Getting Better, In Spite of Myself!

So, yesterday, I should have realized that I was getting back to normal.  Not paying attention to where I was going, I slammed my right thigh into a metal railing.  It's still a little sore today, but no serious damage.  I'm typically a klutz and I do things like this, although usually close to a race.  My left hamstring was tight last night, though that might have been due to the fact that I didn't realize that my seat post had dropped about a 1/2 an inch on my bike.  Adding to that was 6 hours in the car today, driving to Northern California where I'll do the hardest workout that I know, stand for 2 hours giving a lecture tonight.  I got to the hotel in time, however, to do an easy shakeout run.  Wow!  From the very first step I realized that I was doing much better.  My legs felt light and the run felt easy.  In fact, there was never a thought of "jogging", it was more of nice easy strides.  This was never hard from a breathing perspective and I never felt like stopping.  I ran for about half and hour (had to get back to the hotel to get ready), and it all felt good.
I continue to find the recovery from this ironman to be interesting.  I've gotten good at listening to my body over the years, and my body has been talking to me.  Up until now, it's been warning me to be careful.  Today, however, I think that it may be getting ready to let me go just a little harder.  That's exciting.  Fortunately, tomorrow's lecture isn't until noon, so I will have time in the morning to run completely unfettered.  Then, it's another 6 hours in the car:(.  Wednesday, the mover's come, but I know I'll sneak a little time into the swimming pool!

I think I'm going to like my new life!

Yesterday started with a swim in the morning and ended with a swim at night.  The rest of the day was meeting with the landscaper, getting the carpets cleaned and watching our first show being filmed for our venture, GeekNation.com.  We had a blast all day!  My new swimming pool is "only" 33 feet long, but I can make do wearing a band around my legs, doing one arm swim drills, kicking in the deep end, or just swimming in circles at times.  It will be interesting to see how this goes, but I can swim whenever I want and that is great.  My recovery days will be wonderful. 

Today I got up and drove to Westlake to meet up with the Conejo Valley Tri Club.  Todays ride was the Rockstore climb.  I felt good and went to the front with two women and a guy about 4 years older than me.  Ultimately, they dropped me, but not by much.  It felt good to just ride based on how I felt.  I was sweating a bunch towards the top.  My breathing got hard.  My legs weren't screaming though.  It was really nice.  The descent down Decker allowed me to practice my descending skills.  The fun part was tail gating a McClaren that wasn't being an ass, he actually was keeping to the speed limit!  I still have a lot to learn about descending, but I felt fairly comfortable today.  Got back home and jumped in the pool with my family.  Mostly treaded water in the deep end to get some more kicking in.

Rest of the day was running errands and shopping with my wife.  Tomorrow, I drive to Mountain View to give a lecture to a bunch of doctors about how to make Medicare work.  We have trouble getting people to come to these.  I guess they don't want to know how to retire at the age of 53!

This week will be a little crazy, with driving to and from Northern California the next two days, moving into the new house the two days after that.  I'm bringing my running gear to NoCal, and will try to get in at least one run.  Mentally, I'm in a great place.  Physically, I continue to recover, my quads and hamstrings continue to remind me that I am just 2 weeks removed from Ironman St. George, and I'm (almost) 53 years old.  The body needs time to heal. 

