) have been working for years for this day and it is simultaneously exciting and terrifying.

I am and always will be a runner. I will continue to run and race throughout residency and continue to engage in the running community as a competitor, observer and constant supporter. By virtue of my schedule for the next five years, however, keeping this blog going with the level of quality I attempt to achieve is going to be incredibly difficult. I have come very close to pulling the plug on it entirely in the past few weeks but then I read something from the running community that moves me or run a race that I want to recap and I change my mind again.

What I’ve come to is that this blog creates a place for me to gain insight into my running and archive my experiences even if no one else engages. It is also a repository for a lot of experience with the recovery from compartment syndrome, a rare and frustrating condition for many runners. Every few months, I get an email from someone who found my blog after searching for information on CS who is relieved to find SOMETHING out there on coming back afterwards.

This blog is going to slow down after tomorrow. It will still hold race reports as I race and product reviews as I do those. It will have training updates as I work towards my next marathon and towards my much larger goal of the Olympic Trials. It won’t have a weekly training update; I don’t have that many hours in the week to be consistent. It won’t capture every running thought or share as much exercise physiology as it did. In the coming months, I may transition back to a free WordPress blog rather than the very expensive hosted version that this currently is. If that changes something for readers from an interface perspective, you’ll be the first to know.

If you miss a daily dose of me (who wouldn’t…), my Instagram account will stay very active as it’s easier to do on the fly. My Instagram is more diverse than this blog; after all, I’m more than a runner. It includes food, gardens, insight into medicine but also a healthy dose of running. My handle is @runswatrun if you’re interested.

To the 503,666 visitors to this blog (holy sh*t), thank you so much for your support and encouragement and interest.

With Love,

Sarah

Running During Intern Year***

***Caveat: This is a plan. The shit may hit the fan a month from now and this may all be a pipe dream. That said, I went into medical school planning for the worst and it never really happened, so I’m doing the same for Residency.

One of the benefits (??) of Residency is that we know our schedules way, way, way in advance. It takes an inordinate amount of organization to cover a hospital and our schedules are done almost before we Match. Because my program is new, ours will be a little less set as we work out kinks in coverage but we still have a full year schedule to work from which is amazing from a running perspective. Our schedule is unique because we do three month blocks from the beginning rather than one month blocks. From a professional perspective, this allows us to actually get our feet under us and build proficiency. From a lifestyle perspective, this allows us to adjust to a schedule for a longer period of time and supports more normal sleep cycles. The other big change for this year is that the work hour restrictions, a huge controversy in all residencies but especially in surgery, have been loosened. We still can’t work more than 80 hours a week (averaged over 4 weeks), but we are able to take 24 hour call as interns. I know some people hate call because they have to be up for 24 hours but I find it immensely preferable to night float where you work 7 pm to 7 am for a month at a time. With 24 hour call, you take a big nap when you get home, get a half day off and go to bed early the night before the reset.

From the 40,000 foot view, my schedule looks like this:

  • July, August, September on Acute Care Surgery (Tuesday Call)
  • October, November, December on Pediatric Surgery (Sunday night call)
  • January, February, March on Trauma Surgery (Thursday call)
  • April, May, June on Wound/Ambulatory Surgery (Saturday call)

What this means is that I have a guaranteed post-call day off as well as a weekend day off most weekends. Occasionally, I’ll have both days of the weekend off (known as the “Golden Weekend.”) From a training perspective, this means that I have two and occasionally three days for quality workouts. One of the big hurdles that I’ve already experienced in medical school and expect to experience even more as a resident is a lack of recovery. We work about 12 hours a day and much of that is standing. Even with almost no additional social life, this doesn’t leave a ton of time for quality sleep. Planning for my recovery, then, is almost as important as planning my runs. My general plan is to take my call day as my off day, which will allow me to sleep in a bit. On my post-call day, I’ll aim to be in bed early and on a full day off, sleep in as late as I can even if it means my run happens at a warmer time of day. Finally, I’m working on giving myself permission to take an extra rest day to prioritize sleep if I’m feeling exhausted.

