Seizing up the Muscles

Christine, one of our Sunday morning regulars, asked this morning, “How do I get rid of muscle cramps?”  Sounds simple, and surely there is a scientific explanation and answer, right?

No one knows.

That’s the answer.  At least, no one who has done the research and looked for a cause, and has evidence to support their conclusions has an answer.  In an excellent article by Kevin Miller, Marcus Stone, Kellie Huxel, and Jeffrey Edwards, sports physiology scientists, titled “Exercise-Associated Muscle Cramps,” (Sports Health. 2010 Jul; 2(4): 279–283), and provided through the National Institutes of Health, the subject of muscle cramps in athletes is reviewed in depth.

There are myriad theories and cures for this vexing problem.  Most of the theories and suggested cures are based on hunches, anecdotes and guesses.  The most common thoughts about why muscle cramps occur in athletes have to do with dehydration and loss of electrolytes.  The thinking goes that if one is dehydrated, meaning a loss of free water in the body, and loss of electrolytes such as sodium, potassium and magnesium, the nerve terminals to muscles are over-sensitized leading to cramps.

Another leading theory is based on neuromuscular interactions.  This theory states that, in overworked muscles, excitatory impulses and inhibitory impulses are not in balance, and the excitation of muscle fibers wins out.

The report mentioned above goes into detail about these theories, looks at the research that has been done in these areas, and the reasons that these theories are not clearly supported by the research.

Most muscle cramps in athletes occur well into a workout or race, or occur after the end of the event.  There is a period during which muscle cramps occur after the event is finished called the “cramp prone state”, and until this period is finished, which may be eight hours or longer, the athlete is still susceptible.  While some cramps may be minor, and not interfere with performance, often the cramps can be debilitating.  Many cures have been tried over and over, with only anecdotal evidence to back them up.  Sports drinks containing (minimal) electrolytes, pickle juice, mustard, bananas, oranges, cold therapy, hot therapy, massage and TENS (trans-cutaneous nerve stimulation) have all been used.  But studies looking at hydration status, electrolyte status and all the above mentioned cures have failed to show statistical improvement in study groups.  Known to work to relieve a cramp, but not for prevention, stretching will stop the cramp.  However, that is a temporary solution, and not one that will prevent a cramp the moment activity is resumed.

I have been plagued with cramps, mostly of the legs and thighs, throughout my athletic career, starting from when I swam as an eight year old.  In my experience, the cramps are less likely to occur the better condition I am in.  When I was a competitive swimmer, the early part of the season was the worst, but as my training went on, they were less and less a problem.  Now, as a runner, and mostly with long distances, I find the muscle cramps hit me very consistently during a marathon, usually around the sixteen to eighteen mile mark.  This is in spite of maintaining good hydration, using salt or drinking electrolyte drinks, and supports the contention that these factors don’t play a role.  My best marathon performance, in which cramps definitely played a very minor roll, was the one where I had trained the best and most consistently.  There are plenty of good reasons to stay well hydrated of course, which have to do with other body systems.  Running in the heat and humidity causes excessive fluid losses, raises core body temperature as the body has trouble getting rid of excess heat, and can lead to hyperthermia and affect kidney function.  Overhydration by consuming too much water to replace losses, can cause hyponatremia, meaning too low sodium levels, which is equally serious.

Kevin Miller, the lead author of the article mentioned above, wrote a simplified version of myths regarding muscle cramps and what to do about them, called “Exercise-Associated Muscle Cramps: Debunking Five Myths”.

While research into the reason for muscle cramps and the treatment has not provided an answer, he makes sound suggestions on how best to avoid them.  If you wish to have a more complete understanding of the research and conclusions, his paper is a good source, and provides many references on which it is based.  I hope your runs are as cramp free as possible.  Happy running.

Wineglass, Warm and Humid

The frequently flooded Chemung River, a tributary of the Susquehanna, in Corning, N.Y.

The frequently flooded Chemung River, a tributary of the Susquehanna, in Corning, N.Y.

I didn’t expect western New York in October to be warm and humid, but then I didn’t know what to expect.  When we train for a marathon, we start months in advance with a plan to build miles and endurance.  This summer, we were slogging through many warm and humid days.  I was hoping for cool and brisk, but that is not the way it turned out.

Our trip up to the Wineglass Marathon, held October 6, 2013, started with a very nice cruise through Philadelphia and up the northeast extension of the Pennsylvania Turnpike.  This in itself is a cause for celebration, knowing what this stretch of highway can be like.  We stopped at Clark’s Summit, north of Scranton, for lunch with a good friend.  On we went further north after lunch, around Binghamton, NY, then westward along the Southern Tier Expressway through Owego and Elmira.  We passed the bridge with the village name of Horseheads chiseled in large letters.  This village has the distinction of being dedicated to the pack horses of Major-General John Sullivan of the revolutionary army.  The bleached skulls of the horses make for an interesting history.  But never mind this distraction,  we were on our way to Corning.

