RUN DMD

I run…therefore I am


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When the fierce and the fearless face their fears


They say ultra trail runners are some of the coolest and the baddest of the bunch in a world where less than 10 percent of its denizens have an active and regular healthy lifestyle.  By healthy we may think that hitting the gym 3x a week and doing our weekend long runs on trails to no end is enough.  Add the fact that we eat healthier than many (though that’s still subject to debate) and we have our regular 8-hour sleeps (while our contemporaries have to resort to sleeping drugs).  And we feel invincible.  The fact is underneath those bulging quads and strong core muscles lies a complex body system which can actually be faltering without showing any symptom from the outside.

 

 

 

 

 

 

 

 

 

Thus, we all need to undergo our annual physical examinations.  Ever since I was diagnosed with essential hypertension 4 years ago, undergoing those rigorous x-rays, blood tests and laboratory works has become a yearly ritual courtesy of my health insurance plan.  And I thought everyone was doing the same thing, especially those who have reached their 40s.  So it was a surprise when most runners (and even triathletes) I asked seem to (or chose to) ignore this crucial annual medical checkup.

The rationale usually goes that since they have their regular physical activity and basically look fit (though that is still a subject of contention), they need not get in contact with a needle and have their blood siphoned to gauge their health level.  They ‘know’ that they have no problem, physically and physiologically.  See these rippling back muscles and steely gluteus maximus.  Now let’s run into the sunset…

Well, here’s a wakeup call, guys.  Those sub-1:45 21Ks and sub-6 50Ks – they won’t last forever, not even in the next 5 years.  Unless, one is persistent, disciplined, organized and passionate, but most of us mortals will fall on the wayside to give way to the young turks who can easily run circles around us.  For the years I’ve been into running, I’ve seen many colleagues rise to meteoric highs, peak and soon disappear into oblivion.  And they move on to the next health craze.  Parkour, anyone?

I’m what you may call a Keeper.  I don’t move from one hobby or passion to the next.  Once I’ve found my calling, I latch on to it for as long as I can and just keep going.  I guess that’s how you’d describe my running career – a long well drawn out journey with hardly any finish line in sight.  So I’m in it for the long haul, thus the need to maintain my over-all health, patience and sanity.  No short cuts, no supplemental drinks or vitamins (not even glucosamines with chondroitin), no drugs (except for my anti-hypertensives), no stimulants/uppers (except for some energy gels).  And most of all, I religiously have my regular physical assessment, which this year just included the dreaded (and painfree) but potentially lifesaving colonoscopy procedure.  Soon, I will be including my prostate examination.

An M.D.-patient of mine once quipped (when I told her of my regular barrage of medical and laboratory examinations) that perhaps, I’m might be in continuous search for problems in my body.  Which could hold true but more importantly, I simply want a functioning healthy body that I would be utilizing on my runs and adventures.  Whether it’s my car, house, clinic or body, the key is still prevention so I won’t have to blame myself if I ever found damage or problems which could have easily been resolved upon early diagnosis.

So yes, that’s my long term plan and execution.  It’s not totally fail safe but at least I have a road map to where I’m heading.  My partner complains that I stress myself too much on planning and analysis but that’s just what I’m made of.   It’s in my DNA and in the 52 years I’ve been in this world, thinking ahead has always put things in perspective and guided me through life’s confusing and convoluted boulevards.

So, are you ready to face one of life’s most feared rituals?  You know – blood, needles, hospitals, laboratory and physical examinations – don’t worry it’s not as bad as it seems.  In fact, it could actually add quality to your twilight years.  Now picture yourself at 70, still trudging along some lost trail in the steamy jungles of Reunion Island.  Now wouldn’t that be swell?

 


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Molars on the run


Perhaps, one of the more neglected and ignored part of the body, the tooth could easily end up last in a runner’s priority list where a well-toned musculature, a robust heart and formidable legs take center stage.  But the little devil once left untreated and rotting can easily make its presence felt during the most unexpected moment, especially during those crucial periods in a race when one’s resistance and strength are already compromised and waning.

Imagine one appropriately trained, properly nourished and well prepared participant in a trail race that took a year to manage, finance, and map out suddenly experiencing one of life’s most excruciatingly painful episodes – the toothache.  And bam! All those months of blood, sweat, mud and tears suddenly vaporizing into thin air due to one missed dental appointment.  But Mr. Badass soldiers on, having survived a plethora of generalized pain, cramping, fatigue, and sleeplessness in all its degree and variety.  But the most dramatic discomfort coming from a sore molar easily beats ‘em all in a kaleidoscope of physical agony.

