Motivational Monday

Use code EG2019 for a 10% discount at checkout

It's now November, and Fall marathon season has passed us by.  It's getting colder and sub freezing temperatures are upon us, at least in northeast Ohio.  With this chilly temps it can be hard to keep running.  The temptation of eating a tub of ice cream in front of the fire while rocking some cozy pj's under a blanket with dog at your feet sounds way more comfortable than lacing up some running shoes and layering up to go log some slower miles as the air and wind start to hurt your face.

Motivation can be hard to find and severely lacking.  It can come in some of the most random ways to us.  Many times, an inspirational video or quote can really light a fire under us to get out there.  Other times, something might just remind us that we need to go and do it.  Either way, this is your fall Motivational Monday!

Here are some of my favorite videos, quotes and stories:

Just Do It - Original

Jimmy V's Speech - I'm not crying, you're crying

Al Pacino Inches Speech - This speech is on my running list. Every time it comes on, I drop the hammer and go

Dave Mackey's Story - You don't even need your legs to run. More here.

The bear cub that won't quit - worth the reminder that size doesn't matter

Rocky's Run - How I feel running big city marathons

That's How Winning is Done - Another speech I have saved on my running list

Team Hoyt - This is my favorite running duo. Their Espy's speech is also amazing!

Nike's Just Do It - 2018 - Politics aside, WHOA!

And always remember this...

Use code EG2019 for a 10% discount at checkout of the Rite Aid Cleveland Marathon 

(good for all races)

Fall is Running (and Flu Shot) Season

Fall is a great time to run. After putting in miles over the hot summer, it’s finally cooler and much easy to go on long runs without becoming overly dehydrated. The trees are acting like natures own fireworks display to make it all the more enjoyable. Pumpkin decorations are everywhere, football stadiums are packed on Friday nights, people at being stabbed in the arm on every street corner...
That’s right, everywhere you go people are being stabbed. They are being injected with a serum that will make them super humans and provide them the ability to fight off a deadly disease that strikes at different times around the globe. This disease killed about 80,000 US citizens in 2017-18 fall to winter.

What are these people being injected with?

The flu shot


There are many reasons why everyone should get the flu shot, yes even young and healthy runners who think “they can handle it”.  Below are some of the reasons why you should get your flu shot every year, as well as a few, very rare, reasons why you should not.
I’ll save you the trouble of reading all of them right now and tell you this: get your damn flu shot!

Here’s the list:

1. Your family - Believe it or not, a healthy person can carry the flu to others without signs they are sick.  These people act as a vector (explanation with citations here). So if you are around elderly, kids, people with weakened immune systems, or go out in public ever, get your flu shot!

2. You - Sure you are probably healthy and fit, great!  That does not mean you won't get the flu.  of the roughly 80,000 people who died from the flu (or it's complications) in the 2017-2018 flu season, approximately 80% were unvaccinated.  The flu shot does not mean you won't get the flu but it will  help your immune system fight it off better IF you do get it. Odds are you won't even get it, if you get the shot.  Citations here.

3. It’s probably free - Most insurances will cover the shot free either at a local pharmacy or at your primary medical provider's office.  Most, if not all, pharmacies, do not need an appointment.  Most of them can also set up a clinic at your place of employment to ensure less people get sick, less people will call off and herd immunity is better achieved.

4. That person standing over there (points) - As previously mentioned getting the flu shot isn't entirely about you. You need to help create herd immunity for others, who can not get it or are extemely prone to getting it. This is why I am expressing this point twice, it matters that much. Fun link and graphic here.

5. If you do catch the flu, it’ll likely be less dramatic - I often tell patients this, "Even if the flu shot contains a different strain and you catch the flu, it's still better to get it.  It's like training for a football game and then realizing you showed up to a rugby match.  It's still better to be in shape and ready, you'll probably be OK."

6. YOU CAN NOT GET THE FLU FROM THE FLU SHOT - Repeat after me people, "You can not get the flu from the flu shot." It's essentially a "dead" or only part of the virus. Longer explanation here.