The expo for the marathon is held in the Corning YMCA, in a fortress of an old red brick building.  It is not a big expo, in fact, rather small, but then this is not a huge marathon.  The marathon and the half marathon are capped at 2500 runners each.

In front of the Corning YMCA, home of the expo.

In front of the Corning YMCA, home of the expo.

Picking up my number on the indoor track at the YMCA

Picking up my number on the indoor track at the YMCA

Encouraging signs from my wife for me and clubmate Steve.

Encouraging signs from my wife for me and clubmate Steve.

I picked up my number, and the number of my friend Steve, who was going to arrive a bit late.  The friendly young lady behind the rail took Steve’s word by phone that she could trust me and allow me to pick up for him.  Fortunately, I remembered to check for safety pins, too.

After we picked up our numbers, we headed a little out of town to our motel, the Hampton Inn, of Corning.  I am a fan of Hampton Inns.  They always seem so comfortable and clean, and the complementary wi-fi and breakfast are nice benefits.  We had a little trouble finding the Inn.  We knew the address, but all we could find was a Denny’s and a gas station.  Then, we spotted it.  It was behind the Denny’s a little ways, with absolutely no sign directing one in to the parking area.  No matter, we parked and went to check in.  The pleasant woman behind the desk asked me my name, and then informed me that she did not see my reservation.  Of course, I had made the reservation months ago, and even got an email from the hotel advising us that construction was going on, that there would be noise during the day, and that all of their facilities would remain open.  Another front desk person came over, and they re-examined their records.  As it turned out, the reservation I had made was for two nights starting the night before.  I originally planned to come up Friday night.  Since I didn’t show, they gave away my room and cancelled my reservation.  They informed me they were completely booked, but that they would try to help find me a room in another hotel.  Naturally, the marathoners had booked everything in several miles.  Just as I was getting despondent, and here’s where they really shined, they suddenly realized that one room was not taken.  This was a strange, very large, room on the first floor, close to the lobby, equipped with a board room-like table and chairs, a kitchenette, and a Murphy bed instead of a regular bed.  While all the other rooms had been recently renovated, this room had not, and was in the process of a make-over.  We, my wife and I, were more than happy to take it.  The front desk person even assured me she would remove any charge for my missing the night before.

After freshening up a bit, we joined with the other club members staying at the Hampton Inn and headed back to town for dinner.  We found a place to park on Market Street, the main shopping and dining street in Corning.  They have an unusual way of decorating shops on Market Street, with whimsical signage and artwork.

A Dali-esque clock suspended from a second story window.

A Dali-esque clock suspended from a second story window.

It appears to be a boy dipping his finger in a pond.

It appears to be a boy dipping his finger in a pond.

Steve called a few months ago to the restaurant, Sorge’s, an old, established Italian restaurant in Corning.  He was assured that even though they don’t take reservations, they are a large restaurant which can accommodate a large crowd, and we would not have much of a wait.  As you might expect, Sorge’s was packed, and we were told there would be about an hour or so wait.  We were a hungry crew, and did not want to spend an hour thinking about food, and then another hour possibly waiting for it to arrive at the table.  Right down the street there was a small establishment which appeared to have tables set up for an impromptu dinner.  It was the Palate Cafe and Juice Bar, and they were serving a pasta dinner for the marathoners that night.  We inquired, and it turned out a large party had skipped out on their reservation so they had room for us.  Two in our group, Sara and Brian, wanted a more normal restaurant experience, and chose to return to Sorge’s, but the rest of us settled on the home-cooked style of the dinner at Palate.  It appears Palate specializes in wheat grass juice, and their website has a list of forty benefits and things to do with wheat grass juice, some of which I would never consider.  Check for yourselves if you are curious.

Steve and Caren at Palate Cafe

Steve and Caren at Palate Cafe

Tony, Kat and Frank getting ready to have a pasta feast.

Tony, Kat and Frank getting ready to have a pasta feast.

Kat , my number one supporter, and me, Frank

Kat , my number one supporter, and me, Frank

The dinner at the Palate Cafe and Juice Bar was acceptable, not spectacular, but it was pasta.  We felt we had served our bodies well in the carbohydrate loading department.  It was a family style affair, though, seeing the steaming pots and the rest of the preparation area assembled in a corner of the store usually used for other purposes.  After dinner, we met up at a small bar down the street for a beer, the one beer I would have the night before the big event.  We were definitely out-of-place at this locals hang-out.  There were a few of the regulars standing outside smoking, and Tony seemed a bit intimidated by them, although he’s a lot bigger and stronger than they were.  Inside, the choices for beer were limited, and they definitely focused on the usual, Bud, Miller and Coors.  I asked for a Sam Adams, which was on tap, and without any evil look the bartender poured me one.  I was grateful.  Caren paid the tab for us and we sat at a small table near a group ranging from grandma to young adult-on-iPhone playing electronic darts.  Now they did give us an evil eye or two, having crowded in on their territory.  Our nervousness about the next day started to come out as we sat and drank, thinking about the weather, and the prediction for warm and humid conditions.  After the beer, we drove back to our hotel in relative silence.