Running Free

I've been traveling most of the last two days, so really no time to blog.  Plus, we decided to go from renting our house in Colorado to selling it in the span of about 30 minutes on Tuesday night, and ended up with about 15 showings in the last two days and now with multiple offers.  Life is crazy!  But, time to focus on running.  Wednesday was just a long, long travel day.  Fun, though, with my wife and daughter and all of the housing stuff while in the car.  Yesterday, I woke up in Cedar City, Utah.  Put on my running shoes and went outside.  First of all, it was nice to not have my garmin on.  It was also nice to have absolutely no idea as to where I was.  I look up, saw the red rock mountains and just started running in that direction.  I quickly came across a war veterans memorial park and saw a bike path nearby.  Followed the bike path up the road and into a gorgeous canyon.  It was all uphill, but I just got locked into a moderate effort, breathing every fourth step and kept going.  After a little while, I felt like walking briefly, which I did, and then started running again.  My legs felt fine, my body felt fine.  My mind felt fine.  Let my mind wander from idea to idea, though after a little while decided not to think, just to run.  This will be freeing!  I decided to turn back, figuring I'd probably run a few miles, and started back downhill.  Ironically, I now realized that I had been running uphill with a tailwind, and now was running downhill with a headwind.  I let my effort actually increase a little and tried to keep a good compact stride.  As I got about 2/3 of the way down the hill, my quads suddenly started feeling funny.  This was similar to the other day.  It was sort of a tightness/aching in both quads.  I figured that my body was speaking to me.  It's really funny, recovering from an ironman.  Just 11 days out from the race, the physiology would suggest that I am still healing.  My muscles somehow were telling me that I'd run enough and it was time to rest.  My coach had suggested staying under one hour of running right now.  My body was telling me to stop after about 40-45 minutes.  I walked briefly, then started running again.  I was ok, but could feel that it was soon time to finish.  Fortunately, or rather, as my body had clearly planned, I was back at the hotel.  It's a bit of a shame that I've been traveling this week, without access to a good pool or my bike.  My body would love swimming right now.  Fortunately, we've had a change in plans and I'll actually be at our new house this afternoon.  I will be swimming today!  I will be cycling this weekend.  Without a watch:)

A New Journey

It's been 8 days since Ironman St. George and I've gone through different emotions than after the first two ironman races that I did.  The first two times, as I completed the run, all I could think of was "why would anyone do this to themselves?"  This time, all of I could think of was "wow, I'm finishing this sucker!"  While I really don't want to do an ironman this challenging again, I really enjoy the training for ironman.  And, it might be fun to do an "easy" ironman!  For the most part of the last week I've been walking around with a sense of calmness.  While it can be disturbed by the intrusions of real life, I've tended to pop back into my "zen-like" state pretty easily.

Life is about change, and boy have we experienced lots of change.  The last three years has easily been the most tumultuous of our lives.  Starting with producing a television pilot, breaking my collarbone and hip, going through the process of selling my business, daughter getting married, moving away, starting up another new business, and now moving.  Oh, and in the midst of this, I did three of the hardest ironman races in history.  Granted, in some ways, the ironman training has been an oasis for me.  Generally, a healthy one, with a caveat.  I am an obsessive person.  I have to keep track of every workout, noting my pace and power, every detail.  I could blame this on the fact that I want to give my coach data, but the truth really is, I just tend to obsess over these things.

It hit me on Saturday.  I don't want to be "focusing" on a specific goal right now.  In fact, my specific goal is spending time with my wife and family.  For the past 30 years my wife has devoted herself to our kids and to allowing me to do what's important in my life.  Work, work, work, triathlon, work.  It's time that I devote myself to helping assure that she does what's important in her life.  Spending 20 or more hours a week training for a bicycle race just doesn't fit into that.  It doesn't feel right.  In fact, "having" to do any workout doesn't feel right.

So, I spoke to my coach yesterday.  My new training "schedule" is to do what I feel like, when I feel like it.  I will write about how I feel on a daily basis, and continue to try to learn about myself.  Life and training are all part of the same continuum.  It will be fun to just head out the door for a run or a bike.  It will be fun to jump in the pool and just swim.  No paces, no timeframes.  It will be fun to continue to be in the moment with my life, no expectations, just enjoy the moment.  A new journey.

2012 Ironman St. George Race Report

This is long, but so was the day!

