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Can You Run a Marathon?

written by Thu Tran, MD,FACOG
on Saturday, 2nd November ,2013

Last Sunday, the Marine Corps Marathon (MCM) took place in Washington D.C. Every year, about 30,000 runners run this beautiful 26.2 mile course starting and ending by Arlington National Cemetery.  It’s a moving event where runners run along with wounded warriors in their wheelchairs or numerous runners with pictures of their loved ones, who died in various modern wars, pinned on the back of their shirts.  I ran the Marine Corps marathon three times, with the last time in 2010.  I still see in my mind the fairly steep hill toward the finish line where thousands of supporters were cheering for the last few yards of this long journey.  Some runners walked while others dragged themselves to the finish line.  We all were instructed to keep walking after crossing the finish line, while water bottles were given to us and we were wrapped in this "foil" blanket with the MCM logo as finishers.  Two out of three times, I saw people passing out shortly beyond the finish line, and the last time, someone even screamed out for any doctor in the crowd to come and help.  Luckily, I was OK all three times, except for a brief moment of dizziness after the first marathon, as I bent down to get the timing chip off my shoes’ laces to give it back to the volunteers.  Fortunately, that was the last MCM when runners had to take off their computer chips.  The following years, the technology changed and we runners no longer had to take off the timing chips from our shoes. 

For the training of the first marathon, David got me several books, some from a local library.  With my on-call schedule and my full time job, it was not possible for me to train with a group or with the Montgomery Road Runners.  I preferred to run at my own pace and with my own schedule.  As I read the first marathon training guide, I came across the history of the Greek runner who was sent from the town of Marathon to Athens to announce that the Persians were defeated in the Battle of Marathon.  He, however, collapsed and died from exhaustion (after he reached Athens and delivered his message).  I remember saying to myself:

"He DIED, and I am trying to run the same distance? Are you kidding me?"

It didn’t take me long to realize this poor man was not running on a paved road with water and Gatorade given to him every two miles and even orange slices after 16 miles!  He didn’t have any energy bars or beans or " 5 hour energy" drink tucked in his pockets.  He most likely didn’t even wear "breathable" running shirts and shorts and had no sun glasses to protect his eyes.  Do not forget, there were no spectators lining along the rough mountainous route to cheer him on.  If anything, he was lucky not to run into some Persian soldiers who were still fighting the battle.  This Greek runner was running for his life, not like we marathon runners who want to see how our body can tolerate a 26.2 mile distance, with a nice medal and even a "Beer garden" festival waiting for us at the end.

Can YOU run a marathon? It depends on how determined you are.  The true question should be: Can YOUR MIND run, or want to run a marathon? 

Of course, you have to be healthy enough to run a marathon.  If in doubt, it’s a good idea to have a physical exam before running one.  Assuming you have good cardiac function, no orthopedic problems, and determination, you should be able to run this 26.2 mile race.  There are several basic things you need to do to accomplish this seemingly daunting distance.  I will discuss the major ones for you here.  For details, the two books I used for training were:

  1. The Non-Runner’s Marathon Guide for Women, Get Off Your Butt and On With Your Training, by Dawn Dais.

This book was practical, easy to read partly because of its humorous style, and the instructions were easy to follow.   The author obviously was not a good runner, but she was determined to do it.  This book is good for a beginner runner.                                                                                                      

       2. Chi Running, a Revolutionary Approach to Effortless, Injury-Free Running, by Danny Dreyer with Katherine Dreyer.

Mr. Dreyer, a well known running coach and nationally ranked ultra-marathon runner, had more than thirty years experience.  He used the T’ai chi technique learned from master George Xu to train runners.  It was this excellent book, I believe, which made my third marathon pain-free. There are photos in the book of Mr. Dreyer demonstrating some stretching techniques or the proper running posture, which I found very helpful. Between Troy training my legs and the techniques I followed in the book, I also improved my time by more than 15 minutes.  When you are on your feet for several hours, fifteen minutes could feel like an eternity!

