My “running career,” such as it was spanned approximately 40 years. It began with an injury—a broken hand in the fall of 1966, which precluded my participation in normal gym class activities as a high school senior—and ended with an injury: the long-term effects of worn cartilage, and the resultant arthritis that plagues most aging athletes. Perhaps my involvement in several sports well into my forties, and a couple later still, “helped this along” to some degree, but excess mileage—in one way, shape, or form—was still the cause of feeling old, well before I felt it was my time.
It was a great “run” while it lasted. At best I was able to average 5:20s well into the 10K range, which I guess would be considered respectable to some, but then again is pedestrian to others. Still, every personal best promised more to come, so while improvements continued, I trained harder, longer, and faster to reach that next one. Eventually, however, there came a point when I knew there would be no more PRs. And that was when I began to appreciate running from a different perspective, which was rewarding in its own way.
In the time between my first abortive attempt at high school track, way back in those nifty sixties, and my current, ongoing involvement with the sport--aside from a mountain of positive experiences as an active runner--I have also come to two negative, and perhaps inevitable conclusions about the activity: (1) sooner or later, everyone will be injured, and (2) anyone who gets hurt will, at first, attempt to deny its seriousness. Which brings us to 2a; every pain is, in fact, a potential injury that could lead to a far worse one than we could ever imagine.
What follows is definitely not, in any way, scientific. But all scientific investigations begin with an observation(s). Take for example that bored fourth grader who, while staring at a globe, noticed how neatly the continents fit together. It might be years before he is introduced to the theory of continental drift, put forth by Abraham Ortelius in 1596, Alfred Wegener in 1912, and, eventually Ralph Epifanio in 1958, but is his investigation any less tangible than that of the scientists who explore plate tectonics, sea floor spreading, the mid-ocean ridge, and the comparison of the fossil record on continents thousands of miles apart and reach the same conclusion? It’s a start; open to evaluation, criticism, refinement, and rejection or confirmation. And that’s the best road to understanding any subject.
Echoes
Although running for the sheer joy of it has been around for a long time, its widespread practice as a conditioning exercise by large numbers of average, post school aged Americans has been a fairly recent development. Roughly paralleling the impact of “Deep Throat” on American politics during the summer of 1972 was the socio-economic impact of “Deep Pockets” on the part of a growing population of upwardly mobile, increasingly well-salaried baby boomers poised to witness that same summer’s well-publicized Olympics.
That 1972 Summer Games doubly imprinted on the American consciousness, not only because of Frank Shorter’s victory in its marathon, but also the massacre of 11 Israeli athletes in Munich. By then, ABC’s Wide World of Sports (1961-1998) was well on its way to becoming this country’s most popular sports program, and through it, sports in general, and running in particular, was accepted into more homes than ever before. Without knowing how and why Shorter won the gold, Americans everywhere accepted his victory as their challenge: “If Frank can run a marathon, so can I!”
Not quite. First of all, Shorter preceded his first of two Olympic marathon medals (he won the silver in 1976) with the 1969 NCAA 10,000 title, the US Cross Country Championship (1970-73), and four firsts in the Fukuoka Marathon (1971-74). Hardly anyone else alive, then or now—besides Shorter and his training buddy Jack Bacheler--would have survived running 160 miles a week, or train on sand dunes—while wearing double sweats--in the hot Florida sun…or so the legend goes.
Shorter and Bacheler, incidentally, did some of their best work as members of our in-state Florida Track Club. One particular “work” was the 1968 Easter Beach Run—a point to point race along the “World’s Most Famous Beach”—which Shorter won in 16:48. (For math athletes, that was for four miles.)
After Shorter there was “Boston Billy” Rodgers (who was probably the first runner to cash in on his fame with a line of “running gear,” each item monogrammed with a BR), America’s sweetheart, Joan Benoit Samuelson (winner of the inaugural, 1984 Women’s Olympic Marathon in Los Angeles [2:31:04], and who continues to compete in mid-Maine coast races; at 55 Samuelson was the 4th overall woman—38:09--in the 2012 L.L. Bean July 4th 10K), and Alberto Salazar (alive and coaching, despite his well-publicized, 5K-long, heart-related death in 2007; see http://hereandnow.wbur.org/2012/04/16/alberto-salazar-minutes and http://www.runnersworld.com/runners-stories/why-did-alberto-salazar-have-heart-attack.) These were the Americans we loved to run with. What other sport can you think of where fans can, simply by entering a race, “compete against” the best athletes in the game?
It was about this time that the great experiment in re-soling of running shoes came along. That first company was probably 2nd Wind, founded—and expanded into several of America’s first running-only sporting goods stores by national-class hurdler Harold Schwab. Like Schwab, New York’s Gary Muhrcke—winner, in 2:31:39, of that first NYC Marathon in 1970—turned his white Super Runner traveling “shoe-mobile” into a chain of running stores.
