One Mile at a Time: Learning to Run Again

I took my first steps this morning, really.  I haven't run in 2 months, and today I ran one mile.  That was it.  My coaches instructions were one mile and only one mile.  As I walked out to my front gate, I realized that my walking was a little awkward.  The plantar fasciitis has definitely been messing with how I walk.  So, I decided to focus.  Focus on each step.  Focus on my form.  Focus on trying to have each leg move like the other.

Today was exciting in many ways.  One year ago this weekend, I watched the Ironman World Championships on my computer.  I had been avoiding a decision on doing another Ironman for a couple of months at the time, but watching the pros and age groupers ignited the already hot embers inside of me.  It's been five months since Ironman St. George, I've had major life changes and my training had literally disappeared.  On top of that, the foot pain was just getting to me.  I've been working on it diligently, and making progress.  On Tuesday, I spoke with my coach and initiated my 11 month plan towards Ironman Lake Tahoe.  My goal is to achieve the best result that I possible can.  I don't know what that result will be, but I know that I will not leave anything on the table.  Training will be my first priority (after my wife and family, of course).  Saying it and writing it feels so right.  My bike rides the past two days have solidified the feeling that this is healthy for my mind and body.  Years of excessive stress and pressure have taken their toll.  I tend to be a driven person, so channeling that drive to something healthy makes the most sense to me.  I'm also goal driven, although I am not defined by whether I achieve those goals.  Giving them my best shot is enough, I've learned that in my life.

I slept very soundly last night and woke up ready to go.  I swam for 35 minutes, then spent about 5-10 minutes in the hot tub, stretching.  Then, it was time to run.  Left, right, left right.  I noticed that I didn't want to land on my heal, but I just naturally let my stride fall on my mid foot (as best I can tell) of both feet.  The left leg felt different than the right, focus on trying to keep them feeling the same.  Breathing was very easy, stride was comfortable.  No pain, no twinges, no concerns.  Looked at my Garmin, I'm keeping a pace of about 10:20, but I know that I'm running slightly uphill.  I get to 0.5 miles, my coach said "one mile", no more.  It's tempting, but I must and will be cautious.  I turn around and as I head back, just getting lost in the surrounding trees and morning air.  Looking down at my Garmin, I see my pace coming down to 10:00 (now going slightly downhill).  I know that pace doesn't matter, but it's still nice to know that I'm running super easy and my pace is right around 10:00 per mile.  That's ok, for now.

I notice my left heal occasionally, though not any real pain or discomfort.  One mile will be enough today.  I get home, immediately sit down and massage my left foot and heal.  No pain, that's a good sign.  I stretch as well, something it's finally time for me to start doing.  I'll get in the hot tub again, why not?  It's there.

I told my coach earlier this week that it was my intention to train like a professional athlete.  That doesn't just stop at the training log.  It involves my nutrition, my recovery, how I take care of my body, and my mind.  This is a journey that I am looking forward to, one day, one mile, at a time.

What a Difference a Week Makes

One week ago I started training again.  I was pretty pitiful, but I just kept at it the whole week.  Today, I did the same ride as last Tuesday, albeit in much lower temperatures (probably around 65-70 degrees).    I kept my heart rate down in zone 2 most of the way and found myself going faster than last week.  I did my 2 mile hill climb, averaging a heart rate of about 140, with an occasional spike on the steeper parts and did the ride in 12:30, one minute faster than a week ago with a lower heart rate today.  It's nice to see that kind of quick response.  I've still got 3 minutes to take off for an all out effort, which would put me where I was earlier in the summer.  I'm already getting a goal in mind for this 2 mile hill. I'm thinking somewhere in the low 8 minute range.  Why not, I always set the bar higher than I can achieve.  In life and in sports.

Will get in a swim later today and hopefully talk to my coach in the next couple of days.  Kona is this coming weekend, which means it was a year ago that I decided to do Ironman St. George again.  Hard to believe that a whole year has gone by, and that instead of an ironman in 6 months, I've got 13 months to train!  I'm getting quite excited!

I Love Hills

Woke up today and got on my bike.  Was going to ride the same route that I'd taken all week, but at the last minute decided to do some hill repeats.  I guess that I'm a glutton for punishment, and hills have been my nemesis for a long time, so why not start working on it?  I wasn't going to push these, as my body is clearly not ready to do so, plus, I will continue with the theory of building up as much as possible with the lowest possible exertion.  The idea is that if you can do something easy, the harder part gets easier too.  However, the hill I use for this workout doesn't make anything easy.  It's a half mile climb, with an average grade of 11%, with pitches probably as high as 15%.

