24 Hours Aren't Enough

What is it that the wealthiest person on the planet, and the poorest, have in equal measure? That cannot be added to, changed, reversed, or modified in any way? It is time. We all have the same 24 hours in a day in which to do whatever we choose to do, want to do, or need to do. Time moves in one direction- forward. The past is gone, never to be reclaimed. The present and future are all we have and the latter is not guaranteed to anyone.

24 hours. 1440 minutes. Into that non-negotiable time frame I have to fit in time to sleep, eat, attend to various necessary bodily functions, commute, work, spend time with family and friends, and train.  

This brings up a number of issues. The past obviously influences where we are in the present and where will go in the future. This past is never neutral. Like everyone, I have made good and bad choices; seized some opportunities and wasted others; and been both helped and hindered by my own heredity and upbringing in myriad ways. I can use my past as a foundation on which to build my future or let it be the quicksand in which I am forever mired, keeping me from realizing whatever potential I may have. The choice is mine either way. It is perhaps one of the few real expressions of free will that I have- that any of us have.

The past two weeks have been an overwhelming mélange of activities, obligations, and assorted time consuming stuff such that on any given day it was a sheer impossibility to complete all the tasks for that day in the allotted 24 hours. Of course, any carryover from one day just added to the equally overwhelming demands of the next. I have resigned myself to the fact that for the foreseeable future, I will never reach the end of a day with everything on my to do list crossed off. Setting priorities will be critical. One that was not high on the list the past 2 weeks was this blog. So, for what it’s worth, here are some year end “random thoughts”.

Life is good. Despite all the things wrong with our world and the seemingly unending litany of terrible news in the media, there is much about life to love. I feel particularly blessed with a family that I love (and that, despite all my faults, appears to love me), fulfilling work that I still enjoy, good health, and more worldly goods than anyone has a need for, or right to. I know there are many who cannot make such claims. My heart goes out to the family of a friend who apparently felt otherwise a few weeks ago. While I can imagine that level of despair, I cannot understand it. As long as there is life, there is hope. What is especially wonderful about the Christmas season is that where hope in this life ends, another hope begins, one that is all encompassing, overarching, and limitless. If there is any message of Christmas, this has to be it. This blog is not intended to be a Christian rant but everyone has a world view that infuses every aspect of their life, drives every decision, and colors their perspective. This is mine. I’ll try to rein it in and keep it low key. Having said that, Merry Christmas to anyone who happens to read this. May this be a season of calm, peace, and, above all, hope.

Ironman training log:

Readers will notice a dearth of entries on my progress here. Suffice it to say that any progress has been mental and not physical. My motivation remains high but between the hectic office schedule, preparations for the upcoming holiday, bad weather, and a nagging cold (my third this year; what’s with that?), I have not swum (swam?), biked, or run in nearly 2 weeks. Good thing that true loss of fitness takes 3 weeks or more of inactivity. To be honest, and not making excuses, I have not felt any pressure to do too much  until after the first of the year. Still haven't gotten back to Cameron at Carmichael Training Systems about enlisting the services of a triathlon coach versus using someone locally to help me train. That has to be done soon. While I am very self motivated, I know that I will be pushed a little more if I have someone to be accountable to. This is one of my mantras for people who want to make a real change in their lives. My goals, according to priority as fairly straightforward and, I hope, simple: make it to the starting line feeling prepared, not get hurt, complete the triathlon, set a time goal. Oh, and a big goal- have fun with the process.

This week’s summary:

Zip, zero, nada…………..I am trying to enjoy the enforced inactivity and using it to motivate me for the new year.  

A thorn in the flesh

Chronic cryptogenic small fiber peripheral sensory neuropathy. It is quite a mouthful and most people have never heard of it. I have a special interest in it. You see, I have it. There is nothing like having a condition to stimulate an intense personal interest in it. The problem first began when I was training for my third Disney Marathon in 2005. After some long runs I began having pain along the outside of my left knee and, soon thereafter, started to have numbness in my left foot. For a while, I ignored it as only an otherwise supposedly intelligent person, and a doctor to boot, could do. Eventually, though, I had to do something.

I wore a band above my knee for the iliotibial band syndrome causing the knee pain. I got orthotics for my running shoes and some physical therapy for a presumed obturator syndrome. I kept running, though. After Disney, I ran the Boston Marathon 4 months later. By now, both feet were experiencing numbness. Wising up at last, I finally stopped running, saw a physical medicine specialist who ordered nerve function studies (essentially normal) and embarked on a lengthy program of stretching, physical therapy, ice, and laser treatment. Nothing really helped.

Fast forward nearly 7 years. I live every day with an uncomfortable sensation of numbness, tingling, pain, and burning in both feet. The left is still worst. It is such a part of my life that I immediately notice those few periods of a few hours here and there when my feet feel normal. Once or twice, the symptoms vanished for up to 2 days and I had a brief moment of elation thinking, “this is it, I’ve gone into remission!”. No such luck, though.

Two years ago, I saw a neurologist at the University of Miami who specializes in this problem. After a number of tests, all normal, he told me that I had the problem named at the top of this post. The “cryptogenic” refers to the fact that the cause is unknown. It occurs most often in people around 60 and older- another of the wonderful aspects of getting older. He said that if I were 2 inches shorter, I would have no symptoms, as these are related to the length of the nerves.

The good news is that it will probably not get worse. Even if it does, it will be very gradual and I will likely be dead of something else before I have any serious problems. Another piece of good news is that I probably did not get it from running, all those problems of 2005 notwithstanding, and can continue to run, even if it is uncomfortable at times. The bad news is that I will likely have it for the rest of my life. He did not recommend treatment as the drugs used have side effects worse than the condition itself. I can smear capsaicin (the stuff in peppers that makes them hot) cream on my feet. The burn from that will overwhelm the burning in my feet and eventually make those particular nerve fibers inactive.