7. It doesn’t cause autism - Jenny McCarthy is an idiot.  Her views are flat out wrong and the Lancet article she often cites has been discredited and the man who wrote it is not allowed to even practice medicine because of falsehoods he propagated and made up in the article.

8. Zombie apocalypse (or other world shattering event) - Ok, so you're still on the fringe and think big brother is putting microchips in flu shots to track you (I have patients who actually believe this). Well, Mr. Tinfoil hat, what if the zombie apocalypse comes? There's a high likelihood that zombies could carry the flu among other biological diseases.  Wouldn't you rather be protected with your own biologic weapon to keep the herds of the walking dead from getting you sick from the blood splatter?  I would!

9. Your dog - So you get the flu and go to the hospital, you're incapacitated.  You recover in 3-5 days and are discharged.  Meanwhile, your poor pooch sits at home and misses you.  I know this is a pull on the heart strings but my heart melted when a patient of mine had this happen and wasn't able to get someone to take care of their dog because no one knew about her. 

10. Your work - Not everyone likes going to work.  No one likes being sick.  Sure Michael Jordan fought off the flu to help win a championship, dropping 38 points on his way to greatness.  He also put all of the other players at risk in the process, including his teammates.  A huge group of fans (probably 20,000 plus) were also exposed.  You are not Michael Jordan, and if you are, get your flu shot to help protect others.  That's a real legend.

Reasons not to get the flu shot:

1. You’re allergic to eggs - The CDC still recommends you get the shot unless you've had a known allergic reaction to it or your egg allergy is worse than a rash (i.e. anaphylaxis).

2. You hate everyone and believe in only the purest of Darwinism - Well...    That's your prerogative.

3. Guillian Barre Syndrome -

4. You’re sick right now - Once you've been recovered for a while, you can then get it.  Just don't force more on your immune system now as the vaccine won't work right.

5. You have an immune disorder - This is a case by case situation depending on the issues you have.  Talk to a healthcare provider or pharmacist and encourage everyone you know to get their flu shot to help protect you. Be your own advocate.

6. You are on a medication - Certain medications may limit the effectiveness or if you can even get the flu shot.  This is a valid reason, so check with your pharmacist or medical provider.  In most cases, simply waiting until after a course of medication is over with will be sufficient and you can get protected by the flu shot.

7.Jenny McCarthy (or some hack like David Avocado Wolfe) said so - Look, I don’t go to a psychologist to get my car fixed, so why would you go to a has been Playboy model for medical advice. She’s wrong, she’s a moron and the evidence she tries to cite has been discredited a million times over. Her own organization funded a study that even proved vaccines do not cause autism. I was actually banned from their Facebook page after proving them wrong and how their goal is literally hurting people. I wish I could remember the name, but I'm blocked and can't even search for them. Guess they can't handle a little prick...

Now some fun flu shot charts, infographics and photos!

Where to run in Cleveland - Fall Edition

Cleveland isn’t exactly the place most people think of when they think of Fall.  Maybe it’s our Rust Belt history combined with our own burning river past.  Thankfully, agencies like the EPA have really helped clean up or waterways. The Cleveland Metroparks, along with some national parks services and even local cities have done an amazing job in really giving The greater Cleveland area some AMAZING places to enjoy the fall colors while out on the run.

Cleveland Metroparks Rocky River Reservation

The Rocky River Reservarion of the Cleveland Metroparks truly has something to offer every type of runner. Following the Rocky River from Lake Erie around Cleveland Hopkins Airport and down to Berea, this reservation is full of paved bike paths and dirt trails alike.  The accessibility of this park is unlike any others around the city, making it a real treat to those that live near it.

Beginner runners will love the paved paths, which can easily be ramped up by running up the many roadways and sidewalks that dive from the surrounding cities into thickly wooded river valley. Trailheads will love the area surrounding the Nature Center which has lots of dirt trails that climb up and down over hills and even a steep staircase that gives some of the best views of the Rocky River while getting that heart rate up.