At the time of Shorter’s successes, aside from the agate in the dailies, little was published about running. There was no internet, Runner’s World was relatively new (it began as Distance Running News in 1966, had its name changed in 1969, and only became widely read in the 1980s), The Runner came later (and merged with Runner’s World in 1987), as did Running Times (1977). It took another 20 years for Jason Byrne (born February 5, 1981) to make the next quantum leap; flrunners.com—which is truly the best running-related website--and then added the MileSplit network, which also owes its existence to his analytical genius. With these, in steps, came a networking of ideas, and a support system that made running the most common sports activity, not only in America, but world-wide, one literally worth billions upon billions of dollars a year.
While running was well on its way towards becoming America’s most practiced conditioning activity, Jim Fixx, through his classic work, The Complete Book of Running,—first published in 1977—did much to usher in a “golden age of running” (roughly in the 20 or so years between the mid-1970s and early 1990s). This was an era when running, formerly an expression of youthful athletic prowess, transcended the barriers of age and ability, and was adopted as the sport of “everyman and everywoman” in the U.S. of A. Not only that, but “the run” was considered to improve health, or so it was said.
When he first burst upon America’s consciousness, Big Jim—a heavy smoker, who once weighed in at 220 pounds--fixated on a statement by California pathologist Thomas J. Bassler (and published under the auspices of the American Medical Joggers Association) that roughly stated: “Marathon runners actually develop immunity from heart disease.”
Fixx took that one step further, extrapolating an idea that (sic) “any non-smoker fit enough to run a complete marathon in four hours would, regardless of his or her diet, never suffer a heart attack.” He continued to espouse this mantra right up to his fatal heart attack, at 36, in 1984. Ironically, it occurred while jogging.
It is also interesting to note that Bassler, who is credited with the idea that running’s god-like properties, subsequently affixed to Jim’s rhetoric, was equally famous—if not more so--as a science fiction writer. The author’s success, as such, was due to his use of biological science to add a sense of realism to his fictitious plots.
Despite this obvious wakeup call to legions of potential heart-attack patients, runners who survived that era now wax poetic with memorable dates, unbelievable times, and legendary names from every corner of their imagination.
Running itself, both at its level of participation and the amounts of money spent in its pursuit, has come a long way in 40 years, yet we still suffer the same setbacks as we did when it was considered a relatively obscure sport. Sooner or later, we all get hurt. In a general sense, injuries may be attributed to two main causes: over training and the latest designs in running shoes.
While running-related injuries have always been with us, and the rate of injury has run roughly parallel to its participants’ level of involvement, so too has the degree to which running’s “experts” have contributed to the businesses of sports medicine, podiatry, and orthopedic surgery. In selling us overly optimistic, ever-changing training techniques, they have indirectly contributed to the advancement in the treatment of injuries, which might be comparable to the Civil War’s effects on amputation and reconstructive surgery. We now know more about what causes injury, as well as how to prevent it, and how to treat it for a speedier recovery. But what hasn’t changed is an attitude that contributes to even more injuries; that of being seduced by success, and subsequently “over reaching” in a quest for more of it.
Perhaps one aspect that has definitely been overanalyzed is the one piece of equipment essential to running, the shoe. Contrary to some claims, we are long past that point in our evolutionary or societal development when we can run barefoot. And why should we, when competing shoe companies make promises that the latest in their technology will make a difference in our level of success?
In the 60s my first running shoes were team-issued, black Converse track flats with thin, gum-rubber bottoms…and I suffered non-stop shin pain. (Subsequently I spent a few, painful months vacationing aboard the SS Stress Fracture.)
In the 70s, my training shoes had a much more stylish upper, but attached to the athletic shoe industry’s die-hard, gum-rubber outsole, the combination somehow transferred the zone of discomfort up into to my knees, the result being chondromalacia, or runner’s knee. (Undeniable proof that “the shin bone’s connected to the leg bone.”)
In the 80s, shoes gradually grew more complex, and my aches and pains followed the price upward. (Oh, my aching back!)
In the 90s, racing flats brought the pain—but not the price--back down the leg. At some point my “season” had lengthened to 80 races, as did the equally impressive bone spurs in my heels. Plantar fasciitis hitched a ride, orthotics followed, and I was finally convinced that there’s more to life than running wild.
With the new millennia, along with the $200 shoe, come new sorts of injuries, such as “turf toe” and “compartmental syndrome.” As Dr. Ed Fryman, whom I consider one of the foremost sports podiatrists in the country, wrote me:
We seem to be getting increased plantar fasciitis/fasciosis syndromes. As the shoes "improve," injuries evolve. I don't necessarily prescribe to the minimalist concept either. I've seen my share of injuries associated with those shoes as well. I think it has to do with the individual, the foot type, the amount of running and how quickly they build up.
At no time in my four-decade run did a single box contain a disclaimer to “run with your head, not over it.” And why should it? The more you ran, the quicker the shoes wore out, and the sooner you bought the next pair.
Mother Knows Best
When they were still alive, my parents followed my running exploits from a distance, but rarely saw me race. An exception was the annual Amityville (New York) 4.6 miler, reliably scheduled to coincide with that first heat wave of summer. It was at one of these races, on a late-June morning, that I courageously held off a small, but inspired field of Amityvillains, and in a rare feat of underachievement, shattered that previously daunting 25 minute barrier in my winning effort. In observing that self-inspiring feat, my mother adroitly remarked, “Anything that makes you look that bad can’t possibly be good for you!”
