A Surprising Discovery - Sleep

Today, during the fourth of five physical therapy sessions, the therapist asked if I had had many other sports related injuries over time.  Aside from leaving sheaths of my skin on the chipseal and skinning my elbow down to the bone several times and getting some stitches for the same on one of my knuckles and fracturing a few ribs once ... "No.  Not many." 

So these past few months of indolence due to the ripped ulnar nerve from indoor rowing are unprecedented.  But they're pretty much in the past for now.  And I am finding the time to get out on the bike to begin training again. 

Yesterday I spent about 5 hours cutting wood, pounding nails, etc. in the process of building a workbench in the shed.  Lots of lifting, pushing, bending, stooping, etc.  By dinner time I was pretty tired and sore.  Felt good, in fact.

Today I rode the bike for a few hours. 

On returning home I showered, etc., in preparation for a few meetings in the afternoon.  While doing some computer work I felt a heavy wave of sleep overwhelm me.  An hour later, my feet up on my desk, I awoke. 

THAT is what I missed all of these months.  The bliss of intense, blind-to-the-world sleep. 

Tired.  Sore.  Sleep. 

It is free.  Costs nothing but labor. 

The Only People Without Problems ...

... are either gone from this earth or on their way in. 

 

The rest of us have to get up every morning and figure out how to make it to the end of every day. 

 

Problems are essential to the athlete.  And to the rest of us. 

 

We can `react' to a problem in an impulsive, emotion-encumbered way.  Or we can `respond' to a problem from the `neck up.' 

 

When the bike goes off the road or gets caught in a road crevice we have to `react' fast in order to be safe and survive. 

 

When we approach a traffic-heavy intersection we have time to `respond,' to consider the best solution to potential danger. 

 

In both cases we are called to deal with a problem and come out the other side. 

 

As for `training' (the name of this blog). 

 

Joe Friel shouldn't be an unfamiliar name to competitive athletes.  I've read his many books and followed him on his blog for years.  What many may not realize is that he is in his 70's and suffered a serious bicycling accident and injuries in January of 2014. 

 

"The biggest consumer of my time in the last nine weeks was related to recovering from a bike crash on January 24. That resulted in seven broken bones including the clavicle and scapula, a concussion, blood clots in both legs and lungs, a partially torn rotator cuff and shoulder labrum, and what docs call “adhesive capsulitis” (also called “frozen shoulder”). After six days in the hospital trauma center, all of these injuries required numerous trips to various medical specialists, X-rays, CT scans and an MRI. Then there have been three weekly visits to my physical therapist going on since late February. All of this left little time for anything else." (Link)

 

I strongly recommend his work.

 

Training involves `problems.'  Not all of them have to do with finding the time to train, deciding on the best nutrition and diet, getting your workout plans implemented, or fitting yourself with the equipment that helps you achieve your goals. 

 

In Joe's case it involved dealing with a major injury, the impact that age has on his recovery, and, I'm certain, his own assessment of himself now that he is truly among the `elderly.'  (As am I).

 

As I write this blog entry I'm probably within 15 minutes of his home nearby Scottsdale, Arizona.  My wife is dealing with a problem she has had for many, many years that is in another stage of solution / management: knee replacement.  A talented and experience surgeon spent 50 minutes cutting, sawing, gluing and hammering to `install' a new knee joint. 

 

Joe's problem required a rapid and urgent `reaction.'  My wife's problem required a thoughtful and deliberate `response.' 

 

Both Joe and my wife are now engaged in a form of `remaking' of themselves in pursuit of the challenges ahead. 

 

Lucky they have problems.  Think of how empty life would be without problems. 

 

 

Death Rides The White Spars

Did a short out and back to MP 305 on the White Spars today. 

 

Sunday.  Muscle cars, 18 wheelers and parades of checked-out motorcyclists.  Seems that they were all competing for the entire year's Darwin award quota in one day. 

 

I'm hugging the fog line while ten testostified Camaros crossed the double yellow line on blind switchbacks.  Pushing 60 in a 35 mph. Causing vehicles from the opposite direction to dive into the rock face. 

 

Twenty motorcyclists, pitched at 35 degrees, ignorant of oncoming vehicles, 120 degree switchbacks, easy 50+ mph, rubber on the descents, cranking the loudest noise their machines could make.  Did you know that there is an inverse relation between the loudness of your toy and the size of your ... ?

 

And then the 18 wheeler, blithely winding it's way south past MP 305.  I was tempted to roll down to MP 302 to see how many guardrails the driver took out; to find out if he lost his load on that impossible switchback. 

 

The season should clean out the witless twits before only the sane remain. 