I warmed up for 20 minutes and got to the base of the climb.  I really tried to ride "easy" at the beginning, which meaning a pace of less than 5mph and a cadence of somewhere between 30 and 50 rpm's, all in my lowest gear (compact cranks, so 34-28, for those of you who understand that).  I've done this hill in the past in about 4:25 going essentially all out.  Today, for the first half of the first climb, I worked "hard" to go "easy" enough to keep my heart rate from spiking.  In fact, I was able to hold my heart rate right around 150 for the first half of the climb.  I did the beginning of this seated, but after hitting the half way point did stand up for a short period of time and my heart rate immediately bumped up to 160, where it stayed for the remainder of the climb.  There is a slight reprieve about two thirds of the way up, and then it gets steep again.  My breathing was reasonable, albeit pretty quick, as I reached the top.  I took it really easy on the downhill and 9 minutes later was ready to start my second attempt.  Oh yes, I did this the first time in 5:37, not too bad.  The second time, I really "worked hard" at going "easy" and ended up keeping my heart rate down a bit, did go up to about 152 about half way up, but kept it below 160 this time, and closer to 156-158 as I reached the top.  That was enough, as I took it easy on the downhill.

After about a 5 minute rest, I went all out for 2 minutes on a slight downhill with some easy rollers and maintained a pace of 27 mph.  Not sure what my heart rate did, wasn't paying attention.  Rode easy home and then went to visit my daughter in Claremont for the afternoon.  I got home later in the afternoon and got in a 30-35 minute swim, finishing with about 4 x 50 yards of all out butterfly, one of my favorite new workouts.

I've got a long way to go, but at least it feels like I'm doing some real workouts.

My Body is Waking Up!

My coach let me know that my crazy heart rate response is the normal bodily response to getting back to exercise.  I took Thursday off for life.  Plus, I was feel a little sore from three days of cycling.  Friday, however, I got back on the bike and did the same ride.  Fortunately, the temperature was in the 70's and my HR stayed below 150 the whole time.  I did the same 2 mile uphill ride going very comfortably in a little less time (13 minutes), while keeping my HR close to 140-145 the whole time.  I'm really trying to stick with "easy" workouts, but right now, everything is a little hard if there is a hill involved.  That said, this was nice.  Overall, I took a few minutes off the time of the ride the previous day, and it was easier.  I did get in a couple of short swims as well.

Today was for fun.  My dad came over and we played basketball, badmitton, and pickleball.  We were at it for almost 2 hours.  I have to say, I don't know how he did it, because it was a solid work out for me.  My foot is holding up, although it does still hurt, I'm taking the attitude that I have to just start using it and see what happens.  I'm considering a little barefoot running on my front lawn.  I can actually manage about 15-20 yards straight at a time.

Other than that, I just chilled today.  Haven't really had a lazy day like this in a while.  Still glad to know that my body is waking up!

One Step at a Time

Today is Wednesday, October 3rd.  On monday, I started training again.  I was planning to ride my bike on monday, but some other plans came up and I was going to bag it when my wife insisted that I get out for a ride.  The moment I hit the road, I knew that I was ok.  I'd been worried a bit about my motivation, but that concern instantly disappeared.  I went out on a route that I've been excited about since I moved here, but I hadn't taken.  It's essentially a 12 mile out and back that takes me to into the Malibu Hills.  On Monday, I tried to ride as easy as I could, but a 500 foot elevation gain over 6 miles, coupled with 90+ degree temperatures assured that my heart rate would spike no matter how easy I tried to ride.  I was pretty short of breath and my heart was beating rapidly when I hit the turnaround point.  The ride home was enjoyable and I knew that I was back into my training.  A 15 minute easy swim rounded out my workout schedule for the day.

Tuesday, I did the same ride.  I left later, so the temperatures were already in the mid 90's.  I wore my heart rate monitor and at the top of the climb it hit about 170 bpm.  My lactate threshold on the bike when I'm in shape is about 156.  I have no idea what this HR meant, but I was breathing pretty hard as I got to the top of the climb.  Another 15 minute easy swim completed my workout.

Today, I felt a little better, my HR wasn't as high, and I got to the top of the climb feeling good.  I rode 2 miles downhill and then came back up a 2 mile climb that I did back in July going hard in 9:30.  Today, going "easy", it took me 13 minutes.  I've got a ways to go!  My ride today was almost 16 miles, and took me about an hour and 5 minutes.  My HR was around 150 for most of the ride.  It wasn't as hot today, but still was on the warm side.

Since my heel continues to be a bit of a problem, I will continue to focus on the bike and the swim for my training.  Ironman Lake Tahoe is just under a year away, and I need to be ready.  I want to be ready!  One step at at time.

I need a routine

I realized over the weekend is that I've been missing having some sort of routine.  My grand experiment to be unstructured has not been a total success.  That said, I'm not sure that I had a choice!  Life has managed to once again get in the way of my training goals and desires.  The good news is that Lake Tahoe is 14 months off!

On friday I actually managed to run 4 miles, and my heel is holding up, just a little sore (enough to remind me to be cautious).  Saturday was a 1 hour bike ride with three 5 minute hill intervals up a 1/2 mile/11% hill in descending time (5:25, 4:55, 4:25) corresponding to what probably was around 210, 250 and 280 watts---love those bike calculators!).  Sunday was a 2 hour group ride which included the Rockstore climb (2.5 miles/6.5%), which I did on the wheel of someone better than me (who was nice enough to go easy), at tempo effort.  I couldn't wait to get to the top!  But it hurt so good!  Lots of hard efforts in the ride.

