WEBVTT 00:00:10.029 --> 00:00:11.789 Hello anesthesia enthusiasts, and welcome to 00:00:11.789 --> 00:00:15.109 season three of Style Points. I'm not sure what 00:00:15.109 --> 00:00:17.210 that means, other than this being the third year 00:00:17.210 --> 00:00:20.250 of me recording the podcast. However, I feel 00:00:20.250 --> 00:00:22.850 that calling it a season lends the podcast a 00:00:22.850 --> 00:00:25.890 certain sense of gravitas. I'm your host, John 00:00:25.890 --> 00:00:28.609 Crow. Today, we're going to discuss long distance 00:00:28.609 --> 00:00:31.149 running and its physiologic implications for 00:00:31.149 --> 00:00:34.649 anesthesiology with CRNA Jordan Crouch. Before 00:00:34.649 --> 00:00:36.789 I let him run away with things, though, I'm going 00:00:36.789 --> 00:00:39.429 to hand it over to my co -host, Nate Moore, to 00:00:39.429 --> 00:00:42.210 introduce this month's RSI, which of course stands 00:00:42.210 --> 00:00:45.329 for Resident Selected Information. Thank you, 00:00:45.329 --> 00:00:48.009 John. I get to introduce Dr. Wes Young, formerly 00:00:48.009 --> 00:00:50.670 a PA working in a cardiac ICU before he went 00:00:50.670 --> 00:00:52.969 to med school and joined us in anesthesia, making 00:00:52.969 --> 00:00:55.729 him especially qualified to give his RSI on hemodynamic 00:00:55.729 --> 00:00:58.689 management. We think his insights are so valuable 00:00:58.689 --> 00:01:00.609 that the chair of our department, Dr. Stuart 00:01:00.609 --> 00:01:02.770 Birch, is currently sitting stool in his spine 00:01:02.770 --> 00:01:05.349 case so that Wes can be with us. Welcome, Wes. 00:01:06.390 --> 00:01:08.250 Hello, my name is Wesley Young. I'm one of the 00:01:08.250 --> 00:01:10.670 CA1s at the University of Cincinnati, and I'm 00:01:10.670 --> 00:01:12.049 going to talk to you about pressors in the operating 00:01:12.049 --> 00:01:14.549 room. There are hemodynamic effects and common 00:01:14.549 --> 00:01:17.569 uses. But before diving into the drugs and their 00:01:17.569 --> 00:01:19.230 mechanism of action, I think it's important to 00:01:19.230 --> 00:01:22.129 review some cardiovascular physiology. Our oxygen 00:01:22.129 --> 00:01:24.829 delivery system can be broken down into our macrocirculation, 00:01:24.870 --> 00:01:26.530 which we often refer to as like blood pressure, 00:01:26.609 --> 00:01:30.000 heart rate. cardiac output and SVR. But then 00:01:30.000 --> 00:01:32.340 we also have the microcirculation, which represents 00:01:32.340 --> 00:01:34.760 the flow required to deliver adequate amounts 00:01:34.760 --> 00:01:36.900 of oxygen to a particular organ. And this is 00:01:36.900 --> 00:01:39.219 what we really care about. Some organs are great 00:01:39.219 --> 00:01:41.060 at auto -regulation, meaning that they can maintain 00:01:41.060 --> 00:01:43.579 flow over a wide range of blood pressures, and 00:01:43.579 --> 00:01:45.060 others struggle a little bit in the department, 00:01:45.200 --> 00:01:47.099 kind of like the kidneys. But they all, to a 00:01:47.099 --> 00:01:48.840 certain extent, have the ability to have their 00:01:48.840 --> 00:01:51.040 arterioles vasodilate or vasoconstrict depending 00:01:51.040 --> 00:01:54.000 on local meters, like PO2, potassium, lactic 00:01:54.000 --> 00:01:56.859 acid, etc., in order to regulate the flow. So 00:01:56.859 --> 00:01:59.000 from a big picture, our body creates a pressure 00:01:59.000 --> 00:02:01.040 gradient using cardiac output and changes in 00:02:01.040 --> 00:02:03.140 the resistance provided by arterioles to increase 00:02:03.140 --> 00:02:05.939 or decrease flow to our organs, which means we 00:02:05.939 --> 00:02:07.780 can quickly shift blood to our quadriceps when 00:02:07.780 --> 00:02:09.939 running a marathon or our intestines when eating 00:02:09.939 --> 00:02:12.080 a delicious burger. The problem is that in the 00:02:12.080 --> 00:02:14.659 OR, we have departed from normal physiology and 00:02:14.659 --> 00:02:16.719 thrown in drugs that cause venous and arterial 00:02:16.719 --> 00:02:19.240 dilation. Patients bleed, they have inappropriate 00:02:19.240 --> 00:02:22.560 inflammatory cascades, and we often switch them 00:02:22.560 --> 00:02:24.300 from negative pressure to positive pressure ventilation. 00:02:25.289 --> 00:02:27.949 One last thing. Hypotension is the primary reason 00:02:27.949 --> 00:02:30.650 for using vasopressors, but we can't forget that 00:02:30.650 --> 00:02:32.569 even though our blood pressure is the driving 00:02:32.569 --> 00:02:35.009 factor for flow, it's generated through a cardiac 00:02:35.009 --> 00:02:37.409 output and systemic vascular resistance, either 00:02:37.409 --> 00:02:40.370 of which could be the problem. The primary receptors 00:02:40.370 --> 00:02:43.509 that mediate an increase in blood pressure are 00:02:43.509 --> 00:02:47.389 typically the alpha -1 adrenergic receptor. We 00:02:47.389 --> 00:02:50.289 also have our V1 receptor, and then we also have 00:02:50.289 --> 00:02:52.189 the beta -1 adrenergic receptor that increases 00:02:52.189 --> 00:02:55.360 cardiac output and heart rates. The first vasopressin 00:02:55.360 --> 00:02:56.740 that we oftentimes use in the operating room 00:02:56.740 --> 00:02:58.879 is called norepinephrine. It's a potent agonist 00:02:58.879 --> 00:03:01.479 of the alpha -1 adrenate receptor, and that causes 00:03:01.479 --> 00:03:03.280 vasoconstriction. And then there's also some 00:03:03.280 --> 00:03:05.680 modest beta -1 adrenate activity, which helps 00:03:05.680 --> 00:03:07.659 maintain cardiac output and doesn't have much 00:03:07.659 --> 00:03:10.219 effect on the heart rate. We typically give this 00:03:10.219 --> 00:03:14.310 in bolus dosing of around 8 to 16 mics. Phenylephrine, 00:03:14.389 --> 00:03:16.710 on the other hand, is a selective alpha -1 adrenergic 00:03:16.710 --> 00:03:20.430 agonist. It particularly leads to arterial and 00:03:20.430 --> 00:03:23.050 venous vasoconstruction and has very little effect 00:03:23.050 --> 00:03:27.530 on cardiac output. We typically give both doses 00:03:27.530 --> 00:03:30.629 of around 100 mics. Ephedrine acts a little bit 00:03:30.629 --> 00:03:34.009 differently. It indirectly stimulates the release 00:03:34.009 --> 00:03:37.090 of endogenous norepinephrine, and has some direct 00:03:37.090 --> 00:03:40.849 effect by binding to alpha -1 and beta -1 receptors, 00:03:41.069 --> 00:03:43.969 but that effect isn't as pronounced. You can 00:03:43.969 --> 00:03:45.650 see an increase in heart rate and some cardiac 00:03:45.650 --> 00:03:47.810 output, as well as your increase in vascular 00:03:47.810 --> 00:03:50.849 tone. We can give it intravenously through bolus 00:03:50.849 --> 00:03:53.250 dolcing around 5 to 10 milligrams, and then we 00:03:53.250 --> 00:03:58.229 can also use it as an IM injection around 20. 00:03:58.189 --> 00:04:01.870 25 milligrams. Epinephrine is a non -selective 00:04:01.870 --> 00:04:04.789 adrenergic agonist. At low doses, it causes a 00:04:04.789 --> 00:04:07.490 beta -1 effect, mostly by increasing heart rate 00:04:07.490 --> 00:04:09.870 and contractility. And at higher doses, it leads 00:04:09.870 --> 00:04:13.389 to alpha -1 vasoconstriction. We typically give 00:04:13.389 --> 00:04:16.350 bolus doses around 10 mics. Dopamine is kind 00:04:16.350 --> 00:04:18.009 of a dirty drug that we used to use back in the 00:04:18.009 --> 00:04:20.709 day, but it causes so many tachyarrhythmias that 00:04:20.709 --> 00:04:23.350 we've kind of fallen out of favor. Vasopressin, 00:04:23.350 --> 00:04:27.269 on the other hand, is a non -catecholamine vasopressor. 00:04:27.399 --> 00:04:29.740 that acts on the V1 receptor on vascular smooth 00:04:29.740 --> 00:04:32.420 muscle, and that causes vasoconstriction that 00:04:32.420 --> 00:04:37.040 way. We usually give it in one to two units at 00:04:37.040 --> 00:04:40.439 a time. So as a general rule, norepinephrine 00:04:40.439 --> 00:04:42.399 is the most balanced vasopressor that generates 00:04:42.399 --> 00:04:44.720 a nice rise in blood pressure without sacrificing 00:04:44.720 --> 00:04:46.959 too much on your cardiac output. It's usually 00:04:46.959 --> 00:04:49.120 the first -line pressor for the majority of the 00:04:49.120 --> 00:04:51.019 shock states, and you can rarely go wrong by 00:04:51.019 --> 00:04:53.439 giving norepinephrine. Phenylephrine is a great 00:04:53.439 --> 00:04:55.160 drug. We've been giving it for years in the operating 00:04:55.160 --> 00:04:57.560 room. It's a good option for the majority of 00:04:57.560 --> 00:04:59.480 our hypotension that's related to anesthesia. 00:04:59.680 --> 00:05:02.360 You know, a lot of our drugs cause low SVR, maybe 00:05:02.360 --> 00:05:05.439 decreased venous tone as well, and that can be 00:05:05.439 --> 00:05:08.300 quickly counteracted by the phenylephrine. like 00:05:08.300 --> 00:05:11.439 pure alpha -1 agonism. So we'll see a rise in 00:05:11.439 --> 00:05:14.459 SVR that way. But then you also have some venous 00:05:14.459 --> 00:05:16.360 vasoconstriction, which kind of increases venous 00:05:16.360 --> 00:05:18.579 return. We have to be careful with phenylephrine, 00:05:18.600 --> 00:05:21.100 though. It does have a reflexive bradycardia 00:05:21.100 --> 00:05:24.019 that we can see pretty profoundly in the operating 00:05:24.019 --> 00:05:27.699 room. The increase in SVR also can decrease cardiac 00:05:27.699 --> 00:05:30.160 output. So it's something to be avoided in patients 00:05:30.160 --> 00:05:32.939 who have heart failure or severe pulmonary hypertension. 00:05:34.599 --> 00:05:37.040 Epinephrine we use in the operating room as well. 00:05:37.420 --> 00:05:40.360 It increases more of your cardiac output as well 00:05:40.360 --> 00:05:44.379 as SVR. And you'll notice a nice rise in your 00:05:44.379 --> 00:05:45.959 heart rate when you use it in the operating room. 00:05:46.339 --> 00:05:48.720 You should be careful by not giving it too much 00:05:48.720 --> 00:05:50.439 because it does cause some tachyarrhythmias. 