Check the body bag inventory. 

 

Mar 15, '15: MP 305

I Feel Better Now

Four weeks of up and down `pushing the pain threshold.'  What was a subjective level 9 pain four weeks ago is probably a solid subjective level 5.5 now. 

 

Objectively, as well, the level of pain is much reduced.  

 

"I Feel Better Now."  I actually was happy to read that a famous basketball star was going to be off the court for 10 weeks while a torn muscle and pinched nerve healed.  When the man with no shoes sees a man with no feet.  Always "compared to what?"

 

An important experience for an athlete of any age: 29 (basketball star) or 69 (me).

 

Many dimensions to such an experience.  From a greater and personal appreciation of the difficulties people with chronic pain have to deal with (your world gets smaller and smaller, hemmed in and smothered by pain).  To an intriguing learning process of anatomy, physiology and pharmacology.  Not to mention the varieties of positions in which one learns to sleep. 

 

--

 

Two weeks ago the central highland area of Arizona saw sunny days and warm weather.  The last week was cold (though nothing like the Midwest and east).  Coming our way for the next week is rain and cold. 

 

During the warm weather I was feeling sorry for myself while I couldn't train and struggled with the pain.  Now that I feel better it is good fortune that mother nature is enforcing the `no biking' rule.  A hedge against risking a too soon return to the rough and tumble of training. 

 

Instead I will be restricted to indoor activities, specifically the elliptical.  Aerobic effort and increased time on the machine.  Another two weeks and .... I hope for warmer weather.  Another two weeks and .... I hope to return to outdoor training on the bike. 

 

 

Radiculopathy - PINCHED NERVE

I think I'm correct in the identification of an overuse injury to the nerve exiting my C7 vertebra.  A pain that begins in the muscle near the scapula and extends and descends down the posterior of the arm to the little finger.  As it approaches the little finger the pain sensation changes to a pronounced tingling.  Things that can cause the Cervical Radiculopathy include ... uh huh ... rowing a boat.

 

It should have been enough that I sensed this pain two days and 30K meters before I stopped rowing. Too much is never enough. (So say the walking wounded).

 

The pain was very intense for a few days, resulting in loss of sleep and a fair amount of restricted upper body mobility.  The third day into this I started the NSAID ibuprofen.  200 mg every 6 or 8 hours at first.  Little improvement.  The fourth day I increased it to 400 mg every 6 to 8 hours. 

 

By the fifth day the intensity and sensitivity reduced significantly.  Thinking that the acute stage of the injury had passed I began working out on the elliptical, using my arms about half the time (30 minutes) with very little intensity.  On the sixth day the pain was almost entirely gone.  I felt fine lugging some groceries during the day.  In the evening, while sitting at my desk and leaning back in the chair I felt the return of the pain.  That night I was unable to sleep due to the pain and ache. 

 

At this point (day seven) I will be cutting back on the NSAID and will be seeing the doc.  I expect that I will get a cortisone shot and instructions to hold back on the elliptical and a return to household chores, etc.  Or, he may just slap me upside the head and tell me that my penance for `rowing through' is another week of agony. 

 

Pinched nerves are reported to take about 6 to 8 weeks to fully remediate.  Mortality does, in fact, suck.

 

UPDATE: Wednesday, Feb 5th.

 

Went to the doc this morning and he explained it to me in a way I can understand, so that I can manage my own responsibilities carefully.

 

It is a Cervical Radiculopathy

 

When I overextended my reach on the indoor rower (erg) the peripheral nerve passing through the cervical (C7) vertebra was stressed over and over again. The repeated stress of that nerve (that goes down the posterior of the right arm to the little finger) resulted in an irritation and inflammation. The fibers of the nerve `complained' to their boss (central nervous system in the vertebrae), and the boss complained to what in most other people is their brain.

 

I, of course, being of the ultra-this-ultra-that mentality, interpreted all of the complaining as pissy little whining and ignored it. I punished the complainer with

more stress. 

 

I lost. 

 

Treatment?

• Ibuprofen at levels that, temporarily, can be sustained by my system. (400 mg 3 x day) A small increase in blood pressure. Retention of water (weight gain). But it will reduce the inflammation (NSAID).
• Treating my right arm and hand carefully. No heavy stresses. No lifting of weights, etc.
• No extension of the neck (like when in slouching in a chair watching TV, or reading in bed).
• Alternating application of hot and cold (no more than 20 minutes each) on area where the peripheral nerve exits C7 (right side).
• A massage around the muscles in that area to relax them and loosen things.
• It couldn't `hoit' if I stood under a hot shower and rotated my head and shoulders.