I manage to get into the pool for 15-25 minutes almost every day, so I'm keeping my form and some semblance of swim shape.

I wore my garmin of for my bikeride on Saturday.  Maybe I do need feedback to motivate me?  We'll see.  Today is a day of rest for my mind and body.  Even trying to avoid doing do much for the house!  Got in my short swim this morning, may do another one later on.

Trying to Train

It's been a tough month for training.  I've still been fighting some pain in my heel, and remarkably I've had more 15 hour workdays than I've had in a long time.  And I'm retired!  However, I actually feel pretty good about this past week.  Saturday started with a 3 1/2 mile run and was followed by a swim.  Sunday was a solid 2 hour group bike ride followed by a 21 minute transition run.  I even got in another swim later in the day.  Monday and Tuesday were 15 hour days with no training.  Wednesday started with a short swim and finished with 1 hour of hot yoga.  Today, I got in about a 30 minute bike ride with some intensity, and a short swim.  I feel like I'm at least keeping myself moving and getting some intensity in.  I actually feel like I'm finally starting to get back on track.

The last couple of months have really been a test.  I'm so used to a rigorous training schedule, I mentally and physically want to maintain one.  Unfortunately, my days are fraught with uncertainty.  I've certainly been taken "off my game".  This has made it hard to get workouts in.  Today, was a triumph.  I had a pretty full day and still managed to get myself on my bike and into the pool at the end of the day.  That said, I don't want training to be forced.  I continue to dream about the time in my future where my daily focus will be on my wife and my training.  In the meantime, I'll do what I can.

A Week of Training

The week started with some swimming on monday and a cortisone shot in my left heel.  Tuesday and wednesday were limited to swimming only.  Thursday and friday were 3 1/2 mile run days and some more swimming.  Yesterday, I spent four hours on my feet preparing my house to be fumigated.  My foot/heel were starting to hurt again, and I was a little worried.  Today, was a 3 hour, 50 mile bike ride with climbing, hard intervals, and just a very solid ride.  It felt great!  I'm thinking of focusing this coming week on swimming and biking and giving my foot a little more rest and time for the cortisone to do it's job.  I'll be in San Diego on thursday, so I'm hoping that I'll have a chance to run some down there.  It continues to be remarkable how I can bounce back quickly based on my ironman fitness.  Overall, an encouraging week, but also a week that reminds me to show some caution.

Keep Talking About Healthcare

There are 124 days to the presidential election.  The republicans had wanted to keep the focus of discussion on the economy.  Remarkably, they are making sure that won't happen.  The focus of discussion will be on healthcare.  And, it should be!  For the next 124 days we should all keep our focus on healthcare.

Here's some reasons why healthcare should be the #1 topic of the presidential campaign:
Annual healthcare expenditures:  $2.6 trillion
Medicare:  $525 billion
Medicaid:  $401 billion

The population is getting older.  The baby boomers are starting to come of age.  Medicare will only get bigger.  A significant proportion of Medicaid dollars pays for the elderly to be in nursing homes.  In fact, Medicaid finances over 40% of all long term care services.

So, what does this all mean?  It means that our legislators have to stop ignoring the growing cost of the Medicare and Medicaid programs.  They are here to stay and they are only going to get bigger.

Why should people read my blog?  Because I am a geriatrician and a business person.  I have a unique vantage point to look at our health care situation.  For the past 12 years I have made multiple attempts to share my experience with legislators and bureaucrats, to no avail.  I cofounded a Medicare only primary care practice when other doctors were fleeing closing their doors to Medicare patients.  We were successful.

Those who can, do.  Those who can't, become politicians.  If we don't get our act together, we will bankrupt our country.  The politicians can't have it both ways.  As they talk about reducing Medicare expenditures, they can't blame the other side for "taking away your Medicare".  Besides, our legislators really don't know anything about Medicare.  But I do!

The Princess and the Pea

I remember the story of the princess and the pea.  It is a reminder as to how little things can become bigger.  Life is a lot like that.  Yesterday, I was able to get in a nice 1 hour bike ride with a very solid 2 mile climb with an average gradient of 8%.  It was a great way to start the day, then got in some more swimming and then got my cortisone shot.  The cortisone shot caused the outside of my foot to become numb and my pain mostly went away.  My foot relaxed and some of the tight spots that I had in my foot went away almost immediately.  Later on, I would get a massage and find out that many of the tight spots and problems in my left leg had gone away.  So, on one hand, the plantar fasciitis itself leads to other problems up my leg.  Ironically, the "pea" was replaced by a numb foot.  I spent the next three hours on my feet dealing with contractors at my house and, while I wasn't having any pain, I didn't realize the impact of the numb foot.  Suddenly, I could hardly stand.  Walking around on a numb foot takes it's own toll.  I had no choice but to stay off my feet, got my massage, and then just rested.

I woke up early today, got in a short swim where I practiced my body position and kick.  Just read a good article reminding me that fish don't have arms or legs and focused on moving through the water without my arms.

I'm going to the office today to see how things are going with our business.  I'm hoping to start spending more time there in the coming months.  Fortunately, I get to have fun doing this.  Fun is a better "pea" as well!

