Go figure-best run ever!

After Sunday's tough workout, I felt great on Monday, but was pretty tired yesterday. My coach told me to just run based on how I felt today. I slept 10 1/2 hours last night and woke up refreshed and feeling good. Got on the treadmill, and after 2 3/4 hours and 18 miles, literally had to force myself to get off! I could have kept running! Followed that up with over an hour of strenuous snow shoveling (we had a semi-blizzard last night).

It is remarkable what the human body can accomplish! It seems like the further along I get with ironman training, the more I am able to do and the more my body can handle. Today was remarkable for a few reasons, not the least of which was the fact that I kept a smile on my face for 2 3/4 hours on a treadmill! I really enjoyed the run and time almost stood still.

5 weeks and 3 days to go!

6 weeks to St. George!

A week ago I spent three days in Long Beach, California at a meeting and managed to "squeeze in" 42 miles of running. Ran 14 miles each day, the first two days broken into two runs and the third day just one long slow brutal run. Came home and the next day had my best 4 hours of biking indoors. Worked out and recovered through the week, fighting off borderline fatigue and soreness from one day to the next. I've also been fighting pain in my right "shoulder". The quotation marks are for the fact that I've learned that it's not exactly my shoulder, but my right deltoid, as well as my biceps and triceps. I've been massaging my arm daily and stretching and was ready to swim on Saturday. I ended up swimming 5,000 yards, over a 1,000 more than I've ever done before, and it felt easy! Go figure.

Today was the big test, my key workout prior to St. George. I was really excited yesterday, but woke up this morning feeling a little flat. Also, my legs felt sluggish and a little sore. Well, in some ways an opportunity to train feeling both tired and unenthused. I'm sure that will happen at some point during the St. George Ironman:), so figured that I could use this as an experience. With that in mind, I started my 4 hour indoor bike ride, with an effort that was supposed to be similar to the effort I will have on the bike at St. George. While it wasn't "easy", it also wasn't really hard. Well, that's not really the truth. It was a bit of a struggle, but never got unmanageable. I watched Goodfellas and just stayed persistent. At St. George I will have gorgeous scenery to enjoy! I really think that's one of the big advantages of this race. The course is beautiful. So long as I remember to smile and enjoy the surroundings, I'll be ok. When I got off the bike, my legs didn't feel any better, but they really didn't feel any worse. I'm pretty fortunate, insofar as biking hasn't been having much impact on my running legs. So, 10 minutes later, I was out the door for my 13.2 mile hilly run.

The run wasn't bad, the first 10 minutes were a little tough, but I then settled in to a rhythm. I just finished reading "Born to Run", and when I get tired, I just think about the joy of running. Again, at St. George, this will be easier to do, the run course is also beautiful. I kept a solid pace and just kept increasing my effort. Just under 2 hours later, I was done.

My coach has suggested that my pre workout ambivalence may be a sign that I'm right on the edge with my training, so I have a few days to recover and take it easy. This experience continues to be remarkable, as I keep taking my body to places I never thought possible. 6 hours of training today, and as I sit here and type this blog, I have no soreness. A small pizza has helped me replenish (as did some "healthier" calories), as did a one hour nap. Naps are critical!

I have to remind myself that my result at St. George isn't important. It really is about the journey. I'm doing everything possible to have a good result, but an Ironman can be fickle. I made it for 6 hours today, but how will I do after 11-12 hours and at the end of a marathon? I don't know, but I know that when I'm feeling tired or discouraged, I'll try to smile and remember the joy of being outside running or biking.

10 Weeks to Go!

It's remarkable that there are just 10 more weeks prior to St. George. I've been negligent about blogging, but balancing ironman training, work and family is a challenge that I've actually been managing pretty well (another blog for another day). The last month has been amazing! I've felt a lot of the different things that one goes through in ironman training. The highs of completing longer workouts than ever before. The lows from fatigue and occasionally not nourishing enough. Just this last week I went from an incredible day of fatigue to a day of high energy! What is most amazing is that I know that I could do an ironman now if I needed to, I'm that ready. The good news is that I have 10 more weeks to prepare.