I arrived at Sand Hollow Reservoir on Tuesday around noon on our way into St. George.  Ever since the swim at the inaugural Ironman St. George in 2010, one of my biggest concerns each year is the water temperature.  That year, temperatures as low as 52-54 degrees led to fifty people not making the swim cut off.  This year the temperature was already 63 degrees.  The water felt nice when I tried out my new wetsuit, the Tyr Freak of Nature.  My wife had a memorable reaction when she saw the credit card bill and said, “that much for a wetsuit, what is it made out of, gold?”.  Four days later I told her that the wetsuit might have saved my life.

The days preceding the 2012 Ironman St. George were unusual insofar as I felt an unusual calm.  Usually, prior to my races, I feel nervous.  Not this time.  This carried through to the morning of the race, when I awoke before my alarm at 3:15am.  I took in almost 500 calories right away, which was also unusual for me.  Usually my stomach is nervous, but not today.  I gathered my special needs bags and my bicycle pump and made my way to the buses.  As I got on the bus, I remained relaxed, sipping on my pre-race vanilla soy latte.  Arriving at Sand Hollow Reservoir, it was 65 degrees an calm, just like the weather report had predicted.  I pumped up my tires, got body marked, put on my sunscreen, body glide and my wetsuit and handed over my bicycle pump to my friend Rudy.  Rudy and his wife Wendy had come to St. George to lend their support and friendship for my third consecutive Ironman St. George.  

I made my way to the swim start and down to the waters edge.  Mike Reilly, the voice of Ironman, told us to enter the water just before the pros were to start.  I got a little concerned that I was going to be in the water for a full fifteen minutes before the start, but the water temperature was now about 63 degrees and I figured it would be ok.  Besides, I was determined to start right at the front this year.  I got into the water to my knees and the gun went off for the pros.  I then slowly made my way into the cold water, dabbed water on my face and slowly swam towards the front of the line.  I did put myself about 20 yards from the farthest buoy, figuring that I could angle my way in.  The past two years, I had swum 1:11, but both years I had swum relatively easy.  My swim training had gone well this year, and I planned to go off as fast as I could, taking advantage of the potential ironman draft.  Last year, as the time to the start got closer, the front of the line moved forward, and I didn’t, ultimately impeding my attempt to start quickly at the front.  This year, as the front of the line moved ahead little my little, so did I.  The waters were still calm when the gun went off.  I started as fast as I could, and was surprised to find no jostling, no one swimming over me, and I was keeping on the feet in front of me.  I was flying.  I got into a solid rhythm and I felt comfortable.  Occasionally, I would lose the feet of the person in front of me, but then there would be someone else.  As I swam fast towards the first turn buoy, I realized that the front of the pack wasn’t stringing out far ahead of me, which is what typically happens to me in the swim portion of a triathlon.  Later on, another athlete with a lot of open water swim experience would tell me that he realized from how fast we were swimming that there was a pretty strong current building behind us.  

As I turned left at the farthest buoy, staying about 10-15 feet wide in order to avoid the typical turn buoy traffic, I turned into waves coming at my left side.  At this point in time, I really wasn’t thinking about the changing weather and the possibility that this could get worse.  I was just thinking about getting to the next turn buoy.  I realized that the people to my right were getting pushed further out and then I tried to make sure that I was moving in a direction that wouldn’t push me further away from the next turn buoy.  I was glad to be breathing to my right side, since that was away from the waves.  Finally, I saw the next red buoy and realized that I’d been pushed about 20 yards away from it, so I directed myself towards it and made my way around the buoy.  When I made the turn, I began to see and feel the full force of the oncoming waves.  I had recently read an article about open water swimming, so I shortened my stroke and started making my way forward.  Remarkably, the next two buoys came about quickly, which I didn’t realize was probably because the wind had pushed them together!  Around this time the waves began to come faster and with more fury, finally catching me unaware and causing me to swallow/breath in some water.  This is always disconcerting, but under these circumstances it was a little bit frightening.  I gathered myself and continued forward.  The other athletes were scattered all over the place.  Drafting wasn’t something to be considered.  The waves seemed to only get bigger.  I wondered why I wasn’t seasick, but decided that I would just be thankful that I wasn’t.  I was moving forward.  I wondered momentarily if my all neoprene wetsuit was a help or a hindrance, as it kept me high in the water with the waves coming at me.  

