Sunday, October 07, 2012

Some Help from the Maggot Gallery, Please!


I get a fair number of emails asking for running advice, and I answer woefully few of them. (I don’t even answer lots of my work emails these days; I get about 70 daily and if a particular email is not among the 20 that require immediate attention—unless it arrives fortuitously in an interstice of activity—it may not get answered for weeks, if ever.)

So I’m calling out to the experienced Maggots to help me with the following questions. Some of the issues call in part for medical expertise, but many do not, and I know that my readers are steeped in Maggot and other wisdom and could answer some of these better than I could even if I had the time.

Please help me address the following:

Question 1, from Liza:
Do you have any tips on running to lose weight? I gained a lot of weight about a year and a half ago after going on SSRIs—I’m 5'4'' and in less than 6 months went from 125 lbs to 160. The weight gain was probably due to a combination of the meds and no longer being depressed (during the worst of my depression I had truly no appetite). My shrink and primary doc have told me not to worry too much about now technically being overweight, and I trust them. Clearly, suicidal ideation is much more dangerous for my health than the extra pounds. I am in pretty good shape—I bike to work everyday (about 15 miles total) and swam regularly over the summer. However, I would like to lose at least some of the weight, both for vanity reasons and out of concern for my health. I started running a month ago with the hopes of losing weight, and while I feel great with the extra exercise, my weight hasn’t budged. In fact, I actually GAINED a couple pounds. So any tips on how a beginning runner ramp it up and start losing some weight? I’m not totally opposed to dieting, but I already eat very healthfully, so I feel like there’s only so far I can go on that end.

Quick answer: read this post, but I know there’s a lot more you all could offer.

Question 2, from Kristi:
So. Have always had the motto “If I’m running, follow me 'cause some bad shit’s happening behind me.” I have exercise-induced asthma, environmental allergies, and bad knees.

BUT. I’m sick of feeling like crap and want to eventually be able to run without my lungs spasming. I also want to be able to run with my high-energy dog in hopes of finally wearing her out for once.
How can these two things happen together? How can I train myself to run with these three problems (I’ve read all of your advice on running as far as I’m aware, and have never seen a “I have a clusterfuck of RUNNING HATES ME problems, halp” post, but maybe I missed one) without some serious issues, and how can I train my dog to run with me?

Quick answer: You’re going too fast. Almost anyone can run despite many strikes against you if you do it slowly and carefully. And, this sounds a lot like exercise-induced asthma. Other advice from the Maggot gallery?

Question 3, from Covered in Issues and Wanting to Run:
So, I’ll start by saying that I have been walking with only a tiny bit of running, because hey you have to start somewhere right? Every other day for the last 2 weeks…and I LOVE it! I love the running part of it. It’s addicting. I’ve always wanted to be a runner, but let’s face it… I’m SO CLUMSY and SO OVERWEIGHT that I thought it was pretty much not even feasible.

Here’s the rundown on the issues I’m facing and would like to overcome because I HAVE to get my health in check before I become diabetic like my parents or have a heart attack like every other fat person. I’m 26, 5'11'', 290 lbs (I was 311 post-baby, so I’ve been working). I have severely touchy asthma. I lose breath (not just get out of breath, but my lungs tighten up) when I am physically active, have a cold, during allergy season, you get the picture. I’ve been running, but only for 1-2 minutes at a time because I get SO out of breath I can hardly see straight; I’m also getting the WICKED side cramps.

Now, I’m starting to get shin splints. Last time I got shin splints was in middle school PE and within a week they became stress-fractures (in both tibias) and I had to be in a wheelchair for 2 weeks. Suffice it to say I can’t afford to have a 1 year old and be in a wheel chair, and I decided to run to make me HEALTHIER, so WHAT the hell am I supposed to do!?!! I don’t have health insurance (yet: it’ll start in December), so going to the doctor is limited. I’m considering going just for a new inhaler.
I would appreciate any and all help you can give me. Thanks in advance for even reading this!

Quick answer: Yet again I say, SLOW DOWN. Side cramps = going too fast. Re: asthma—you will have a hard time without an inhaler. Other advice?

Question 4, from Didi:
What do you think about Jeff Galloway’s Run Walk Run? 

I tried getting myself into running slowly by your method some time ago and kept getting short of breath—realized it was exercise-induced bronchospasm and did better with some albuterol, but then my enthusiasm kind of faded. A friend convinced me recently to sign up for a half marathon (it was 8 months away at the time), and I have actually been running 2-3x/week using Run Walk Run (this is a lot for me since I’m a 2nd year resident with a 6yo and always exhausted). I’m in a rut in the sense that I’ve been having a lot of trouble increasing the run portion and the total run/walk time (haven’t gotten beyond running for 2.5 min max before walking and beyond 40 min total run/walk). 