For the first three months of intern year, then, this is the basic mockup of my schedule with strength training in italics and a presumption that my weekend day off will be Sunday which isn’t necessarily true. Because we’re easily the luckiest residents ever, we work 7 am to 7 pm (instead of 5 am to 5 pm), which means I can get my runs in before work without having to get up at 3 am. My hope is to keep my mileage between 50 and 60 miles a week but I will reassess this after the first couple of months and see if 40 to 50 might be more appropriate/improve recovery.

  • Monday: Interval Effort. Short hills or time based interval paced effort. Legs and Core.
  • Tuesday: Call Day. Off.
  • Wednesday: Post-Call Day. Long Run with/without steady state or tempo miles. Legs and Core.
  • Thursday: Recovery run. Arms and core.
  • Friday: Regular run. Core. 
  • Saturday: Regular run with striders. Core. 
  • Sunday: Workout with tempo and turnover work.

One of the biggest challenges for me is going to be being flexible in my training. I get stressed out when I deviate from my schedule or miss a workout but I’m working on accepting that this is a given with my current life. There will certainly be days when I can’t get a run in but there will also be days with surprise opportunities to get an extra mile or even an extra run in. A training cycle isn’t made or broken with one workout or even one week, and I will need to remind myself of this regularly.

I’ll cover my strength training approach in a post for tomorrow (I have a new app and I want to give it appropriate attention) but I’ve recently gotten in a great routine of getting some aspect of strength building in daily and want to continue that trend. Thankfully, this is the easiest piece to keep in my routine. Squats when I brush my teeth, crunches and pushups in the charting room, stairs at work etc…

 

Small News: I Picked a Fall Marathon

I just signed up for the RDC Marathon in November.

Yes, you read that correctly. I’m about to start General Surgery Residency and I registered for a fall marathon. Before you think I’m entirely crazy, let me attempt to explain.

First, I need something outside of the hospital for me. Running is an excellent outlet for stress for me but I need something to focus me more than just vague “stay in shape,” so a long race is a great motivator.

Second, I need to dip my foot back in the marathon pool. My last marathon was in 2014 and my last big focus race was the Philly Half in 2015. As I’ve covered, perhaps ad nauseam, Philly and the failure there wounded me more than I can express and it’s been an ugly road back. I’ve self sabotaged races, half assed training and generally faced an enormous amount of fallout from that one race. I’m at a point now where I’ve accepted that I can’t expect to come back at the same place I left in 2015. I haven’t trained at a high level in over a year and have had numerous setbacks in that time. What I can do, however, is start fixing the foundation and looking forward to the Olympic Trials for 2020.

So why a full marathon and not a half? I often joke that for a marathon to go well, God himself needs to come down and anoint you for the perfect day but that you can run a good half marathon with locusts falling from the sky. That’s still true, if you have the perfect training setup. If you don’t, however, you lack the requisite speed to run fast at the half distance. As I’ll detail in an upcoming post, my schedule for the next year is a bit…challenging and will require a ton of flexibility on my part. What it does include, however, is a guaranteed post-call day when I can get my long run in.

Why did I choose a brand new marathon that it unlikely to have a ton of people or crowd support? See above with Philly. I considered trying to get into the elite field of a race but my times are too old and I didn’t want to automatically assign the pressure of being an invited athlete to my comeback. As Abbey said the other day, “just let me run with regular people and drink from paper cups and run fast.” Yes, the ultimate goal is to post a 2017 time that will get me back into invited fields but I don’t need to add pressure for this first big race back.

Right now, I don’t have any hard goals. After all, I have 23 weeks and almost half a surgical intern year between then and now. In my mind, I would really like to break 3 hours but I’ll reevaluate that as I get closer to the race. My other big goal is to have a good training cycle that will help me to put Philly behind me once and for all.