00:05:51.139 --> 00:05:53.040 Vasopressin used to be a drug that we use in 00:05:53.040 --> 00:05:55.639 our ACLS algorithm all the time. It's a useful 00:05:55.639 --> 00:05:58.319 adjunct to increase vascular tone. And there 00:05:58.319 --> 00:06:01.319 is a theoretical benefit that we can increase 00:06:01.319 --> 00:06:04.819 SVR without really affecting your pulmonary vascular 00:06:04.819 --> 00:06:07.279 resistance. And so sometimes we'll try and use 00:06:07.279 --> 00:06:09.160 vasopressin more in patients who have severe 00:06:09.160 --> 00:06:11.680 pulmonary hypertension as opposed to other pressors. 00:06:12.040 --> 00:06:14.660 And then finally, we have ephedrine. And like 00:06:14.660 --> 00:06:16.600 we said earlier, this is the one that mostly 00:06:16.600 --> 00:06:20.399 relies on endogenous catecholamines. And it can 00:06:20.399 --> 00:06:22.540 be given IM, which gives it kind of a longer 00:06:22.540 --> 00:06:26.899 acting range. And it's useful in our OB population 00:06:26.899 --> 00:06:30.519 who oftentimes have hypotension from either the 00:06:30.519 --> 00:06:33.480 epidural causing the sympathectomy. and it will 00:06:33.480 --> 00:06:35.939 slowly wear off as the epidural wears off as 00:06:35.939 --> 00:06:38.519 well. It's simply not recommended in patients 00:06:38.519 --> 00:06:40.439 who are critically ill because they likely have 00:06:40.439 --> 00:06:43.199 depleted catecholamine stores and therefore wouldn't 00:06:43.199 --> 00:06:45.560 have much effect on their blood pressure. I hope 00:06:45.560 --> 00:06:47.740 this quick review on vasopressors was helpful 00:06:47.740 --> 00:06:49.360 and hopefully next time in the operating room 00:06:49.360 --> 00:06:50.920 you can choose the best drug for your patient. 00:06:57.339 --> 00:07:00.959 My athletics started in football, then to a 5K, 00:07:01.120 --> 00:07:06.420 then to Ironman. into endurance running. I feel 00:07:06.420 --> 00:07:10.740 like 5k to Ironman is maybe a little bit of a 00:07:10.740 --> 00:07:15.079 jump there. Yeah, it was a progressive process. 00:07:17.579 --> 00:07:19.899 It's kind of like a draw the rest of the owl 00:07:19.899 --> 00:07:24.540 situation. Okay, Jordan, thanks for joining us. 00:07:25.180 --> 00:07:28.500 Yeah, thanks for having me. Absolutely. Jordan, 00:07:28.540 --> 00:07:30.699 before we... get started I'd love it if you'd 00:07:30.699 --> 00:07:32.980 tell our audience a little bit about yourself 00:07:32.980 --> 00:07:36.439 and your training all that sort of thing I've 00:07:36.439 --> 00:07:40.120 been a nurse anesthetist for five years I trained 00:07:40.120 --> 00:07:47.779 at UC and my athletics background is I played 00:07:47.779 --> 00:07:51.839 football for a while and after football really 00:07:51.839 --> 00:07:57.279 wanted to stay in shape and keep exercising but 00:07:58.040 --> 00:07:59.620 Wasn't really interested in going to the gym 00:07:59.620 --> 00:08:05.240 anymore. And I think football kind of made weightlifting 00:08:05.240 --> 00:08:09.740 feel like a job. And for whatever reason, I just 00:08:09.740 --> 00:08:13.019 kind of got burnt out on that. And I think you 00:08:13.019 --> 00:08:15.220 see that both ways. Some runners gravitate towards 00:08:15.220 --> 00:08:17.639 weightlifting after, you know, after their collegiate 00:08:17.639 --> 00:08:22.980 careers. But yeah, so I took up running and I 00:08:22.980 --> 00:08:27.769 started off with a 5K and then gradually. Kept 00:08:27.769 --> 00:08:31.750 growing my running volume to some longer endurance 00:08:31.750 --> 00:08:37.009 and then eventually into Ironman distance What 00:08:37.009 --> 00:08:41.529 what is Ironman distance Ironman distance? It's 00:08:41.529 --> 00:08:46.850 like 140 like point six miles and it involves 00:08:46.850 --> 00:08:52.230 a 2 .4 mile swim 112 mile bike ride and then 00:08:52.230 --> 00:08:57.620 a marathon so It's an all day event and it's 00:08:57.620 --> 00:08:59.860 a lot of endurance and I really like that. But 00:08:59.860 --> 00:09:04.440 there's I think there's parts of Ironman that 00:09:04.440 --> 00:09:06.460 you gravitate towards more like you really like 00:09:06.460 --> 00:09:09.059 swimming or you really like biking or like running. 00:09:09.440 --> 00:09:14.299 And I really fell in love with the running part 00:09:14.299 --> 00:09:16.860 of it the most. So I tend to gravitate towards 00:09:16.860 --> 00:09:21.080 that afterwards. One of the reasons why I wanted 00:09:21.080 --> 00:09:24.240 to have you on the podcast is because I've heard 00:09:24.240 --> 00:09:26.700 you. talk about your running experience before 00:09:26.700 --> 00:09:30.320 and i found it super interesting um you have 00:09:30.320 --> 00:09:35.240 run i think probably more distance than maybe 00:09:35.240 --> 00:09:38.340 the rest of the department combined i would say 00:09:38.340 --> 00:09:41.120 is there anyone else in the department that runs 00:09:41.120 --> 00:09:43.220 anywhere close to as much as you that's a good 00:09:43.220 --> 00:09:45.600 question i don't know i i have heard there might 00:09:45.600 --> 00:09:49.019 be somebody who's Trying to do like all the marathons 00:09:49.019 --> 00:09:50.940 and all the states or something or all the all 00:09:50.940 --> 00:09:53.500 the big marathons I'm not sure but every now 00:09:53.500 --> 00:09:54.980 and then people you know when they hear you run 00:09:54.980 --> 00:09:56.899 though Though it like mentioned somebody else 00:09:56.899 --> 00:09:58.659 that also runs and it's hard to keep them all 00:09:58.659 --> 00:10:01.379 straight But yeah, it's a lot of it's a lot of 00:10:01.379 --> 00:10:05.720 running. It's a lot of miles. So I think the 00:10:05.720 --> 00:10:09.759 my weekly volume I try to keep around 50 to 70 00:10:09.759 --> 00:10:12.399 miles a week at least and then you kind of go 00:10:12.399 --> 00:10:14.720 up or down from there depending on You know races 00:10:14.720 --> 00:10:19.340 or what you have going on Excellent. So how do 00:10:19.340 --> 00:10:22.379 you fit in 50 to 70 miles per week? How does 00:10:22.379 --> 00:10:26.259 that look in your life? Well, I'm very lucky 00:10:26.259 --> 00:10:29.639 that I live close enough that I can run to work. 00:10:29.940 --> 00:10:34.980 So, you know, that's about six miles there. See, 00:10:35.100 --> 00:10:37.320 that's just right out for me, because if you 00:10:37.320 --> 00:10:40.360 said the same for me, if I said I live six miles 00:10:40.360 --> 00:10:42.500 from work, that would exclude me from running 00:10:42.500 --> 00:10:45.740 from work. Yeah, yeah, yeah. I mean. So it actually 00:10:45.740 --> 00:10:47.720 it's only so it's six miles total, but it's like 00:10:47.720 --> 00:10:51.580 three here, three home. Yeah, that's a little 00:10:51.580 --> 00:10:54.879 bit. It's not as much. Yeah. But I think that 00:10:54.879 --> 00:10:59.399 that's easy because, you know, after work or 00:10:59.399 --> 00:11:02.440 before work, if you want to add a little distance, 00:11:02.679 --> 00:11:05.480 you know, it's very easy to just keep going and 00:11:05.480 --> 00:11:07.779 get like the training plan done or whatever you 00:11:07.779 --> 00:11:11.120 have for that day. And it's honestly, it's a 00:11:11.120 --> 00:11:15.240 great stress relief after work to. you know, 00:11:15.240 --> 00:11:19.100 be able to go outside and move around. You kind 00:11:19.100 --> 00:11:21.279 of learn to value the nice weather, you know, 00:11:21.299 --> 00:11:24.379 after you have some bad weather. So it works 00:11:24.379 --> 00:11:26.100 out really well for me. I know not everybody 00:11:26.100 --> 00:11:28.179 has that luxury, you know, if you live, you know, 00:11:28.179 --> 00:11:32.519 10, 15 miles out, but finding a way to make it 00:11:32.519 --> 00:11:36.539 work is key. Well, let me back up for a second. 00:11:36.559 --> 00:11:39.299 I want to ask the same question that I like to 00:11:39.299 --> 00:11:42.259 ask everybody. If you could invite anyone over 00:11:42.259 --> 00:11:44.539 in the world for dinner, could be somebody from 00:11:44.539 --> 00:11:46.440 the past or even from fiction, who would you 00:11:46.440 --> 00:11:52.440 invite over? That's a good question. I think 00:11:52.440 --> 00:11:57.879 right now, just on top of my mind, is this character 00:11:57.879 --> 00:12:00.799 called, his name's Gary Cantrell, and he goes 00:12:00.799 --> 00:12:08.299 by the alias Lazarus Lake. recently featured 00:12:08.299 --> 00:12:11.159 in a book i'm reading it just came out uh it's 00:12:11.159 --> 00:12:13.059 a really good book but the book's called the 00:12:13.059 --> 00:12:19.340 endurance artist and um gary cantrell he's um 00:12:19.340 --> 00:12:23.419 credited for creating a lot of the race formats 00:12:23.419 --> 00:12:26.820 and endurance running and he's designed a lot 00:12:26.820 --> 00:12:30.139 of the racing styles that we that we use in an 00:12:30.139 --> 00:12:33.840 ultra running um including the backyard race 00:12:33.840 --> 00:12:38.899 it's a Last man standing race where you will 00:12:38.899 --> 00:12:50.059 run 4 .1 miles every hour on the hour until there's 00:12:50.059 --> 00:12:53.299 one person left standing. So he has these really 00:12:53.299 --> 00:12:58.279 unorthodox or unique racing designs. And he also 00:12:58.279 --> 00:13:01.720 is the guy behind the Barkley marathons. And 00:13:01.720 --> 00:13:05.019 the Barkley Marathons have a pretty famous documentary 00:13:05.019 --> 00:13:08.519 about them that made it really popular. But just 00:13:08.519 --> 00:13:12.639 to give you an idea, the race is so difficult, 00:13:12.860 --> 00:13:15.100 like very few people have ever finished it. I 00:13:15.100 --> 00:13:17.740 think it's been going, you know, I'm not really 00:13:17.740 --> 00:13:19.820 sure on the exact year, but around the 1980s, 00:13:19.820 --> 00:13:23.440 it's been going on like that long. And, you know, 00:13:23.460 --> 00:13:25.539 there's only been a handful of people that's 00:13:25.539 --> 00:13:28.440 ever successfully completed it. So he really 00:13:28.440 --> 00:13:31.009 threads the needle on. making a race that's just 00:13:31.009 --> 00:13:34.370 difficult that it's possible to do but like very 00:13:34.370 --> 00:13:37.190 few people can actually do it and i i think it's 00:13:37.190 --> 00:13:38.850 interesting the book actually made him even more 00:13:38.850 --> 00:13:40.850 interesting to me because you learn a lot more 00:13:40.850 --> 00:13:44.210 about him and now i have more questions or more 00:13:44.210 --> 00:13:47.529 things i want to like ask him if i could so that's 00:13:47.529 --> 00:13:52.690 who i'd pick to have dinner with if i could i 00:13:52.690 --> 00:13:55.960 don't know That person would want to have dinner. 