Wisdom of Wellbeing: Walking a Marathon – to Survive and Thrive! Monday, May 15, 2017 Wisdom of Wellbeing By Dr. Karen Arscott and Dr. Paul J. Mackarey The Marathon – The Race of Your Life! Part 1 With the Scranton Half and Boston Marathon behind us, many local runners are getting pumped up to get outside and run. In fact, many will be getting ready to begin their training for the Steamtown Marathon in October. Well, before you begin…this column will present a new perspective on marathon participation…walking a marathon. This informative and inspirational story is about a lung cancer survivor who ran the race of her life and went on to finish the walk of her life to live well and walk a marathon! As a long time recreational runner, for many years I dreamed about attaining “the holy grail” … crossing the finish line of a marathon! The only problem was that I was unable to run any more. While this fact seems like a pretty big problem when talking about completing a marathon, I am eager to share why this is not impossible. Nine years ago, I heard about “Walker Friendly” marathons and I was intrigued. Before we knew what we were getting into, my husband and I registered for the “Walker Friendly” Philadelphia Marathon! Upon further research, we discovered that we had to find the time to train – yes, you do need to train to walk a marathon. One might wonder why my husband and I decide to register for the “walk friendly” Philadelphia Marathon without knowing the details. Well, my walking marathon was the reward for my successful survival marathon… In January 2006 I was diagnosed with lung cancer. At age 46 and without any known risk factors (non-smoker), to say we were shocked is an understatement. My husband and I are both physicians and we are up to date on all required medical education. However, we had no idea that lung cancer in never smoker women was on the rise and actually made up almost 20% of all lung cancer patients. Our education about lung cancer was really only beginning as I had much ahead of me, including surgery, which was thought to be a cure. Lung cancer quickly became a personal scare and now hopefully a distant memory. Despite my positive attitude, this disease presented ongoing challenges. Since I always considered myself athletic (some would say a jock), I decided to take control of my life through physical activity. I trained to complete a 5K race seven months after surgical removal of the upper part of the upper lobe of my right lung. This went well and we went on with our lives. However, sixteen months after my initial diagnosis, my lung cancer returned as metastasis in lymph nodes in my mediastinum (the middle of my chest). Suddenly, at 48 years old and feeling healthy, I was statistically looking at a 9% chance of living 5 years. Once the initial shock had passed, I told my doctor to hit me with everything possible. My doctor laughed and said, “We will hit you with everything including the kitchen sink!” My marathon to live had just begun! First, was a port-a-cath placement which is a surgically inserted tube for vein access for the delivery of chemotherapy. Next, chemotherapy treatments began. The chemotherapy regimen I was given included carboplatin and docetaxel – this predated the tumor maker therapy now available. Every 3 weeks I received these medicines for four rounds. While receiving the chemotherapy, I continued exercising at spinning class. It was imperative that I maintain my cardiovascular fitness level as a major chest surgery was going to be next. Nine years ago there wasn’t any evidence concerning exercise and chemotherapy and so I decided to do what I felt would be best for me – which included exercise (it is now proven to be helpful, especially for lung cancer, to exercise while being treated). My only self-imposed rule was no exercise on the day I received my chemotherapy. The spinning class was an excellent choice for me as I knew everyone in the class and they were a cheer squad for me and my family – my family exercised with me throughout. I would close my eyes and pretend I was racing cancer and I always won! My survival marathon continued. After the twelve weeks of chemotherapy, I had surgery to remove the entire right upper lobe of my lung along with the lymph nodes in the right side and middle of my chest. A little less than three weeks following my surgery, I started radiation five days per week and weekly cisplatin (another chemotherapy drug) for 7-8 weeks. Once I finished chemo in December 2007, it took almost 3 months for my blood counts to normalize and I started to feel like myself again. In the spring of 2008, I was back at the gym in spinning class regularly and the seed of walking a marathon was planted by two women in the class. The Philadelphia marathon takes place in November which is Lung Cancer Awareness month – seemed like a perfect fit…I had finished the survival marathon for life and now I wanted to complete the walking marathon to live! The Marathon – The Race of Your Life! Part 2 Last week we learned how this lung cancer survivor ran the race of her life and went on to finish the walk of her life to live well and walk a marathon! As a long time recreational runner, for many years I dreamed about attaining “the holy grail” … crossing the finish line of a marathon! The only problem was that I was unable to run any more. While this fact seems like a pretty big problem when talking about completing a marathon, I am eager to share why this is not impossible. Nine years ago, I heard about “Walker Friendly” marathons and I was intrigued. Before we knew what we were getting into, my husband and I registered for the “Walker Friendly” Philadelphia Marathon! Upon further research, we discovered that we had to find the time to train – yes, you do need to train to walk a marathon. One might wonder why my husband and I decide to register for the “walk friendly” Philadelphia Marathon without knowing the details. Well, my walking marathon was the reward for my successful survival marathon… as a lung cancer survivor! I had finished the lung cancer survival marathon to save my life … I wanted to complete the walking marathon to live! WHAT IS A “WALKER-FRIENDLY MARATHON? A “walker-friendly” marathon is a marathon that accommodates the needs of those who chose to walk the 26.2 mile course instead of run. Moreover, it means that the course remains open for 7 hours instead of the normal 6 hours. An open course provides water and Gatorade stations, first aid support, road closures, and in general it means that you are not alone. A