At first, I thought, “I take care of myself, don’t have any bad health habits, and there is no one with this in my family. Why me”? Then it occurred to me that a better question might be “why not me”? After all, millions of people have terrible health problems that I do not have. What makes me special? I do know that it has made me more spiritual. After all, if the Apostle Paul had a “thorn in the flesh”, why shouldn’t I? Having a constant reminder of my age and the limitations of my body has made me more appreciative of my otherwise excellent health and thankful that I can do most anything physical that I wish to do. I now regard this neuropathy as background static in my life, something I am aware of, annoying but able to be ignored if I keep my mind busy and focus on other things. In some real ways, it is a blessing, although not necessarily one I would have asked for.

Ironman training log:

I have taken a small step back due to a number of factors. My plate is full, the holidays are rushing like a freight train, and there is much to do at work and at home. I am working on the mental aspect of organizing and preparing myself for the year to come, something I find more difficult to do than any physical training. Just bought some aero bars for the road bike- I have decided not to use a tri bike due to the expense and the fact that I do not plan to do the type of riding for which this bike is designed very often. Am getting the bike refitted for these bars. Meanwhile, I am talking to Carmichael Training Systems for possible coaching assistance. More on that later.

This week’s summary:

Swim- none

Bike- 30.43 miles at average of 15 mph. Training effect 3.0

Run- None

Midi-Chlorians anyone?

One has to be careful drawing deep theological or philosophical inferences from pop culture but sometimes they can be useful for purposes of illustration. Last week I alluded to the human body as a Lamborghini sports car. I can defend that analogy but to those who would take from this that I subscribe to a mechanistic view of life- that we are nothing more than very sophisticated biological machines- I would like to say emphatically that this is not the case.

The long running popular movie serial, Star Wars, repeatedly references “the force”, a nebulous, all encompassing field of energy that envelopes the universe and imbues all living things with life and vitality. Tapping into this force can actually give certain individuals nearly superhuman capabilities. In the first installment of the second series of three movies, The Phantom Menace, we are introduced to midi-chlorians, microscopic life forms that reside symbiotically in living cells and mediate “the force” within humans. The concentration of these midi-chlorians is directly tied to the strength of the force and its expression in the life of the individual.

Is there a real life version of midi-chlorians? Not really. The closest we come is the concept of endosymbiosis. The simple explanation of this concept is that it theorizes that many of the structures in our cells were once independent organisms that, over time, became assimilated by primitive cells and formed the various parts of the modern cell. An example is the mitochondria, which basically serve as the power source for the living cell, and have some characteristics that suggest they once were independent primitive organisms. The verdict on this theory is out and it is not widely accepted among scientists.

Even if there aren’t midi-chlorians, what is this life force that gives us vitality and the ability to think, reason, love, question, i.e. to be who we are? Let’s start at the smallest unit of life as we know it, the cell. Our bodies are made up of billions of them, each with its own life and vitality. They die by the millions every day as we go about our daily routine but they don’t change who we are. Cells aggregate to form tissues- skin, muscle, bone, nerve, etc. Related tissues join to form organs and organ systems. We can lose major portions of these through accidents or disease without changing the essence of who we are, or diminishing our vitality.  A great example of this is Max Cleland, a multiple amputee (both legs, one arm) from the Vietnam War whose inspirational postwar career includes terms as a U.S. Senator, Secretary of the State of Georgia, Administrator for Veteran’s Affairs, and, currently, Secretary of the American Battle Monuments Commission. 

 

Where does this life force, this essence of our identity, come into play? Alas, modern science has no idea. Despite splitting the atom, traveling through space, and solving many of nature’s mysteries, we are no closer to answering this question now than the thinkers and philosophers of ancient times. Within each of us resides a “breath of life”. When it is gone, our body becomes an empty physical shell. We can choose to believe it comes from the nature of matter and physical processes, i.e. we are just biological machines, or through divine gifting. I choose the latter. How we choose will determine nothing less than how we live our lives.

Training log: This week, after 4 back to back days of running last week, I decided to cut back a little. My neuropathy in my feet (more on that later) has been a little more bothersome and, although I don’t think running caused it, it does seem to aggravate it at times. I did do my first “brick”, a bike/run, although a light one. Right now, I am still working on putting together a training plan which I hope to have in place by early next year. I think the hardest part is going to be getting organized as this is not my nature.

Training summary:

Swimming- none

Running- Saturday, 3.5 miles at 8:41 min/mi pace (this after riding my bike, see below)

Bike- Saturday, 18.2 miles at 14.8 mph average

Three quarters of an ounce

One minute he was there, the next he was gone. Nothing had visibly changed but the body laying before me was no longer my father. The Bible says that at some point in time, God breathed into man the breath of life. In the eons of time that have followed that singular event, we have not been able to truly grasp what that really means. Is sentient life simply the interesting byproduct of chemical processes and the physical nature of matter or something else, something ethereal, intangible, inhabiting the body but distinct from it? This question has occupied thoughtful men for centuries. Modern science and medicine have been unable to provide an answer.

In 1907 Dr. Duncan MacDougall, of Haverhill, Massachussets did an interesting experiment in which he placed terminal patients on a bed set on a very precisely calibrated scale. When the first patient expired, he noted that the body suddenly became lighter by ¾’s of an ounce. He postulated that this was the weight of the human soul. Unfortunately, other investigators and he himself in later experiments failed to corroborate these results.

Be that as it may, something changes when you die and that body you once occupied becomes an empty shell. Very odd. Despite the unavoidable deterioration over time the human body, when occupied by a living being, is a remarkable piece of biological machinery. While an elephant may be stronger, a cheetah faster, and a monkey more agile, no other animal combines the total package of physical capabilities of human beings. Our combination of speed, agility, dexterity, and endurance are unique in a single species.

Who wouldn’t love to own a high performance, limited edition sports car like a Lamborghini? What we often don’t realize is that we are that sports car. Talk about high performance- our bodies make even the most exotic sports car seem pathetically simple and mundane. Try taking any sports car engine and revving it repeatedly, week after week, month after month, and year after year.  It will undoubtedly require extensive, and frequent, maintenance by experts, and, despite that, it will probably break down and/or wear out in a few short years. Try  mistreating it; filling it with contaminated gas, putting in dirty oil, etc. and it will break down in short order. The human body requires only a very modest amount of care and maintenance, which anybody can do. If physically stressed it actually becomes stronger. Although the aging process cannot be forever postponed, it can be pushed back further and further by physical activity. Don’t take my word on this. There are studies galore that support this position.

