PET Scans, Diets, and Mountain Training

Well I have some fabulous, fantastic, super, wonderful, amazing, awesome, tremendous, astounding, splendid, breathtaking, great, extraordinary, remarkable, magnificent, huge, enormous, very big, terrific, superb, marvelous, brilliant, spectacular, astonishing, good news. My PET scan came back squeaky clean again. My Oncologist is very impressed. In the past when asked about how he felt about his pathologist’s diagnosis (a curable type of lymphoma,) and Mayo’s diagnosis (an incurable type), he refused to give any speculation and just concluded it was a difference in opinion and there’s not much we can do about it. But now he is thinking a little differently. He still talks with great care. He is a well seasoned oncologist and knows how to talk to the patients without scientific backgrounds. I’m working on him to communicate in my language - science, math and probabilities. These are not the exact words he said, but rather my interpretation.

Being a seasoned oncologist, he has seen many cases of both types of lymphoma: diffused large B-cell (DLBC) and follicular. He has seen how patients of each type respond to chemo and that, on the average, there is big difference in response characteristics. I speculate that many more DLBC patients have rapid and complete responses than follicular patients. It may be rare that follicular patients have a complete remission that lasts any period of time. Therefore, since my response has gone so well and so complete, the probability that I have follicular lymphoma (incurable type) is low and it is much more probable that I have DLBC. We will never know for sure, but the more time I stay in complete remission, the more probable I have been cured.

Getting through the first year in complete remission is a huge milestone. At the one year milestone my odds of surviving and being cured are much greater than 50/50 odds I got just before starting chemo. (I intend to calculate those odds based scientific papers I found on the internet, but I’ve been too busy enjoying life). The first year milestone is the biggest for burning down risk, but the second year is a big one too. However, it doesn’t matter what happens here on out. I’m very gratified with the extension of life I’ve received thus far. From here on out, it’s icing on the cake.

Even though my diet and my training have not gone exactly to plan, my weight loss has. During the work week I do a pretty good job of staying under 2000 calories a day. But I haven’t been able to count my calories close enough to record them. It’s easy to measure food when I’m home, but whenever we dine out or eat at someone else’s house or when I’m on a business trip, I just have to estimate how many calories I eat. And I don’t always count them either. I have been traveling to Phoenix on business trips for the last couple of weeks, but that is a good thing when it comes to my diet. For business travel I don’t dine out but rather get a hotel suite that has a kitchen and cook my own food. Since I buy all my groceries, I don’t get the tempting treats that my wife gets for our sons. So I actually eat much healthier when I travel on business. I haven’t given up on calorie counting; it is still the basis for my weight loss plan. I’ll still do it when I can and when trying new meals. Many of my meals I already know how much to take to stay within my calorie limits.

Keeping track of my weight every day has also been a learning experience. I’ve noticed that my weight has a big cycle that repeats itself over a one week period. Every weekend my weight goes up 2 or 3 pounds, and then drops during the week. I think the weekend weight gain is mostly water weight. I speculate that on the weekends I tend to eat foods that are much higher in sodium, which can make the body retain water. So monitoring your weight on a daily basis can drive you crazy if you’re not careful with interpreting the data. The first plot of my weight shows my daily weight over four weeks. The first week I was not on my diet. During the fourth week I was in Phoenix so there is some missing data. You can see my weight being all over the map, but there does appear to be a downward trend too.

A better way to look at weight is by averaging the daily weight over a one week period. This takes out the weekly cycle and reduces random variations. As you can see in the second plot the data points fall much closer to the fit line, which shows that I’m losing on the average 1.2 pounds a week (rounded up), slightly better than my goal. The fit equation shows a good R^2 factor of 0.98 (rounded up) which means the data follows the fit line to a very high degree. Isn’t science amazing?

My running training has gone very well too, but not always as planned. Over the prior two weeks I have run two half-marathon (13.1 miles) runs. The first one I didn’t have a great finish time of 2:02, a long ways from my goal of 1:39. However, I was running mostly on my local trail which had fresh loose snow on top of ice. The slipperiness robbed energy from every step I took. I was exhausted and beat up near the end of the run and hoping it was due to the slippery conditions. The following week the loose snow had melted and I was mostly running on hard pack snow, in which my trail running shoes get pretty good traction. My finish time was 1:54 and I felt great at the end of the run. My guess is that my time will improve even more just from better traction after the snow and ice disappears this spring.

My weight loss plan included running at least 30 miles a week to burn roughly 3500 calories or more per week. Well that hasn’t worked out to plan either. The biggest deviation comes with business travel to Phoenix. Not because I don’t run, but because I do a different type of run while in the desert. My favorite kind of running is trail running, and my favorite trail running is in the desert, and my favorite desert trail running is up and down a mountain trail. I have read that some marathon coaches feel that hill training can also improve speed or finish times. Well, mountain training must be the best then, right? One of my favorite mountains to run up and down is Shaw Butte in the North Mountain Park of Phoenix. Going up the mountain I try to run as much as I can, but need to take walking breaks at the steepest part. There’s something about running up a mountain that is motivating and makes it easy to push harder than usual.