While many of these trials and tribulations most runners had the chance to experience, embrace and adapt to during training days and lesser races, this rare yet unbearable episode was something unfamiliar and seemed impossible to remedy immediately. At the third aid station, Mr. not-so-bad Ass gulps a strong analgesic to ease the discomfort but an hour later, the gremlin is back with a throbbing vengeance.

Alpha male finds various ways to mask the awful experience as he nears the last aid station. He puts pressure on the cheek area, places some ice to numb them and even pinches it once in a while.  Marshalls at the last aid station are baffled to encounter one bruised runner with half of his face swollen.  The expression on his face was a mixture of relief, nervousness, and frustration.

Relief from the next pain reliever is finally coming down as two emotions surface: nervousness since time is ticking away and this thorn by his side has dramatically slowed him down, and frustration for delaying his dental appointment for weeks.  An hour after leaving the last aid station, the rest of his niggling discomfort in the muscles, the mind and the joints conspire with the odontalgic main man.  Together they collaborate to make Mr. Poor Ass one broken, pained, and wandering zombie runner.

He still makes it within the cutoff time but so do the rest of the participants who were mostly high spirited and vibrant at the finish line.  Meanwhile, our Mr. Thrashed runner is looking lost and out of synch.  In one of nature’s cruelest joke, once he completed the final kilometer of the race, all of his suffering disappears like it never happened at all.

And so he survives this one but now he has learned his lesson.  Or so we thought.  He still foregoes his dental appointment but instead arms himself with sheets of narcotic analgesics.  It works like magic, of course.  Now all the savings he made foregoing his dental visits can go to registration fees for more races to come.  After all, once all his teeth start to rot and thaw, new dentures await.  So from Mr. Badass he has completed his transformation to Mr. Toothless.  And yes, he bites more than he can chew.

Your nigging tooth, if left untreated can result to more than sleepless, lancinating nights.  Let’s look at the other possible complications:  dental abcess, difficulty in breathing (once infection crosses the midline), difficulty in mouth opening (trismus), facial swelling (cellulitis), bone loss, teeth loss, including medical problems such as heart disease and diabetes.

Jose Lorenzo Mina Jr has been practicing dentistry for the last 27 years and has been witness to the Filipino patient’s evolving attitude and knowledge in dentistry.  While many patients are now armed with various knowledge (some bogus and highly questionable c/o of Mr. Goggle) in dentistry and dental care, a considerable number of patients still want to hold on more to their fancy cellphones and flashy gadgets than their good ole chompers.

Special thanks to Glairold Recella for Van’s picture after ascending Mt. Ayaas last May 27, 2018 during the Outrun your Dreams trail race.

 

 

 

 

 


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Trail Wonders and Late Night Encounters


By Van Denn Cruz, D.V.M.

“Doc, emergency!”
Dazzled from my REM deep sleep, I had to peel off the covers and get up from my bed. Our veterinary assistant was pounding the door at 2:00 AM.
“The patient is vomiting and pooping blood” the assistant greeted me as I opened the door. “Looks critical.” He greeted me with his half-swollen eyes and a literally out-of-bed look.
I hurried downstairs to our emergency department’s treatment room. A worried client was almost in tears, presenting her dog in a debilitated state.
“Good morning. What happened to him?” I asked.
“He just puked and pooped blood a while ago. He collapsed afterwards.” After which a flood of tears came running down her cheeks.
As a doctor in a 24/7 veterinary hospital, I had countless nights of staying up late attending to numerous emergency cases. Such practice requires waking up in the unholiest of hours to save a four-legged, tail wagging munchkin.

During those times, I can’t help but credit the times I had also been awake at 2 AM with my feet pounding on soil and gravel along treacherous trails. It was my source of comfort.
Our local trail races usually start when the stars and moon still alight the dark sky. I always enjoy that time when everything is so quiet and peaceful up in the mountains. No life and death situations. No stressful cases and patients. No vet emergencies. It’s just you and your natural biological habitat. I value the feeling when the cold wind embraces my warm body and gives me some relief. It’s awesome to see the moon glow amid the sleeping yellow lights of the city below. Up there the trees stand eerily tall and quiet, casting shadows on the beaten path. For several hours I escape the crazy and busy urban jungle I have below the hills. I am free.

