Thursday, May 24, 2018

Rite Aid Cleveland Marathon

May in Cleveland, Ohio means one thing, besides LeBron taking the Cavs deep into the the playoffs.

It's time for the Rite Aid Cleveland Marathon! 

This year marks my ninth consecutive year participating this event, and it is where I ran my first marathon in 2010.  There have been many course changes over this time frame and weather ranging from rain, snow, hail, and blistering heat and sun.  The best summary I have have ever heard about the predictability of weather for these race was in the movie Forrest Gump.  It's like a box of chocolates, you never know what you're gonna get.

Volunteering at the Rite Aid Cleveland Marathon Expo was something I had never done before but as an ambassador I thought I should really do what I can to fully embrace this race as much as possible and try to make it fun for others. I was assigned helping pass out bibs to other runners of the 5k, 8k and challenge series races with another volunteer on the opening Friday of the expo.  I must say this was quite fun.  I got to talk to a lot of different types of people and made sure to tell everyone who was running in the Challenge Series with me that there was only one rule, they weren't allowed to beat me.

As someone who loves to run and talk to other runners, I found it really fun to get others excited about the races they signed up for.  Cleveland is a fairly diverse city but I was honestly surprised at the diversity of people who showed up.  One surprise to me was just how many families were signed up together for the shorter races.  As a pharmacist, I deal with a lot of people who have not taken care of their bodies as they should or have major health problems.  It was refreshing to see so many people making their health a prerogative in their lives and making it a family event.  I would highly recommend volunteering at this expo to anyone who wants to help support running and people who are trying to better themselves.  The expo has a great positive vibe!

For 2018, I decided to run the Challenge series which included the distances of 8k on Saturday and the full marathon on Sunday.  I usually run 4-5 miles the day before a big race to make sure everything is feeling right, so naturally the 8k just made since.  This year I somehow managed to start getting a cold and sore throat just days before the race.  I knew running the 8k would be vital to me knowing how my body would handle running a full marathon the next day.

Walking to the start of the 8k on Public Square had me a little nervous.  Something never feels quite right before races for me. Either a knee seems wonky, I question my hydration, or in this case my throat felt extra scratchy as well.  As I got to the starting corral I saw a friend, and fellow Rite Aid Cleveland Marathon Ambassador, Brian Burk.  This was great for me, as I knew Brian ran about the same pace I did and would help take my mind off the race a bit since he loves to talk about running and his crazy adventures.  The plan worked great for Brian and I as we both ran faster than we thought we would and felt good while running.

The 8k course was a fun course to run.  Starting in Public Square, heading around the Browns stadium and by the Rock and Roll Hall of Fame before finishing with a nice flat section to complete the course.  It is probably not a course to set a PR, mainly due to the hill on East 9th street, but it provided plenty of great views including ones of the famous Free Stamp and Fountain of Eternal Life.  The 5k course was very similar but without the longer flat section.  The weather held out and was perfect for a morning run with a thousand or so other runners.

After the 8k race, I went home and rested up.  After a shower and nap, it was time for one of my favorite traditions of the Rite Aid Cleveland Marathon weekend: Carb loading at Trattoria on the Hill in Little Italy!  Honestly, who doesn't like a good reason to go eat pasta until you're silly?

(Highly recommend this place for carb loading!)

Post coma inducing food binge, it was time for my least favorite tradition of marathon weekend: having to organize all of the thing I will need into one pile for the race.  Unlike a lot of runners, I'm not type A.  I'm definitely type B and my running shows it.  I run based on feel, not on time or splits, I take the race as it comes and often times I forget stuff that I wanted or needed.  I've even shown up to races wearing the wrong shoes before.  I did look at the forecast and see that it was not supposed to rain, although there was cloud cover.  This is perfect for running!

Sunday morning, I woke up at 4:50 am, at a bagel with peanut butter and some orange juice plus a few glasses of water.  Since my wife was sick, I walked our three dogs and made sure they all did their business so she wouldn't have to worry about it.  She was sicker than I was and needed some rest.  Walking our dogs before a race is great for me as it is usually super peaceful and lets me focus on how I am feeling and my rough plan for that day.  This day I knew it could be a struggle for me as my throat was sore and cough drops had become necessary for me to talk.  I was unsure how my body would react to the race as I somehow have avoided running a marathon sick before.

As I got into my car with all of my necessities, I checked the forecast again and saw no rain was forecasted.  There was zero percent chance of ran in Cleveland. Sweet Jesus!  After parking near the starting line, I put on all of my racing attire and stepped out into the rain to walk to the start.  Cleveland weather once again showing it's schizophrenic nature and bucking whatever any meteorologist can forecast.  My phone said it was still not raining.

In making my way to the starting line, the other Rite Aid Cleveland Marathon ambassadors and I took several pictures of our group.  Some were professionally taken and look amazing, even in the light rain I'd say we are a photogenic bunch.