Kat and I settled back in our room, the large space intended for meetings, and got into the Murphy bed.  It was no regular bed, with awkward straps holding up a thin mattress.  One had to adjust one’s body so that the hips and shoulders appropriately fit in the hollows created by the straps.  I slowly drifted into dream world, thinking about what to wear the next day.

The morning of the marathon I arose early, waking at my usual 5:00 AM.  I checked the weather on my iPad.  It didn’t look too daunting, with light rain and temperature in the mid 60’s at that moment.  I could hear the rain outside, and it sounded a bit more than “light”.  I decided to go with shorts and my club singlet, and my Saucony compression knee-high socks.  Donning some light cover up pants and a jacket, I headed out to get breakfast, nicely set out for us runners by the hotel staff.  They came in early to set up, since they usually don’t start serving until 6:00.  A number of other runners were there, having a coffee and some oatmeal.  My club mates, Steve, Brian and Tony soon arrived, and we had breakfast.  I went with the oatmeal, too, but Brian went for the pour-your-own waffle, freshly cooked in the waffle iron.  After a bit more conversation and a second cup of coffee, we gathered our stuff and headed out.  Caren was nice enough to drive Steve, Brian and me to the start, in Bath, N.Y., while Tony headed separately for the buses in Corning.  Since he was doing the half marathon, his start was half way down the route from our start.  We gathered up a hill in Bath at a Philips Lighting Company plant.  We were not aware at the time that the plant had closed, laying off 280 workers.  It appears that due to changes in demands in the home lighting industry, this plant made the wrong type of bulbs, and so rather than change the technology in the plant, the company, based in the Netherlands, decided to close it.

The start area was well equipped for the runners.  There were plenty of portable toilets, and UPS trucks were waiting to take our bags to the finish line.  Since the Boston bombing, all running events where bag check is allowed have gone to allowing only clear plastic bags provided by the race.  It’s a bit like making every passenger remove his or her shoes to board a plane, since there was an attempt to set off an explosive in a shoe in the famous “shoe-bomber” incident.  As we gathered for the start, it was misty and a bit warm.  The runners lined up, there was a very nice rendition of the Star Spangled Banner by a local singer, and then we were off.

I get an odd feeling starting a marathon.  I don’t know whether I’ll cramp up or when, whether my training will prevail, or how long it will take me to get to the finish.  One thing on my side, I’ve finished every one of the eight marathons I’ve run to date.  As we headed down the hill I was reminded of last year’s Steamtown Marathon.  That start was a long down hill run, but this one was only about a half mile before the road flattened out.  In spite of the warm, humid conditions, I was feeling alright.  I kept reminding myself to keep my pace in check, and I kept it around an 8’35” pace, according to my trusty Garmin.  I have the 305 model, with a large face which one of my friends referred to as a Dell laptop on my wrist.  It is easy to read on the run, though!

The early part of the race was very nice.  My pace was good, the legs felt good, and the scenery was quite attractive.  We could see the surrounding hills with trees turning colors, and there were ponds reflecting the colors.  We passed through a few very small towns, and some of the locals came out to cheer us on, but they looked a bit sleepy, standing by the side of the road, coffee cup in hand, and not saying much.  Moving on, Steve, running with me, and I were greeted enthusiastically by Caren and Kat, who were driving from cheering stop to cheering stop to give us support.  I stopped for a moment to let Kat get a photo, but she yelled “keep going”, and I did.

Frank (L) and Steve (R) moving on.

Frank (L) and Steve (R) moving on.

Hey Steve, how much farther do we have to run?

Hey Steve, how much farther do we have to run?

It did occur to me that I was losing a lot of fluid.  My clothing was soaked and clinging to me, there was a constant flow of sweat from the brim of my hat, and it wasn’t raining, so the wetness was coming from me.  I was stopping at every water stop, alternating Gatorade and water, and trying my best to keep well hydrated.  The trick to drinking on the run is to crimp the cup.  That way only a third of it sloshes out of the cup on me and my shoes, and two-thirds goes down the right way.  We got to the half way point still feeling fairly good.  By this time, the crowds had picked up and were very enthusiastic.  After passing through the 13 mile mark, there is a significant hill, but it is the last of the real climbs.  As we got into the second half, I started to feel the first signs of trouble from my legs.  There were little twinges of muscle spasm coming from my calves, and I was getting concerned.  The last time I passed her, my wife held out a water bottle filled with sports drink, which I grabbed and downed along the route.  I also was taking gels, about one every six miles.

Caren, heading out to give Steve some encouragement.

Caren, heading out to give Steve some encouragement.