marathon is 26.2 miles and so to walk one in 7 hours translates into walking 16 minute miles on the average. You actually need to plan for a little faster than that because you will need to use the portable toilets (that is another story!) since you are out on the course for 7 hours. Training – this is how we did it in about 5 months – and it worked! However, it is probably wise to begin earlier, six to eight months before the race, if you have the time. It really helps to find a partner or two. It was so great doing this with my husband as we had time to spend together talking – a true rarity nowadays! Moreover, as discussed in last week’s column, as a couple, we had just survived a very stressful time during my treatment and survival from lung cancer. One important benefit to walking, as compared to running, a marathon is that you are able to have a conversation with someone. I am not a proponent of wearing headphones while walking on streets as you cannot hear cars or animals coming up from behind. First, you need to find a safe place to walk. You can start on a treadmill – treadmills are okay for a few miles but really get boring as your walks lengthen. Your first session will be to get an idea of what a 16 minute mile is like – because it is faster than you think. On a treadmill if you set the speed at 4.0 you will be walking a 15 minute mile. A setting of 3.7 will give you 16.12 minute miles. If you walk outside, which is really preferable once the weather breaks, find a 4 mile course by driving your car and measuring the distance. Hills are definitely beneficial in your course. Walk the 4 miles and see how long it takes. Keep walking that 4 mile course until you are able to walk it in one hour. You should plan on walking at least every other day. When walking swing your arms – this helps the natural fibrous coil built into your back muscles and therefore improves your efficiency. Once you can walk 4 miles in an hour, add 2 miles on to the course or find a new 6 mile loop. Walk this 6 mile course until you can walk it in 1 ½ hours. The 4 mile and 6 mile loops will be your mainstay as you increase your mileage. We could only find time to walk the longer distances on the weekends and so we would walk the 4 mile or 6 mile loops during the week after work. In retrospect, it might have been wise to enter a half marathon (13.1 miles) as a warm up to the full marathon. Oh well! Our courses were 4 miles, 6 miles, 9 miles, 14 miles, and 19 miles. After 2 months or so you will start the longer walks. Take water with you and try the different energy gels, beans, packets, and drinks. You will find that you will need the energy packet after about 7 or 8 miles and then every few miles to keep your muscles feeling strong. The practice walks are where you find what works best for you – I liked the gel and my husband liked peanut butter sandwiches! Plan on at least 19 -20 mile training walk 2 or 3 times prior to the actual marathon. If you can do a little more, such as 24 – 26 miles, that would be preferable. When training and in the marathon, walk fast on flat surfaces and up hills be sure to swing your arms. Be careful and fight the urge to run down hills – running down hills is very hard on your joints especially your knees The 26.2 miles in a marathon is truly a challenge and around 21 or 22 miles it is common to start to feel really tired and sore – if you get to that point and start visualizing your normal 4 mile loop you will start to feel the energy and excitement return. When you hit 25 miles you are home free and realizing that you are in the final mile is an unbelievable sensation – you will have energy and drive. Here is the thing – no matter how long it takes even 7 hours when you cross the finish line and they place the medal around your neck and wrap the silver blanket around you it will feel like you won – seriously you did win. Only about 0.5% of the country’s population complete a marathon. It is something to be very proud! The Philadelphia marathon in 2008 was cold. The morning started at 26 degrees as more than 20,000 participants gathered at the starting line. As walkers we started towards the back and didn’t cross the starting line until 30 minutes after the race began! We walked fast just like we trained, but didn’t plan on the 15 – 20 minute wait for the portable toilets! We neared the rear of the Art Museum and suddenly heard the announcer say that he could see two more walkers coming up toward the finish. We were bursting as he said, “these will be the final runners of the 2008 marathon! Let’s play the song everyone is waiting all day to hear!” With that the “Rocky” theme song came on all of the speakers and the crowds (yes there were still thousands of people lining the street!) cheered. It was truly amazing and far beyond what we ever expected. My husband and I crossed the finish line, medals were placed around our necks, and silver blankets wrapped around our shoulders. There were people cheering and high-fiving us. We felt like we had won – and actually we had won. We won a personal battle and proved to ourselves that we could do anything, survive cancer and complete a marathon, one mile at a time! I had finished the lung cancer survival marathon to save my life … I wanted to complete the walking marathon to live! With good planning and a positive attitude, you too may be able to walk a half or full marathon. Good luck and maybe I will see you in the port-a-potty line sometime! Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org Dr. Karen Arscott is an Associate Professor of Medicine at GCSOM. She graduated from Philadelphia College of Osteopathic Medicine with D.O and is board certified in Neuromuscular Medicine and I am Chair of the Northeast Central Pennsylvania Interprofessional Education Coalition. I am Co-Chair of PA Lung a non-profit bringing awareness and support to those touched by lung cancer – this is in conjunction with Lung Cancer Alliance of which I am on the Medical and Professional Board. My walking buddies are my sister and my husband. I reside in Waverly with my husband James Arscott, D.O. and my granddaughter Sophia. Paul J. Mackarey, PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. This article originally appeared in The Times-Tribune on May 8 & 15, 2017. Reprinted with permission. TCMC Media Contact: Elizabeth ZygmuntDirector of Media and Public RelationsOffice: 570-504-9687On Call: 570-687-9703 Geisinger Commonwealth School of Medicine is committed to non-discrimination in all employment and educational opportunities.