Although this memorable moment occurred way back in the early 80s, now years later I am quite regularly reminded of her acerbic comment—or was it a motherly warning?—by an occasional e-mail from an almost forgotten running friend. After polite salutations, the message gets to the heart of the matter: one of my old running mates, whether an age group champion or former Olympic qualifier, had recently and unfortunately skipped a few age groups, and is now running with wings on his feet. It is almost always due to one kind of heart-related problem or other. Those who hang vociferously to their memories of “better days,” will eventually admit to having an “irregular heart beat,” and finally stop buying ridiculously expensive running shoes. Even I, who could once boast of a resting heart beat of 52, can now claim proximity by default: “Oh, I just miss a few beats every now and then.”
Now comes more bad news from various sources that point that motherly finger indicative of an “I told you so” attitude. This is from a November 30, 2012 article written by Lisa Collier Cool and published by Healthline (http://health.yahoo.net/experts/dayinhealth/running-may-be-harmful-your-heart):
“Running, long considered a healthy hobby, may actually be dangerous for some. At least that’s the prevailing opinion of the country’s top cardiologists and a new study due out next month from British journal Heart. According to the editorial, endurance training and marathon running can literally push your heart to its limit, causing a variety of acute problems, such as arrhythmia or irregular heartbeat, and lasting damage, including calcification and scarring.”
The key phrase, of course, is “dangerous for some.” But we already knew that. Anyone who follows running knows that some runners train hard and do well, some train even harder and do worse. Some short, fast guys win lots of races, and others develop hip problems and sink into oblivion. Most of the time, we think, “Not me; they’re talking about ‘that other guy,’”--like renowned long-distance runner Micah True, who they found dead in the desert four days after he may of had a heart attack (but as the jury is still out on that, you’ll read more on him in a subsequent section). Or Ryan Shay, who collapsed 5 ½ miles into the 2007 New York Marathon—an Olympic Marathon Trial—and died at 8:46 AM. Or the “occasional” athlete who competes until interrupted by such calamities as heat stroke, broken femurs, calf strain (gastrocnemius or soleus; a new decade, a new shoe-related injury?), or torn Achilles which, after that race, will force them onto a different route to the finish line (aboard a fast-moving EVAC).
But hey, until you approach that finish line where the timer is leaning on a scythe, and wearing a black hoodie, keep pushing it. What doesn’t kill you, will eventually cause arthritis, but if you last that long, that’s a good thing, right?
Running Through Extremes
Because of where we Floridians live, perhaps the greatest number of running-related problems is caused by our climate, mostly during the cross country season. Since track seasons start earlier, begin cool well before becoming hot, the distances races are generally shorter, and runners have had months to acclimate to the change in the HI (heat index, or humiture), heat-induced events are relatively rare in that sport. Not so with the longer races of cross country, especially for newer runners, less athletic participants, or those who neglect to build a base during the summer, thus beginning the season unprepared, and are un-acclimated for a state with just about the most tortuous “fall” running weather in the country.
From late summer to early fall, there are basically four heat-related problems that can be encountered. Roughly, in order of severity, they are: heat cramps, heat exhaustion, and heat stroke (classic and exertional).
Heat cramps--although extremely painful, but easily prevented by adequate hydration and the maintenance of a proper electrolyte balance--are generally considered less life-threatening than the others. They are what the name implies, and though in severe cases might be confused with the imminent emergence of an alien from deep inside a sufferer’s abdomen, should be classified under an “I told you to drink lots of fluids!” category. Ounces of prevention, in other words, are more desirable than a pounding by the experience.
The signal for heat exhaustion—by which time, one way or another, the race is definitely over-- is usually cold, clammy skin, and any combination of fatigue, headache, dizziness, confusion, fainting, nausea, vomiting, muscle cramps, pale skin, and dark urine (due to dehydration). This would be the athlete whose dramatic finish is observed by those gathered at the finish line. As everyone watches in rapt attention, he/she weaves, stumbles, crawls or rolls towards the finish line. Usually, someone yells out, “Don’t touch her! If you do, it will be considered ‘aiding a runner,’ and she will be disqualified!” Well, yeah. But if she had a gunshot to the forehead, would you wait for her to crawl to the gurney? Dumb question either way. The main reason for this is that in their excruciatingly slow forward progress, the closer they get to the finish line (that is, the longer treatment is delayed), the closer they get to the next category of hyperthermia, which follows (and yes, that was another fast-moving double entendre).
It has often been said, and verified almost as frequently, that “Heat stroke never has a happy ending.” By the time skin that was “cold and clammy” becomes “hot and dry,” added to the disaster are such additional symptoms as high body temperature (in the neighborhood of 104 degrees), flushed skin, inability to sweat, rapid breathing, a racing heart rate (in other words, cardiac stress), and unconsciousness. All this does not have to happen immediately; it is not uncommon for a victim of heat exhaustion to experience worsening effects as that day progresses. In one case, I observed a man who, hours after exhausting himself in the hot sun, had a full-blown stroke, which was misinterpreted by his “friends” as intoxication. So they ignored it until the beer ran out. Although he finally got to the emergency room (at 8-something that night), and eventually out of the hospital (two weeks later), it was several months before he came close to again acting like the “Bob” they all knew and loved.
