An ounce of prevention......

I once heard it said that we all pay one of two prices in life. One is the price of discipline. The other is the price of regret. If the first is measured in dollars, the latter is measured in tens of thousands of dollars. As a physician, I see the reality of this played out daily in the patient traffic that comes through my practice. It is sad to say, but the overwhelming majority of patients appear to be paying the price of regret, and so don’t even know it.

It is difficult to sit across from a patient who has been neglecting, or actively abusing, their health and body for most of their adult life, listen to the litany of complaints about their health and/or appearance, and not say, “well, what did you expect?”. Doing this is not only too easy, but borders on cruelty. I don’t think people consciously set out in life to purposely screw up their health. With obvious exceptions most kids start life healthy and active. Like the apocryphal frog in the pan, events in life transpire slowly enough that they don’t see what is happening until one day they look in the mirror and see someone who, as the title of the popular documentary states, is “fat, sick, and nearly dead”.

These are the people who are in the last grouping of the three kinds of people in the world: those who make things happen, those who watch happens, and those who wonder “what the heck happened?”. The challenge isn’t pointing this out; that’s the easy part. The challenge is getting them to own up to the fact, face their situation realistically, and make the switch to the first group, those who take charge of their lives and make the necessary changes to restore their health and bodies. Some are simply so immersed in our present culture of victimhood and emotionally/psychologically crippled that what they really need is a "life coach" to guide them through the process of becoming independent, self-actualizing human beings. It is a daunting challenge that modern medicine seems ill equipped to meet. Who pays for the life coaches? Even though we would probably save money in the long run, such preventative steps are usually not covered by any insurance. We (physicians and others in the medical arena) are so conditioned to treat disease that we are only now beginning to truly appreciate the critical importance of prevention.

Discipline is not easy nor, truth be told, much fun at times. It means denying oneself at times when it is very tempting to indulge. It means getting up in the dark to go out for a run, swim, or to the gym; eating mindfully rather than just stuffing our mouths with whatever is offered or whatever tastes good; refraining from taking that extra helping at the end of a meal; and doing a myriad of things each day that benefit our health, versus doing the opposite. The price of doing this, in my personal and professional experience, is pennies compared to the cost of the regret that I see all the time from those who chose differently. On a personal level, it is the difference between a life well lived and one of constant physical deterioration and a revolving door relationship with the medical establishment. On an aggregate, national level, it may just be the difference between solvency and prosperity for our country and eventual economic collapse under the burden of medical health care costs. The choice is ours.

Florida Ironman Training Log:

Best week yet in terms of doing all three disciplines. The bike ride allowed me to see how the adjustments and aero bars feel- they feel good. A little right knee soreness but nothing substantial. Next week I begin my assessments at the National Training Center with a swimming stroke analysis. Maybe I’ll finally be able to show those pollywogs in the pool a thing or two…… Now I need to begin increasing my workouts to 4-5/wk instead of the 3-4 that I have been doing. 

Week’s Training Summary:

Swimming- Wed. Jan 23: 2575 yds, 2.32min/100 yds,  1:05:03 total time

Bike- Sat. Jan. 26:  55.26 mi @ ave. 15.8 mph, 3:30:00 total time

                                 6.11 mi @ ave. 12.3 mph (first ride with Sal on her new bike), 0:29:42

Run- Thu. Jan. 24: 5.42 mi @ ave 9:05min/mi, total time 49.13

Superman exists only in comic books

As I looked out the window of our hotel, overlooking Main Highway in Coconut Grove, FL, wave after wave of bicyclists rode by, singly and in groups of as many as 20 or more. It was a moving parade of kaleidoscopic jerseys over black spandex, rolling by on bikes some of which were probably worth up to five figures. We can largely thank Lance Armstrong for the current popularity of cycling in the U.S.  

I wanted to believe Lance was clean. So long as he continued to vehemently deny doping, and all of his testing was clean, it was possible to hold to the pleasant fiction that perhaps, just perhaps, he was the real deal: the cancer victim who returned from near death to win 7 Tours de France and establish one of the most powerful and successful organizations to fight cancer in the world. We love our heroes, especially those who overcome overwhelming odds.

Still, there was always that small nagging cynical thought that just wouldn’t go away, like a gnat that keeps buzzing around your head and just won’t leave you alone. How, in a sport so rife with doping, against a field of the best cyclists in the world, could someone be so dominant, year after year, without doping themselves? It just didn’t seem possible. Alas, it wasn’t. Superman, after all is said and done, is still just a comic book hero.

