Journey Back to Kona Day 155: Dreaming

I haven't blogged in 12 days, and my last blog was about needing an intervention. Last night I felt like I was up all night dreaming!  I literally had a broad range of dreams that were incredibly vivid. In my last dream I was as soldier during WWII and I was with other American soldiers, and suddenly, I was running around a building and there were Nazi soldiers everywhere.  I couldn't get away from them.  I was about to shoot a man when I was captured and forced to sit down with a group of people.  One of them was an old woman.  She said something to me and I slapped her across the face.  Suddenly, I apologized, and tried to explain that I didn't hit old women.  Weird.  I could probably try to remember the range of my dreams, but as I write this their already flowing back into the recesses of my brain.  They were so real, and every time I woke up from one, it felt like I hadn't slept.

I kind of had that intervention.  Somehow, I've been trying extra hard to take some semblance of control over my life again. I've been good about working out, to the extent that my fatigue levels have been rising.  Two nights ago that reached a crescendo when my wife told me that I looked tired.  That's always a sign that I'm fried.  She also told me, after I mentioned this the next day, that I had been grumpy.  Grumpy old man, that's not what I want to be!  Nevertheless, that's my signal to rest, and yesterday was a pretty mellow day, although I did get in a 40 minute bike that included 5 two minute hard repeats up the 7% hill that runs up my neighborhood.  According to my coach, older men need those VO2 workouts, and I'll particularly need them for the hilly St. George Ironman in May.

I did manage to do the best workout ever last week, pushing my granddaughter in a jogging stroller for 8 miles, and I'll say, 8 very hilly miles that included a 1 mile 6-8% climb.  I followed that up with a 5 1/2 mile stroller run two days later that included the same climb.  That was one of the reasons for my fatigue at the end of the week.  If I'm going to be ready for my upcoming races, I'm going to need to keep up my training.  However, that also means that I'm also going to need to to modulate and not let the physical and mental stresses get the best of me.  

I'm someone who tends to remember my dreams, although I rarely, if ever, write them down right away. That might be an interesting experiment sometime. I wonder what I would learn.  I bought a book over a year ago about dreams, started to read it and never finished.  Always something more to learn in life. Always something to dream about.

Journey Back to Kona Day 143: I Need an Intervention

I've been desperately trying to find my balance, and regularly screwing it up. Today was a prime example. I'm no longer able to juggle all of the competing aspects of my life. I'm not sure that I ever have been, but I've convinced myself otherwise many times.  I talk about how my family comes first, but I continually let work get in the way. What is really screwed up is that I'm retired! I need an intervention.

I suppose calling yourself out for needing an intervention is much better than having the people who love you sit you down and telling you that you need one.  I am going to need help. That's key. I have proven time and again that I am unable to do this by myself. Left to my own devices, I say yes to everything that comes my way. That's the irony of anyone suggesting that I put anything less than a full-time effort into my last job running a nursing home chain. I've never had a full-time job where I've put in even close to 40 hours a week!  I've always put in a lot more. Now that I'm retired, I suppose that could explain why I'm floundering to find my proper balance.  My time is essentially unlimited.  That's why I need an intervention!

I have an Ironman coming up, but have already realized that I can not, should not, and will not set any expectations.  It would be great if I were prepared for it. It would also be great if I wasn't fully prepared, and just enjoyed the day and finished before the requisite 17 hour limit. I've never paced myself through an Ironman that way, this could be a first time.  Imagine taking some extra time during transition (naw, that will probably never happen for me, it's not in my DNA, besides, it's wasted time)? More appropriate would be to take extra time hydrating and nourishing for the first half of the bike (or more), and during the first few miles of the run (or more). Taking time to recover from the impact of each discipline would go a long way towards finishing comfortably, and actually taking time to enjoy the landscape and the experience. This is definitely an option, one which will be dictated by what happens over the next 12 weeks.  With that said, when all is said and done, Ironman should remain my healthy purpose, or rather my healthful purpose.