Week in Review 4.24.17 to 4.30.17

MEDICAL SCHOOL IS OVER!!!!!!! Finished up my last shift in the SICU on Friday and when it was done, wasn’t sure if I was supposed to spike my badge, fist pump through the halls or run out of the building. Med school was never as bad as I expected it to be but I would never, ever want to do it again. Sorry, not running related but good riddance!

Monday: Tested out the ankle with a 30 minute trail run. All good, although I was being a wimp on the more technical portions. Legs after.

Tuesday: Simple treadmill fartlek with 10 by 1 minute on, 1 minute off. On pace was somewhere between MP and tempo.

Wednesday: Got out of the unit early and snuck in a 13 mile long run. Did a couple of miles alternating between regular pace and MP to shake out lazy legs.

Thursday: Rest Day, prorated at 4. Much needed after three days that were harder than easy in a row.

Friday: 7.6 miles easy. 82 degrees out so I felt terrible! Arms afterward.

Saturday: 3 mile shakeout. Ran to the track and back, then a mile of ins/outs.

Sunday: Sleepy Hollow Mountain Race.  Remember the last time I ran a trail race? My only goal for this morning was to use some of my lessons from last year’s Rivah. My biggest goal was to keep both shoes on, which I did! I’ll recap the rest in a Race Report tomorrow but I had a blast, stayed upright and finished somewhere around 1:01:50, although I don’t know what place I was.

Total Miles: 44 miles, 2 strength workouts

Total April Miles: 153

Going up…

Now that school is done and I have a couple of months off, I’m looking forward to getting in some more consistent training. I’ll slowly be increasing my mileage towards 55 and working on fitting three explicit strength workouts in weekly (plus my daily toothbrush squats/core etc). My next race focus is the Asheville Half Marathon. I haven’t honed in on goals yet but as I get back into workouts, I’ll be setting my A, B and C goals. I also spent a lot of time putting all sorts of possible races on my calendar for the next year. Although I don’t have my call schedule, I’m hoping that I can just keep myself in good enough shape to jump in races as I can!

 

Race Report: Unplugged Half Marathon 2017

First race of 2017 done!

When I came into 2017, I had planned on making Unplugged a focus event for the spring but then life got in the way and it ended up being a workout/rust buster/engine check. My A goal was to break 1:30, my B goal was to be under 1:32. My (unstated) C goal was to finish and not get injured, which was not a forgone conclusion. I came in at 1:31:54 and felt pretty good, so mission mostly accomplished!

Despite living and training in Burlington for many years, this was my first year really running Unplugged. Until recently, it fell on Boston Marathon weekend and I was either running or going down to spectate or in the midst of VCM training. The race is truly unplugged; no awards, just water on the course, few spectators. All of this sets up for an awesome opportunity to get a good workout in without too much stress.

I was excited to have a chance to get a marker for moving forward for the Asheville Half and a fall full, but I was even more excited to see my dear friend Abbey who is my running buddy/confidante extraordinaire who was coming back to Burlington to race. Warming up with her and standing on the start line was enough to make the whole day worth it. She went on to kick ass and I can’t wait to work towards our next running (and life) goals together.

On race morning, the only piece I was worried about was the weather. The forecast called for snow, rain, windy and high 30s which is a tough temperature to dress for. While the mountains got anywhere from 4 to 9 inches of snow, Burlington was relatively dry but the start was COLD. I warmed up in two pairs of pants and two coats and for the first time ever, planned to race in full tights. Will tried to convince me to do a singlet and arm warmers but since he wasn’t at the start and I was being wimpy, I put a long sleeve on under my singlet which would ultimately turn out to be a big mistake.

The gun went off and we had a mile of out and back. I eased into the race and tried to resist the urge to chase after people. The first mile was distinctly uphill and conversely, when we turned, the second mile was downhill. I tried to stay in control but ended up running 7:03 and 6:49. I’m not sure if this second mile ultimately bit me in the butt but I did have to remind myself that I didn’t have the fitness to run that whole race in the 6:40s. The first few miles of the race had multiple turns and full circles through neighborhoods and it was hard to get into a rhythm. Miles 3, 4 and 5 were 6:50, 6:54 and 6:57. The 6:57 was the mile where I had to strip off my undershirt, a feat I accomplished without losing a step or falling down.