Am I disappointed? Yes. Do I hate Lance? No. None of us can truly know the internal and external pressures on someone like Lance to excel and achieve. As someone once said, thousands of years ago, “let him who is without sin cast the first stone”. Lance, after all, is human and, therefore, flawed. No one can deny his drive, desire, and passion that let him to the podium seven times in the Tour. Perhaps it was that overarching fire to win, to succeed at any cost, that led him to cheat. Perhaps the pressure of cheating by his peers, and the knowledge that without doing this himself he could never be competitive, led to his decision. Ultimately, in a sport in which cheating was built into its very fabric, he was not only the best cyclist, he was the best cheater as well. What mitigates this is that, to a degree unique among elite athletes, Lance used his success to help others. No other athlete has ever had the positive influence on so many people as Lance through his Livestrong foundation. Maybe it was his stab at absolution for the rest of his life.

Many will say his “confession” on Oprah was an expedient move, borne of desperation and as coldly calculated as any of his Tour wins. For my part, I think he had to do this at some time. To live the lie that he did for so long must surely have been as corrosive as acid to his spirit. At some time he would have confessed, or he would have died, spiritually if not physically.

While I have never had cancer, as a physician I treat cancer and hold Livestrong in high regard for its advocacy on behalf of cancer victims, survivors, and their family. It is a force to be reckoned with in the ongoing battle against this scourge and, doubtless, if and when cancer is finally defeated, Livestrong will have played a major role. On a more personal note, Lance got me back on the bike. I cycled all through college but abandoned the bike in favor of motorized transportation from medical school on. Only after watching one of Lance’s victories in the Tour was I inspired to get back to riding and I have continued to benefit from this marvelous activity ever since. It has helped me stay fit when running began to take a toll on my legs. It has re-connected me with old friends and brought me a new group of friends who also love to cycle. It has given me the opportunity to raise over over $20,000 in the past 4 years for the Multiple Sclerosis Society of Central Florida through their annual Citrus Tour cycling event. For all these, I owe Lance a debt of gratitude.

Lance’s story and cycling prowess fueled his success as the founder and major fundraiser for Livestrong. Neither could have done this alone. Inspiring cancer survivor stories are, unfortunately, a dime a dozen. Successful athletes exist in every sport. Only the unique combination Lance brought to the table could have allowed him to accomplish what he did. As his personal house of cards has collapsed and he has lost all that was clearly dear to him, I hope we all realize, “there but for the grace of God could go I” and avoid judging too harshly. In addition, let us pray that Livestrong will outlive Lance. For now, the Livestrong bracelet stays on my wrist.

Florida Ironman Training Log-

This week I traveled to Miami to lay my Dad to rest next to my Mom. It is weird to think that, now, I am the “patriarch” of the family. I’m not sure I am ready for that role but, in life, we often have roles thrust upon us before we are truly prepared. I hope that I live a life of example to my kids, and to my grandkids and others around me. This week I decided to make an appointment with the National Triathlon Center in Clermont, FL, just down the rode about 30 min from my house. It doesn’t make sense not to use this great resource. I decided against Carmichale Training Systems because, in the final analysis, I don’t believe there is any doubt the Chris Carmichael could have worked with Lance so closely through 7 Tours and not known of the doping. Since that built his reputation, I don’t want to support that.

The swims felt great. The run made my R ant tib muscle sore and L hamstrings sore.

Training Summary-

Swim- Mon. Jan 14, 2050 yds in 1:02:18, 3.03 min/100 yds, 13 strokes/length

            Tue. Jan 16, 2000 yds in 47:04, 2.21 min/100 yds, 14 strokes/length

Run-    Fri. Jan 18, 6.01 mi in 53.11 min, 8:49 min/mi pace, TE 3.9*

            Fri. Jan 18, 1.97 mi in 17:31 min, 8:53 min/mi pace, TE 2.8**

                        * Training Effect- goes from 1-5 with 5= “overtraining”

                        **ran this one after 20 min rest from first run

Age, it isn't only in the mind

I hear people say all the time, “age is only in the mind”. I’ve said it myself. To some extent I even believe it. But, that is not strictly true. Age isn’t only in the mind; it is also a matter of biology and physiology. Our bodies age. Anyone who has ever taken even a cursory look at an infant and a senior citizen side by side can tell you that with absolute certainty. An interesting, and sobering, if not downright scary, exercise is to lay a series of photographs of yourself side by side from you infancy until now and see how you have changed over those years.

The wear and tear of use, of environmental factors, and of our own genetics cause gradual weakening and breakdown of our tissues. We may peak in different aspects of our lives at different ages, but always fairly early on, with gradual decline with age. Gymnasts may peak in their teens in the sport while some endurance athletes or those in strength sports may not peak until their 30’s. All, however, decline with age.

Our minds do not age in the same way. The expression “youth is in the mind” takes note of this. We all know people who seem to be more youthful than their ages or physical appearance would suggest. It is that they see themselves as more youthful and this carries over to everything from their outlook to their choice of activities. The problem comes when the mind/body disconnection becomes too great.

