The Snotty Chronicles

Part 2: Getting Organized

2012-02-28T06:34:00.003-08:00

This is Part 2 in a 5 part series on exercise and time management.

In Part 1 we talked about making exercise a priority and preparing to sacrifice other aspects of your life in order to reach your fitness goals. The next step is putting this into practice. Making time for exercise requires commitment and planning. Here are some tips for making the most of your time and your workout routine.

At the beginning of a new week sit down with your schedules and plan your attack. On Sundays I will usually take a look at my work schedule for the week and start thinking about when I will be able to work out. Work is pretty rigid so I need to know what my work commitments are for the week. I know that in any given week I want to swim three times, run three times, and cycle at least twice. That is the minimum. If I can manage it, a strength/core session or two and another bike ride would be nice too. For me, the early mornings are when I do the bulk of my training. I also squeeze in a few noon hour workouts and maybe one evening session a week. I have decided that I will not sacrifice family time to train so I try to keep my evening workouts to a minimum. Additionally, I am typically fatigued at the end of a day so my workouts are never as effective in the evenings as they are in the early mornings. Many times I am back from my morning workouts before my kids ever wake up.

Those of us with children know that work is only a small part of this whole time equation. The next thing I do is look at the family calendar which has all my kids’ sports, activities and other family events on it. I try to make sure there is nothing on there that will prevent me from doing my training. So then I start penciling in my workouts for the week. I fill my mornings up first. Monday, Wednesday and Friday mornings are for swimming. Tuesday and Thursday mornings are for running. Tuesday Evening I have a group ride. Saturday morning is usually a long run. Sunday morning is usually a long ride. Then I try to squeeze a short bike in on a lunch hour and a couple of strength sessions. A typical week might look something like this.

Monday: AM-easy swim or rest
Tuesday: AM-run, PM-group ride
Wednesday: AM-swim, Noon - bike
Thursday: AM-run or brick
Friday: AM-swim
Saturday: Long Run
Sunday: Long Bike

As you can see, I fit in all the workouts I need to do and still have wiggle room to adjust or add a strength session or another bike ride.

The idea here is to go into the week with an idea of how you will be spending your time. Make sure you schedule time to complete the workouts you feel you have to get done and allow room to make adjustments or add a workout as the opportunities present.

In Part 3 "Get With the Program" I will discuss the benefits of using an organized program to meet your fitness and training goals.

When One Door Closes...

2012-02-24T07:05:00.003-08:00

As I walked out the door this morning following my final swim workout at the Champaign County YMCA McKinley facility it was hard for me not to wax nostalgic. This place means so much to me and my family. Even though the new facility is so much nicer and has so many more amenities it is hard not to be sad.

Although I’ve only been a member for a few years, this facility has had a profound impact on me. I’ll never forget the first time I set foot in the place. It was a bitter cold Sunday in February. I think the year was 2007. I was not member at the time and we ended up there more or less by accident. As I recall, my son really, really wanted to swim on this cold day. So, I planned to take him to the Urbana Indoor Aquatic Center. Unfortunately upon arrival, we discovered there was a swim meet and the pool was closed. I called the Y and they told me that we could swim during the open swim hours after paying a nominal guest fee. We went. I remember thinking the place was kind of a dump but we had a great time. My son often asked to go back but we never did.

In 2009, I was training for the inaugural Illinois Marathon and had made the decision to accept the challenge to try my hand at triathlon later that summer. I had been a regular fitness swimmer during the summer but never went in the off season. I knew I had to join a pool. The Urbana Aquatic Center seemed to be the logical choice since it was close to my home and was a very nice facility. I soon realized that the lap swim times at UIAC were so restrictive that I would never be able to adequately train. I talked to some people about the Y. They told me it was rarely crowded in the early morning. I was sold. I joined.

The CCYMCA pool at McKinley was the anchor point in my transformation into a triathlete. This transformation has altered my life in so many ways…almost all of them in a positive way. So I feel a special connection to that pool. It’s where I cut my teeth. Don’t get me wrong. I am so looking forward to getting into the new pool but there will always be a special place in my heart for the old junky one.

My son has developed an absolute love for sports. This love was introduced and fostered by youth programs at the CCYMCA. He has played in multiple seasons of soccer, basketball and flag football and he has every single participation trophy proudly displayed in his room. He speaks with great fondness of the time spent in Y sports camps during the summer.
My daughters were first introduced to gymnastics through the CCYMCA. They continue to develop this skill to date. They are both anxiously awaiting the opening of the new pool and gym.

I think of all the people that I have met as a result of my membership at the Y. There are regular swimmers with whom I cross paths in the pool and locker room. Guys like “Iron Mike.” A fellow triathlete and easily one of the nicest guys I’ll ever meet in my life. He helped inspire me to complete my first Ironman. He’s an incredibly talented athlete who has taught me a great deal about being positive in the face of adversity both on and off the race course. There are staff members like Henry, a friendly white-haired chap who always greats me by name and bids me ‘good day’ as I exit. There are guys like Homer and Jeff who work tirelessly to ensure that youth sports activities are fun and safe for the kids. There are countless others who I have neglected to mention but are no less significant in their contributions to make the CCYMCA a special place.

The more I think about it, it’s not how many pools or other shiny amenities we will have in the new building. Those things will be nice. However, the real strength of the Champaign County YMCA is the PEOPLE. The members, the staff, the board of directors, and let’s not forget community volunteers. All of these people have made CCYMCA what it is and hopefully all of them will continue to make it what it will be. And what it will be is a flagship community asset which will serve as the cornerstone for improved health and wellness among our citizens.

Exercise: Make it a Priority. Make it Automatic.

2012-02-21T08:27:00.000-08:00

This is the first entry in a 5-part series on exercise, wellness and time management.

The decision to embark on an exercise program is the first step to meeting your fitness goals. Many people start the new year with lofty goals in mind only to falter after just a few weeks. Like building a house the concept of fitness needs a foundation. Before you can begin exercising, you must lay the foundation in your life for this activity.

In the previous post, I talked about time management and being active in CHOOSING how to use your time. For most of us, our time is already stretched to the max. We have work obligations, family obligations, community obligations, social lives and a host of other time sinks to contend with. How do we ‘fit’ exercise in? The answer: we don’t! You heard me. If you are going to be serious about exercise and fitness it is not something to be ‘fit in’ amidst all the other facets of your life. Think of your time as a bucket, a bucket that is full to the brim. There is no room in the bucket to add any additional activities. So…something needs to come out of that bucket.

Making exercise a priority in your life will require making choices and making sacrifices. What are you going to give up so that you can begin exercising? This is where it is important to take stock of what is really important in your life. You also need to assess how you are currently spending your time. Are you already making the most of the time you have? Some people can sacrifice sleep. Others might choose to sacrifice time with friends or time spent on other leisure activities. The bottom line is this: make these decisions BEFORE you begin your routine. Don’t wait for time conflicts to occur because they will anyway even after you have made these sacrifices. Decide before you start your exercise routine what other part of your life you are going to give up. Maybe you will be lucky and somehow be able to make it all happen but at least in your mind, you have to be prepared to make that sacrifice.

Those of us who are habitual exercisers do so automatically. Exercise and training is as much a part of our lives as eating, sleeping and working. It’s not something we have to ‘remember’ to do. It is so much a part of our lives that when we don’t or can’t do it, we suffer. This is a process and only comes after exercising regularly for some time. Your body will crave it. To that end, you need to set yourself up for success. Find a time of day that you know consistently will be available for you to exercise. For me, it is the early morning hours. It’s automatic for me. I get up, brush my teeth, drink a cup of coffee and exercise. That is how I start pretty much each and every day. I don’t have to think about it.

Remember that fitness, exercise and activity are really less like activities and more like a lifestyle. It is a way to shape your day and everything that you do. You do have choices to make as mentioned in a previous entry. Go make the right one!

I haven't got time...

2012-02-14T07:22:00.000-08:00

A few weeks ago I tweeted something, very randomly, based on a thought that came to mind. I don’t recall the exact wording of the tweet but the main idea was to say “I choose not to….” rather than “I don’t have time to …” For whatever reason it sparked a bit of a discussion with proponents and opponents alike. The fundamental idea in that wording is, at least for me, an example of how we view the world. Are we active or passive? Do we make things happen or let things happen to us?

My inspiration for this tweet was based a little bit on this blog post: http://www.left2devices.blogspot.com/2012/01/one-constant-in-life-is-that-people.html. It is also based on my experience with family and friends who seem to always be TOO BUSY. I’m not immune to this way of thinking. I’m a busy guy and I’m sure that I’ve used that excuse more than my fair share. This whole concept first came to light for me when I was training for Ironman. When one is tasked with completing anywhere from six to sixteen hours of training a week over the course of six months, it requires time management. I remember when I was in the bulk of my training bemoaning my lack of free time to my wife. She was quick to correctly point out that I had made this choice and nobody was forcing me to complete this race. This realization was a bit frustrating and empowering at the same time.

Time is the ultimate precious resource. We are given a fixed number of hours each day and we for the most part get to decide how to use them. Yes, we have work and family obligations but every minute we spend in our day comes back to a choice we made at some point in our lives. If I am tied down with family responsibilities then that goes back to my decision to be a father. When we decided to have a family, we knew our lives would change and we accepted that. If I find that my work life is taking too much of my time, that decision can be traced back to my career choice. At any given time, one task may trump another in terms of priority but every minute we spend of every day goes back to a choice that WE made.

When we say, “I’m too busy” or “I don’t have the time…” we are suggesting that we somehow don’t have control over how we spend our time. That is not the case. If I decline a party invitation citing that I don’t have the time it creates a sense of being repressed or denied. If I decline the invitation citing that I would rather spend the evening with my family then I am in control, empowered. Some have suggested that it is more polite to use the passive terms to avoid hurting feelings. I can see the logic there; however, if we are truly making good choices with our time, shouldn’t we be able to proudly stand behind those decisions? If on the hand you cannot, then maybe it is time to take stock of your life and your priorities.

I know some are saying to themselves “who cares what other people think” or “I don’t have to justify how I spend my time to others.” This is true. However, this exercise is not so much about justifying how you spend time to others as it is about justifying it to yourself. It’s a good self reflection to make sure you are living up to your own priorities. Ultimately we are accountable to ourselves so we need to be satisfied that we have made the proper choices and not feel shame about it. Unlike with money, with time we are all more or less equal. We are all given the number of hours within a day to live our lives. Ultimately, the choice of how to utilize this resource lies with each individual. With every choice comes an opportunity. But there is also a cost, in the form of what we choose not to do. In the end we can only hope that our opportunities outweigh the costs.

Regulated to Health

2012-02-05T11:50:00.000-08:00

A recently published article by prominent obesity researchers at UCSF has likened sugar to ‘poison’ and has called for the regulation of sugary foods in the same manner as alcohol and tobacco are regulated. The Huffington Post did a nice summary article on this position paper which can be reviewed here: http://www.huffingtonpost.com/2012/02/02/sugar-toxic-regulation_n_1248397.html. I am certainly a supporter of healthy living and wellness. I support initiatives to improve nutrition and access to quality food. I advocate for exercise and increased physical activity both in our youth and our grown-ups. However, I simply cannot get behind this type of proposal. There are many reasons which I will outline below.

The first and most obvious reason why I would object to any kind of regulation of sugary food is that it puts us one step closer to the ‘nanny state’ society which seems to be formulating around us. The tone of this article, in my opinion, exemplifies the arrogance of academia and government in their dealings with the general public. The creation of legislation to restrict access to certain types of food sends a clear message: “You fatties are too stupid to control yourselves. We (the bright souls who sit in government and academic ivory towers) need to protect you before you kill yourselves.” What we need is more education, more self-control, and more empowerment not more governmental regulations.

I liken the proposed food restrictions to the food bans in schools due to food allergies. A food ban in a school creates the appearance of a safe environment. It shows the public (and the courts) that the school has taken action to protect children and thus reduces liability for any potential mishaps. However, it creates a false sense of security for allergy sufferers who must live in the real world. It lets the child ‘let his/her guard down’ possibly setting them up for an accident in the ‘real world.’ So what does regulating the access to sugar, particularly those that are age-related, do for people to teach them to make good choices? Some may argue that our current alcohol and tobacco laws promote irresponsible behavior once people reach a legal age. Is there as much binge drinking in young adults in cultures that have a more liberal attitude toward alcohol consumption? I fear any kind of restriction, particularly aimed at youth, will backfire once they reach adulthood. If you’ve ever watched the Biggest Loser then you know there come times when significant temptation is presented to the participants and they are forced to make a choice. This type of challenge is essential to their process because we do not live in cocoons.

I think we have always known that fatty and sugary food is bad but perhaps not HOW bad. New advances have helped define just how harmful some of these foods really are on a metabolic level. So why not try to use some of this new knowledge to help EDUCATE rather than RESTRICT. If after all that, people still want to kill themselves…well we tried, right? Look, we still have alcoholism, drug addiction and tobacco dependence don’t we? Do you really think a law that restricts sugar is going to cure the obesity epidemic?

Our dependence (yes it is a dependence) on fast food and highly processed foods is a multi-factorial problem. Yes, these foods are much more accessible than in years past. Yes, one can make the argument that fast food and processed foods are engineered to manipulate sugar, salt and fat content to make them ‘addictive.’ However societal changes have played a significant role in our diets and the obesity epidemic. The two biggest factors in my opinion are the move toward two income families combined with suburban sprawl. By the time most working families get off of work, pick the kids up from child care or school and commute home they are well into their evening hours. Everyone is hungry. Parents are tired. There is housework to be done and homework for kids to complete. Fast food/convenience food to the rescue! It is true that with a little bit of planning even the busiest of families can enjoy healthful meals made at home; however enter technology to distract us even further. Why should I spend my precious evening hours prepping tomorrow’s veggies when I can be watching American Idol or surfing the internet or playing Words With Friends. We haven’t discussed the whole concept of exercise and activity levels. Clearly this works in tandem with diet to prevent obesity and lifestyle illnesses. The same factors cited above that impact our diet also impact our physical activity levels. There is just no one easy answer.

I try to eat healthy and be active. I enjoy candy, sweets, and soda in moderation and so does my family. I have educated myself on nutrition and I pass that knowledge on to my children. They are still young and hedonistic. Their behavior is driven by their pleasure centers so they need guidance and restrictions. However, those restrictions need to come from ME the parent not the government. Forgive me if I am skeptical that the same government that brought us high fructose corn syrup through shaping agricultural policy is going to be able to ‘regulate us to health.’ What I want from the government in regards to nutrition could be summed up as follows: HELP US OR GET THE HELL OUT OF THE WAY.

1. Create nutritional guidelines that are TRULY good for us and not dictated by special interest groups hoping to pedal their wares (eg. crappy food) to our families.

2. Create agricultural policies that support local/organic farming rather than food factories.

3. Improve access to fresh/healthy foods in ‘food deserts’ particularly in areas with high governmental assistance.

The idea of passing a law restricting access to sugary food is so reactionary that it is just laughable. But isn’t that what we Americans are all about. We want the quick fix. We want bariatric surgery and fad diets. We don’t want to be educated and informed as we would rather have the people on CNN or Fox News tell us how to think. We would rather pop a pill than make lifestyle changes. It’s time to change, PEOPLE! We need to empower ourselves to take care of ourselves. If we fail, someone will be all too eager to step in and try to do it for us.