For runners, there are worse things. According to a Position Stand by The American College of Sports Medicine entitled Exertional Heat Illness During Training and Competitions—in which they also discuss other heat-related illnesses—“exertional heat stroke is defined by hyperthermia (core body temperature > 40c)”—104 degrees Fahrenheit—“associated with central nervous system disturbances, multiple organ failure…Almost all EHS patients exhibit sweat-soaked and pale skin at the time of collapse, as opposed to the dry, hot and flushed skin that is described in the presentation of non-exertional (classic) heat stroke.” (http://stopsportsinjuries.reingoldweb.com/files/pdf/ACSM-position-statement-Exertional-Heat-Illness.pdf)
While the subject of exertional heat stroke was discussed in a previous article by this author (Seven Deadly Decisions), the seriousness of the condition, the potential for its occurrence among distance runners in the Sunshine State, and its tendency to be misdiagnosed, I felt it important to revisit the subject. Plus, the weekend after the article appeared on flrunners.com, I witnessed a similar event at another cross country meet, which required a visit by the local fire department, and a trip aboard an EVAC. Do we ever learn?
The symptoms of EHS are, for the most part, not unlike “classic” heat stroke; however, among them is profuse sweating, which might cause minimally trained, or inexperienced sports medicine personnel to confuse it with those of heat exhaustion, as might have been the case with my son Andrew. Although he collapsed—which a bystander described as “fainting”--he never stopped sweating, and at first seemed somewhat responsive. The initial “treatment” was to hold him in a sitting position, and encourage him sip water from the lone 16 ounce bottle that was—more or less—available. It proved to be too little, too late, and later still, when a bag of ice was plopped down on his chest—instead of areas such as the back and sides of his neck, his wrists, ankles, and groin—he was pushed further along towards shock.
The first time I saw ice worsen a heat-injured victim was in Tennessee, where a Civil War re-enactor, clad in wool, went down in the mid-day, mid-July heat, and a licensed EMT removed his clothing—but did not remove the victim from the direct rays of the sun--and placed a bag of ice on the man’s chest. The patient almost immediately went into shock. In Andrew’s case, shock was evidently preceded by delirium. In his heat-altered mental state, Andrew’s desperate need for water caused him to behave unpredictably, subsequently putting his life in immediate danger.
While my son’s slip into inexplicable behavior was surprising enough, my research has turned up possible examples of even more spectacular “meltdowns.” Although I can offer only speculation, since, as I said, I suspect that EHS may often be misdiagnosed—I believe it is far more common than one might assume. I remember reading about two long-ago events that raise that suspicion. They are (1) the female athlete who left the track during an NCAA Championship 10K, ran out of the stadium, down the street, and (reportedly head-first) dove off a 35-40 foot high bridge (apparently, she missed the river flowing beneath the overpass, and landed in the wet grass on its banks); and (2) the runner who ran past the finish line in a race out west, and off into the desert beyond. (If I remember correctly, he was eventually located, and steered back towards first aid.)
Another runner who entered the desert, but did not emerge alive, was ultra-distance legend Micah True. On March 27, 2012 True went on a “routine” 12 mile run, but didn’t return afterwards, and wasn’t found until four days later. An autopsy was inconclusive, but how he was found—scrapes on his hands, arms and knees—and where (his legs in a stream and a water bottle beside him)—remind us of the unfortunate lady who also landed near water. And of course, there is that most famous runner of all, Pheidippides, whose death at the end of “the first marathon” is a legend which we all hold so dear. Too bad there weren’t coroners back then, but there aren’t too many ways a professional runner, such as he, could have succumbed to a run.
From such scant evidence, it would certainly be easy to discount a theory. However, let’s return to a body of evidence reported by The American College of Sports Medicine.
First, is their statement that the:
“Importance of hyperthermia in fatigue and collapse have been investigated. These studies show that the brain temperature is always higher than the core temperature, and heat removal is decreased in the hyperthermal brain compared to control. Brain hyperthermia may explain why some exercising individuals collapse with exhaustion, while others are able to over-ride central nervous system controls and push themselves to continue exercising strenuously and develop life-threatening EHS.”
After Andrew’s brush with death, we wondered, “Why was he the only runner to go down, in a race comprised of 48 well-conditioned college men?” In an effort to answer that question, I looked at three things: the heat index, his size, and his strong desire to start the new season even better than he finished the last.
Based upon personal observations, my estimate was that the temperature at the start of the race was (at least) in the low-to-mid low nineties, with humidity level nearing that of rain (the higher the temperature, the more water that can be held in the air). Running as a 19 year old junior, Andrew is 5’6” and 125 pounds, and substantiated by a study of the photos, probably the most compact runner in the race. As such, his storage capacity for body fluids was minimal. Compared to the 21 year old (female) junior in the aforementioned NCAA track race, (5’5” and 108 pounds), who was in fourth place, and working hard to stay up with the lead pack, there is an unmistakable similarity in both athletes for their maximum “reservoir” of available fluids.
