The Clinic.

LEUCODERMA AND OUTDOOR RUNNING

I have a skin condition called leucoderma or vitiligo, which makes me extremely vulnerable to sun exposure. Until recently I have confined myself to running indoors on a treadmill to limit my risks. But I live in a beautiful part of California where the weather is nearly always gorgeous (and sunny). I would love to be able to run safely outside. Besides sunscreens or heavy clothing, do you have any suggestions?

Mary Tandon

San Diego, CA

Vitiligo is an autoimmune disease in which some areas of the skin have absolutely no pigment to provide protection from the ultraviolet rays of the sun. Even though people with leucoderma have an extra reason to be careful, protection from the sun is always important for everyone. You can still run in the sun as long as you take extra care to protect yourself. The key elements for being safe are to avoid activities during the peak effect of the sun's rays (between the hours of 11am and 2pm), wear sunscreen of at least SPF 20 and wear protective clothing, including hats. Sun Precautions, Inc. (1-800-882-7860) makes clothing from fabrics designed to block most of the sun's rays, and yet still be comfortable when you exercise. Another resource for information is the National Vitiligo Foundation at www.vitiligofoundation.org.

Brian B. Adams, MD.

Cincinnati, OH

RUNNING IN ALTITUDE

Trail running and mountain climbing are my two favorite activities. I have heard of a supplement called Microhydrin, which claims effectiveness for altitude sickness including headache, nausea, and fatigue. I feel the effects of mountain sickness when I exercise over 12,000 feet and would be very interested if the claims are true. I have not found any objective information about it. The only thing I'm familiar with to treat altitude symptoms is Diamox, although I've never tried it myself.

Do you know whether Microhydrin is effective in treating mountain sickness and can you give me any recommendations regarding Diamox? I would love to run at higher altitudes without the miserable side effects.

Thaddeus Kellam

Oakland, CA

I was unable to find any good objective evidence that would support a beneficial effect of Microhydrin on prevention of acute mountain sickness. Even if its proposed action as an antioxidant were true, this would not affect altitude sickness.

Diamox (azetazo-lamide), however, does effectively address the symptoms caused by high altitude. As you probably know, the symptoms of acute mountain sickness are headache, loss of appetite, nausea, vomiting, irritability, fatigue, difficulty concentrating, insomnia, and decreased exercise performance. These symptoms generally start in the first 24 hours and rarely last more than a week. Severe consequences include high altitude pulmonary edema and high altitude cerebral edema, which are both medical emergencies. Treatment of these two life threatening conditions is descent and supplemental oxygen. Diamox is an adjunct to these definitive therapies.

Diamox has been shown to be beneficial for the treatment of milder symptoms of acute mountain sickness when given at a dose of 250 mg every eight hours. It can also be effective as prevention for acute mountain sickness. The usual recommended dose is 250 mg twice a day beginning 24 hours before ascent and continuing for the first two to three days at altitude. Possible side effects of therapy include frequent urination, tingling, visual disturbance, nausea, fatigue, and rash. It should not be taken during pregnancy or by those with sulfa drug allergy.

Non-drug measures for the prevention of acute mountain sickness include gradual ascent, sleeping at altitudes lower than those of activity, and avoidance of strenuous activity until acclimatized. Increased fluid intake and high carbohydrate diet beginning 24 hours before ascent and continuing for the duration of the stay at altitude can help. Also be sure to avoid alcohol.

Jeffrey M Hubbard, MD.

Clovis, CA

OVER WORKING THE CLYDESDALE

I seem to be right at the edge of semi-harmful pain and about once or twice a year cross over into harmful pain. The frustrating part is that I have been running about 300 miles a year for three years and it seems as if there is some sort of upper limit that I cannot break through. I currently run Monday, Tuesday, Wednesday, and Saturday, mixing up easy runs with hillwork and speedwork My long run is on Saturday with up to five miles. Total weekly mileage is about 11 to 12 miles. I also do some strength training three to five times a week and always include stretching in my workouts.