The Coach's Kid

2012-02-03T12:48:00.000-08:00

This is the first of what I hope will be a regular feature of posting parenting and fatherhood related entries on this blog. I will aim to have at least one "Fatherhood Friday" each month, probably on the first Friday. If content arises, there might be more. Stay tuned...

Whenever a parent volunteers in some kind of authority position whether at school or in sports it creates a unique dynamic with his/her own children that can be difficult to manage at times. My wife and I are well acquainted with this concept as she is a regular fixture at the kids’ schools and I am often involved in my son’s sports. Admittedly, I feel she handles her role much better than I do mine. She is a teacher and family counselor by trade so this type of thing comes naturally to her. I struggle with this every day.

A few weeks ago as we were driving back from one of the basketball practices for my son’s team that I help coach he commented that I was harder on him than on the other kids. I dismissed this and assured him that I wasn’t. Then the other night was one of those hell practices. The kids were rotten. No one listened. No one followed the prescribed drills. I played along with it for awhile. Redirected the kids the best I could but finally toward the end of the session I had had enough. My son and one of his buddies, also a coach’s kid, were the ring leaders of the shenanigans. I finally took action and sent my son to the bench while I continued working with the other kids on the drills.

On the ride home, there was silence from the back seat. I took the opportunity to express to my son how disappointed I was in his behavior. Unfortunately, I did let my emotions get the best of me and I probably used a tone with him that I shouldn’t have. He was extremely upset when we got home especially after he failed to get any sympathy from his mother over the situation. When he calmed down and we were finally able to talk about it, it was clear that he felt picked on and bullied by me. He was embarrassed not so much by his behavior but by the fact that he had been punished in front of his teammates. The more I thought about it throughout the night, I began to doubt the way I handled the situation.

There is no question that I have a different standard for my son on the team than I do the other kids. Yes, I try to treat everyone equally but in the end there is a bond and a history between my son and myself that colors the relationship we have as player and coach. I suppose some of this stems from the fact that I expect my son to help set an example for good behavior and good sportsmanship. How can I expect to garner respect from the other players if I cannot get it from my own child?

Then there is the issue of favoritism. The last thing I want to do is create the appearance of playing favorites to my son. For this reason, I probably am little more strict with his behavior and overall performance than I am with the other kids. I have to be especially careful because his skill level has always been toward the high end compared to his teammates so it can sometimes appear that he is getting preferential treatment in terms of ball touches and scoring.
When it boils down to it my son is not just another member of the team. He is my son. I know what his skills are and the kind of behavior he is capable of. The other kids…not so much. So when my son fails to meet these expectations it is easy for me to call him on it…more so than the other kids. I feel comfortable disciplining my kid. I do it every day. As a parent it comes naturally and I don’t take off the parent hat when I put on the coaches whistle. I don’t know these other kids as well. I don’t always know their parents. It is a dicey endeavor to know how far to take disciplining kids in this situation. It’s a tough call and some are better at it than others.

Try as we might to be fair and impartial it simply is not entirely possible. It just goes with the territory. If being a coach is hard then being a coach’s kid is equally as difficult. I think it helps to address these issues the best you can before the start of the activity. Obviously the really young kids won’t grasp the more advanced concepts but kids always surprise me in what they can understand. Let your children know what your expectations are. If you expect more out of your kid than the rest of the group let him/her know and explain why. Having these discussions will by no means eliminate the potential for conflict but at least it’s out there and on the table.

I probably need to do a better job at being sensitive to my son’s feelings in these situations. I admit I have no frame of reference for this type of thing. My parents weren’t exactly the ‘involved’ type so I never really found myself in these types of situations. Still, I must be doing something right because he always wants me to help coach his teams and due to the pervasive apathy for such things in our culture, there are unfortunately more than ample opportunities to participate. Being a coach for youth sports has been one of the most challenging endeavors I've ever engaged in. For those who know the kind of stuff I'm into, that says alot! Still, despite all the challenges, being a school volunteer, coach, troop leader, choir director or chaperone can be rewarding and enjoyable for parents. There is no better way, in my opinion, to get to know your children in a different environment and get to know their peers. Without a doubt, helping to guide other people’s children will make you a better parent for your own.

Hippocrates and Hypocrisy: Unhealthy Healthcare

2012-01-31T06:07:00.000-08:00

The subject of our workplace wellness program has been the subject of previous posts and today I revisit the subject with a slightly different twist. It has been a source of frustration for me how our numbers of employees enrolled in the program are on the decline when clearly there is a need for this program. What is even more disappointing to me is the relatively low numbers of physicians in our institution who participate in the program or attend sponsored events. We have a small core of dedicated physicians who have religiously supported our endeavors from the beginning and those individuals I am indebted. We are always attempting to increase involvement among all of our employees but especially our physicians and advanced practice providers.

One issue that has been brought up by many I’ve spoken to regarding this subject is that many healthcare workers are themselves unhealthy. People outside of healthcare are quick to point out the high percentage of healthcare workers who smoke or who are overweight. I would hypothesize that an overweight doctor might have some difficult addressing the issue of weight and exercise in an obese patient. I know I would. I used to smoke and I remember the guilty feeling I had when counseling head and neck cancer patients about the evils of tobacco. It didn’t stop me from doing the right thing but I felt that I was something of a hypocrite. I can’t help but think that this might be part of the reason why these lifestyle issues seem to go unaddressed time and time again. As it turns out this idea has been put to the test and published just last week in the journal Obesity. You can review the results of this study in this NPR report: http://www.npr.org/blogs/health/2012/01/27/145990665/heavy-doctors-avoid-heavy-discussions-about-weight?sc=emaf.

Literally translated, the word ‘doctor’ means ‘teacher.’ This can be interpreted in many different ways. The way I see it is that as a physician, it my duty not only to diagnose or treat illness but also to promote health. The promotion of health or as we like to call it ‘preventative medicine’ is a core tenet of primary care medicine. This is one area where our current health care system seems to fail patients. There are many reasons for this which are beyond the scope of this post. Consider this story I heard recently from a classmate who practices pediatrics out of state.

A young girl, age 13, presents to her family doctor with respiratory symptoms. Over the past two years she has been seen at least a dozen times with similar complaints and each time diagnosed with acute exacerbation of asthma. Several times she was sent home with a prescription for steroids. Now…it is worth mentioning that this young girl at her most recent visit was tipping the scales at nearly 300 pounds! Over the course of the last two years her weight had steadily increased resulting in a weight gain of some 25 to 30 pounds over that period.

My colleague, who inherited this patient from another doctor upon retirement, took the time to review the medical record in some detail on the first visit. At each previous encounter, the provider (not always the same person) did make mention of the patients weight by noting her to be ‘obese’ or ‘morbidly obese.’ However, that was pretty much where it ended. On only one occasion, did the provider actually attempt to address the patient’s obesity in the treatment plan. By account, the provider did confront the teen about her weight, she became very tearful and stated she hated being overweight. The provider gave her some pamphlets on weight loss and sent her out the door with a prescription for steroids to treat her asthma.

In my opinion, this story exemplifies a fundamental problem with modern healthcare. We are so intent on pushing pills and creating billable encounters that we miss the opportunities to truly impact our patients’ health by addressing lifestyle issues. Let me just say that I am not a primary health care provider and I am many years removed from having the kinds of discussions with patients that I am currently advocating. However, I am quite certain that if given the opportunity I would feel comfortable doing so.

This is where the concept of workplace wellness comes in. If we can improve the overall ‘healthy-ness’ of our healthcare providers, particularly when it comes to smoking and obesity, we can better serve as role models to our patients for living a healthy lifestyle. A healthcare provider who is fit and healthy should have no problem addressing dangerous lifestyle issue in his/her patients. We expect our clergy to live according to the teachings of their churches. We expect our law enforcement officials to themselves be lawful. Should we not EXPECT those to which we have entrusted our health to themselves be healthy? Healthcare workers have been given a free pass for far too long when it comes to their own health and lifestyle. Many will cite stress or long hours as a challenge to accomplish this change in lifestyle. I don’t buy it. I train with individuals who work longer hours and have more stressful jobs than most doctors and nurses that I know. They find a way to make it work. I am quite convinced that if we were able to improve the overall health of healthcare workers, then the stories like the teen girl above would be less common. It’s time for us to stand up, walk the walk, and preach what we practice. We owe it to ourselves, our families, our patients.

Programmed to Eat

2012-01-26T06:31:00.000-08:00

There are many theories floating around regarding the obesity epidemic that plagues our society. Almost all have some merit and I’m thoroughly convinced that the issue is multi-factorial and thus there is no “magic bullet” for a cure. A recent article in ChambanaMoms.com left me pondering another issue that doesn’t seem to get discussed much. That is the idea that we are somehow being programmed to eat regardless of our hunger. This was spurred on by a discussion of the relative merits or lack thereof of ‘snack time’ in elementary school. You can read the entire article and comments here: http://www.chambanamoms.com/2012/01/18/sound-off-sometimes-a-snack-isnt-just-a-snack/#comments

Wikipedia defines Hunger as a sensation experienced when one is required to eat food. This differs from appetite which describes the desire to eat NOT based on physiologic need. The whole ‘snack time’ debate addresses the issue of whether kids NEED to have a mid-morning snack. Many of us grew up without such a snack and ended up just fine. Regardless of the NEED to ingest food to satisfy true HUNGER, I would bet most young children would avail themselves of a snack when presented to them, particularly if it happens to be a sugary or salty treat. When I look around our everyday lives there are many instances where people of ALL ages find themselves in similar situations. We tend to associate the gathering of people for whatever reason, social, educational, professional, spiritual etc. with food. Food is omnipresent and represents a huge temptation and often detractor from a healthy lifestyle.

The two biggest offenders in my opinion are the motion picture and sports industries. When my family and I sit down to watch a movie at home on a snowy afternoon we don’t automatically start filling up vats of junk food. We are all perfectly capable of sitting through a couple of hours of a movie or basketball game on TV without popcorn, candy, soda or other delicacies. However, the minute we set foot in the movie theater or the Assembly Hall we are bombarded with the sights and smells of food. It is just instinct to buy a treat regardless of the time of day. I’ve started instituting some restrictions at the ball games. If game time happens to coincide with meal time, for instance an 11am kickoff, then my son and I will eat lunch at the stadium. But if we go for a 2pm game and we’ve eaten lunch there’s no need for it. Yes, it’s hard to control yourself when everyone around is shoveling popcorn, pretzels and hotdogs in their faces but you cannot give in to every single temptation. I’ve gotten to the point where it kind of disgusts me to see people shoveling all kinds of crap into their mouths. Invariably, some jackass will spill his 32oz Coke all over the place and it will conveniently puddle in my space. The focus on food is so great it almost detracts from the sport. For instance, it’s hard to get the crowd on its feet after Brandon Paul knocks down a three if half the people in the hall have vats of nachos and troughs of soda sitting in their laps! College football tailgating has become a sport in itself. I know people who will spend hours eating and drinking in the parking lot, never set foot into the stadium and are completely oblivious to the outcome of the game. The message that the sporting industry sends is not a healthy one. Here, come sit and be sedentary for 2 to 3 hrs and watch other people run around…oh and while you’re at it…go ahead and take in an extra 1000 calories for the day!

Then there is the business arena. When was it decided that every single meeting needs to be accompanied by food and drink. Sure, if I show up for a 7am meeting at work it is nice to have a little breakfast available since that would normally be my breakfast time at home. But come on! Do I really need to provide a snack for a 2pm, hour long meeting? It is almost as if every time you call people together, for whatever reason, be it social, business or sports, you have to feed them.

The bottom line is that people want you to eat even when you are not hungry and most of the time they want you to eat food that probably isn’t the most nutritious. In essence, we are being PROGRAMMED to eat. There is much money to be made selling crappy food to people who are not hungry. Unfortunately, this is not going to change. There are entire industries built around this principle. I feel a sense of compassion for those who are struggling to lose weight and live a healthy lifestyle because EVERY TIME they walk out the door they are confronted with attempts to derail their success. For an obese individual struggling with what amounts to a food addiction, setting foot in a movie theater is the equivalent of an alcoholic walking into a tavern. However, if that person is going to succeed, he or she needs to be able to confront those threats and overcome them.

So much of what we eat is done not to satisfy true hunger but rather to satisfy the pleasure centers in our brains that respond to that stimulus. I once heard the saying, “…if you’re not hungry enough to eat an apple then you are not hungry.” I believe in this and try to live by it as much as I can. Before you go off calling me a ‘carrot-munching killjoy’ let me tell you that I love to EAT and I eat A LOT! I love junk food as much as the next guy. I have those same pleasure centers in my brain too. I just try to be sensible about it. For my sake and for the sake of my family’s health I try to exercise some self control and encourage my family and friends to do the same. I am proud to say to that last Sunday, I was able to walk into and out of the Assembly Hall, past the yummy smelling roasted almonds with cinnamon, past the cheese pretzels, nachos and soda without dropping a single dime at the concession stand. My son never even asked for anything as we had nice bowls of soup before the game. There was no food in our laps to impair our ability to jump up and make some noise in the last minutes of the game while an inferior Wisconsin Badger team brought the ‘paign to the Illini in our own house. Now…had I had access to beer during that game…well then that would be a different story.

The Road to Wellness: Where's the EASY button?

2012-01-24T07:11:00.000-08:00

For the last two years, I have sat on the wellness committee for our organization. We have been trying to develop a comprehensive, rewards-based program for health and wellness to benefit our employees. We have had several areas of success and a few areas of setback. One disappointing fact I learned recently was that our enrollment for the rewards program has decreased for the current year relative to the prior year. This got me to thinking that perhaps we are doing something wrong.

The rewards program for our wellness initiative allows those enrolled to save money on their health insurance premiums. The requirements are pretty minimal: attend a once-a-year personal health check and log healthy activities on the wellness website in order to accrue enough points to qualify. The amount of points required to save on the insurance premium are quite minimal that anyone could qualify. There is also an opportunity to obtain a cash reward by attending a once-a-year fitness evaluation and logging additional points for diet, exercise, healthy habits and participation in sponsored events.

One recurring theme that our committee has received is that of making participation easier for the employees. I have advocated for this myself and as a result we have increased the number and locations of our personal health check events for enrolling. I remember receiving some push-back initially from one of the coordinators of the program citing the need to make people ‘commit’ to the program. He stated that he wanted employees to have to make an effort to join the program. At the time, this seemed very counterproductive and contrary to what I felt needed to be an inclusive atmosphere. I thought it seemed somewhat arrogant on our part to have such a mindset when what we are supposed to be doing is encouraging people to start down the road of a healthy lifestyle.

Recently we sponsored an event called the Resolution Run. (http://us.cisionpoint.com/BouncingBallVideoPassThrough.aspx?locator=6-27D80CEFE1-AA06DB4-AEE3F94) This was our second year and despite very cold temperatures in the teens, over 350 people came out to participate in the fun run and walk. I considered it a great success. There were employees from our organization and members of the general public. There were dogs and kids and strollers all bundled up together in the cold in the name of wellness.

Before the event and even afterwards when talking with people a recurring comment began to manifest: “….it’s so cold. Can’t you do it when it is warmer out?” This made me think about all the criticism we have taken over the last year regarding the convenience of joining our program. I also got to thinking about the initial comments made by the coordinator and began to reconsider my stance. Perhaps he was right. The whole point of wellness is to make a commitment, at least to yourself, to better yourself through diet, exercise, nutrition, stress relief or however else you define the term. I started to think about all the things I have done in my life for wellness. Not one of them was easy…at least not initially. It took courage to begin and self discipline to continue. Nobody handed this to me. I had to work and continue to work very hard for my healthy lifestyle and there is always room for continued improvement.