My "work" life has become a love:hate relationship.  First, to be clear, I'm not actually "working." I'm retired! I work for purpose. That purpose has to do with helping others. But, for the last forty years that obsession has been to the detriment of my family life.  At the age of 62, with a forty year anniversary coming up in May, it is longer healthy. It never was, but I managed. I can't manage any longer. Being a husband, a dad and a grandpa is too enjoyable to sacrifice.  It's time. But, knowing how much I've been trying to get there myself over the past few years, it is clear that I need an intervention.

But there are limits to purpose. Especially when it consumes every waking moment and detracts from the other things that bring you joy.  I wish I could separate them, but I can not.  It hasn't helped that we've been in the middle of a pandemic, and a quasi-dystopian world that has highlighted all of my expertise and skills. Purpose. Yeah, maybe there's a limit to purpose. That's why I need an intervention.

Journey Back to Kona Day 140: The Rubber Meets the Road

13 weeks to Ironman St. George, which also happens to be a World Championship race. If I am going to have the best race possible, there is no longer any time to waste.  It could be argued that I've already passed the point of no return, but I am rejecting that.  Two years ago, I was far less prepared and fit, and was going to do the race around the same time. In fact, it was February 24, 2020, a week before the world changed.  This time, I'm at a nadir of my physical fitness, and haven't been too far behind in terms of my mental fitness.  But, and I still don't really know if this is true yet, now is the time. It's time for the rubber to meet the road.  

If I'm truly going to be prepared in 13 weeks, it's time to go all in.  That means training every day. That particularly means putting in lots of hours on my bike.  And it means, continuing to put up the run numbers that I've grown accustomed to.  And, yes, it means swimming.

I started yesterday with my nearly 10 mile hilly run. I didn't push hard, but also didn't run too easily.  That went well.  Check.  In the afternoon, I got on my bike for almost an hour and just rode for fun.  That actually included some relatively hard efforts.  That went well.  Check. I'm anticipating getting in the pool before the week is over.

The backstop to all of this is that it doesn't matter.  I will not be defined by whether I'm fully prepared for St. George.  In fact, I will not be defined by whether I even do the race! It's just another goal. I've had many goals in my life and I've accomplished many of the most difficult among them. If I let my goals define me, I'm not who I want to be.  I just want to be me.  Maybe, that's actually where the rubber meets the road.

The past week has been a struggle, but for that matter, so have the past six weeks. I've struggled to find my balance point, and in doing so, the motivation to train has been subsumed by other motivations.  There's no right or wrong to which motivation should provide me my goals.  I've hit a lot of other goals over the past few weeks.  However, getting out of the bike yesterday was a reminder that I have unfinished business in St. George and that I still have my Journey Back to Kona. So, this week, the rubber meets the road.

Journey Back to Kona Day 137: Sliding Backwards

I've written a lot about the need to find balance, and I've truly been failing at it over the past few days. Heck, I've been failing at it for the past 6 weeks, ever since I allowed myself to not truly shut down during a short vacation to the mountains with my family. My obsession isn't going to change the world, if I haven't learned that in the last 2 years, I never will.  Maybe that's the point. I haven't been very good about learning this lesson.  In some ways, I just have a tendency to trade one obsession for another, although I've really tried to focus on my healthy obsessions instead.  Again, I haven't really been succeeding as of late. So, all in all, I find myself sliding backwards.

It hasn't helped that my low back tightened up on me again a few days ago.  That's always hard, as pain makes it hard to focus and easier to slide backwards into old habits.  And that's where I find myself.  Sliding backwards.