Today, Sunday, is a day off for me, the first real planned complete day off I've had in awhile. No training whatsoever. I'll even try not to think about training today, except while writing this blog! Over the last 3-4 days my mind and body have been telling me it's time for a break, which is good. If I didn't learn anything from my accident and subsequent lay off about the value of rest, I'd be pretty stupid. I took 8 weeks completely off from running, and my running is now, just 8 weeks later, as good as its ever been!

So, let me review some of my recent accomplishments. In the last week I did a 4,000 yard swim workout, which didn't seem that hard! I also swam 6 x 500 yards in 50 minutes. Both of these results bode well for my 2.4 mile ironman swim. A week and a half ago, I ran 2 1/2 hours on a very hilly course. My average pace was close to 9 1/2 minutes/ mile. I'd like to get this down to about 9 minutes/mile pace for the hilly St. George course. That said, my recovery from these runs has been excellent. Yesterday, with tired legs, I ran 7 miles on the treadmill at 8:53/mile pace. The effort was very comfortable the whole way, never having to breath hard at all. My biking continues to go well. I'm gaining power at lower exertional efforts and have ridden 4 hours in doors. In fact, last weekend, on Saturday, I swam 4,000 yards, and then between Saturday and Sunday rode 112 miles indoors and then was able to complete a solid run. A few days before doing this, I essentially ran a marathon over the course of 2 days on hilly courses.

Next weekend I'll be in St. George at Triathlon camp! I'm looking forward to riding the course.

Also, I've managed to find my run mantra, "I am strong". It came to me one day while running after a very hard bike. It has stuck with me ever since. I plan on using it to get me through the marathon at St. George. What was most exciting was that I wasn't trying to come up with a mantra at the time, it just came to me in a moment of clarity!

I'm back!

Well, just a few days into the new year, and I can say that I'm truly back. In the past few days I've had great swim, bike and run workouts. Considering that I'm 4 months out from St. George, this bodes well. Now, I just need to be patient and not do more tha my coach tells me to do.

First of all, I'm back to running. With ice still on the ground, I'm sticking to the treadmill. I've been able to run (with some intermittent walking) for 70 minutes/7 miles without any significant pain or soreness. Today, I actually ran for 40 minutes (4.4 miles) immediately after a 90 minute bike ride. I managed to get up to 7mph pace and stay in zone 2 (effort pretty comfortable). While this isn't my peak pace for this heart rate, it's a great starting point for St. George.

Next, my shoulder is coming back pretty well in the swim. Despite some soreness (which probably stems from biceps tightness from limiting my motion for 8 weeks), I was able to swim 2600 yards, with 5 x 300 yards at a very respectable pace (1:40/100 yards), again, not my best ever, but a really good starting point for my upcoming training.

Finally, my biking has certainly not suffered, especially since that's about all I did for a month. Yesterday, I was able to ride 3 hours on my indoor trainer, with a good portion of that time in my aero position in my zone 2 heart rate (comfortable), at a power that again is not my optimal, but a good place to be at this point in time. Today, I rode 90 minutes with better power and lower heart rate than yesterday. It actually felt like I've "snapped back into place" in terms of my fitness level!

I think that the most exciting part of this is that I'm about to enter my 4 month training period for Ironman St. George. I am taking an extra day off every week, giving me three half days off during the week (Tuesday, Wednesday, and Friday). This really feels good, insofar as it really takes any pressure off of me for the training I am about to embark upon for an ironman. If I had to do the training with a full work load, I don't think that I could have handled it.

I continue to contemplate the nature of my desire to do an ironman. Triathlon and the training it comes with is certainly "a place" I like to be. Training for an ironman certainly gives me plenty of time to be in this "place". I want to do well, but really to the extent that I feel fine doing the race. I want to put myself in a position to have a successful race, which means, feeling very good during and after the swim; having a comfortable bike ride; starting the run feeling reasonably good. The rest will be what it is:). I don't have any other major goals. Is it possible for me to qualify for Kona? Yes, but I can't try to do that, and I can't really make it a goal. It's also not really why I'm into this. I just want to give it my best effort.

Happy New Year, it's good to be back!