Here’s what the ACSP has to say:
“When fluid deficits exceed 3-5% of body weight, sweat production and skin blood flow begin to decline, reducing heat dissipation.” Plus, Andrew’s race came after training all summer long, and well into the hottest month of the year; the young lady was competing in the last, and arguably the hottest part of her track season. (Eyewitness reports provide information that it was quite warm on that particular night.) On that, ACSP says “Day-to-day dehydration affects heat tolerance.”
Some other factors in EHS susceptibility might include a sudden increase in training, exposure to heat and humidity leading up to the event (ACSP mentions “ambient temperature that remains elevated overnight”), illness, prescription drugs or dietary supplements, (obesity, although this was certainly not a factor here), poor nutrition, sunburn, skin disease, a genetic predisposition, pack running, and uniforms.
On the subject of clothing, “dry weave” vs. cotton could play a small part in the overall measure of a body’s ability to cool itself in torrid conditions. While cotton absorbs perspiration and aids cooling, dry weave was developed to imitate wool, which—as a “living” fiber, wicks away moisture, much like an animal’s fur—thus can contribute to overall heating in summer. (Animals that have thick winter coats, which act as a barrier against the elements, need its ability to remove chilling dampness in cold weather, but shed their winter coats when the temperature moderates.) Since a degree here or there can add to an athlete’s physical distress, a tight-fitting, non-breathing shirt and compression shorts—Andrew was wearing both—that cover more than half of an athlete’s body certainly can’t help the cooling process. Additionally, the ACSP notes:
“Tissue thresholds and the duration of temperature elevation, rather than the peak core body temperature determine the degree of injury.”
The latter statement has two implications. The first is the length of the race. The young lady was running a 10K in June, my son an 8K in August. (Reports are that she made it to 6.4 K, a course map indicates my son went down at 7.2K.) The second factor is an immediacy of treatment.
“Athletes with EHS who go unrecognized, or who are not cooled quickly tend to have increased morbidity and mortality. The primary difference between light and severe EHS cases appears to be the length of time between collapse and the initiation of cooling therapy.”
Once again, time is of the essence. Cool, wet cloths and sheets on the body, or properly placed ice should be applied to the back of the neck, the armpits, wrists, ankles and groin. Of course, availability of water is an issue. How common is a cross country or track race where water is offered during a distance race, when it is needed most?
When Andrew went down, what little water that was found during his 22 minute exposure to an estimated 106 degree core temperature was grossly insufficient to treat his life-threatening condition. This situation, much to the credit of the college’s concerned race organizers, was thoroughly remedied by the next race on the same course. Ample water was provided at the start and finish—which was handed to runners--water stops were strategically placed on the course, medical personnel with water and ice circulated on golf carts, and school personnel—in constant communication with walkie-talkies—closely monitored the race. This adjustment not only assured the safety of the runners that day, but also showed evidence that advanced planning could avert another near-tragedy. An ambulance, already on hand, treated a number of athletes that day.
In summary, the American College of Sports Medicine says:
“Immediate recognition of EHS cases is paramount to survival. The appearance of signs and symptoms depends on the degree and duration of hyperthermia. The symptoms and signs are often nonspecific and include disorientation, confusion, dizziness, irrational or unusual behavior, inappropriate comments, irritability, headache, inability to walk, loss of balance or muscle function resulting in collapse, profound fatigue, hyperventilation, vomiting, diarrhea, delirium, seizures, or coma.
“EHS is a life-threatening medical emergency that requires immediate whole-body cooling for a satisfactory outcome. Cooling should be initiated and, if there are no other life-threatening complications, completed on-site prior to evacuation to the hospital emergency department. EHS casualties often present with multiple organ failure, cardiovascular collapse, and shock.
In other words, plan for the worst and hope for the best.
Shadows
White Shadows, Black Shadows and Those Trapped in Between
The Stuff of Legends
Terrence Stanley Fox was born on July 28, 1958 in Winnipeg, Manitoba, Canada. After growing up in Vancouver, he moved to Port Coquitlam, British Columbia with his family.
He graduated, with honors, from Port Coquitlam Senior Secondary School (now Terry Fox Secondary School), also having achieved great success as a hard-working athlete despite his short stature and only average natural ability. Although an accomplished basketball player and soccer player, his experience as a cross country runner, which began in eighth grade, proved to be his catapult to national fame.
In a traffic accident in November of 1976, he suffered a relatively minor injury to his right knee. The pain, however, did not subside, and the next year he was diagnosed with osteogenic sarcoma (bone cancer). In an effort to save his life, his doctors determined that it would be necessary to amputate his leg, six inches above his right knee.
“The night before my amputation, my former basketball coach brought me a magazine with an article on an amputee who ran the New York City Marathon. It was then when I decided to meet this challenge head on,” explained Fox.
Moved by his own indomitable spirit, and the suffering of the cancer patients he came in contact with while hospitalized, upon release he began an 18 month training program, during which he ran approximately 5000 kilometers (3,107 miles) on his new prosthesis.