Another wave hit me in the mouth, and again I swallowed/breathed in some more water.  This took my breath away and I stopped to tread water.  Unfortunately, this only exposed me to waves crashing over me as I struggled to maintain where I was, kicking my feet in more of a bicycle kick.  This only made me feel more short of breath.  I looked around and didn’t see any kayaks, or for that matter, any other athletes.  Then, my right calf suddenly cramped up.  For a brief moment, I got scared.  Several years ago I struggled with panic attacks in the open water and the feeling of panic began to invade my consciousness.  I thought, what if I can’t do this, how do I get help?  Raising my arm would only cause me to sink, besides, I couldn’t see anyone.  I might die, I thought.  And then, I remembered what my coach had told me about ironman, “stay in the moment”.  And so I did.  I decided to just start swimming forward and focus on each stroke, not to think about what had already happened, or worry about what might happen.

There was one thought that did stay in my consciousness for the rest of the swim, and that was my hope that no one was going to drown today.  I had stopped worrying about myself, but I knew that there were athletes that normally struggled to finish the swim.  What was happening to them?  Were they going to cancel the swim?  How would they do that?  Stay in the moment, I kept reminding myself.  I relaxed, tried to time the waves so that they wouldn’t push me back and began sighting the large rock that I knew I had to swim around.  I was moving once again and before I knew it, I was to the right of the rock.  Only then did I realize that there were a lot of smaller rocks sticking out of the water and the 5 foot swells might push me into them.  I aimed to my right, looking forward to getting around the rocks and turning left towards the swim finish.  I hoped that once I turned it would get easier.  That didn’t happen.  The waves kept coming, and now they were coming to my breathing side.  I occasionally breathed to my left, which I had practiced and was comfortable with, but that didn’t allow me to see the waves coming at me.  The waves pushed me to the left of the swim exit and I realized that I had to negotiate getting around a large platform out in the water.  I swam towards the exit, almost not giving myself enough room, as another wave almost pushed me into the platform.  Soon, I could see the bottom and I’ve never felt better about touching the ramp at the swim exit.  As I came out of the water, I looked up, the time on the clock showed that I had completed the swim in 1 hour and 19 minutes.  

I had originally hoped for a 1 hour and 5 minute swim, but I knew that my time was good under the impossible conditions.  I did not know at this point that close to 600 people wouldn’t make it past the swim.  Close to 1800 people had signed up for the 2012 Ironman St. George.  Close to 1200 would be contesting the rest of the race.  Sixty percent of the women who started did not  make the swim cut off!  Approximately 100 men in my age group started the swim, and only 59 made it onto the bike.  The older men fared much worse.  This was a swim course for younger and stronger men.  The hypothermic 2010 swim that led to an approximate 15% DNF (Did Not Finish) rate, was a distant memory.  We had just set a new standard for one the toughest ironman swims ever.  Later, I would hear some stories that would add exclamation marks to my frightened journey.  Two kayaks overturned.  In fact, one athlete found an empty kayak with a life jacket floating next to it.  Another athlete saved a person from drowning and got them on a boat.  One of the boats was completely filled with athletes and began taking on water.  The driver’s 9 year old daughter was screaming in fear.  Athletes in the water, unable to move forward, were calling for help and they were told they had to wait for the boat to come back for them.  It was becoming ironic that Titanic: The Musical was playing at the Tuacahn Ampitheater.  The idea of Ironman St. George:  The Musical was beginning to form in my mind as I tried to make sense of this day.  I laid down for the wet suit strippers, grabbed my bag and made my way to the changing tent.  I sat down and the guy next to me told me that he had been pulled from the water and had already called it a day.  I didn’t get the full import of this until later.  I followed my well rehearsed transition, putting on my helmet and my shoes, putting on sun screen and quickly made my way out of the tent.  I stopped for more sunscreen and got my bike.  Transition time right around 5 minutes, almost the same as last year.  Pretty good under the circumstances.  After I passed the timing mats, I saw my friend Rudy.  I took the time to walk over and say “I hope that no one drowned today”.  I mounted my bike and began pedaling.  Later I would find that I had the 314th fastest swim time overall, and was actually 14th in my age group out of the water.  My first two years at St. George I was around 30th in my age group.  