There is no “big red EASY button” for health, fitness and wellness. We as wellness promoters can be inspiring, encouraging and welcoming but in the end, every single individual is responsible for his or her own success or failure. Sitting on the couch is easy while getting up to exercise is hard. Stuffing your face with fast food from the drive-thru is easy while cooking a well balanced meal with good ingredients for your family takes effort and planning. Turning a blind eye to your health risks such as high blood pressure is convenient but managing your health issues takes time, money and lifestyle modifications. Health and wellness is not EASY. I am no longer going to concern myself with the people who demand to be handed their health on a silver platter. Clearly these are individuals who will not make the effort to succeed. I will instead focus my efforts on enhancing the experience for those who have made the commitment. I still welcome all to join this fray but I must insist that each individual take the first step and prove they are willing to put forth the effort. If you give all you can to your health and wellness then so will I.

My Thoughts: The Radiology Board Exam and Dishonesty

2012-01-17T06:27:00.000-08:00

It has taken me awhile to process my thoughts about the recent whistle-blower episode involving the American Board of Radiology and the written board examination. For those of you who are unfamiliar with this scandal you can get the ‘full’ story here courtesy of Anderson Cooper: http://www.cnn.com/2012/01/13/health/prescription-for-cheating/index.html?hpt=hp_c2.

As a practicing radiologist nearing his ten year anniversary of board certification I can certainly see this from both angles. I can see how one might construe this as ‘cheating.’ However, I know many, many excellent radiologists who have prepared for board examinations with the use of exam recalls and I take issue with the integrity of my profession being called into question by people who have created a system that not only encourages but in some instances facilitates the use of old exam questions for test preparation.

The recent investigative report by CNN does not, in my opinion, paint an accurate picture of the use of recall questions for board prep. They would have you believe that this practice represents a short-cut, the equivalent of taking a cheat-sheet into an exam. In reality, for most radiology trainees studying for the written exam, the use of recall questions is but a small part of the overall preparation. The recall questions are generally used to introduce the trainee to various concepts and topics that are frequent subjects of the examination and as a GUIDE to further study in textbooks, journals and case reviews. I can tell you from personal experience that the average radiology resident spends hundreds of hours over the last several months of his/her training preparing for both the written and oral examinations administered by the American Board of Radiology. I can also tell you that some of the concepts introduced by the recall questions are so obscure that they are not addressed in any of the major Radiology textbooks. The bottom line is that there is subject matter to be mastered and no trainee can effectively pass the ABR exam simply by memorizing questions.

On the other hand, there is a part of me that feels that perhaps this practice goes against the ‘spirit of the law.’ If it sounds a little bit like high school students in 3rd period U.S. History coming out of an exam and feeding test questions to the 4th period students, well that’s because it sort of is. Furthermore, if individual program directors are requiring residents to sign an agreement forbidding them to engage in this practice then clearly they are violating their departmental policy and should be subjected to whatever disciplinary actions are warranted. Some of the ‘highly organized efforts’ on the part of radiology trainees to memorize and recall test questions does somewhat push the boundaries of academic honesty and professional standards. There really is a gray area. It is not black and white. At some point the line of professionalism is crossed but I’m not exactly sure where that line resides. I was a teaching assistant for second year medical students when I was in med school. I generated study guides for my students based upon subject matter that I had ‘recalled’ being on exams the year before. Was I committing academic dishonesty? I don’t think so.

The fundamental issue I have with this situation is the reaction from the leadership of the ABR and some high profile radiology program directors interviewed in the CNN piece. As previously mentioned, this practice has been ubiquitous within radiology training programs for years. Generations of radiology trainees have utilized exam recalls to study for the written exam and generations of program directors and ABR officials have been fully aware of the practice. Not only have they been aware, but they have encouraged and institutionalized the practice. There has been some discussion that this practice goes on in other medical specialties as well. I think the harsh words spoken by ABR leadership and program directors directed at radiology residents, painting them as ‘cheats’ is inaccurate and hypocritical. It is simply an attempt to save face in the wake of a scandal. If radiology residents are engaging in a questionable practice that has been cultivated by program directors and allowed to exist by the ABR for years, then to me there is a SYSTEM problem. While it is easy for those in charge to condemn their subordinates for this behavior whilst they sit in their academic ivory towers, in my opinion, this exemplifies poor leadership. If there is a system or cultural problem with radiology training programs then it needs to change from the top down not the bottom up.

In closing I would like to say that I am proud of my American Board of Radiology certification. I consider this one of the greatest accomplishments of my life. I stand by my training and certification and that of my colleagues in the profession. The ABR certification process is a grueling task and the vast majority of those in my profession take on this task with dedication, integrity and professionalism. There are no short cuts to board certifcation. Anyone who has earned that designation has done so through years of hard work. I want the public to rest assured that regardless of what pointed commentary CNN would feed you, when you step into a radiology department you will be treated to the best possible care and benefit from physician expertise that is the result of years of dedicated training, study and certification.

3 Key Questions to Ask Before a Medical Imaging Procedure

2012-01-13T08:22:00.000-08:00

The use of medical imaging has increased greatly over the last several years. Recent studies have raised concerns about the risks of excessive radiation from medical imaging tests. Furthermore, there is significant cost associated with medical imaging. While imaging can be useful and in many cases is essential to establish a diagnosis or monitor treatment, some exams that are ordered may not be the most appropriate for the medical question at hand. As a patient, it is essential that one become educated about such procedures in order to partner with the healthcare provider to achieve the best possible care. What follows are three key questions to ask of your healthcare provider when medical imaging is being considered.

What information do you hope to get from this test and how will that impact my treatment?

This seems pretty basic; however, this question can be the most difficult for some to answer. Ideally, this should boil down to basic “IF, THEN” logic. Let’s say a patient goes into the doctor for a cough and fever. The doctor orders a chest x-ray to see if there is pneumonia. If there is evidence for pneumonia, then the doctor will prescribe antibiotics. If not, then the patient is discharged with supportive care. This is the kind of answer you want. If the treatment decision is not altered by the results of the test, then the patient needs to question the value of the test.

What are the risks involved with this procedure?

Many medical imaging tests (x-rays, fluoroscopy, CT scan, and nuclear medicine) involve the use of ionizing radiation to generate the diagnostic information. In addition to radiation exposure, the administration of contrast agents (dye) often used in CT scanning, MR imaging and kidney x-rays poses some risk such as allergic reactions and kidney damage. In most cases, the potential risk of the radiation or contrast is far outweighed by the potential benefit of performing the exam or the potential consequences to your health by NOT performing the exam. However, it is essential that you, as the patient, partner with your physician to come to this conclusion together. It is your body at risk and you should know all the benefits and risks of the test being ordered.

Are there any alternatives to the imaging test being ordered?

In medical imaging there are often different means to the same end. With multiple modalities available, sometimes choosing the right exam comes down to the preference of the doctor. Sometimes there is an option to use an imaging technique such as ultrasound or MRI that does not utilize radiation in place of a technique that does. This can be particularly useful in patients who have to undergo repeated imaging, young patients or pregnant females.

With the increased use of medical imaging, it is more likely than ever patients will receive such tests in their lifetime. It is important to understand the potential benefits, risks and costs associated with these procedures. I firmly believe that the safest patients are those that are well informed. Take the time to learn about what is being done to your body.

Exercise and Training: Run with the Pack or Lone Wolf?

2012-01-10T07:14:00.000-08:00

Almost every article I’ve ever read regarding fitness, exercise or training extols the virtue of having a training buddy or group with which to work out. However, in my experience I have rarely taken advantage of this. I have had many discussions regarding this subject with people who claim that they have to have their posse in order to work out. I’ve always been sort of a lone wolf. That is not to say that I never enjoy a group workout but for the most part my training is solo and I rather prefer it that way. It got me to thinking about why I do what I do and what the relative advantages and disadvantages of group training versus solo training really are. What follows is my personal experience broken down by discipline.

RUNNING: I have been a runner longer than I have been a triathlete so we will start there. I would say that the vast majority of my running is done solo. Back in my early days of running I would do occasional, mostly recreational runs with some friends. However, as I became more serious, I found that most of my runs were solo. I found it difficult and less enjoyable to run with people whose normal pace differed greatly from mine. As iPods came into play, I really enjoyed plopping in the ear buds and setting off on a solo run: just me, my tunes and the road. Now with marathon training starting, I have specific workouts and pace goals for every run. This does not lend itself well to social running. I keep thinking I may join a group of friends that do tempo runs one morning each week, but I never seem to be able to drag myself out of bed for their 5:30am start time.

SWIMMING: If ever there was an activity that favored solo participation, swimming would be it. I have participated in training groups and even taken group lessons but for the most part I do my swim training solo. If one thinks about it, being underwater doesn’t promote much social interaction. That is not to say that that a slightly faster swimmer in the next lane won’t push you to perform at a higher level; however, there is not much benefit to be had from a partner while doing kicking and technique drills. I have found that having a buddy at the pool is often a distraction. What would normally be a minute rest period between sets, often turns into a 3-5 minute chit-chat session at the wall. For the athlete trying to be time-efficient, this is not ideal.

CYCLING: This is the activity where I do the bulk of my group training. During my peak training months, over half of the time I spend on the bike is with at least one other cyclist. For me, the primary motivation to participate in group rides is safety. Let’s face it, going out on the road is a risk every time one hits the pavement. There is a certain advantage in visibility that is had when one rides with a larger group. When I ride with a group, I feel a certain sense of security that I don’t get riding solo. I know that if I’m 30 miles away from home and I have a mechanical or injury, there are at least a couple people in the group who will have my back. Then there is the obvious advantage of paceline riding on windy days which are more than plentiful here in the Midwest. Granted, paceline riding carries its own set of stressors and dangers, particularly for novice riders; however, the overall benefit outweighs the risk for most. I must admit that I do enjoy the social aspect of the group ride. I’ve met several interesting people that I never would have known had I not participated in the group rides. As a group leader last summer, I tried to make the rides fun by organizing occasional post-ride beer and pizza excursions. I miss that and am looking forward to starting up again in the spring. Despite my affinity for the group ride, as a triathlete, I know I have to do some solo training. There is no drafting in triathlon, so I have to train my body to power through a headwind. Also, paceline riding doesn’t allow for much time spent in the aero position. For me, both types of training are essential. I schedule my long, aerobic effort rides to coincide with the group rides and save my harder interval efforts for the shorter solo rides. It works well for me. I have found a definite benefit from riding with cyclists who are more powerful than myself and force me to dig deep and push in order to avoid getting dropped. I know this has translated into better performance on the triathlon course last season. Then there is the issue of indoor training. I know people who swear by their winter spin classes or who set up large group ‘suffer chambers’ for group indoor cycling. I have participated in these and have enjoyed the social interaction that accompanies those rides. However, for me, the time-starved athlete, it comes down to hassle factor. I have a very nice trainer setup in my basement and the convenience and time-efficiency it provides outweighs my need for social interaction.

The relative benefits of group versus solo training will differ among individuals. It is worth mentioning that there is a difference, in my opinion, in whether one is exercising or training. To me, exercise is more about fitness, activity or weight loss. Training, on the other hand, tends to be more oriented towards a race or performance goal. For the most part, training routines are much more highly structured and often more intense than an exercise routine. For instance, I can find many people with whom I can go running. However, when I am in the middle of a race training plan and have specific types of workouts and pace goals to complete, then finding a TRAINING partner becomes much more difficult.

The bottom line is that you need to do what works for you as an individual, an athlete. If your workout group is the main motivator to get you out of bed in the morning then that is how you roll. The point is get out, be active and more importantly, be consistent. Exercise, fitness, training whatever you want to call it is not just an activity…it is a LIFESTYLE. Whatever YOU need to do in order initiate and MAINTAIN your activity…that is what you need to do.

I’m interested to learn your perspective on group versus solo activity. Please share your comments below.

My Initial Experience With Kindle Fire

2012-01-03T09:23:00.000-08:00

I have been asked on a few occasions to provide a ‘review’ of the Kindle Fire as I received mine the first week they shipped and have been using for about six weeks. I’ve read many of the online reviews and it seems that there are mixed feelings about the Kindle. Some serious shortcomings have been pointed out by the critics and I will attempt to address those in my review.

I received my Kindle Fire as a gift from my wife, though I knew I was getting it. I had planned on purchasing the Fire as it seemed to have the functionality I desired at a price well below that of the iPad2. Let me tell you a bit about myself. I consider myself to be moderately savvy in technology. I work in a high tech field and the technology that I utilize I know well. Other aspects of computing are somewhat more foreign to me. I have both Windows and Mac computers in my home. My wife and I both use the iPhone 3GS. We both utilized Blackberry phones prior to the iPhone. I use social media on a daily basis and the majority of that time is on Twitter. I have no prior experience with the Android platform. I have very limited experience with the iPad2.

The primary use that I have for the Kindle Fire is as a means to web-browse, use social media apps, check email, stream music and video, and as an e-reader. I will address my experience with these functions first.

Web Browsing: As a web browser, the Fire is adequate. The pages load quickly and navigation is what you would expect. The shortcomings come mainly from the keypad and touchpad functionality which I will elaborate on below. Overall score: Average

Email: It was easy to set up my Yahoo account with the Fire. Managing email with the Fire is comparable to my iPhone and having the larger screen is nice. The display motif, a dark brown/grey with white text is not particularly pleasing to my eye and I haven’t figured out how to change it as of yet. There may not be a way. Overall score: Average

Social Media: I have Facebook and Twitter apps installed. I actually prefer the mobile Facebook app to that on my iPhone. The appearance and functionality is more akin to the full web version. I cannot say that I care much for the mobile Twitter app for Android. It has some of the functionality that the web version has (that the iPhone version doesn’t) but for overall use, I much prefer the iPhone. Every time I open the Twitter app, it opens a new page in the web browser. This gets messy after awhile. The timeline will have larger gaps than the iPhone app and there is no notification of @-replies and DMs as there are with the iPhone. So the bottom line for me: Facebook is above average while Twitter is below average.