(you can't see how much it is actually raining in this picture)

Immediately following the bonding and photog sesh with my fellow famous ambassadors, I did what every runner does and head for the port-O-potties.  While looking for a short line, I found my friend Janelle waving to me.  This might have allowed me to cut a few people in line, sorry other people!  I knew this was Janelle's first marathon and that she was nervous about it.  She had attempted a 50k trail race a few weeks before but had an ankle injury and took it easy as to not ruin this race for herself.  We discussed what her goals where and figured out where we needed to be in the corrals to line up.  This is where I decided to change my race plan.  I told Janelle I would help her finish as best I could and decided that I was going to stick by her throughout the race and try to get her to her goals.  Janelle said her coach told her to run with the 4:10 pacer, but she really wanted to finish in under 4 hours.  I told her I would do what I could to help her.  In my mind, I wasn't truly sure I could run this race in under 4 hours with my cold, but knew that I managed to do so at the Pro Football Hall of Fame Marathon 3 weeks ago, while totally blowing up mid race.  I was a little nervous, but did not want to show it.

Janelle and I had a hard time finding a spot in the corral but did manage to start about 30 feet behind the 4:10 pacers.  The rain was still coming down but lightly, with fog canvasing the skyline.  With the start of this race I made it my objective to have Janelle follow me through the crowd, since I was larger and could easily wedge through the thousands of runners who were at the starting line.  We ping ponged through the crowd until about the mile two, when we noticed we finally caught up to the 4:10 pacers again.  The crowds slowed us down quite a bit in the start, but near mile 3 we caught the 4 hour pacers and where running at a comfortable pace.  From here I made a point in my head to stick with this pace group for a few miles to see how well Janelle and I would handle it.  If everything went to plan and we made it through a few small hills in downtown Cleveland and into the Tremont neighborhood fine, we could start to step up the pace a little bit to build a cushion of time on our goal.

I must pause here to say that I absolutely LOVE the 4 hour pace group.  Most of these runners are either newbies with high aspirations, or runners who love the sport but don't have nearly enough time to train for a Boston Marathon qualifying time.  The pacer Angel has paced this group for the past few years and is possibly the funniest pacer I have ever ran with.  He sings songs, splashes himself in puddles, tells jokes, stories and even does his best to motivate others if he thinks they need it.  Angel is amazing!

As we headed out of downtown, we crossed several bridges.  These are big or famous bridges, hell most people hardly noticed them.  A lot of runners probably don't care about this but I really enjoy these crossings.  These bridge crossings over the Cuyahoga River remind me that because this river caught fire, we have an EPA. These bridges and their ability to move represent engineering marvels that helped us build this city.  The old bridges, that are permanently stuck in the up position to make way for freighters now, are often mocked and used as a sign of Cleveland.  These bridges helped build the city we are running in and I find that pretty cool.

After this brief section, we headed up an into the Tremont neighborhood.  Tremont is always packed with some of the first large crowds for the race.  As Janelle and I ran through here, we caught a ton of smiled at the signs, enjoyed the music and local cheerleaders, and laughed hysterically when one man had a free PBR to any runner who would take it.  A girl behind him took him up on this and I think she attempted to chug it.  The man made her keep it, even after one of his friends asked if she was 21.  Immediately after this came my favorite part of the race.  While still in Tremont about to turn north by Lincoln Park, I saw my wife Julie Anne and my dog Fitz.  I knew Julie Anne had been sick for the past several days and was feeling far worse than I was.  To see that she got up, despite feeling awful, and came to stand in the rain with my furball was amazing!  She did this despite me telling her she didn't have to and having little to no voice to cheer me on.  We blew a quick kiss to each other as Janelle and I continued on our pace.  Now we were starting to pick up or pace a bit as we were past the 10k mark and were feeling great.

(Julie Anne and Fitz)

After Tremont and past West 25th St. there is a bit of a nice long flat section through some residential neighborhoods of Cleveland. This year there was a good gathering of people outside cheering on the runners. This is the second most needed spot for fans, in my opinion.  While I love Cleveland, this area isn't particularly scenic and can get a bit boring. At this point Janelle and I were making use of the flat terrain and running at around an 8:50 or so pace, trying to put some cushion between ourselves and the 4 hour pace group just in case there was a late race blow up.  Despite this stretch being long there are 2 water stops that were fell stocked. The Rite Aid Cleveland Marathon had 19 water stops (some you hit twice) which is great!  Janelle had brought her own water, but I used every single stop to grab something quick while running.  We all know hydration and carbs are key to getting through long distance running and the supply was abundant here, possibly the best I've seen on any road marathon.

As the marathon makes its way to Lakewood, we came up on the magical mile of 13.1.  There were more crowds basically lining all of the course through Lakewood.  Janelle's husband Ben was there on a bike and making sure she was OK and ensuring she had everything she needed.  Ben's dedication to making sure Janelle finished was vital and very endearing.  Ben is a great guy and it was on full display during the race.  He was ready with anything at a moments notice and was giving direction of where he would be for Janelle. Shortly after seeing Ben, Julie Anne appeared again with Fitz.  I think for Janelle and I, it was nice seeing our loved ones support us to keep us going.  We also both had a lot of friends who were out to support us on on race day, especially as we ran through the Lakewood sections.  Janelle's running group was all around on race day, as where some friends of mine from Birdtown Crossfit. Seeing the members of Birdtown always make me smile because they always were supportive of me while I went there and mainly because it's where I met my wife.