In previous years, I remembered that the bike ride from Transition to the main road went by pretty quickly.  As I began my ride, I began wondering why it seemed to be taking so much longer.  It wasn’t like my legs were a problem, or that people were passing me.  I didn’t realize that I was already feeling the force of 20-30 mph headwinds.  One of the reasons I probably didn’t notice was that I was already having pretty severe stomach cramps.  Last year, I had suffered with stomach cramps throughout the day.  This felt worse.  I cautiously took sips of water.  I made my way up the longest sustained climb on the course.  My legs felt fine, but I needed to get calories.  I tried to take some gel, but it was tough.  Every so often, I would belch and the contents in my stomach would come up.  That wasn’t good.  I tried my best to stay tucked in my aero position, but that was uncomfortable due to the cramping.  I had survived the swim, I had to survive the bike.  I made my decision to stop at the first water station and try to use a port-a-potty.  I did, and it didn’t help.  Back on the bike, I continued to persevere.  Being a physician, I palpated my own abdomen, only to find it was quite tender.  I began to realize that I may have an ileus.  That would mean that my intestines had shut down.  Swallowing too much of the Sand Hollow Reservoir could have set this off.  My GI tract was not working properly.  I continued to try to sip water and take in some gel, and the cramping got worse.  When I arrived at the next water station I tried the port-a-potty again and then went to the medical tent, where I sat in a chair and pondered my day.  Should I just give up?  

Suffering with this level of cramps would make for a horrible day.  As I sat there, I felt a little better.  I also thought, hell, I just made it through the most difficult ironman swim ever, I was a three time registrant for Ironman St. George, and damn if I’m not going to be a three time finisher.  If I’m going to sit down, I might as well sit on the bike, I thought.  So, that’s what I did.  I got back on my bike and just began pedaling easily into the jaws of the 25 mile climb towards “The Wall”.  Ironman is about the ability to adjust your plans and compensate, to adapt to the conditions.  I decided to stop eating and drinking.  While I knew that I could not sustain no nutrition all day, I figured that I needed to give my GI tract a chance to rest.  For the next hour and a half I took in no nutrients and just worked on pedaling as comfortably as possible.  I stayed in the moment and tried to ignore the fact that the mile markers were coming along at an interminable pace.  When I reached the climb before “The Wall”, and saw people walking their bikes up it, I realized the full force of the winds.  I guessed that the average wind speed was 30 mph, with gusts to 40-50 mph.  Later, I read that Ben Hoffman, the eventual winner of the race, was almost knocked off his bike by a wind gust.  Another athlete later told me that he was producing 250 watts of power on a gradual downhill against the wind and was going all of 10 mph!  Two years ago, on the friday before the inaugural St. George Ironman, winds of 40-50 mph reared their ugly head.  I’ll never forget thinking, I don’t know how I could handle this course with winds like this?  I was now finding out the answer.  