One of the crazy things that I haven't spent too much time thinking about is how close I was to being at peace nearly two years ago.  I'd decided to sign up for Ironman St. George, although I probably wasn't in Ironman shape. I'd identified some projects to work on. I was starting to feel at peace.  Then, the pandemic struck and my "worst" habits reared their head. I put worst into quotations because I've accomplished a ton over the past 2 years, but at what price?  Many days are a struggle, and it's all too easy to just obsess for the entire day to avoid the reality of the impact of that same obsession. I understand the addictive nature of my obsession to help others.  There is no doubt an adrenaline aspect to it, which creates all sorts of issues. I spike my adrenaline with my workouts, but the ongoing, all day, emotional stress and release of adrenaline definitely has an effect.

I've been working at reading every morning, which I did today.  I then stretch, which I did today. I then write, which I didn't do until now (the afternoon).  I keep thinking about meditation, but I haven't done it.  Maybe it's time to get back in that habit. I will continue to acknowledge that this thing called the internet is not good for someone with OCD. The ability to continuously look up information is great, but it's way too enabling. And, so here I am, trying to keep myself from sliding backwards.

Journey Back to Kona Day 136: Obsessed Again

 My morning in a Tweet:

I’ve spent the morning scouring CDC vaccination, booster, case & death data for NHs. CDC reports all rates by 1,000 resident weeks (even staff data). Peak #COVID19 death rate among residents was 5.6 in December 2020. Nadir was 0.06 in late June 2021. We are now at 1.2.

Peak death rate among staff was 0.06 deaths/1,000 resident weeks in late November, 2020. We are now at 0.02. Nadir was June/July 2021 at <0.01. Of note, peak staff death count was 69 individuals in one week in July 2020. Latest count is 26 in a week.

Since July, 80+% NH residents have been vaccinated. Since mid-October, 85+%. Presently ~87%. Since November 1, 25+% boosted residents. Since December 5th, 53+%. Since January 2, 63+%. Now ~66%.

Since July, 60+% of staff have been vaccinated. Since mid-October, 74+%. Since December 5, 80+%. Since November 1, 12+% boosted. Since December 5, 23+%. Since January 2, 29+%. Now ~32%.

Why did I spend my morning scouring the data? Because I’m frustrated by the perceived lack of focus on NHs. Plus, I’m trying to make sense of our strategic plan. At the end of the day, I’m a geriatrician who cares about vulnerable older adults and their incredible caregivers.

Interim conclusions: Vaccines & Boosters matter in NH residents. Death rate is 10x from nadir, 20% less than peak, but only 66% of residents are presently boosted. Vaccine & Boosters matter in NH staff. Death rate is ~4x above nadir, and ~1/3 from peak, but only 32% boosted.

Nursing home residents and the staff that care for them in often old, poorly ventilated facilities are the proverbial canaries in the coal mine. Total deaths from Omicron continue to rise nationwide. Cases will subside, leaving 10’s of thousands more dead in its wake.

It would be helpful if @CDCgov posted hospitalization and death rates by vaccination status. This would be particularly helpful in #PALTC settings. We still have limited data from ALFs and memory care facilities. @AMDApaltc @CALTCM @AmerGeriatrics

      

It would be helpful if @WHCOVIDResponse had a #PALTC “war room” manned by experts in #Geriatrics, LTC Medicine, ID, LTC operations & Public Health. With >640k older adult deaths & ~250k deaths in LTC, this should not be an afterthought. @DorisMatsui https://matsui.house.gov/news/documentsingle.aspx? DocumentID=2021

Provisional death counts for week ending 1/15: 85+=2,240
75-84=2,239
65-74=1,919

55-64=1,248
45-54=541
Blacks & Hispanics continue to be significantly over represented among deaths.

NH & community disparities are being “looked at,” meanwhile, more people of color continue to die. “Looking at” disparities is not enough. “Encouraging” vaccinations & boosters among NH residents & staff is not enough. @CMSGov should acknowledge we’ve fallen short.

History will not look kindly on how we cared for older adults, particularly those of color, throughout the pandemic. It’s not time for blame, however, it’s time for action. After nearly 2 yrs, @POTUS @WHCOVIDResponse @CMSGov @CDCgov @HHSGov @ASPRgov need to focus on older adults.