I'm a Clydesdale at 195 to 200 pounds, 45 years old and have been running steadily now for over five years. I run three I OKs a year for T-shirts and fun. Can you help me with my training schedule so that I can avoid injury and maybe even improve in volume and quality of training?

Steven Crowley

Holland, MI

There are several suggestions and concerns I have regarding your present training program. Why do you run on three consecutive days? Have you tried running and resting on an every other day schedule? Try adding more variety to your workouts. For instance, a hard day could be followed by rest followed by a day of medium intensity.

Incorporate torso and lower body strengthening exercises into your resistance-training program. I prefer dumbbell and multi-joint body weight exercises to weight machines. Multi-joint exercises require the body's musculoskeletal system to work in a synergistic rather than segmental fashion, much like running does. Two to three times a week is plenty to keep overall general fitness and to increase running efficiency and economy. Less time in the weight room could give you more time for other cross training activities such as swimming or cycling.

Other concerns deal with your weekly mileage totals and intensity of training. Seven to 12 miles a week is probably not enough for someone who runs 10K races, even if only three times a year. Additionally, I would question whether or not you include enough higher intensity runs in your current training. Gradually increase the intensity or mileage if you don't want to be wiped out by your races.

Finally, what you call "harmful pain" concerns me. You should see a qualified sports medicine professional in your area who is familiar with runners' injuries to make sure you are not suffering from a chronic injury that resurfaces each time you push with miles or intensity. I hope these suggestions are helpful for improving your training.

Douglas B. Lent, C.S.C.S.

Chambersburg, PA

Editor's Note: An excellent source for information on training schedules and how to develop your own, is Daniels 'Running Formula, by Jack Daniels, Ph.D., 1998, Human Kinetics Publishing, 287 pp., $16.95. It is available at a discount to American Running Association members calling 1-800-776-2732 or online at www.americanrunning.org.

RUN MORE MARATHONS?

I am 67 years old and recently finished the Cowtown Marathon in five hours even. This was my second marathon--I ran the same one last year and finished it in almost the same time. It seemed like an awful lot of training for a once-a-year run. What I have been thinking about is to run four marathons a year with approximately three months between each one. This makes more sense to me as I can stay in good shape between the marathons and it won't be such a strain as doing it only once a year.

Does this seem like a reasonable strategy for a man of my age? Would it be best to do a long run every other weekend or every third weekend between the marathons? What distance would you recommend for the long runs?

Wes Collins

Fort Worth, TX

Your strategy for running more than one marathon per year is reasonable. Two or three marathons would be better than four, which might allow for better recovery, tapering, and training between events.

Doing a long rum every other weekend would make you stronger. However, monitor your recovery. It may take you two weeks to recover from a long run. Vary your long runs according to their position in your taper or build-up. Your standard long run should be in the neighborhood of 18 to 20 miles, but that can increase somewhat in your long run three to four weeks before the marathon. Long runs on recovery weekends could be between 10 and 13 miles. These runs could be shorter if necessary.

Lee Fidler, Ed.S.

Stone Mountain, GA

Running two marathons in one year is enough for most runners, while some might be able to get through three with reasonable results. At 67, why risk injury, staleness, or overtraining? How about setting different goals for yourself, like knocking some time off your marathons?

Bob Glover

Sleepy Hollow, NY

ARE YOU BOTHERED BY AN INJURY? DO YOU HAVE A TRAINING OR DIET QUESTION?

Ask The Clinic, in care of The American Running Association, 4405 East West Highway, suite 405, Bethesda, MD 20814, FAX [phone], or e-mail at [e-mail]. Write a letter including as much relevant information as possible about you (age, weight, etc.) and your injury (type and location of pain), training schedule (typical weekly workouts, pace, surface), athletic and medical history, sole wear recent changes in training, etc. Type or print your letters. Hand-written FAXed letters cannot be accepted All letters even e-mail must include your name, address and phone number. Responses usually take three to four weeks, but can take as long as five.