00:13:56.039 --> 00:13:57.980 They'd want to maybe go on a jog with you. Yeah, 00:13:57.980 --> 00:14:03.120 that's right, yeah. Okay, you have sort of a 00:14:03.120 --> 00:14:07.360 unique perspective as both an ultramarathon runner, 00:14:07.480 --> 00:14:11.500 really, and as a practitioner of anesthesiology. 00:14:12.360 --> 00:14:15.320 Tell me about how those things intersect. How 00:14:15.320 --> 00:14:18.740 does it influence how you think about endurance 00:14:18.740 --> 00:14:22.399 and physiology when you're thinking about your 00:14:22.399 --> 00:14:26.120 training as a CRNA? and how it applies to running 00:14:26.120 --> 00:14:33.279 these enormous distances? I think the right amount 00:14:33.279 --> 00:14:35.220 of training and knowledge about the body allows 00:14:35.220 --> 00:14:37.620 people to go a lot farther than what they think 00:14:37.620 --> 00:14:43.919 is possible. And I guess that kind of comes across 00:14:43.919 --> 00:14:51.200 in anesthesia in the sense that the body is not 00:14:51.200 --> 00:14:53.679 really a machine. A lot of people think that 00:14:54.120 --> 00:14:57.480 You're going to wear your joints out. But the 00:14:57.480 --> 00:14:59.639 thing with, you know, machines is that they can't 00:14:59.639 --> 00:15:01.620 heal themselves or they can't really adapt, you 00:15:01.620 --> 00:15:05.179 know. So, you know, if you need new car tires, 00:15:05.259 --> 00:15:07.080 you just go buy new car tires. They don't really 00:15:07.080 --> 00:15:08.919 heal themselves or they don't really adjust the 00:15:08.919 --> 00:15:11.899 amount you're driving. So one of the things, 00:15:11.980 --> 00:15:14.120 you know, from the health care background or 00:15:14.120 --> 00:15:17.340 from anesthesia is that our bodies are way more 00:15:17.340 --> 00:15:20.480 incredible than what we give them credit for. 00:15:22.940 --> 00:15:24.820 They're unique to machines in the sense that, 00:15:24.820 --> 00:15:29.860 you know, you can train and build up your physiology. 00:15:31.039 --> 00:15:35.899 And with through like, you know, consistent training, 00:15:36.220 --> 00:15:41.639 you can really allow yourself to go farther than 00:15:41.639 --> 00:15:45.080 what you think is possible. That's really interesting. 00:15:45.279 --> 00:15:49.639 I think that in anesthesia a lot, we see people 00:15:49.639 --> 00:15:55.389 that. are what we would consider to be surprisingly 00:15:55.389 --> 00:15:58.830 alive, who are kind of pushing the limits of 00:15:58.830 --> 00:16:03.269 human physiology, less because they're healthy, 00:16:03.490 --> 00:16:05.990 but more that they are dramatically unhealthy. 00:16:06.730 --> 00:16:09.690 So we see people who are just clinging to life 00:16:09.690 --> 00:16:12.950 with an extremely low ejection fraction, or maybe 00:16:12.950 --> 00:16:16.330 an extremely high BMI, things like that. But 00:16:16.330 --> 00:16:19.250 you're talking about pushing it the other direction, 00:16:19.330 --> 00:16:23.460 where... You're so healthy that you can overcome 00:16:23.460 --> 00:16:25.580 some of these other things. Is that sort of what 00:16:25.580 --> 00:16:28.220 you were saying? Oh, yeah. Yeah, I think that, 00:16:28.259 --> 00:16:32.580 you know, the biggest thing that I notice in 00:16:32.580 --> 00:16:35.379 ultra running is it'll show you really quickly 00:16:35.379 --> 00:16:38.860 is consistency. You know, being consistent is 00:16:38.860 --> 00:16:43.580 what allows for those adaptive changes. And it's 00:16:43.580 --> 00:16:47.600 evident just in a personal level, but also just 00:16:47.600 --> 00:16:49.179 through a lot of the training plans you see. 00:16:49.919 --> 00:16:52.019 One of the benefits, you know, honestly, going 00:16:52.019 --> 00:16:55.960 back to the run commuting is some would argue 00:16:55.960 --> 00:16:58.960 that doing a double exercise during the day, 00:16:59.019 --> 00:17:01.679 like two runs a day instead of like one long 00:17:01.679 --> 00:17:04.160 run, is that you're actually activating a lot 00:17:04.160 --> 00:17:07.940 of those physiological responses. You're activating 00:17:07.940 --> 00:17:10.779 those twice. So rather than just running once 00:17:10.779 --> 00:17:13.220 and kind of turning everything off or on and 00:17:13.220 --> 00:17:15.019 then showing it all back off again in terms of 00:17:15.019 --> 00:17:19.880 your exercise, doing that more frequently. could 00:17:19.880 --> 00:17:23.619 could be beneficial so I think the consistency 00:17:23.619 --> 00:17:27.519 of if I work you know a 12 -hour shift I'm kind 00:17:27.519 --> 00:17:29.599 of like running every 12 hours you know if I'm 00:17:29.599 --> 00:17:31.240 running home and then running to work and then 00:17:31.240 --> 00:17:34.519 adding some so it really becomes like interwoven 00:17:34.519 --> 00:17:37.720 into your life and it becomes second nature almost 00:17:37.720 --> 00:17:40.299 like climbing a flight of stairs or walking into 00:17:40.299 --> 00:17:45.319 work so so a lot of people are really interested 00:17:45.319 --> 00:17:49.190 in biofeedback and People like myself, I wear 00:17:49.190 --> 00:17:54.210 my Apple Watch or you've got Oura rings or all 00:17:54.210 --> 00:17:56.369 these sort of things that help you measure different 00:17:56.369 --> 00:17:59.589 physiologic parameters. And that's sort of what 00:17:59.589 --> 00:18:01.930 we do in anesthesia as well. Is that something 00:18:01.930 --> 00:18:05.029 that you like to take a close look at when you're 00:18:05.029 --> 00:18:07.690 doing your runs? Is your heart rate and heart 00:18:07.690 --> 00:18:09.509 rate variability and all those sorts of parameters? 00:18:10.530 --> 00:18:13.130 Yeah, I do. I'm actually, as we sit here, I have 00:18:13.130 --> 00:18:16.230 two watches on. I'm just noticing you have two 00:18:16.230 --> 00:18:18.309 watches. Yeah, that's kind of a leading question, 00:18:18.450 --> 00:18:20.930 I think. But yeah, it's like, you know, I do 00:18:20.930 --> 00:18:23.869 have two watches on. So I wear the Apple Watch 00:18:23.869 --> 00:18:27.170 while I'm at work. It connects nicely too. the 00:18:27.170 --> 00:18:30.170 iPhone and messages, but I like to wear the running 00:18:30.170 --> 00:18:33.769 watch at the same time because it's tracking 00:18:33.769 --> 00:18:37.210 my recovery and a lot of the other health metrics 00:18:37.210 --> 00:18:39.349 that you get from wearing it for extended periods 00:18:39.349 --> 00:18:42.430 of time, like when you sleep or while you're 00:18:42.430 --> 00:18:44.349 moving or at rest throughout the day. So even 00:18:44.349 --> 00:18:45.990 though I'm not exercising, it's still collecting 00:18:45.990 --> 00:18:48.970 some data that gives me information on my recovery. 00:18:49.609 --> 00:18:51.569 How do you track your recovery? That's really 00:18:51.569 --> 00:18:54.349 interesting. Yeah, it's mostly like heart rate 00:18:54.349 --> 00:18:57.710 variability is a common tool. And these things 00:18:57.710 --> 00:19:00.170 fall in and out of favor all the time. But I 00:19:00.170 --> 00:19:03.309 mostly like to do like the sleep score. And, 00:19:03.349 --> 00:19:05.289 you know, I like to trend these things because 00:19:05.289 --> 00:19:08.809 I think that, you know, like an anesthesia, trending 00:19:08.809 --> 00:19:11.230 is always a little bit more evident than just 00:19:11.230 --> 00:19:14.950 any single number by itself. So I kind of just 00:19:14.950 --> 00:19:19.289 hop on the trends of heart rate variability, 00:19:19.410 --> 00:19:22.319 looking at my resting heart rate. really tell, 00:19:22.480 --> 00:19:25.380 like, for instance, yesterday, I ran, I ran 20 00:19:25.380 --> 00:19:28.759 miles yesterday. And this morning, on my way 00:19:28.759 --> 00:19:32.160 to work, as I ran in here for this podcast, my 00:19:32.160 --> 00:19:34.880 heart rate was quite a bit higher. And that just 00:19:34.880 --> 00:19:36.500 kind of shows that I had a big effort yesterday. 00:19:36.819 --> 00:19:40.160 So you can kind of tell, you know, like, based 00:19:40.160 --> 00:19:42.759 on how your heart rate responds from the previous 00:19:42.759 --> 00:19:47.019 day, how how difficult that exercise was for 00:19:47.019 --> 00:19:50.839 you. The issue with heart rate specifically is 00:19:50.839 --> 00:19:53.880 that It's not as much as we love numbers and 00:19:53.880 --> 00:19:58.640 anesthesia. It's not always the greatest insight 00:19:58.640 --> 00:20:05.059 into your efforts. Why not? Well, I think it's 00:20:05.059 --> 00:20:08.180 usually it can be very jumpy and it can be affected 00:20:08.180 --> 00:20:11.660 by a lot of things. And again, in anesthesia, 00:20:11.700 --> 00:20:13.619 that's one of the things we notice is that when 00:20:13.619 --> 00:20:15.940 we like a number, you can realize that that number 00:20:15.940 --> 00:20:18.619 can be affected by. you know, surgical stimulation. 00:20:18.740 --> 00:20:20.940 It can be affected by epinephrine injection. 00:20:21.240 --> 00:20:23.279 It can be affected by all kinds of different 00:20:23.279 --> 00:20:25.819 things. So depending on what's happening, you 00:20:25.819 --> 00:20:27.680 know, there's a number of explanations for it. 00:20:27.980 --> 00:20:33.160 So a lot of people like to lean towards this 00:20:33.160 --> 00:20:36.119 scale that they create called the rate of perceived 00:20:36.119 --> 00:20:39.279 exertion. And it's a lot of times it's abbreviated 00:20:39.279 --> 00:20:43.619 RPE. So using the rate of perceived exertion, 00:20:43.619 --> 00:20:46.259 you kind of come up with a scale in your own 00:20:46.259 --> 00:20:49.970 mind. And you give yourself a score, like how 00:20:49.970 --> 00:20:52.650 difficult is this run for me right now? Is that 00:20:52.650 --> 00:20:55.430 what pops up on my Apple Watch after I work out 00:20:55.430 --> 00:20:56.970 and it says, how difficult do you think that 00:20:56.970 --> 00:20:59.289 this was? Yeah, that's exactly it. Yeah, it's 00:20:59.289 --> 00:21:02.410 kind of getting that in your mind. So it's able 00:21:02.410 --> 00:21:06.369 to maybe help you plan your training from there. 