Time for a cortisone shot

Went cycling with a friend on Saturday, put in some very solid climbing (about 2500 feet of vertical in less than 2 1/2 hours).  Spent time in the pool over the weekend, focuses on kicking drills and swimming with a band around my ankles.  My left heel still hurts and my friend, who is an orthopedic surgeon, offered to inject my heel with steroids today.  I was going to try to wait this out, but I'm tired of waiting.  If I get a steroid injection, I can jump back into training more aggressively than I have been.  This will be good for my state of mind and my fitness.  My friend is an athlete, and understands that you can't just say "rest for 6 weeks and see what happens".

Plumbers, roofers, painters and electricians at the house today.  Amazing.  I'm no longer stressed by all the stuff going on, it will run it's course.  Did I mention the termites?  Oh well, we'll figure it out.  I've discovered that fixing your house is a lot like fixing your body.  You'll get multiple different opinions, and you just have to decide which one to go with.  Everyone thinks that they're right, and most of them are sincere.  Sounds just like going to the doctor!

Alzheimer's Disease and Hospitalization

Picture waking up in an unknown bed with your hands tied down and unfamiliar people around you.  Imagine the desperation that would go through your mind.  Think about the level of stress that would pierce through your entire body.  Then, think about going through this over and over and over again.

Someone with Alzheimer’s Disease experiences this very feeling when they are hospitalized and restrained.  They do not have the cognitive ability to cope with the situation and figure out what it going on.  This is why familiarity is one of the most important components in the care of someone with Alzheimer’s.

As a Geriatrician, I have often told the loved ones of Alzheimer’s patients that hospitals are dangerous places.  This is but one of the reasons.  The other reasons are also quite powerful.  Hospital borne infections, medication errors, unproven treatment modalities.  These are but a few more reasons to keep someone with Alzheimer’s out of the hospital.  

Are there times that hospitalization is required?  There certainly are.  One interesting example is the surgical treatment of a very enlarged prostate.  If the prostate enlargement is so great that a long term catheter is required, the short term risks of hospitalization often outweigh the long term risks of a catheter.  Keep in mind, aside from the inherent increased risk of infection, having a device inserted into ones body when the person will not remember why it’s there can be just as disconcerting as situation we described at the beginning of this article.  

If hospitalization is necessary, how do we approach it?  It is often a good idea to have a familiar person stay with the patient.  Nursing staff must be trained in how to interact with the Alzheimer’s patient.  This means not confronting them with their lack of memory.  It means constant reassurance.  Physical restraints are generally out of the question.  A kind word, a loving touch, often forgotten in the hustle and bustle of the hospital setting, may be enough to soothe the patient.

What are alternatives to the hospital.  Pneumonia, for example, doesn’t always require hospitalization.  Oxygen can be provided in the home.  Antibiotics can be given orally, or intramuscularly.  A loving caregiver, familiar food and surroundings, will make the recovery process easier.  Assisted living or nursing facilities, with staff trained in the care of someone with Alzheimer’s, may actually provide a better and more comfortable surrounding than a hospital.

Now, here’s the kicker.  The approaches that I’ve noted above are usually less costly than the hospital setting.  They are typically fraught with few complications.  Yet, our traditional health care system continues to choose the expensive, less effective approach to caring for our loved ones with Alzheimer’s Disease.  How can we change this?  Through education of health care clinicians.  That will be the topic of my next blog.

Listening to my body

I always tell my patients to listen to their bodies.  As a physician, I've realized the importance of looking for signs that are right in front of you.  Well, the last four weeks have been a struggle.  After moving to California, I've not only been plagued with tons of life stresses, but with some physical issues.  It started as a mild case of plantar fasciitis, which I babied, then did a 5K.  The afternoon after the 5K, I could hardly walk.  I babied it again, but even my wife noted that I was limping.  I did some swimming and a little biking, worked on massaging my calves.  This helped, but I still had some bad days.  I kept looking forward to doing an olympic tri today, but in the back of my head I knew that I could be pushing my foot too much.  On Friday, I woke up with my foot feeling better than it has recently.  No pain at all.  I went for a walk with my wife, and unfortunately, I could feel some discomfort.  I had a theory that walking was worse than running, so I went out for a run.  Overall, it felt pretty good, but later in the day, the pain came back.  In fact, I was really limping and was truly in a fair amount of pain whenever I put pressure on the foot.  Now, I am not one who really complains about pain, so I needed to listen to this.  Moreover, my left thigh was hurting because I had clearly been favoring the left foot during my run.  Lots of self massage, time in the jacuzzi, and finally some advil and I woke up today with only a little discomfort.  However, I know what I have to do.  I need to rest my foot.  Having just signed up for Ironman Lake Tahoe in September of 2013, I have a long ways to go before my next truly big race.  There is no need to cause any damage right now.  I have a pool to swim in every day.  I have my bike.

