Flashes of our vacation

It's been a roller-coaster. Everyone reading this has already read the Girl's blog so they know what happened to her pregnancy. The last two days have had lows and, surprisingly, some good highs. One develops a morbid sense of humor on a day like yesterday and we both laughed when the Girl pointed out the fact that the remains of our would-be baby ended up in a trashcan outside Duluth Running Company.

I'm far from an obstetrician and the times I have dealt with pregnant ladies in the ER, I try to get them out to a "higher level of care" as soon as I can, ie. as far away from me as possible. My skills go as far as to do an exam to see if the cervix is open and the lab can check to see if there is amniotic fluid in the discharge, meaning that the water has broken. So I have never, not even as a student, seen a spontaneous abortion in progress. The Girl, as it turned out, had been carrying a non-vital embryo for weeks, although the pregnancy hormones were still quite elevated and she certainly had a lot of symptoms of pregnancy. I can't claim to understand this, actually, but that's the working diagnosis.

So she actually had to deliver this little 4mm sac, in a way. With back cramps and everything, she passed several clots over the day, each of which was inspected by us both. Sometimes knowing a little is worse than knowing nothing, as when we looked at a hard little seed, that had the shape and feeling of a scaled-down grain of rice. Could this be it? If so, it blew off the Girl's finger and now rests near Big Manitou Falls south of Superior, WI. But her cramps continued, and as I was looking at my fat, hairy legs in a pair of Sugoi running shorts in Duluth Running Co, the Girl passed the above-mentioned clot. In Danish, she briefly let me know what was going on and we went outside to play embryo pathologists. The ultrasonographer had told us that the actual remnants of the embryo, and who knows if there was ever a viable embryo per se, would be 1mm in size. We found nothing and dumped the clot in a trashcan. Miraculously, and this is the part of the story I have working up to, the Girl felt completely normal. No backpain, no cramping. Within the hour, her little potbelly disappeared and we even think her face changed a little from some swelling disappearing.

Okay, so we dealt with it through a very mechanistic lens. We already have the Lorax so we know we can make normal babies. This one just wasn't going to happen.

But out vacation has been other things than losing babies.

I taught my son, Andreas, how to ride a bike. After two frustrating hours of me trying every trick I could think of, he suddenly got it. Now, we have cruised around Riverside Park in La Crosse so many times that he knows every landmark there and comments on them. I run behind him with a broomstick stuck attached behind his seat. I save his life every quarter mile or so, but the saves are becoming less frequent and less impressive. It's our thing now; he even talks to me on the phone up here in Duluth, which he never did before. I can't wait to take him out again on friday, when we get back to La Crosse.

I ran a 5K race in 16:32 on a super hot night. The winner, Sammy Korir, ran more than two minutes faster... Still, I was happy with my time. A group of fast people showed up and I was actually in 6th place for most of the race. Did get into fourth with a half mile to go and was closing in on the Duluth Running Co guy in third. Didn't quite get up to him but the dead embryo in his trashcan should teach him a lesson.

Vacation!

We're off to a summer vacation to Wisconsin, Minnesota and Thunder Bay, Canada. We're not working at all, so it's a rare three weeks with nothing on the agenda but to enjoy ourselves.

Of course, our vacations aren't really what you consider normal. There's always drama when we come to town. I expect my son to bond with me more than he does, and he gets overwhelmed with having his dad in town, spoiling him for a precious few days. It usually leaves him moody and ill-behaved and doesn't bring us any closer. This time around, I want to teach him how to ride a bike. I remember teaching Natali when she was 5; she was a slow learner but finally came around.

My son, Andreas, is almost 7 and very tall for his age. He still can't ride a bike for unknown reasons. My ex-wife says she has tried to teach him but that he is just too scared. I see it as a sign that he is left immature in this and other ways, because he has no dad; this makes me feel guilty. I also see it as a sign that my ex-wife has too much going on in her life to spend the time teaching him how to ride a bike. He isn't in any sports either and has no close friends. This annoys me, but there is nothing I can do about it.