I’d appreciate any advice!

Quick answer: Slow … oh for heaven’s sake you know the rest. If you can’t increase the amount of time you’re running and keep having to walk, you’re running too fast. Maggots? What say you?

Question 5, from Amy:
Do you have any tips for running with rheumatoid arthritis? (Don’t worry, of course this is not a substitute for real medical advice from my doc!) I’m a young person (and med student) who used to be a dedicated runner—NEVER fast, but used to run 6-8 miles most days and LOVED it (college). Diagnosed with RA last year, quit even trying to run b/c of the pain. Whenever I’ve asked about exercise, I’m told “well, if it doesn’t hurt it’s ok, if it hurts don’t do it.” Thanks guys. But I really miss running, and it’s the most convenient way to exercise with my schedule. Problem is that every time I get excited about trying it again is when I’m in a flare … Thanks, love your blog!

Quick answer: running most days instead of every other day is a recipe for injury, so if you’re doing that again, STOP. What else?

Help them out, Maggots.

12 comments:

Old MD Girl said...

For the person who wants to run with the dog, first a question: Does your high energy dog *walk* well on the leash now? Or is your dog constantly pulling, darting this way and that after cats/squirrels/other dogs/etc? If the dog doesn't already walk well on the leash, you need to get that down before you can expect the dog to run well on the leash. At least that's been my experience with my (reactive, high energy) pit bull mix.

Some people have success running with their dog OFF leash, but I am far too paranoid to do that. I wouldn't recommend it even with a well behaved dog because *other* people, children, dogs, and cars cannot be relied on to be well behaved. Also, it is illegal.

You may never get there with your dog. I've tried running with my dog for years, and despite massive improvements it continues to be really unpleasant because of her pulling and reactivity. Instead we go for long walks on non-running days.

As for running to lose weight, I second everything DM has already said. I'd also like to add that pretty much everybody eats more than they think they do, so it's probably not a bad idea to keep a food diary for a week or two. You may need to measure your food to get a realistic idea of how much you're really consuming.

Second, you need to make small sustainable changes to your life to lose weight, and try not to get discouraged if the weight loss is really slow. Most people put weight on slowly, so you should expect it to come off slowly too.

Third, expect that you will have setbacks. Learning to lose weight and maintain a (more) healthy lifestyle takes practice just like any other skill. Don't beat yourself up about the really large meal you just ate. Instead, strategize how you will prevent yourself from doing it again the next time the same situation presents itself.

As for running with RA, I don't know about that... but I used to cycle with a friend who was status post bilateral hip replacements from his juvenile RA. His arthritis actually improved with the moderate low-impact exercise that he got from cycling, and his doctors were shocked. Running may end up being too high impact (don't know), but low impact exercise might be helpful in the long run.

fuzzy said...

Running to lose weight:

Ok, If I kept off all the weight I'd lost in my life, I'd be non-existent. That said, I'm a huge fan of Pale/Primal diets, which are basically no grain diets and are the only sustainable method of weight loss I've found. I lost ~70 lbs a couple years ago, moved and was too broke to do Paleo, so I gained some back and now have lost it again.

When I started running, I used a treadmill and actually cracked the deck from being too fat---so if you go this route, don't buy a cheap one. The decks, though, have a bit more "give" than the ground, so it can be helpful at the beginning. Second: Get good shoes. I don't mean heavily padded, super supportive shoes. Look for zero drop shoes that will encourage you to use proper striding. NB has good one and their Minimus line has some with padding, which I think you need right now.

I had horrible horrible shin pain for the first 2 months of running and then my bones got stronger. At your weight, I might try high intensity walking although the striding is totally different. If you are running, make sure you have a midfoot/forefoot strike and aren't heel striking, or you will hurt yourself.

As for running with asthma: I have it. What i found was that running slower built up endurance and that my trigger point for wheezing moved further away the better shape I got into. Cold makes it much worse, tie a scarf or something around your nose and mouth. When it gets soggy, it will moisten the air, which is actually helpful.

Anonymous said...

