Sunday, May 22, 2016

On Being Passionate and Humble

My good friend Rudy loves to tell the story of how we first met.  I was looking at the results of a sprint triathlon that we had just finished and I introduced myself as the guy who beat him!  This was vintage Mike Wasserman.  I was quite excited about my efforts that day and enthusiastically wanted to share my excitement.  The results were actually secondary.  A few years later, I was just as excited when Rudy passed me during the run of another sprint triathlon.  What has always mattered to me when I race triathlons is giving it my best effort.  Of this I am quite passionate.  

There are many people in the field of geriatrics who have known me for many years.  I have worn my passion on my sleeve in a similar fashion.  Having been blessed to have had success in a number of endeavors in my chosen profession, I am often excited to share my knowledge with others.  I recognize that at times this can turn people off as my passion can be overwhelming and come across as if I have too big of an ego.  This is actually something that I am working on.  It can be difficult, however, when my gut tells me that I have some answers as to the best way to care for frail older adults.  In both clinical situations and in business, I have always trusted my gut, and it has often served me well.  Figuring out how to effectively channel those instincts has become my holy grail.

Today was week 13 in my mission to complete a 20 mile run every week for 20 weeks.  It was easily my most difficult run and it was truly humbling.  The fact that I essentially completed 85% of an ironman over a weekend just two weeks ago, and did a solid 20 mile run in Central Park last weekend, culminating with a 10K, put me in a position today where my legs were tired and were pretty sore just 10 miles into my run.  However, there was no way I wasn’t completing my run today.  In my usual enthusiastic and optimistic approach, I actually went out a little faster than usual today for the first eight miles, which in retrospect may have been a bit ambitious.  Again, that’s me, and as I started slowing down, I had to remodulate my plans and adjust my effort.  I made one last attempt to pick up my effort with four miles to go, but my right calf started to spasm, and I realized that today was just about completing the twenty miles.  Still, running 20 miles at nearly 57 years of age under such circumstances at about a 9 minute per mile pace is something I am quite proud of.

I always say that Ironman often imitates life and today was no exception.  There have been many times in my career that my enthusiasm to share my thoughts and ideas about the most effective way to deliver care to older adults is too strong.  In these circumstances, as of late, I have been learning to slow down, just as I did today when I got ahead of myself during my 20 mile run.  There is a definite balance between allowing ones passion to show through and maintaining a level of humbleness that assures that we can get to the finish line.  The challenge, on the other hand, if figuring out when it’s time to push forward and when it’s time to back off.  While I am proud of the fact that I am nearly 2/3 of the way to my goal, I was quite humbled by my experience today.  

This week was the Annual Meeting of the American Geriatrics Society.  As is my annual experience, each day lasted about 15 hours.  I saw many old friends, heard lots of great talks and learned a lot about the state of geriatrics in today’s world.  There was a lot of angst over the upcoming new government rules for physicians.  My experience from the business side of healthcare over the last three decades is setting off lots of bells and whistles in my head and heart.  I kept my thoughts and opinions mostly to myself this past week, a departure from my usual passionate desire to tell everyone what I think.  Over the coming weeks, I think that I’ll formulate my thoughts in a constructive fashion so that anyone who is interested might have the opportunity to consider my suggestions.   

Saturday, May 21, 2016


On my way to completing a weekly 20 mile run over 20 consecutive weeks, I keep gaining new experiences.  Each of these are filed away in my brain to be used when I need them the most, during an ironman.  My most recent occurred during my 20 mile run in Central Park, NYC.  I had timed this run to coincide with my 34th wedding anniversary trip to NYC with my wife.  It came just 6 days after my last twenty miler, which was run just a day after a very solid 100 mile bike ride.  When I headed out to Central Park, I thought I felt good.  However, by the time I was coming around to finish the first loop in the Park (about 6 miles), I noticed that my quads were feeling sore.  This is highly unusual, and may have been due to a couple of factors.  First, I had literally done nearly 85% of an Ironman the weekend before.  Second, I had walked a ton the day before, which was highly unusual for me and puts an unnatural strain on my leg muscles.  Nevertheless, this was what it was.  I put the pain out of my head and just kept running.  I followed my usual protocol of starting with an easy effort and letting the effort get gradually harder.  This meant that my pace at the beginning was around 9 minutes per mile, and this pace did slow a little during miles six through twelve, when my left knee started getting a little sore.  I’m not used to the unrelenting ups and downs that Central Park surprisingly has.  I did stop once to stretch, which actually helped my quads and my knee.  My last loop was timed to coincide with a 10K being run in Central Park that day.  There were a lot of people running and I was in a pack of people the entire time.  I did have about 5-10 minutes in between my 12th mile and the 10K so I stretched some more and hoped that I wouldn’t tighten up from stopping.  As soon as I got rolling (took about a quarter of a mile due to the number of people), I just ran hard, and actually managed to maintain an 8:30 pace most of the way.  As usual, I just let the difficulty come to me, which it did, as did the quad and knee soreness that returned to my legs a few miles into the final 10K.  But the thought of completing my 20 mile run never entered my mind.  It just so happened that today’s run would be associated with quad and knee pain.  This fact wouldn’t even have a huge impact on the pace I was running at.  This has been the most mind blowing part of my weekly 20 milers.  My commitment to doing this has trumped any self doubt or questions about my ability to not only run twenty miles, but to run it at somewhere in the vicinity of a 9 minute per mile pace, every time I go out!