Streaming of Music and Video: I have been very happy with the Fire’s performance in this area. While the screen is a bit smaller than the iPad, it is adequate for my use. I should go on record as saying the smaller size of the Fire compared to the iPad was actually a PLUS for me as I value portability. The Netflix app works wonderfully. I used to use an old laptop to watch video on the treadmill. This always took so long to load and navigate Netflix. This is so much easier and it fits nicely into the treadmill’s book holder. I had my reservations regarding the music. I use iTunes so not having ready access to my iTunes library was a huge drawback. But then I started to analyze how I use my mobile devices to listen to music and for the most part I am streaming from Pandora. I installed the Pandora app and it works very nicely and has a nice interface that is at least as good as on the iPhone. The sound quality is good with headphones. I have even played through the built in speakers which for the size aren’t terrible. The big downside…lack of volume control. Overall Score: Above Average

E-Reader: This is my first experience with any kind of e-reader. I have downloaded a few books, some of them free, from Amazon. The process is pretty simple and ‘painless’ with ‘one-click’ ordering. I have purchased a few children’s picture books which are great with the color screen. For standard reading material on the backlit screen (as opposed to the standard Kindle) I do think there would be some eye fatigue after awhile but I’m usually not reading for more than an hour at a time. The e-reader experience is almost entirely dependent on the content- specifically, how the Table of Contents is constructed. Some materials are better than others and some (such as the free fairy tale e-book I downloaded) have no Table of Contents at all which leaves you pretty much screwed as far as accessing particular content. Why a book of short stories wouldn’t have a table of contents is beyond me but I suppose you get what you pay for. The Bookstore and Newsstand have ample material to choose from and downloading is a snap. I have yet to actually purchase any magazines or newspapers but there are many to choose from. The single issue magazine prices seem to me to be a bit inflated. I feel the need to highlight one of my favorite features and that is the Pulse, the news app for Android. With this app, which is featured on the Fire’s homepage for easy access, one can customize a page with specific news content available on the web. It is a convenient way to keep up on the news that matters most to you and it is easy to share articles on social media. Bottom Line: Amazon has made it very easy to browse and obtain material. Prices are fair and the reading experience is good. Overall score: Above average. (Though admittedly, I have no frame of reference.)

Document Management: The Quick Office app included with the Fire does a very nice job handling most documents from Microsoft Office. Some PDF files do not display well and I haven’t quite figured out way. Powerpoint files, Word documents and Excel Spreadsheets are all very good in this app. Overall score: Above Average

Recent reviews have criticized the Fire for several issues: security, the touchpad/keypad, volume control.

Security: I’m not exactly sure why this has been made such an issue. For one, the screen can be locked requiring a password to enter. This function can be turned on and off pretty easily. I like this because I can keep it off when I have the Kindle with me but then enable it when it is sitting on the charger at home tempting the kids. The ‘one-click’ function for Amazon can be problematic particularly if you have kids that like to play with your device. This can also be disabled but I found that when I did this, it automatically enable the process again. Of course the first time I used it after that I was required to enter a password. My verdict: NON-ISSUE.

Touchscreen: This is the aspect of the Fire with which I am least satisfied. I do suffer from ‘fat-finger syndrome’ and for me at least, entering text is a cumbersome chore. Furthermore, the autocorrect is even worse than on the Apple so typos are plentiful. When choosing, or attempting to chose, an item to click on, I will often ‘fat-finger’ the choice and the wrong page will load. This is frustrating but easily remedied with the ‘back-arrow.’ Attempts to make choices on the homescreen or even with some apps like Netflix or Pandora can be difficult, especially when pounding the treadmill at an 8:00/mile pace. Attempts to make a choice from the home screen often result in my scrolling away from my choice. Perhaps there are nuances to performing these tasks that I am inept at but I would to think that a device such as the Kindle Fire would be somewhat more intuitive. My verdict: Touchscreen is an issue.

Volume Control: The lack of volume control can be problematic at times. One has to access the settings menu, choose volume then make an adjustment from there. Since I do use my Fire for audio and video quite a bit, I do find the process of adjusting volume somewhat cumbersome. Again, this is a difficult task to perform on a treadmill. My verdict: Lack of Volume Control is an issue.

In conclusion I would say that I am generally satisfied with my Kindle Fire. It does what I need it to do. Could it be better? Absolutely. I simply wasn’t willing to spend the extra money for an iPad for a bigger screen and functionality that I would be less likely to utilize. I’m still not convinced that I am 100% in favor of the e-reader experience. One the one hand it is a convenient, cost-effective, compact, and eco-friendly way to manage media. On the other hand, it is another screen to stare at and sometimes you just want to hold a book or magazine. I’m sure there are many more apps and functions that I will discover as time wears on. I will update you all after a few months. In my opinion, it is unfair to compare the Fire to the iPad. They are in two different classes of devices even though they do share some functionality. My advice: if you want an iPad, then buy and iPad. You will be disappointed with the Kindle Fire. However, if you are looking for a compact tablet, e-reader experience and are not beholden to the Apple, iTunes platform, then the Fire might just be right for you.

You Cannot Change What You Do Not Measure

2011-12-18T10:19:00.000-08:00

When I was in training for my first Ironman triathlon, I made an appointment with a local sports nutritionist. I was well aware of the fact that hydration and nutrition was the fourth discipline of long course triathlon and I wanted to make sure I was on the right track. When I spoke to the nutritionist on the phone, she stated that I was to bring a ‘food diary’ to the first appointment. She wanted me to record everything I ate for an entire weak. I was also to record workouts and how I felt throughout all of this. Needless to say the day came for my appointment and I hadn’t completed a damn thing as far as a food diary. I cancelled the appointment citing a work conflict and never rescheduled.

I was lucky in that I made it through my training and my race without significant issues on the hydration and nutrition front. I did lose a helluva lot of weight though. When I checked in for the race I weighed 137.5 lbs and had less than 5% body fat. With a body fat percentage that low I can only imagine that I was in a catabolic state: metabolizing lean muscle for energy. During heavy training weeks I would consume large amounts of food, much of it junk. I needed calories and fuel. I know I needed carbs but I really didn’t pay much attention to the TYPES of foods I was eating. I just knew I needed to eat more.

Throughout the last year I have started to pay more attention to my diet. I still don’t need to lose any weight but I do want to build some lean muscle mass in the offseason to carry me through my heavy training months this summer. I now eat whole grains almost exclusively for bread and pasta products. I make a solid effort to consume my required amounts of fruits and vegetables. I am paying much more attention to the nutritional QUALITY of the food I am eating.

I thought I was doing fairly well but recently I had noticed a change. I work out twice a day on most days: once early in the morning and once in the noon hour. I typically don’t eat before my morning workout and this usually isn’t a problem. I eat a good breakfast, mid-morning snack and an additional snack 30-45 minutes prior to my mid-day workout. I started to notice that on my mid-day workouts, especially the run and swim sessions, I would feel ‘bonky.’ A few times I had to stop my workout or slow my pace to a point that significantly impaired the quality of the workout.

I decided I needed to do what I should have done 2 years ago and start keeping track of my food intake. Luckily, we have a new wellness website that makes this very easy and less time consuming. I can put my food in and it automatically calculates calories, carbs, protein, fat and sodium. It also gives me a nice graphical representation that I can monitor throughout the day.
For instance, I found that after my breakfast and morning snack I was still well below my caloric, carbohydrate and fat limits for the day but that I'd almost reached my sodium limit. The website has me on a restricted sodium diet due to borderline hypertension. I also learned that my consumption of calories in the morning was much less than prescribed which may have contributed to being under-fueled for my mid-day workout.

What I learned from this exercise is how everyday foods and drinks that I consume push me over the edge on some areas, notably carbohydrates and sodium, but do little for me nutritionally. Having this kind of graphical feedback has really helped me to change my habits. The biggest impact has been on my soda consumption. I LOVE my regular Coke. I don’t typically drink diet soda. However, seeing the impact that a coke has on the graph makes me think twice about grabbing one from the fridge.

Tracking my food intake and relating it to workout performance is also helpful. For instance, I found that I often would get that ‘bonky’ feeling if I consumed a banana as a pre-workout snack. Perhaps the bananas I eat (which tend to be on the ripe side) have a higher sugar content and thus cause an insulin spike which coincides with my workout. The perfect recipe for a BONK. When I eat a soy nut butter sandwich on a wheat bun or a Cliff Bar, I don’t have that problem.

I have been training with GPS for years now and over the last year have been wearing a heart rate monitor. I have all my workouts meticulously logged. I’m not sure that I use this data the way I am supposed to but at least it is there. There are so many training and nutritional tools available to us it is quite easy to go overboard. I think that if one has a particular goal in mind whether it is a race, weight loss or other fitness goal it is imperative to take the time to record what is happening. Our perceptions of how hard we exercise or how much we eat may be very different from what the objective data show. To the extent that this data can help alter behavior and help you to achieve your goals it is perhaps the most important piece of your training or diet regimen.

I heard someone use the phrase, "...you cannot change what you do not measure." I think this makes sense and is good advice for exercise and training. It's not necessary to go overboard but if you have real goals in mind whether it be weight loss, body composition or event performance, then you owe it to yourself to use all the tools available to you to reach that goal.

My Golf Game: May it Rest in Peace

2011-12-18T08:37:00.000-08:00

When the clock strikes midnight on New Year’s Eve, I will have reached a significant milestone in my life. The year 2011 will mark the official death to my golf game. Unless I have some sort of breakdown within the next two weeks, 2011 will represent the first year within the past 12-13 years that I have not played a single round of golf. This death was inevitable and has been several years in the making.

The cause of death is multi-factorial. During my first few years in practice I was a regular fixture at the golf club. I participated in men’s league each week, played in club events and even went on a few out of town golfing trips. I played regularly averaging 27 to 36 holes a week. I was decent, not good. At my high water mark, I was an 11 handicap. I derived much enjoyment from golf and it served as the cornerstone of my social life.

As my family grew and with it time commitments and responsibilities, I began to play less. My participation in men’s league became more sporadic. There were no more golf vacations. My handicap rose steadily. My level of enjoyment for the game waned. It got to the point where I would force myself to go play golf if for no other reason to justify the club membership fees that I was paying. Many of the people that I had enjoyed playing with had left the club. It simply wasn’t the same experience.

Something else happened around the time my golf game was becoming critically ill. After a long hiatus from competitive running I started back on the 5K circuit. The following year was the inaugural Illinois Marathon and I knew I had to participate. Most of this training was done in the winter and early spring so it didn’t interfere with my golfing but that year I also decided to try my hand at triathlon. This was the death blow. The hours I had previously spent on the golf course were now spent on the bike. With a growing family and new training requirements, there simply was no time to golf. The following year I decided to enter an Ironman race which I successfully completed but needless to say the training required left NO time for golf. I did manage to play 2 rounds in 2010: one with my father in law and the other as part of a charity outing. Both of these rounds came at my wife’s urging not my own desire to play.

The transition from golfer to triathlete mirrors other lifestyle changes that have come about in my life. One cannot participate in triathlon, especially at the Ironman level, and not be conscious of everything good and bad that he does to his body. For me, golfing was always associated with a very fun but also very unhealthy lifestyle. My golf was usually accompanied by ‘healthy’ does of drinking alcohol, smoking cigarettes and eating fattening food. To the contrary, triathlon requires adherence to a strict training schedule, attention to proper rest, nutrition and hydration. There is no doubt that this lifestyle change has resulted in an overall improvement to my health.

One drawback to my lack of participation in golf is the social aspect. When I moved here and joined the golf club I had formed a good social network. Some of the connections I originally made through golf continue to this day through friendships and professional relationships. However, when one door closes, another one opens. My participation in triathlon and cycling has exposed me to a whole new group of people that I probably never would have crossed paths with otherwise. I have met some incredible individuals whose accomplishments inspire me on almost a daily basis. I can’t say that for my old golfing buddies. I have to say, though, it is much easier to get a buddy to play 18 holes of golf with you than it is to get him to saddle up for a four hour bike ride.

I recently read an online article shared by a Twitter follower and fellow triathlete regarding the decreasing popularity of golf particularly as it pertains to being a tool for professional advancement. You can read the full article here: http://www.fastcompany.com/1798290/golf-is-an-abominable-game-that-wont-help-your-career. There are some many good points raised both by the author and to the contrary by some in the ‘comments’ section. While golf may have always been a ‘gentleman’s game’ and associated with the well-healed in society, those in business, particularly the financial services industry should take heed to what follows. People who engage in endurance sports tend to be well educated and professional. The average income reported by the nearly 3000 athletes who registered for Ironman Louisville in 2010 was about $170,000/year. It could be that networking with the local cycling or running group may yield significant business contacts that the local country club cannot provide. I can tell you I personally made a significant change in my investments based upon a relationship that was born out of triathlon training. Times are changing. Golf is fun but as a tool for professional advancement, I think its value is decreasing. There are also many positive professional traits that are born out of endurance sports. Rob Schultz, a repeat Ironman finisher and venture capital professional outlines this nicely in his blog: http://www.robschultz.com/rob_schultz/2011/05/3-entrepreneurial-lessons-from-ironman-athletes.html.

There are certainly times when I miss golf and wish I still played. However, I have to say I do not miss it as much as I thought I would. I have filled the void with something else and I really like where I am at right now: physically, professionally, and personally. The endurance sport lifestyle is all about continual self improvement. This is not limited to your performance on the course but also carries over to your personal and professional life. Some days when the weather is perfect, I’ll look out my window on to the meticulously manicured greens and fairways with a sense of longing. Then I go outside, put on my cycling shoes, clip in and hit the road.

The Top Ten Reasons NOT to exercise and THE CURE

2011-12-12T08:55:00.000-08:00

1. I Don’t Have the Time
Yes you do. You just choose to do other things with it. Make exercise a priority in your life for your own good and that of your family and friends. You will likely need to sacrifice some other activity such as watching American Idol, sleeping, time out with friends etc. Think about that BEFORE you start and be mentally prepared to make that sacrifice. Maybe you won’t have to but be prepared.

2. I Don’t like the gym.
Then don’t go. You don’t need a gym membership to be fit. Walking, running, and biking are just a few things you can do outdoors to become fit. Look outside. The world is your healthclub and there are no membership fees.

3. It’s too expensive
Hogwash! You have shoes? You can walk. Better yet, walk barefoot. That seems to be the thing to do these days. You have arms and legs, you can do pushups and other body-resistance exercises. Get my drift?

4. My (insert bodily part of choice here) hurts.
Newsflash: Backpain and arthritis are linked to obesity. Just make sure your planned activity and intensity level don’t aggravate the problem. Perhaps you should consult a physician before you embark on your new lifestyle.

5. My kids won’t leave me alone.
Don’t beat em…join em! Or have them join you. The family that is active together…well…they are just way more cool than those who don’t. Going running? Take your kid along. He can’t run that fast? I‘ll bet he can ride a bike at least as fast as you can run. You can be active playing one-on-one with your kids in the driveway, tossing the football at the park or pushing them on the swings. Now you’ve just rubbed off on your little ones and set them down the road to an active lifestyle. Doesn’t that make you feel good?

6. My wife/husband is afraid that if I get too buff, I’ll start attracting 22 year old girls/guys and leave her/him with three kids, four cats and a fat mortgage.
You laugh but this is a real barrier for some people. There is great variability in tolerance for this kind of thing among relationships so try to know where you stand. You may not find out until it becomes an issue. There is a great feeling of self confidence that comes when you become fitter, stronger, faster, etc. This can be positive when we apply it to other facets of our life to make ourselves better. Bottom line: use this new confidence and physique to make you a better spouse or parent. Don’t let this go to your head. Don’t do anything to justify your mate’s jealous feelings.

7. I can’t workout during the day because I’ll sweat and smell when I go back to work and don’t have access to a shower.
Two words: Baby Wipes! If you can’t get to the showers after a workout, baby wipes work great for freshening up. Keep a box of wipes and some deodorant/body spray on hand in your office and you won’t be sent home from work to shower….GUARANTEEEEED! You can also choose a less intense activity such as brisk walking which has many benefits and doesn’t produce significant sweat…in most people.

8. I can’t workout alone. I need training buddies.
You’re in luck. We live in a community (real and virtual) full of active people who are looking for companions. There are running clubs, walking clubs, biking clubs, ski clubs even a cricket club! Whatever floats your boat. Get on the internet and check it out. Social media is a great tool for finding workout buddies. If you are not on facebook or twitter, this is a good excuse to try it out. It can be intimidating to exercise with strangers especially when you are starting out. I was looking for people to cycle with but was too intimidated to try to ride with the competitive cycle group. So, I hit the bulletin boards and started my own ride. Put yourself out there and you will find other beginners.