During this section another runner who was keeping rough pace with us, turned and said, "I think you two know every person out here!" Janelle, laughed and said we might.  I was immediately reminded of my first marathon where I didn't see a person I knew until I saw my family at the finish.  It made me feel like it was me against the world, how was everyone else so fast?  Now after years of running this race, the opposite has occurred.  I think this goes to show how much of a community Cleveland is, especially the running community.

This part of the race through Lakewood gets tough, it's essentially an out and back to Rocky River.  The crowd support being so amazing, in spite of the earlier rain, definitely helped keep Janelle and I running.  We managed to run sections of this at an 8:40-8:45 pace and really build on the extra time we had accumulated earlier. Ben was there again for Janelle, just before mile 16.  He took her empty bottles and filled them up for when we came back through.  This was smart on Janelle and Ben's part.  Rather then rely on the aid stations, Janelle always had access to hydration in case she needed it.  This is a great idea for a first time marathoner who may not know what to expect.

After running to the turn around in Rocky River and back, I told Janelle, "Remember all those fast runners who we saw that were kicking our butts as we made it out here? Well now that we made the turn, we are those fast runners!" She laughed at this as we made our way back through the northwest side of Lakewood and it's large, luxurious looking homes that sit on Lake Erie.  Ben was there to replace Janelle's water bottles and Julie Anne surprised us by moving down Lake Ave a bit and I got to see her and Fitz one last time as we headed back towards downtown Cleveland and the finish.  Julie Anne was all smiles, I think because she could tell we were doing well, which always uplifts my spirits.  She has a way of making me feel better by just seeing her, which I guess is why we are married.  Smiling and loving faces make you run faster, it's science.

During this stretch back through Lakewood, I actually saw quite a few of my patients from my pharmacy.  One of them had even put together another make shift water stand.  He yelled, "There's my favorite pharmacist!" and handed me some water.  I was happy to take his offering and spill nearly all of it down my front while attempting to drink it. I hardly remember the rest of the run through Lakewood as I just kept talking to Janelle to tried to keep her mind on anything other than the fact that we were still running.  As we approached the end of the Lakewood segments, I saw the mile 21 flag.  I couldn't help but tell Janelle that if I made it to mile 22, this would have been the farthest I have ever ran without walking.  I'm not sure how she felt about this, but I was motivated.  Not only were Janelle and I on pace to meet all of her goals, were were also on pace for me to set a PR of sorts.  When we hit the mile 22 flag, I was pumped and said from here on out we have this, it's all a PR from here!

I'm a firm believer that in long distance running, your mind is every bit as important as your physical preparation.  If you get in your own head and think you will have a bad day, you will.  Positivity might seem simple, but I've had it break me before and have seen it done to others as well.  Race day should be a victory lap of all of your training, not a suck fest to Misery Town.

Janelle was slowing down a bit after mile 22, but I could tell that she was absolutely determined to finish this race.  I've read some studies that show that a higher percent of women finish marathon and ultra marathons that start them than men.  There were several reasons for this that I read, but seeing the look on Janelle's face and determination in her stride, I could see why. When I wanted to walk, she persisted.  After mile 23 on, Janelle actually pushed me the rest of the way.  I could make a student became the teacher quip here but I think rather the truer statement is that we just equally motivated each other throughout the whole race, it was just Janelle's turn to take the lead.

With a steely resolve and a refusal to quit Janelle and I made our way over a small hill by Battery Park (which was steeper than anticipated) and down Detroit Ave.  When we saw the Detroit Bridge, we knew the end was near and we had made it.  I accidentally sped ahead a bit on the bridge, but walked for a brief moment, maybe 10 seconds, to allow Janelle to catch up quickly when I was at the bottom.  We ran through the finish, and I gave her a gross hug.  We were done! Janelle finished and in 3 hours and 56 minutes.  She blew it out of the water!

Janelle was so relieved to be done and to make all of her A and B goals, I remember that feeling.  Today I had a new feeling, I was more happy for her than anything.  Running is about overcoming and bettering yourself. Today I got to witness a friend I've know since roughly 2003, closely since 2007, finish a dream of hers. That is pretty awesome!  It's a great feeling when you can celebrate with someone, while motivating them the whole way.  I honestly don't think I would have run nearly as well without have Janelle motivate and push me for this race.  Somehow I sucked up the cold and with motivation from Janelle, Ben and the amazing support of Julie Anne was able to finish with my second fastest marathon time, too.  It might have stared with rain but it ended with rainbows.  This was my favorite marathon I have ever run to date!

(actual rainbow during/after the Rite Aid Cleveland Marathon)

(Janelle and myself)

Lastly, I'd like to give a shoutout to the best sign of the Rite Aid Cleveland Marathon.  Thanks Gretchen for making every single runner laugh with this well played sign!

See you in 2019 Rite Aid Cleveland Marathon! PR or BUST!

Friday, April 20, 2018

Medications and Running

Use code EGCLE10 to save 10% on registration for the Rite Aid Cleveland Marathon!