My favorite part though is running down the backside of Shaw Butte, which is very steep and rocky in places. It’s a type of meditation for me. Any mistake could lead to a serious injury, so one must keep constant and absolute focus on each step. This kind of focus really clears the mind of the daily garbage.

When I mountain trail run my running distances (about 4 miles) are less than the typical 6 miles I run on flat land. So it may seem that I’m burning fewer calories if going just by distance. However, based on time and heart rate, I think I’m burning more calories. There are websites that calculate how much calories you burn for just about any activity, including mountain climbing and mountain biking, but I haven’t seen anything on mountain running.

So my diet and running training have not gone exactly how I planned. I actually thought of giving up on my diet method. I’m kind of a perfectionist and have trouble finishing things that don’t go to plan. But this time I listened to the words of Winston Churchill, “never, never, never give up”, and decided to stick to my plan but adapt. I can’t stick to 2000 calories every day because many days I just don’t know how much I’ve eaten. But I keep working on learning how many calories on in each meal. I think it’s important to know what you eat. But that just doesn’t happen overnight. It’s like training for a marathon. You certainly don’t start out perfect; it takes a long time to get into a good routine. You’ll always have some bad days, some that you have control over and some that were self inflected. I think one of the key things to succeeding in anything is to realize that nothing including you is perfect and that perfection is not required to move forward. As long as you never, never, never give up, one step back and two steps forward will get you to your destination every time.

My New Adventure: The Lake Minnetonka Half Marathon

I miss having a marathon in my plans, but I promised my family I would take a break from full marathons. So I’ve decided to run in the Lake Minnetonka Half Marathon (http://www.lakeminnetonkahalfmarathon.com/) on May 3rd, 2009. To make it adventurous I’m setting a time goal of better than 1:39, which should place me in the top 10 for my age group (50 to 59) based on last year’s results. I was in my best shape when I ran the TC marathon in 2007 and at the halfway point my time was 1:48:52, so I need to cut ten minutes off that time to reach my goal. Now my thinking is I should be able to do that. When I made 13.1 miles in 1:49 time back in 2007 I had to complete another 13.1 miles, so I was saving a lot of energy at that point. Furthermore, it was hotter than heck during the 2007 TC marathon. So I’m thinking with good training I should be able to do this no problem. Last week I get on the treadmill and crank up the speed to 8.0 MPH or a pace of 7:30/mile. Holly smokes! I was surprise how fast that was. There’s a huge difference in the speed for a half marathon time of 1:49 vs 1:39. I can’t imagine running 8.0 MPH for 13.1 miles. Never the less, I’m going try.

I wanted some adventure into the unknown, well here it is. This requires a big change to my training. I’ve never done any serious speed training before, but now’s the time. Last week I started by speed training by employing the Fartlek (http://www.wikipedia.org/wiki/Fartlek) method on my treadmill. I’ve tried Fartlek training in two different ways. One is to start out at normal pace for a few minutes to warm-up, then run for about 3 minutes at 9.1 MPH (almost a sprint for me), then back to normal pace to rest for a few minutes, then sprint again. I repeat this cycle until I finish 6 miles. The other method I’ve tried is to run again at normal pace, then up my speed to 8.0 MPH (my goal speed for race day) for as long as I can, then back to normal speed to rest, then repeat the cycle as often as I can. I love this type of training. It makes time go much faster when running on the treadmill.

Speed training may not be enough to reach my goal so I’m planning on doing something else to help my speed – loose weight. During chemotherapy last spring I gained about 7 or 8 pounds. There were a few reasons for that. The Prednisone increased my appetite. It also caused my problems with stomach acid and gas to flare up, way up, and eating actually helped with that, so I ate very often. The other cause of my weight gain was comfort foods. My sons like milkshakes. During chemo I would get through the day by looking forward to an evening of making and eating milkshakes with my sons while we watched our favorite TV shows. Fortunately I was running about 40 miles a week, otherwise my weight gain would have been much more.

I’ve read that you can improve your percentage improvement in marathon time is about the same percentage in weight loss. I’m assuming this is roughly true for a half marathon too. I’m at about 175 pounds right now. So I if loose about 15 pounds I could expect about a 9% improvement in my half marathon time. A 9% improvement over my 2007 TC time gets me pretty close to my goal. I have 15 weeks before the race so I need to loose about 1 pound a week. That’s not unreasonable.