We talk about the kids, and invariably end up fighting. I bring up the unfairness of having to pay exorbitant child support and she threatens me with not letting Natali spend the next year in Denmark. I consider the implications of an all-out war between us: we have shared custody but she is designated the primary parent, even to Natali, who has lived with me this last year. I would have to stay in Wisconsin for the court proceedings for the tiny chance of getting a judge to let me get custody of one or both of them.

I don't want that at all. I don't to fight and I would lose, anyway.

We are actually caught in a weird detente. I pay generous child support; generous even if she had both kids living with her. Wísconsin child support actually thinks Natali is staying with her. So I don't bitch about the child support and she lets me keep Natali. If she were to open up the war, her child support would certainly be reduced; whereas I would lose Natali, should I fire the first shot.

This makes it sound like we hate each other. Quite the contrary, actually, but these cimcumstances are so hard to deal with that there is bound to be ample disagreement.

So, yeah, not a normal vacation. The Girl and I are taking one week away from all three kids, though. Yes, that's right. My mother-in-law, thankfully, has more than a thing for her Danish-speaking, blond grandson and has offered to watch him for a whole week! It's insanely sweet; and this is where Minnesota and Thunder Bay come in. Just the two of us, feeling young and unburdened. The best part, of course, will be coming back to the kids when it's all over, but the second-best part is us alone for a whole week.

The running is going well. I have been doing intervals and feel smooth, light and fast. It's not a PR-setting shape at all. More like the kind of shape where running is fun. I'll be pacing the pregnant Girl at Voyageur next weekend. Well, maybe not pacing per se. More like taking pictures of her and trying to not get in her way; she hates it when I run with her during races. Probably, my main task will be to get her to take it easy. For all her running-in-pregnancy bravado, she isn't planning on racing hard - but may need to be reminded once the gun goes.

And boy am I glad I am not racing. I think my range may reach as high as 50 miles in the next few years but not yet. Voyageur was terrible for me last year, so, instead, I'll do the 5K fun run the night before.

Welcome back, intervals

My running seems to be getting nowhere.

Last week, we ran a marathon that was supposed to be a training run and I ended up dropping out. I ran the first half in 1:26, which turned out to be too fast. I think the problem was that I had expected to easily finish in the top 3, based on last year's times. It was won in 3:02 last year, but this year the winner came in in 2:44. Not sure what happened there.

Anyway, I got really nauseated at 30K and couldn't run anymore. The legs still felt ok, but things just weren't passing through my stomach anymore and I decided to quit. I used the same nasty gels that I used at the Copenhagen marathon, where I got stomach cramps, so I have promised myself never to use them again.

Overall, the picture is clear, bad gels or not. This spring, I have run a 50K and three marathons about a month apart. I tapered for each one and they all left me too sore to run for a week afterwards. The first race, Hells Hills, went really well. The next, Copenhagen Ultra (I just ran the marathon), also went really well (2:50 without really trying). Then the Copenhagen Marathon didn't go well (2:49 while really trying) and this last one just plain sucked. The overall picture is that I need to train more and race less.

The good news is that I have a decent base and I'm 95% injury free. My right ankle still bugs me a little but it feels like it will abate on its own. So, starting tonight, I'm doing two interval sessions a week.

I don't have any big races coming up. Sometimes, it's nice just to be able to concentrate on training.

Natali

Natali is almost at the end of her first school year here in Denmark. She has come a long way from the first day I brought her to school and all the girls stared at her. I told the class that she could understand a lot of Danish, but couldn't speak much, because she had lived abroad for so long. They stared some more.