00:21:06.509 --> 00:21:08.589 So if that workout was really difficult, it might 00:21:08.589 --> 00:21:12.730 suggest an easier exercise the next day. But 00:21:12.730 --> 00:21:16.029 it's good to kind of be in tune with that a lot 00:21:16.029 --> 00:21:19.930 of times. The biggest thing that I think happens 00:21:19.930 --> 00:21:23.250 is as an ultra runner, if you're really good 00:21:23.250 --> 00:21:25.490 and consistent in your training, the thing that 00:21:25.490 --> 00:21:28.170 tends to throw a wrench in the works is when 00:21:28.170 --> 00:21:30.849 you have to start tapering to go into a race 00:21:30.849 --> 00:21:33.690 because that's when your consistency fluctuates 00:21:33.690 --> 00:21:37.549 a lot. And by tapering, I mean you start to decrease 00:21:37.549 --> 00:21:41.990 your weekly miles and you kind of rest yourself 00:21:41.990 --> 00:21:45.750 leading up to a big event. That big event when 00:21:45.750 --> 00:21:48.609 it starts and sometimes because of the rest you've 00:21:48.609 --> 00:21:50.849 taken your heart rate is like all over the place 00:21:50.849 --> 00:21:53.990 It'll shoot way up and you're not even running 00:21:53.990 --> 00:21:57.609 that hard, but your heart rates really high It'll 00:21:57.609 --> 00:22:00.230 also be very erratic. So if you stop it'll it'll 00:22:00.230 --> 00:22:02.029 come way back down And then if you start again, 00:22:02.109 --> 00:22:04.910 it'll shoot back up or if you start going up 00:22:04.910 --> 00:22:10.130 hilly terrains so That's where the rate of perceived 00:22:10.130 --> 00:22:12.509 exertion comes in because a lot of times you 00:22:12.509 --> 00:22:14.150 won't feel like you're working very hard at all. 00:22:14.250 --> 00:22:17.150 It's really just a physiological adjustment to 00:22:17.150 --> 00:22:19.690 maybe drinking a ton of fluids, eating a huge 00:22:19.690 --> 00:22:22.809 meal the day before, and also just taking that 00:22:22.809 --> 00:22:25.089 week off. It's just your body's kind of getting 00:22:25.089 --> 00:22:27.730 set back into what you're about to do. And it 00:22:27.730 --> 00:22:30.690 could also just be race anxiety, you know. So 00:22:30.690 --> 00:22:34.369 what is your resting heart rate? My resting heart 00:22:34.369 --> 00:22:38.750 rate. So. When I'm at sleep, it's occasionally 00:22:38.750 --> 00:22:40.630 dipped into the 30s, which people love to hear 00:22:40.630 --> 00:22:43.369 about. You know, they like to think that, you 00:22:43.369 --> 00:22:46.089 know, my heart's beating it like once every two 00:22:46.089 --> 00:22:48.630 seconds. You know, I don't know. It's some people 00:22:48.630 --> 00:22:52.950 that causes anxiety. But yeah, it's most of the 00:22:52.950 --> 00:22:58.190 time it's in the 40s or 50s. You know, I would 00:22:58.190 --> 00:23:00.509 say if you were to look at your resting heart 00:23:00.509 --> 00:23:01.990 rate, like if you're like throughout the day, 00:23:02.009 --> 00:23:04.089 if you're sitting, it trends more towards like 00:23:04.089 --> 00:23:10.059 the mid to high 50s. So a lot of people, when 00:23:10.059 --> 00:23:12.140 they see a heart rate of 50 on an anesthesia 00:23:12.140 --> 00:23:15.460 monitor, start to feel a little bit anxious because 00:23:15.460 --> 00:23:18.019 they think, oh no, the heart's slowing down and 00:23:18.019 --> 00:23:20.259 I must give glycopyrrolate to speed the heart 00:23:20.259 --> 00:23:24.140 rate back up. And what I will typically tell 00:23:24.140 --> 00:23:28.019 the newer practitioners who might want to treat 00:23:28.019 --> 00:23:31.740 a heart rate of 49 or 50 is I will point to my 00:23:31.740 --> 00:23:35.630 heart rate trend on my watch and say, Well, my 00:23:35.630 --> 00:23:38.049 heart rate was 48 last night while I was sleeping. 00:23:38.690 --> 00:23:40.670 Please don't sneak into my house and give me 00:23:40.670 --> 00:23:42.569 glycopyrrolate. I don't need that to keep me 00:23:42.569 --> 00:23:44.670 alive. That's right, yeah. Yeah, they are asleep, 00:23:44.890 --> 00:23:47.230 yeah. And a lot of times when we're noticing 00:23:47.230 --> 00:23:49.609 that, it's, you know, in this phase between like 00:23:49.609 --> 00:23:51.329 after we've put them to sleep and before the 00:23:51.329 --> 00:23:53.470 surgery starts. They're truly just laying there, 00:23:53.549 --> 00:23:55.309 right? Like they're not even having surgery yet. 00:23:55.569 --> 00:23:57.710 Their rate of perceived exertion is very low. 00:23:57.869 --> 00:24:00.109 Yeah, very, very low. It's like they're in the 00:24:00.109 --> 00:24:01.690 deepest sleep they've ever been in technically, 00:24:01.950 --> 00:24:06.109 you know. So, yeah. That is a very interesting 00:24:06.109 --> 00:24:09.470 point. I try to remind myself of that too because 00:24:09.470 --> 00:24:12.970 it's very different when you see things like 00:24:12.970 --> 00:24:14.769 that. You cycle up blood pressure and you go, 00:24:14.789 --> 00:24:16.849 okay, it's asymptomatic bradycardia. They're 00:24:16.849 --> 00:24:20.150 totally fine. There's no reason to really be 00:24:20.150 --> 00:24:25.529 that worried about this. So when you do endurance 00:24:25.529 --> 00:24:27.970 training, it changes your heart rate and your 00:24:27.970 --> 00:24:30.470 stroke volume, things like that. Can you talk 00:24:30.470 --> 00:24:34.990 a little bit about that? Yeah. So what you'll 00:24:34.990 --> 00:24:39.450 generally see as you start to exercise is, you 00:24:39.450 --> 00:24:41.309 know, they always talk about this left ventricular 00:24:41.309 --> 00:24:43.710 left ventricle dilation that you get and you 00:24:43.710 --> 00:24:45.930 get like a slightly increased amount of muscle 00:24:45.930 --> 00:24:49.890 on your left ventricle that will, you know, increase 00:24:49.890 --> 00:24:52.630 your stroke volume to help you meet the demands 00:24:52.630 --> 00:24:56.009 that your body's asking for. And I think, you 00:24:56.009 --> 00:24:57.890 know, that's why the consistency is so important. 00:24:58.009 --> 00:25:00.869 You have to activate these things very consistently 00:25:00.869 --> 00:25:04.799 over a long period of time. To get all the adaptions 00:25:04.799 --> 00:25:07.799 that you that you're looking for to to reach 00:25:07.799 --> 00:25:13.140 your potential and. The heart rate for me with 00:25:13.140 --> 00:25:15.859 consistency and, you know, it wasn't with like 00:25:15.859 --> 00:25:19.220 very hard runs all the time or anything. You 00:25:19.220 --> 00:25:21.259 know, extra crazy. It was really just getting 00:25:21.259 --> 00:25:23.180 outside and moving consistently, consistently. 00:25:24.839 --> 00:25:28.180 My heart rate started to trend down where I noticed, 00:25:28.299 --> 00:25:30.099 you know, after a couple of weeks or months. 00:25:30.900 --> 00:25:34.539 At the same. running pace my heart rate was much 00:25:34.539 --> 00:25:36.859 much lower and much comfortable much more comfortable 00:25:36.859 --> 00:25:39.799 um i think a lot of people start off running 00:25:39.799 --> 00:25:44.380 too hard or too fast for themselves and uh i 00:25:44.380 --> 00:25:46.160 learned early on that every training session 00:25:46.160 --> 00:25:48.420 doesn't have to be like the hardest training 00:25:48.420 --> 00:25:51.460 session you've ever done so i you know i definitely 00:25:51.460 --> 00:25:54.180 started off as like uh they call it like you 00:25:54.180 --> 00:25:56.420 know the the workout hero or the training hero 00:25:56.420 --> 00:25:57.859 where you're like trying to like break records 00:25:57.859 --> 00:26:00.400 in your training every day. And a lot of that's 00:26:00.400 --> 00:26:02.980 just carry over from my football experience where, 00:26:03.079 --> 00:26:06.000 you know, it might be motivational to do that 00:26:06.000 --> 00:26:08.480 if you're like lifting weights and you're really 00:26:08.480 --> 00:26:11.000 trying to, you know, throw heavy weight around 00:26:11.000 --> 00:26:12.759 and things like that. But I think for running, 00:26:12.859 --> 00:26:15.680 it's really just about like, like a consistency 00:26:15.680 --> 00:26:19.579 that you can maintain and sustain and going too 00:26:19.579 --> 00:26:22.039 hard every day is not sustainable. It's just, 00:26:22.079 --> 00:26:25.079 it's going to lead to injury and, and, some you 00:26:25.079 --> 00:26:28.519 know other complications and also burnout are 00:26:28.519 --> 00:26:30.759 you shooting for a particular heart rate when 00:26:30.759 --> 00:26:34.099 you're running yeah for me everybody has a little 00:26:34.099 --> 00:26:35.819 bit different that you can calculate there's 00:26:35.819 --> 00:26:38.319 ways to calculating your heart rate zones um 00:26:38.319 --> 00:26:40.420 you know the oldest one that we hear about is 00:26:40.420 --> 00:26:44.599 220 minus your age and uh you can kind of calculate 00:26:44.599 --> 00:26:47.440 it from instead of the generic 220 you can kind 00:26:47.440 --> 00:26:49.539 of calculate it from a maximum heart rate where 00:26:49.539 --> 00:26:52.750 you give your hardest effort See how high your, 00:26:52.769 --> 00:26:54.690 you know, heart rate will get and then kind of 00:26:54.690 --> 00:26:57.170 calculate some heart rate zones from there. It 00:26:57.170 --> 00:26:59.210 gets a little bit more complicated because with 00:26:59.210 --> 00:27:01.509 your training, you can actually dilate out these 00:27:01.509 --> 00:27:05.509 heart rate zones. Heart rate zones being like, 00:27:05.509 --> 00:27:08.730 like zone one would be, you know, like you're 00:27:08.730 --> 00:27:11.269 almost at rest or not really doing like very 00:27:11.269 --> 00:27:14.730 difficult activity at all. And zone two would 00:27:14.730 --> 00:27:18.730 be like a very comfortable. slightly elevated 00:27:18.730 --> 00:27:21.470 heart rate so for me i think it's around