The other thing I've realized is that my motivation has also been lacking somewhat.  There's been so much on my mind lately, it's been hard to stay motivated about training.  That said, when I get out and train, it feels good.  That's been a struggle.  I want to spend time with my wife, work on my new website and our new business, and...aren't are retired?  I'm going to need to come up with some priorities, but it's really been hard to find the time to even think about that lately.

Back to my body and my foot.  Yesterday, I was hobbling around like an old man.  My father in law, 87 years young and status post a recent knee injection for his arthritis, was walking much better than I was!  Plus, I was really hurting.  OK, no race today.  And, time to give this foot a rest for at least a couple of weeks.  I'll try to spend as much time in the pool as possible.  But I also think that some mental rest would be good as well.  It feels right coming up with this plan.  Listen to my body:)

Training, in life

Since my last post a couple of weeks ago, I mentioned my plantar fasciitis.  It continues to nag me, but life has really been the nag for the past two weeks.  Construction on our new home, personal life challenges, dealing with a start up business, dealing with issues from my old business, it seems like I'm busier now than I was when I was "working".  I have realized one thing.  When I was working full time, my wife dealt with a lot of these things.  She dealt with contractors.  She dealt with our rental properties.  She dealt with the bills.  She dealt with the kids.  I "just" went to work.  Granted, I was a workaholic and took work home with me every night.  Granted, work was often far more stressful than I let on.  It's certainly all relative.  My plantar fasciitis seemed better for a couple of days, then got worse again.  I wonder how much is my body just rebelling right now?  My training has slacked off big time, I blame it on not having any time (which is partially true), but in reality, I'm just not feeling it at the moment.  The fact that my heal hurts with most every step doesn't help, but I can still swim and bike.  I've signed up for an olympic distance tri this weekend, and may not know if I'm doing it until Sunday morning.  Part of me just wants to do it for fun.  Part of me is worried about worsening my foot.  Part of me is just tired.  Could I make my foot worse?  Possibly, but in reality, if my heal acts up too much on the run, I could just pull the plug on the race and have gotten in a good swim and bike workout.  Well, maybe life isn't quite like racing.  I can't really pull the plug on life.  I've got to finish.

Waiting for the Supreme Court

We will soon be hearing what the Supreme Court has to say about the Affordable Care Act.  Does it matter as much as everyone thinks?  I have to say that I'm so tired of hearing both sides talk about the Act as if it's either the solution to the health care crisis or the end of civilization as we know it.  It's neither!  And the worst part of all of this is that we're all spending our time fighting, rather than finding solutions.  How can we have life, liberty and the pursuit of happiness without adequate health care?  I just moved from Colorado to California and I will have to reapply for health insurance (with the same insurance company, no less!).  Of course, I have to buy automobile insurance, but that isn't an infringement on my personal liberty (I know, it's a state requirement, not a federal one.  State governments can tell me to buy broccoli, but the feds can't)?  There are a bunch of items in the Affordable Care Act that are truly a waste of everyone's time and money, but because an intern in a Senator's office was interested in it, it got put in the bill.  The Republicans came up with many of the core elements of the Act, but now that the democrats support it, they're against it.  Most people that are against the Act can't even tell you what's in it or what it does.  There is no rationing of health care in the act.  There are no death panels.  At the same time, there is really no part of the Act that effectively puts free market forces back into healthcare.  The health care market is presently a free market for insurance companies to make as much money as they want.  It's also set up for specialists and medical device makers and pharmaceutical companies to spend our hard earned dollars on treatments that have not been shown to be beneficial.  We are in the 21st century of snake oil and don't even know it.  So, what are we really waiting for?  The entire legal battle over the Affordable Care Act has been nothing more than another way to kick the health care can down the road.  Neither party is truly interested in solving this problem.  They're only interested in getting reelected. Maybe it's time to throw them all out!

Is the Juice Worth the Squeeze?