Why I'm a Geriatrician

I was probably destined to become a Geriatrician from the time I was a kid, although I didn't know it then. I was definitely destined to become a Geriatrician in the summer of 1983, although it took me the greater part of a year to figure it out. I can remember the day like it was yesterday. I was doing my cardiothoracic surgery rotation at UTMB in Galveston, Texas. I had five hospitals to go to and 13 patients to see before morning rounds. The first hospital on my way in from our apartment was St. Mary's Hospital. It was a private hospital and there was an elderly woman there who'd had an aortic aneurysm repair. I had been seeing her two straight weeks. As this was my first stop, I would wake her up at 4:30am every morning, and in her Texas accent she would cuss me out something fierce every morning. On the last day of my rotation I was leaving her room and she called out, "doctor". Now, I wasn't a doctor, just a medical student, but I turned and went back to her. I remember the moment like it was yesterday. She said, "I'm sorry for yelling at you every morning." To this day I remember feeling, I'm the one waking up this poor lady every morning, and she's apologizing to me. I felt genuinely bad and told her, "you're the patient, I'm waking you up every morning. It's ok if you yell at me." And I meant it. Whether I knew it or not, that was the moment that I realized that I wanted to take care of older people the rest of my career.

I subsequently focused some of my fourth year elective rotations on Geriatrics, working with Tom Cole and Dr. Derek Princely. I even wrote a paper on why I thought that Geriatrics should be a primary care speciality. I then went on to do my internal medicine residency as Cedars-Sinai Hospital. But, it was always a Geriatrics residency. I read everything I could about Geriatric Medicine. I tried to see my patients through the eyes of a Geriatrician. I was fortunate to have as one of my mentors, Mark Levinstein, a Geriatrician who spent a year at Cedars while I was there. I even took the initiative and did a research project that I ultimately published on the value of the white blood cell count and the peripheral blood smear in diagnosing bacterial infections in the elderly. I obviously then did my Geriatric Fellowship at UCLA before beginning my career with Kaiser-Permanente in Woodland Hills. But I'm getting ahead of myself.

From a young age I always wanted to be around "the old people". Whenever family was in the house, I always wanted to sit around and talk and listen to the older people. I was close to my grandparents. My grandfather and I shared a love for sports. He always had the Dodger game on the radio or television. My grandmother was just about the nicest and most non-judgemental person I've ever known (a gene I think I inherited). My grandparents would take me to the horse races at Hollywood Park or Santa Anita. When I was 17, we traveled to Chicago to visit our relatives. I always had an affinity for being around older people. I also had an affinity for wanting to change the world. I was writing letters to the President of the United States when I was six years old, telling him to get us out of the war in Vietnam (yes, my father was an anti-war protester). I wrote letters to Menahem Begin with my ideas of how to solve the problems in the Middle East.

Once I realized that I wanted to be a Geriatrician, however, my life began to revolve around that concept. The paper I wrote as a fourth year medical student was but one example. I digested everything thing I could about Geriatrics, about the politics of health care as it related to Geriatrics. It's funny, but I've always told people that being a Geriatrician is not a job, it's a life. You have to be a doctor, a clergy person, a social worker, an economist, a financial planner, even a politician. And I've been and done all of that. From the moment I made my decision, everything I have ever done has been focused on trying to not only be the best Geriatrician that I could be, but also to try to make society a better place for seniors to live.

I have been quite fortunate to have had some great mentors. I've already mentioned a few, but that was just the beginning of a list that I look back upon in some degree of awe. John Morley, David Rubenstein, David Solomon, Al Sui, Joe Ouslander, Dan Osterweil, Dave Reuben, Mark Beers, Fran Kaiser, Richard DellaPenna. This virtual who's who of Geriatricians were my source of information and inspiration. These were the people who touched my life during my training and first years as a Geriatrician. They inspired me to want to make a difference.

Somewhere pretty early along the way I realized that just seeing patients was not enough for me. I wanted to touch more lives than the ones that only I could see and personally care for. This lead me to pursue administrative duties while at Kaiser-Permanente. It ultimately led me to leave California to move to Denver to join a company called GeriMed of America, a geriatric medical management company whose purpose was in line with my goals and dreams. When this didn't work, I founded Senior Care of Colorado with Don Murphy. I would create my own practice and allow myself and others to practice Geriatrics the way it was meant to be practiced. There was always one obstacle clearly in the way of this path. It was the government. Medicare is a federally legislated program. Congress determines how it is run, how physicians are reimbursed, etc. It wasn't long before I got involved with my congressmen and senators. I believed that this was going to be necessary in order to make a bigger difference. That, unfortunately, has been a frustrating path (more on that another day).