As a runner, I hear all the time about how someone should take this or use this to help treat various problems.  Although most times these are usually decent recommendations, the pharmacist in me can't help but interject whenever I hear this.  Rather than criticize all of the bad advice I've heard, I decided to make a relatively complete list of common medications, what they are used for, and how their use relates to running.  I tried to include some brand and generic names to minimize confusion for everyone as well.

Please let me know your thoughts and questions, I'd be glad to help!

NSAIDs (ibuprofen, Advil, Motrin, naproxen, Aleve, meloxicam, etc.) - These are all general pain relievers for running related injuries and to help bring down inflammation.  Definitely should be taken with food to avoid upsetting the stomach, or at least a gel and lots of water if need while running.  Possible issues with high doses and ultramarathon running due to the kidney affects.
Remember, that if you have serious pain it is a sign your body is possibly 
experiencing something that isn't right.
At the very least, stop and do a systems check of yourself.
It's OK to push yourself but don't break yourself

Aspirin - Not much a role here as a pain reliever.  Can be used prior to long flights or drives to races to help minimize the chance of forming blood clots.  Some studies have linked its anticlotting effects to helping reduce cramps in long distance running.  Take with food and watch for stomach pain with this in high doses or chronic use.

Acetaminophen (Tylenol) -  Good overall pain reliever but doesn't help to reduce inflammation, so not the best thing for most running injuries.  Doesn't have to be taken with food and can be used with NSAIDS to help reduce pain.

Pseudoephedrine (Sudafed) - Great decongestant but can really elevate heart rate and blood pressure.  Don't use while running as this can really can cardiac stress.

Ephedrine (Bronkaid) - Good over the counter medication to help relieve some asthma and breathing issues, but avoid in running.  This medication is sometimes used as a performance enhancer (like it's cousin pseudoephedrine) and has been linked to the possible death in several athletes, due to the affects it has on heart rate and blood pressure.  
Commonly used in weight loss plans known as ACE stacking, do NOT use this method!

Phenylephrine (Sudafed) - Weaker decongestant than pseudoephedrine, but still has the same risks.

Cough medicines - ALWAYS read your labels! Many cough medicines have multiple ingredients and several in any one product may not be right for your symptoms and hurt your running.

         Guaifenesin (Mucinex) - Good for helping to break up mucus in the lungs and coughing up.  Mixed reviews on it's effectiveness but safe to use while running or helping fight a cold while getting your miles in.
When sick, run conservatively! 
Your body is under a lot of stress fighting sickness off, don't push it over the hill by running.
Take it easy and dial it back a bit.

         Dextremethorphan (Delsym, DM) - Good for stopping a cough so you can get some sleep at night and recover.  Can be used while running, but limit use.  Coughing helps clean out the lungs, stopping it can leave irritants in the lungs.  Can make some people dizzy or "trippy".

Antihistamines - Generally split into two classes due to their strength and likelihood to make a user drowsy.  commonly found in many cough and cold combination products

         Non-Drowsy (loratadine, Claritin, cetirizine, Zyrtec, fexofenadine, Allegra) - Great for seasonal allergies, paricularly if the allergies are too bad or the allergan count isn't too high.  Cetirizine can cause some drowsiness, the others generally won't and are better to take if running because of this.

         Drowsy (diphenhydramine, Benadryl, chlorpheniramine, Chlor-Trimeton) - Great for all allergic reactions or allergies but can really leave the user drowsy.  Some of these can also be used as sleep medications, so avoid use prior to races.

Nasal Sprays - Various types with various uses, watch this as they are usually sold near each other and marketed similarly

         Nasal Steroids (fluticasone, Flonase, mometasone, Nasonex, etc.) - Great for seasonal allergies as they stop the immune response and don't cause the drowsiness of antihistamines. Some forms of fluticasone have alcohol and may cause nosebleeds, mometasone usually does not.

         Decongestants (oxymetalzine, Afrin) - great decongestant with limited risk of cardiac issues, especially compared to pseudoephedrine or phenylephrine. Should only be used for 3 days or less as they can caused rebound congestion if used longer.  

         Saline (Ayr, Deep Sea) - Good for cleaning out the nose and helping to relieve most nasal symptoms, can be used quite often too.

Loperamide - Good for treating diarrhea. Safe to use while running but be careful to not cause problems by taking this unnecessarily
Runner's trots are a thing and are normal. Avoid taking loperamide preventatively.
Most races have port-a-potties.

Constipation medication - Most runners do not suffer from this issue. This is just here for completeness sake and to not how they work.

         Polyethylene glycol (Miralax) - works by drawing water into the colon and helping to form stool. Not ideal for runners as dehydration is already a risk of the sport, this might make it worse

         Bisacodyl (Dulcolax) - increases the movement of the GI tract to help make stool.  Most runners can get some cramps as physical activity helps work the same way, again not ideal.

         Docusate (Colace) - Stool softener that works to help make it easier to pass a stool.  Probably the best choice for runners but can lead to very soft stools.

         Senna (Senokot) - works similar to bisacodyl, with similar results.  In many "natural" constipation remedies.