Finally, I could see “The Wall”.  It’s a half mile section of the course that reaches gradients of 14%.  As I got closer to it, I suddenly realized that we would make a right turn, maybe the wind would be different.  That turned out to be the case.  I won’t say that I flew up “The Wall”, but it was relatively easy compared to everything I had already done.  A 30 mph tailwind will really help a steep climb!  Unfortunately, the top of “The Wall” led to a left turn back into the brutal headwinds.  Fortunately, there was another water station ahead.  I stopped yet again for the port-a-potty’s.  Still, not much help, but I was doing somewhat better.  I got back on my bike and started to pedal and my chain stuck.  Shit!  I got off and called for help.  My chain was stuck between my small chain ring and the frame.  It wasn’t loosening up.  Three mechanics finally made their way over and started working on my bike.  This wasn’t looking good.  As I stood there, all I could think was, “I’ve made it this far, I can’t be stopped by a mechanical”.  I also thought about the Tour de France and how professional cyclist’s make use of the time when they have mechanical failures.  I asked for a banana and a bottle of Gatorade Perform and sat down and took in some nutrition.  It felt ok.  Finally, with the use of something akin to a small crowbar, they got my chain loosened.  It has probably taken 10-15 minutes, but I was feeling somewhat better.  I got back on my bike and tested the shifting.  Everything worked and I was on my way.

Soon, I made the right turn at Veyo.  Normally, you hit a headwind at this point, but not today.  Finally, after over 50 miles of cycling, I had a consistent tailwind.  I was flying.  I began passing people and the only cyclist that passed me was a pro triathlete on his second loop of the bike.  As I made my way down the highway, I realized that my speed was probably right around 50mph.  I kept reminding myself to stay relaxed, I wasn’t going to waste this opportunity.  I got to the end of the first loop and began my second loop.  Things were looking up.  I began passing the same people that I’d already passed twice before (remember, I had stopped three times).  I never wondered what my bike split would have been like without the stomach cramps and the stops.  It didn’t matter, I was “in the moment”.  I started taking in nutrition.  I had stopped for my special needs bag and picked up a cooked red potato with some olive oil and salt.  It was like manna from heaven, and actually helped to settle my stomach.  I would nurture that treat onto the run.  It may have saved my day.  The mile markers felt like they were coming faster this time around.  When I hit Mile 80, I recalled how two years earlier I had bonked.  I checked myself and realized that I was doing ok.  Mile 90 came, “The Wall” came again, albeit a little harder than the first time.  However, I realized that I didn’t even remember going up the climb before “The Wall” the second time around.  I was going to make it through the bike.  I had spent somewhere between 30-40 minutes of my bike ride off of my bike.  I didn’t push for the last 12 miles, mostly downhill and flying.  I wanted my legs to be ready for the run.  I had no idea how my GI tract would react this year, but I wanted to give it my best shot.  Coming to the dismount line, I have to admit that I was relieved.  My bike split was 7:51, almost an hour longer than 2010 and almost an hour and a half longer than 2011.  My age group ranking ended up being 47th (out of 55 who finished) and I had dropped from being 14th after the swim to being 40th in my age group.  I was now 684th overall.  But I was on my feet!

I grabbed my bag and took the time to stop and pee (a good sign from a hydration perspective), then quickly put on my socks, my shoes, my fuel belt and my hat and made it out of tent.  I stopped again to have sunscreen slathered everywhere on me and made my way out of transition.  Another solid 5 minute ironman transition.  Not too bad.  I had seen the clock and knew that I was already 9 hours and 23 minutes into my day.  I would not finish this race in under 13 hours, but I could make it in under 14.  But enough of that, stay in the moment!  I began running, and it felt good!  Shortly thereafter, I ran up to Toby, and found that he was on his second lap.  We began running together and it felt good.  We were going downhill and I asked him what our pace was.  He said about 8:20/mile.  Woah!  That’s a little to fast I said and he agreed, so we found a moderate pace that we both felt comfortable with.  In fact, he told me that I was helping to pace him.  I told him that he was helping to pace me.  We ran together for the entire loop, shared stories and just helped each other.  After we finished my first lap, he pushed ahead and I decided not to push too hard.  I was following my race plan.  It turned out that I maintained a very solid and steady 9:20 pace for the first 12 miles of the run.  I was still gentle with my nutrition, alternating Gatorade Perform with occasional sips of coke and water to keep the stomach contents form being too strong.  It seemed to be working.  As the miles went by, I had expected to see my friend Rudy.  I had no idea what was unfolding for my family.  The ironman.com tracking was not functional and they had no idea whether I had even completed the bike.  Rudy had based my expected time into transition on my very slow first loop, and I had made it onto the run course about 15 minutes sooner than he had expected.  My wife was freaking out, worried that something had happened to me.  What they didn’t know was that I was beginning to worry if something had happened to Rudy.  He was supposed to see me at Miles 2, 4, 6, 9, and 11.  Finally, Rudy found out that I had dropped my bike off and taken my run bag.  He did the math and found me at Mile 11.  He told me that my pace was solid.