She may have been telling him to "be careful, we need you at home".

She may have told him to “be careful, we need you at home”.

He was looking better just a moment ago.

He was looking better just a moment ago.

Perhaps the photos project the warm and steamy conditions we were facing.  The rubber bands had snapped, the legs had turned to pudding.  By around mile 18, both Steve and I were shot.  In spite of working hard to stay well hydrated, it seemed the loss of sweat, and the inability to get rid of body heat had taken a toll on us, and we both wound up walking a ways.  It really is amazing how much time one loses off one’s goal when the walking starts.  At this point I recognized that my hopes for a Boston qualifier were not going to become reality, so I did what I could to make it to the finish without hurting myself too badly.

Even the supporters along the route were a bit subdued.

Even the supporters along the route were a bit subdued.

My legs were toying with me.  One moment I was able to run, the next they were cramping up and sticking out to the point I could hardly stand.  I was reminded of Peter Sellers’ arm in his role as Dr. Strangelove, and his “alien hand syndrome”.

Walking was the best I could muster around miles 18-20.

Walking was the best I could muster around miles 18-22.

After some walking, some more Gatorade, and another gel, I felt revived enough to run again, although I had completely lost my stride.  I was able to manage around a ten minute mile, and I kept trudging along.  I noticed an awful lot of other runners doing the same at this point.  My plan, what I had practiced for, was to pick up my pace at this point to go for a good finish.  That plan will have to wait for another day.

Back to a running stride, and trying to keep smiling.

Back to a running stride, and trying to keep smiling.

About the last four miles we headed through a park along a bike path, and I could see we were starting to get close to finishing.  The legs, while not working well, were at least working, and I managed to carry through to the finish line.  The last stretch before reaching Market street is over a bridge, with a slight rise.  This gave me cause for concern, but my fears were unnecessary, as I crested the relatively minor hump without incident.  On the other side of the bridge, Tony, having finished his half marathon, was cheering on runners and spotted me.  He yelled “go Frank, you’re looking good”, and it definitely helped.  The finish down Market Street is a very nice finish.  The crowds were out and yelling for us, and I could see the finish line in the distance.  I saw a bank sign with the temperature showing 80 degrees on that last stretch.  As I crossed, it was a great relief to stop.  I needed fluids, and I quickly downed two bottles of water and grabbed a third.  I received my medal, a large glass medallion in purple, hanging from a broad white ribbon.  I walked through the food line, took some broth and a few other items, and met up with Kat, who had spied me on the final stretch.  It was great to see her smiling face at the end of the race, and have her support all along the way.

After the race, we headed down towards the Market Street Brewing Company, where we all met up for lunch.  Brian had turned in a terrific performance, given the conditions, finishing in the 3:34 range.  I had come in at 4:21, and Steve a bit behind that.  We all agreed that the race organization and course were very good.  I would certainly like to do this marathon again.  I just would rather do it when it is in the 40-60 degree range and dry, not 70-80 degrees and humid.  But, one can’t plan that part of the marathon, and you take the conditions as they are.

Brian, who turned in a great time.

Brian, who turned in a great time.

Brian's wife Sara, displaying the sleeveless "T" look for a hot day in October.

Brian’s wife Sara, displaying the sleeveless “T” look for a hot day in October.

Half marathon man Tony, who will be running Boston this spring.

Half marathon man Tony, who will be running Boston this spring.

Steve, who suffered the most this marathon.

Steve, who suffered the most this marathon.

Kat and humble author Frank, two beers down.

Kat and humble author Frank, two beers down.

There’s Better Days A-comin’

Been through some rough times lately.  Things were going okay, in fact I was looking forward back in April to running Phillie’s famous Broad Street Run on May 5 .  With only a week before the race, I was coming off a week of hospital call.  That always requires some recovery time.  But this week, which ended April 21, was particularly rough.  In a short phrase, there were a lot of sick folk.  The following week, I seemed to be coming down with a virus.  I developed shaking chills, fever, muscle aches, in other words all the typical viral symptoms.  Oddly, though, they also seemed to come and go.  One half of a day I would be in the grip of the ague, then a few hours later, I’d feel back to my normal self.  By the end of that week, it seemed to have passed.

That was just hopeful thinking.  The following week, the virus changed it’s tactics and decided to attack my intestinal tract.  While I no longer had the shakes and chills, I couldn’t eat anything without it seeming to pass through me in two hours, and not stop to get absorbed.  So, I stopped eating, took only tea, and managed to make it through the next few work days without cancelling anything.  At the same time, my trial was about to start.  As a physician, I was being sued by one of my patients for allegedly going outside the standard of care and causing her harm.  This trial had been scheduled originally last September, then October, then November, and then February.  Each time I was told I needed to cancel all my usual clinical duties and be present at the courthouse.  I would need to testify, but also be present to listen to all the other testimony of expert witnesses.  A colleague of mine was also named in the suit and would likewise need to suspend all his activities.  Each time the trial was scheduled it was cancelled for the lawyers’ or judge’s conflicts with other trials.  This time, starting Thursday of the week when I’m in the throws of my GI hullabaloo, I was told it was definitely going ahead, since it was the oldest case on the judge’s docket.  Thursday was jury selection day.  I presented to the courtroom as instructed, and jury selection commenced.  It took a full day, but a jury of eight was chosen.  Meanwhile, I was getting a bit weak, having no real food for two days.  Not wanting to run in and out of the courtroom, I didn’t dare try to eat something that day.  The actual trial was not to start until the following Tuesday.