Caffeine - In many products that runners use including some beverages, gels, chews, etc. Can increase heart rate and blood pressure and has a diuretic effect.  Limit use to small and infrequent doses, ensure enough water is consumed as well to help prevent dehydration.  Not a lot of benefit for the risks. Some runners swear by it, but be very careful. More benefit in ultrarunning as fatigue and sleeplessness is a bigger issue.
Caffeine has a takes a surprisingly long time to get out of the body.  Generally avoiding it a day or two before races is a good idea to ensure your hydration is ideal for race day.

B-Vitamins - Good to take in certain types of anemia or in a daily multivitamin.  Will not "give energy" as most supplements claim. Little to no negative effects though.

Vitamin D - Most reports now show people who live in the northern part of USA need more of this.  Most outdoor runners get more than less active people, but still OK to take in moderate doses.  It's a good idea to get a blood level drawn from a provider before taking regularly or in high doses.

Calcium - New evidence shows it is best to get calcium through diet and supplements may lead to cardiac issues. Some specialists have recommended these to help with things like shin splints or to recover from broken bone issues.  Generally should be avoided unless a professional recommends them.

Garcinia Cambogia - Going tangential here for a moment, most things marketed for weight loss do NOT work.  Most things marketed by Dr. Oz as miracle products or anything like that do NOT work.  The man is a quack at best.

Creatine - Thought to help the body store water in the muscles. Limited if any actual benefit is proven from using this in lifting or in endurance sport. Probably a waste of money all around

Steroids (prednisone, methylpredinsolone, Medrol) - Great for most running injuries that have swelling or if there are breathing issues with an infection. Would avoid running while on these as the body needs to recover properly but some light running could be OK, check with prescriber. Can give someone the feeling of energy but should be taken with food to avoid stomach issues.

Antiobiotics - There are many classes here but just some of the more commonly prescribed ones are included for brevity. Of note, if sick running should be limited so the body can focus on recovering from that and not the run. With all of these, stay hydrated, keep it light and most can cause diarrhea so watch for that.  Not everyone is Michael Jordan and performs best with a killer instinct when sick, even he said he regretted how he felt after some of his epic games when sick.
Do not tell your provider what antibiotic to prescribe!
They will make the best judgement based on IF you need antibiotics (many cases do not warrant them) and what is the best choice to kill the bacteria bothering you, should you need them.  You can help direct their decisions but remember running is fun but your overall health is more important.

         Penicillin related (amoxicillin, penicillin, cephalexin, etc.) - Generally safe for runners to take and continue to run.  Little to no issues with anything running related unless running ultramarathons while taking, which is ill advised for multiple reasons.

         Doxycycline - Generally safe for runners but may make skin more sensitive to sun, use sunscreen as recommended for outside use anyways. Avoid taking with multivitamins and calcium containing foods.

         Flouroquinolones (ciprofloxacin, Cipro, levofloxacin, Leavquin, etc.) - Avoid in runners and most athletes.  While these due have a time and place to use them, be very careful as this class of medications is known to cause tendon issues, especially in athletes. If these are needed, take it very light, stay hydrated and don't over stretch.

         Macrolides (azithromycin, Zithromax, erythromycin, Ery-tabs, etc.) - Watch for any sort of cardiac issues or chest pain with this class that is known to prolong the QT invterval, which means it can affect your hearts electrical activity.  

         Clindamycin - Safe to use while running, diarrhea is very common as well as stomach issues.  Probably not the best choice due to side effects but little other risks.

         Nitrofurantoin (Macrobid) - Super important to stay hydrated with this antibiotic as it is excreted mainly  through the kidneys and needs a minimum level of kidney function to work. Few other issues.

         Metronidazole (Flagyl) - Generally safe for runners, but alcohol must be avoided while taking this.

Oseltamvir (Tamiflu) - Should avoid running while taking this medication, not because of this medication but because the flu is seriously dangerous.  Take long walks or light hikes instead.

Opiates (hydrocodone, Vicodin, oxycodone, Percocet tramadol) - If someone is on opiates, they probably shouldn't be running.  The cause of pain would determine if they should run or not. Opiates are highly addicting, which can be dangerous as many long distance runners have addictive personalities. Opiates also cause a great deal of constipation, which physical activity can help with, but should be cautioned. Judgement can also be very clouded while taking these and these will make users tired. Injuries might get worse while running on these, especially since the feeling of pain is blocked or limited.

Muscle relaxers (cyclobenzaprine, methocarbamol, tizanidine, baclofen) - Much like opiates, someone probably shouldn't be running these.  Injuries could get worse while running with these and all muscles may not fire quite as they should. Judgement can be impairment and can make the user tired.

Antidepressants - This term is being used a little loosely here to cover a few of that many psychiatric medications out there.  Most of these are totally safe to use while running, almost all of them do have warnings that if your depression (or other psychiatric conditions) worsen make sure to let a medical professional know.  If suicidal thoughts occur or become common, PLEASE call 1-800-273-8255, they can help.  Read the patient information with these, mainly to understand these medications but do not stress about all of this information. Share any possible side effects with a medical professional to seek their advice.