I probably slowed just a little towards the end of my second lap, but was still in the nine minute/mile range (maybe now a little closer to the upper end).  As I started the third lap, I had hoped to start pushing, but when I hit Mile 19 and tried to increase my effort, my stomach began acting up and my legs also tightened a bit.  I decided to modulate.  Pushing too hard now could have a huge impact.  This is the point where trying to go 30 second per mile faster could ultimately add a half an hour to my run.  So, I ran the downhills and did a walk/run on the uphills.  Ultimately, my pace for the last 9 miles would slow to about 12:00 pace.  Still, not that many people were passing me.  As I ran up the last uphill section, hitting mile 24, I suddenly felt very nauseated and weak.  I slowed to a walk and collected myself.  I walked to the final turnaround and began to jog the last downhill section.  I wouldn’t fly down this hill, but I would run it.  I stopped a couple of times to walk for 20-30 feet, just to make sure that I would be ok.  I was going to finish in under 14 hours.  As I came down the finishing chute, I had my right hand up with three fingers showing, as Mike Reilly said, “Michael Wasserman, a three-time St. George finisher, you are an ironman!”

My finishing time of 13:52:21, put me in 479th place overall (passing 205 people during the run).  My marathon time of 4:30:39 was the 18th fastest in my age group and moved me from 40th off the bike to 24th in my age group at the finish.  While this was my slowest St. George finish, it was my best placement.  Approximately 100 men in my age group started the race, and only 55 finished.  1800 people were signed up to race, we may never know exactly how many actually were at the swim start, but only 1024 finished.  This was arguably the highest DNF percentage of all time for an ironman.

Because of Ironman St. George’s reputation as one of the toughest ironman courses in the world from it’s first two years of existence, it had already been decided that this would be it’s final year as an ironman course.  It is remarkable that 2012 made the first two years seem easy!  The toughness of the course, combined with the brutal weather conditions, made this a fitting end to what will go down in history as a legendary Ironman.  I started the day as only one of eighty people to have the opportunity to finish all three years.  Ultimately, only 26 of the eighty made it to the finish line in 2012.  I’m proud that I was one of them.

Staying in the moment throughout the day not only may have saved my life on the swim, but it allowed me to endure on the most difficult day in Ironman history.  In the end, I can think of  only one word to describe this day, and that is epic.

Why Warren Buffet may finally be making a mistake

When I saw that Warren Buffet was diagnosed with prostate cancer, I wondered, why did he even get his PSA checked?  I often tell my patients that if a man lives to be 100 years old, he will have prostate cancer and he will not die from it.  Granted, there are exceptions to every rule, but in my career as a geriatrician, I have seen two men over the age of eighty die from prostate cancer.  I’m pretty sure that both of them had the disease before they turned seventy.

I don’t know the specifics of Warren Buffet’s prostate cancer diagnosis.  It is theoretically possible that he has an unusually aggressive form of the disease.  It is much more likely that he has a PSA of 6 or 7, and that a biopsy showed that he had evidence of prostate cancer.  In this case, before undergoing treatment, he needs to take a long, hard look at the risks of treatment.  Being a multibillionaire will not keep him from the potential side effects of treatment!

Radiation has become a common treatment for prostate cancer.  While radiation will kill the prostate cancer cells, it can also cause side effects like radiation proctitis, incontinence and erectile dysfunction.  