Feeling for a weak pulse, I immediately put the adult, male mongrel on an Oxygen mask. His femoral pulse was weak and asynchronous. We attached an IV catheter to establish a venous access and immediately gave doses of the medicines we deemed necessary. The heart beat was very quick and the legs were getting cold.
“What’s happening!? Pooochieeeeee! Nooooooooo!” the client screaming her head off.
“Poochie is in a state of shock. We need to up his blood pressure so the different parts of his body can equally receive the right amount of blood it needs” I replied.
The client was on the verge of hysteria as we put the patient under a heat lamp.
“Chie-chie don’t leave me!!!”
The client charged to her dog and smothered his head with kisses and tears. Adrenaline was bouncing from room to room.
We were defined by the white walls and glass walls of our space. The space was bare and hissed with the sound of Oxygen. The white fluorescent ceiling lights casted ominous shadows on the empty room and chairs beside us.

My right foot got stuck in ankle-deep mud as I finished my downhill descent. Focusing my head lamp below, I found my way out of the obstacle. Several meters from where I stood is a stream of jet black water. The sound of dribbling fluid played its song under the cover of the night. I sat at the bank and scooped out water. I drank it even when I was not thirsty. It was great to be in such a tranquil place.
“He’s gone!!!” the client shouted to me as the mutt’s ECG reading flat lined.
The heart beat was gone. The ECG indicated a systole – cardiac arrest.
I injected epinephrine with the hope of reviving its failing heart and administered chest compressions.
The client filled the room with her rage and hysteria. It was a scene straight out of an afternoon soap opera. Her loud painful cries resonated the quiet halls of our facility. It’s as if she was losing her mind. Her heartache was reverberating throughout the whole building. It was just too much to bear.

It was a steep uphill climb when my sweat started to pour and my heart started to beat tremendously fast. My quads began to complain. But I was having a great time feeling this suffering. The crickets were humming in unison. I started to walk slowly, rethinking of how terrible and euphoric I was at the same time. I closed my eyes and became more aware of myself and the peace that the experience was bestowing upon me.
The dog started to have a cardiac activity on the ECG. We all felt a wave of relief. He stabilized after several minutes. The rodenticide antidote must be working its magic.
We all sat down and I looked outside. The night deemed to be long and infinite. “So far, so good” I murmured. I turned my attention back to the client. “This is her second life” I told her.
“Thank you so much, Doc. I thought I was going to lose him. For 10 years, he was my source of strength and happiness. I can’t imagine a life without him.”
I smiled to her and checked Poochie. He was breathing normally and his mentation was somewhat improving. Laying on the table was this large, well-loved dog who was someone else’s family member.
“He accidentally ate the rat poison that our maid left open on our kitchen table. I was furious about it. You think he’ll make it?”
“It depends on the amount of poison Poochie’s body has absorbed. I’m afraid he may have had a lot of it.”
“Please do everything you can!” as tears welled again. “I had lost so much pets in the past few years. I don’t want it to happen again.”
“The outcome of this treatment will ultimately depend on Poochie’s fighting will and response to the medications.” I said.
Suddenly, Poochie had a seizure. The ECG was thumping with a series of tachycardias.
I hurriedly administered an anti-convulsive medication.

I drifted on top of CM50’s highest peak. It was dawn. The sunlight glistened on the evergreen fields of grasses. The clouds were hiding by the landscapes below. It was chilly and we barely made it to the cut off time at the turn around. My partner was smiling as we stopped by to sit down and ingest the awe of what we were seeing. We opened our zip lock bag of trail mix. I laid down on the blanket of grass beneath me while I munched on the nuts and dried fruits. We were halfway through the course.

In my mind, Lana del Rey’s Video Game single was playing. “Heaven is a place on earth with you/Tell me all the things you wanna do/I hear that you like all the bad girls/Honey, Is that true?”.
I was humming on the song as Poochie finally collapsed. Heart rate gone, breathing is none. I looked at his owner, indignant.
Poochie is in doggie heaven, running across the fields of glistening grass and eternal sun shine. He was running his own race, on the trails.

*Based on true events
*Written in dedication to the love mutually shared by people, their pets and the trails