On April 12, 1980 he dipped his artificial leg into the Atlantic Ocean on the shore of St. John’s, Newfoundland, and began his Marathon of Hope across transcontinental Canada.
On September 1st, 1980, 143 days and 3,339 miles later, breathing difficulties forced him to stop running just short of Thunder Bay, Ontario. He had averaged more than 23 miles a day--nearly the distance of a marathon--on an artificial leg.
By now a national hero--he was dubbed “the real Six Million Dollar Man” by Lee Majors, the actor who played that role on television--Fox returned home to British Columbia where an examination revealed that cancer had spread to both lungs.
In June he developed pneumonia, went into a coma on June 28th, and died the next day at 4:35 AM.
Then Canadian Prime Minister Pierre Trudeau eulogized him thus: “It occurs very rarely in the life of a nation that the courageous spirit of one person unites all people in the celebration of his life and in the mourning of his death….We do not think of him as one who was defeated by misfortune, but one who inspired us with the example of the triumph of the human spirit over diversity.”
Fox has been the recipient of countless awards, honors, statues and place names. This modern age Pheidippides is also remembered every year by Terry Fox Runs throughout Canada, and in 30 countries around the world. His image, the subject of a special edition dollar coin, is arguably the most popular regular circulation coin ever minted in Canada. It was so coveted by the Canadian populace, that by the time of my visit to the Canadian Maritimes--shortly after it began to be circulated--I found it impossible to find one.
For anyone who has seen photos taken of Terry Fox during his trans-Canadian Odyssey, the unforgettable image of his pained face, struggling to outpace the disease that took his life and limb, will forever haunt us. Even decades after his death, the shadow of Terry Fox—through the foundation that carries his name—continues his crusade to end this cruel reaper of young men’s lives.
Terry’s fate, unfortunately, was not determined by his courage--the level of which has more than guaranteed his lasting fame--but by the prescribed medical treatment in the year(s) he was being treated. Since the time he was originally diagnosed, the treatment protocol for osteosarcoma has changed considerably, as has the increased rate of survival among its victims. With subsequent advancements in cancer treatment, results grow increasingly more promising.
(To read further about Terry, and learn about the foundation that continues his legacy, go to wwwterryfox.org.)
In the Shadows of Fear
All runners know pain. It is impossible to run without pain. In fact, the more pain he can endure, the “better” the runner, hence the term, “No pain, no gain.”
Which pain is worse, however; physical pain, or the sting of a coach’s tongue: “Push past the pain! Pain is weakness leaving the body. Remember the runner’s creed, ‘Quitters never win and winners never quit.’” Runners even have t-shirts with such mottos as “Pain is temporary, pride is forever.”
But where, if it exists, is the boundary between pain and injury? Is it when your pain is so great that you are forced to slow down, or stop? Or is it illustrated by the sight of a runner sprinting towards the finish line, as her leg bones literally break under her?
The White Shadow
On November 27, 1978, a television series premiered on CBS starring Ken Howard as Ken Reeves, a high school basketball coach who promised to cover his team like a “white shadow.” Running until March 16, 1981, it was the first prime time TV drama with a predominately minority cast.
In a memorable episode, a promising recruit joins the Carver High School squad in mid-season, but only after a strong lobbying effort directed at gaining his parents’ permission. The newcomer works hard to catch up to the rest of the team in conditioning, but along the way he and his coach fail to recognize warning signs of a possible heart condition.
When he collapses at practice and subsequently dies, the coach and his team are forced to do a lot of soul searching. How much should Reeves ask of his players? When should the players say, “That’s enough, Coach; I can’t give anymore.”
Practices would never again be normal at Carver High.
Dark Shadows and a Ghost from the Past
Christopher Epifanio remembers the pain starting during his summer training runs, we think sometime after stepping into a hole and falling. After that, it progressively got worse, but he was a trooper, and fought through it. He complained from time to time, but kept training and racing with his brother, Andrew. They were a good team; Chris trained hard, his brother raced hard. For years, they had pushed each other toward mutual success.
While back at college that fall, Chris ran races every Tuesday night as part of a series. Usually finishing first or second overall, his times continually improved. However, the pain lingered.
When he sought help at his college Wellness Center in October, their suggestion was, “Take ibuprofen.”
He tried an Urgent Medical Care clinic. After listening to his description of the problem, the doctor said (sic) “Don’t worry about it. It’ll go away.” On the way out, Chris glanced at his file and saw that the doctor had written “Calmed patient down,” on his chart.
On Sunday evening, November 2, 2008, while kneeling in church, Christopher fainted. Afterwards, he called home and described what preceded it; working hard all day on his schoolwork, snacking on candy, completing a hard one hour run in the evening, then off to church for a night mass, but without dinner. We decided his light-headedness was probably due to low blood sugar. At 5’7”, he weighed about 138 pounds, so this conclusion was not entirely without foundation.
After having eaten and still not feeling quite right, his college buddies convinced him into letting them drive him to the closest hospital. Late that night my wife and I were awakened by a call from the emergency room. The doctor, suspecting a heart attack, wanted to hold him over for tests. I was rather dubious that my healthy and athletic son could have a heart condition, but when you love someone, personal opinions rank well behind caution, and my wife and I supported the tests that were being recommended.