like 00:27:21.470 --> 00:27:26.049 120 to 140 but you can actually extend these 00:27:26.049 --> 00:27:28.970 out so that they're they're wider to some extent 00:27:28.970 --> 00:27:30.990 you know depending on how your training is focused 00:27:30.990 --> 00:27:35.349 so you know track athletes might have a very 00:27:35.349 --> 00:27:39.529 like wider upper range or a very like you know 00:27:39.529 --> 00:27:41.809 steep upper range where they can go into like 00:27:41.809 --> 00:27:43.690 very high heart rates because that's what they're 00:27:43.690 --> 00:27:47.759 pushing a lot of the time so when you're Prepping 00:27:47.759 --> 00:27:52.000 for a really long run, it strikes me as some 00:27:52.000 --> 00:27:54.160 of the same prep that we would do for a really 00:27:54.160 --> 00:27:56.619 long anesthetic. There's things that you have 00:27:56.619 --> 00:28:01.960 to plan on in terms of hydration and sodium and 00:28:01.960 --> 00:28:04.240 all those sorts of things. Can you talk a little 00:28:04.240 --> 00:28:07.299 bit about the physiology of what it takes to 00:28:07.299 --> 00:28:09.859 plan for a really long run and what you do to 00:28:09.859 --> 00:28:14.119 prepare? Yeah, I think that is something that 00:28:14.119 --> 00:28:18.019 is kind of... overlaps a lot with ultra running 00:28:18.019 --> 00:28:21.680 is like the planning component um it's tough 00:28:21.680 --> 00:28:24.220 because as a as the runner and you're the only 00:28:24.220 --> 00:28:26.000 one that's being affected by your own decisions 00:28:26.000 --> 00:28:29.059 so it's very easy just to to go out the door 00:28:29.059 --> 00:28:31.019 without without doing the planning you need to 00:28:31.019 --> 00:28:34.099 do um but you learn quickly that it's important 00:28:34.099 --> 00:28:37.019 to take the second to think like do i need gloves 00:28:37.019 --> 00:28:39.359 before i do this because you know cold hands 00:28:39.359 --> 00:28:42.700 can really just kind of ruin the whole run if 00:28:42.700 --> 00:28:46.319 your hands are cold the whole time uh but Yeah, 00:28:46.339 --> 00:28:51.680 you know, there are a lot of things I basically 00:28:51.680 --> 00:28:55.819 for myself personally, I'll take, you know, maybe 00:28:55.819 --> 00:28:59.640 some electrolyte drink with me. If not, then 00:28:59.640 --> 00:29:01.960 I kind of just rely on gas stations, which I 00:29:01.960 --> 00:29:03.839 think is kind of fun. Like you just run to like 00:29:03.839 --> 00:29:06.539 some unknown area that you haven't been to before, 00:29:06.619 --> 00:29:08.339 haven't been to in a long time and pop into a 00:29:08.339 --> 00:29:11.200 gas station, get a snack, get a drink, and then 00:29:11.200 --> 00:29:13.339 you just kind of keep the run going. I usually 00:29:13.339 --> 00:29:15.579 do that if I'm doing like 20 plus miles, I'll 00:29:15.579 --> 00:29:19.279 do that around like mile 13. And I'll grab a 00:29:19.279 --> 00:29:22.099 drink, grab some food, and then just go back 00:29:22.099 --> 00:29:23.960 out and finish the next, you know, seven plus 00:29:23.960 --> 00:29:26.940 miles. The nice thing about that as well is that 00:29:26.940 --> 00:29:28.900 it kind of is a little bit of a stomach training. 00:29:29.160 --> 00:29:34.640 And it's very similar to a race in which as I'm 00:29:34.640 --> 00:29:37.559 running, I will, you know, stop and get all this 00:29:37.559 --> 00:29:41.319 food and, you know, eat maybe like a snack and 00:29:41.319 --> 00:29:44.319 then. drink a bunch of fluid and then uh start 00:29:44.319 --> 00:29:47.640 running again and that's kind of very similar 00:29:47.640 --> 00:29:50.920 to like a race where you might come up to an 00:29:50.920 --> 00:29:52.779 aid station you're going to eat and drink a lot 00:29:52.779 --> 00:29:53.980 and then you're going to start running again 00:29:53.980 --> 00:29:56.359 and it kind of helps your body get used to that 00:29:56.359 --> 00:30:00.180 feeling if you're running one of your big 100 00:30:00.180 --> 00:30:04.400 mile races or something like that how much fluid 00:30:04.400 --> 00:30:08.460 do you need to support yourself in that sort 00:30:08.460 --> 00:30:10.680 of environment is it just purely based on thirst 00:30:10.680 --> 00:30:13.250 or is there calculations that you have to do? 00:30:13.269 --> 00:30:15.750 How does that work? Yeah, I kind of wish it was 00:30:15.750 --> 00:30:17.549 purely based on thirst because there would be 00:30:17.549 --> 00:30:20.130 a lot less calculation needed. But unfortunately, 00:30:20.309 --> 00:30:24.009 I think when you're setting a goal, you know, 00:30:24.029 --> 00:30:26.769 goal -based fluid replacement, you know, when 00:30:26.769 --> 00:30:28.910 you're setting a goal to it, that's when it kind 00:30:28.910 --> 00:30:30.630 of becomes dangerous because you can override 00:30:30.630 --> 00:30:33.130 a lot of those mechanisms because, you know, 00:30:33.150 --> 00:30:35.349 you've calculated that you do, in fact, need 00:30:35.349 --> 00:30:37.940 a certain amount. And you're going to override 00:30:37.940 --> 00:30:39.779 like I'm not going to wait till I'm thirsty. 00:30:40.019 --> 00:30:42.579 It's an ultra running. It may be too late, you 00:30:42.579 --> 00:30:44.220 know, to start eating when you're hungry. Like 00:30:44.220 --> 00:30:48.460 it's very hard to to meet the demands. You know, 00:30:48.519 --> 00:30:50.740 once once you're already getting like signals 00:30:50.740 --> 00:30:53.000 really firing that, oh, you're thirsty, you need 00:30:53.000 --> 00:30:56.019 water. And it's like it's hard to replenish and 00:30:56.019 --> 00:30:58.099 keep it going for an extended period of time. 00:30:58.400 --> 00:31:01.460 It might not be a bad option to drink to thirst 00:31:01.460 --> 00:31:04.339 in a shorter event like a 5K or even the Camarathon. 00:31:04.880 --> 00:31:07.619 But. I think a shorter event, like a marathon, 00:31:07.680 --> 00:31:11.460 like a marathon, just because you on that. Yeah, 00:31:11.460 --> 00:31:15.359 I think, I think because, you know, the consequences, 00:31:15.500 --> 00:31:18.180 well, marathons can be long, you know, depending 00:31:18.180 --> 00:31:20.900 on the speed and things like that. The consequences 00:31:20.900 --> 00:31:24.460 don't play out over like. over the entire night 00:31:24.460 --> 00:31:27.640 you know like a 24 -hour race if you make a mistake 00:31:27.640 --> 00:31:30.140 you have to deal with the consequences until 00:31:30.140 --> 00:31:34.059 like from 7 p .m to 7 a .m so it can be it can 00:31:34.059 --> 00:31:36.900 be a long haul but you know back to the question 00:31:36.900 --> 00:31:40.380 about the electrolyte goals and then the fluid 00:31:40.380 --> 00:31:44.000 replacement so I tend to the best way to kind 00:31:44.000 --> 00:31:45.900 of come up with a plan for fluid replacement 00:31:45.900 --> 00:31:51.490 that I've come across is You weigh yourself before 00:31:51.490 --> 00:31:54.630 an exercise without clothes or anything as a 00:31:54.630 --> 00:31:57.869 variable. You go out into the heat and run for 00:31:57.869 --> 00:32:01.230 about an hour and come back and weigh yourself 00:32:01.230 --> 00:32:05.630 again. That will essentially, the only thing 00:32:05.630 --> 00:32:08.509 that will be different there is that the amount 00:32:08.509 --> 00:32:11.349 that you sweated is gone. So any kind of sweat 00:32:11.349 --> 00:32:14.269 loss is out of the equation now. And you'll come 00:32:14.269 --> 00:32:16.150 up with a weight difference. You'll convert that 00:32:16.150 --> 00:32:19.819 to liters in terms of water. Um, and you'll, 00:32:19.819 --> 00:32:22.559 your goal would be to replace 90 to 95 % of that. 00:32:22.940 --> 00:32:27.279 So if you lost, you know, like two liters of 00:32:27.279 --> 00:32:29.779 sweat in an hour and like a very hot condition, 00:32:30.099 --> 00:32:32.420 um, that's kind of on the upper, upper end of 00:32:32.420 --> 00:32:34.680 the sweat loss. But if you were to do that, you 00:32:34.680 --> 00:32:37.579 would aim for, you know, like 1 .8 liters of 00:32:37.579 --> 00:32:40.299 replacement. And then is that just water that 00:32:40.299 --> 00:32:42.720 you're replacing? Yeah. So in this equation, 00:32:42.799 --> 00:32:45.359 it's, it's, you kind of just figure out the water. 00:32:45.789 --> 00:32:49.009 component so it'd be like 1 .8 liters and the 00:32:49.009 --> 00:32:52.029 most important part of this is that the amount 00:32:52.029 --> 00:32:56.029 of electrolytes you replace is a ratio so you 00:32:56.029 --> 00:32:58.849 don't really want to like pick like an electrolyte 00:32:58.849 --> 00:33:02.190 like and think i'm going to take 500 milligrams 00:33:02.190 --> 00:33:04.750 of sodium every hour that's like not what you 00:33:04.750 --> 00:33:06.769 want to do you always want to replace electrolytes 00:33:06.769 --> 00:33:09.869 as a ratio to water because as your water intake 00:33:09.869 --> 00:33:14.549 changes then your electrolyte intake will change 00:33:16.650 --> 00:33:20.150 To give you an example, one of my races, I had 00:33:20.150 --> 00:33:23.710 a very difficult time with electrolytes. My goal 00:33:23.710 --> 00:33:25.849 was to kind of just drink this amount of water, 00:33:25.950 --> 00:33:27.710 take this amount of electrolytes every hour. 00:33:28.529 --> 00:33:32.049 What I ended up finding out was that I had severely 00:33:32.049 --> 00:33:36.410 low sodium at one point because I had taken in 00:33:36.410 --> 00:33:39.950 about three gallons of water and very, very little 00:33:39.950 --> 00:33:43.269 electrolyte because the hourly intake electrolytes 00:33:43.269 --> 00:33:46.369 I had calculated seemed okay. Until you add in 00:33:46.369 --> 00:33:49.170 the three gallons of water. It was very imbalanced. 