Journey Back to Kona Day 194: Back to Prioritizing

Multiple things on my brain today.  Life priorities and training priorities.  The training priorities have been complicated by left knee pain, which I believe that I can trace back to having my bike shoes adjusted when I got my bike fit dialed in some weeks ago.  My first real long ride last weekend left me with some significant left knee pain.  I rested it, it improved, and when I rode yesterday, it came back.  Yuk!  If there's one thing a triathlete hates, it's this type of pain.  Pain from a long run is fine, but pain from a relatively short bike, where the rest of my legs felt fine, is frustrating.

That probably messed with my mind yesterday, which wasn't a good thing, as I was already pondering my life priorities again.  I'm sure that I can look back at previous blogs and find many that address this complex issue.  Too many things that matter to me. Not enough time in the day or week.  Which ones do I choose.  With a half ironman next week and an ironman on the very near horizon, that decision should be pretty simple.  Just get through Ironman St. George and then come back to the priorities.  That should be my path.

In the meantime, I can process a bit.  Once again, this past week was a reminder of the clash of priorities.  With my son-in-law out of town, we were helping with the grandkids.  I absolutely love my time with my grandson and granddaughter, but chasing a two year old around all day can be more exhausting than doing a full ironman!  In some ways, the timing with my knee injury might have been fortuitous, lest I would have pushed too hard with training to train through the injury.  Again, no regrets. We can only take life one day at a time and deal with the issues that we are faced with on a daily basis.  Ironman as a metaphor for life, stay in the moment.  

Sometimes that concept is easier said than done, and injury-pain certainly messes with one's brain.  It also doesn't help that my mind has been significantly blown over the past few weeks with the progress I've made on the advocacy front.  I'm having the type of potential impact that I've always dreamed of.  But, be careful what you wish for.  That type of success is not only addictive, but also opens up a number of rabbit holes.  Opportunities lead to more opportunities.  This only opens up more chances for priority conflicts.  And, so I'm back to prioritizing.

Journey Back to Kona Day 175: Ventura Half Marathon Race Report

 I’d been visualizing this race for a while.  I’ve done some half marathons in the last few years and most recently did one that I was very happy with, managing to run it in 1 hour and 44 minutes, which was still off my best time of 1:32 over a decade ago, but was pretty much the fastest I’d run in the years since.  My run training has been off the charts good.  I’ve been putting in more miles on a regular basis and 10-14 mile runs have literally become commonplace for me.  With a Half Ironman and then a Full Ironman coming up in the next couple of months, I didn’t want to do anything to hurt my training, but at the same time, I was intrigued by a couple of things.  First, the course is literally all downhill (except for the first mile). The knowledge of this brought a couple of thoughts into play.  The first thought was how fast a pace I could maintain for a half marathon.  Knowing that my endurance is solid, but that I haven’t really focused on speed, I was intrigued.  At the same time, I didn’t want to do any harm to myself. But that brought up the second point.  Running downhill for 13.1 miles would definitely give my legs a pounding, and with five weeks go before the Oceanside 70.3, it could provide an outstanding training stimulus. With that in mind, I knew that I’d listen to my body and do what I could on race day.

 

I woke up early on race day and took care of all of my bathroom needs (or so I thought) before driving to Ventura, where I parked and got a bus to the start.  I was ok with the bus, as everyone was still wearing masks (and it was still required).  When we got to Ojai, I got my race bib and headed to the port-a-potties for one last stop.  Not a moment too soon!  While standing in line, I really had to go (like really had to go!).  Fortunately, I was able to hold things long enough to complete my final preparation for the race.  I managed to run 0.8 miles on the track to warm up and then made my way to the starting line.  I had kept a long sleeved compression shirt on, as it was pretty cold out (low 40’s), and I took it off with a few minutes to go before the start.  I wore gloves, otherwise, nothing special.  

 

We started on the track for a couple of hundred yards and I really focused on not going out too fast or too hard, keeping my heart rate close to 140 an letting it come up into the 150’s by the end of the first mile, which actually had a net elevation gain of 30 feet.  Remarkably, my pace settled in at 7:40/mile, which I wholeheartedly accepted with the realization that it didn’t feel hard  I got to the end of the first mile, which really was the start of the downhills. My time for the first mile was 7:40 (which adjusting for elevation change was equivalent to 7:34), my average heart rate was 137 and my maximum was 157.  I was off to an excellent start.  I had in my head the idea that I might be able to keep 7:40 pace, knowing that last summer I started a half marathon at that pace, but was only able to hold it for the first few miles, before slowing down considerably (especially at the end).  On the other hand, I’d done another half in December and ended up holding an 8:00 pace for the entire race.  So, 7:40 was a reasonably conservative start.  The second mile was downhill, with a net loss of 82 feet.  Again, I kept it comfortable, with an average heart rate of 150 and a maximum of 159.  I got to the second mile marker with a time of 7:23 (7:46 adjusted for elevation change).

