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.

Journey Back to Kona Day 132: Priorities and Detours

I titled my blog for the past 132 days, "Journey Back to Kona." That's truly something that mattered to me 132 days ago.  It still does. However, it's not the most important thing every day.  I truly meant to jumpstart my training over the weekend, but other stresses, pressures and priorities got in the way.  I managed to run 14 miles on Saturday, but was really exhausted afterwards.  I continue to realize the physical exhaustion that comes from mental stress, which I've had impacting me from multiple directions. Today was going to be a day for riding my bike.  For all I know, I still might, but again, I need to adjust my priorities and be prepared for detours.  I continue to juggle a number of commitments and, when under other pressures, sometimes freeze up. Such is the nature of anxiety. When I look back, I recall when I first began having panic attacks, which I didn't realize at first. I'll never forget describing my symptoms to a cardiologist, and literally realizing my own panic attack diagnosis.  To this day, I know that feeling and its various manifestations. The most important thing I can do to deal with it is to acknowledge my priorities and the fact that detours are inevitable.

I reread a book about Wilt Chamberlain and Bill Russell over the past several days.  Books like this take my mind off of the other stresses and pressures that I've placed on myself, but they also remind me of my childhood, when I could never get enough sports.  Reading about the 1969 Basketball championship, I literally returned to being 9 years old. The Lakers were my team. I'll always remember my disappointment when they lost to the Celtics in the seventh game.  Those feelings returned as I read about the intrigue that went on during the end of that game. An intrigue that ultimately spanned decades in the relationships between the individuals involved in the game that very day.  I've previously read a biography of Jerry West, and realized how much we have in common. A deep desire to help others, to want to be collaborative, but also to have an intensity and perfectionism to balance, is extraordinarily stressful on the human psyche. And so, I must once again come to grips with my priorities and detours.

I keep saying that I'm going to cut down on my priorities, and then I keep adding to them. I continue to make excuses based on both opportunities and an inability to say no. On those occasions that I really focus on my training, I believe that I feel better, but when fatigue builds up, especially with the combination of physical and mental fatigue, my struggle heightens. 

Reading something that isn't work related, such as the basketball book, is definitely the best way for me to begin my days.  Writing is critical, and I've been improving on my habit of getting my blog written in the morning, such as I'm doing today. Stretching is a physical necessity. My physical activity levels have been a bit of feast or famine. That is probably something I need to work on.  I've come to either work out for 2 hours, or not at all.  There might be an in between. 

My grandson told us yesterday that he'd been sad because he hadn't seen us over the past two weeks.  We were staying away due to the Omicron variant and out of an abundance of caution. This damn pandemic has its tentacle in too many aspects of my life. I really haven't been able to avoid it or to separate myself from it. When work and family become intertwined, it's really difficult to separate them. But, I guess that's all part of my determining my priorities and detours. And so another day goes by. I was planning, and hoping to ride my bike. But, I have too many commitments that I've made. I need to clean them up first. That's what I'll do today.

Journey Back to Kona Day 129: Time to Train!

I've struggled over the past couple of weeks with life issues, but honestly, just haven't felt like going full bore in training.  In reality, it doesn't matter. I won't be a slave to training, and I won't do what I don't feel like doing.  However, I really do want to acquit myself well both in the half ironman in Oceanside and definitely at St. George. St. George and I have a score to settle! So, it's time to train!

I've essentially taken the week off, but that means that I should be well rested and ready to go this weekend.  I'm anticipating putting in some significant running miles in the morning and follow it up on the bike afterwards.  A solid weekend of running and biking should give me a pretty good idea as to where I am and what will come next.

I've been following both my mind and my body for some time. There's no question but that my run fitness is beyond good.  The bike fitness will come quickly, but at the end of the day, in May I'll be looking to bike a very hilly 112 miles and wanting to feel reasonably well with the subsequent marathon.  It won't happen by wishing it to happen.  It will only happen if I'm well trained.

I never got around to writing this morning, but I did read and I did stretch. So, I've now gotten my writing in. I managed a 3 mile run, which was something. I guess I'm challenging myself now for what the next couple of days hold, and after that, what the next week holds. No goals, no expectations, listen to my body, listen to my mind. There's a reason I've titled these blogs "Journey Back to Kona." I really want to get back to Kona. I really want to qualify. I really know that I'm capable of it. But, if it's going to happen, it's time to train!