9. I don’t like to exercise
Do you like living? Hello, people! Physical activity is NOT an option it is a necessity. It is a biological need for our bodies just as are food, water, shelter, going to the bathroom and sex. We don’t get enough of it…physical activity that is. When we don’t our bodies get angry with us and do foolish things like plug up our coronaries and make us resistant to insulin. Once you get past the initial “oh, this is painful…” stage of exercise your body will begin to crave the activity. You will feel unfulfilled unless you are exercising. You will desire your morning workout just like you desire that fudge brownie…maybe more.

10. I’m too tired…
Did you ever consider the fact that perhaps you are chronically fatigued because of your lack of physicial activity? Yes, we work long hours. We don’t get enough sleep and all that. I’ll admit that there are days that I do not want to get out of bed to exercise. But I force myself to and I’m always glad that I did. A workout first thing in the morning will do wonders to energize you throughout the day. The more fit you become, the more baseline energy you will have throughout the day. Guess what? The same kind of physical stamina that is required to stay up late working or caring for children is also require to run a marathon. There is definite crossover between physical fitness and daytime/workday energy. There will be an adjustment period and the first few weeks will be tough but if you can stick it out (and you WILL stick it out won’t you?) you will start to reap the benefits of your new lifestyle.

Charitable Giving 101: A Donor's Perspective

2011-12-12T06:27:00.000-08:00

The holidays are among us. It’s a season for giving. Whether it is because we feel particularly generous this time of year or we need to decrease our taxable income, the end of the year is a very popular time for making charitable donations.

It is quite easy to get caught up in the holiday spirit and start shelling out money willy-nilly but I would suggest approaching the concept of charitable donation in the same manner that you approach any large purchase or investment. Most of us would not just show up at the mall and plunk down several hundred to several thousand dollars without at least doing a little research first…I hope not anyway. So why shouldn’t we do the same for our charitable dollars?

Here are a few key pieces of information to ferret out in order to get the very most for your charitable dollar.

1. How much of my donation is actually being used to help those in need?

This seems pretty basic but it is surprising how much this can vary among organizations. If I show up at church with a few cans of food for the food bank I can rest assured that all of those cans will end up at the food bank. But what about a check that I write to a large national charity? Fortunately, this information should be readily available for most organizations. I quick phone call to the office of any local or national charity should readily yield this information. This information should also be readily obtained within a charity’s annual report. As a general rule, the larger the charity, the larger the percentage of overhead. Many larger charities offer online giving or workplace payroll deduction options. These are extremely convenient but they do come at a cost. Keep this in mind when you give. Every dollar that is paid to a salaried employee of the charitable organization is NOT going to someone in need.

2. Where does the money go?

Again, this question often comes down to size. As a general rule, small, local charities often offer much more transparency in regards to this question. I remember that a few years ago, we donated to a local church-sponsored charity. We received a letter from the director which outlined the stories of three different families that our donation helped that Christmas season. I thought that was a very nice touch. Again this information can often be found in the annual report for larger organizations, but for smaller charities you might need to contact the office and speak to staff.

3. Does the mission of the charitable organization align with your personal beliefs?

This is somewhat esoteric but it is important for many people. I have read stories about frustrated donors who have given to particular organizations who have in turn supported organizations that are contrary to the donor’s religious, moral or political beliefs. This is sort of the same concept as ‘fair trade’ consumerism. If you have a strong belief or desire that your money not be used to support particular types of programs, then ask about it. Be frank with the charity’s staff and specifically request the information that you desire.

4. May I direct my donation?

Many charities that support a variety of programs will allow you to direct your donation to a particular program or organization. Again, do not be afraid to ask. Many larger charities will have such options available on their website or donor form. If not, get on the phone and talk to someone to discuss options. Fund development is not just about raising money, but also about building relationships. Many charities are more than happy to work with donors on this point in order to build a long term relationship for continued giving.

There are many organizations jockeying for your charitable dollars. Whether it is a few coins in a bucket or a large endowment, the decision to give should not be taken lightly. Giving feels good but it feels much better when you know that your dollars have had the most impact that they can have on the people and programs that matter most to you. The bottom line: BE AN ACTIVE DONOR.

Do You Really Know What’s Wrong with Healthcare?

2011-02-20T13:52:00.000-08:00

Last week I got a pretty good insight into our health care system. Yea…I know I’m doctor so I should know all about this stuff already. In fact, being a physician does give me great insight into the strengths and weakness of our system but being on the other side as patient is a totally eye opening experience.

I’ve been to the doctor several times over the last couple of years but it’s not the same ‘patient experience’ when you are a physician. See, in our system, it’s easy to get special privileges. Here’s an example. A month or so back we had these health screenings for our wellness program. My blood pressure came back a bit high. I’ve had higher reading in the past and I’m not exactly the most mellow guy out there so I figured I better get this checked out. I decided to check my BP at home and the readings were coming up similarly elevated. So, at work the next day I walk two or three doors down the hall to the office of my primary care physician to get his opinion. I also tell him that during an insurance physical last year I had protein in my urine but blew it off because I figured being the elite endurance athlete that I am it was just muscle breakdown and protein supplements. He listens to this, quietly gets up from his chair, grabs a piece of paper, writes down a few things, walks me over to the lab and tells the girls that I need to have blood drawn and a urine sample for protein. It’s almost quitting time, so the lab is about empty. They get me right in, I pee in the cup, they draw my blood…bada bing…I’m on my way home. A day later he calls to tell me all is good but to keep checking my blood pressure because if it stays high I might need to go on meds. And that was that. No waiting for an appointment, no waiting for the doctor who is running behind. I got rock star service. I fully understand, more so now than ever, that this is not how most people roll.

So last week I had to take my dad in to the hospital to have his pacemaker battery replaced. He had to be admitted overnight for IV antibiotics and had to be at the hospital at 6am the morning of the procedure. So I made plans to go the night before and get him the hospital bright and early. While I would have to say that overall the care he received was very good and the people were friendly enough, I did notice many areas for improvement.

Communication

When my sister called me to tell me dad had to have his battery replaced, I thought, “…no big deal...routine procedure.” As I was talking to my dad a few nights before the procedure it became very evident that he was confused about what exactly was going to happen to him. Let me explain that my dad is 88 years old, a retired physician but still working reviewing disability claims for the state. He is highly functional for his age but his mental capacity has slowed in recent years. He very intelligent but he doesn’t process information as quickly as he used to. He was under the impression that he was having a cardiac catheterization in addition to the battery change. He started reading me his instruction sheet which was entitled “Your Outpatient Cardiac Catheterization.” On this sheet were general pre-procedure instructions…you know the stuff about not eating after midnight…etc…etc. As he was reading this off to me, I immediately knew what the problem was. While the procedure was to be performed in the cath lab by the cardiologist, it was not a cardiac catheterization. They had given him a generic cath lab instruction sheet and this confused him. My father can be quite stubborn and he insisted he was having a cath. I explained to him that he probably wasn’t but we would iron this out on the morning of the procedure. I told him to just follow the instructions which interestingly enough didn’t have anything about holding his aspirin which is pretty standard procedure. Luckily, my sister had instructed him to hold it several days before.
I feel that he could have been given better instructions. I understand the concept of using a standard instruction sheet but there should somewhere to write in the exact procedure the patient is to have done.

While we are under the subject of communication, let me tell you what else I observed while I was there. While my sister and I sat in the waiting room for him to be done, a cardiologist came out to talk to a patient’s family that was seating on the other side of the waiting area. Now some of you are familiar with HIPAA or the Health Insurance Portability and Accountability Act. This law contains a privacy law that basically means that healthcare providers are bound by federal law to protect your confidential patient information or else risk serious sanctions…read fines…big fines…and prison. So this cardiologist must be ignorant to this law which has been in effect since 2003 and really has been practiced by conscientious healthcare providers for centuries. He proceeds to identify the patient by name then describe the finding of the woman’s procedure and his recommendations. This is all well and good except for the fact that had he done so with a bullhorn, he wouldn’t have been much louder than he already was. EVERYONE in the waiting area could hear what was supposed to be a confidential medical conversation. The problem is unless you are a healthcare provider yourself or an extremely well informed patient you probably don’t realize what a serious infraction this is.

But getting back to my dad and his situation I feel that there could have been better communication on both sides. To fault the hospital, the use of standardized forms while convenient and timesaving, has potential to create confusion in certain circumstances. To fault my dad, he should have taken measures to ensure he knew exactly what was going on. I think part of my dad still thinks he is the doctor but as I mentioned, he is 88 years old and doesn’t process information like this the way he used to. It would probably benefit him to take someone along who can help gather all this information. By the way, this is a great idea for patients of ANY age. When most people go to the doctor, they are stressed. Perhaps they are sick or are getting bad news. Anxiety sets in and this decreases the ability to accurately process information. Taking a family member or friend along to serve as an extra set of ears and/or act as an advocate would benefit most patients more than they could ever realize.

Killing a Mouse with an Elephant Gun

When it comes to healthcare costs, expensive diagnostic tests…read lab and xray…are often in the crosshairs for elevating the healthcare budget. As a radiologist I am acutely aware of this fact and try to practice in a manner that minimizes patient cost and still provide quality diagnostic information. So let me walk you through what was done to my dad for this minor procedure he was to have. Upon arriving at the pre-op area at 6am as advised we were promptly checked into a prep room. The nursing staff took over and started doing their thing. The first thing they did was to take a nasal swab of his nasal mucosa for MRSA or Methicillin-resistant Staph aureus. This is a major problem in hospital acquired infections and is particularly troublesome in patients with any kind of implanted device so this seemed entirely reasonable to me. After my dad got changed into his gown and we bagged up all his earthly belongings, another young lady came with a wheelchair. She identified herself as an x-ray tech and that she was to take my dad off for a chest x-ray. So off they went and they were gone for about 15 minutes. I though it was kind of odd to be getting an x-ray BEFORE the procedure. Usually at our institution the x-ray is obtained after the pacemaker insertion. But what the hell…when in Rome, right? While he was off in radiology, the phlebotomist came by to ‘draw labs.’ Also, there was a urine specimen that was require. Really? A urine specimen for a 15 minute pacemaker procedure? What the hell for? Then a nice guy from St. Jude, the pacemaker manufacturer, came by to interrogate his system and check the leads, etc. That seemed appropriate. Then the nurse came back to finish her pre-op evaluation. She went through his whole history as they are required to do. Then came the part about his meds and when exactly did he take the last dose of this and that. This is when my dad, and me, started to become frustrated. He was having a hard time remembering the exact timing of his meds and his responses were becoming inconsistent. I understand why they might need this information but perhaps sending the patient a pre-op form to fill out the day before with this information might be more fruitful than trying to get an 88 year old sitting in a hospital bed to remember the precise timing of his last dose of Lisinopril.

I know the explanation for all of this already. There are standard order sets that are generated for each doctor’s patients that come into the cath lab. These standing order sets are generated based upon what most people require when they come in for cardiac catheterization. The fact that my dad was coming in for a 15 minute procedure to have his pacemaker battery changed didn’t matter. He was a Dr. So and So patient so he gets this lab and that test just like everyone else. Once again, having standing order sets and protocols creates time efficiency for staff and lessens the chance than anything would ‘fall through the cracks’ so to speak. I hate to admit it but there has been a real ‘dumbing down’ of healthcare workers over the last several years. Registered nurses command decent salaries and hospital administrators have figured out that they can hire less RNs if they offload some of the tasks traditionally performed by RNs to lesser skilled employees. Enter the ‘healthcare tech’ or ‘nurses aide’ etc. Some of these individuals have no formal training other than what they get ‘on the job.’ Knowledge of medical terminology…forget it. And that is why these standard order sets exist…to make things idiot proof…because…once again I hate to admit…we have a lot of idiots working in healthcare. When I look at some of the nurses coming out of training to today, I just cringe. I tend to compare them to my older sister who is a master’s educated registered nurse and can’t believe how far the profession has fallen. Of course the nurses like my sister have figured out they can make more money outside the hospital so we are stuck with the lesser-trained vo-tech grads who don’t even know how to properly pronounce the medications that have become licensed to administer to patients. So in conclusion, the hospital’s attempt to reduce their own costs by dumbing down the workforce has resulted, although indirectly, in higher healthcare costs to society by the performance of unnecessary diagnostic testing.

Big Pharma

Something else I learned about last week was the influence Big Pharma has on our healthcare. This is not necessarily new information. Michael Moore demonstrated this to some extent in his documentary “Sicko” a few years back. We all see the pill commercials on TV and in magazines. It’s a huge business. And we all need these great new medicines to treat our infections, curb our anxiety, lower our cholesterol and let spry octogenarians like my dad get a chubby. It’s when the line between business, healthcare and government becomes blurred that I have a problem.

I got to spend a few hours with my sister, a nurse by training, who now works as a lobbyist for the pharmaceutical industry. I must admit that I do not know exactly who she works for and who signs her paycheck but given the fact that she is an insufferable workaholic I got to see her in action as she spent most of our time together glued to her laptop and cell phone. She loves to talk about how hard she works and all the traveling she has to do and all the legislators she has to woo and all the bills she and her team are working around the country. We went to lunch and I swear she spent the whole time talking on the cell phone to some guy on her team about how they needed to get some bill to a vote in the Indiana legislature. This bill would require ALL healthcare workers to be immunized against influenza. That sounds reasonable on the surface but then I got to thinking and it made me mad. As far as I could surmise, the pharmaceutical industry is drafting legislation which is then presented to various lawmakers in various states to adopt into law. This is where my sister comes in. She is the liaison between the vaccine manufacturers and the lawmakers. This is ludicrous! Why should healthcare policy be written by the pharmaceutical industry? I am not anti-vaccine, not by a long-shot. My kids get all their immunizations and I am hard pressed to think of one development that has had a larger impact on our collective public health than vaccines. The fact that vaccines are relatively safe and effective make this an easier pill to swallow (NPI). But wouldn’t it make you feel better to know that this legislation was being drafted by the health care subcommittee or some other public health organization? I know this kind of crap goes on and in multiple different industries but it still doesn’t make it right. Perhaps Big Pharma could use the millions of dollars it spends on lobbying efforts to provide low-cost or no-cost vaccines to the financially disenfranchised. Just a thought.

What bothers me even more is the thought of Big Pharma becoming so entrenched in my family’s healthcare. Imagine this scenario. Your child goes to school. He starts having some behavioral problems. So the teachers and school social workers administer a standardized screening test for ADHD. Your child takes the test and scores in the range that some ‘experts’ have decided falls within the range for ADHD. The school sends a letter home to you stating that your child has been diagnosed with ADHD and that according to state law (passed with the help of lobbying money from Big Pharma) he is required to be medicated so as not to be disruptive to the class. Do you think that sounds far-fetched? Maybe so. But I wouldn’t put anything past Big Pharma. If they’ll screw with your immunizations, they’ll screw with your kid’s brain too!

We Have It Pretty Good!

I don’t mean to sound too critical of our healthcare system, after all, I am part of it. I believe in it. I honestly believe we have the best care in the world. That doesn’t mean things couldn’t be better. Our system fails some people and for different reasons. The President and Congress have set out to ‘fix’ our broken system. Quite frankly this scares me. I have never known the government to adequately ‘fix’ anything in my lifetime but we will see how this all plays out.