First, get a good pair of running shoes that fit you well, and get them several weeks before the marathon so your feet would adjust well to the shoes before the race.  It is important for the "shoe experts" to help you find a pair that fit you well.  For example, I went to "Fleet Feet" in Gaithersburg where my feet were measured and the proper shoes were picked.  Shoes are not cheap, but the wrong shoes can add to the risks of injury during this long run.  Remember, unlike a long biking trip where you can even wear sandals, you are "pounding" your feet on a hard surface for 26.2 miles! You have to be kind to your feet or you will "pay back" after the run or not even able to finish the run.  The truth is, you will run more than 26.2 miles in a marathon, since the route is not a straight road. With all the crossing, turning, swerving to avoid people on your sides or ahead of you, this 26.2 race is more like a 27 mile distance!  In my last marathon, my computerized watch indicated I ran 26.8 miles by the time I reached the finish line.  Many expert or professional runners might have strategy to avoid going this extra distance.  The "amateur" marathoners like you and me, however, just do whatever we need to get to the finish line, and inefficiency can lead us to run an extra mile!

The rest of your "running accessories" can be as economical as you want them to be.  My running clothes were mostly from TJ Max or Marshall, where I found plenty of Nike shorts and shirts, my favorite running wears, for a fraction of price in the sport stores. 

For the first marathon, I would suggest at least four months in advance for your training.  Three months would be more than enough for the subsequent ones.  I would try to run a full marathon or close to it at least once before the race.  During the first marathon training, I followed the advice in the books of "If you can run 20 miles, you can run 26 miles"  I ended up "hitting the wall" around mile 24, and "dragging" myself to the finish line for almost two miles!  This unrealistic advice didn’t tell you that, if you want to run 26 miles with little or no pain in the last few miles, you should train to run close to 26 miles before the race!   It’s like studying for an exam; you shouldn’t close your book after reviewing 75% of the exam.  Many questions might be in the last 25% of the test! 

I will let you read about the nutrition need during the training period.  My only advice?  We can only eat what we like.  It is hard to "force feed" ourselves especially the night before the marathon with the kind of food we are not familiar with.  Remember carbohydrates and starchy food can also be found in Asian noodles and not just "pasta".    Potatoes can be prepared in so many ways instead of just eating "mashed potatoes".  You don’t have to snack on tasteless or chewy protein bars.  Instead, eat nuts, eggs, peanut butter sandwiches, hummus and crackers etc...for your protein.  Be flexible and creative.  The truth is to have plenty of carbohydrates before your long runs and protein within half an hour after. 

The most important component in a marathon, in my opinion, is your mind power.  Again, if you are healthy and free of orthopedic problems, you can run a marathon!  You might not run as fast as the 80 year old Catholic nun sister Madonna Buder, known as "The Iron Nun" and author of the book "The Grace to Race" Sister Buder finished her first triathlon at 52 and has completed 325 triathlons including 45 Ironman Distances!  She even finished two Hawaii Ironman, with the last one in 2006 at 76 year old!  She has run numerous marathons and holds several records in various distances.  Your genetic make up and your weight have a lot to do with how fast you can run, besides your practice.  To me, a very heavy runner who can finish the race, as I have seen many during the three marathons, is as admirable as the lean, fast runner.  A champion, in my world, is one who gives his best.

Play with your mind during the long training runs.  As I often tell my friends, you can be alone but not lonely.  I even named my legs and my Gatorade bottles! They were my friends on the road.  I often didn’t bring my iPod during my long practice runs because I wanted to be fully aware of the surroundings, as the runs often started before sunrise.  I used my long runs to think about different personal, family, global issues.  I often found solutions to different problems during these long hours on the road.  On the day of the marathons, I saw quite a few people running in T shirts with spiritual or religious messages, as if God was running along their sides.  I got annoyed at first.