I played soccer throughout school, including 2 years of high level college soccer, with nary an injury before my studies became too rigorous to continue this. The next time I tried to play organized soccer was in my 40’s. By then, it was immediately evident that I no longer had the endurance to run a soccer field for two 45 minute halves. I could have worked back up to that but there were other issues. My knees hurt when I made sharp cuts and turns and they became swollen. An MRI showed a small meniscal tear, probably from wear and tear rather than an acute injury. I realized that my days of playing organized, competitive soccer were over. Even though my mind still loved the game and wanted to play, my body wasn’t cooperating.

I still feel more like I am in my late teens or twenties, than 60. I believe that I have taken reasonable care of myself and that my physical condition is pretty good for a 60 year old, but 60 is 60. I will never be as fast, as strong, or have the endurance that I would have had in my teens, twenties, or thirties. What I do have is more insight, less competitiveness, and, hopefully, a great deal more wisdom.

The first gives me more awareness of my motivations and desires; the second makes me want to set certain goals for their own sake, not because I want to beat others doing the same thing, and the third tells me such things as not to push too hard or ignore certain aches or pains, to make allowances for my age, whether my mind wants to or not. Dr. Millard, my mentor and professor in plastic surgery said in one of his books on principles of plastic surgery not to leave all of one’s best effort in the gym or out on the road. I think about this often when exercising before work, knowing that I need to save some energy for my patients that day.

The war on getting older is not a full out assault but more of a delaying action to slow down the inevitable. The goal is not to try to live forever but to try to live each day to the fullest and to do what we can to avoid unnecessary problems.

Florida Ironman training log:

This week I finally got into more of a routine but still have a ways to go to feel like I am truly working a plan. Still have to decide on coaching but having trouble working out the pros and cons. I tend to like doing things on my own, but for this particular effort, there are a lot of reasons to have expert help.

Training summary:

Swim- Monday, Jan. 7- 1225 yards in 28:24

            Thursday, Jan. 10- 1475 yards in 34:20

Bike-   Saturday, Jan. 12- 31.39 miles in 1:59:34 (average 15.8 mph)

Run-    Wednesday, Jan 9- 3.52 mi in 30:57 or 8:47/mi pace

            Friday, Jan 11- 5.43 mi in 48:23 or  8:55/mi pace                                                                                                                                          

ADHD and Me

I have had Attention Deficit Hyperactivity Disorder (ADHD) all of my life but only discovered this fact when I was 45. When I was a boy, children didn’t get labeled as ADHD or Attention Deficit Disorder (ADD). They were simply hyperactive or a discipline problem. I was both. In third grade, my teacher sent me home with a note to my parents that I was going to grow up and become a menace to society. She has no idea how close she came!

Discovering ADHD explained so many things about my life that it was, in the truest sense of the word, an epiphany. It was as though a light had been turned in my life illuminating things that had long frustrated and mystified me. It explained my constant state of activity, even to the toe tapping that I do when trying to sit still and the tics that have always been a part of me; the fact that I can pretty much burn energy just sitting down; my distractedness that for years drove my poor wife to distraction herself; and my occasional laser-like focus which, at time, made me oblivious to the world around me when reading, or during surgery. All this, and much more. I was finding out who I truly was.

Many individuals with ADHD who successfully navigate the early academic years to make it to medical school become surgeons. The specialty is ideal for those, like me, who do best with tasks that are both cerebral and physical. It is more than just liking to work with one’s hands; it is a total absorption in any task that interests one. Give me something that truly occupies my attention and you can set off fireworks around me and I won’t notice.

Having ADHD means that I am easily distracted. A humorous but true ADHDism is “They say I have ADHD but I think they are full of…..oh, look at the kitty!”. It is absolutely true. I am also very disorganized. I start things multiple things but rarely finish any one thing (right now I am simultaneously writing two articles; it took me 10 years to finish writing my book). I procrastinate. Yes, I know everyone procrastinates at times but I am an elite level procrastinator. I have elevated this to an art form. I could go on and on.

In the context of trying to train for something as complex and demanding as an ironman triathlon while simultaneously engaged in a busy clinical practice and trying to fulfill the myriad other obligations that are simply a part of life, ADHD becomes, not a gorilla, but King Kong. Planning, organizing, and budgeting my time, while absolutely critical to this task, are also the things I do worst. This will probably be, after medical school and my surgical residencies, the hardest thing I have ever done. More on ADHD at some later time.