As I write this post, so many more ideas have come to me about how our healthcare system could be improved. As a physician, I have quite a few insights. I plan to make this a series on my blog. If you have any healthcare-related topics or ideas on how to improve our system please leave a comment and I’ll see about incorporating that into future posts. So long for now. Stay well!

Train Like a Virgin

2011-01-30T12:40:00.000-08:00

Many of you will remember the erudite monologue delivered by Quentin Tarantino in the opening scenes of Reservoir Dogs. If not, you may sample that speech here: http://www.youtube.com/watch?v=hPZ9kidioi8 but be warned that this is not a family film and some content may be offensive to some. Anyway, these guys are debating the meaning of the song "Like a Virgin." Tarantino says it's about a woman with somewhat loose morals who happens upon a gentleman who...how shall we put this...is generously endowed. As a result of this...ahem...generous endowment, the woman is feeling the same kind of pain that she felt during her first carnal encounter. Hence the title "Like a Virgin."

This spring I will complete my fourth marathon not counting the one I did for my Ironman. However, for the first time I am following a real training plan. I have a real goal in mind. I want to break four hours and I have embarked on a plan to do just that. I have been using the Furman Institute's marathon training plan. This is a great plan and perfect for triathletes because there are only three scheduled runs a week leaving plenty of time to bike and swim which is encouraged in this plan. You can review the basics of this plan here: http://www.furman.edu/first/firstfeatures.htm.

You might say that when it comes to endurance events I would be the equivalent of the 40 year old divorced barfly. I've been around the block of few times. I've been injured. I've had PRs that I'm proud of and race days I'd just as soon forget about. But yet I keep coming back for more. When I did my first marathon, I just wanted to finish. My second marathon was done eight years after the first and so, again, I just wanted to finish. Last year, I did number three but I had a larger event on my horizon at summer's end...the Ironman. So, I really just absorbed the mid-spring marathon into my IM training routine. I didn't want to mess things up so I didn't push myself too hard. Of course that didn't stop me from suffering from a nasty case of ITB Syndrome which required intensive therapy just to get me to the finish line. But this year I have no excuse . There is no race longer than a 70.3 on my schedule so it's time aim high...try to get out of the mid-pack.

I didn't use formal training plans for my first three marathons. Instead, I focused on making my weekend long runs progressively longer as the race got closer but my shorter runs during the week were just the same old routine four to six mile runs. I didn't concern myself with speed work...wasn't even on my radar. I didn't care about running fast, just finishing. But now I have a new formula. Each week consists of three key runs: one speed session, one temp run and a long run. I had to pick a target pace for my marathon and all training sessions are built around that pace. I first I thought the workouts were pretty easy but now about a third of the way into the program, they are getting to be kind of a bitch. I don't have much trouble with the tempo runs but the speed sessions are becoming brutal. This week I will have to hold my speed pace (currently a 6:40/mi pace) for one mile times 3 with 90 seconds of rest between. That is going to be brutal and my legs are burning just thinking about it. Which brings me back to the original theme for this post. When I would train for prior marathons, I always trained at a comfortable pace, never pushing myself too much. But now, I have to grind through speed sessions and tempo runs and my legs are killing me after each and every workout. I have pace goals for each and every workout and I obsess about meeting those goals. I have become a complete data freak, analyzing my workouts for pace, heart rate zones, etc. I have become very scientific about my training. My body is a machine and I am tuning it.

There are two ways to build fitness: increase duration or increase intensity. For too long I focused on building duration because that is what endurance athletes do. But I have already gone the distance. I now need to go faster. It is time to increase the intensity. I am not sure when I decided to make the switch from complete to compete but I'm on that road now. Every week brings with it new challenges and my body responds but I definitely feel it the next day...any sometimes the day after that. The trite expression "no pain, no gain" really is true. In order to gain fitness and increase performance, we need to take our bodies beyond what is comfortable and force it to the extremes. You do this enough times and your body then begins to think what used to be the extreme is now normal. And then you push beyond that point...and so on and so on.

So, after years of what I will refer to as 'comfortable' training I am in performance mode. I now end my workouts exhausted but exhilarated. I lie in bed at night, my legs burning they way they used to after hill repeats during high school track practice. I feel the pain...pain I haven't felt in years. But just like the woman that Madonna sang about in "Like a Virgin," I welcome the pain for what it does for me and how it makes me feel. I guess we will see what happens on race day.

Freaky Flipped Out About Taxes

2011-01-21T08:08:00.000-08:00

I am disturbed by the recent diatribe put forth by a local fast food magnate (who shall remain nameless to protect the innocent) regarding the passage of a significant income tax increase here in the state of Illinois. While I agree with this dude in theory, his delivery and general media presence were distasteful and borderline offensive. I will attempt to explain why.

Those who know me well understand my political leanings. I am Republican but more of a moderate Republican. I believe in limited government, personal responsibility, fiscal conservatism and a pro-business environment. Where I tend stray from the typical conservative Republican dogma is in regards to social issues. There are many litmus tests that I would never pass to be a ‘conservative’ Republican but I’m OK with that. I do not vote straight party Republican. I have voted for Democrats before when I feel that they are the better candidate. But overall, my leanings are to the right. Ok…now that we’ve gotten that outta the way let’s talk about this tax hike.

In general, I am opposed to the knee-jerk tax and spend mentality that permeates Washington and Springfield. I was opposed to the recently passed state income tax hike and I applaud our local legislators who took the stand to oppose this hike. I have been very outspoken on social media regarding my opposition to the income tax hike. I have also been called out for supporting a local referendum that would raise property taxes to help finance the construction and maintenance of new outdoor aquatic center while at the same time rallying against the income tax hike. This is a reasonable inquisition so allow me to reconcile this apparent contradiction.

I am not opposed to all taxes as I believe they are a necessary evil. I was opposed to the state income tax hike because, in my opinion, the State of Illinois has proven itself to be fiscally irresponsible. Raising taxes without making appropriate adjustments to expenditures is throwing good money after bad and I cannot support that. The local tax referendum is a different story. This tax is to be levied by our local park district. I have spent the last 3 years working with the park district on their advisory committee and can assure you that they are one of the most fiscally responsible government bodies in existence. We are providing the citizens of our city the opportunity to decide if they are willing to spend the money to have this community amenity. If they vote YES, we build. If they vote NO, the pool stays in mothballs. It’s that simple and that is the way it is supposed to work. The alternative that the state of Illinois likes to practice is to spend our way into a fiscal crisis to the point that key services are being threatened then propose a tax increase as the only way out. This is not fiscal responsibility!

Now back to our fast food boy. So, this guy is so dismayed about the corporate income tax increase of 46% (the personal income tax increase was 66%) that he is contemplating (threatening) to move his corporate headquarters and 100 or so employers to neighboring Indiana. He went so far as to get on the local news TV and newspapers and deliver a whiney diatribe that was quite frankly embarrassing to watch and read. He stated that he ‘enjoyed being courted’ by the other states. He then went on list all of the local business that he and his family patronize as if his decision to relocate would result in immediate collapse of the local economy. Forget about the large Big Ten University and two health systems that employ the vast majority of people in this community, we can’t lose him or his 100 employees. For if we do, the local hotels and restaurants and bars will suffer. His rant was almost delusional! What’s even more sad is how some people bought into this. One individual posted on her Facebook page that we should all go out and flood this guys shops and buy his food so he won’t leave town. Like that is going to make one lick of difference!

Here’s my problem. I understand this guy’s position and I agree with it to a point. If I were in his shoes, I would be thinking the same way. As a business owner, you have to be cognizant of the bottom line. It’s great to be loyal to your community but in the end, if your business suffers many people and families suffer along with it. He needs to position his business in the best possible atmosphere for growth and continued success. For God’s sake, just don’t be such a friggin’ tool about it!

Let me offer a slightly different perspective. At the end of the last Congress there was a little talked about piece of legislation put into law (little known unless you are a doctor or health care administrator). There were major cuts slated to go into place involving Medicare reimbursement. Had these not been repealed the effect could have catastrophic for many health care institutions. The effect of this cut on our system would have been to the tune of $12 million! That right…$12 million off the books with one sweep of the pen. Couple this with the fact that due to the budget crisis, the State of Illinois was several months behind on insurance premiums to our system, and you have the recipe for a health care crisis of a different kind. Some hospitals can absorb this…others not so much. Programs and service lines would get cut. Access to care would suffer, especially in struggling rural areas. People would lose jobs…good jobs…skilled jobs…not minimum wage McJobs. Yet, you probably never heard about this. Our CEO never got on TV and whined about the state not paying its bill or threatened to move out of state. Nope…never heard any of that.

The Republican Party has an image problem. I acknowledge that. This became very evident in 2008. I am encouraged by the results of recent mid-term elections but we have a lot of work to do. Our party has been hijacked by the Tea Party. When people think of Republicans, they think of ignoramus shock jocks and ranting illiterate tea party protesters. We are looked upon as the ‘spoiled rich boys’ and ‘angry white men’ of politics. Somewhere out there is a happy medium and I sure as hell would love to find it. The local Republican Party has recently been injected with new life with appearance of young political upstarts on the scene. These guys and their type are the future of our party and we can be proud of them.

Our cause is not at all helped by the likes of multimillionaire fast food boy who gets on the local media and whines about having to pay more taxes. His delivery of what could have been a very important message was reduced to the equivalent of a bitchy teenage girl who storms out of the room, slamming the door behind her because her parents won’t indulge some frivolous request. My message to fast food guy is this. It destroys me and tears me apart to see you have to go but you gotta do what you gotta do. No hard feelings. Rest assured, our community strived for 100 years prior to your business setting up shop in town and although it will be a real struggle, I think we just might make it without you. So, farewell, dude and you might as well take all your Salmonella laden fat-injected morsels with you…we don’t need them here.

Warming Up to Treadmill Running

2011-01-12T09:30:00.000-08:00

I have always been a staunch opponent to the treadmill or the ‘dreadmill’ as I like to call it. I recall many times pointing out the window and telling people, “…THIS is MY treadmill!” But all that is beginning to change for me. There are multiple factors at play here.

Equipment Quality

Most of my disdain for treadmill workouts was based on my experience with our old noising clunker of a machine that we purchased back in the mid 90s during my residency training and had in our basement until last spring. That piece of junk was loud and uncomfortable to run on. It would seem like it would take much more effort to run on the treadmill at a similar pace than it would on the road. This piece of equipment sat pretty much idle in our basement taking up valuable space until about a year ago when my wife decided to start working out again. She started using the machine with some regularity so it was decided to purchase a new model. We opted for a moderately priced unit, not exactly entry level but not the $2000 health club quality job either. I had kind of figured this would be mainly for my wife who exercises moderately and that I wouldn’t be using it so I didn’t see the point in spending a lot of dough. But we wanted something decent. I was so surprised at how quiet the new units were compared to our old clunker. I was also impressed with the technological advances such as built in iPod docking stations, Wi-Fi compatibility and built in ventilation. We had our new unit for several weeks before a stormy day forced me to complete a run workout prescribed by my Ironman training program on the treadmill. I was so pleasantly surprised by the feel and all the options for adjusting the pace and the incline. I remember running on the old machine and wishing my run would be over by the time I hit the half mile mark. Not here, not now. This run was more than tolerable, it was almost enjoyable.

Mother Nature, Old Man Winter and the Need for Speed.

So here we are in the second week of January in beautiful Champaign-Urbana, Illinois. The Illinois Marathon is 15 weeks away and most of us are well into our respective training programs. We have been blessed (or cursed depending on your take) with ample precipitation this winter. There was snow on the ground for much of December and after a brief reprieve of dry, warmer weather over the New Year holiday we have just been doused with another blanket of snow. The snow banks on the shoulders of the roads reduce the amount of room available for running safely and out of the way of oncoming cars. Furthermore, the paved trails that I typically frequent in my area do not fall under the jurisdiction of the public works department so they stay snow and ice covered until the temperature increases enough to clear them. Then there is the daylight issue. I’m an early riser. I get my workouts done in the morning and over the lunch hour. Anything more than a five mile tempo run is difficult for me to fit into my lunch hour. I prefer to leave my evenings free so as not to impose on my family too much. Then there is the issue of pace. This will be my fourth marathon not counting the one I ran for my Ironman. Every time I have done this before, I have pretty much been focusing on finishing the race. I logged my miles, not keeping any particular time goal in mind, just wanting to finish. OK, last year I kinda wanted to break four hours but a nasty case of ITB four weeks out from the race curbed that goal. But this year is different. I’m going break four hours. I plan to run the race at an 8:30/mile pace and I am following a program to do just that. For the first time in my marathon career, I am incorporating speed workouts into my training regimen. I am doing intervals, tempo runs, threshold runs, and run-til-you-nearly-puke runs. So let’s put this all together. It’s cold, it’s dark outside, there are patches of snow and ice on the ground, I’m dodging oncoming cars and I need to run fast. This sounds like a recipe for disaster to me. I rather like my fibula. It doesn’t seem to do much but, Boy, if it got broken, I’d be in a world of hurt, literally and figuratively.

My training program requires me to complete run workouts at prescribed paces and perform interval speed work. It is so much easier to do this on the treadmill where I can dial in a particular pace and go. On the treadmill, I do not have to try to light up my Timex Global Trainer to check my pace only to see that it has slowed below my lower limit because I am battling an 18mph headwind. On the treadmill I am safe, I am warm (very warm, almost too warm) and the quality of my workout is superior to what I could accomplish on the road under current conditions.

Now That’s Entertainment

I love music. Music motivates me on my workouts. I never leave for a run without my iPod. I am most sad when during a long run my iPod battery runs out…it’s as if someone has pulled the plug on my workout. I love music so much that I purchased a waterproof MP3 player for my swim workouts. If I thought it would be safe to listen to music while riding my bike, I would do that too. Apparently, there is some contraption out there that puts stereo sound into one earbud leaving the other one free. It is supposed to be used for cycling but I still think that is a bad idea. Last year, while training for Ironman with some other guys I got turned onto watching movies during longer trainer rides. We had all our indoor trainers set up in a clubhouse and would watch various movies during our rides. I rather enjoyed it and it made the time go by faster. I have my indoor trainer set up now in my basement with a small TV, DVD player and headphones and have been watching movies during my indoor trainer rides for some time now. Recently, I discovered that my treadmill was designed to hold a laptop…to be used for Wi-Fi workouts and virtual training. So…I got the brilliant idea to set up my laptop on the treadmill and with the help of Netflix I now have access to movies and TV shows to watch while I’m working out. I’m not much of a TV watcher. My life is too busy for that. I enjoy movies but tend not to have much time for movie watching either. So this seemed like a good idea. I could work out and get caught up on all the movies and TV shows that everyone is talking about. Plus, since I am running I can indulge in my TV/movie habit without appearing to be a couch potato. It’s a win-win situation. Hour long TV episodes on Netflix without commercials run about 40 minutes, perfect for a 5 mile tempo run. I can indulge in a full length feature presentation during a long run. Unfortunately, some of my intermediate length runs have resulted in my having several partially viewed movies in my Netflix instant queue but I’ll get around to them eventually.