And she was different from them in other ways. They are almost all blondes, and the ones who aren't are still of much fairer complexion than her. Mind you, she doesn't get her melanocytes from me. She also dressed differently with her jean shorts, t-shirt and flip-flops. Her hair was short and rarely, if ever, organized or combed and she never wore (or wears) two matching socks. The girls in her class wore very expensive fashion-conscious outfits.

Her first few weeks were tough and she took a nap on a couch in school on two occasions, because trying to fit in was so taxing. She simply lay down to sleep, because it was a way for her to get away for a little bit. But thankfully her Danish kicked in very quickly and she inched her way into a trial membership of a group of girls.

Natali weighs a little bit too much; she has always been a little heavy but gained a few dangerous pounds during the divorce. But she carries it well and certainly didn't stick out in her school in La Crosse. In Denmark, her weight is something the girls comment on, sometimes to be mean, sometimes simply because it's something to talk about.

I worried about the girls teasing her; but it didn't turn out that way at all. I think her accent helped a lot, and the fact that she could sing along with the Jonas Brothers and Miley Cyrus. The accent disappeared quickly but she is still able to throw in an unusually constructed sentence to seem exotic. She is not a great singer but when I asked one of her friends how music class was, she said that Natali was, of course, the best singer in her class. Amazing. She even composed a rap song about how people shouldn't call her Natali but Natty (Natty is very un-Danish), and people made their own versions of that song.

So, to my surprise, my little poorly dressed pot-bellied daughter became supremely popular in school. She pressed her luck by asking Simon to be her boyfriend; she was turned down immediately by email. A few boys made fun of her, but the girls stood by her.

She is still bothered by the fact that we live in an apartment, as opposed to her friends' big houses by the river. She begs us to buy a house in the neighborhood by the school, so she can walk over to her friends' houses to gossip and jump on the trampoline. Even though she is popular, she is still different from the other kids, and they are all very aware of it. Right now, my ex-wife has only allowed me to keep Natali here until the summer of 2011 (which is sooner than we plan on moving back, so there is a shock waiting on the horizon), and Natali talks about this with her friends. Even though it's more than a year away, she worries about having to leave and told me the other day that she wants to stay in touch with everyone on Facebook.

Lately, I have worked a lot of nights. When I leave, Natali often breaks down in tears and cries herself to sleep in bed, because I am not there. Not that she doesn't like the Girl, but they are more like friends than mother-daughters. I read the Hobbit to her these days (or, actually, she reads it to me). We lie in bed and whoever is not reading gets hair rub from the other. It's heavenly quality time but when it's over, she wants me to tuck her in and come check on her again and again. It's separation anxiety to the extreme, brought on by the divorce and the constant changes that followed.

She leaves for a long summer in la Crosse in less than two weeks. Her first trip as an unaccompanied minor, from Copenhagen to Chicago, where her mom will pick her up. when we went back in March, she loved her new step-sisters and had a great time. She didn't want to return to Denmark and cried for days, because she missed her mom so much. I worry about how she will feel after 6 weeks.

I worry about her about her in so many ways every day but she also brings me so much joy in life. I often think of how wonderful it is to have a 9-year old daughter and be able to see the world through her eyes. I worry about her, feel gut-wrenchingly guilty about my son in La Crosse, and feel confident that, no matter what, the Lorax will turn out okay.

The Evils of Screening

The other day, the Girl wanted to try her fancy ophthalmology equipment on me, before unleashing it on the population of Southern Zealand. She checks vision and refraction with a fancy machine, checks for strabismus and color blindness and then takes a photo of the retina. I cruised through the first parts of the exam and was diagnosed with perect vision and refraction. Ahh. Of course I knew that doctors are immune to illness, but confirmation is always nice.

Then she took a high-resolution photo of my left retina. No signs of diabetes, hypertension, age-related macular degeneration or other disease. She focused in on my right eye, the blinding flash went off and, almost before I could see again, she exclaimed "huh?". She took another picture to make sure what she was seeing wasn't an artifact, but whatever she had seen was apparent in both photos. She let me walk around to the doctor side of the room and see what had surprised her. There was a little crescent-shaped brown lesion between my optic nerve and my macula. She had no clue what it was, but it wasn't supposed to be there.