By Friday, the evil GI virus seemed to have run it’s course.  I was able to take in solid food again, and start to rebuild my strength, which had taken a real dive.  By Saturday, I was still feeling a bit dizzy and washed out.  But the Broad Street 10 miler was coming up Sunday, and I really wanted to run it.  It’s a big event in Philadelphia, with over 40,000 registered.  It’s the largest 10 miler in the country, and a big celebration.  This year, it would also stand as a tribute to the Boston Marathon and the awful events that took place there a few weeks earlier.  So, Saturday morning I went to the expo to pick up my number.  Sunday, I joined my fellow club members at 5:45 AM to carpool to the race.  It is a point to point race starting at North Broad Street, and heading straight down 10 miles to the end of Broad Street at the Philadelphia Naval Yard.  The only turns are around the Philadelphia City Hall, which sits in the middle of Broad Street between the five and six mile points of the race.  It’s known for being a fast course, and many of the speedier, younger runners look for a sub-one hour time.  We parked near the end of the race in the sports arena parking lot, and joined our fellow runners on the Broad Street subway heading north to the start.  It is an interesting site to see several thousand runners cramming the subway trains in their running shorts and singlets, numbers on.  It is not the usual workday subway scene.

The organization of the race was superb.  It went off on time, the corals were well organized, and even the increased police presence was organized and really not intrusive.  I could tell though, that this was not going to be a record setting year for me.  I probably should have listened to my body, as they say, and not run, because of being so ill the week before.  I was never really able to get into gear and push myself, and as I was coming up to mile nine, one of my friends from another club passed me and said I looked like I was “hurtin’.”  I made it across the line in 1’23”, much slower than I predicted.  But it was a nice day for a race, and I joined my club members afterwards on the grounds of the naval yard, to drink water and have a nice, fat Philly pretzel.  Our goody bag after the race also included a couple of Tastykake bars and some Peanut Chews (designed to pull fillings and destroy dental caps), all products of Philadelphia.

Some of our SJAC club members at the Naval Yard after the Broad Street Ten Miler, 5/5/13

Some of our SJAC club members at the Naval Yard after the Broad Street Ten Miler, 5/5/13

The following day, Monday, was not a trial day, so I had cases scheduled all day in the OR.  At the end of the day that day, I noticed my hands and ankles seemed to be swollen.  I woke up the next morning with the swelling even worse, and I seemed to be having a hard time walking.  I went to our usual Tuesday morning conference at the hospital, then headed to the courthouse for the trial to start.  Everything felt tight.  My watch, which usually dangles a bit on my wrist, was stuck in one spot and making an impression on the skin.  My shoes felt tight.  When I made a fist, my skin looked taught over the tendons, and I couldn’t see them clearly as I usually would.  My co-defendant and I sat through the first day of testimony, paying attention to the plaintiff, taking notes, and discussing things with our lawyer.  That afternoon, though, after court adjourned for the day, I headed back to the hospital to make rounds.  I found my own physician on rounds, and told him about my week of GI bug, the race, and now the swelling.  He thought it could be some acute kidney injury, or a post-viral syndrome, and had me get a few blood tests.  I actually carried through with the tests, although as a doc, one must write one’s own prescription for these things.  The following morning I found out that my BUN and creatinine, measures of kidney function, were above normal, and my CPK, a measure of muscle breakdown, was on the high side of normal.  Texting this info to my physician, I was told it looked like I had suffered a bit of acute kidney injury, probably from racing after a week of little or no food, and that with proper hydration and time I would recover.  This is very scary.  I should have known better, and not run the past Sunday.  I was definitely foolish, but had gotten drawn in because of the commitment to run and the nature of the race.  I did as told, stayed well hydrated, and slowly recovered.  By Friday we had heard most of the experts testify, and it was now our turn to take the stand.  My co-defendant went first and did a good job answering sometimes difficult and lengthy, convoluted questions.  I looked forward to being able to give my story.  I hoped the jury would not only believe me, but feel I had done the best for the patient.  This is an anxiety producing position to be in as a surgeon.  I feel perfectly comfortable in the OR, but not in the courtroom.