I cannot understand someone who owns a Lamborghini and does not, now and again, want to just take it somewhere, such as a track or empty stretch of highway, and open it up. What a waste not to. I feel the same way about my body. The analogies abound. We have to fuel both with high quality fuel. The engine/muscles must be properly tuned. Good quality tires/shoes are a must. The difference is that every mile driven wears the Lamborghini down whereas, up to a point, pushing the human body makes it stronger, faster, more flexible, or any combination of these. Who wouldn't want to see what their body can do?

In swimming, running, or cycling, with practice it is possible to turn inward and monitor all the systems involved in propelling you forward, making adjustments as necessary. Breathing, heart rate, perceived effort, muscle fatigue, and more can be adjusted on the fly to either conserve energy or push the pace. It is a fascinating exercise just once to do something and observe, truly observe, your body in action. Watching other athletes can be inspirational. Observe an elite sprinter at top speed and you have the sense that they are practically flying. Their feet barely touch the ground and the forward motion seems effortless. They appear to be but moments away from reaching taking off speed and simply leaving the ground behind. It is beautiful. The same with a bicycle peloton. It is truly an organic marvel as riders spin up to 30+ mph for hours at a time. Watching it from the air, you feel as though you are seeing a King Kong-size unicellular organism undulating across the countryside. Watch an Olympic swimmer moving through the water and you cannot help but feel that they are being pulled by an invisible ski boat to go that fast.

I suggest that to experience sheer joy, get your body tuned up and take it out for a spin now and again. You may never wish for a Lamborghini again!

This week's training summary, Thanksgiving notwithstanding: 

Running- 

        Monday: 5.45 mi @ 8:46 min/mi pace

       Tuesday-Wednesday: rest

       Thursday: 8.18 mi @ 9:26 min/mi pace

       Friday:  4.17 mi @ 10:54 min/mi pace

       Saturday:  4.25 @ 10:53 min/mi pace 

       Sunday:  6.85 @ 10:13 min/mi pace

Total for the week: 28.9 miles

Priorities matter

Imagine, if you will, the following order of priorities. You put a dollar in the coffee machine. Out comes the sugar, then the cream, followed by the coffee, and then, last of all, the cup! Priorities matter. Sometimes I chafe under the restriction of priorities in my life. At times, when I would rather go for a bike ride, swim, or for a run, I have to do other things. Some of them are work related. A physician's time is rarely his own and discretionary time is a priceless and rare commodity. Other priorities are family related.

This morning, I had the awesome privilege of seeing my 93 year old father draw his final breath. He was a man of moderate habits and never quite understood my attraction to endurance events. A competitive swimmer in college, he swam all of his adult life but it was a leisurely pursuit and not one that taxed or stretched his abilities. Despite this, several years ago he won 3 gold medals in the state Senior Olympics held in The Villages, FL.He was the only one competing in his age group. His strategy was that if he couldn't out swim the competition, he could outlive it! He was married to my Mom for 52 years and after she passed away in 2002, he lived independently into his 90's. After a period of deteriorating health and 3 falls in his apartment resulting in 3 serious fractures, he decided the time had come to move to assisted living.

Two weeks ago, with his active participation and blessing, we jointly decided the time had come to allow nature to take its natural course in his life. We discontinued all of his medications except those needed for comfort. He called this final chapter of his life "our project". Two days ago, he slipped into a coma. This morning, his breathing changed. My two sisters and I gathered at his bedside and after a brief prayer we began sharing stories of our family and its many "characters" with much laughter. In the middle of this, Dad briefly opened his eyes, closed them slowly, and, six breaths later, he was gone. It was the calm, dignified, and peaceful death we had hoped and prayed for him. It was perfection.

I didn't run, bike, or swim today. There was too much important family stuff to do and I was OK with this. After all, priorities matter. Seeing my father off was a privilege I would not have missed for anything. We did not have that opportunity with Mom and so this was his final gift to us.

This week's training summary:
Swim- 2525 yards in 59:14
Run- Thursday: 5.46 mi at 8:28/mi average pace
         Saturday: 4 mi at 8 min/mi averaga pace (Fall Four Miler in Mt. Dora). Took 2/6 place for age.
Bike- None this week.

The Moment of Truth

Did you know there is an 11^th commandment? No, it wasn’t inscribed on the stone tablets and it is largely ignored but is very real none-the-less. It is, stated in the style of the King James Bible, “thou shalt not kid thyself”. We kid ourselves in so many areas of our lives that it would probably be easier to list where we do not. We know we aren’t going to live forever but we behave as though we will never die. We practice lifestyles whose consequences are basically a foregone conclusion yet kid ourselves that we will somehow dodge those consequences. We spend, individually and as a nation, as though the supply of money is endless and kid ourselves that the accumulated a debt not one day crush us. As I said, it is, by all appearances rarely heeded.

This post is actually not about this commandment but rather about “the moment of truth”. The relevance of the former should be evident shortly. Sometimes, when initiating a discussion on a topic, just for the heck of it, I will type the topic onto Google search and see what turns up. In this case, I entered “the moment of truth”. To my mind this expression, as used in the popular lexicon, describes a momentous point in time wherein some decision must be made which will determine the course of future events. At the risk of digressing from the topic of this blog, I was surprised to learn that this is the title of the report by President Obama’s bi-partisan national commission on the national deficit and debt, delineating the problem and offering solutions. Ironically, the president refused to accept his own commission’s findings and recommendations. There is a “Moment of Truth Project”, which grew out of this commission as a non-profit, non-partisan organization dedicated to furthering dialogue aimed at implementing the commission’s goal of responsible deficit and debt reduction. I know I am tiptoeing through a political minefield in discussing this but regardless of one’s political persuasion, it is a mathematical fact that one cannot continue to spend more money than one takes in. This is the definition of going broke. To ignore this is to break the 11^th commandment on a monumental scale.