Not a Complete Convert Yet

Don’t get me wrong, I love outdoor running and when weather permits I’m hitting the road. There’s just no complete substitute for that. One of the downsides of treadmill running, as my wife has found out, is that you are in the basement (in our case) and as a result the kids always have access to you. My kids are early risers and my wife and I have both been interrupted during workouts by kids with various needs. But for right now during this snowy Chambana winter, the treadmill is meeting my needs. It helps that I have one in the basement because I doubt I would be as jazzed about treadmill running if I had to go to the health club. So while the winter chill is on and the roads are icy, I’ll be in my basement, pounding out speed workouts and sweating my ass off to Season One of Undercover Boss. I’ll see you on the road this spring!

Don't Call Me Doctor

2011-01-09T11:19:00.000-08:00

PASTOR JACK

A few weeks ago I had the pleasure of meeting a gentleman who refers to himself as “Pastor Jack” during some community work I was doing. Pastor Jack is a bona fide member of the clergy. He even has his own church albeit a small one but it is his. Anyway, when it comes to churches, building size shouldn’t matter. In fact, when I was in school, they always taught us that a “Church” is made of people not bricks. When I first met Jack it was at his church so it only seemed appropriate that he introduce himself as a Pastor. However, as time went on and we began to cross paths outside of that realm he still always referred to himself as “Pastor Jack.” I began to wonder about how and when people use titles and even started to reflect on my own use of the title ‘Doctor.’

PLEASE CALL ME 'DOCTOR'

I remember how very proud I was the day I earned my medical degree. I wasted no time in referring to myself as ‘Doctor.’ I had M.D. printed on my checks and always signed my name to everything with those two magical letters following my surname. I recall how charged up I was every time I heard my last name with the title ‘doctor’ in front. I felt powerful, authoritative, deserving of respect. But as time went by the magic wore off. Having practiced medicine for 15 years now, I no longer feel that my profession is so special or deserving of special attention. Don’t get me wrong, I love my profession and love what I am empowered to do on a daily basis, I just don’t see it the same way I did fifteen years ago. I studied and worked hard to earn a degree, a degree that let’s me help people and yes, earn a nice living. But how does this make me any more special than a teacher or a social worker or even a member of the clergy?

GENERATION GAP

Some of this is generational. My father who is a retired physician and 88 years old still refers to himself as ‘Doctor.’ It doesn’t matter if he’s talking to the customer service rep at the local bank, making a dinner reservation or meeting a new acquaintance, he is ‘Doctor.’ And why shouldn’t he be? He worked hard all his life. He overcame great obstacles, too numerous to delineate in this entry, to receive his medical training and build a successful career. My father practiced medicine in the glory days. He practiced in small and medium sized cities where the social stature of being a physician was exalted to levels not currently experienced anywhere. In his day, being a doctor really meant something. It wasn't just a job. He wasn’t an employee of a big organization. He was a professional, a healer, a doctor. And he still is. Many of his generation and also people quite a bit younger still hold this view of themselves in the world. But the world around them has changed.

PAY ATTENTION TO ME, I'M IMPORTANT

Looking back, I would have to say that my own use of the title ‘doctor’ was inversely proportionate to my self confidence and ability level. The less sure of myself I was, the more I used the title. That is why over the years I have significantly reduced my use of the title “Doctor” outside of the professional setting. I never introduce myself socially to anyone as “Doctor.” When I look back at the times I have used the title outside of the hospital setting it was generally due to lack of confidence or my need to overly impress someone. For instance, when addresses staff at the local country club, I would always refer to myself as “Doctor” and they too to me in kind. I imagine this use of the title outside of the professional setting was due to my own lack of confidence and insecurity that somehow the only reason I belonged there was because I was a doctor.

WHEN IN ROME...

Now at work, it’s a different story. I still prefer to be called ‘Doctor’ at work, especially in front of patients. It’s one thing if I am conversing with another physician colleague, then first name is the rule. Most docs my age don’t use the title when interacting with other physician colleagues. Some go as far as being on a first name basis with their staff…I haven’t reached that level yet. I remember we had this administrator at work that was real piece of work. She was decidedly anti-physician despite being married to one. If you ever met her husband you’d understand…but I digress. Anyway, she used to call the docs by their first names. I viewed this an kinda ballsy but she had big ones. If she hadn’t of been canned in the process of our merger I would probably have had a conversation with her to inform her of my preferences for how to be addressed in the workplace but fortunately that is a conversation I never had to engage in.

MUDDY WATERS

Sometimes the lines get blurred. I have a friend who also happens to be a coworker and subordinate. One time at an event she went to introduce me to a member of her family and as she did I could tell she was having a dilemma. She paused for a second right before introducing me as “Doctor.” I immediately thrust out my hand for a handshake and introduced myself by my first name. That singular event set the stage for all future interactions. I didn’t have to say anything about it as she was able to learn from the situation. Of course she is smart enough to know how to read people and social situations. She calls me by my first name when appropriate and refers to me as ‘Doctor’ when appropriate. It’s no big deal. There is another employee at my work, also a young female. She babysits our kids sometimes so we know her out of work. She has been to our home and knows our family well. I have no problem with her calling me by my first name at home or even at work when we are talking privately. However, the other day she called me by my first name several times and within earshot of several of her co-workers at the office. I let it go without saying anything mostly because I didn’t want to make her feel uncomfortable. She is a very nice person and I know she wasn’t doing it to be obnoxious. If I thought she was I would have said something. But it did make me feel a bit uncomfortable. But not why you would think. I didn’t care that my authority was being undermined. I’m not that friggin’ egotistical. What worried me was that all these other young hens at the office were going to think there was something going on between us that was …well…inappropriate. I’m sure most of her co-workers know about the babysitting but for those that didn’t, that interaction probably seemed strange. People love to gossip about doctors especially (relatively) young male doctors. I know there are purists (mostly HR professionals) who would heavily frown on the kind of fraternization that I engage in with people who are my effective subordinates. I think that is BULLSHIT. I will be friends with whomever I please and if I find a good babysitter, dammit, I’m not gonna let that go just because she works with me. Still, these relationships do pose dilemmas due to the work/social environment dichotomy that exists.

IF YOU KNOW YOUR SHIT, IT DOESN'T MATTER WHAT THEY CALL YOU!

Given all this, I now view anyone who hides behind titles or alphabet soup suffixes to their name with some degree of suspicion. As a physician and academic faculty member I am constantly surrounded by people obsessed with titles and credentials. The same could be said for academic pedigrees but that is a subject for a different post. I see people, often nursing professionals, with all kinds of letters behind their names. I have no fuckin’ idea what half of it means and I’m in the business so does it do any good at all to put these credentials in every communication? Ironically, those people that seem to have the greatest insistence of being called “Doctor” are not physicians but rather academic professionals. I guess I don’t have a problem with it, after all, they earned an advanced degree. What irks me are the allied health professionals (physician’s assistants and nurse practitioners) who allow their patients to address them as ‘the doctor.’ There are quite a few of them who do not discourage their patients for doing that and that is most offensive to me. At least the linguistics professor who insists on being called ‘Doctor’ earned his/her degree. When I come across these people I just assume that they are either grossly incompetent, insecure or both because that is how I acted when I was younger, insecure and inexperienced.

PEOPLE ARE PEOPLE...

In closing I would just like to comment about how our society places a certain amount of importance to one’s job by attaching a salutation to it. We don’t go around greeting people by saying, “Good morning, Customer Service Rep. Dave.” Or “How’s it going Accountant Jennifer?” So really, why should we do that for physicians or members of the clergy? It’s one thing to show respect but let’s not forget that there is a person attached to the title. Americans place far too much emphasis on jobs and career when it comes to defining self worth. This is a subject for another post. I may practice medicine for a living but “Doctor” is more of what I do than who I am. I have many accomplishments in my life and things that I am proud of. I would honestly rather be recognized for being a good dad or an Ironman than being a doctor. Society doesn’t necessarily see it that way but who knows? Maybe in the future people will just be people and not be so hung up on their titles. Until such time, if you see me out and about having a beer or at a basketball game, please don’t call me “Doctor.” “Jay” will do nicely.

Confessions of a ChrEaster

2010-11-30T03:47:00.001-08:00

A friend recently posted on Facebook about the coming of Advent. I thought to myself, gosh, is it that time again already. It seems as if I had just finished my Lenten church-going obligation complete with my son's First Communion thrown in and here we are again. I resolved that this time it would be different. My family will go church through the holiday season and keep going throughout the year!

Ok, I'll admit it. I am a ChrEaster...you know the kind of guy who only goes to church during the Christmas and Easter holiday seasons. I'm not so bad that I will only make two appearances a year. I do try to start going periodically throughout the Advent and Lenten seasons respectively. However, the rest of the year I'm really pretty bad. Let me preface all this by setting a few things straight. First, I do believe in God or some power higher than myself. Second, I recognize the need to attend church and/or provide some kind of spiritual guidance to my family. Third, I am not now, nor will I likely ever be a fan of organized religion.

When I really started to dissect this problem, if it is indeed a problem, I saw so many facets. I can give you a hundred reasons why I do not attend church regularly but not one of them is really any good. My wife grew up going to church every Sunday. She is Episcopal and I am Catholic so there is one major stumbling block. We have in the past gone to the Episcopal church for services but since my son has started Catholic school, I feel the need to support the Catholic parish. This causes some conflict. I can go to the Episcopal service and fully participate, including communion. My wife is not allowed to receive communion when she attends Catholic masses. Though the services are very similar, some of doctrine and traditions are quite different and this scares her I think. Attending church had never really been part of our routine as a couple. We have tried to make it so on occasion, but it just never takes. I don't think the lack of church-going bothers my wife as much as it bothers me. I am quite convinced that if she wanted our family to go church, then we would go. She just has that way of making things happen in our family.

I was raised Catholic. I attended Catholic school from Kindergarten through high school. I can recite the mass pretty much by heart. However, my upbringing probably did more to turn me away from the Church than anything. My father used to take me to mass when I was young. My older brothers and sisters had already reached the age where they could decide for themselves and they did not go regularly. My mother did not attend...EVER. I only saw my mother in church three times: twice for my sisters' weddings and once for her own funeral. My father had been married and divorced before marrying my mother. This in essence, made my parents ex-communicated. My father would sit with me through mass but we always left at Communion time even when I reached the age of being able to receive. By the time I reached high school I had suspended all regular attendance at church with the exception of mandatory school masses. I never really got it back. The issue was never really pushed forth.

I have a genuine desire to have more of a spiritual life and I seriously respect those people who are able to devote so much to their faith. I am just not one of those people. That's not to say that I couldn't be. I spend a lot of time motivating people to excel in areas of life where I feel that I have succeeded. The most obvious example of this is with fitness. Some might refer to me and my endurance athletic escapades in the same manner as they would a religious zealot. I hear the same story over and over from people about how they can't exercise or race or whatever. Whenever I talk to someone who has been exercising and then quits, the story is usually the same. They didn't feel that they were getting the results they wanted so they quit. I might be on to something here. I always tell people to find a fitness activity that they really enjoy participating in as that will promote compliance. Every person who has started an exercise routine knows that there is that point where the activity goes from something you 'have to do' to something you 'want to do.' You reach a point where your body craves physical activity the same way it craves food, shelter and sex and when you don't get it, you are unhappy to say the least.

So maybe the problem is not all me. Maybe it is my routine. But wait! There's a big difference between choosing between yoga and pilates and choosing between Roman Catholic and Southern Baptist. While I know that some people do, I am not the kind of guy who can just wake up some day and decide to be a Methodist when I was raised Catholic. Somehow I've got to find a way to make it work...for me...for my family. I do have choices but they are rather limited and somehow I feel that I just need to stick it out.

If I apply the same principles regarding fitness to my spiritual health I would tell myself that in order to be successful I have to at the very least go to church regularly. Furthermore, I need to go with an open mind and with the mindset that this is something I WANT to do. Even today, I only go to church out of a sense of obligation. I feel that if I don't make my tithe, then I cannot justify paying the parishioner rate at my son's school. There have been times that I have just thought about paying the extra money and being done with all the guilt, but what kind of message would that send to my kids? I need to get to that point that my body er soul craves the spirituality that I can only obtain by attending church. I will not reach that point by sitting on my couch and watching football. I need to get to the point where I feel as guilty about missing a Sunday mass as I do about missing a long run. I'm obviously not anywhere close to that point yet but then again every fitness program has to start somewhere.

What Do I Get For My $10?

2010-11-18T14:52:00.000-08:00

As part of a new wellness initiative, my employer is helping to sponsor a new 5K race locally. We are promoting this race among our employees with an emphasis on bolstering participation among sedentary individuals. The theme is ‘Resolution Run’ and it is to be held in January. The idea is to help everyone kick off their New Years resolutions. That’s pretty catchy, huh?

So we have a blog at work and we have been promoting this race. Of course there is plenty of interest. One of the members of our wellness committee has even gone so far as organizing some training runs utilizing the ‘couch to 5K’ plan. I know several people that are really fired up about it. There has been the usual bantering on the blog about this and that, routes, training runs, etc. A couple of posts from one particular individual caught my attention. These are excerpted below. Names have been changed to protect the innocent.

David S writes: Will there be any shirts provided? In my experience most 5k’s provide race sponsor shirts to participants. I can run a 5k for free. What is the registration fee for?

Maxwell D responds: Registration fees usually cover any equipment rentals like timers, finish line ropes, chalk or spray paint for arrows on the course, water and drinks for participants, race numbers, safety pins, packets with race maps… not to mention the time spent by organizers and volunteers that help people get registered, supervise the race, and clean up afterward. These add up quick even with help from sponsors, especially if shirts are made and take a chunk of the registration fee. Most races have something closer to a $20-$30 fee, so this $10 seems very reasonable.

David S then writes: Maxwell, I agree the fee is a reasonable one, but to put my effort into a race that provides nothing more that what I would normally gain from my training at home seems like a waste of time. Just saying that from a participants point of view – what do I get for my 10$.

I must admit that when I first read David’s posts I was kinda pissed off. I thought he was being a complete tool and that his negativity was eroding the spirit of the race. I mean, come on! This guy is balking over a $10 entry fee. I’ve never raced in any event that was less than $20 and don’t get me started on what I spent on Ironman! I think Maxwell did an excellent job outlining the costs of race operations. He neglected to mention facility rental fees and payments to the police and EMS who don’t usually work for free. That is a significant cost. But it did get me to thinking…what the hell do you get for your entry fee? Free tee shirts and swag aside, what justifies the entry fee?

I do triathlon, so I know all about expensive entry fees. To me these seem to make some sense. Multisport events have got to be logistical nightmares. We all balk at the thought of spending $550 to enter the Ironman but when you figure that they have to create a course that is 140.6 miles long including 2.4 miles of open water, 112 miles of cycle route that needs to be marshaled and 26.2 miles of running course, usually in an urban area, with aid every mile, that cost will add up quickly. So, I think we’ve addressed that point. However, David brings up yet another point, albeit in somewhat of a snarky manner, regarding the purpose of having a race at all. I find this aspect very thought provoking. There is the obvious competitive atmosphere of a race that appeals to athletes of all abilities. But let’s face it. Most of us are middle packer, age groupers who are just looking to finish the damn race. I could go out on any given day and run 26.2 miles and say I ran a marathon…WOOT! I would save the $75 entry fee. I could do it at my convenience. My wife and kids could cheer me on from my house…so why should I…as David suggests…waste my time?