That weekend was Mother’s day weekend.  My wife and I took a short trip to visit a friend in Mt. Kisco who is leaving for the West Coast, and a new job in Silicon Valley.  It was a very relaxing two days.  I got in a run on Sunday, in the hills near the Hudson River. We visited my younger daughter and son on the way back home, and drank a happy Mother’s day beer.

Kat and Dan at his house in Mt. Kisco.

Kat and Dan at his house in Mt. Kisco.

We were back in court Monday for the last of the expert witnesses.  Tuesday was the day for the attorneys to give their final arguments.  It took the judge about two and a half hours to give the jury their instructions, which were fairly complex.  They had to consider whether they thought my co-defendant and I had deviated from the standard of care, each of us separately.  If so, they would need to decide to what percent her pre-existing conditions contributed, how much her pain and suffering were worth in dollars, to what degree we had contributed to that, and several other issues of reward should we be found at fault.  As it turned out, they took about an hour to decide that both my co-defendant and myself had, in fact, done the right thing, and were not guilty of negligence or failure to perform according to standard of care.  I had already left the court because I needed to get back to the hospital.  When I got the call from my lawyer that we had won, I was elated.  I was not happy because we had beaten the other side.  I was very disappointed the patient felt we had not done well by her and that she needed to sue.  I was happy because we had successfully shown to a lay jury that we had done, at the very least, an acceptable job within the standards of care.  Was this a Pyrrhic victory?  This comes from the Greek King Pyrrhus of Epirus, whose army suffered considerable losses in defeating the Romans in 279 BC.  He felt that if he had to fight another battle, he could not, as the toll extracted would be too great.  For me, taking the two weeks away from my usual work does not really harm me, other than the anxiety it produces.  The patients that depend on me have to wait, a number of surgeries needed to be postponed, and it’s not possible to make up for that lost time.

With a strange virus that took a long time to run it’s course, causing mayhem in the process, to a “touch” of acute kidney injury perhaps brought on by my own foolishness, to having to defend myself in court, it has been a tough few weeks.  I know I’ve learned a lot from the experiences of the last several weeks, I just haven’t figured out what I’ve learned so far.  Now, though, I can return to my usual schedule, get back to work and get things done.  That is, after I return from a trip San Diego to see my oldest daughter graduate from her MBA program.

Frank K.


Rudolph’s Red Nose Ale

“To alcohol!  The cause of–and solution to–of all of life’s problems”  Homer Simpson

I did a quick check on Google, asking the question, “Why do runners like beer?”  Not too surprisingly, there are plenty of comments, articles and pseudo-scientific research about how running and beer go together.  There is an entry in a Runner’s World forum asking why runners like Craft (Craft is capitalized in the entry) beers more than the general populace.  This query, posted in March, 2012, got answers ranging from “that’s because runners are snobs” (I’m paraphrasing here), to runners are craft beer fans who like the quality over the Bud/Miller/Coors brews.  There were a few comments on why Michelob Ultra might be marketed to athletes, or at least, to sedentary slugs who see drinking that beer as a first step towards fitness.  Little mention though, at least in the first several pages of hits on Google, on home brewing and running.  So, that’s where I step in.

Last spring I made a beer of my own recipe which I called “Long Run Ale”.  The idea was to make a beer dedicated to my running friends about to run the Boston Marathon.  In order to make it special for runners, I investigated how to make home-made energy gel.  It turned out that two primary ingredients were honey and molasses.  I made the brew as a very hoppy American pale ale, with Cascade and Willamette hops, and honey and molasses as part of the sugar source.  It turned out it was a real hit.  My running friends loved it.

When I wanted to make a Christmas Spiced Ale this winter, I decided to include the “Gu” in the recipe in order to keep it runner oriented.  Not that including honey and molasses makes it sweet.  The yeast convert all the sugar to alcohol and CO2, and the honey and molasses add to the color and impart a bit of flavor.  This is my version of a Christmas or Winter seasonal ale.  It is a partial mash recipe, which means part of the sugar for fermenting comes directly from steeped grains, and partly from malt extract.

Partial Mash:

  • Belgian 2-Row Pale Malt  5 lbs.
  • Caramel 80    0.5 lbs. (for the red color)

Boil 60 minutes

  • Grain extract from partial mash
  • Amber Dry Malt Extract   4 lbs
  • Honey  1 lb
  • Molasses  0.5 lbs
  • Spices:  Nutmeg, Ginger and Clove (I intended to use Allspice, too, but the stores were all out, every one I tried).


  • Centennial                0.5 oz. at 60 min.
  • Northern Brewer     0.5 oz. at 30 min.
  • Sterling                      0.5 oz. at 10 min.

Yeast:  Wyeast 1214 Belgian Abbey

The first step in the brewing is the partial mash. The crushed Belgian 2-Row malt and the Crystal malt are put in a nylon bag and suspended in water heated to 154 degrees Fahrenheit. This extracts the sugar from the crushed grain, dissolving it in the water. The grain is then sparged (rinsed) a couple of times with hot water to extract as much sugar as possible. The grains are then discarded, although they can be saved and used as an addition to bread, for animal feed, or as mulch.