Closer to home, ‘the moment of truth’ actually comes up daily, in fact, multiple times daily in most of our lives, whether we realize it or not. We face innumerable decisions in the course of each day, some large, some small, and the choice we make will in some measure determine the course of our life from that point on. I face a moment of truth every morning when I step into a shower stall, which is getting ever colder as winter sets in, and have to turn the cold water on full. Despite all the benefits that I feel have accrued due to taking cold showers, it is still a moment that gives me pause and the temptation to say “the hell with it” and switch over to “hot” is ever present. So it is with contemplating leaving the comfort of my desk and computer chair to go for a run, heading to the YMCA at 6 AM for an hour of swimming laps, or resisting the urge to indulge in a sweet desert that I really don’t need.

For me to claim that I intend to do an ironman triathlon in 12 months and then not put in the effort and the hours necessary to prepare for this is breaking the 11^th commandment big time. And, so it goes, with any goal that we may have for which we are not willing to make the right decision when the “moment of truth” arrives, in its myriad forms. Don’t be surprised if that goal remains elusive.

This week was not a particularly good one for training. I do have a day job, after all, and it was a bit demanding of my time this week. In addition, family matters, including a father who is now in hospice and who deserves some of my time in whatever time he has left, further eroded my discretionary time. I used it for some contemplation and reflection, and to begin planning my strategy for training. There will be weeks like this along the way. It remains to be seen what I will do when the opportunity to train presents.

This weeks progress toward FI 2013- it was the first truly cold week of the year:

Swim- none

Run- none

Bike- 44 miles at 14.9 mph average.

OK, now it's real

The first hurdle has been overcome. Actually, this was the second hurdle; the first was actually deciding to do this crazy thing. As of this afternoon, I am officially registered for the 2013 Florida Ironman Triathlon to be held in Panama City, FL on Saturday, November 2, 2013. After all of the worry and anxiety about actually getting this done -  the 2012 triathlon sold out in 16 minutes – it was surprisingly easy and went without any glitches. Even the laptop computer cooperated without any frozen screens, failure to connect to the internet, or any of the myriad things computers are wont to do when you really need them to perform. Registration opened at 1 PM and I was logged on at 1:01 PM. 10 minutes and $800 later, I was officially a registered participant. Panama City here I come!

Now, it gets real. As of today, I have exactly 364 days to plan and prepare for what will be the most challenging physical thing I have ever done. I watched the live stream coverage online of this year’s event yesterday. The most inspiring and encouraging thing that I saw was the 88 year old man who finished the course in 16 hours and 50+ minutes, barely within the allotted 17 hours for official finishers. The final participant crossed the line with less than a minute to spare. OK, if an 88 year old man can do this and another middle-aged guy can hang in there for nearly 17 hours, I certainly can. The fact that an 88 year old finished does not take away anything from the magnitude of the challenge; it just makes me look on in awe at an 88 year old that is capable of this. What is discouraging is to realize how few people in their 80’s, 70’s, or even 60’s (my decade now) are remotely capable of physical effort even approaching a fraction of that required to finish an Ironman triathlon. We have become a nation of “couch potatoes”, and obese ones at that.  

Mark my words. You heard it here first. If we do not realize a major change in our country’s trajectory away from personal indulgence and dysfunctional eating, and toward personal responsibility and serious changes in lifestyle, I predict that we are soon going to experience a collapse in our economy under the weight (no pun intended) of the obese and their related medical problems, which will overwhelm our medical system and “break the bank”, Obamacare or no Obamacare. We simply cannot provide Cadillac level medical care to our citizens if the demand becomes too great. We speak of the fiscal cliff looming in 2013 when a variety of tax laws and financial manipulations will possibly send our economy in a downward spiral toward a new recession like a plummeting out of control airplane "augering in" as Chuck Yeager was fond of saying. What I feel is equally, if not more, possible is the looming “physical” cliff over which our inactivity is going to throw us. Think rationing of medical care; think panels of citizens empowered to determine who gets dialysis, who gets cancer care, who gets a transplant or heart bypass; think no care for those who, according to actuarial tables, are predicted to pass away in 6 months or less; think of an entire nation full of elderly people incapable of doing the least bit of physical activity without the assistance of an army of nursing assistants. I see the latter as a huge growth industry for the future. Even when we live longer, that largely means is we are living with more chronic diseases and so we are also living worse. It is going to get ugly.

So, this little project of mine is, I hope, more than just some individual’s self-centered attempt to prove something to himself by engaging in conspicuous consumption on an athletic playing field. I hope it will serve as an impetus for a few readers to get up off the couch and do something to change the trajectory of their lives, as a source of encouragement, of information, of advice, of, well, whatever one chooses to make of it.

Hopefully, anyone reading this will still be around in 364 days. What will your next 12 months bring?

This weeks training summary:

Swimming- Monday: 2625 yards in 1:01:27

Running- Wednesday: 3.7 miles at 8:30/mi average

                 Friday: 5.44 miles at 10:14/mi average (with my brother-in-law at easy pace

Biking- None (bike in shop for adjustments and minor repairs)

Next week: Goals

Between a rock and a hard face

I am wealthy man. Yes, as a physician, I am financially comfortable, however, I mean much more than that. I am wealthy in creature comforts, in relationships, in experiences, in life in general. While I try not to take this for granted, I know that at times I do. When your life is one of plenty, it is easy to assume that it should be thus, and will always be thus.

While some corner of my mind is aware that life carries no guarantees, I still make plans for the future as though this is assured. I am embarking on a project with a timeline of over 12 months. The culmination of this is a goal toward which these next 12 months will be dedicated, a goal to achieve a personal dream. Much can happen in that time. Luke 12: 13-21 tells the parable of the rich fool, who plans and plans for his future only to be informed by God that his life will end that very night.