Chris filled out the usual medical forms, and where it asked, “Have you had any physical problems lately?” he wrote in, “My right knee has been bothering me.” Nonetheless, convinced that Chris had a heart problem, the doctors who saw him that night, and in the days following, did not look at the knee. When they found no further indication of a heart problem, he was scheduled for a follow-up stress test, and released on November 4th. The stress test, done a week later provided no evidence of a heart condition.
Returning to campus, Chris resumed his studies, but as it turned out, he would never run again. The pain, still severe enough to cause sleepless nights, was a constant reminder that all was not well. When he brought it up on the phone one night, and still convinced that it was a running injury, I said “Ice it, elevate it when you can, and take something for the pain. In consideration of his not being able to run, I suggested that he exercise by biking, which I viewed as a low-impact form of replacement conditioning.
About that time, we also suggested that he see a chiropractor, a practice I’d always found useful, since they tend to view things more objectively than a medical specialist. The doctor he saw, Christopher Michael Green—the same first and middle name--prescribed an MRI, which was done on November 15th.
My wife and I will never forget the call from Dr. Green that same afternoon. Essentially, alarmed by the mass that showed up as a dark shadow near his right knee on the outside of the leg, he was in the process of scheduling as immediate an appointment as he could with a highly respected oncologist in a Tampa hospital, one well-known for expert cancer care.
I left early the next morning--ironically the same weekend as that year’s FHSAA Cross Country Regionals--and subsequently drove roughly 1000 miles; from home, to the college, on to the hospital, back to the college, and then home in the four days that followed.
The oncologist who saw him seemed concerned enough to do a bone biopsy--which resulted in pain far worse than the original ache in his knee--the outcome of which was described as “inconclusive” in the pathology report. Chris was scheduled for another appointment. A month later, however, the diagnosis was still not definitive. Chris found himself trapped in the shadows between relief and fear, where he, and his family, would languish for months.
We wanted to believe that “inconclusive” meant it was not cancer, but rather a severe running injury. Of course, Chris had already stopped running. Still, there was that nagging concern that it was serious, and over the space of the next two months, combined, Chris, my wife and I contacted over two dozen professionals: orthopedic surgeons, orthopedic oncologists, a biochemist, sports medicine specialists, numerous nurses representing our insurance company, college trainers, and personal friends in the medical profession. All listened, most expressed their sympathies and a few said that we should seek a second opinion. However, none whom we attempted to make an appointment with would consent to help; some even declined to see Chris. Explanations as to why were not exactly forthcoming. It was later suggested, by an experienced sports medicine specialist, that Chris had encountered “the long, white wall.”
This latter development left the family feeling quite abandoned by the medical profession in this real-life drama.
Finally, three months after his first visit to the cancer center, and after seemingly little definitive movement on the hospital’s part, Chris pursued a follow-up MRI. Dr. Christopher Michael Green, who seemed to have become an archangel fighting a shadowy side of the medical profession, entered the picture again. He continued to do so pro bono, which could be explained by the fact that he is not a participating provider on Chris’s health insurance, however his motives may have been far more humanitarian. He agreed to prescribe a second MRI, and followed up with phone calls to get a radiology report to the family that same day.
The conclusion of the radiologist who read the images was that it had increased in size by a third. Chris would need treatment without delay.
A neighbor suggested Shands Hospital, in Gainesville, one that I immediately pursued.
Finally, on Thursday, February 19th, an orthopedic oncologist, Dr. Parker Gibbs in Gainesville, took Chris in as a patient. Upon examination of Chris, the bone biopsy, X-Rays, and MRIs, it was determined that Chris had bone cancer in his right leg.
Strike Two
I’m sure that no one, regardless of the severity of its pain, or how long they have endured it, is fully prepared to accept a diagnosis of cancer. Even after it does finally sink in, its effect on all aspects of your life cannot be imagined. Chris, I’m sure, thought, “They’ll treat me, I’ll go back to college and be able to finish up the semester.”
However, the bad news kept coming: First, “You’ll have to use crutches, because if you break your leg at this stage, there’s little hope of saving it. You have to begin treatment immediately; first, there will be 10-12 weeks of chemotherapy, then major surgery to implant a prosthesis in place of the cancerous bone, followed by months more of chemotherapy, during which you will be too ill to continue attending classes, full-time, at college…and you’ll have to give up running, permanently.”
Then came more bad news. Two, perhaps three, small spots showed up on an X-ray of his lungs. We wondered, “Was this a result of the first hospital not acting more aggressively? Was it caused by microscopic cancer cells broken free during the biopsy?” These will forever be the unanswered questions.
We are Family
Cancer patients, because of the people who care for them--either by family, friendship, or medical ties--are not left to face this crisis alone. Once he knew what he was up against, the concern and prayers of those who are part of Chris’s life began to wash over him. Soon, it became a flood of love that, if it were a medicine, no doubt could have him cured in no time. Because it is not, their fate is fear of loss, sleepless nights, and indescribable feelings of inadequacy.