Sunday, May 8, 2016


11 weeks ago I begin my journey to do a 20 mile run weekly for 20 weeks. Today I completed number 11. What made today's run remarkable was that yesterday I did a 100 mile bike ride with about 6000 feet of climbing and I did it with an effort that was arguably as hard as any Ironman bike ride I've ever done. That set me up today for a 20 mile run on tired legs. Moreover, my bike fit is probably slightly off and I have been having some trouble with left knee pain when doing long rides on my triathlon bike. Fortunately, the left knee pain is superficial and I doubt that there's any structural problems with my knee. That said, I started today's run definitely tired with minimal soreness except for my left knee as well as a tight left hamstring. I decided not to look at my pace the entire run and to just run based on feel. I ran the first 6 miles at a very easy effort in relationship to my breathing (breathing every sixth step). The next 6 miles was done breathing comfortably (every fifth step). The next six miles were done at my MAF breathing (every fourth step).  I saved the last two miles for going as hard as I could, breathing every 3rd step.  My legs held up fine, although there was some burning in them the last few miles ("shut up legs" was definitely in order during these last four miles).  My pace the first 12 miles was 9:36, and the last 8 miles was 9:12, for an overall average pace of 9:26.  My last mile was my fastest, 8:59!

The best part of todays run was my mental state and attitude.  Despite the circumstances going into the run today, I knew I would do well.  It almost never crossed my mind that I wouldn't complete this workout.  In fact, during the three hours and nine minutes of my run, negative thoughts entered my consciousness for less than a total of one minute!  I knew that I could do this run.  This is a great place to be with 13 weeks to go before Ironman.  It's also a place I've never been before.  The idea of doing the twenty 20 mile runs has always been about reaching this point.  I thank Coach Lucho for the concept and for supporting me as I've gotten here.  What is somewhat "surprising" to me is that I've reached this mental state with plenty of time to spare. Perseverance has definitely paid off!

Saturday, March 12, 2016


About six weeks ago, my coach put an idea into my head.  One of my great challenges since I  began ironman racing has been my run.  Not that my ironman runs have not been adequate.  I’ve been pretty consistent in doing the marathons in under 5 hours, but the fastest I’ve been able to go is right around 4 1/2 hours.  I know that I’m still probably capable of running an open marathon in almost an hour faster than that, so I’ve had in my mind the idea that I would love to run an ironman marathon in under 4 hours.  Like anything in life, if you want something, you have to put in the necessary work to achieve your goal.  So, the idea that my coach put into my head was that of doing a 20 mile run every week for 20 weeks.  The moment he said it, I knew that was what I had to do.  It’s remarkable how sometimes you just know something to be true when you hear it, and this was one of those things.

For a little background, I had taken off September and October completely from all exercise in order to recover from some pretty ingrained adrenal fatigue.  By the end of December, I had increased my long run to about 11-12 miles, but somehow managed to “tweak” my ankle using an elliptical machine at a hotel fitness center, so I actually ran very little during January, but built up my bike riding pretty solidly.  With my coaches idea in my head, I went out five weeks ago and ran 16 miles comfortably, stopping immediately when I felt my IT bands tighten up.  The next weekend, I did 17 miles, again stopping when I felt good.  I also began to develop a recovery process, that I think has been very helpful.  As soon as I finish these runs, I get on the bike for 20-30 minutes, then soak my legs in a cold pool, then I compress my legs using my NormaTec machine for an hour and finally, if I’m able, I take a nap.  