This was brought home to me in a rather dramatic fashion this week. I set my alarm on Thursday morning for 05:45 in order to get in a good run before work. This gives me time to run 45 minutes to an hour, shower, have breakfast, and get to work on time. It was still dark and with no moon, black "as midnight in a coal mine". I ran my usual route around Silver Lake having done it so many times in the dark that I can almost do it with my eyes closed. About 2 miles into my 5 ½ mile loop I saw approaching headlights. Despite wearing a bright yellow top, I did not have on my reflective vest so I decided it best to step off the road onto the grassy shoulder. I should have stopped running but did not and, in an instant, found myself airborne, sailing headfirst in the air, having tripped over a bowling ball-sized coral rock. There was apparently a row of these lining the yard of this particular home on the lake. I had undoubtedly seen these on past runs but never imprinted them in my memory since they never seemed noteworthy. In the darkness, I couldn't see a thing as I flew through the air and, almost instantaneously my face smashed into the next rock in line. The whole incident probably took less than 2 seconds. 

In a near miraculous turn, my hands hit the ground just before my face made contact with the rock so that I was able to use my arms to decelerate and cushion the blow a bit. Even so, I hit it face first, pretty hard. I was momentarily stunned then felt the warm, burning sting that indicated I had not escaped unscathed. As it was too dark too see anything, I took a mental and tactile inventory: no broken or loose teeth, no pain in the jaw to indicate a fracture or dislocation, no vision problems, glasses intact, nothing warm or wet dripping off of the face. My upper lip felt swollen. I resumed running planning to abort the rest of the run and head straight home to take better stock of the damage but after a few steps, I felt pretty good and decided to finish the full run. It seemed I got off pretty light. 

On reaching home, the mirror confirmed what I already suspected, I had a number of scrapes and cuts on my face and a pretty good gash inside the lip. All things considered, not too bad. When I think of what might have been, I have to say a silent prayer of thanks- no broken neck, broken jaw, or broken face; no major gashes; no eye injury; no permanent disability or disfigurement.

It was as though I was being reminded that I should not take any day in the next 12 months for granted. Whatever happens, and whether or not I make it to the start of the 2013 Florida Ironman, I resolve to be thankful just for the opportunity each day presents and for being able, at 60, to run at all.

This week's training summary- It was a blustery week with high winds and some rain from Hurricane Sandy
Swam- 2825 yards in 1:16:48 I felt faster and more efficient in the water.
Ran- 5.48 miles at 8:38min/mi average
Bike- Approx. 15 miles ( no computer or Garmin to provide data) Perceived effort- moderate

Next Saturday, November 3 is the 2012 Florida Ironman. Registration for 2013 opens early the following morning. I will have to be on the computer and ready to go. The 2012 triathlon filled in 16 minutes!

Stuckness

Over 30 years ago I read Robert Persig’s Zen and the Art of Motorcycle Maintenance, a ‘non-fiction novel’ about a cross country motorcycle ride of a father with his young son. I cannot recall much about the book except for one concept, which has stayed with me ever since, the concept of “stuckness”. Persig can describe this better than I can.

"...stuckness, a mental stuckness that accompanies the physical stuckness of whatever it is that you are working on. A screw sticks, for example, on the side cover assembly (of a motorcycle). You check the owner's manual to see if there might be any special cause for this screw to come off so hard, but all it says is 'Remove side cover plate' in that wonderful, terse technical style that never tells you what you want to know. There's no earlier procedure left undone that might cause the cover screws to stick.

If you're experienced you'd probably apply a penetrating liquid and an impact driver at this point. If you're inexperienced and you attach a self-locking plier wrench to the shank of your screw driver and really twist it hard, a procedure you've had success with in the past, but which this time succeeds only in tearing the slot of the screw.

Your mind was already was already thinking ahead to what you would do when the cover plate was off, and so it takes a little time to realize that this irritating minor annoyance of a torn screw slot isn't just irritating and minor. You're stuck. Stopped. Terminated. It's absolutely stopped you from fixing the motorcycle."

In the example above, even though you are already thinking ahead to what you want to accomplish, the little, minor thing- a stuck screw- is now a major thing, preventing you from doing what you want to do, what you know you need to do. I believe we all get “stuck” at times in life. Some people live in a perpetual state of “stuckness”, knowing what they need to do, even wanting to do it, but unable because of some small thing that assumes major significance.

For me, “stuckness” is mental and is induced by a combination of three things, my three “D’s” if you will: distractedness, disorganization, and lack of discipline. Each of these alone I could probably manage but the combination is downright near impossible to overcome. This is where the cold showers and the road to the ironman come in. The former serve to focus me and the latter will require organization and discipline in equal measure. I only hope and pray that I can carry this over to other areas of my life.

Stuckness can be anything in your life that prevents you from reaching your potential, or even just being someday better than you are now. Getting unstuck doesn’t necessarily require cold showers or doing an ironman. It does require taking a first step toward your dream or goal. That step leads to the next, which leads to the next, and so on. At least that’s the way I believe it works.

This week’s training summary (I was traveling and caught a cold, so I didn’t push it- there will be plenty of time for that):

Swam- none

Biked- 34 mi @ average 16.8 mph

Ran- 5.57 mi @ 9:40/mi pace

60, It's only a number

On Wednesday, October 10, I achieved a milestone, having now lived 6 decades and embarked on my 7^th. On one hand, it was a day like any other. I really can’t be given too much credit for having been born. Truth be told, if given a choice I probably would have hung around in the womb for a little while longer. After all, although I have no memories of the place, from what I have learned, it was probably very safe and comfortable in there, and not much was expected of me. As to reaching 60, I just kept inhaling and exhaling, and putting one foot in front of the other. Even so, society seems to think it is a big deal, given the congratulations from family and friends, even some from those of the latter group that I haven’t heard from in years.

On the other hand, I do have to admit that as a milestone, this one seems slightly surreal, especially since I don’t feel anywhere near mature enough to be this old.

Having reached this exalted state, several things apply. For one, I cannot claim the designation of “middle-aged” anymore. I am far past the middle of my life. To be there, I would have to live to be 120 years old, an unlikely (and probably undesirable) proposition. For another, I guess I am supposed to have attained some degree of wisdom and perspective on life in general, and my life in particular. Not too sure about the former, but I think I have a bit more of a handle on perspective.