So, today I've been hobbling around.  I'm a little embarrassed by that fact, as my wife seems to feel sorry for me.  But it's my fault.  I was determined to do a 5K yesterday despite struggling this past week with some plantar fasciitis.  I was doing a lot better, and didn't really have any pain in the foot yesterday morning.  Last night and today are a different story.  Ahh, but back to the race.  It's a local 5K/10K in Westlake Village supporting an organization called Senior Concerns, which provides service for seniors in the area.  I chose to do the 5K, because I only wanted to suffer for about 21-22 minutes.  In fact, I really wanted to see how hard and how fast I could go.  It was about 65 degrees, but it was humid out.  I ran the course for my warm up, going pretty easy, with four forty-five second efforts fast towards the end.  I sweated a ton and decided that I wasn't going to wear a hat, as all it seemed to be doing was keeping the heat in.  I seeded myself at the front, which was good, as it turned out that over 650 people were doing the 5K (about 250 men, and over 400 women).  I was actually a little hemmed in at the beginning, but quickly made my way out, letting all the young people do their 100-200 yard sprints.  I really focused in on keeping a fast pace and breathing every 3rd step.  One thing was odd today, it almost felt easier to run fast than it did to do my slower warmup!  I didn't wear any electronics, so was just going by feel.  Through the first mile, only a few people passed me, and I found myself passing the folks who went out too fast.  The effort started to get harder, but unlike some of my past 5K's, I didn't feel like I was slowing down as I started the second mile.  In fact, when I got to the turnaround, I was still feeling fairly solid, though it was definitely getting harder!  I passed a few more people and by the time I got to the 2nd mile marker, I realized that my breathing had started to pick up and was just now getting closer to every 2nd step.  I passed a couple of more people and then noticed that I was keeping pace with the woman in front of me.  There was a guy behind me, I pushed a little, he stayed with me, I was starting to hurt, but I knew that I was getting to a slight downhill just before turning to the uphill finish.  The guy behind me passed me, and I didn't feel like I had another gear.  As I turned the corner to the uphill finish, I felt like I was giving it all I had, but didn't really have a "kick".  I did see the clock as I approached the finish line, and knew that I was going to be right around 21 minutes.  I glanced back and there wasn't anyone close.  My finish time was 21:06.  This was my fastest 5K in the past few years.  It was probably the best I could have done.  I always over analyze races, and my over analysis of this one would suggest that maybe, just maybe, I had 20-30 seconds in me.  However, I can't really be sure.  I feel like I slowed a bit over the last mile, but I think I really nailed the pace/effort over the first two miles.  Afterwards, I ate and drank and then went to look at the results.  Lo and behold, I was first in my age group!  Of note, there were two 55+ guys who beat me:).  That said, I was still about 24th amongst the men, and only 4 women beat me.  It was a very solid result.  I waited for the awards ceremony, this may have been the first time I'd ever received a 1st place AG award in a running race.  Standing around was probably not good for my plantar fasciitis, which reared its head later in the day.  This morning, I hobbled around and have been hobbling a lot.  But, I do have that medal!  I guess the Juice is Worth the Squeeze after all.

California Dreamin'

This may end up being a perfect day.  I woke up early, as usual, had some breakfast and went to Home Depot to get some pieces of wood for a step for our jacuzzi (didn't work in the end).  Drove out to Newbury Park to pick up my bib for tomorrow's 5K and then headed to Westlake to meet up with Larry from the tri club for a tempo workout.  It was a group workout, but just the two of us showed.  It was a little cool, and a little humid, but it quickly warmed up and the humidity did lead to a lot of sweating.  I warmed up for about 10 minutes before Larry arrived, then we did a warm up ride out to the starting point for our 4x5mile tempo intervals.  The ride is along a long country road, not too many cars, and we even get to pass by Tom Selleck's house!  Larry and I are probably fairly even on the bike, although I had my aero helmet on and he didn't.  The first interval started nicely, I really tried not to go out too hard and let the effort come to me.  It did, and we were against a headwind with some rollers along the way.  I maintained a solid cadence and pushed fairly hard, leaving something in the tank for the next three intervals.  Took a short break to get our breath back and did the 5 mile return.  Most of this was with a tailwind, but I still managed to push my effort quite solidly.  The third interval was the one I'd been waiting for.  I got up to speed and then held a hard effort that got me nauseated about a mile from the end, but I really worked to hold on to the effort at the end.  Stopped briefly to talk with a couple of 70-80 year old guys who were out riding and were impressed with our bikes.  We were impressed with their engines!  I hope that I'm riding when I'm 80!  The last interval was quite solid, probably not quite as hard as the third one, but definitely pushing into the red zone a bit.  Cool down ride back and we were done with what turned out to be about an hour and 45 minutes of cycling.  Drove back to my daughter's house, they're out of town, so I mowed their lawn (hand mower!).  I managed to break a sprinkler head.  Cleaned up around their yard.  All in all, about an hour's worth of yard work, the mowing was intense.  Got home and spent time in the pool with my wife and daughter.  These days when I'm in the pool I'll swim, do drills (one armed swimming, sculling, kicking), swam some with a band around my ankles.  Hopped into our new jacuzzi and then showered and am writing this blog.  Frozen yogurt is up next, then we're going to see a friend's young daughter in the musical Annie, she has the lead!  My plantar fasciitis is improving by the day, hope all will be ok with the 5K tomorrow.

Yay, my butt hurts!

I know the title of this post sounds silly, but I felt yesterday's run today.  Hill repeats are a great way to work on ones running strength, especially the glutes.  So, that's why my butt hurt today.  But, it was a good hurt!  While I never had time to do any training today (more meetings with people with the new house, more driving for my daughter), all day long I felt yesterday's workout and it felt good.  Every day I realize more and more why my present approach to training is perfect.  I don't feel like I'm having to choose my training over my personal life.  I do what I can do.  Every so often, the thought of increasing training, doing the bike experience, racing, creeps into my mind.  But, I realize, do what I can, but keep the focus on being around for my wife and family.  They deserve it so much!  In fact, I probably could do this for the next 30 years and not give back what they've given to me.  That's why it felt good to have my butt hurt:).  Tomorrow is another busy day with lots of driving, but I do have some plans for the weekend.  The tri club I ride with is doing long tempo intervals on saturday, due to the 5K on sunday.  So, I plan to do both!  The idea of getting some good intensity in this weekend feels good.