I'm taking an aside here to call out something I've recently seen on the social media and even in running groups.  The picture below is NOT based on fact.  Yes, nature bathing is a thing that can help improve your mood.  Yes, getting outside and being active can make you feel better.  Some people need more than this and we should NOT shame them for needing medications.  Depressions, bipolar, anxiety, schizophrenia and other mental health conditions are real and yes many runners can suffer from them.  We should embrace them trying to help themselves, not shame them for it.
This is FAKE news:

This is the TRUTH:

        SSRIs (citalopram, Celexa, fluoxetine, Prozac, etc) - Generally safe to use while running and are usually the first thing tried to treat depression or anxiety.  Mayt take several weeks to fully work and not cause a tired feeling. Not a lot to really watch for, other than be sure to take regularly and avoid abruptly starting or stopping with out medical advice advising such.  

        Buproprion (Wellbutrin, Zyban for smoking cessation) - Generally safe to use, but some reports have found that this may actually make runners slightly better at endurance sports. Those same studies also showed while athletes could go longer, they were also more susceptible to push themselves to the point of collapse and had some intolerance to heat.  Knowing your limits in running is key while on this medications.

Birth Control - Almost all are safe to run with.  Some of these do have mild potassium sparing diuretics, which are considered performance enhancing drugs despite not really doing much. Let the proper authorities know if you are on birth control and this is a concern.

Seizure medications - If someone has seizures, they should definitely look into if running is safe for them.  If anything start small and run with a friend who has a cell phone, just in case.  While running may help reduce stress for some and thus prevent seizures, for others the physical stress may actually induce seizures. There has been documentation of runners with seizures running marathons and taking medications like diazepam on the course to help stave them off.  Although this does sound like an amazing and inspiring battle of illness, it is probably not the safest course of action.
Rather than dive into this class, I'd advise anyone with seizures to be careful.

Blood pressure medications - This may be the hardest class of medications to take and continue running. Any person who has high blood pressure knows that physical activity is good for reducing blood pressure long term, however it can spike blood pressure in the short term.  There is a balancing act with these medications and running. There are many types of blood pressure medications, this is a quick overview of the most common ones used in first or second line treatment. Cardiac issues and heart attack risks should always be considered before running, especially long endurances races or races in extreme settings.

        ACE-Inhibitors (lisinopril, ramipril, enalapril, etc.) - Great for protecting the kidneys from the affects of long term high blood pressure but can cause the kidney to retain potassium and creatinine.  Build up of potassium and creatinine can cause issues for runners.  Proper hydration can help minimize some this issues as urination will eliminate them, but do be careful particularly in long and hard running adventures.

        Beta blockers (metoprolol, propranolol, atenolol, etc.) - Generally speaking these medications can limit a person's heart rate and cause them to feel "run down" especially when starting them.  Dizziness may happen when exerting one's self on these medications.  These medications improve the heart's efficiency but, since they limit the heart rate, may leave users feeling limited or like they are redlining when running.  There are some reports that show propranolol might be an outlier of this group, particularly for endurance athletes, but more evidence may be needed.  Running with these may be difficult, sticking to a slower pace, to keep the heart rate down, would be advisable.  All beta blockers are also considered performance enhancers as well, so let the proper authorities know.

        Calcium channel blockers (amlodipine, diltiazem, verapamil etc.) - Some drugs in this class can work like the previously mentioned beta blockers and lower heart rate, however there is more evidence that they may be safe in exercise. For all intents and purposes, very similar to the issues beta blockers have with running, amlodipine being a bit of an outlier and can cause some peripheral edema due to it's unique way of working compared to other calcium channel blockers

        Diuretics (hydrchlorothiazide, spironolactone, furosemide, etc.) - Diuretics can cause problems for runners due to the effects they have on electrolytes and hydration, both of which are key to running. Most of these should be avoided while running.  Runners tend to have were kidney issues occur, as well as things like edema.  Holding these for after a race may be advisable for some, but definitely worth checking with your medical provider based on your exact situation.  All diuretics are considered performance enhancing so let proper authorities know.

Statins (atorvastatin, Lipitor, simvastatin, Zocor, etc.) - Many people worry about the affects this class of medications have on their muscles due to horror stories they have heard.  They are generally safe to use while running, especially since they minimize the chance of having a heart attack or stroke.  Statins due increase the chance of rhabdomyolysis, which is a concern for extremely intense runs or in longer runs. One interesting thing about these is that their beneficial effects for most people are due to their long term use, therefore they may be able to be stopped in the harder parts of training or racing to minimize the recovery periods and risk of rhadbomyolsysis, BUT that should be discussed with a medical provider.

ADHD medications (amphetamine salts, Adderall, Vyvanse, methylphenidate, Concerta, etc.) -  These medications are all considered performance enhancers.  This class can also elevate the heart rate and blood pressure, so should be used in caution in strong aerobic activities like running.  There have been studies showing that running is good to minimize the need or dose of these medications.  These medications may also be stopped prior to long periods of exertion, which would help minimize the cardiac risks, although this may not be the best option for all. 
Many runners I know who take ADHD medications claim they don't use them on race day and do just fine. 
They state the run itself is easy enough to focus on and they don't have a need for these medications on these runs.