Journey Back to Kona Day 128: To Sleep, Perchance to Dream

I woke up a few times last night, each time thinking of something that I wanted to write about. Of course, it was about the pandemic, and little our country seems to care about older adults, particularly those that live in nursing homes.  It is what I've been focused on for the past 22 1/2 months. I also just finished a book about Lincoln's Second Inaugural Address and have Lincoln's writing style in my brain.  I think that I kept waking up with a combination of an article and the style of Lincoln mixed in.  When I woke up this morning, the thoughts were gone.  I'm reminded of a few things.  The first is that there are times that I wake up with a thought and I actually get up and write it down.  I didn't do that last night.  I'm ok with that, because I needed to get my sleep, having to wake up this morning for a meeting. I also know that the thoughts are still within me, and they'll come out soon enough.

I process things when I sleep, and some of my dreams provide me with answers and direction. In some ways, not getting up last night to write down the article that was in my dreams and thoughts was also a recognition that I'm trying to move on.  I have a call this morning, it's an Advisory Council for a project that I'm interested in.  I know that I'll have my differences of opinion on the plans for the project.  That's who I am. If everything was just right, I wouldn't be. At the same time, I will mostly listen and take notes, made much easier (in some ways, but not in others) by the virtual nature of today's meetings.  Multitasking has become the enemy of an effective participation in a meeting. That includes daydreaming, which can occur whether you're in the room or not. Taking notes will help.

There is so much yet to do. Projects to work on, articles to write, Initiatives to promote. Strategy and tactics to plan. There is also my training, which has taken a complete back seat over the past two days, and may very well do so today. I actually went to bed a little late last night, but, in the end, I slept, and I dreamt.

Journey Back to Kona Day 127: Feeling Overwhelmed and Reminiscing about St. George 2012

We're having trouble with the ventilation in our house, or so we think.  It's also allergy season, with pollen levels higher than usual.  We recently added insulation to our attic as well as a radiant barrier, and we're quickly trying to become atmospheric scientists, trying to learn about airflow. Oh yes, we're now 22 1/2 months into a pandemic that has us living in a somewhat dystopian world. Does this add up to stress? I'd say that it does.  How do I handle this stress? It really depends on the day, but I'll admit that I didn't handle it yesterday, it handled me. In times like this I tend to find my way back to Ironman St. George in 2012.

I remember how fast I was swimming initially.  Instead of the lead group of swimmers rapidly pulling away from me, it seemed like I was keeping them within my reach, until the first left turn. I remember the chop starting at that point, but for some reason it didn't really connect. Until I got to the next turn, which brought us back directly in the face of what had been a strong tailwind on the way out. I remember it like it was yesterday.

I couldn't see any other athletes. I was alone. The waves, acting more like a washing machine going up and down, were all around me. I swallowed some water, never a good feeling. I switched briefly to treading water, and my left calf cramped up. I will always remember that moment. For the briefest of moments, I was worried about my own safety. I'd previously had issues with anxiety attacks in the water, that I had ultimately correlated to having gotten kicked in the face during a triathlon. I'd fought through this and hadn't had any problems. This was not the time for this to resurface. In fact, it wasn't the time to worry about myself. And so, I worried about others.

It's ironic to think, as I look back on that day, that the focus of my thoughts for the remainder of the swim was on the safety of others.  With every stroke, I thought to myself, "I hope that no one dies today." In fact, my focus was on taking one stroke at a time.  I recalled my coach's guidance that doing an ironman was all about being in the moment.  At that point, I took that concept to heart.  For months afterward, despite a variety of life stresses that included moving and getting involved in a stressful new business that I literally had no clue about, I took that guidance to heart in my life.  But, after awhile, life filtered back in and I lost that sense of equanimity. And so, here I am today, feeling overwhelmed.  

When I feel this way, I try to recall that day in the water at St. George. I try to focus myself on that feeling in the water and the concept of just putting one arm in front of the other. In many ways, the past two years hasn't been totally different.  My focus has been on worrying about others, and on trying to do whatever I can to help.  Obviously, that day in St. George, the only person I could actually help was myself. Maybe that's part of the message today.  I need to take care of myself.