00:33:49.329 --> 00:33:53.069 You know, it's very water heavy So I kind of 00:33:53.069 --> 00:33:56.390 went through the cascade of every symptom of 00:33:56.390 --> 00:33:59.730 low sodium that you could have, you know Let's 00:33:59.730 --> 00:34:01.829 go over hyponatremia. Let's go back to internal 00:34:01.829 --> 00:34:04.670 medicine days. Yeah. Yeah, so step by step, you 00:34:04.670 --> 00:34:08.489 know, I I Didn't really notice the first couple 00:34:08.489 --> 00:34:13.789 signs, you know It was hard it was eventually 00:34:13.789 --> 00:34:18.199 became hard to to want to take in anything um 00:34:18.199 --> 00:34:21.960 so i started having like like lack of thirst 00:34:21.960 --> 00:34:25.119 and then kind of lethargic a little bit and i 00:34:25.119 --> 00:34:27.280 felt like my performance was lacking like in 00:34:27.280 --> 00:34:29.039 terms of like the run and i was having a hard 00:34:29.039 --> 00:34:31.659 time like running um and that's one of the first 00:34:31.659 --> 00:34:33.719 things you'll see with dehydration in a sense 00:34:33.719 --> 00:34:36.860 is that you're having a difficulty like maintaining 00:34:36.860 --> 00:34:41.139 the performance you were you were before But 00:34:41.139 --> 00:34:43.019 eventually it got to the point that I was kind 00:34:43.019 --> 00:34:45.360 of confused and a little bit delirious. But again, 00:34:45.500 --> 00:34:47.940 you're running a race at the sun setting is starting 00:34:47.940 --> 00:34:49.760 to get dark outside. So you're thinking like, 00:34:49.800 --> 00:34:54.019 you know, it's just all part of the race. What 00:34:54.019 --> 00:34:57.239 I ended up realizing as things progressed down 00:34:57.239 --> 00:35:00.659 were that I began to lose fine motor function, 00:35:00.760 --> 00:35:05.179 which is one of the very final signs of hyponatremia. 00:35:05.519 --> 00:35:10.889 So, yeah. Talk about what that means. What did 00:35:10.889 --> 00:35:15.829 you notice? Yeah. Again, this was all of these 00:35:15.829 --> 00:35:18.090 things. I think at the time I wasn't the best 00:35:18.090 --> 00:35:21.650 person to step back and analyze this at the time 00:35:21.650 --> 00:35:23.829 because I was, in fact, the person who was being 00:35:23.829 --> 00:35:27.690 affected by it. But I remember as the sun went 00:35:27.690 --> 00:35:31.409 down, I felt like my hands were cold. And in 00:35:31.409 --> 00:35:33.650 reality, it was just that they weren't working 00:35:33.650 --> 00:35:37.269 because of hyponatremia. Because I think it was 00:35:37.269 --> 00:35:40.730 like 78 degrees outside. I remember I was having 00:35:40.730 --> 00:35:44.190 a hard time like turning my headlight on, things 00:35:44.190 --> 00:35:47.050 like that. And I felt like I needed gloves, you 00:35:47.050 --> 00:35:49.090 know, even though it was 78 degrees out. And 00:35:49.090 --> 00:35:50.889 I just I couldn't put the pieces together. I 00:35:50.889 --> 00:35:53.449 wasn't the best. At the time, I was the best 00:35:53.449 --> 00:35:57.070 person to help myself. But thankfully, the crew 00:35:57.070 --> 00:36:01.869 that I had, you know, in my last ounce of self 00:36:01.869 --> 00:36:03.909 -preservation, they gave me a sodium tablet. 00:36:04.940 --> 00:36:06.800 And even though I was being pretty uncooperative 00:36:06.800 --> 00:36:10.420 at the time, I guess, I think they were able 00:36:10.420 --> 00:36:15.300 to get me to take this sodium tablet. And I kind 00:36:15.300 --> 00:36:18.000 of laid down for a second and eventually came 00:36:18.000 --> 00:36:21.179 to and felt 100 times better just from like getting 00:36:21.179 --> 00:36:24.380 sodium in my system. So, you know, you live and 00:36:24.380 --> 00:36:27.900 you learn. And that's something like I didn't 00:36:27.900 --> 00:36:30.360 always try to connect dots, you know, from my 00:36:30.360 --> 00:36:33.280 anesthesia experience. But, you know, that. You 00:36:33.280 --> 00:36:35.579 know, these ratios that we use in terms of fluid 00:36:35.579 --> 00:36:37.320 replacement, like having a balanced crystalloid 00:36:37.320 --> 00:36:41.019 solution, you know, in a sense, that's kind of 00:36:41.019 --> 00:36:44.340 what you need to do for fluid replacement. Another 00:36:44.340 --> 00:36:48.300 area this came up in is we did the analysis on 00:36:48.300 --> 00:36:50.480 whole blood replacement, you know, rather than 00:36:50.480 --> 00:36:53.300 reconstituting whole blood, you know, making 00:36:53.300 --> 00:36:56.179 whole blood through multiple units of packed 00:36:56.179 --> 00:36:59.000 reds and FFP and cryo and all these components. 00:37:01.739 --> 00:37:04.199 we're trialing this whole blood, uh, and, and 00:37:04.199 --> 00:37:05.960 traumas. And it's very similar to that. It's 00:37:05.960 --> 00:37:09.659 like, it's much easier to do, um, like the, you 00:37:09.659 --> 00:37:12.260 know, like the solution that's like a, you know, 00:37:12.260 --> 00:37:14.739 electrolyte drink or electrolyte mix versus like, 00:37:14.840 --> 00:37:16.519 I'm going to drink a bunch of water and then 00:37:16.519 --> 00:37:17.980 I'm going to take a bunch of sodium and then 00:37:17.980 --> 00:37:19.719 I'm going to drink a bunch more water. And then 00:37:19.719 --> 00:37:20.960 I'm going to take a bunch of sodium. It's like, 00:37:21.039 --> 00:37:24.920 you know, having a more stable, smooth, uh, hydration 00:37:24.920 --> 00:37:27.519 plan is, is much, much easier to maintain and, 00:37:27.539 --> 00:37:33.000 and, uh, easier to control. So some of the different 00:37:33.000 --> 00:37:36.800 races that you've run or been adjacent to deal 00:37:36.800 --> 00:37:40.719 with some pretty extreme temperatures too, right? 00:37:40.800 --> 00:37:43.440 Can you talk a little bit about that? Yeah. So 00:37:43.440 --> 00:37:48.619 I, you know, the crazy thing about, you know, 00:37:48.619 --> 00:37:52.659 performing outside is temperature starts to affect 00:37:52.659 --> 00:37:55.659 you. And this is from, you know, research, but 00:37:55.659 --> 00:37:58.849 the heat. In particular, heat starts to affect 00:37:58.849 --> 00:38:02.690 you as little as 45 degrees Fahrenheit. So if 00:38:02.690 --> 00:38:06.190 it's over 45, you're dealing with heat. And even 00:38:06.190 --> 00:38:09.190 though that's typically a cold temperature, that's 00:38:09.190 --> 00:38:12.030 where it begins to affect your performance. So 00:38:12.030 --> 00:38:16.710 heat training has become really popular lately. 00:38:17.369 --> 00:38:21.829 It's shown to increase red blood cell mass and 00:38:21.829 --> 00:38:26.840 kind of help you adapt to... oxygen carrying 00:38:26.840 --> 00:38:30.840 capacity and and uh heat um during your exercise 00:38:30.840 --> 00:38:34.500 or during your races so one of the races i was 00:38:34.500 --> 00:38:38.980 a part of um was you know one of the hardest 00:38:38.980 --> 00:38:41.800 ultra marathons in the world it's uh called the 00:38:41.800 --> 00:38:45.260 bad water 135 um i was able to go out and crew 00:38:45.260 --> 00:38:49.530 and pace uh my friend uh harvey lewis He was 00:38:49.530 --> 00:38:52.090 doing it for the 14th time, which is absolutely 00:38:52.090 --> 00:38:55.889 incredible to think. Somebody's done that race 00:38:55.889 --> 00:39:04.550 14 times. He's very skilled and talented. We 00:39:04.550 --> 00:39:09.909 went out there this past summer, and again, of 00:39:09.909 --> 00:39:13.349 course, it's in Death Valley. The race is in 00:39:13.349 --> 00:39:15.389 the summer, so they really leaned into the heat 00:39:15.389 --> 00:39:18.190 component of this race. How hot is it there? 00:39:18.909 --> 00:39:23.409 race is going on yeah so uh there's nobody ever 00:39:23.409 --> 00:39:25.050 really confirms anything but there's rumors that 00:39:25.050 --> 00:39:28.630 it's the 135 miles and it's the bad water 135 00:39:28.630 --> 00:39:32.230 because it's been 135 degrees out there before 00:39:32.230 --> 00:39:36.269 so there's like some kind of like link to that 00:39:36.269 --> 00:39:41.010 um i think uh when we were out there it was a 00:39:41.010 --> 00:39:43.309 it was a chilly year you know it was kind of 00:39:43.309 --> 00:39:48.690 cool that year and it was like 120. You know, 00:39:48.710 --> 00:39:51.210 it's not too hot, you know, just 120 degrees. 00:39:51.469 --> 00:39:56.489 Did you wear a jacket? Yeah. Yeah, I wore a jacket 00:39:56.489 --> 00:40:04.150 and I wore gloves also. No, the the the interesting 00:40:04.150 --> 00:40:09.250 thing. So the the heat in Death Valley, a lot 00:40:09.250 --> 00:40:11.650 of people were saying that like, oh, well, Death 00:40:11.650 --> 00:40:15.030 Valley, it's a dry heat. I always before this 00:40:15.030 --> 00:40:17.090 was leading up to the race and I kept thinking. 00:40:17.739 --> 00:40:20.159 yeah it's dry heat but it's still feel the fuel 00:40:20.159 --> 00:40:22.659 like temperature is still 125 you know like it's 00:40:22.659 --> 00:40:25.739 still like if it's 125 degrees it's 125 degrees 00:40:25.739 --> 00:40:28.699 that's something i can set my oven to yeah exactly 00:40:28.699 --> 00:40:33.800 so yeah um it certainly was hot but i will i 00:40:33.800 --> 00:40:37.920 can you know give a testament to the heat training 00:40:37.920 --> 00:40:41.179 i think that the sauna really helped and again 00:40:41.179 --> 00:40:46.449 it's it with sauna specifically the saw in a 00:40:46.449 --> 00:40:48.809 training plan they actually had one from the 00:40:48.809 --> 00:40:50.550 race you know it's the first race i've ever been 00:40:50.550 --> 00:40:52.349 a part of that had requirements for crews and 00:40:52.349 --> 00:40:55.969 pacers where they actually sent us a a guide 00:40:55.969 --> 00:41:00.230 and kind of showed us the how to you know prepare 00:41:00.230 --> 00:41:04.329 yourself for the heat out there as hard as the 00:41:04.329 --> 00:41:06.489 race is they have a really good safety record 00:41:06.489 --> 00:41:09.949 and they're really well organized and making 00:41:09.949 --> 00:41:15.010 sure everybody is safe during the event and the 00:41:15.670 --> 00:41:18.550 like just like ultra running the sauna plan is 00:41:18.550 --> 00:41:21.190 mostly about consistency it's about exposing 00:41:21.190 --> 00:41:23.769 yourself to heat very consistently so that you 00:41:23.769 --> 00:41:27.389 get these adaptive changes and what you'll find 00:41:27.389 --> 00:41:30.610 is that throughout these sauna sessions after 00:41:30.610 --> 00:41:35.110 a week or so you tend to get way more comfortable 00:41:35.110 --> 00:41:38.210 and you'll surpass thresholds where you would 00:41:38.210 --> 00:41:40.289 previously feel like you really had to get out 00:41:40.289 --> 00:41:42.849 of the sauna You'll kind of meet that mark and 00:41:42.849 --> 00:41:44.289 be like, oh, I remember this part. You know, 00:41:44.329 --> 00:41:46.289 I remember when that used to be very, very difficult. 