"With all the wars going on, I hope God is not taking his break running a marathon.  It wouldn’t be fair for an atheist not to get an extra push from behind like these guys"

However, I quickly realized whatever technique works for a runner, he should use it!  A mental or spiritual push can be an important force that keeps you going until the end.  It is also important to run for a cause, as I did in every marathon.  I ran the first one and collected almost five thousand dollars for Memorial Sloan Kettering Cancer Center for pediatric cancer, and almost as much for Treatment & Learning Center, a wonderful local organization supporting people with various disabilities.  Whenever I got tired during the races, I would think of the children who will benefit from my runs, whether a child with cancer or one with hearing impair or autism.  When you run for some cause or someone beyond yourself, you have an "extra" force behind you.  You are not running for yourself, you are running to make someone’s life better or easier!

I also trained my mind to be "tough" by running the same route many times.  A few weeks before the marathon and before I had to "cool down" and run less to save my legs for the real race, I would pick a Saturday, put on my iPod, and run my 3.2 mile neighborhood route which has ten hills, EIGHT times!  I forced myself to go up and down the ten hills a total of eighty times for this longest training run.  I left several big Gatorade bottles in front of my house to stop and drink every time I went past my house, closing on another 3.2 mile loop.  During the second marathon, I got so sick at looking at a purple crayon someone left on the grass at the corner of Ballantre and Tara Rd.  When I saw it for the eighth time, however, I knew I was almost home for good.  By running these hills, and on the same route, my mind and my legs were ready for the fairly flat and scenic MCM route a few weeks later.

If you prefer to listen to music, pick your favorite songs but those with lively beats.  I was horrified once, as I was to climb a steep hill in Chesapeake Beach, when a slow song of Louis Armstrong came on!  I often turned to "Pink Floyd", on the other hand, as I had a few miles left.  To hear " The Lunatic is in Your Head", I couldn’t help but running home faster!  Whenever I got tired, I replayed numerous times that wonderful Tom Petty’s song " I Won’t Back Down"  Remember the famous lines?

"Well I won’t back down, no I won’t back down

 You could stand me up at the gates of hell

  But I won’t back down.

  Gonna stand my ground, won’t be turned around

  And I’ll keep this world from draggin’ me down

  Gonna stand my ground and I won’t back down"

When your wave of runners starts moving, do not get too excited and sprint to avoid the crowd.  During the first marathon, I was not experienced enough to pace myself.  I ran so fast I was running out of steam as I reached 24th mile marker.  The last two miles were like running through hell, as I dragged myself and watched many people dragging themselves to the finish line.  Be calm, be patient and be mindful of your pace.  For the third marathon, David got me a Garmin watch and I was able to look at my pace to slow down whenever it showed me that I was running too fast.  It was such a pleasant run when I did not experience any pain.

Another important advice I have for you amateur runners is not to overtrain.  You have to run with common sense.  I tried to follow the running schedules designed by the books, but I was very flexible in changing the routine on certain day depending on how well I felt.  If I stayed up all night when I was on call, I would skip the long run the following day and rest instead.  I never trained beyond 40 miles a week, partly because I wouldn’t have time to, but partly because it was not necessary to do so.

I had a patient who hired a professional marathoner to train her for the MCM.  She ran more than 60 miles a week, and at a very fast pace.  She followed a strict running schedule with multiple interval long runs during the week. He also supervised her nutrition program. On the day of the marathon, my nurse Roxanne came to cheer for me and informed me afterward that my patient, who was a decade younger than me, came to the finish line less than twenty minutes before me.  She experienced so much pain toward the last few miles that it ruined her whole race. The following year, she was training in a similar manner and was injured three weeks before the marathon.  I don’t even know if she still wants to run for another marathon, but all that expense and training didn’t work at the end.  She probably was overtrained by this running guru.  You have to let your body be your guru or you will stop running sooner than you want to!