After mile 5, we turned onto the bike path and I was able to cruise a bit. Since the race started at 11, I was pretty hungry by the time we started and took my gel shortly after 6 in hopes that it would stave off a bonk. This seemed to work and Miles 6 and 7 were 7:02 and 7:03. I threw my gloves at another friend at mile 7 and was collected but definitely starting to feel some quad fatigue and quickly shed the idea of pushing the last 3 miles in favor of just staying consistent.

Mile 8 passed quickly in 7:03 and mile 9 was the downhill mile in 6:54. I was starting to get some confidence back after this but when we crossed into Waterfront Park, I came to what felt like a complete stop with stomach cramping and the worst GI distress of my life. I can generally tolerate gels without too much water but since I went into the day a tad dehydrated, I expect it sat like a brick in my stomach. I limped through mile 10 in 7:04 (no WAY was this race worth a GI disaster) and just hoped I could hang on for 3 more miles. Mile 11 passed in 7:07 with waves over the Causeway ala VCM 2013.  At least this time, the wind was at our back! Mile 12 was a mess and I alternated between smooth running and stomach saving pace, ending up with my slowest mile of 7:16. I was able to collect myself and ran mile 13 in 7:06 pace. I failed to stop my watch after crossing so have no idea what the last .1 was but I just tried to stay smooth and didn’t do much of a kick.

Is it easy to be excited about my second slowest half ever? Not really. Am I thrilled for the effort it took to accomplish my B goal? Yes! I have had a tough season of training and to be able to run a 1:32 comfortably off essentially no training is something even I have to begrudgingly be proud of. The best part, however, is that it left me hungry for more. I want to get back to being 10 minutes faster, to chasing that sub 1:20 and my Olympic Trials qualifier. I want to push my fitness forward. Onward and upward!

Week in Review 4.3.17 to 4.9.17

Monday: Kicked my own rear. 1.5 miles at tempo up the UVM Bike Path, 1 mile at T on the track and 2 by 200 all out (ha!) on the track. Did this full body lift and loved it!

Tuesday: 4 mile recovery run in the torrential rain. Quite miserable.

Wednesday: 2 miles easy plus round robin lift.

Thursday: Off day. Didn’t totally intend to do an actual off day but exhausted from my first week back in the ICU.

Friday: 3 mile shakeout run with 5 by 1 at MP, 5 by 1 at T Pace.

Saturday: 2 mile warmup then Half Unplugged at Steady State pace. Finished in 1:31:54. Super happy with my ability to do my workout and not overdo it despite two early miles that were probably too aggressive.

Sunday: 5.25 mile recovery run in 60 degree weather. Amazing!

Total Miles: 37.6

Quite pleased with this week. I started up in the SICU again this week (read, dead legs from all day standings) and still managed to get some reasonable training in including a huge workout yesterday at Unplugged. It was mentally challenging not to press as hard as I could but I was really happy to get a controlled tough effort in and am especially happy today as I’m tired but not trashed.

What I’m most excited about, however, is that I am much more interested in training again! I don’t know if it’s the weather or getting something like Unplugged under my belt, but I’m ready to get back into workouts and start the improvement cycle.

One thing I did differently this week was run after work. I have to be in by 5:30 and with our current schedules, it’s hard to go to bed early enough to get good sleep in time to get up at 3:30. Even with compression on, my legs were miserable but at least I got some runs done in the light! For this week, I’m going to try am workouts and see if it’s better.

One thing I didn’t do well at this week was hydration. It’s hard to drink enough water in the ICU because we can’t have water on our work stations and we spend a lot of time running around trying to keep critically ill patients safe. Every day this week, I would come home completely parched and realize that the only water I’d had was in my coffee. I need to prioritize drinking more water this week so I’m not so miserable by 6 pm.

 

Week in Review 3.27.17 to 4.2.17

What?! A real week of training?