 

By the time I'm finished with this body I might actually learn something about how it works.

 

HERE is a really great little slide show that explains this common cause of such pain. Excellent and easily understood.

Afraid to Win

I'm not emotionally mature enough to be a good sports competitor. 

I avoid competition with others.  I don't fear competition.  But I avoid it because it dredges up so many ugly parts of my personality. 
 

I'm juuusstt beginning to understand the edges of me and cycling competition.  Just a peek under the covers at this point. 

How do I know this?  Because I don't take sports competition seriously.  I take it GRAVELY. 

Victory or death.  At least that is the silent message I've given myself all these years.  Crazy.  Absolutely crazy. 

I am in over my head.  I shut down all other parts of my life.  I'm all gas pedal.  No brakes.  Even less steering.  Just a big glob of dangerous intensity. 

Dangerous.  That isn't a macho compliment. 

I'm all `below the neck' and very little `above the neck.'  A sure fire guarantee for reckless failure. 

And I succeed sometimes only due to dumb luck.  Weather.  Bad luck on the part of others.  Suspension of the laws of physics.  (There have been times when tragedy escaped me.  And I still don't know how, let alone why).

Though I've never actually cheated in sports I am a hair's breadth from attacking my fellow sports competitors.  More than aggression.  Outright hostility.

Attacking.  Like ... pushing them, physical assault, making them stop for good.  It's right there in my mind, in front of me.  My whole body wants to stop the other competitor. 

Maybe I stop myself from competing for fear that I'll actually do something that I would regret, feel ashamed about.  Maybe not competing, not trying to win, is a kind of an unconscious restraint. 

If I fear doing destruction to others, and am unaware of the psychological dynamics underlying this fear ...

I became aware of this desperation only recently.  And I don't really know why this insight has bubbled to the surface at this time and place.  But it helps. 

It helps because this awareness allows me to more carefully and thoughtfully identify cycling competition goals.  And to train more thoughtfully. 

For example, here is what I'm thinking about now, in advance of the coming warmer months: 

 

• Participate in more short competitions.  That is, shorter distances. 
• Why?  Because being in the mix of competitions more frequently will allow me to get closer to the part of me that gets undone. 

I need more time. 

Action Defines Us.

 

Cross Training with the Indoor Rower

For those wanting to keep fit without freezing or risking ice and calamity on the roads you may want to do some cross training on an indoor rower. 

 

Concept2 Indoor Rower is the company that manufactures the most used indoor rower in the world.  Most health clubs offer their members the use of the Concept2 indoor rower.  Many of us have a Concept2 indoor rower of our own. 

 

I've posted on my Training Blog how I'll keep from turning into a mass of jiggling jello over the cold months.  Indoor Rowing is one method. 

 

If you would like to join me in a `Virtual' (i.e., internet) rowing challenge during the month of January 2015 just log on to the Concept2 LogBook, register and join the team called Training.  It's free and it is a way we can keep fit, active and ready to put the rubber to the road come the warmer weather. 

 

Feel free to contact me at psychling@gmail.com if you have any questions. 

Doctors With A God Complex II: Why Rude Doctors Make Bad Doctors

 

Link to Source of Article: Aeon Magazine

29 January 2014                

 

MEDICAL DISRESPECT

 

Bullying doctors are not just unpleasant, they are dangerous. Can we change the culture of intimidation

 

He comes to the operating room late, greets no one, and berates the nurse for not setting up the stepstools the way he likes. He tells the resident she doesn’t know the anatomy and sighs when she adjusts her grip on a surgical tool. He slaps the hand of the medical student when she reaches for the retractor to pull back skin for a clearer view. The operating room is tense for hours. ‘I need a different clamp,’ he says at one point, ‘this one is too dull.’ ‘I’m on it,’ says the scrub nurse. ‘You’re not,’ he retorts, ‘or else it would already be in my hand.’  

All of us adorned in blue scrubs and surgical caps stand on edge, braced against the next wrathful outburst. ‘I want to see the tip of my blades,’ the resident explains, staring intently at the monitors where her laparoscopic instruments have not quite come into view. ‘Just cut,’ the lead surgeon barks at her. By the end of the operation, the intern’s hand shakes as he sutures the wounds closed, to the beat of the running condescending commentary on his halting speed and less-than-perfect stitches. 

One doesn’t have to work in a hospital long to experience or observe some form of disrespect. This is hardly a secret. The bullying culture of medicine has been widely written about and portrayed in popular media. In one study, published in 2012 and conducted over the course of 13 years at the David Geffen School of Medicine at the University of California, Los Angeles, more than 50 per cent of medical students across the US said they experienced some form of mistreatment. Behind closed doors, we share advice on whom to hang around and whom to avoid.