Running to lose weight: I started running regularly three months ago and over the past two months have been running three times weekly, 30 minutes at a time most days except sometimes on weekends I go crazy and do a 5k (~35 min for me). I have been using My Fitness Pal, available both on the web and as an app (I use an iPhone, I think it's available for Android as well), to track food and exercise. The app in particular is incredibly helpful as it lets you scan the barcode of the food with the camera, and then automatically pulls up the nutritional info. It can also give you a breakdown of the components of your diet (sugar, fat, protein, etc) as well as calcium, iron, etc. I've dropped 11 lbs and quite a lot of inches in three months just running and tracking my food. I'm also eating a lot better because it's a bit depressing to realize at the end of the day I've eaten a ton of sugar and nothing of any nutritional value.
~GraniteDoc

Anonymous said...

To everybody: Run SLOWLY, SLOWLY, SLOWLY...start with jog alternating with brisk walking. It will take a long time to advance but as you do, it gets easier.

Running and weight...I'll be honest, when I was 25 I could run an extra day each week and lose 10 pounds in a month, now (at 45), not so much. Make sure you are eating enough. Sometimes not eating enough to sustain increased exercise output makes your body hold onto the weight.

To #3, make sure you stretch your calves and shins properly before and after running. Ice your shins after running to reduce pain and swelling. You may need shoes with better arch supports. Do shin strengthening exercises (google them) and make sure you run on softer surfaces for awhile.

Running with RA...no experience with that. Could you alternate running with swimming?

Laurel said...

Unlike other years, I have not had any success losing weight while running this year... I think I'm hitting a metabolically tough age (36) and I like food too much. So I can't advise there except to say that you shouldn't look at the scale but at the fit of your clothes. First of all, day to day, weight fluctuates back and forth a few pounds without much meaning; second of all, lean body mass is indeed denser than fat, so if you get stronger you may slim down without weighing. (I'm pretty sure that's correct, DoctorMama will school me if not!)

Second, about run/walk. YMMV (literallly!) but I tried Couch to 5K for a couple of years and never succeeded at running more than 20 minutes in a row until I slowed down as per DoctorMama.

Anonymous said...

Running to lose weight: As others have said, keep a food diary. Lose It (an app) works for me- you also add in your activity, so you get "extra" calories. I try to keep my calories around 1500/day total, and I've lost about 25 pounds.
Also, cut out sugar and you will see the pounds fall off. Drink tons of water to stay hydrated.
And, I've been slowly increasing my mileage (up to 25+ miles/week) and the weight continues to come off.
I've heard some people talk about how they couldn't lose weight running, but it turns out they were eating every calorie they exerted running. Cut the calories & increase your activity and the weight will come off. It may be a slow process (you'll be building muscle), but it will happen. Stick to it!

Good luck!

AW

aibee said...

Running to lose weight person; exercise as a part of the weight loss solution, but on its own, it's not going to shift much weight. No matter though, as running is an anti depressant in its own right. Run because it feels good, run because you love it. Let weight loss be a consequence of running for the joy of it, rather than the other way around, because looking at it as a weight loss tool kind of misses the point of running for all its other magical abilities :)

Oh, and the initial weight gain? Initially, muscles swell (as a consequence of building stronger muscle fibres from breaking the ones you already have. Another story! Onward!) because you've started using them at a higher intensity than they're used to. Swelling requires fluid, fluid shows up as tighter jeans and higher numbers on the scale. Ditch the scale for a few weeks, okay? They mess with your head (okay, MY head) at the best of times, and the extra weight thing will resolve itself in a few weeks.

Asthma people; have a talk to your own doctor about using your albuterol (or whatever your reliever medication is) maybe five or so minutes before your planned exercise, regardless of whether you feel you need it or not. My own doctor didn't think to suggest this (truth is, he didn't even know abut it) and neither did the doctors of ANY (srsly, capslock that) of the doctors of my asthmatic clients, but using a bronchodialator before you run can head of exercise induced asthma while you run. Your doctor might say "nah, that's bs", so it's up to you if you want to try it or not.

If you use a daily preventer medication, again, talk to your doctor first, but depending on your medication, and if it contains a bronchodilator, you can also have a blast of that maybe an hour before your planned run. Preventors' brochodilators take longer to work, so that's why the difference in preemptive dosing.

And finally, always, ALWAYS have your reliever handy, regardless of what you have or haven't taken before you run.

Shin splints: strenghtening your anterior tibialis (the muscle on the front of your shin ie the Ouchy Zone) can help prevent and ease shin splints. I do it by walking on my heels for a couple of minutes a day. You can stretch your calves as much as you want, but imo, if your ATs are too weak for the strength you've built in your calves, you're pushing mud up a hill. Also, ice. Ice, ice, ice. Even when you're all "Oh yay, that fresh hell is OVAH!", Keep it up regularly for several weeks AFTER the pain has resolved itself to EALLY get the inflammation under control. It also gives you time to strengthen your ATs, and that shit is what's really going to knock your shinsplints on their ass. And as always, consult your doctor fist, bla bla bla.