Journey Back to Kona Day 125: Fear is a Powerful Motivator

Twenty eight years ago, I was awakened by our house shaking.  I felt like the house was going to fall down.  Fear and protecting my children were my immediate motivation. Fear is a powerful motivator. I jumped out of bed, and was quickly thrown against the wall of our bedroom by a powerful shake.  That didn't deter me as I ran across our upstairs hallway, as another shake threw me against the wrought iron railing that looked over our stairwell.  It was only later that I would see the 1/2 inch indentation in the wrought iron that my knee had slammed into. Continuing on, I saw my oldest daughter, six years old, standing in the hallway looking dazed.  My first instinct and primary emotional reaction was to get my youngest daughter, who was almost three years old.  I ran into her room, grabbed her out of bed, and was soon thrown against the wall by another shake, while holding her in my arms.  Fear is a powerful motivator. 

While all earthquake guidance says to get under a doorway, I literally wasn't thinking.  I bounded down the spiral staircase, two steps at a time, while carrying my daughter.  Our front door, double dead bolted, was wide open, as I  briefly heard our home alarm go off.  I ran out the front door and onto our front lawn, where I put my daughter on the ground, turned around, and was about to run back into the house to get my older daughter.  Fear is a powerful motivator.  But, my daughter immediately started crying, and I knew that I couldn't leave her.  So, we waited.  It seemingly took forever, but the quaking subsided and I called to my wife and daughter, still upstairs in the house.  They made their way downstairs and joined us on the lawn.  And then I passed out.

My wife thought that I had passed out from the fear and excitement of all that was happening.  The reality was probably more simple.  I finally felt the pain in my knee from slamming against the wrought iron railing.  I was fortunate that I hit my knee squarely on my patella, or I might have managed to injure the joint itself.  Instead, the bruise would hurt for the better part of six months.

Fear is a powerful motivator. In that moment of fear, I'd forgotten the mantra that I'd learned twenty years earlier while taking a lifesaving course: "Suck, tuck, sink and think." Or, as a physician encountering a code blue situation, as describe in "The House of God": "first, take your own pulse." On the day of the earthquake, I'd forgotten both and reacted solely to the fear.  

Nearly two years into a pandemic that has elicited similar feelings and engendered a near daily (if not hourly) motivation to protect the vulnerable, I am reminded by the power of fear.  There are many who criticize that fear and debate whether and how it should guide our actions.  I will readily acknowledge that reacting in fear does not generally result in the wisest or pragmatic response.  It is, after all, an emotional response.  It's time to take a breath, sit back, and take my own pulse.  It's time to let go of the fear,

Journey Back to Kona Day 124: Hitting the Reset Button

Yesterday's long run (14 hilly miles) was reminiscent of other times where I've gone out for a run after taking some time off and finding that my heart rate was higher than usual.  It's an interesting phenomenon, and I don't know if it's just a pure coincidence or has some basis in science.  I chose to run based on how I felt and how I was breathing, which should have correlated to a lower heart rate, but didn't.  There are schools of thought on this that suggest that the higher heart rate reflects a higher work load and should be considered as such.  There are other schools of thought that suggest that heart rate may be higher or lower based on a variety of circumstances: heat, humidity, etc.  Regardless, I just decided to go for it.  It wasn't like I'd taken a prolonged amount of time off from running.  In fact, I'd run three days before, albeit, only for four miles.  And, I was only one week removed from a fairly average running week of 40 miles, which came at the end of a nine week stretch where I averaged nearly 45 miles a week.  I'd also began cycling a couple of weeks ago.  Oh yes, more importantly, as I noted yesterday, the past few weeks were a regular adrenaline cornucopia.  The feeling of fatigue, and an increase in my allergy symptoms were telltale signs.  So, lots of reasons for my heart rate to run higher during yesterday's run.  Perhaps it was time to hit the reset button.