Florida Ironman Training Log

296 days to go to the Ironman. That sounds like a pretty reasonable time frame to train. It is 42 weeks, which doesn’t sound like so long, which means that I have to make each of the next 42 weeks count toward getting me ready. The good news is that the right knee seems fine. I did another run this week and no problems whatsoever. I have no idea what in the world causes that pain. The other good news is that I am getting back into the swing of a regular workout schedule. The bad news is that the ADHD is kicking in big time with disorganization and procrastination in putting together a plan. I just haven’t put together a training schedule in any real sense and this will have to be done.

Training summary:

Swimming- none, back in the pool next week, though

Running-

            1/5- 3.5 mile run. Felt sluggish but still average 8:34/mi. Right knee felt fine

Bike-

            1/1- 8.66 mile fun ride with family at 13.5 mph average

Next week, the training begins in earnest. ………..

Brrrrringing in the New Year

It was in the 30’s this weekend. For our northern friends, this probably qualifies as balmy weather but for a Florida boy it feels like the beginning of the next ice age. The past few days were gray and even some rain fell. It was depressing weather and made the thought of getting outside to do anything very unappealing. How often do outside circumstances dictate our actions and even our attitudes?

This is the time of year for reflection, re-commitment, and resolutions. Resolutions can be fairly accurately described as promises to ourselves that we do not intend to keep. Rather than shoot for the moon and make resolutions that are (choose one or more) 1. unrealistic (“I’m going to win the lottery!”) 2. a source of constant frustration (“I AM going to herd this bunch of cats”)  3. too far in the future to be real (“I’m going to win the Olympic gold medal in fill in the blank in 2016”), how about something a little more down to earth?

I recently watched the movie, Bicycle Dreams, which chronicles the 2005 Race Across America (RAAM). The RAAM is an annual ultracycling event in which participants race from the West Coast to the East. While the race has grown to include various categories, such as team, tandem, relay, etc. the race belongs to the winner of the solo category. To give some perspective on the grueling nature of the RAAM, which has been called the most difficult sporting event in the world, consider the Tour de France. This averages around 2000 miles over 2 weeks with 2 rest days. Riders are in teams with the principal riders on any team surrounded by team mates to protect and draft them. Riders sleep each night in comfortable beds and teams have professional chefs to prepare their meals. Solo riders in the RAAM ride 3000 miles in as little as 8-9 days. The top riders average over 300 miles per day and ride up to 22 hours in a day. There are no overnight stops for those who wish to be competitive. Sleep is optional. Pain and suffering are a given.

You're thinking: down to earth? Are you crazy? No, I am not trying to imply that everyone should resolve to do something like the RAAM in 2013. Far from it. Something like this would strike most people as an ordeal bordering on insanity. For a few, however, that are wired in a peculiar way, it is oddly compelling. There is an innate urge to push oneself to the absolute limit that appeals to certain people. I am one of those. Few of us will every actually do this. No, what I took from the movie was this. In an interview with one of the participants, he recalled his days rowing on a crew on the Charles River in Boston. In the early morning chill, he and his crew team mates weren’t thinking of how each pull of the oars brought them closer or farther from their goal of winning the next meet; they were thinking of a warm, comfortable room and a hot breakfast. Their coach pulled alongside and said, “you are either getting better or you are getting worse; you are definitely not staying the same. It is up to you”. This became the operative theme for his life. For 2013, I plan to make it mine. You might consider making it yours.

At the beginning of each day I intend to ask myself what I can do that day to improve myself in some way. At the end of the day, I hope to be able to honestly say that I have improved in some tangible way. The good thing about this resolution is that it is 1. possible 2. does not rely on anyone else, 3. immediate on a day to day basis. Even better, it allows for occasional failure. There is always the next day to get back on track. Happy New Year!

Florida Ironman 2103 training log:

Between a virus, the cold weather, and the holiday activities, not much got done this week. That’s OK; that’s what holidays are for. The most workout I got was chasing after granddaughter, Emerson, who celebrated her 2^nd birthday yesterday. Today, January 1, 2013, however, marks the first day of my 2013 run up to the Ironman in November. I have to make decisions about how I will train, commit to a program, and do what I can to insure that every day moves me forward. As I noted above, every day I want to look back and feel that I did something to improve. I hope this will apply not only to my ironman training, but to my life in general.

Training summary:

Swim- none

Bike- none

Run- Wednesday: 3.4 mi run with Olivia at slow pace*

         Thursday: 3.4 mi run with David at slow pace*

* the right knee is sore and this is puzzling and troubling. It feels exactly as did when I had severe chondromalacia of the right patella (softening and inflammation of the cartilage behind the knee cap). This is due to poor tracking of the knee cap while running, causing it to rub excessively on the end of the femur (thigh bone). The underlying causes are weak quadriceps muscles, which stabilize the patella and running excessively. I am icing down the knee and taking some ibuprofen. Hopefully, I will quiet this down and it will pass. Odd that it would pop up now, after being dormant for nearly 30 years.