Most importantly, do not forget to hydrate yourself.  Beyond one hour of running, as in any intense sports, start drinking electrolyte fluids such as Gatorade.  Leg cramps or abdominal cramps could end your marathon dream and your months of training by cutting short your 26.2 mile.   In Crystal City, during the third marathon, I heard and saw a very athletic looking young man screaming and rolling on the ground.  I knew his pain must have come from electrolyte deficiency, causing severe body cramps.  Hydration is a big part of success in a marathon!  David once found me, during the training for the first marathon, wandering the streets of Chesapeake Beach, looking dazed and exhausted.

"Are you ok?" He was alarmed.

" I lost Harry!" I told him in agony.

"Harry? Who’s Harry?" He was puzzled.

"My Gatorade bottle! Somebody took my Gatorade bottle!" 

I named my Gatorade bottle, my companion on the road, Harry.  Like Tom Hank looking for his "coconut friend" in the movie "Lost", I was looking in exhaustion and desperation for "Harry the bottle", thinking someone had stolen it.

It turned out that nobody stole my bottle.  I must have been dehydrated enough to lost my way and didn’t pick up "Harry" as I finished running a certain block.  Instead, I unknowingly left "Harry the bottle" on the ground and went onto the next block.  By the time I was thirsty enough, I realized I had lost Harry.   This incident made me more focused during my runs and more aware of where I had been before.  I purposely skipped certain roads where the ferocious dogs inhabited, instead of having pebbles in my pockets or sticks in my hands, as I often did in the first several weeks of training.  To wake somebody up with loud dog barking before sunrise on a Saturday morning, I thought, was not polite anyway. 

As a physician, I was very mindful of keeping my body healthy during the training.  I took multivitamin, Glucosamine and Chondroitin every day.  I know Chondroitin and Glucosamine is a controversial topic, but my physician mother in law Cathy and I both agreed they work for us.  There are some scientific observations, not clinical trial, that you should take these two supplements separately and at least two hours apart in order for them to be effective. 

Do not forget to get the Flu shot and be updated with your TDAP vaccine!  Unlike what you think, long distance runners are not necessarily the most healthy people.  Indeed, at the peak of their training, the immune system of these marathoners could be compromised and they can have many episodes of common cold.  It’s best to be updated with all the vaccines, beside careful planning for your nutrition.  

Last Sunday morning, after intensely spinning for 45 minutes followed by an hour of kickboxing in the gym, I realized I would have had almost another 2.5 hours to run, had I done another marathon.  Even with all the kicking, jumping, pushing up in the Kickboxing class, I realized it was still easier than running a marathon.  Do not underestimate anybody who could finish a marathon, whether she did it in 3 or 6 hours.  After all, if she trained and ran as fast or efficient as her body could, 26.2 mile is still an impressive distance to pound on the road with her two feet.  I once looked at the car odometer and realized the distance from my house in Potomac to Germantown where my son had his piano lesson was only 17 miles, with most of the drive on the high way.  I was astonished, as the first marathon was only a few weeks away.

" I will have to run another 10 miles beyond this distance, which already seemed to be so far away? How am I going to do that?"  I was asking myself.

The lesson I learned? Do not try to measure how long the distance from your house to a certain distance less than 26.2 miles.  It will only add more to your anxiety.  The truth is, 26.2 mile is a long distance!  You will get exhausted but hopefully you will not collapse like the Greek soldier.  As long as you do not skip too many water stations, you will be wrapped in the foiled blanket and have a medal around your neck at the finish line.  Your hair might be messy, and your skin full of salt particles, but do not forget to smile as you might have your last photo taken before you cross that magical finish line.  Some runners might look much better than you, but they might have run the 10K or half-marathon route, and their legs would not feel as dead as yours.  You just accomplished a task only a few people in the world could do.  Be proud but hurry home to ice your legs and, if needed, take some painkillers like Ibuprofen, so you won’t look like a wounded soldier at work the following morning.  Unless you get a ride home, empty your bladder before heading for the metro station.  The lines are extremely long as the supporters and the runners racing for the trains.  So many people will smile at you, because they realize you just accomplish what you have been working on for so many months.  Good luck, and try to have fun! 

"The journey of a thousand miles begins with one step."

                                          Lao Tzu

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