Perspective is an interesting thing. Webster’s aside, I think perspective means having a realistic assessment of life, based on one’s experiences and world view. For one thing, I will never be a giant in my field as my plastic surgery mentor and residency director, Dr. Millard, was. All I can hope to do is to represent my training and my professor to the best of my ability in my little sphere in Lake County, FL. It is doubtful I will ever be a major celebrity, history making researcher, politician, or athlete. Rather than find this disappointing, I am totally OK with my relative anonymity. It has been my observation that most, if not all, people who attain uniquely lofty achievements pay for these in some other area of their lives. This is perfectly described by the chorus in Sophocles’ play Antigone which declares, “Nothing vast enters the life of mortals without a curse”. I think Sophocles nailed it.

I could have spent MY “special” day in many ways. I could have done some grueling endurance event, jumped from an airplane for the first time, visited some heretofor unknown exotic land, or done any of a number of landmark things. Instead I spent that day as one of several babysitting my granddaughter, Emerson, with my wife, while my daughter and son-in-law headed off to a 3 day conference. It was perfection.

(I had to add this part after completing this blog earlier- Sal suggested we plan a nice, belated birthday dinner on  when our daughter, Lindsey, and David had returned from their conference. In the late afternoon, David left to meet someone for a talk. Later, he texted that he was back with some groceries in the car, so Lindsey sent me out to help bring them in. I hit the garage door button and as I approached the rising door, I noted 3 pairs of legs coming into view outside. As the door opened, I was looking at my son, Travis; girlfriend, Heather; and daughter, Olivia, who had flown up to be here for my birthday. This was Sally’s surprise gift to me. To say I was in shock would be a gross understatement. I began laughing uncontrollably. Did I say that Wednesday was perfection? No, this was perfection and the surprise of my life. Having all my family with me for the celebration, now THAT was perfection!)

I truly believe that 60 is only a number. I can't say how old I feel but it certainly isn’t 60. If 60 feels like this it certainly isn't what I envisioned. 40, perhaps, or maybe even 30. In my own mind, I am still a somewhat insecure 17 year old with a broad range of interests and a fascination about life and this world in which we find ourselves. Like I said earlier, surreal. 

Meanwhile, the slow march toward FI-2013 proceeds inexorably. Without planning, discipline, and proper training I know that it is unlikely I will see this to a successful conclusion. Besides, I want this to be fun. Being uncomfortable is one thing. Agony and possible injury are another altogether. The next month will be spent strategizing and planning, while trying to build a base from which to jump off when the training begins in earnest. Of course, I still have to get registered on November 3.

This week’s summary of my road to FI2013- 385 days to go:

Swam- 2350 yards

Ran- 21.57 miles

Bike- None this week as I was out of town. 

Comfort is overrated

What makes an ironman so daunting to contemplate? Yes it is a long way to swim, bike,and ride, all in one day. I think what it is though, is the knowledge that to complete an ironman, you will have to get used to the idea of being uncomfortable. The images of participants along the course projected during televised ironmen competitions are those of pain, even agony. Even those who seem to cruise to the finish have had to deal with discomfort along the way. Contrast this with the elation and jubilation of finishers as they cross the finish line. I submit that the source of this pinnacle of emotion, which many describe as life-changing, is the realization that all the discomfort that preceded it was worth it, and then some.

It all started, as these things often do, with a simple comment. My son-in-law, David, told me that he had heard many triathletes take cold showers regularly. There are several reasons to do something so “uncomfortable”. It toughens them to the rigors of training; it instills a mindset that makes being uncomfortable seem not so, well, uncomfortable; and it serves as a reminder of what they are ultimately striving for. I decided to give it a try.

That first morning, July 1, 2012, I woke up in my comfortable bed in my comfortable climate controlled room in my comfortable home. I felt COMFORTABLE. Stepping naked into a cold shower stall I had to contemplate for a moment what I was about to do. I steeled myself and turned the shower on full cold. The water spray couldn’t have felt colder if it came from a glacial waterfall. I sucked in my breath and my body went rigid for a moment. I wanted to hoot and holler but didn’t want to wake up my wife. Let’s say I didn’t dawdle in taking that shower. That was 97 days ago and I haven’t taken a hot shower since. In that time, my life has undergone a dramatic change, truly a paradigm shift that has been, no kidding, physical, mental, and spiritual.

We take our comfort for granted never pausing to think that perhaps we are an aberration. Comfort is not the default mode of human beings. The vast majority of people in this world will never know the level of comfort that is our norm. Even the poorest Americans live a life of comfort beyond the imaginings of someone in, say, Somalia, Sudan, India, or any of dozens of countries. Many people in the world will never know a comfortable day in their entire lives. I’m not trying to make anyone feel guilty here; this is just a fact of life. There is nothing wrong with feeling comfortable. I think where we go astray is in seeking out comfort at all costs and ignoring the important role that feeling uncomfortable can play in our lives.

If our primary goal is to be comfortable, we will never seek a challenge, we will never push ourselves in any area of our lives if this creates even temporary discomfort, we will not deny ourselves that second helping of food we really enjoy, we will look away from things that might be disturbing in the world around us. In short, life will revolve around avoiding any discomfort, whether it is physical, mental, emotional, or spiritual.

It was the cold showers that made me think, “I can do this”. “I can train for, and do a full ironman”, something I have contemplated and dreamed of for years, ever since I first heard of this crazy event. They helped me deal with the fear of being uncomfortable. I have come to conclude that being comfortable is highly overrated. For the foreseeable future, the cold showers stay.

This week’s summary of my road to FI-2013 with 392 days to go:

Swam- 4100 yards

Ran- 5.48 miles @ 8:40 avg/mile pace

Bike- 1 hr 37 min (no data as my Garmin 910XT shut off several times during the ride. Technology!)

Florida Ironman 2013 Here I Come

This morning I swam 60 laps in the 25 yard pool at the Golden Triangle YMCA. That’s 1500 yards for you non-math whizzes. It marks my first “official” day of training leading up to the Florida Ironman triathlon which will take place on Saturday, November 2, 2013. Why so early when the 2012 Ironman hasn’t even taken place yet? It is because I have ADHD (Attention Deficit Hyperactivity Disorder for those who don’t know the acronym) and if I don’t start planning now, I will find myself sometime in September or October of next year realizing that I got distracted and forgot to do something essential, like sign up for the event. This way, I can start planning and training to include registering for the event on the weekend of the 2012 race.