Cuyahoga National Valley

Despite being a lesser known national park, at least nationwide, this is still one of the most visited parks in the US.  It can be a little tough to access but offers everything. With some very technical and hilly sections off of Truxell Road, winding in and around some rocky ledges, and some very flat and easy trails, following the historic Towpath, it has something for every skill level all year long.

This valley is home to many races, including the Burning River 100, which is a better known 100 mile race that occurs each July. Fall is amazing here given the amount of foliage that changes color and will never dissapoint. Some of my favorite areas also include, Kendall Lake, the Ledges, the Towpath, the ski areas and the Camp Manatoc Boy Scout Camp, which is only open to the public on special occasions. 

Here are some other fun places to plan your runs through the valley.

Fairhill Road Rockefeller Park/Ambler Park/Shaker Lakes

These obscure and small parks are located in the heart of the near east side of Cleveland, mostly between Fairhill Road and N. Park Boulevard. They are small and very hidden, yet offers some amazingly technical and hilly single track trails. The park has some amazing views of land that use to be here before development, and seems to have somehow escaped time. This park is even home to a tough 50k, which makes it that much cooler, despite it being relatively unknown. 

Cleveland Metroparks Brecksville Reservation

I now consider this my home course. Having moved to Brecskville in part because of the massive parks system that butts up to the Cuyahoga Valley National Park, giving me total access to run all the trails I can tolerate. While smaller than the valley, it offers a ton of trails with one even called My Mountain, that overlooks the Chippewa creek. 

The trails here offer a ton of wilderness like feel, while always being fairly close to place you can go to for safety, or an Uber pickup in case your lost or dead tired of running. The hills here can really build a runner’s endurance and simulates some of the courses you’ll see in more mountainous regions, albeit without the elevation.

Cleveland Metroparks North Chagrin Reservation

This large Metropark is home to the famed Squire’s Castle, a 19th century castle style home, which is the starting point of the Burning River 100.  This unique place is a real treat to the east side of Cleveland and it’s nearby suburbs and a great place to see something you won’t see anywhere else in Ohio. 

With views of waterfalls, bridle trails and even paved path, this is a quintessential place to log some miles while tree gazing. Being so close to the mess that is 271, this reservation offers an amazing reprieve with every amenity the Metroparks offer, sans a beach. 

Hinckley Reservation 

This southern park has a lot of rolling hills and aggressive trails that job across ledges, and is not for the faint of heart. It’s easy to get lost here, but worth the drive and hike to really be one with nature while pushing yourself to the max.

Home of the buzzards, and a rare wintery 100k race, the trails here are great for those train for trail marathons or ultra marathons. Despite being in sleepy Medina county, don’t sleep on the beauty of this park with its large lake and sceneic overlooks.

Girdled Road Reservation 

This far east park system, which lies almost in Painesville, offers a lot of nicely groomed trails that provide quite a few rolling hills. This parks butts up to a few other parks and his home to a very unique bridge, that’s is amazingly fun to run across. 

Trails here are clearly surround by wetlands and dive into the woods leaving a great feeling of solitude, this far our from the "big city".  Despite how far this park is for most people, it’s a great place to plan a long run with a friend and has a few covered areas where you can plan in your own aid stations or a sit down lunch on a long run. Wildlife can abound out here, so who knows what you will run into!

Mill Stream Run Reservation

This Metropark is much larger than most people realize at first. Follow the southern parts of the Rocky River, this winding park has a lot of great river views with paved paths surrounded by wetlands.  Being easily accessible to many densely populated suburbs, this park is a big draw for many West siders. 

Most of this park is fairly flat and great for runners who really want an easy place to stretch their legs and go meander without the worries of getting lost or tackling big climbs. An ideal place for beginning runners, or those who just want a quick run through the park to break up the hustle and bustle of everyday living.

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!

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.