Senior Care of Colorado grew from six physicians and two physician assistants over nine years (2001 to now) to close to thirty physicians and thirty five physician assistants and nurse practitioners. I find myself employing over 150 people. Is this what I signed up for? It has to be, because I'm still the young medical student feeling guilty because an elderly woman apologized for yelling at me. I'm still the idealist wanting seniors to get the best possible care. I revered my grandparents and I love working with seniors. Their stories and insight are of great value. We live in a society that sometimes forgets this and treats our elderly like children. In fact, I was reminded of this today by the sudden death of Fern Osborne. Those who knew Fern knew her to be a tireless and headstrong support of senior issues. She was someone to look up to and she will be sorely missed. I am fortunate, however, to interact with many children who care deeply about their parents and try to juggle everything that society throws us in dealing with very complex issues. Some children have their frail elderly parents living with them at home. Others visit them daily in their assisted living, retirement and nursing homes.

Being a Geriatrician is about making a difference. It's about doing whatever it takes to help seniors live a better life. It's about listening and understanding. It's about being there for people who are vulnerable, and their families. When I think about it, it's not ever really been a hard decision to see me having gone in this direction. It is who I am, and who I always will be.

St. George Here I Come!

So, yesterday I loaded my new St. George Ironman Bike Course Real Interactive Video onto my computer and computrainer and rode my bike (indoors) for 4 hours. This is exciting for a few reasons. I got to actually see the course from T1 through mile 57, which basically covers all of the uphill portions and some of the downhill portion of the course. I always ride slower than my wattage would suggest on my computrainer, so my relatively small distance for 4 hours doesn't concern me (It typically takes me close to 3 1/2 hours to ride the 56 miles of the 5430 course on my computrainer, and I've done that course in 2 1/2- 2 3/4 hours on race day). Anyway, I'm excited for two reasons. First, here it is, early December, and I'm riding 4 hours indoors. It's actually the longest indoor ride I've ever done. Second, I only have a small amount of soreness in my quads the day after doing this ride.

I'm five months from race day and I know that I'll be in great bike shape for the race. I'm really not worried about the swim, that will come once I can use my left arm again, although I continue to be encouraged by my one armed swimming! That leaves the run, and that will be whatever it is, but I'll have between 3 and 4 months to get in run shape. Having completed an open marathon several years ago on very minimal run training (about 15 hours a week, longest run of 5 miles), I know that I'll be much better prepared than I was for that marathon!

Took today pretty easy, swam in the morning, did a radio show after that (that was fun!), and then did a recovery ride on my bike. We had company this afternoon and saw the latest rough cut for the first two episodes of Little Blossom, on our big screen t.v.! It was awesome! I continue to be so proud of my daughter. She is an editing genius!

Lots going on at work, and I have a pretty full week ahead of me. I'm trying my best to ignore the political situation, as I have no control over it.

I'm six weeks removed from my bicycle accident and feel like I'm healing pretty well. I let someone hug me yesterday, however, and my shoulder hurt the rest of the day. No more hugs:(, at least not for several more weeks.

Rest Day:)

Realized that I've actually done some type of workout every day for the past two weeks, so, in preparation for this weekend, I took the day off from exercise. My allergies/sinuses have also been bothering me, which tends to happen when I've pushed the exercise a little too hard anyway, although that's always hard to tell.

Spent the afternoon with my family, we went to Best Buy and raided the $4-5 movie bin! Now that I'm a television producer, I've really got to watch as much as possible to learn more about the business:)

Justine is "in the zone" with her editing for Little Blossom. She will be finished with the rough edit of the second episode this weekend. It's looking terrific, I couldn't be a prouder father.

Had a great week at work, really getting back in the groove and doing what I enjoy. Did some house calls today, and spent some delightful time with the sharpest 98 year old I've met in awhile! My two little fractures don't really mean much compared to some of the things that my patients live with.

Will be kicking back and taking it easy tonight!