What’s remarkable is the progression that I’ve made in the last three weeks, having now completed my first three twenty mile runs in three weeks.  I’ve only got 17 more to go!  What’s amazing is how my body and my mind have come together to make this happen.  Somehow, the fact that I’ve made the commitment to doing this is not only pushing me to do it, but to do it right.  I’ve made these first three 20 milers into progression runs, where the first 7 miles are done very comfortably, the next 7 miles are done with greater effort, but manageable, and then I go as hard as I can until I can’t, and back off as needed in order to get my 20 miles in.  The first two 20 milers had me backing off pretty quickly during the last phase, in order to complete my run.  Today, however, was another story.  

On thursday, I actually managed to ride my bike over 3 hours, with a solid last hour of intervals thrown in to work my legs.  I then did a short run afterwards, so I definitely built up some fatigue from the days work.  Yesterday, I just did an easy bike ride to keep the blood flowing.  When I woke up this morning, I was a little tired, but my mind was set.  I was going to run 20 miles!  The first 7 miles went by reasonably well, my mind wandering to a variety of thoughts, including calculating the fact that I may be able to just get my next 17 twenty milers in before my taper for Ironman Boulder.  With that said, my mind wasn’t focused.  My legs felt ok, although they were a little tired.  My breathing was easy, which corresponds to a breath every 5 steps, and my pace was just under 9 minute/mile pace.  The next seven miles was when the fun started.  I immediately upped my effort, breathing every fourth step, and my pace dropped to about 8:35/mile.  This effort corresponds to a high Zone 2 effort, and my legs were still fine, not surprisingly, my cadence increased from about 165 to 170 foot strikes/minute.

Something else happened during the second seven miles, my mind began to focus.  It became all about the run.  Nothing else could find itself into my brain, and time stopped in a way.  My legs were fine, they still felt a little tired, but they didn’t hurt.  As I neared the end of the 14th mile, I began planning for what was to happen next.  By this point in time, I already knew that I could easily relax and slow down a bit, take the pressure off, and get my 20 miles in without any concerns.  I also knew that I wanted to see what my body could do today.  Originally, I contemplated taking a mile easy in order to prepare for going harder, but I quickly overruled that thought and decided to “go for it!”  As soon as I finished the 14th mile, I picked up my effort yet again, increasing my breathing to every 3rd step.  This was my “tempo” effort.  It’s a hard effort, but not overly so, at least until it would just get harder.  My pace increased a little to about 8:33/mile, which showed that I had reached a point where in order to maintain my pace, my effort needed to increase.  My focus was like a laser, as the only thing that mattered was my form and my running.  As the completion of each mile approached, I would look at my watch, somewhat surprised to find my pace holding.  My breathing frequency was the same, but it was getting harder, and I even began to grunt, which has been my trademark approach to maintaining focus.  I kept contemplating the idea of slowing down and just getting the miles in, but as I neared the end of the 18th mile, I realized that I was just two miles from completing an almost perfect progression run.  That was enough incentive.

The last two miles were a bit of a daze, holding close to 8:30 pace, while my breathing alternated between every third step and every second step, which is closer to my 5K effort, but not quite there.  My legs still felt ok, and in fact, there was very little soreness.  There were times that I actually felt like my form was as solid as it has been in some time, and that was encouraging.  There were no intruding thoughts, no negativity.  I knew that I was going to complete one of my best runs ever today.  That thought certainly helped me through the last mile.  I got home with an average pace for the entire run of 8:42/mile.  I realized that the last six miles could easily be akin to the last six miles of a marathon, and was happy to know that I didn’t slow down and didn’t waver in my commitment.  

The idea behind the twenty miles for twenty weeks is that marathons are 26 miles long, regardless of time or place.  Getting my regular training runs to 20 miles with consistency brings me right up to the edge of where I need to be to feel both strong and confident for those last 6 miles.  The progression runs also create both a mindset and a legset, if you will, that prepares me for those last six miles, when I have invariably slowed down considerably.  

I will not be a slave to this concept, insofar as I will end one of these runs if I don’t feel well, or my legs rebel.  But, somehow I don’t think that will happen.  Part of the reason is that every week becomes a balance in my other training to enable me to effectively get in my twenty mile run.  It’s not like I’m taking it easy all week.  I’ve been getting in some speed work with my run, and some definite power intervals on the bike.  At some point, I’ll have to increase my bike volume, although a 3 hour bike ride on my trainer just two days before today’s run certainly isn’t too shabby.  I don’t have a set training program any more, as I just chat with my coach once a week to make sure that I’m on the right track.  My training is all about listening to my body, and not pushing too hard.  At the same time, it’s recognizing how hard I can push at times.  It’s been pretty cool, reaching this stage of training development.  