Malted crushed barley

Combined and crushed malted barley and caramel 80 grains.

Partial Mash

The crushed grains being steeped in 154º F water for one hour.








The sweet liquid which is left is called the wort, not yet beer, but that is its destiny.  Water is added to bring the volume to about 2.5 gallons, and the wort is brought to a boil.  The additional malt extract, which is sugar extracted from malted grain, just like in the mash, above, but prepared and pre-packaged either in liquid (LME) or dry (DME) form, is added to the boil.  Now, all the wort needs is the hops.  Hops are a wonderful aromatic flower which grows on vines, and add bitterness and aroma to beer.  Hops added early in the boil are the bittering hops, in the middle, flavoring, and those added at the end are the aromatic hops.

Wort on the stove.

The wort is boiled and the hops added according to a time schedule.

Once the boil is finished, the wort must be cooled to approximately 70 degrees F as quickly as possible.  There is equipment for this, but I use a very basic method known as putting the brew pot in the sink and swirling cold water around it.  It takes about 30 minutes to bring the temperature down this way.

Brew pot being cooled with cold water.

At the end of the boil, the wort is chilled as quickly as possible to 70ºF.

After the wort is chilled to room temperature, it is ready to pour in to the fermenter.  This is done fairly vigorously, to aerate the wort in preparation for the yeast.  Water is added to bring the volume up to five gallons, and the mix is again aerated to supply oxygen.  Also, a measurement of the specific gravity of the wort is taken, which will be used later to estimate the percent alcohol in the beer.  For this recipe, the O.G. (original gravity) was 1.066.

Package of yeast

The yeast comes packaged with nutrients, and is activated before adding to the fermenter.

Then comes the almost ceremonial “pitching” of the yeast.  This is truly how the magic happens.  In the days before the microscope, beer was made with barley, water and hops (or other spices before hops were used).  The yeast was there, but no one knew it.  Then, Louis Pasteur discovered what was happening at the microbe level.  Now, we have the remarkable choice of numerous strains of yeast, each with their own behavior, which is how beers get certain fruity, spicy or caramel flavors, achieve higher alcohol levels if provided enough sugar from the malt, and may also contribute undesirable flavors.  I chose this particular yeast because it is often used for Belgian style spiced seasonal ales.  Once the yeast is pitched in, the fermenter carboy is sealed with a lid with an escape airlock.  As the yeast go to work, producing alcohol, carbon dioxide is also created which is released through the airlock.  It takes a day or so for the yeast to start converting the sugar to alcohol, and there is nothing more satisfying at this stage than seeing the bubbles merrily making their way through the air lock.  Ales are fermented between 65 and 75 degrees F.  Lagers are fermented at lower temperatures (45-55 degrees F) for longer times (weeks to months) using yeast which are active at those temperatures.


The fermenter, with lid on and airlock up and ready.

There’s nothing left to do at this point except wait for those marvelous little yeasts to do their job.  After about a week, the beer is transferred, this time with a siphon to prevent aeration, to a secondary fermenter.  The first week is for the major conversion of sugar to alcohol.  The secondary phase is for conditioning, when the yeast are still active, but taking on more complex sugars and initial byproducts of fermentation.

After another week or two in the secondary fermenter, the beer is ready to be bottled.  Bottling day can be busy.  One needs all the bottles cleaned, sterilized and ready to go.  The bottling equipment, including a bottling carboy, siphon and tubing, bottle filler and tubing, and bottle caps all need sterilizing.  I find the first step in this process is to pour a homebrew from the last batch, and then set about tackling all these steps.

Bottle of beer and glass.

A bottle of my last brew, a German Hefeweizen.


Nice head, nice color, this should augment the bottling day activities nicely.

Bottling is best done with a helper.  It is possible to do it by yourself, but a whole lot tougher, and it is not easy to keep all those parts I mentioned clean and sterile without an extra pair of hands.

The beer is decanted into the carboy used for bottling, which has a spigot at the bottom, and doesn’t require a lid.  Priming sugar, which has been dissolved in boiling water to sterilize it, then cooled, is added to the mix.  This provides the additional amount of sugar needed to allow carbonation to occur in the bottle.  The yeast are still there, and will convert this small amount of sugar to additional alcohol and carbon dioxide, not enough to change the alcohol content significantly, and just enough to provide carbonation in the sealed bottle.  Many tales of exploding bottles are told by home brewers of their early attempts at getting this right.  The amount of sugar needed is readily available in homebrewing books and online.  A final gravity (F.G.) measurement is taken, with my brew having a F.G. of 1.010, which indicates the yeast did their job.  This should be about 7.3 percent A.B.V.   The spigot is then opened and the bottling begins.

Filling the bottles

Filling the bottles takes a bit of concentration and assistance.