At the start of my third year of medical school, when we would finally enter the hospital wards, we had an orientation: ‘Wear a raincoat,’ the doctor standing at the podium advised. I could expect to get rained on.

For the most part, I’ve been pleasantly surprised. The majority of doctors, nurses, and other health care professionals I’ve worked with have been courteous and respectful: strong teachers and compassionate caregivers. I have met colleagues whom I would feel honoured to work alongside in the future and mentors whom I’d want to treat my own family should they become ill. I’ve been amazed by residents who work 24-hour shifts and somehow still have the energy to teach those who do not yet know as much as they do. I both admire them and am grateful for them. 

But there is a reason those orientation warnings exist. The surgeon who chides the nurse for her inability to be in two places at once? The nurse who snaps at the medical student for reading the patient’s chart the same moment she wants to write it in? They are a substantial, troubling minority, and they can set the mood for the rest.

Most of my friends in medicine have witnessed flagrant episodes of hospital bullying and have juicy tales to tell. But medical disrespect is usually far less dramatic, dished out in the form of ‘micro-aggressions’: exasperated sighs, a sarcastic tone, the dismissal of alternative ideas.  

It’s the subtle put-downs about a trainee’s competence that erode confidence; the public shaming for an incorrect answer on rounds; or the denial of simple privileges such as taking a chair or reading a chart. It’s the psychological effect of being called by your rank instead of your name, or having it made clear that your presence is a burden instead of a help. It’s being ignored. It’s other team members looking on when the disrespect occurs, afraid to challenge it and defend those lower on the totem pole. These are the acts that affect our state of mind in small but cumulative ways. This is the stuff that creates a culture. 

You learn to deal. This is how it is. That’s the system. It’s ingrained. You excuse bad behaviour with the platitude: ‘That’s just the way (s)he is.’ You appreciate from your elders that it could be much worse – at least they can’t throw scalpels at you anymore. You make allies and whisper in solidarity with those in the trenches alongside you. You train yourself, just as they advised you on your very first day, to wear a raincoat. You start to wear it, and it becomes thicker as your training progresses. You add boots and an umbrella.  

Then, as you get better and more confident, perhaps you become impatient with the inevitable lack of expertise in the new trainees. Maybe in a few years, you start to rain on others. 

We’ve known for years that entering the ranks of medicine means developing a thick skin to criticism and being made to feel small. For a long time there was a mystique that this culture held everyone to high standards, and it was the price we paid for the care we got. What is disturbing is the increasing recognition that bullies are not only bad people to be around – they’re bad doctors, too. 

Get admitted to any hospital, and you might notice that no longer is a single doctor on your case. Contrary to popular television scriptwriting, treating patients is rarely about the inspired intervention of one brilliant physician or surgeon. Rather, we work more like an ecosystem, with every organism in the hierarchy contributing to the whole.

In the old days, interns straight out of medical school would man the hospital wards, see very sick patients, and learn to become doctors by practising on them. They’d experiment, they’d figure out stuff, and they’d grow. And sometimes, when they were wrong, patients would pay the price. 

Today, we still recognise that newly minted doctors must be trained, but there are more checks and balances in place for patient safety. Interns still see very sick patients and propose plans of action, but those plans are run by more experienced doctors before being implemented. In teaching hospitals, we meet on team rounds daily, discuss updates on patients, and talk through goals for the day.  

Questions get run by senior residents, and senior residents run things they’re unsure of by attending physicians. Whenever there is uncertainty, the question works its way up the hierarchy. At the same time, decision-making reports back down, so that the newest of the doctors carry out the plans and learn by doing. 

So far, so good – this is a better system than it used to be. But it is also much more dependent on the communication and relationships among different members of the team. Now, enter the culture of disrespect. Suppose an attending physician makes withering critiques or unreasonable requests. A resident, hoping to avoid such abuse, slowly but surely starts to hold back. She holds back some questions for fear of burdening and, under the constant stress of being scolded, becomes immersed in details of efficiency. Whether she intends it or not, she gives off vibes of unavailability, spending hours hunched over a computer in the physician’s conference room cranking out progress notes and scheduling patient appointments.  

Meanwhile, a patient starts to take a turn for the worse, but it’s not completely clear-cut – his vitals are just a bit off, his belly seems distended, and he complains of abdominal pain but is also known to the team as someone who complains. The nurse hesitates to voice her concerns to the resident, who is swamped doing paperwork and updating discharge summaries exactly the way the attending prefers. The patient continues to go downhill, and by the time word gets out the patient is much sicker – and needs to be treated far more aggressively – than would otherwise have been the case. 

