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.