Most race recaps you hear are the highlight reel — the PRs, the podiums, the "everything clicked" days. This one isn't that.

In this episode, I walk through a 50-mile mountain ultra in Ithaca's gorge country that I'd trained hard for — the best shape I've been in in a decade — and the day it came apart anyway. I DNF'd at mile 35 with 7,200 feet of climbing already in my legs, then spent the night back at the hotel watching the clock, worried I was sliding into rhabdomyolysis.

I pull up my heart rate and elevation data and talk through exactly where it went sideways, why the descents (not the climbs) wrecked me, how I made the call to stop, and the dehydration and rhabdo scare that followed. As a PT, I also break down what rhabdo actually is and the warning signs every endurance athlete should know. If you've ever wondered whether quitting can be the disciplined choice, this one's for you.

Dr. Kate Ackerman, co-founder and president of the WHSP Institute (Women's Health, Sports & Performance) and head doctor for US Rowing, joins the show to walk through one of the most important and least understood topics in women's endurance sport: Relative Energy Deficiency in Sport, or RED-S.

When Dr. Ackerman made the US national rowing team during her first year of medical school over 25 years ago, she opened her sports medicine textbook and noticed something strange — women were a chapter. A single chapter. Every protocol she was training under had been studied in men. That gap shaped her entire career, from founding work in the female athlete space to helping the International Olympic Committee design the RED-S clinical assessment tool used today.

In this episode, Steve Gonser sits down with Dr. Ackerman to unpack how the field has evolved — from the original 1990s Female Athlete Triad to the broader, system-wide picture we have now. They walk through the science of what's actually happening when energy availability drops: the body's caveman-era survival logic, the reproductive system going first, and the cascade through thyroid, cardiovascular, GI, cognitive function, recovery, and ultimately performance. Performance is the framing Dr. Ackerman has found resonates with athletes who don't yet care about osteoporosis or missed cycles.

The conversation then walks the full female athlete lifespan. Adolescents going through peak height velocity before peak bone mineralization, and why that window is so vulnerable. The social media feeds quietly reinforcing thigh-gap culture for teen girls while the rest of us scroll past entirely different content. Postpartum runners trying to chase a pre-baby body while breastfeeding pulls calcium directly from bone. The bone density arc — 90% of peak bone mass built by age 18 — and what that means for everyone after. Why runners' linear, single-plane loading doesn't build bone as well as multi-directional movement does, and why even elite male cyclists end up with osteoporotic bones. And finally, perimenopause and menopause: the symptom cornucopia, the GLP-1 question, the supplement noise, and the lifestyle levers that actually move the needle.

Throughout, Dr. Ackerman makes a clear point: women have real questions, the answers are starting to come, but the space has filled with people on Instagram calling themselves experts. Knowing where to look — and which clinicians, dieticians, and resources are actually credentialed — is half the battle.

If you're training through your 40s, raising a young athlete, navigating perimenopause, or trying to make sense of why your body is responding differently than it used to… this episode is the framework you've been looking for.

Connect with WHSP Institute:⁠

https://www.whspmedical.com/institute⁠⁠

https://instagram.com/whsp_institute⁠

Connect with Dr. Ackerman:

https://www.instagram.com/drkateackerman/

Connect with RunSmart:⁠

https://instagram.com/runsmartofficial⁠⁠

https://runsmartonline.com⁠

Saucony pro runner and NYU medical student Felicia Pasadyn returns to Early Miles for the conversation no one wanted to record. Months after signing her first pro contract, Felicia ran a 32:04 PR to win The TEN in late March… and days later was diagnosed with a calcaneal stress fracture. Boston was off the calendar.

In this episode, Steve Gonser sits down with Felicia to walk through the full timeline. The delayed symptom onset. The diagnostic journey from a clean X-ray through to the MRI at NYU that finally caught it. The unusual location of the injury and what likely tipped a manageable training load over the edge. Felicia also shares what happened when she fed her entire training log into ChatGPT and got back the word "psychotic"… and what that prompted her to reconsider about living almost exclusively in zones three through five, skipping rest days, and running high-risk, high-reward when the next five years of residency are about to make that style impossible anyway.

The conversation also digs into territory most running podcasts skip. As a soon-to-be diagnostic radiologist talking to a PT with fifteen years of running clinical experience, Felicia and Steve land on opposite sides of an honest debate about imaging, conservative care, and when an MRI actually changes management. They cover RED-S and hypothalamic amenorrhea, why a full hormonal workup mattered even when she suspected the injury was purely mechanical, and how the conversation around energy availability has finally started to normalize in elite endurance sport.

Felicia then talks through her return-to-run plan with her ortho, the cross-training base that gives her more options than the average injured runner, and the mental traps Steve has seen athletes fall into at every level — the bargaining, the phantom pains, the slow creep of "just ten more minutes." She's heading into a Cleveland Clinic radiology residency in Florida with two weeks of vacation per year for the next five years, and she's clear-eyed that this chapter of her running will look different. Slower, healthier, more patient. And, by her own framing, worth it.

If you've ever come back from a stress fracture, wrestled with whether to push for imaging, or felt the tension between training hard now and training sustainably for the long haul… this one will land.

Catch Felicia's first appearance on Early Miles here:

https://runsmartapp.com/felicia-ep1

Connect with Felicia:https://instagram.com/feliciapasadyn

https://instagram.com/wellfeliciafit

Connect with RunSmart:https://instagram.com/runsmartofficial

https://runsmartonline.com