00:41:46.389 --> 00:41:50.050 And now I'm like, you know, zoned out completely. 00:41:50.170 --> 00:41:52.929 I'm not even really focused on my effort in here 00:41:52.929 --> 00:41:59.809 up until five minutes after that now. So what 00:41:59.809 --> 00:42:03.869 happens with your GI system when you're on these 00:42:03.869 --> 00:42:07.329 long runs? Do you find that you still need to 00:42:07.329 --> 00:42:10.440 go to the bathroom the same amount or? How does 00:42:10.440 --> 00:42:12.519 that work? Are you finding yourself hungry? What 00:42:12.519 --> 00:42:16.300 do you eat? Yeah, you know, I'm lucky that I 00:42:16.300 --> 00:42:18.440 don't I haven't really had any stomach problems. 00:42:19.840 --> 00:42:24.360 So I guess I'm lucky in that sense. And I generally 00:42:24.360 --> 00:42:28.420 I find it easiest in races to eat things that 00:42:28.420 --> 00:42:32.880 are familiar to you. A lot of people, you know, 00:42:32.900 --> 00:42:37.219 you could try these like the sports sugar supplements 00:42:37.219 --> 00:42:39.920 like the. goo like the gels and things like that 00:42:39.920 --> 00:42:42.920 these uh they have like sachets of um different 00:42:42.920 --> 00:42:45.460 components of it's like maltodextrin powder with 00:42:45.460 --> 00:42:48.519 water and some fructose um they're essentially 00:42:48.519 --> 00:42:51.699 simple sugars that are easy easy to digest as 00:42:51.699 --> 00:42:55.159 the thought and uh they work in you know a more 00:42:55.159 --> 00:42:57.340 timely matter once you consume them they'll get 00:42:57.340 --> 00:43:01.000 into your bloodstream quicker um but i you know 00:43:01.000 --> 00:43:03.119 i find for these longer events one of the enjoyable 00:43:03.119 --> 00:43:06.280 parts is coming up to an aid station with a like 00:43:06.280 --> 00:43:08.840 wide variety of snacks. And you can kind of just 00:43:08.840 --> 00:43:11.639 look at the layout and just find something that 00:43:11.639 --> 00:43:14.300 looks good to you and eat it. And I think that 00:43:14.300 --> 00:43:18.960 that for a lot of people starting out is a really 00:43:18.960 --> 00:43:21.280 good way of going about nutrition because in 00:43:21.280 --> 00:43:24.039 the end, the goal is just to keep eating and 00:43:24.039 --> 00:43:27.260 not to be dependent on something that you're 00:43:27.260 --> 00:43:30.239 like very tired of eating. And you can get palate 00:43:30.239 --> 00:43:33.079 fatigue with some of those gels where. You just 00:43:33.079 --> 00:43:36.099 can't stand to eat another one. And that's not 00:43:36.099 --> 00:43:38.099 a situation you want to be in because ultimately 00:43:38.099 --> 00:43:41.739 in these events, your body needs fuel. So just 00:43:41.739 --> 00:43:44.599 finding fuel any way you can get it, you know, 00:43:44.619 --> 00:43:47.300 whether it's something sweet or salty, just finding 00:43:47.300 --> 00:43:48.719 something that sounds good to you at the moment 00:43:48.719 --> 00:43:53.320 and keeping your palate moving. In a really long 00:43:53.320 --> 00:43:56.639 race, I imagine you've been doing essentially 00:43:56.639 --> 00:44:00.139 the same thing for a very long time. How do you 00:44:00.139 --> 00:44:03.059 manage the mental fatigue and stress of being 00:44:03.059 --> 00:44:07.739 in these extremely long events? Yeah, you know, 00:44:07.739 --> 00:44:10.579 that's a really good question. I think that, 00:44:10.579 --> 00:44:15.880 you know, with training, to be honest, the difficulty 00:44:15.880 --> 00:44:19.320 and the time component, it actually just extends 00:44:19.320 --> 00:44:21.679 everything out further. So in a sense, you're 00:44:21.679 --> 00:44:24.960 chasing the dragon of that difficulty even further 00:44:24.960 --> 00:44:29.619 every time. For instance, the last race I did, 00:44:29.840 --> 00:44:32.559 I had one of the best, you know, trainings like 00:44:32.559 --> 00:44:35.519 blocks going into it. I had really great training. 00:44:35.659 --> 00:44:38.000 I had a lot of really great guidance from friends 00:44:38.000 --> 00:44:41.159 and things. And I remember going into that race. 00:44:41.519 --> 00:44:46.099 I actually didn't feel any difficulty until around 00:44:46.099 --> 00:44:49.480 like mile 70. Like it felt very comfortable. 00:44:49.500 --> 00:44:55.400 And I, you know, I just felt. You know, to be 00:44:55.400 --> 00:44:57.579 honest, I didn't have any issues. Like the weather 00:44:57.579 --> 00:45:00.619 was like relatively good. It was kind of hot 00:45:00.619 --> 00:45:03.000 during the day, but I had done a lot of heat 00:45:03.000 --> 00:45:06.480 training. So overall, you know, I felt very, 00:45:06.539 --> 00:45:09.179 very good up through mile 70. And when it gets 00:45:09.179 --> 00:45:13.179 difficult, I really just more appreciate it. 00:45:13.219 --> 00:45:15.659 I find a way to appreciate it because you had 00:45:15.659 --> 00:45:18.420 to run 70 miles for it to get difficult, you 00:45:18.420 --> 00:45:20.800 know. And that's something you've worked really 00:45:20.800 --> 00:45:25.010 hard to feel. I don't really dread it at all. 00:45:25.090 --> 00:45:28.869 I think that like, you know, you find out how 00:45:28.869 --> 00:45:31.289 deep your well is in a sense whenever you get 00:45:31.289 --> 00:45:33.469 to that moment and you get some difficulty from 00:45:33.469 --> 00:45:39.070 it. The component of like kind of like getting 00:45:39.070 --> 00:45:43.570 stressed out during a race is a lot of times 00:45:43.570 --> 00:45:46.309 if the weather changes, you know, if you're dealing 00:45:46.309 --> 00:45:49.449 with things that you kind of didn't anticipate 00:45:49.449 --> 00:45:51.860 during the race, like. You think the race is 00:45:51.860 --> 00:45:54.260 going to be hard, but when it starts thunderstorming 00:45:54.260 --> 00:45:59.460 and things get really muddy, there are ways to 00:45:59.460 --> 00:46:04.920 deal with, you know, stress or like, you know, 00:46:04.920 --> 00:46:07.940 some like negative mental aspects during a race. 00:46:08.099 --> 00:46:11.019 One of the big things with that that I learned 00:46:11.019 --> 00:46:17.139 from Harvey Lewis is to kind of reframe or just 00:46:17.139 --> 00:46:21.780 really focus on what you can control. I think 00:46:21.780 --> 00:46:25.559 that that, again, has a lot of overlap with anesthesia. 00:46:26.219 --> 00:46:28.000 You know, if you get into a critical situation, 00:46:28.239 --> 00:46:30.539 we have like protocols already in place. We have 00:46:30.539 --> 00:46:32.619 a plan of how we're going to do it. And you really 00:46:32.619 --> 00:46:34.420 just focus on that. You're not really focused 00:46:34.420 --> 00:46:37.900 on, you know, something not going well. If all 00:46:37.900 --> 00:46:40.400 else fails, do chest compressions. Exactly. Yeah, 00:46:40.500 --> 00:46:45.880 there's always a plan B, C, and D. So that's... 00:46:46.739 --> 00:46:48.860 that's really helpful in that sense is I really 00:46:48.860 --> 00:46:50.780 just focused on what I can control. The one race 00:46:50.780 --> 00:46:53.500 I did that had a lot of mud and, you know, as 00:46:53.500 --> 00:46:56.119 a runner, that's one of the most dreaded things 00:46:56.119 --> 00:46:58.280 because you do a lot of training and you do a 00:46:58.280 --> 00:47:00.579 lot of running. And then if you get to a race 00:47:00.579 --> 00:47:02.980 and you have to walk through mud for like eight 00:47:02.980 --> 00:47:06.380 hours, it's like, it's like, you know, you start 00:47:06.380 --> 00:47:07.940 to really think like, I didn't come out here 00:47:07.940 --> 00:47:11.880 to walk through mud for eight hours, but I just 00:47:11.880 --> 00:47:14.159 kind of. You know, you can reframe it and, you 00:47:14.159 --> 00:47:16.440 know, think, well, you know, it's muddy for everybody 00:47:16.440 --> 00:47:18.760 and it's everybody's wet and it's raining on 00:47:18.760 --> 00:47:21.719 everybody. So it's not a problem that's unique 00:47:21.719 --> 00:47:27.360 to you. And with the with the mud, you know, 00:47:27.400 --> 00:47:31.480 if you just keep going, it's it gets better. 00:47:31.980 --> 00:47:34.380 And that race in particular, it rained again 00:47:34.380 --> 00:47:37.639 and there's like puddles that formed. And the 00:47:37.639 --> 00:47:39.420 puddles actually helped you clean the mud off 00:47:39.420 --> 00:47:41.659 of yourself a little bit. And it actually made 00:47:41.659 --> 00:47:44.739 the mud less sticky. So as much as everybody 00:47:44.739 --> 00:47:46.559 was frustrated about the additional rain, it 00:47:46.559 --> 00:47:48.679 actually made the course better, you know, in 00:47:48.679 --> 00:47:52.679 a sense. So, yeah, I just try to focus on what 00:47:52.679 --> 00:47:55.360 I can control. And in that sense, like, am I 00:47:55.360 --> 00:47:57.199 getting blisters because of this mud? Like, maybe 00:47:57.199 --> 00:48:00.440 I need to do extra management with my feet or 00:48:00.440 --> 00:48:04.019 my shoes to help manage it. Or maybe I need to, 00:48:04.019 --> 00:48:08.679 you know. change, you know, clothes a little 00:48:08.679 --> 00:48:10.880 bit more often or prepare, you know, try to wipe 00:48:10.880 --> 00:48:12.420 some of the mud off your legs if you're starting 00:48:12.420 --> 00:48:14.599 to get like, you know, friction or rubbing around 00:48:14.599 --> 00:48:18.539 like your shorts and stuff like that. So what's 00:48:18.539 --> 00:48:21.000 the next big race that you're planning to do? 00:48:22.300 --> 00:48:26.719 So the plan right now, the very next one is going 00:48:26.719 --> 00:48:31.920 to be in just about a month, I think. So in December, 00:48:32.019 --> 00:48:36.239 there's a race called the Dreadmill. And it's 00:48:36.239 --> 00:48:40.559 a treadmill race, so it's – I'm sure everybody's 00:48:40.559 --> 00:48:44.280 done this, but – You're going to have to explain 00:48:44.280 --> 