This year I have been floundering personally with no set goals toward which to direct any training. I tend to be goal oriented and without one, I wander aimlessly. A full ironman has been on the “bucket list” for a number of years. Completing a half ironman in 2011 just got me thinking that maybe, just maybe, I could do this. The thought is both frightening and exhilarating at the same time. Isn’t that how it is any time one steps out of one’s comfort zone to pursue a daunting challenge?

Why should anyone care? Well, perhaps because we all have goals, some of which seem like pipe dreams that will remain forever that, dreams. Using a tripod as an example of stability, I am building my foundation for this effort on three things: having a goal, determination to see it through, and accountability. That’s where this blog comes in. I hope to post my progress weekly so that there will be some accountability in that, whether it is real or not, I will imagine myself to be under scrutiny. I am trying to keep from breaking the 11^th commandment. You know the one. It says, “Thou shalt not kid thyself”.

My plan, and this blog, will undoubtedly evolve as the weeks and months pass. I have no idea where I will be November 2, 2012. Perhaps standing on a beach with thousands of other crazy people about to charge into the water. We make our plans, but truly God holds the future. It should be interesting.

Won’t you join me? If you have a goal that you have wanted to achieve but never quite found the incentive that would get you up and moving toward it, perhaps we can travel this road together, me toward my goals, you toward yours. It doesn’t have to be a triathlon. Because that floats my boat doesn’t mean it has to float yours.

And to think it all began with a cold shower. More on that later. Until next week’s post…... 

Reflections on cosmetic surgery

“The high profile, high profit stuff makes it possible to do reconstructive surgery on needier patients.” Thus spoke actor Michael J. Fox as Dr. Benjamin Stone, a budding plastic surgeon, in the 1991 movie Doc Hollywood. When I began to consider pursuing the specialty of plastic surgery, after already completing a full residency in general surgery, I could not help but wonder if I was going to be wasting a great deal of my general surgery training. Although my knowledge of the specialty was embarrassingly limited, I knew enough to know that cosmetic surgery was a big part of it. The idea of spending a career doing "nips and tucks" on people who simply weren't happy with their looks, in a world filled with trauma, cancer, and congenital defects, was distinctly unappealing. I put this question, in a round about way, to Dr. Millard (I didn't want to ask directly lest it bias his decision to accept me into his training program). His answer was, "Rick, unless you can take a normal physical feature and make it better than normal, you will never be as good as you can be in taking a deformity and making it look normal". This made sense. Fast forward about 20 years. I still do cosmetic and reconstructive plastic surgery but the former pays the bills. Reimbursement for reconstruction is so low that if I did just that, I would have to totally retailor my practice, fire a number of employees, sell the office, and essentially start over with a very little overhead. Don't get me wrong, there is much to like about cosmetic work but here's the thing; it is the only area in medicine where we perform surgery which is not medically necessary. Because of what has happened in medicine over the years, now everybody and his brother wants to be a plastic surgeon. Patients tend to be healthy, surgery is elective, you can charge what you feel you are worth, and patients pay cash, in advance. What's not to like? As a result, it is the wild wild west out there when it comes to finding a plastic surgeon. Even family practitioners and other non-surgical specialists are getting in on it. As if that weren't bad enough, American ingenuity, innovativeness, and entrepeneurship, plus a sprinkling of greed, have led to a prolifieration of devices, procedures, operations, lasers, and more, some useful, some worthless, designed to make us look younger. I can't even begin to keep up with all the "new and better" stuff out there that I can add to my practice.

So, where is all this blather leading? Just this. Although it may seem a strange, indeed counterproductive, thing for a plastic surgeon to say, I truly believe that if people can make peace with their own natural features and the aging process, without resorting to plastic surgery, they are MUCH better off. Don't misunderstand. I am here to help those who can't but my role is not to sell anyone on a particular product or procedure. I also never want to find myself feeding someone's insecurities about their real or imagined issues. I know of plastic surgeons who, when you go to them, even if for a single concern, will give you a "laundry list" of the things you "need" to have done. I can't do that. Don't applaud. I'm as tempted as the next guy to cash in on someone's interest in cosmetic surgery but, as the guy in the Hebrew National commercial said, "I answer to a higher authority". One of the problems with much cosmetic surgery is that people are trying to get plastic surgeons to fix the consequences of a lifetime of bad decisions. Decisions like baking their skin in the sun, eating poorly, not getting enough rest, smoking, never exercising, drinking too much, and on and on. The ways in which we abuse and/or neglect our bodies are too discouragingly numerous to mention.

So, when you go to a plastic surgeon and ask him or her, "What do I need, doctor?", realize that the answer is, "nothing". You don't need cosmetic surgery. It is something you do for yourself because there is some physical feature or issue that you don't like and wish to fix. As long as the concern is legitimate, your expectations are realistic, you understand the risks and limitations of the procedure, and you are financially able to pay for it, I, and my plastic surgery colleagues are here to help. But, and this is an important but, we cannot undo the effects of a lifetime of neglect and abuse, nor can we stop the march of time altogether. We are, after all, surgeons, not magicians. 

Adventures in Running

 Running is undeniably the oldest and purest sport. Our earliest ancestors ran, although more likely for survival than fun. It requires no special equipment and with all due respect to manufacturers of running shoes, running apparel, and other running accessories, one can run just fine naked even though this hasn’t caught on to date except in a few naturist camps. You can do it anywhere. Marathons have been run in war zones, in deserts, and there is even an annual marathon in Antarctica. I have run on the rolling deck of a U.S. Navy ship in the middle of the Pacific Ocean.

Running is not regarded as a contact sport. True, contact with other runners is not a typical aspect of running, but there are other forms of contact. On one early morning run, I was jogging in our neighborhood. I was on the right shoulder and could hear a car coming up behind me. I could tell by the sound that it was still a good distance away and decided to cross over the left side of the street. As I angled to my left, I stepped forward with my right foot and, as I went to lift my left foot for the next step, face planted into the road. It happened so fast that I did not even have a chance to put my arms out so that when I say “face planted” I mean exactly that. I was dimly aware of the car behind me rushing past uncomfortably close and I would estimate that it missed running over me by no more than a foot or two. The driver never stopped.