When they could, his college friends visited him--either at home or at the hospital--each driving hundreds of miles to do so. Friends of the family did likewise, offered rides for his non-driving siblings, and volunteered kindnesses that the family would never have thought to ask. We were reminded, on a daily basis, that we were not alone in this.
In the days just prior to the surgical procedure that would change my son’s life forever, he was at an emotional low-point. It was obvious that the upcoming surgery to remove part of his right leg was weighing heavy on his mind.
Although I had spent pretty much all of my time with Chris that spring, one night while I was out running an errand, a stranger walked into Chris’s fourth floor room. That visit was probably the single most uplifting event in this long, drawn-out ordeal, one that, as the next few days unfolded somehow buoyed Christopher’s spirit, and got him through the worst ordeal of his life.
“He was a big guy,” Chris reported to me when I returned later, “probably a football player. I think his name was Tim-something.”
Since his life pretty much revolved around running, Chris had neither seen, nor heard of Tim Tebow, who at that time was quite the celebrity for quarterbacking his Gators to a national college football championship, and with this talented team, working hard to follow up with another. But to Chris, more importantly, Tebow—far from his field of fame and glory-- cared enough to visit the pediatric unit and do what he does best; inspire those he comes in contact with.
True miracles come when you least expect it, and sometimes angels wear pads instead of wings, but that, and several other “appearances” by a true American hero—and his coach, Urban Meyer--got Chris through fear of the unknown. Chris survived the chemo, like Wolverine learned to adjust to “adamantium” implant, and finally celebrated the same “birthday party” that all outgoing cancer patients receive at Shands. With his new leg would begin a second chance at life.
Thank God for small miracles, and while he can never run again, Dr. Gibbs was able to implant the cobalt chromium prosthesis under the skin of my son’s right leg, so unless you look close enough at his leg to see the long scar, or notice his unique way of walking, you’d never guess that Chris is now the center of attention every time he attempts to pass through airport security.
The Loneliness of the Long Distance Runner
There are family photos of Chris and Andrew running together in the hills, along country roads, and doing intervals on the track. In them, frequently their stride is so well-matched that their legs are frozen in images as if they were intentionally synchronized; both with the same leading leg, the same trail leg. Now they are mementos…family heirlooms.
Involuntarily, my mind drifts towards a scene in the more recent past. Seen are two athletes, miniaturized by distance, traveling along a nondescript road. One is on foot, the other on a bike. They chat freely, debating things that brothers do with such enthusiasm. It is at the same time a look back and a look forward. Success of one, once judged by minutes on stopwatch, is now determined by the turn of calendar pages.
The Road Ahead
When should pain be considered the result of a running injury, and when should it be taken more seriously? Even today, my mind keeps going back, years earlier, to Chris’s very first complaints of knee pain. Probably like many coaches who see pain as a byproduct of hard work, in the very beginning I saw his as a minor setback in training. But should I not have been quicker to realize that his knee pain was a warning of a far more ominous problem?
When discussing a possible link between Chris’s running and his osteosarcoma, the response from two experienced doctors helped to clarify things. Both agreed that (sic) “We can’t assume every ache and pain is a warning sign for cancer.” Dr. Fryman, added, “If we did, we’d irradiate half the kids in America.” Dr. Gibbs suggested that in most cases of osteosarcoma, there may seem to be a connection between injury and a subsequent discovery of bone cancer. He wrote:
“Almost 90% of kids with osarc report some sort of mild trauma, but millions of kids bang their knee every day and do not get cancer. “So, the trick is figuring out if there is a true connection and if so, just what it is.”
Statistically speaking, the young reader needn’t be consumed with worry at every sign of leg pain. Osteosarcoma is a rare disease. But in light of the fact that approximately 2000 new cases of primary bone cancer occur each year in the United States, there are, and will continue to be others in Florida, some of which may impact the lives of people reading this story. Those who do suffer this fate are predominately males, and in their teens to early twenties, but can be as young as elementary school children. In half of those who share the experience of Terry Fox and Christopher Epifanio, the tumor will arise in the femur, and 80% of these occurrences will be in the distal (near the knee) end.
In any case, remote as the potential for osteosarcoma may be, pain is a warning sign that something is wrong with your body, and as such, you should always, always listen to your body.
We all know of coaches who make a practice of keeping coolers full of ice for treatment of athletes after races or games. Which of them will suffer the misfortune of someday realizing that while icing may alleviate pain, it can also hide the seriousness of the cause behind it? In the end, no one can hide from the sort of emotional pain that can be its result.
Note: For a related story, read: Florida Cancer Survivor, 11, With Broken Prosthetic Crosses Finish Line on Back of Marine (http://abcnews.go.com/US/florida-cancer-survivor-11-broken-prosthetic-crosses-finish/story?id=17446320#.UN2itm-aXlV)
For further readings on osteosarcoma:
- http://www.touchmusculoskeletal.com/articles/osteosarcoma-evaluation-current-diagnosis-treatment-and-chemotherapy
- http://www.researchgate.net/publication/51518769_Evaluation_of_selected_cytokines_in_children_and_adolescents_with_osteosarcoma_at_diagnosis_-_preliminary_report