In the end, I really feel that the commitment is what is now driving me.  I think about this run during the week, and am preparing for it almost every day.  That means eating properly, getting enough sleep, and trying to manage my stress level.  All of those factors go into my ultimate ability to successfully achieve my twenty miles for twenty weeks goal.  It’s amazing what commitment will do!

Monday, February 15, 2016

Politics, Life and Priorities

I generally don't blog about politics anymore.  Everyone has their own views and sometimes those views can be pretty strongly held.  At the same time, I've always been somewhat of a political animal, and it's impossible not to be intrigued by the political machinations going on today.  I have long realized that the next presidential election isn't about Obamacare or gay marriage, it's about the Supreme Court.  This weekend, that became even more apparent.  It is no longer a theoretical possibility that there will be openings on the Supreme Court.  It is now a fact.  I've watched the unfolding of the political posturing with fascination.

I find it remarkable that "conservatives" who espouse the concept of following the constitution, so easily state that the President should not nominate anyone to the Supreme Court because there will be an election in 9 months.  Does that mean that once a President is within 12 months of the end of their term, they should stop being President?  What about 12 months a one day?  The constitution states that the President should nominate a candidate when there is an opening on the Supreme Court.  It doesn't say, "but not if the President only has 9 months left in office."

At the same time, I will readily admit that both Democrats and Republicans do the same thing.  I am not going to let the Democrats off the hook.  However, just because the Democrats have been partisan does it mean that the Republicans are allowed to be just as, or even more, partisan.  I read an interesting article today on the fact that our system of government is unique, and in some regards has not yet withstood the test of time.

Oh yes, I've discussed politics.  How does that have to do with life?  Well, I have been driven much of my life to want to make a difference.  I even thought of running for office at one point.  The degree to which I want to effect change has not always been a healthy motivator for me.  Whether it is in regards to traditional political change, or my favorite subject of healthcare, I have often felt obliged to do everything possible to influence policy.  When I take it too seriously, it is not healthy, so I have endeavored to take it less seriously.

Finding ways of sharing my viewpoints is great.  Whether anyone listens is actually not important, or at least not too important.  Whether change occurs is even less important.  Why?  Because ultimately we can not and should not be judged by outcomes.  We need to live with ourselves based on whether we speak out for what we believe in.  My priority in life is my family.  I have a great wife, kids, and now a grandson.  My other priority has, and, I have recently realized, will always be improving the lives of older adults in our society.  That is why I went back to work.  That is what I work towards every day.  My final priority, not surprisingly, is exercise.  Not because I love running 20 miles, but because I love being both healthy and healthful.  Also, because I need balance and exercise provides me with the ultimate balance.

Friday, February 12, 2016

My road back to mental and physical fitness

2014 was an incredible year for me from the perspective of triathlon.  I completed three ironman’s, the last one with a PR.  I was excited about 2015 and signed up for three more races.  In retrospect, I might not have taken off much time before jumping back into training, and was actually “punished” by my own body when I tripped and fell warming up for a half marathon in January of 2015 and popped a rib out of place.  Most painful experience ever, by the way!  I never fully got untracked, decided not to do the first IM I’d signed up for, did manage to race at Ironman Boulder, where I felt like the light switch was flickering on and off all day.  In fact, while I was proud of giving the run everything I had, I’m pretty sure that in doing so, I completely fried my adrenal glands.  As luck would have it, my third IM was cancelled due to weather, as I arrived at the airport in Baltimore!  The fact that I was relieved should have told me all that I needed to know.

Ultimately, I took September and October off almost completely.  A solid two months without any training whatsoever.  I wasn’t feeling well, mentally and physically, and since I’m a doctor, was convinced that I was developing some terminal disease.  My return to fitness began in November when I spoke to my coach, Tim Waggoner (aka Lucho), and decided to forgo any specific training plan.  I would come back totally based on feel.  He would not give me any workouts, but we would talk once a week.  I did what I felt like, when I felt like it.  At first it wasn’t a lot, and it wasn’t hard.  I used no electronics.  As the weeks passed, I started to get some of my motivation back.  

Just six weeks back into my training, I actually went out and did a 25K trail race, although I really focused on pacing myself.  One thing was clear, twenty years of regular exercise, including 8 Ironman’s over the past 6 six years, matters.  Also, my body tends to tell me what I need to do.  Over the next couple of months I intermittently struggled with hip, glute and low back issues, but they were ultimately fleeting.  I have kept doing what I feel like, when I feel like it.  