The Girl being a lowly resident, I hoped her attendings, including a renowned retinal speicialist, would be able to tell her it was nothing to worry about. Instead, after getting multiple opinions, she told me that it was "most likely not cancer" and that it might be a scar or toxoplasmosis. The advice was for me to get it checked out. How, I asked, followed by a pregnant pause. By getting a new retinal photo in a few months. Good thing I am married to the woman doing a population study using retinal photography, huh?.

Or maybe not. Ironically, I have always told the Girl that she has to worry about the incidental finding on her screening exams. She plans to have a clinic day a week, dedicated to the patients with newly discovered disease. Or at least to the ones with disease beyond the scope of a regular ophthalmologist. It has been a complete unknown how many patients she would have to work up through that clinic, and what problems they will have. Thing is, no one has ever done a study like hers before. Right now, her only patient is me (and my odd lesion that's probably not cancer).

Her study starts on Monday.

Screening for disease is an accepted medical practice in clearly defined areas of medicine. Pap smears, colonoscopies (or at least sigmoidoscopies), cholestoerol and blood pressure screening have solid data behind them. A yearly TSH, checking for thyroid disease, might; I am not sure. The screening exam known as the annual physical exam has no data but is still performed in some parts of the world.

Then we have the controversial modes of screening, PSAs and mammography. Honestly, if one cuts out emotion, these tests would have a place in medicine, but they wouldn't be used in population screening. Some studies have shown no benefit, but considerable harm; others have found a small benefit, but considerable harm.

Screening is a huge industry. Take a woman, who carries a small early cancer that most likely will disappear on its own. Imagine the money involved in the follwing process: first she get s mammogram, where a density is seen. Then, she gets an ultrasound or maybe an MRI. A biopsy shows cancer and a lumpectomy is performed. She may get adjuvant radiation and chemotherapy and almost certainly hormone treatments for five years. That's a lot of money. And, a woman in her 50s with no other health problems, is a perfect patient. She has good insurance, shows up on time, pays her bills and has no annoying questions about other health problems.

Drug companies and makers of medical equipment make tons of money on this. Every time a patient is brought into the sick group, it's a boon for the industry. Most physican opinion leaders are sponsored by these companies and the studies conducted by them are sponsored by the same companies.

Many studies have shown no benefit of PSAs and mammography but, interestingly, people aren't happy to hear this fact. Well, some men are happy they don't have to worry about PSAs (and some aren't), whereas most women all determined to get their mammograms. The typical news release talks about a study showing no benefit, as though the result is controversial. Experts then talk about all the limitations of the study. It's rarely mentioned that the experts are sponsored by the drug companies. Sometimes women, whose "lives were saved" by screening, comment too.

And I think there is the rub. The men and women, who have "been saved", are hard to ignore. Of course, out of a hundred women with minimal cancers at diagnosis, only very few (if any) have been saved statistically. But we can't tell who is who. The 98% of women with parts of their breasts missing, having gone through radiation, chemo and hormone therapy, would have done just fine without their mammograms. Of course, we tell them they have been saved. Who the heck wouldn't say that? I have done that over and over again, myslef, and I'm not sponsored by anyone; it's just human nature to paint an optimistic picture.

Drug companies are everywhere. At my previous department, the makers of the different hormone treatments, came to visit all the time. I should say that chemo and radiation are both pretty cheap, but the hormone treatments, including anti-estrogen therapies, aren't. They bought fancy lunches, paid the attendings well for speaking to patient groups and invited all of us on trips to various conferences. Needless to say, as doctors make less money these days, the companies are very influential. I know an MD/PhD, who works in endocrinology, which is generally not very well paid. I imagine he makes more money doing drug talks than he does working as a doctor. And he is the one making guidelines for the hospital about when to use which drug. He is a nice guy, but does anyone really think he isn't biased?