 

Things were getting interesting.  I really had no clue how I would feel holding a 7:23 pace, but I was running downhill and I was still quite comfortable, so I just continued to go with it.  It was still cool out, but I was definitely warmed up.  I was also staying with some of the same runners at this point.  I really wasn’t looking at my heart rate, and would occasionally look at my pace to see where I was.  Mile 3 came along in 7:30 (adjusted 7:40), having only had a net loss of 36ft.  My heartrate had come up to 154 with a maximum of 161.  Of note, I’d been breathing comfortably hard every 4^th step, which was perfectly according to plan.  Mile 4 also only had 29 feet of descent and my time was 7:40 (adjusted 7:53), while my average heart rate climbed a bit to 160, and I actually managed to hit a heart rate of 168.  At some point my breathing had switched to my routine “Tempo” breathing of every third step, but it really didn’t feel too hard.  The grade also got a little steeper and Mile 5 ended up being 7:20 (adjusted 7:49) with a 108ft descent.  My average heart rate only came up a little to 162, though I did touch up to 174 at times.  The next two miles continued with pretty solid descents, and Mile 6 and 7 were completed in a blazing 7:17 (adjusted 7:53) and 7:27 (adjusted 7:50) with respective drops in elevation of 138 and 86ft, respectively.  My average heart rate stayed right around 168-170, with a maximum of 174.

 

Five miles to go.  At this point, I began switching my mindset from what was possible to what I needed to do to make it possible.  I really bore down on my effort, while keeping my breathing the same, and really focused on maintaining my speed.  Maintain that speed, I did, actually doing Miles 8-10 in 7:33, 7:32 and 7:32 (adjusted paces ~7:40)!  The elevation drop for these three miles averaged around 35 feet and my heart rate actually came down to an average of 155.  Three miles to go and my legs started feeling the impact (literally) of the downhill running.  Fortunately, they only felt a little sore, although I definitely needed to focus to maintain my pace.  Mile 11 pleasantly surprised me with 7:38 (adjusted 7:48) with what was now a routine 36ft descent (pretty small) and my heart rate began to come up again to an average of 160 with a maximum of 172.  

 

Holding my pace was everything I could do, and somehow, I managed to maintain my pace over Miles 12 and 13, finding myself completing these miles in 7:43 and 7:42 respectively (adjusted 7:51 and 7:52) all the while seeing my heart rate start to climb again to an average of 163 for Mile 12 and 168 for the final mile.  As I turned toward the finish line, I sprinted as hard as I could, managing the final strides at a 7:22 pace and my heart rate ending up maximizing at 173. As I crossed the finish line, I knew that I’d given it my all.  I found an area on the grass and lay down for a few minutes.  I needed it.  

 

I felt somewhat sore later in the day, but the usual delayed onset muscle soreness was pretty mild the following day.  I followed up my effort with two days of solid swimming before taking a day off and finally ran again on Thursday (four days later), with a hard 2 hour and 15 minute bike (including 10 minutes of all out efforts and a brutal 25 minute climb) followed by a comfortable 10 mile run that left my legs feeling a little sore and stiff.  Friday was another swim and Saturday was a 12 mile run that was mostly comfortable except for a 10 minute uphill effort alternating between all out and hard every minute, resulting in a 1 minute PR up a steep ¾ mile climb halfway through my run. 

 

Four weeks to go before the Oceanside 70.3.  My swim fitness is where it needs to be. My run fitness is better than ever.  I can complete a solid 56 mile bike ride, but could still put in some more volume in the coming weeks.  I’m excited for Ironman St. George, and can only hope that I can hold together a solid marathon in May!

Journey Back to Kona Day 155: Dreaming

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

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

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

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

Journey Back to Kona Day 143: I Need an Intervention

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

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

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

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

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

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

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

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

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

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

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

Journey Back to Kona Day 137: Sliding Backwards

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

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

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

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

Journey Back to Kona Day 136: Obsessed Again

 My morning in a Tweet:

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

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

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

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

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

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

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

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

      

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

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

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

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

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