Getting up, I could feel the burn of a significant “road rash” on the right side of my face, right arm, and knee. The cause of the misstep was immediately evident; my left shoe lace had come untied and I had stepped on it with my right foot. If it had happened two steps sooner, I would have been under the car. I have triple tied my shoelaces every since.

Running in Florida presents some unusual hazards to the uninitiated. A few years ago, I lived in a neighborhood that, although near town, was decidedly rural in character. Most of the houses had large, multi-acre lots. There were untouched woods and wetlands scattered throughout the area and a large lake nearby. The streets were unlit. One morning, running in the early twilight, before the sun truly was up and with no moonlight, I noticed ahead of me a dark object across the road. Thinking it was a large branch, I deviated slightly so as to go around it. As I passed it, one end of the “branch”, the one near me, opened its mouth, revealing a white maw full of teeth. It was an alligator, perhaps 6-7 feet long. They tend to travel from place to place overland during the mating season, a fact that came to mind just a little late. This one was a least a quarter mile from water. Fortunately it was a cool morning and the reptile was apparently sluggish and did not press its advantage beyond what was evidently a warning display. For that matter, it may have just been yawning. Even so, the adrenaline burst that this display released flung me through the air to a point about 10 feet away almost without apparent effort. I found myself looking back at it wondering how many places can you run where there is a real threat that you might be devoured by giant, prehistoric lizards?

Running in the tropics is one thing. The cold is another matter entirely. I was training to run a ½ marathon with my soon-to-be niece, Dawn, who was running her first. I hoped to encourage her and keep her company over the distance. Her fiancée, Nephew Brandon, and my wife, Sally, were going to cheer us on. As part of my training program, I had to schedule some long runs. One of those happened to fall on the weekend when I would be in Atlanta for a conference in January, which can get pretty cold. I planned to do a 12 mile run while there. My conference schedule was such that this had to be in the morning so, in order to get to downtown Atlanta by 8 AM for the conference, I had to get up around 4 AM, be out of my sister’s house by 4:30 to run and be back by 6:30. I ran the outward leg in the dark, in near freezing temperatures. On the return, it began to drizzle, freezing rain just shy of being cold enough for snow. Within minutes I was soaked. I ran the entire way back in a near freezing downpour and when I arrived back at the house, hurried to take a hot shower. As I undressed, I noticed something unusual for the first time: no feeling below the belt. I checked and discovered that the anatomy was about the color of a boiled cocktail frank (major shrinkage). Let’s say that the “thaw” was uncomfortable and leave it at that. Fortunately, feeling returned and all seemed to be fine after the shower. If I had run a couple more miles this story might have had a very different ending!

This next adventure also came with a life lesson, along with great embarrassment. Some background is necessary. When I ran my first marathon, at Walt Disney World in Orlando, in 1995 I learned something interesting. Some might say it should have been obvious. The marathon start was in the early, pre-dawn hours and because of the thousands of runners, we had to arrive at the staging area at least an hour before the gun went off. When you put nearly 20,000 runners in one place, all of whom have spent the past 12 hours massively hydrating with fluids, the results are predictable. The ‘porta potties’ provided were overwhelmed and the lines outside them were reminiscent of the popular attractions in the Magic Kingdom on a busy day. As I walked to the staging area, the bushes lining the path were thick with runners relieving themselves. The part that amazed me was that it was fairly evenly divided between the sexes. Women were just walking behind a bush, dropping “trou” and whizzing too. There were clearly male and female clumps of bushes. When you had to go, you had to go. It was all very business-like and discretely done with as much privacy as circumstances allowed. During the early miles, it was commonplace to see runners peeling off from the road, into the bushes, for the same purpose. This dramatically exemplified the pragmatic attitude of the long distance runner regarding the natural need to empty one’s bladder.

Fast forwarding a few years, Sally and I were staying at her sister’s condo on Fort Lauderdale Beach. One morning we set out together, she to walk/run, me to run. I sped on ahead and about 15 minutes into the run realized that I had to pee. My options were to go back to the condo, find a restroom, or go “au natural”. The former was unappealing as I did not want to retrace my steps. The second was moot as I had passed no public facilities on the way out and could see nothing ahead in the distance, which was an unbroken string of high rises on the beach on one side of the street and a wall on the other. The third presented some challenges since there was no obvious out-of-the way area out of view of the road which seemed to present itself. Passing one high rise, I noted an area of thick landscaping that appeared to have a path back into it. Following this path, I found myself in a space against the base of the building and completely out of sight of the street. Quickly relieving myself, I turned to leave and WHAM! I was staggered back by an impact to my face that left me dazed. At first I thought someone had hit me with a 2 X 4. As my vision cleared, I saw the pipe and simultaneously felt a warm trickle running down my nose that could only be blood. I had walked into a horizontal pipe precisely at face level. I had absolutely no memory of having ducked under it going in, although I had to have done so, and totally forgot it was there coming out. I walked out from behind the foliage into the sun. My glasses were irreparably bent. I straightened them as well as I could, put them back on, and ran on, dripping blood, looking for a place to check myself out, hoping to avoid being seen. A few blocks down, I found a Dunkin’ Donuts and walked in, careful to hide my face as I headed for the bathroom. The damage looked worse than it was. My nose was cut, some skin was missing, but no fracture, and, thankfully, no eye injury. My neck was sore for weeks afterwards. So, what was the lesson here? Well, if you ask my wife, it was to not pee in public. I tried to draw a little loftier conclusion. It never occurred to me that this decision to stop and pee would nearly give me a concussion. I could have been knocked cold and/or injured myself more severely. It drove home that, in life, everything can change in an instant. Despite all of our preparation and anticipation, we can be blindsided by the unexpected: lose a loved one, be diagnosed with cancer, or find that all of our plans for the future have been wiped out by the irresponsible acts of others. And, yes, I did learn to be more careful where I chose to relieve myself.