Monday: 5 hilly miles in Asheville. Made a dog friend on my run who followed me for 2 miles. His name was Finn and he was a sweet old guy who loved to run. Happy to reunite him with his dad, however!

Tuesday: 6.4 miles with striders. Super slushy out.

Wednesday: Humbling 7 mile progression run. Legs after.

Thursday: 6.2 mile recovery run. As I thought for 90% of this run, getting back in shape is the pits!

Friday: 4.5 mile run.

Saturday: Another snowstorm! 12 miles on the treadmill. Mind numbing but happy to get a longer run in.

Sunday: 3.4 miles plus this arm workout which was a killer. I can barely type.

Total Miles: 44.5

This week was humbling with a capital H. Almost every run (except my long run thank goodness) felt like a total slog and I spent most of the week being grumpy about being out of shape. That said, I am beyond grateful to be able to run and lift almost at a normal level (and for friends who reassure me that my out of shape isn’t that bad). I was also extremely diligent about my pre-run mobility drills and glute activation exercises, so it’s not surprising that I was sore and tired all week.

The week ahead has the Unplugged Half Marathon and I am looking forward to it! As I’ve said, I’m going to treat it like a workout. My plan is to warm up, ease into the first 2 miles then run at steady state pace until Mile 10. At Mile 10, I’ll try to pick it up if I can. I will be wearing my Garmin to make sure I don’t get over excited and to get a sense of where my fitness is. In my dream world, I would come in under 1:30. In a more realistic world, I’d like to be under 1:32 and feel like I executed a great workout and felt comfortable cruising along.

For the rest of the week, things will be as normal. I start in the SICU tomorrow morning (my last requirement EVER in medical school) and will be back to running at an inhumane hour until I figure out what my schedule looks like.

Week in Review 3.13.17 to 3.19.17

Monday: 2 miles easy. Downhill skied.

Tuesday: 2.5 miles easy. Downhill skied again as Stella rolled in. Shoveled the first foot of snow in the evening.

Wednesday: Shoveled the second foot of snow (and the next 6 inches). Downhill skied in the most amazing powder ever.

Thursday: 3 mile run easy.

Friday: Match Day!

Saturday: 45 minute nordic ski at Catamount.

Sunday: 5.75 mile run outdoors.

Total Miles: 13.2

The first big news is that we Matched!!! We will be heading to Asheville NC and Greenville SC for our General Surgery and Emergency Medicine residencies respectively. We were incredibly lucky to interview at a whole host of amazing institutions and are looking forward to starting our careers in the Blue Ridge.

To see just how excited I was, here’s a great video my friend Jack got of the whole shebang:

We also got an INCREDIBLE snowstorm on Tuesday and Wednesday that dropped 30 inches on Burlington and an insane 58 inches at Bolton Valley, which is where I am lucky enough to have my pass. I spent the first three days of the week bombing around on my skis and Wednesday was easily the best day of skiing of my entire life.

I was also able to start doing some easy running this week. I was doing well and excited to get back to normal running…and then my steri-strips fell off which leaves my incision in direct contact with my sports bra. I did finally get 6 miles outdoors in today and although I felt 100% out of shape, it was good to get out there.

One of the nicest things about knowing where I’ll be for residency is being able to plan upcoming races! I now have my schedule set through June and have even been doing some longer range planning for my fall sub 2:50 marathon.

For this week, I’m trying to get back into regular training while also listening to my body. At this point, it’s clear that Unplugged is going to be a training run but I’m hoping to set myself up such that it can be a great workout as well.

Week in Review: 3.6.17 to 3.12.17

Monday: I didn’t have high expectations for this run. I’d been sick and expected to basically survive this. Instead, I had a darn good run! Warmed up then 2 by 2 mile at tempo pace on the track. First set was 6:32 pace, second set was 6:23 pace. Both felt totally in control.

Tuesday: Surgery Day. Didn’t do much besides sleep in the OR, sleep in PACU and sleep on my couch.

Wednesday: Back to class. Short walk with the dogs.