In the past month, I’ve started added intensity, and have actually been having a lot of fun.  Regular computrainer workouts with 10 x 1 minute at a solid wattage really gets the blood flowing.  I even got in a 4 hour ride on my computrainer, which is encouraging from the perspective that I know that when the time comes to increase my bike volume, I’ll have no issues.  

My weakness in ironman races has always been my run.  I’m relatively consistent, but have felt that I am capable of running faster.  After discussing this with my coach the other day, I have set a goal of doing as many 20 mile runs as possible over the next 5 months.  My next IM is in early August.  Today, I went out and ran 16 miles at a comfortable pace of 9 minutes/mile.  We’ll see how my legs feel tomorrow.  If they feel good, I’m on the right track.  

The mental side has also been coming back.  When you aren’t feeling good physically, your mental attitude suffers.  In December I went on a prolonged Facebook sabbatical.  I don’t miss it, although I may tiptoe back in gently to keep up with friends I have made over the last several years.  It just can’t be something that is a priority in my life. I have a new grandson who takes precedence over everything else.  I have a new job that I love, I still like training and I still like ironman training in particular.  I love to see what my body can accomplish through regularly increasing effort.  It’s remarkable to me that just a few months after a two month layoff that I can go out and run 16 miles comfortably.  Rest and recover do matter.

Thursday, November 19, 2015

Facebook Sabbatical

I’ve been using Facebook for several years.  At first I thought it was a good way to keep in touch with friends and family.  I soon found it to be a way to meet other people with similar interests, triathlon in particular.  I also saw it as an opportunity to share my thoughts and ideas with others.  Unfortunately, Facebook has its pitfalls for someone like myself who battles with being a workaholic.  I have obsessive compulsive tendencies that are hard to keep in check in a Facebook world.  I would find myself checking Facebook regularly throughout the day.  Since I was retired at the time, I didn’t really take note of the impact of doing this.  Since I have started working again, it has become very clear to me.  

In the last couple of months I have realized the value and importance of prioritization.  I have a new grandson.  There is a priority that is filled with wonderment for me.  Watching this little guy enter the world and seeing him grow on a daily basis is a reminder that I still have room to grow.  I also want him to know his grandpa.  My wife and best friend deserves my undivided attention.  It is too easy to take the person who means everything to you for granted.  Distractions and unnecessary habits detract from what’s really important in life.  I have two daughters and now two sons whom I would do anything for.  I also have a commitment to my health which I have focused on the sport of triathlon due to my need to be goal oriented.    And, I have a job.  Fortunately, I have found a job with no real pressure.  I can channel my passion for older adults in a meaningful way.  Since it is a job, however, I now have some control over the time I spend in the pursuit of my passion.  I really should strive to maintain my commitment to the vulnerable elderly to 40 hours a week.  In the past, I went way off balance in this regard.

Balance….being a grandpa is having a nice pull on my recognition of this need.  Priorities….In the past, everything was a priority.  In fact, I have rarely been able to truly prioritize.  This is no longer healthy for me, and I come back to the discussion of Facebook.  Is there really a need to communicate with people via this mechanism?  What happened to actually talking to people?  Do we need feedback on everything we do in life?  It seems nice when a bunch of people “like” something that we post, but is is necessary?  What matters is that I “like” what I am doing and talking about.  

One of the truly unhealthy aspects of Facebook has to do with the fact that we can easily be reminded of the priorities of others.  It is human nature to make comparisons.  We all want to be loved and cared about.  Facebook becomes an artificial way of receiving attention, but it can also be a reminder that we are not as important to others that we wish to receive attention from.  The psychological aspects of Facebook continue to intrigue me, but I think that I’d rather be intrigued as an outside observer, rather than as someone who occasionally sees the smiling faces of those who don’t care about me.

I do have a blog that I rarely use anymore.  It was meant to be a place where I could share my thoughts, ideas, feelings….a journal of sorts.  I think that it’s time for me to go back to that space to share things.  If people choose to read my blogs, that’s ok.  I’m inclined to disable comments, as that’s really not the purpose.  If someone knows me and wants to talk about what I’ve written, they can call me, or ask me to have a cup of coffee.  Whatever happened to getting together for a cup of coffee?  

So, I will be taking a sabbatical from Facebook.  I’m not sure if I’ll ever go back to it.  At the very least, I won’t even ask that question until the new year, which is 6 weeks away.  Maybe by then I won’t even remember what Facebook was?