So we have patient organizations, doctors, hospitals, drug companies and makers of medical equipment all in favor of screening that has minimal or no effect. No politician or even insurance company will dare come out against screening.

Imagine a pill that prevented an occasional cancer. Some studies even showed it prevented no cancers. It had horrible side effects, including severe anxiety, humiliation, pain, the loss of a prostate, impotence and incontinence. And it was supremely expensive. Would that pill ever get approved? Then what is it about PSA screening that makes it acceptable?

I worry about the future. People are getting screened with CT scans, sometimes out of trailers in parking lots. This screens for atherosclerotic heart disease and aortic aneurisms, and a lot of incidental findings better left alone. Every time a diagnosis is made, a work up plan is formulated and a medication is started, someone is making big bank on it. The industry wants people sick; that's just the way it is.

Take a field, where no one is making any money: old folks with multiple medical problems. Care is getting so fragmented that an old patient often sees 6 specialists, who treat "their" organ with disregard for the overall picture. Having been briefly in primary care, I can testify to the fact that being the quarterback on such a patient is impossible. Often, the patient complains of fatigue, pain or general decline. Each specialist points out that their organ is doing well and generally presents an overly optimistic picture to the patient. It takes a brave and skillful family doctor to cut through the clutter, start reducing meds and discuss the fact that old age is cathing up to the patient.

Reimbursement is extremely poor in these complicated old patients, so there is little incentive to improve care. Many folks have miserable deaths, because there was no time and money to formulate a living will or simply have a talk about what the patient's wishes were. A fraction of the cost of screening could sponsor the palliative care programs and multi-disciplinary meetings that are so sorely missing.

Never Again

At least I stuck with the plan. Came through the half in 1:21.10, so just on track. Came through 30K in 56:50ish, which meant I was starting to slow but still had a sub-39 10K average. Up until this point, I felt inappropriately smug, drafting well, eating well, feeling well. At 30K, had you asked me, I would have said I was ready to speed up.

The slowdown came at 32K. At first, it was stomach cramps, which I have never had before. I was running with a guy, actually leading in the headwind. I had to slow down and told the guy that I was having a crisis and asked if I could sit behind him for a while. There were little ups and downs over the last 10K but, overall, I slowly came apart and got passed by some 20 runners.

Dead man (very close to) walking:

My time was low 2:49, so just a measly 90 seconds faster than my training marathon 4 weeks ago, where I started slowly and ran very negative splits. I kept imagining the ghost of 4 weeks ago, running behind me in that last 10K, passing people while enjoying a huge runner's high. Honestly, had the ghost known about me, he would have caught me.

Where did I go wrong?

1. Started out too fast. I'm probably just not in shape for a 2:42. It sure felt easy but I guess that's no guarantee. Maybe if I had started out running a 1:23 half marathon, I wouldn't have imploded. Too late, I've vowed never to set a goal time in a big city marathon. If a low 2:40s is in my future, it will come off a slowish start and deeply negative splits.

2. New gels. We bought a new kind of gel (Multi-Karbo?) at the expo before the race. BOth flavors (orange and cola) tasted like overly concentrated melted popsicle. The new kind of gel may explain the stomach cramps but not the whole deroute.

3. Weight loss? I lost quite a bit of weight leading up to the race, from stress and lack of time to cook. It surprised me how easy it came off.

4. Training on trails. I haven't run on roads, barely, this whole winter and spring. I love training on trails, but perhaps the pounding of pavement for 2 hours was too much for my spoiled lower extremeties.

The Girl's race has been well-documented on her own blog. I think the pressure got to her, as it got to me. People have been guessing finishing times that were unrealistically low, and she went for such a time. She is fine and is already looking at other races. We will probably do a trail marathon in 4 weeks.