The first half of my run was fairly mundane.  I kept my breathing to every 5th step most of the way, which would theoretically have translated to a low Zone 2 effort.  My pace was actually right up there, however, which might have been an indication that I wasn't breathing hard enough for the effort that my body was exerting.  Fascinating concepts that I don't always consider.  I endeavored, on the way back, which begins with three miles of continuous climbing, culminating in a nearly one mile climb of around 8% incline, to stick to my Zone 2 breathing effort.  Of course, my heart rate still ran high.  I was doing ok until I got to the hill at the end of Mile 11.  Something inside of me suggested walking up the hill.  This might have (ok, it probably was) an indication that my breathing and effort weren't synchronized, and that my heart rate had been reflective of my effort.  At the top of the hill, I got back to my running effort and maintained it until my final short climb home, which I once again walked.  My downhill pace during Mile 14 was slower than usual, suggesting yet again that my body had felt the impact of the run.  But, this is where the concept of the reset comes in.  In my experience, it's runs like this that actually allow my body to reset itself.  

In the past, instead of a long run like yesterday's, I might have done a shorter run with high intensity and high heart rate to get my heart rate response back to normal. It might be two sides of the same coin. Or, it might all just be a coincidence.  While I will admit to some general fatigue and slight soreness yesterday after my run, I woke up today feeling relatively good.  Not great, but good.  My allergies seemed less intense, my soreness was minimal, and my attitude was good.  Not great, but good.  I got up, read the newspaper, stretched, and now am writing my blog. Read, stretch and write.  Now it's time to run.  For how long? I won't know until I get out there. How hard? The effort will definitely be easy today. What will my heart rate do? I'm about to find out.  We'll see if I actually hit the reset button yesterday.

Journey Back to Kona Day 123: Getting Back on Track

It's hard to believe that I haven't written in 20 days, and that my last blog was about getting "off track." The last 20 days have been anything but getting back on track. With the rise of Omicron and the uncertainty around its spread and impact, I went back to some of my old ways.  Instead of awakening to reading, stretching and writing, I found myself obsessed and consumed yet again.  For a couple of weeks, I still managed to run and start biking (which felt great). But, there was something wrong.  It finally reached its pinnacle several days ago, when I began feeling fatigued in a way that wasn't good.  It wasn't just the training, which had actually been solid, but hadn't been overwhelming.  It was the daily adrenaline rush.  

My first effort was to get CALTCM's Board to approve a resolution, which they did on December 31st. My secondary effort was to promote the resolution in social media. Ahhh, social media. Twitter. Where I think I have an impact, but may only be speaking to my own echo chamber. Yes, I've been quoted in a few news articles in the past few weeks.  Yes, my message continues to be honed.  But, I spend an inordinate amount of time in my echo chamber.  Writing this, I can feel the unhealthiness of it all.  And, so, here I am, endeavoring to get back on track. 

I have expunged certain tasks and jobs over the past two weeks.  Yet, I keep finding new things to do.  Part of this is my ever thinking mind. Part of it is circumstances beyond my control, but are they really? It's up to me how I spend my day and what I focus on. I've written about the need for structure and consistency, and then, I get off track. Twenty one days. That's what my father has always said. Twenty one days to a habit.  And so, on Day 123 of my Journey Back to Kona, I must commit myself to the next 21 days.  

Read, stretch, write. That is what I am doing right now. That is how my days must begin.  I know that grounds me. I know that sets me up for whatever I need to do in a day.  I can choose to write what I wish every day. I can choose to read what I wish every day.  Ultimately, my ironman training will define itself, as it typically does, by how I feel and what I choose to do.  Ironman training is for me.  That is something that I've come to realize and appreciate.  It's why I chose to title my blog the "Journey Back to Kona." It's what I am choosing to do for myself.

I've struggled my whole life with wanting to do things for others.  Oft times to the detriment of my own family, others is a broad term for humanity.  From writing a letter to President Johnson to end the war. To writing a letter to President Carter and Menachem Begin regarding Middle East peace. To writing letters to President Reagan and Carter, I've long tried to make a difference.  It should come as no surprise to me that my greatest weakness might come from actually succeeding. I'm communicating with public officials and the media. My voice is being heard. It only drives me to do more. But what about me?

And so, it is time to get back on track.  I have a half ironman in 11 weeks. A full ironman in 16 weeks. I'm literally in the best run shape of my life.  I should get into bike and swim shape. No pressure. That, I've made clear to myself recently. It truly is about the training and how I feel. Results don't matter, whether it's ironman or life.  Which is why getting back on track is what truly matters right now.