Finally, the bottles need to be capped.  My son and I worked together on this, with him holding the bottles so they wouldn’t tilt, and with me working the capping device.

Bottle capping.

Capping the bottles.

The yield from five gallons of beer is about 50 twelve ounce bottles, plus or minus a bottle.  We eked out forty eight and three quarters.  The beer is now ready to be bottle conditioned, which means storing it in the cellar for about four weeks.

Two cases of beer.

The beer is in the bottles, and they are capped and ready to go to the cellar.


On the shelf in the basement, they will sit and condition, adding flavor and carbonation over the next several weeks.








At this stage I just need to forget they are down in the cellar, and let the weeks roll by.  While I can get an idea of how the finished product will taste, from various whiffs and sips of the dregs, I won’t really know the outcome until it is ready to drink.  We’ll probably uncap a bottle at Christmas time, since the family will be around, but it will be a bit early yet.  Also, higher alcohol beers like this can use a much longer bottle conditioning time before they reach their best flavor, mouth feel and overall presentation.  It is mentioned, the time a homebrew is ready to drink is when you are opening the last remaining bottle from the batch.

Is beer good for runners?  That’s not an easy question to answer.  I do believe in the relaxing and socializing qualities of beer, and nearly all of my running friends like it.  It turns out Ben Franklin was speaking of wine, not beer, in the quote attributed to him about how god loves us and wants us to be happy, but it applies to beer, too.   Pro-temperance zealots have their own reasons for disliking all alcohol, and some trainers will come out strongly against it for their athletes.  On the other hand, there is tremendous support in the running community for beer.  It’s freely distributed at the end of many marathons.  The international group known as the Hash House Harriers is based on the combination of beer and running, and they admit that they are a drinking club with a running problem.  Our neighbor, Philadelphia, has a great group of runners known as the Fishtown Beer Runners, who hold weekly runs which end at the selected pub of the week.  I think the combination of running and beer is here to stay, and I couldn’t be happier.


Hydration, Electrolytes, and Running

My cycling friend, Dan T., brought to my attention an article in Mother Jones, an online and print news magazine, which asks the question, “Do Sports Drinks Really Work?”  The article is a discussion of seven articles in the British Medical Journal which discuss the research supposedly supporting sports drink manufacturers’ claims that their products actually improve athletes’ performance.  In the articles, very valid arguments are made that the whole science behind sports drink claims is heavily tainted by the source of funding for the research, the small number of participants enrolled in the studies, the lack of adequate controls, no blind studies, the proprietary nature of the studies, little or no studies showing negative results, and the sources of funding for the journals and societies themselves.

The lead article of the seven, titled “The Truth about Sports Drinks,” is an investigative essay looking at the rise of the sports drink industry, the ownership of the various sports drinks by the giant multinational corporations Coca-Cola, PepsiCo and Glaxo Smith Klein, and the way the have used supposedly scientific research to support their claims that sports drinks are a necessary adjunct to superior athletic performance.  The science comes from institutes owned by the sports drink companies themselves, or from researchers heavily supported by the companies.  Assumptions, such as the major role of maximizing hydration, the claim that thirst lags behind the need for fluid replacement, that water alone is inferior to the sports drinks for achieving hydration, that color of urine is a key indicator of whether one’s hydration is adequate, are all made without good  scientific evidence.  For the article, the writer and staff studied hundreds of articles used by these companies to justify their claims, and found that the “quality of the evidence was so poor that it was impossible to draw firm conclusions about the effects of the sports drink.”  The research and marketing have been taken as proof by many sports medicine physicians, coaches, and everyday athletes, and become a kind of gospel of training and competing.  A major criticism in the article is that the marketing is also directed to teens and children participating in typical school or club sports, contributing to child obesity.

All of us who run marathons, participate in triathlons, engage in long cycling events, or do other endurance sports, have been influenced by this.  Not everyone buys into it.  We are offered either water or a sports drink at most running events, and my personal observation is that about half the runners go with water.  I’ve been offered gels and salt packets at marathons, advised to “make sure to start hydrating at least a day before”, told to drink before I got thirsty, and all sorts of other hydration related advice.  It becomes especially confusing training in the summer, with warm days of high humidity when we sweat so much our socks squish with every step, and we look like we jumped in a lake.  I know I need water, and I even get terrifically thirsty, but knowing what is appropriate fluid replacement, and whether the sports drink claims have any merit at all is not a simple thing.  I would recommend anyone with an interest in this to look at the articles, and see how they examine with the rigor of true, objective scientific investigators the truth about the claims and marketing of the sports drink makers.

Ref:  BMJ 2012;345:e4737 doi: 10.1136/bmj.e4737 (Published 18 July 2012)

Mother Jones, “Do Sports Drinks Really Work?, All that stuff about replacing electrolytes and so on you’ve been hearing all these years? Not so much.”  By | Mon Jul. 30, 2012 3:00 AM PDT

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