I’m not planning on loosing weight just to improve my race time. I’ve wanted to do this for a long time. 160 pounds is a very healthy weight for me. Maintaining a good weight has tremendous health advantages that are obtained in a natural way and without drugs. Before I lost my 30 pounds in 2007 my cholesterol was high and my doctor wanted to put me on drugs to control it. I lost 30 pounds and my cholesterol came down into the normal range without drugs. There are so many health risks associated with being overweight (http://www.cdc.gov/nccdphp/dnpa/obesity/) and one of them is an increase risk in cancer. I don’t need that! So I’m going to use my half marathon time goal as a motivational means for obtaining my weight loss goal. I’m also using this public announcement as a motivational means – I must be crazy!

This will not be easy. Many of you know that loosing weight is not easy. I love food and many of the foods I love are not good for me. However, there are a lot of foods that are healthy and are wonderful for the palate too. For the most part I do have very healthy eating habits. My diet is very high in fiber, I eat a lot of fruits (mostly berries which are the best fruits) and vegetables (probably could do better with veggies), I go with low fat versions of most foods, I avoid foods with refined sugars as much as possible, and get low or no sugar added foods when available. So all I need to do is tweak my diet; mostly cut out those evening milkshakes. I’m not going on any special diet. My plan is to have a well balanced diet and to watch calories. For weight loss the bottom line is calories. To loose weight one has to burn more calories than what one consumes. It’s that simple. However, I’m not going on a strict diet like a 1200 calorie a day diet. I don’t have to with the running I do.

Here’s my plan and how I’ve figured it out. I’ve checked with many websites that have online calculators that calculate calories burned. They don’t all give the same answer, so I’m taking an average. For my weight, age and gender, I burn about 2000 calories a day without running – if I were to lead a sedentary lifestyle. The calculators also show that I burn at least 700 calories for 6 miles of running. So if I run 6 miles a day for 5 days a week I’ll burn 3500 calories per week just running. One pound of fat is equivalent to 3500 calories. So, if I eat 2000 calories a day and run 30 miles a week, I should loose 1 pound a week and reach my weight goal by race day on May 3rd. One way to look at this is that all my weight loss is due to running, not cutting calories. I just need to be careful and not eat extra calories.

Ok, now I’m going to get a bit anal with this plan. To make sure I eat the right amount of calories I’m going to watch my calorie intake very closely. I’ve bought a kitchen scale to weigh all the food that I eat. Weighing food is a lot easier than trying to measure the volume. For example, for breakfast I put my empty bowl on the scale, hit the tare button to zero out the scale, add my cereal, write down the weight, hit the tear button, add my fresh blueberries, hit the tear button, and so on until I have the weights of all my ingredients. It really doesn’t take much effort and it’s kind of fun. Then I’m going to try a trial version of some software from CalorieKing’s website that will help me keep track of calories. Once setup I’ll just enter in the weights and the software will keep track of calories and other nutritional data. If the software works well I’ll buy it. My poor wife, she didn’t know what she was getting into when she married me.

Besides keeping track of my calories I’ll keep track of my daily weight. They say you shouldn’t weigh yourself every day because there are normal fluctuations that occur and a normal but temporary weight increase may be discouraging. However, they weren’t addressing a scientist with this advice. By using curve fitting functions I should be able to average out the normal fluctuations and get a better measurement of weight loss trend with daily measurements than I can get with weekly measurements. Here is my weight over last week:

The solid line is a linear fit to the data and shows that over the week I had a weight gain trend of about a quarter of a pound a day. Kind of alarming! But my guess that besides a daily variation there is also a weekly variation. After a couple of weeks I get a better idea of things. The R2=0.6 is basically an indication of how well the line fits the data. The closer to 1.0 the better the fit. A value of 0.6 is not good correlation and is due to having a lot of variation over the fit period. What this means is that there is not a lot of confidence in the accuracy of quarter of pound weight gain trend. Whew! Eventually I hope that the fitted line extrapolated (extended) out to May 3rd will show that I will eventually get to my goal. I suspect that a linear fit may not be the correct model to use and I may need to go to something like an exponential fit (a curve that starts out steep and the beginning and less steep at the end).

Besides monitoring my weight I’m going to monitor my improvement in running speed each week. In a couple of weeks I’ll be running 13.1 miles for my long run each week. I’ll keep track of my time to finish 13.1 miles and chart that too. Hopefully a fit to that data will show that I will eventually reach my race time goal.

I’m really excited about this. Training for a half marathon will not take nearly as much time as a full marathon and there will be less risk of injury. From my experience I start to run into injury problems when I start running about 16 miles or longer. Keeping my weekly long runs to 13.1 miles will save a lot of time. Not only from running shorter distances, but also shorter recovery time. When I run 16 miles or more, I’m kind of useless for about 2 or 3 hours afterwards, whereas I can do something like mow the yard after a 13.1 mile run. That helps a lot in the wife department. The speed training is a lot of fun and from what I read can actually help reduce injury risk.

I can’t believe I’m doing this – posting this kind of detail on the internet. Oh well – I’m on the hook now.