MJ said...

I'm a very brand-new runner so have little personal advice to offer on these questions. (I did manage to overtake an elderly man using a walker today but just barely and I don't think he was trying.)

However, my local paper published this article on shin splints this week. The article is based on Australian research that appeared in the British Journal of Sports Medicine and offers simple tests for determining whether you will get shin splints or not. The journalist, who is a serious runner, also offers a strengthening exercise that helped in his battle(s) with shin splints.

Here's the link for those interested:
http://www.theglobeandmail.com/life/health-and-fitness/fitness/try-this-handy-new-tool-to-predict-your-likelihood-of-getting-shin-splints/article4609401/

Alexicographer said...

On the dog question: I would no more try to run with either of my large dogs on a leash than ... try to fly to the moon. My running-with-dog approaches have (successfully) included the following: run places that off-leash dogs are allowed. We have state game lands near enough to us that I can get to them, and run on them (sometimes). As, obviously, people who hunt with dogs do not keep the dogs on leash -- off-leash dogs are allowed and even expected. That works (reasonably) well for me. For obvious reasons I don't run (or otherwise traverse) that area in what might colloquially be referred to as the "no holds barred" gun season, which around here runs roughly Thanksgiving to New Years. Running slowly makes running in the woods (gameland trails) possible, rough ground and the not-so-occasional protruding root or rock notwithstanding.

Running in foul weather: in my experience a good rain pretty much clears folks off local tracks (e.g. at the nearby middle school) and trails, so that provides a good opportunity to let the dogs run.

Just yesterday evening, I went to a school on the edge of town after dark (around 8 p.m.) and ran with the dogs. I'd hoped to access a track but it was in fact locked and gated, so I just ran around (and around) the school campus; it's far enough from roads I wasn't worried about the dogs getting up to them, and my dogs and I were completely alone -- it was in fact quite nicely peaceful.

So, depending on where you are, any of those approaches could be an option. The biggest thing for me that has made running the Doctor Mama way manageable is that I have given myself permission for any particular attempt at running to be a failure. So I have tried running all sorts of places and ways (wooded trails, in the dark, in the morning) that I wasn't sure would work and yet, in fact, they have. Thus far, a few have been a bit of a slog or have been something where I've thought, well, won't try that approach again, but I've managed to stick them out (and many others have been surprisingly great -- it's not all slog!), and knowing I could stop if I find I really dislike *this* run has (so far) been enough to keep me going.

tadpoledrain said...

Shin splints: Don't try to run how you think you should run. Sort of "shuffle" run, very flat-footed, not even really picking up your feet. And get some "barefoot" style shoes, like the Minimus ones made by New Balance that someone suggested above. I'm pretty fat (200+ pounds at 5'1"), and I used to get shin splints, until I stopped wearing "good" running shoes. Sometimes I even run in my Keen sandals, in the summer, and those are better than regular running sneakers. Also stretch well, especially after running.

Losing weight: I don't have any advice about losing weight, but I do have some advice: Don't worry about it. Don't keep a food journal, don't obsess over food, don't even really weigh yourself, especially if, like you said, you are comfortable with the way you eat right now. You're just setting yourself up for a vicious cycle that will destroy the healthy relationship you have with food right now. Like you said, being suicidal is way more unhealthy than being fat. And if you weren't eating when you were depressed, then that former weight wasn't really your natural weight anyway. Now that you are eating again, it will take some time for your body to adjust and find its normal weight. Maybe the pounds will drop off again, maybe they won't. In the meantime, try to accept your body as it is, and dress it well -- don't put off wearing the clothes that make you happy, or buying new clothes, until you lose the weight. You'll only make yourself unhappy. Be kind to yourself and your body -- dealing with depression is hard, and you shouldn't be feeling bad about some of the results of fighting that battle!

Asthma: Slow down. Wear a scarf or something that you can pull over your mouth and nose when it's cold out. I never found my inhaler to help much with my exercise/cold-induced asthma (Dr. Mama, any thoughts on that?), but I also hate using my inhaler because I also have high anxiety, and the side effects of my inhaler make me feel like I'm panicking, so... Mostly I just slow down and then wheeze for a few hours after running, which I'm sure isn't the best plan.

nomoresecrets said...
This comment has been removed by the author.
kristib said...

I'm the dog person; thank you all for your input :)