00:48:48.539 what a treadmill race is. Yeah, so it's a race 00:48:48.539 --> 00:48:51.619 that's 48 hours on a treadmill, and the goal 00:48:51.619 --> 00:48:59.519 is just to go as far as you can. So it's pretty 00:48:59.519 --> 00:49:03.739 easy. I'm pretty sure the Geneva Convention has 00:49:03.739 --> 00:49:06.340 outlawed what you're talking about. Yeah, it 00:49:06.340 --> 00:49:12.000 might be a war crime. You're right. Yeah. So, 00:49:12.199 --> 00:49:14.880 yeah, the Dreadmill, I did it last year. It's 00:49:14.880 --> 00:49:19.340 actually a really fun race because there's people 00:49:19.340 --> 00:49:23.639 who you know that might not run or might not 00:49:23.639 --> 00:49:26.340 run your pace. But they can come over and hang 00:49:26.340 --> 00:49:27.699 out with you the whole time you're doing it, 00:49:27.739 --> 00:49:29.219 you know, and you can be right next to them. 00:49:29.340 --> 00:49:31.900 So it adds like a lot of layers. Like that's 00:49:31.900 --> 00:49:33.579 the fun thing about these races is that there's 00:49:33.579 --> 00:49:36.619 different formats and there's always like a different 00:49:36.619 --> 00:49:38.260 layer that makes it a little bit more interesting 00:49:38.260 --> 00:49:41.860 or a little bit more fun. While like, you know, 00:49:41.880 --> 00:49:45.940 a lot of these races are very solo, you know, 00:49:45.960 --> 00:49:48.340 the community around them is really good. So 00:49:48.340 --> 00:49:51.300 almost every race I've made. two to three friends 00:49:51.300 --> 00:49:53.639 that I talk to you regularly, you know, and like 00:49:53.639 --> 00:49:55.760 the network has grown so much just because of 00:49:55.760 --> 00:49:58.719 the community and I think people knowing like 00:49:58.719 --> 00:50:00.739 the consistency and the training it takes you 00:50:00.739 --> 00:50:06.000 kind of find solidarity in that and My one of 00:50:06.000 --> 00:50:10.619 my first races I met you know a friend that I 00:50:10.619 --> 00:50:13.059 now use their treadmill for this treadmill race 00:50:13.059 --> 00:50:15.659 and We kind of do it together and it's it's been 00:50:15.659 --> 00:50:20.000 a lot of fun so Do you have any rituals that 00:50:20.000 --> 00:50:23.579 you will do before a race or after a race? Yeah, 00:50:23.619 --> 00:50:28.980 I think the lead up to a race can be it's different 00:50:28.980 --> 00:50:32.139 for everybody. But a lot of people mentioned 00:50:32.139 --> 00:50:35.139 if they really taper their training, it's strange, 00:50:35.260 --> 00:50:37.019 but you can kind of get a little bit irritable 00:50:37.019 --> 00:50:39.780 from not running as much. It's just a strange 00:50:39.780 --> 00:50:42.869 phenomena. I think it's like. Maybe you're not 00:50:42.869 --> 00:50:44.610 getting the outlet or maybe you have like this 00:50:44.610 --> 00:50:47.250 extra energy that's kind of given off an irritability 00:50:47.250 --> 00:50:51.469 or, you know, it's really hard to describe. I 00:50:51.469 --> 00:50:54.309 don't find that I'm like super irritable, but 00:50:54.309 --> 00:50:58.530 I do feel like I have like some like energy that 00:50:58.530 --> 00:51:01.989 I can't really do anything with going into a 00:51:01.989 --> 00:51:07.250 race. So in addition to that, I also cut my caffeine. 00:51:07.489 --> 00:51:10.150 So I've completely stopped caffeine the week 00:51:10.150 --> 00:51:13.519 of a race. to kind of make myself more sensitive 00:51:13.519 --> 00:51:17.960 to it. And basically going into a race that last 00:51:17.960 --> 00:51:23.659 day or so of prep can be very, uh, like stressful 00:51:23.659 --> 00:51:26.940 and frustrating, I guess, because you're doing 00:51:26.940 --> 00:51:29.380 a lot of stuff for the race, but it's not running, 00:51:29.480 --> 00:51:32.400 you know, and it can be a little hectic sometimes 00:51:32.400 --> 00:51:34.559 where you kind of just want to be done with all 00:51:34.559 --> 00:51:36.800 that background stuff and just start running 00:51:36.800 --> 00:51:40.000 in the race. So I think the biggest thing that 00:51:40.000 --> 00:51:44.519 I do is I, plan in that I'm going to have everything 00:51:44.519 --> 00:51:47.760 done by a certain time and truly have like a 00:51:47.760 --> 00:51:50.019 window of time where I do like nothing where 00:51:50.019 --> 00:51:53.199 I can just relax and not have to do anything 00:51:53.199 --> 00:51:55.840 else for the race. And just that way I'm able 00:51:55.840 --> 00:51:57.619 to say everything is done. Like everything's 00:51:57.619 --> 00:52:00.079 been checked and double checked and I have everything 00:52:00.079 --> 00:52:04.460 I need. And most importantly, my ritual is try 00:52:04.460 --> 00:52:07.679 to go to bed early. A lot of the races, either 00:52:07.679 --> 00:52:10.059 the commute to the race or the race itself will 00:52:10.059 --> 00:52:12.739 start early in the morning. And, you know, if 00:52:12.739 --> 00:52:16.440 you're doing a race that's going to go for 24 00:52:16.440 --> 00:52:19.079 hours or more, you know, sometimes 30 plus hours 00:52:19.079 --> 00:52:23.019 or sometimes days, then you really want to start 00:52:23.019 --> 00:52:25.300 that off with a good night of sleep, you know. 00:52:25.519 --> 00:52:29.900 But I think that that as a ritual is giving me, 00:52:29.980 --> 00:52:32.360 you know, I think success so far in terms of 00:52:32.360 --> 00:52:37.360 feeling tired during a race. So lastly, what 00:52:37.360 --> 00:52:39.920 style points or points of personal preference? 00:52:40.489 --> 00:52:44.329 have helped you both in and out of the operating 00:52:44.329 --> 00:52:48.889 room or both on and off of the race course? I 00:52:48.889 --> 00:52:56.070 think being consistent in some kind of exercise 00:52:56.070 --> 00:52:59.030 is super important. You know, I kind of talked 00:52:59.030 --> 00:53:01.429 when I first did my introduction, I talked about 00:53:01.429 --> 00:53:06.889 this circuitous path to ultra running. And, you 00:53:06.889 --> 00:53:08.789 know, when I look back at that, I realized that 00:53:08.789 --> 00:53:11.480 it's. really just like a legacy of just like 00:53:11.480 --> 00:53:13.239 physical activity. Like, you know, that's kind 00:53:13.239 --> 00:53:14.820 of what it's chalked up to. It's not really, 00:53:14.920 --> 00:53:17.960 you know, it's just my personal story of just 00:53:17.960 --> 00:53:20.820 being physically active. And it doesn't have 00:53:20.820 --> 00:53:23.420 to be, you know, one specific thing. You can 00:53:23.420 --> 00:53:26.219 always like change out of, you know, different 00:53:26.219 --> 00:53:28.679 things that you're into at the time. But in the 00:53:28.679 --> 00:53:31.000 end, it's all physical activity. And I think 00:53:31.000 --> 00:53:34.280 that having some component of that, even if it 00:53:34.280 --> 00:53:36.519 changes over the years, is super important to 00:53:36.519 --> 00:53:40.539 your professional life. a great work -life balance 00:53:40.539 --> 00:53:46.139 it's a great like stress reliever um it um yeah 00:53:46.139 --> 00:53:47.820 it keeps you healthy you know like weight -bearing 00:53:47.820 --> 00:53:50.960 exercise and just you know it helps you age better 00:53:50.960 --> 00:53:59.760 and um you have a much better uh quality of life 00:53:59.760 --> 00:54:03.780 for much longer that's really neat i appreciate 00:54:03.780 --> 00:54:07.059 that and i have one last question for you do 00:54:07.059 --> 00:54:08.820 you feel like you're running towards something 00:54:09.289 --> 00:54:12.730 or away from something oh man that's a good question 00:54:12.730 --> 00:54:19.269 it depends you know i yes you asked me a question 00:54:19.269 --> 00:54:22.849 earlier about uh the competition during or about 00:54:22.849 --> 00:54:25.449 the the last part of a race in the last 80 miles 00:54:25.449 --> 00:54:28.650 or when you get to mile 80 of a race and uh you 00:54:28.650 --> 00:54:31.010 know a big part of that is the competition at 00:54:31.010 --> 00:54:32.969 that point you know in the beginning of 100 mile 00:54:32.969 --> 00:54:35.570 race mile one for me personally i'm not super 00:54:35.570 --> 00:54:37.690 concerned about the competition or really looking 00:54:37.690 --> 00:54:40.760 at the competition, but around mile 80, it can 00:54:40.760 --> 00:54:42.980 be a big motivator. And in those cases, you do 00:54:42.980 --> 00:54:45.239 feel like you're both chasing somebody and you're 00:54:45.239 --> 00:54:47.340 running away from somebody. So that's kind of 00:54:47.340 --> 00:54:50.320 the fun of the race is that like, there's a lot 00:54:50.320 --> 00:54:52.539 of camaraderie, like your competition will be 00:54:52.539 --> 00:54:54.659 like offering you water, like offering you help, 00:54:54.800 --> 00:54:57.820 um, at the same time as like you're racing them. 00:54:57.920 --> 00:55:00.559 And it's, it's, you know, that's, that's all 00:55:00.559 --> 00:55:03.280 part of like the, the fun culture of, of ultra 00:55:03.280 --> 00:55:06.880 marathons. Jordan, thank you so much for joining 00:55:06.880 --> 00:55:12.219 us. Yeah. Thanks for having me. Thanks for joining 00:55:12.219 --> 00:55:14.659 us for yet another episode of the award -winning 00:55:14.659 --> 00:55:18.559 style points podcast. What award you ask? That 00:55:18.559 --> 00:55:21.300 would be the award for the best anesthesiology 00:55:21.300 --> 00:55:24.239 themed long form interview style podcast at the 00:55:24.239 --> 00:55:26.760 university of Cincinnati, which I am proud to 00:55:26.760 --> 00:55:29.079 have won and also conceived of. Congratulations. 00:55:30.670 --> 00:55:32.750 If you would like to help us win additional awards, 00:55:32.909 --> 00:55:35.030 please feel free to give us a five -star rating 00:55:35.030 --> 00:55:37.469 or write a brief review. This is what really 00:55:37.469 --> 00:55:39.889 helps other people find the podcast. You can 00:55:39.889 --> 00:55:42.769 also email us at stylepointspodcast at gmail 00:55:42.769 --> 00:55:46.889 .com. Well, we have reached the end of the marathon, 00:55:47.030 --> 00:55:50.550 everyone. Take a deep breath. Open your eyes. 00:55:51.110 --> 00:55:52.170 We're all done.