I will admit that I did not cite all of my sources for this blog post, but they are all good sources and inline with what I know professionally as a pharmacist (and non professionally as a runner).  There would literally be hundreds of citations that would take me forever to post.  Please rest assured that I double checked anything I was even the least bit questionable on and want to keep my professional reputation in the highest regard.

Do you have any questions for the pharmacist? 😏

Thanks for reading.

Tuesday, April 3, 2018

March Madness - Final Rounds

With March fully over, it's time to wrap up the March Madness of running!  Below are the final rounds and the winner.

Round 3

1. Scott Jurek vs. 2. Roger Bannister

Winner: Scott Jurek

Bannister set one of, if not the, gold bar in running.  His credentials and ability to give back to the sport of running until his recent passing puts him in the stratosphere of running. To this day his 4 minute pace is still basically the US standard for Olympics qualifications in the 1500 meter distance (1500 meters in 3:54:00 is the US standard to make the Olympic trials).  Whenever your record holds its own for over 60 years as the mark everyone knows and aims for, you've done something amazing.

Jurek might not have quite the name Bannister does right now, but several books written by him or about him have changed the running world immensely.  Ultramarathons are now much more common and more people are doing them then ever before.  Jurek's plant based diet has also changed the diet of many runners. As human's continue to push the limits, both of these men will be remembered for what they have done to raise and set records but while Bannister's time will remain one of legendary proportions, Jurek helped launch runners into new unthinkable distances at a record clip.

1. Steve Prefontaine vs. 2. Kathrine Switzer

Winner: Kathrine Switzer

Prefontaine is iconic due to his influence and style.  Prefontaine helped launch Phil Knight's little running shoe company from Oregon to the world, and I think Nike will be around for awhile. Prefontaine is in large part credited with helping spark the running movement in the US, Kathrine Switzer just did him one better by allowing women to run in longer distances.

Switzer's breaking down of the gender barrier is possibly the only thing in this bracket that could have stopped Prefontaine.  While Nike certainly grew due to Prefontaine, there were other factors that helped it more and it would invevitably succeed on it's own right.  Without Switzer, it could have been years or more before women could run marathons.  Given that marathons and half marathons are a near 50/50 mix of women and men these days, I'd say her shadow is more ever present now than ever before.

1. Jesse Owens vs. 3. Dean Karnazes

Winner: Jesse Owens

Sorry Dean, your run stops here.  While Karnazes did help teach people about ultramarathons, and arguably inspire as many people as Jurek, he never set any world records that were heralded by millions around the globe the way Owens did. Karnazes has his wins in some of the toughest races on Earth, but Owens did it on the biggest stage while staring down the Nazi's.

1. Usain Bolt vs. 2. Ann Trason

Winner: Usain Bolt

Ann Trason is legendary for winning so many races and virtually being untouchable, especially among women, in the ultramarathon world.  Her longevity, consistency and times are still unbroken.  She proved in the steps of Kathrine Switzer than women can and will compete with the men.  Usain Bolt is just the best to ever do it, on a bigger stage, with more fans and more influence.  Trason never had a shot at the Olympic golds the way Bolt did, but Bolt is the Lebron James of sprinting.

Round 4

1. Scott Jurek vs. 2. Kathrine Switzer

Winner: Kathrine Switzer

Jurek is actually my personal favorite runner on this list and unquestionable ultrarunning legend.  Jurek's influence is well documented previously and his ability to make ultrarunning appeal to masses is only on par with Dean Karnazes.  While Jurek rarely loses and has even set the one time speed record on the Appalachian trail, Switzer's impact is greater.  Although Jurek would probably beat Switzer in any distance of running, Switzer paved the way for legends like Ann Trason.  Switzer has her wins but becoming a symbol of female power and the ability to overcome edges out Jurek's awe inspiring stories of battling the Tarahumara.

1. Jesse Owens vs. 1. Usain Bolt

Winner: Jesse Owens

Usain Bolt is the Lebron James of sprinters, but Jesse Owens is the Michael Jordan.  Bolt might have more medals and faster times, but he never had to overcome militant racism at the Olympics or unfair racism at home. Owens, an Cleveland, Ohio man like myself, faced it all and won.  It's sad despite all his fame and legendary status, still faced all of the discrimination he did.  Owens had to work other jobs and even race horses to survive, yet was still considered the greatest to ever do it.  A recent article actually compared the two head to head holding for variables and Bolt won, by only one stride. People have claimed that Usain Bolt is decades ahead of his time, so what does that make Owens? Centuries ahead of his time?

Final Round

2. Kathrine Switzer vs. 1. Jesse Owens

Sometimes becoming the greatest runner isn't about speed but the impact and lasting effects of your runs.

This is a tough battle of two very different athletes from different times and exact opposite distances.  Both overcame adversity and both did so for a better cause in a relatively short period.  Switzer still runs today and has written books.  She is unquestionably the most influential female runner. Owens however has several Olympic gold medals, world records and overcame just as much if not more than Switzer did, although he never had to breakdown the huge gender barrier...