Copenhagen Marathon Preview

Oh boy. The marathon is getting close. Before most races, I am nervous but also excited. Before this one, I'm nervous and just want to get it over with.

I have raced three marathons in my life and all three have been miserable experiences. I ran the Copenhagen Marathon when I was 22 and 23 in 3:08 and 3:09, as I recall. Both times, I did what young guys often do: started out fast and finished slowly and in pain. The first time wasn't 100% bad, mainly because I didn't know what to expect and that seemed to make the race go by faster. The second time, I remember cramping up in my legs and abdominal muscles after the race, while throwing up. I vowed never to run a marathon again but did, anyway, the same summer. This time, it was the Paavo Nurmi Marathon in Ironwood, MI. Same thing: cramps and vomiting and a promise never to do it again.

Fast forward ten years, and I have run a few ultras with mixed success. This winter/spring, I have even run (but not raced) two marathons, in which I have started out slowly and sped up at the end. This last one was in 2:50.

If only there was another big race after Copenhagen, so I could sandbag this one under the guise of using it as a training run. But this is, unfortunately, the target race and there will be no starting out slowly. I may as well state my goal: 2:42 (ie. Steve Quick's PR. He has PRs in all the shorter distances that I will never beat but his marathon PR is weak, comparably). Some might say that cutting 8 minutes off a 2:50 "training" marathon shouldn't be too hard, but when I look closer, I start to worry. I'll be going for a 6:08 per mile pace, which amounts to 38:20 per 10K. Now, I don't think I can count on running negative splits on Sunday, so I actually have to start out running the first 10K in 38:20 - or less. See, that seems pretty fast to me and it makes me realize that I am risking a complete collapse in the second half of the race. In fact, I could end up running slower than the 2:50.

So, yes, I have been toying with running without a watch and simply going by feel. It sure would make for amore enjoyable experience.

There are other worries. I seek out small races where I have a chance of winning; and this to the point of now having been in a race for years, where I couldn't line up in the front of the pack. I can't do that on Sunday; the fast people (including women; I will get chicked on Sunday!) will look at me and wonder who the old, fat man is. There are 12,000 runners all starting at once. There are probably going to be fences and corrals and guards and a fair amount of agoraphobic activity on my part. I should rightfully be able to line up near the start, say close enough to see the front. But I'm not even sure I can find the front with all the people there. I worry a lot more about this than I should.

I have even devised a cop-out plan if I get stuck somewhere in the middle of the hoard of runners: just start out slowly and enjoy the day. What a thought, huh?

The Girl has tapered by running the least this last week I have ever seen her run since she was pregnant and injured. Instead, she has biked with the triathlon club and swum several miles. She is ready to rock and will easily PR. She won't break 3:20but it will be close.

My claim to fame during the Copenhagen Marathon will be my friend Justin Stakston, who is coming over to run - and win - the race. Justin has a PR of 2:27, so winning might be a tall order. He could podium, though, which in itself is huge in such a big race. I know the course snakes around the city, so I am hoping to see the front group a couple of times. I should mention that the Copenhagen Marathon is one of the few big city marathons in Europe that doesn't offer money prizes, which means there is no group of second-tier East Africans showing up to lay claim to the top 10. It's usually won in low 2:20s by an elite (but non-pro) foreigner or by a fast Dane, especially when the marathon doubles as Danish Nationals (it doesn't this year).

Finally, there is an issue with my right foot. It goes back to this winter, when I ran obsessively on snowy trails in heavy trail shoes. A point on the outside of my right foot, which I think may be the insertion point of the short peroneal muscle, has been aching. Just aching but not enough to stop me from running or racing. It warms up and goes away during longer runs and races but comes back afterwards. I thought it would disappear for good during my marathon taper, but instead it has come back even worse. I don't think I will feel it during the marathon but I fear that it might turn into a real injury afterwards.

Report follows.