Journey Back to Kona Day 134: Cutting it Close

Fourteen weeks to Ironman St. George. I haven't been out on my bike for more than two hours since October.  I haven't swam since October. That's cutting it close.  However, my very first ironman was preceded by a bike accident which laid me up for nearly two months and set me back considerably with my training at the time.  Ironically, it was the first Ironman St. George in 2010.  My bike accident was at the end of October in Australia.  I didn't start running until January, prior to which, I was cycling indoors and swimming with one arm. I guess that was cutting it close.

There are two competing factors right now. The first is prioritizing my purposeful efforts.  There's still a pandemic going on and I've found great purpose in fighting to protect vulnerable older adults. There's still a pandemic going on and I keep juggling the important purpose of being there for my family. There's still a pandemic going on and I definitely benefit from the purpose of training, which has the potential of keeping me balanced and healthy. Running has definitely been my savior over the past year and a half, and particularly over the past few months.  But I am coming dangerously close to the 12 week mark that experience has shown to be critical.  The last 12 weeks prior to an ironman are essential.  It helps to go into those 12 weeks prepared. And so, I find myself cutting it close.

I did get caught up considerably yesterday with my other purposeful efforts.  That means I need to run today. I will continue to put running front and center.  It's the core to ironman preparation and training. But the bike must follow.  The bike takes time, and time has been something that I should have plenty of, but has turned out to be at a premium.  At the end of the day, it's only a race. 

Journey Back to Kona Day 133: Why?

When I was a kid, my next door neighbor, who was a bit of an asshole, told me a story of a paper he had written in college.  The topic was "Why?" His answer was succinct, "Why not." I thought it was clever at the time, but honestly, as I ponder my life and the struggles that I've been having, I realize that it doesn't address the question. There is no question and no doubt that I am in my element when I am focused on doing something purposeful.  Perhaps that's the point. It's not about the specific purpose, or whether one has a specific purpose, but that what we do each day is purposeful.  That concept certainly opens up a lot more doors and possibilities for how to live each day and how to focus.

I think it's all too easy to get caught up in the struggle of the moment. Which is ironic. My Ironman metaphor has always been to live in the moment.  However, when that moment is stressful, dwelling on it provides no benefit. Yesterday was one of those days where I found myself caught up in a stressful moment, or series of moments, and I let it get me down.  I suppose that means that I haven't truly accepted the meditative processes that I've tried to learn. When you're hit with something stressful, you note it, you don't dwell on it. You accept the feeling at the moment, but you don't start thinking about how it will impact the rest of your day.  Perhaps I need to add meditation back to my morning routine of reading, stretching and writing?

It is also a fact that I have too many whys. On days like today I realize that I have projects that need to be caught up, emails that need to be answered, work that needs to be done. I also want to go out and run, but I recognize that not only takes up physical time, it ultimately impacts my mental time.  I suppose that I have a finite amount of energy for my day, and that workouts use that time up in ways that make it more difficult to get the mental work done.  

My mornings actually are conflicted. First, there is no question but that I start my day with a routine in order to get into the correct mindset. However, I then have a choice, do I get mental work done, or physical work. That choice impacts the rest of my day. I've been struggling to get my work responsibilities organized and completed.  The stress of having things waiting to be done tends to pull me down. Why? 

I was going to run this morning, but I've already approved one textbook chapter, and I have one left.  I also have a presentation to prepare for next week. And, I have a third presentation to prepare within the next two weeks.  If I spend my day getting these done, I will be nearly caught up on my projects.  At least for today.  I also know that I'm feeling some pressure knowing that I have races coming in the months ahead. But, I've already promised myself that racing would not be an added stress to me. I know that I'm cutting it close, in terms of my preparation for finishing an ironman solidly. Sounds like the topic of tomorrow's blog.