Another common treatment are medications that lower a mans testosterone level.  This will also kill prostate cancer cells.  The problem with this is that low testosterone levels also have their own pathology.  The classic triad of symptoms of low testosterone in an older man is heart disease, muscle weakness and anemia.

Our health care system is structured to pay for treating disease, regardless of whether the treatment is beneficial to the patient.  In the case of prostate cancer, the doctors get paid, the pharmaceutical companies and medical device companies make money.  What about the patient?  Men over the age of 80 should look carefully at the risks of treatment versus the potential benefit.  We really have no scientific evidence that treating prostate cancer in men over the age of 80 either saves lives or improves the quality of life.  

For the past twenty years as a geriatrician, I have approached prostate cancer in my patients very conservatively.  Two stories illustrate my experiences and the potential consequences of treatment.

About five years ago, one of my 89 year old patients was showing evidence of decline in his functional abilities and overall health.  He was hospitalized for pneumonia and had been to the emergency room for episodes of passing out.  He had been treated for several years for his diagnosed prostate cancer so that his PSA was maintained at zero.  We discussed stopping treatment.  His urologist balked when I called to suggest not only discontinuing his hormonal therapy, but putting him on topical testosterone to get his testosterone level back to normal.  I pointed out to the urologist that there is good evidence that PSA’s under 20-30 are generally not associated with extension of the prostate cancer to the bone.  He agreed.  Over the past five years, my patient has maintained a relatively healthy and functional life.  In fact, he has not been hospitalized once during that period of time.  His PSA has slowly risen and now hovers around 17-18.  

Several years ago, I saw an 85 year old man for the first time.  He had moved from another state where for four years he had multiple hospitalizations for falls.  His medical records indicated that hundreds of thousands of dollars had been spent on his health care needs.  He was now in a wheel chair.  It turned out that he had been diagnosed with prostate cancer and had actually been treated with the least costly antihormonal therapy.  His testicles had been removed.  We put him on topical testosterone and within six months he was out dancing!  He lived another five years and died from natural causes not remotely related to prostate cancer.

If you are over the age of eighty and are diagnosed with prostate cancer don’t accept the recommendation of treatment without grilling your doctors about the risks and benefits of treatment.  Ask them to provide scientific evidence that the treatment is beneficial.  Make sure that they tell you all of the potential side effects.  

Warren Buffet, are you listening?

Last day of "work"

It's hard to believe that twenty five years ago this month I got my first paying job as a licensed physician.  Today, I head out the door for my last day of "work".  I'm not done being a Geriatrician.  There is still so much to do to advance the health care needs of seniors.  While I can truly say that it has never really been a job, from now on it will only and always be my passion.

It has been an incredible journey.  From the very beginning I have always loved what I do.  But, it has also been about making a living.  And, about making a difference.  Sometimes, it has been hard to discern between the two as I reached higher and higher up the career ladder.  This is something I will never have to deal with again.

My future as a Geriatrician will never be about making a living.  It will solely be focused on caring for seniors.  Through my new website (www.wassdoc.com), I am looking forward to sharing what I have learned in the past thirty years, and to carry on the journey of discovery that we should all do on a daily basis.  I absolutely know that I will volunteer to be an educator of young, and hopefully old, clinicians.  Needless to say, my passion for triathlon will continue to be an example for others that we can be physically fit as we get older.

I can not ignore the daily articles about the financial future of Medicare.  I have been part of an incredible group of people who have demonstrated that we can deliver compassionate, cost effective and appropriate care to seniors. My mission to share this knowledge with others, especially the legislators that have been tone deaf to hearing it, will not only continue, but in some ways has only just begun.

Last, and most importantly, when I wake up in the morning I can savor gazing at my beautiful wife.  I don't "have to" be at work, or at a meeting, or even getting a workout in because I "have to" get to work.  My journey and my passions would not be possible without the support that she has given me for the past thirty years.  I look forward to the next thirty.