I also got some new running shoes today, neutral shoes with some good padding, already feels like it's helping my heel, which continues to nag me.  Also, some self massage of the calf is helping.  Driving sucks, but I try to flex my foot as often as possible.

I'm also incredibly proud of my family.  My wife has been helping to orchestrate our move, provide moral support for both of our daughters, and for the last two days, taken care of our grandbunny.  My oldest daughter is putting in long days for a pretty intense graduate school class, and loving it.  My youngest daughter and son (in-law) is in Philadelphia working for our internet venture, which launches on saturday.  They've been essentially working around the clock.  Genetics, I guess:).

Oh, yes, our new hot tub is up and running.  Guess what I'm doing next?

Moving In

Wow!  Moving in is its own ironman!  Yesterday, I managed to sleep in til about 8am, but then had to meet with contractors, pool people, electrician's, an interior decorator, etc.  We then had to help get dinner for my daughter and son in law who have been working long hours in preparation for the launch of our new internet site.  I didn't get to bed until about 1am and got up at 5:30 am this morning.  Finally, waking up early!  Put on my running shoes and just ran around our neighborhood, really trying hard not to pay attention to time.  The effort was moderate, and I sprinkled in some fast strides towards the latter half of the run, before doing 4 trips up a 1 minute steep hill at all out effort.  It's kind of fun, the first fourth of the hill is moderately easy, the next fourth is moderately hard, the third fourth is very hard and the final fourth is extremely hard.  I walked down to the bottom each time.  Four times felt like enough today, I jogged to Starbucks and then home to read the newspaper.  Then, a 3 1/2 hour excursion driving my daughter and son-in-law to the airport.  Got home and took a two hour nap, this helped, but was still tired.  Did manage to jump in the pool for a short swim before talking to our real estate agent in Colorado.  Isn't retirement fun!  My left heel continues to nag me, last weeks massage helped, looking forward to another one on Sunday.  I think all the driving is putting the foot in a bad position and trying to cause me to have some plantar fasciitis.  I need to keep flexing the foot and keeping it stretched.  So, getting back to training in fits and starts, I am planning on doing a 5k on sunday.  That should be interesting!

Exhaustion, not so much!

Yesterday was a pretty tough day.  I felt completely exhausted, did jump in the pool twice for some exercise and relaxation.  Did some unpacking.  Tried to nap, a few times.  Honestly, I felt like an old man.  I was tired, I was aching.  I began to wonder if I'd ever do another triathlon, much less an ironman.  I went to bed at 8pm, woke up before 6am and was out the door driving to my CV Tri Club Sunday bike ride by 7:30am.  The group is great, lots of really nice people, pretty laid back.  I felt great!  We rode out to Point Magu, then back along Pacific Coast Highway with a 7 person pace line.  I was comfortable with about 1 foot between me and the person in front of me, I know, I can still improve, but not too bad.  I felt pretty darn strong today.  The final part of the ride was a 9 mile climb at about 4% grade, I essentially did it as a tempo workout.  Didn't quite keep up with the two people who went ahead, but pretty much held my own today.  Great day, riding in a group, climbing, riding in a paceline.  I am back!  All in all, this was about 3 hours and 15 minutes in the saddle today (I know, I'm not supposed to look at time, but I couldn't help looking at my clock when I got in my car).  I was thinking of a number of things to blog about as I rode, but decided to focus in on how exhausted I felt yesterday, and how good I felt today.  It's a reminder that I need to train!  It gets my adrenaline going and keeps me feeling good.  The best part was getting home and telling my wife, "let's drive to Malibu for lunch!"  Spent the afternoon with my wife, came back home and took my daughter and son-in-law out for frozen yogurt.  Still with energy...this is a good sign.  Yes, endorphins are good for you!  It was also a reminder how other stresses can tire you out, like unpacking all week, and driving a ton.

Well, enough for today, still have some daylight left, might jump in the pool for a short swim!

The benefits of massage

For the past few years, I have been getting a weekly massage.  I struggle sometimes with the cost of doing this, but with my training schedule, I've believed that regular massages have helped keep me injury free.  In the past 3 week, post Ironman St. George period, I had one massage.  In addition, I've driven from Denver to California twice, then drove to Northern California and back in the course of two days.  Plus, we've been unpacking...need I say more.  I've been noticing my feet hurting every day.  Tonight, I finally got a massage her in California.  I think that every muscle in my body felt tight and a little sore.  Now, it feels better.  I clearly must get back in the routine of taking care of my body.  Also, I think the soreness was beginning to mess with my mind a little in terms of training.  I've been looking forward to getting back to my regular training regimen, but have to admit, the soreness was tugging back at me somewhat.  I was also concerned about finding a good massage therapist, but I think that I've lucked out.  Some members of the local tri club that I've joined recommended someone to me, and she's different than what I've been used to, but seems to be effective.  I've definitely been spoiled over the last few years, and finding the right person can be challenging.  When you train for an ironman, you are pushing your body, it needs to be treated well, and massage is part of that.