Well, in my mind, there is something to be said for all the hoopla of a big event, a race, no matter what the distance. The coming to together of like minded individuals to test their bodies and their spirits is a thing of beauty. There is great energy to be derived from the race environment not the least of which involves the crowd. I just loved plodding through the streets of Louisville during the run leg of my Ironman with total strangers seeing my name on my bib and personally cheering me on. There is energy that comes from the other athletes. I could never replicate some of my race paces during a training run. Something happens during the race whether it be an adrenaline rush or the sheer competitive nature that pits one athlete against another that drives people to perform at levels that previously seemed unattainable. It’s hard to put a finger on it.

Well, David, I still think you are a major tool and I don’t appreciate the poison you infect the blog with but you did get me to think about why I race and hopefully others as well. For that I suppose we owe you thanks…but you’re still a tool!

Misery in the Dropoff Line

2010-11-17T12:18:00.000-08:00

I’m a big fan of Man Versus Wild with Bear Grylls. One episode I remember, Bear was being deployed onto some deserted island though I cannot remember exactly where. The terrain was rough and inhospitable to a chopper landing. The chopper, therefore, hovered just off the coast and Bear jumped right in so he could swim with what little gear he had to shore. Bear described this type of landing as a ‘rapid marine insertion.’ Apparently it is a technique used by the special forces. You would certainly have to be a commando to do something like that. I started to wonder if there was an application for this technique in everyday life. Then it hit me! Of course there is…the DROPOFF LINE at my son’s school.

Ok, we have already established that I am an impatient individual. I’ll admit to that. I also want to go on the record as saying that I really cherish the time my son and I are able to spend together on the twenty minute drive to school. It’s a good bonding experience for us. However, that experience is being eroded by the frustration caused by the dropoff line. I just don’t understand why people can’t keep the line moving. OK, OK…I know you have to drop your kids off but is it really necessary to stop, get out, open the trunk, retrieve book bags, etc? There have been times when the line is backed up for block and doesn’t move for the better part of 2 minutes. I know 2 minutes doesn’t seem like much time but for me it is an eternity. I am on a very tight schedule. If I’m not at my desk at 8am promptly, people could die! OK, maybe I’m over-exaggerating my self worth but I gotta get to work on time.

I have brought this up several times to my wife but she has never noticed the problem. Of course , she is the Type B in the relationship, much more laid back about such things than I am. We have a schedule worked out. Last week she ended up having to drive on a day that I usually would have driven and she admitted that it seemed to be more of a problem. Ah hah! So now what? I try to do my part to make sure I don’t hold the line up. I instruct my son when we are a couple of blocks away that he needs to ‘prepare to deploy.’ And he does. Ok there was the one time that he left the house without shoes…but THAT won’t happen again! When the car rolls to a stop, he jumps out, we say our goodbyes and off he goes. Why can’t everyone be like us, huh????

Here’s my solution. I understand that different sized families have different needs in terms of deployment so I would suggest a sliding scale time limit. I propose 15 seconds per kid. Every car entering the dropoff line will display a placard with the number of kids clearly visible. There will be two ‘dropoff line czars’ stationed at the dropoff point. These will be burly eighth grade boys with facial hair. So as not to be sexist, girls with facial hair would be allowed to serve as czarinas as well. The czars would help pull the kids from the vehicles, assist with gear, get the kids out of the LZ (landing zone for you civis out there) and keep the vehicles moving. Fifteen seconds per kid will be all that the vehicles will be allowed to stop. Violators will be fined and the money used to help pay for the eighth graders class trip. If we could figure out a way to deploy the kids without actually have to stop the vehicles that would be preferable but I’m afraid the safety concerns would nip that idea.

Something has to be done. These parents who hog the dropoff lane are becoming my public enemy #1 right behind the groups of marauding young men playing ‘polar bear.’ Maybe I could try not to be in such a damned hurry all of the time but that’s just how I’m wired. So I will make it my crusade to clear the way for ‘rapid schoolyard insertion.’

How to Get From 'I Can't' to 'I Will'

2010-11-16T08:46:00.000-08:00

Here is a companion piece to "Alternate Routes."

What follows is a post I made to IamTri.com back in September that sparked quite a bit of discussion. Though it focuses on triathlon, health and fitness, the same principles can be applied to life in general. Visit Iamtri.com to view all related content. There is some really good stuff there from some really amazing people.

http://iamtri.com/forum/topics/how-to-get-from-i-cant-to-i-1

So today I attended the first meeting of a committee that was formed to develop and oversee a wellness program for my employer, a large regional health care organization. My participation on the committee was requested due to my prior experience with wellness initiatives for the physician group and the perception that I am a ‘fitness nut.’At one point during the meeting when we were discussing various forms of communication, I mentioned how useful blogs and social networking sites can be. I specifically mentioned the IamTri website as an example of how athletes can connect, interact and support each other. I let the committee know that information and connections that I made on IamTri and another local triathlon bulletin board were paramount in my Ironman training process and successful race completion.

Now, fast forward to later in the meeting. One of the committee members is discussing activities and she makes a point of saying, “…we need to make our programs appealing to the average person. We can’t all be Ironmen…” At first I didn’t think much of it but then as it sunk in, it started to make me mad. So I thought to myself…”…Well, why the hell not?” I don’t have a big ‘S’ embroidered on my chest. I never played varsity sports in high school. A few years ago I couldn’t swim more than 100 yrds without stopping for a rest. How dare you imply that this was somehow easy for me. Don’t get me wrong, I don’t think that every out of shape individual out there should go out and start signing up for endurance events. However, what makes one person say “I could never do that,” and another person say, “I will do this.” This mindset is the key to success not only in Ironman but in life. The key to motivating individuals is getting them to turn that corner from the negative/self defeating mindset to one of confidence and determination.

So how does this happen? We’ve all seen the videos on YouTube and heard the inspirational stories of Ironman athletes who have overcome what would seem to be insurmountable odds. How do we bottle that up and get it to the masses? No one is born an Ironman. I saw all kinds of people in all shapes and sizes out on the IMKY course. At some point all of us have doubted our ability to do this. What was the turning point to get from “I can’t” to “I will.” Fellow Ironman athletes, I ask how did this happen for you? I believe that addressing this mindset will be the key to the success or failure of our fledgling wellness program. I appreciate any insight you all can give.

Alternate Routes

2010-11-16T08:38:00.001-08:00

Driving through all of the Chambana road construction has got me to thinking about human behavior. In particular, I am thinking about what drives people to follow a particular path in life. Do we follow the leader or do we strike out on our own?

Recently there has been a lane closure affecting the route that I use to drive my son to school. If we don’t leave at precisely the right time, we get stuck in a huge line at a four-way stop. You just gotta love all the four-way stops in Chambana but that is a topic for another day. Now, let me preface this by saying that I am a VERY impatient individual. My wife finds my lack of patience while driving a cause for some concern. However, I have never been issued a moving violation in over twenty years of driving. I’m the type of guy who if given the option of waiting to turn left out of a parking lot onto a busy street will opt to go right, turn around in a parking lot down the street and take off in the opposite direction. Sometimes this saves me time, other times it doesn’t, but the important thing is that I keep moving. I gotta keep moving. I hate standing still. This is why Disney World generally annoys me but, again, a subject for another day.

So after about two mornings of getting stuck in this four-way stop hell, I decided to find an alternative route around the obstruction. I set out amidst the side streets in Urbana. This was also the source of some frustration as the street grid in Urbana is somewhat devoid of through streets. I found myself circling around dead end cul-de-sacs but finally made my way back to the point of obstruction. I noticed that I had only negotiated the intersection a couple of cars ahead of what my position would have been had I stayed in line. However, I was at peace because I kept moving. I kept using my new route and was able to avoid headache, delay and frustration.

I made an interesting observation on my return trip to the office. Each day I would pass by the huge line heading the opposite direction and would see the same cars there day after day. I started wondering why these people chose to stay in the line of traffic rather than set out on a new course. Then it dawned on me that some people are quite content to follow along. They are not annoyed by the delay. They are much more relaxed and ‘laid back’ than I am. Some people are really quite content to take what life gives them and not complain too much. I realized that this traffic obstruction is really a metaphor for life and it was kinda cool.

I see this all the time at work. We have challenges like any workplace. I am continually frustrated by the people who love to bitch and moan about everything that is wrong but will never lift a finger to provide a solution to what irritates them. I can handle that. I’m kind of a ‘help me or get the hell outta my way” kinda guy. What irritates me most is when those people take action to derail my progress. You see, I don’t understand the guy or gal who bitches about something but then is too afraid to change things. It sort of reminds me of the Garbage song “Only Happy When it Rains.” Some people, I believe, find contentment in unhappiness and frustration. It’s sort of their normal baseline state and they don’t want it to be disrupted. If things were ever such that they couldn’t bitch and complain, they wouldn’t know what to do with themselves.

There are leaders and there are followers. I don’t mind being a ‘trailblazer,’ going where no one has ventured before. It is what keeps me going. I love to find solutions to problems. I love to have new and novel experiences. Sometimes I think it is that fear and anxiety that I experience while doing this that keeps me alive. In any event, I do understand that not everyone shares this outlook. I am happy that there are people who are content to follow MY lead. Without them, I would never be able to accomplish my goals. There would be no point in having leaders if there were no followers, right? Still, I can’t help but feel a little sorry for the people stuck in the long line of traffic at the four way stop sign. Everyone needs to be a follower at times and a leader at others. Some people simply gravitate to one role more than the other. For now, I am most content to take the alternate route.

On Personal Privacy

2008-09-12T20:12:00.000-07:00

If you are expecting a profound discussion on the relative constitutionality of the Patriot Act…then read no further.

I am fortunate enough to have a new office in a newly constructed multimillion-dollar health care facility. It is step up, to say the least, from my old digs. The surroundings are quite posh. As an added bonus, I have a restroom right across the hall. This comes in quite handy throughout the morning in order to facilitate the egress of the 5-6 cups of coffee that I drink.

As seems to be the custom in new construction, particularly in health care facilities, the builders have opted for the creation of multiple, single user, unisex restrooms that are strategically scattered about the facility rather than the larger, multi-user, gender specific public restrooms that we are all too familiar with. On the one hand I can see the appeal of this. This is much more family friendly particularly for the parent with multiple kids in tow or the dad who is tasked with responsibility of taking his eight year old daughter to the potty. However, this type of facility opens up a whole new world of potty etiquette. This came to light for me during my first few days in the new office. I would occasionally hear a soft knocking sound. I reflexively replied, “come in.” Nobody came. I soon realized that they were knocking on the bathroom door. Hmm…this is something I hadn’t thought of doing. Granted, when I need to use the restroom, I typically have a good idea whether or not it is occupied. I just open the door and go in. So far there have been no surprises. But, it got me thinking. Should I be knocking to announce my presence? When I go into a restroom to do something that I don’t want other people to see, I close the door and lock it behind me. I just assumed that everyone else did the same. This got me thinking about privacy. In particular, it got me thinking about how to protect one’s privacy. There is a balance between respecting the privacy of others and safeguarding your own privacy.

As a society, we have become obsessed with privacy. We live in constant fear of identity theft and other violations of personal privacy. This has resulted in the creation of legislation at the federal level to help protect our private information. At the same time, we as a society have become so much more public. People are quick to blame technology and the internet but I contend that it is more about personal behavior. While technology gives those wish to violate our privacy weapons with which to strike, it is we, the potential victims, who have let down our guard to the point where we are practically inviting them to violate us.

I think social networking sites are great. I use them to communicate with friends and family both near and far. It is amazing, however, the things that people choose to share on them. I have done crazy and foolish things in my past but thankfully these are archived only in the memories of those I shared those moments with. There is a whole generation of individuals who are going to be reliving their sordid youth for many years to come.

The types of conversations that were once thought to be taboo or of the most intimate nature are now commonplace at the water cooler. I will not forget riding in the elevator with two young nurses who were having a conversation about how their abnormal Pap smears were worked up. They didn’t seem to mind that I could overhear what I would consider a conversation of a sensitive nature. They had on name badges so there was no anonymity. Now, had I accessed their medical records, I would be subject to termination, fines and possible prosecution. The behavior of these individuals completely negates the efforts made by lawmakers on our behalf to protect such sensitive information.

My father had suffered from erectile dysfunction due to his diabetes. I know this only because some years ago when I was home visiting from college I found some suspicious looking vials and syringes in his armoire while I was looking for deodorant to borrow. When I asked him about this he told me that in the vials were papavarine and that he injected this to help get an erection. This was obviously before the days of Viagra. I cannot imagine needing sex that badly that I would be willing to stick a hypodermic into my schlong but apparently this is what he did. Nothing more was ever said of this and I learned a valuable lessen about respecting others’ privacy. My point is this. This was not a public matter. It was not discussed at the dinner table. But today, I cannot even watch a football game with my seven-year-old son without fear of having to explain what erectile dysfunction is. Not that there is anything wrong with that but this will undoubtedly lead to a string of questions and conversations that I am not quite ready to have with him. I have already formulated my response, “erectile dysfunction is when a guy has a hard time building things and this upsets his wife.” To that he will probably suggest that I start taking Cialis.

One day after giving a lecture on women’s health care, one of the students came up to me and started telling me about problems she was having with her birth control. I was not her doctor but somehow on that day she saw me as the authority on the subject and felt comfortable discussing this within earshot of her classmates who were filing by on their way to happy hour. I remember thinking to myself how very inappropriate this was but I handled it as tactfully and as medically responsibly as I could under the circumstances. When I passed her a few weeks later walking down the hall with a male friend, I didn’t take the time to stop and ask her how her problem was.

Then there was the time that my wife and I were out to eat with another couple. We were at one of those trendy bistro style joints, you know the ones with tables crammed so close together that you feel as if you are in a German beer hall. Two women who were seated next to us were involved in a detailed discussion about the psychotropic medications that they were taking. This prompted my wife’s friend with whom we were dining to strike up a conversation about her depression and how it was being treated. Pretty soon the other two women joined the conversation and we had a regular mental health love fest going on between the salad and entrée course. It is worth mentioning that my wife’s friend is from the Netherlands. We all know that the attitudes of many Europeans, particularly the Dutch, are much more liberated that those of the somewhat puritanical American. For this woman, discussing her depression was as natural a thing to do as discussing the weather.

As a health care professional, part of me really likes the fact that people are as comfortable discussing some of these issues that were previously unmentionable. It makes me sad to think about all people in previous generations who suffered from mental illness or other ‘social diseases’ in silence because of the shame they felt. On the other hand, there is such a thing as TOO much information. I do not know why coworkers feel the need to confide such niceties to me like extramarital affairs, venereal diseases or marital problems. Some things are better left unsaid. Before you embark on a cathartic endeavor such as revealing the fact that you are screwing the babysitter to a friend, take a moment to think about what the impact is going to be upon the recipient of that information. While you may feel better, the recipient may become sick to his or her stomach. I know I have in these situations.

Our privacy is only as protected as we make it. Despite laws aimed at the protection of ‘privileged information,’ this information is as vulnerable as we allow it to be. So, if you wish to discuss your health in a public place within others’ hearing capabilities, post sensitive material on the internet, engage in physical intimacy outside of the confines of your personal domicile or make your morning doo-doo behind the unlocked door of a public restroom, well then, I am afraid you have relinquished your right to privacy. You and no one else are ultimately responsible for protecting your privacy. No one can take from you what you do not give them.