Thursday: Light arm lift with resistance band workout from here.

Friday: Hour walk in the woods with the dogs.

Saturday: 20 minute uphill (10% grade) walk on the treadmill and at-home Barre routine from here. 

Sunday: 20 minute jog on treadmill. Light arms and legs.

Total Miles: 10.3

I had no expectations that this week would be a big one for running. My hope was that I could get a little physical activity in for sanity and heal up so I can get back running soon. I attempted to run on Saturday but a few steps in, knew that it was too soon and settled for an uphill treadmill walk. Today, I was able to do an easy jog.

My restrictions are 1) no strenuous activity and 2) no lifting anything heavier than a milk carton. The latter is pretty objective, the former not so much. What is strenuous? For me, a jog isn’t technically strenuous but perhaps it is on a new scar. I chose (and this is NOT medical advice) to let pain or discomfort be my guide. If anything felt off, I had to stop doing it. I’ll continue that plan through this week. Suffice to say that New Bedford looks to be out of the question. I’m adding some other local races, however, in hopes that I’ll heal quickly enough for those.

There have been two major upsides from this week, however, besides the obvious of a safe, successful surgery. The first is that since I haven’t been running, I’ve had a ton of time to deal with my to-do list. I’m psyched to say that today, I finished a first draft of my manuscript and that by Tuesday at noon, my goal is to have a completely.empty.to do list. Can you imagine?!?

The second upside is that I’ve had to be creative about lifting options and came across some really fun (but really hard) low weight ones. If you think you’re in shape, I encourage you to try to resistance band one. In full disclosure, there was no way I could do 100 of the lying pullovers. I did 50 and literally couldn’t do another one.

The other exciting news for the week is that it’s MATCH WEEK!!!! Tomorrow at 11 am, we find out if we matched via a cryptic email that just says yes or no. On Friday at noon, we have a big ceremony at school (as do all 4th year medical students) where we open envelopes and find out where we’ll be going for Residency. I think I’ll breathe a sign of relief tomorrow at 11 but I have a feeling it’s going to be a long week.

Week in Review: 2.27.17 to 3.5.17

Monday: 10 K of skate skiing at the second part of the State Championships. Kids did AWESOME. Boys ended up third overall and girls were second. Such a fun day and an amazing end (sob) to my coaching career (for now).

Tuesday: Back to reality. 4.5 mile run before work. Legs totally exhausted from skiing. 300 abs at night.

Wednesday: 7 mile fartlek workout with 5 by 30 second hills hard then 4 by 2 minutes at tempo pace.

Thursday: The post call day that just wasn’t. Didn’t leave the hospital until 5 pm and then had to pretend to study for my national shelf exam that was happening Friday morning.

Friday: The niggle of a cold on Thursday turned into a full-blown cold by Friday morning and it.was.gross. I brought a roll of toilet paper to my exam and apologized profusely to my classmates for the 2.5 hours of sneezing, sniffling and nose blowing. 5 miles on the trails behind my house, however, between components of the exam.

Saturday: Down for the count. Couldn’t breathe, think or move. Since Will is gone for the next month, we attempted to have a nice day together but all I could manage was a coffee shop and then sneezing my way through the rest of our errands.

Sunday: Still sick but decided to move (slowly) to try to feel better. 5 miles on the trails again. Didn’t feel great but didn’t feel awful and I’m glad I got out there. Arms afterward.

Total Miles: 27.2

Total February Miles: 137

I am the poster child for burning the candle at both ends right now. I had a few threats of sickness over the past few weeks but was lucky and never fully crashed until Thursday, just in time for my first full weekend off in a while. Compounding this is the fact that tomorrow (Monday) will be my last run for a week because of my Tuesday morning surgery. As I said to Erin Lopez yesterday, this winter has been a total bust for training and only some of it has been in my control. I’m obviously going to play it by ear this week and let pain be my guide but my hope is to be doing light cardio by Thursday with hopes that I can be back to running for next Monday. After that, it’s scramble as best as I can until Unplugged and hope for the best!