No training today, if you don't count getting up at 6am and unpacking until about 4pm.  I even washed some windows in our new house.  My wife is beginning to wonder where her husband disappeared to, or perhaps I've been taken over by space aliens.  It's funny how new surroundings and a new life can help you change an evolve.  Just like triathlon, it's really all about the journey!

Finding Trust in Today's World...at Starbucks!

I was going to blog today about moving...that's what I spent my day doing yesterday, and it may have been harder than Ironman St. George!  Unpacking 30 years of "stuff" is going to take a good part of the summer, if not longer.  However, my day started in an interesting fashion.  I woke up around 6am, that seems to be my "retirement" wake up time, stumbled to the counter in the kitchen of my daughter's house (where we're staying for the time being), grabbed my wallet, keys and I-phone and went for my walk to our new house about 1.25 miles away.  About one mile into the walk is my new favorite Starbucks.  On the way, being very careful, I read Moonracer's blog about Pinterest on my I-phone.  I recently read an article about reading while walking, but I only read on the sidewalk and keep an eye out for cracks, etc.  I learned that Pinterest is about pictures, and women really like it.  I may have a ways to go yet, but I'm going to try to learn it.  I got to Starbucks, got my L.A. Times, my Blueberry Oat Bar and ordered my Venti 2 pump Vanilla Soy Latte and went to get my Starbucks card out of my wallet, oops!  I had taken my son-in-laws wallet!  Alas, no money (we need to have a talk), and no credit cards (that's ok).  I realized that he probably needed his wallet today, so I decided to head back to the house.  The guy behind the counter said, "you can pay tomorrow, I've seen you here before".  Wow!  This is Starbucks, this is Los Angeles, this is 2012.  Granted, I've been coming here for the last few days, but trusting me for my $7, what has the world come to?  I know it's a little thing, and it is really good business, but it was nice.  Really got my day off to a good start.  I am a very trusting person, and sometimes we trusting people are taken advantage of.  In fact, I've contemplated the value of being a trusting person in an untrustworthy world and generally have decided that I'd personally rather go to sleep at night being trusting and recognizing that not everyone is to be trusted.  I need to be me in the end.

Speaking of being me, I decided to run back to my daughter's house.  Fortunately, I had actually worn running shorts this morning!  So, I got 2 miles of unplanned running in this morning, it felt good.  My feet hurt from months of ironman training, the race, and standing around all day yesterday with the movers.  But, running doesn't hurt, go figure.  Then, back to Starbuck's, where my 2 pump vanilla soy latte became a regular vanilla soy latter (needed the extra sugar with the 2 miles of running) and on to our new house to eat my blueberry oat bar, drink my coffee and read the L.A. Times (I still like a real newspaper in the morning).  There is some peace in the quiet of the morning in our new surroundings.  That's one of the reasons we bought the house, the yard is like an oasis.  Of course, the house is full of boxes today, the painters are here and I'm presently blogging in order to avoid unpacking:).  Well, enough of that.  Time to go to "work".

It's good to have my running legs back

Woke up this morning in San Jose, giving a lecture at noon, so had some time.  The Stevens Creek Trail is right near my hotel, the Hotel Zico, and I just ran on it until it finished and then ran some more along the peninsula on the San Francisco Bay Trail.  I tried hard not to think about time or distance, but years of running and being obsessive didn't allow me to completely free those thoughts from my mind.  The goal today was to just run and enjoy, did the "out" part pretty much in zone 2, very comfortable, breathing up to every 4th step, enjoying the scenery and just enjoying being out there.  My right quad was actually still a little sore from the bruising that I certainly caused running into the metal railing two days ago.  Fortunately, running didn't make it worse.  After what seemed like a reasonable amount of time and a reasonable location (somewhere between 5-6 miles/40-50minutes), I stopped, stretched for a few minutes (this is for my wife, who says that I don't stretch enough!) and turned around.  On the way back I did fartlek's (speed play for the non-runner reading this), pushing myself to breathing every 3rd step (Zone 3-4) for anywhere from 2-5 minutes, and alternating with just comfortable running  When I was within about 10-15 minutes of my hotel, I walked for a couple of minutes just to let my legs unwind.  Then, ran to the Hotel.  Seems that I ran about 80-90minutes.  Sorry, I'm not supposed to pay attention, but I'm weaning myself from that:).  My legs held up just fine.  Looking forward to my lecture.  I'm trying to teach doctors what it takes to be successful in billing for and caring for Medicare patients.  Turnout is typically poor, as doctors are stubborn creatures of habit who don't like listening to anyone (I can say this, because I'm one of them!).  While it goes against my nature, I'm starting to share that I'm 53 years old (triathlon years of course, as my birthday isn't until next month), and I'm retired.  Wouldn't these doctors like to learn how?  Or, would they rather continue complaining that Medicare sucks?

I am 17 days out from Ironman St. George, I felt good running today.  I think I'm recovered pretty well.  Tomorrow the movers come, though I'm sure I'll find a way to jump in the pool.  There's a 5K in Westlake Village in 1 1/2 weeks, supporting local senior services.  Can't miss that opportunity, and after todays run, I feel like a 5K would be just what the doctor ordered!  Now, I just need to avoid metal railings!

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.