Sorry Kathrine, but this was very tough.

Winner: Jesse Owens

Let me know what you think in the comments, retweets or messages.  This was fun for me and I hope you learned something about running greatness along the way!

Use code EGCLE10 to save 10% on registration for the Rite Aid Cleveland Marathon!

Sunday, March 25, 2018

March Madness - Round 2

With March Madness fully underway and the glass slipper still on at least one time in the basketball bracket, we continue on with the Running March Madness Second Round.


1. Scott Jurek vs 5. Hal Higdon

Winner: Scott Jurek

Higdon is a legend for his writing and devotion to running.  His influence can be felt at every single marathon in the US, if not world.  His over 100 completed marathons are nothing shy of amazing, but Jurek is an almost mythical person in the running world.  Jurek set the record for the fastest time to run, yes run, the Appalachian Trail and has a book to show for it.  Jurek's influence has also been wide spread after "Born to Run" came out, which started several major running trends and turned ultramarathons into a much more common place event.  It's sad to see Higdon lose in this contest, but it is an honorable defeat to one of the all time running greats.

6. Allyson Felix vs. 2. Roger Bannister

Winner: Roger Bannister

Allyson Felix is the most decorated female Olympian track and field athlete of all-time!  With 6 gold medals and 3 silvers, she is not use to losing and has earned herself a solid seat among the all-time greats.  That being said, Roger Bannister is and forever will be the standard for track and field with his golden 4 minute mile. Bannister did what many thought, at the time, could never be done. His 4 minute mile was to running what the Wright Brothers were to flying.  It happened a long time ago, and now is common, but it set the standard that we still all use today for greatness.

1. Steve Prefontaine vs. 4. Karl Meltzer

Winner: Steve Prefontaine

Meltzer broke Scott Jurek's Appalachian Trail record, the very next year.  His unquestioned durability, longevity and wins make him standout in a world of crazy people that don't know when to stop running.  Meltzer breaks the mold, but his mold of recklessly setting the bar was made by Prefontaine.  Prefontaine inspired millions as he broke almost every American record he attempted.  Prefontaine had movies and books written about him, however his untimely death has made him the Jimi Hendrix of running.  We know he was great and we loved his bravado, we just wonder in awe at how great he could have been, had he not died so young.  Prefontaine is the sort of all American dream we all wish to be.

3. Florence Grffith-Joyner vs. 2. Kathrine Switzer

Winner: Kathrine Switzer

Florence Griffith-Joyner was an icon even after her death.  She was the fastest and the loudest.  Flo-Jo was a rock star on the track like few ever were and backed it up.  Where Kathrine Switzer beats Flo-Jo is that she herself was a bigger rebel, while trying to blend in.  Switzer;s iconic story of the 1967 Boston marathon is one I can never get enough of.  She tried to blend in, to prove women could run with men.  Switzer ended up breaking down the gender wall, allowing the women to flood the running world

1. Jesse Owens vs. 5. Kenensia Bekele

Winner: Jesse Owens

Bekele was great, no doubt. Three Olympic Golds and five world championships proves he rarely lost.  Jesse Owens just never lost.  Owens faced tyranny and won.  Owens faced racism and won.  Owens faced world records and won.  Jesse Owens was a running icon like there never was.

3. Dean Karnazes vs. 2. Pheidippides

Winner: Dean Karnazes

In an interesting battle of the Greeks, Karnazes comes out on top.  The irony that Pheidippides would probably beat Dean is not lost here, or how Dean wrote a book largely based on the legend of Pheidippides.  For the current time, Karnazes wins purely on his influence on the sport of ultrarunning.  His books have inspired millions by simply opening their eyes to the possibility that people can run more than a marathon. Sure, Pheidippides did this as well, and the marathon is named after his famously fatal run, but Karnazes has dominated the field of running books, helping design clothes and been a semi-relatable person who many have aspired to be like.

1. Usain Bolt vs. 4. Carl Lewis

Winner: Usain Bolt

In a true battle of sprinting titans, Lewis loses out, even though he is the second most decorated track and field Olympian of all time (barely edging out Felix who was also in this bracket).  Lewis did this over a very long period, but he was never quite the spectacle that Bolt was.  Usain Bolt shattered the records books and was evolutionarily ahead of every other competitor.  It was never if Bolt would win, but by how much.  He did it on the biggest stages, with the world holding their breath, even it is was for less than 10 seconds.

3. Wilma Rudolph vs. 2. Ann Trason

Winner: Ann Trason

Wilma Rudolph was an American prodigy, making the Olympics as a high schooler.  She helped raise the bar for women and for minorities, at a time that this was not the most socially acceptable.  She paved the way for many of young girls and women ahead of her.  Ann Trason did the same but in the opposite end of the running spectrum.  While Rudolph was a sprinter, Trason ran ultras.  Trason didn't just run ultras, she set course record after course record, even winning the Western States 100 (the Super Bowl of ultrarunning) 14 times.  If it wasn't for a legendary tribe of Indian runners, she would have won and set the overall record at the 1994 Leadville 100, having to set the women's record that still stands.  Rudolph was a beast on the track, but Trason was a certifiable monster.