A substantial body of data attributes medical errors to interactions among hospital workers. Calls for improved patient safety gained traction from the late 1980s through the early ’90s, when Australian researchers reported a shocking find: the vast majority of medical errors, some 70‑80 per cent, are related to interactions within the health care team.  

In the early 2000s, a report by the Joint Commission that accredits health care organisations in the US studied adverse events over a 10‑year period and discovered that communication failure was the number-one cause for medication errors, delays in treatment, and surgeries at the wrong site. It was also the second leading cause of operative mishaps, postoperative events, and fatal falls. 

The link between harsh words and medical errors was reignited in 2012 when Lucian Leape, professor of health policy at the Harvard School of Pub­lic Health, published a two-part series in Academic Medicine. ‘A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect,’ Leape and his co-authors asserted. ‘Disrespect is a threat to patient safety because it inhibits collegiality and co-operation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices.’ 

It’s not that jerky personalities are reserved for those at the top. There are nice people and mean people at every rank. But in a system dependent on the proper functioning of hierarchy, it works like this: when anger and intimidation flow down, information stops flowing up. The chain of communication becomes clogged.

In a system dependent on hierarchy, it works like this: when anger and intimidation flow down, information stops flowing up

This information block goes beyond doctor-doctor interactions. In a now-classic, 1986 study by William Knaus and colleagues at the ICU Research Unit in Washington DC, communication between nurses and physicians was the single factor most correlated with increased mortality in hospital intensive care. Meanwhile, newer research by Alan Rosenstein and Michelle O’Daniel at the healthcare alliance VHA West Coast in California has identified a pervasive trend in which nurses are reluctant to call physicians – even as a patient deteriorates. Some of the most popular reasons provided, according to their research? Intimidation. Fear of confrontation. Concerns about retaliation.

In another study by Rosenstein and O’Daniel, nurses and physicians self-reported behaving badly in near-equal numbers. Most felt this behaviour resulted in increased errors, lower quality of care, and lower patient satisfaction. Seventeen per cent could name a specific adverse event that occurred as a direct result of disrespectful behaviour. 

When someone is unpleasant or demeaning, something switches in the minds of those on the receiving end: they sacrifice honest communication to save face. I’ve seen it in action so many times that the pattern has become predictable. Preoccupied with fear of appearing incompetent, team members keep uncertainties under wraps. Other times the opposite occurs. Annoyed that they’re being denigrated and prideful themselves, others fight back – even when they’re unsure of the thing they’re fighting about. Once I saw two residents argue back and forth in front of the attending about a finding on a physical exam; the issue was unrelated to the patient’s illness, and the fight, a clash of egos, took mental energy and focus away from the patient’s needed care.

Many in medicine actively protect the culture of disrespect because they hold a fundamentally flawed idea: that harshness creates competence

Contrast that with cultures steeped in mutual respect. I’ve been on some truly outstanding medical teams that worked in opposite ways. Though everyone knew their place in the hierarchy, it also felt more egalitarian. Patients came before pride. The senior staff told others how to reach them and opened the lines of communication. Nurses attended morning rounds with the doctors; their input was valued and they were kept in the loop at every step.  

One night, we were on call with a ‘watcher’ – that is, a patient who could take a turn for the worse quickly. The resident made clear her door was open – literally and metaphorically. The nurses came by often and clarified orders. When the patient began to look even slightly ill, the nurse immediately got the doctor. They examined the patient together as the doctor explained what to do next and why. Questions were encouraged. Communication was crystal-clear. And the patient did well. 

Yet despite such outcomes, many in medicine actively protect the culture of disrespect because they hold a fundamentally flawed idea: that harshness creates competence. That fear is good for doctors-in-training and, by extension, good for patients. That public shaming holds us to higher standards. Efforts to change the current climate are shot down as medicine going ‘soft’. A medical school friend told me about a chief resident who publicly yelled at a new intern for suggesting a surgical problem could be treated with drugs. The resident then justified his tirade with: ‘Yeah, yeah, I know I was harsh. But she’s gotta learn.’ 

Arguments such as these run counter to all the data we have on patient outcomes. Brutality doesn’t make better doctors; it just makes crankier doctors. And shame doesn’t foster improvement; it fosters more mistakes and more near-misses. We know now that clinicians working in a culture of blame and punishment report their errors less often, pointing to fear of repercussion. Meanwhile, when blame is abolished, reporting of all types of errors increases. 

We can no longer deny the facts. Bad cultures lead to bad outcomes. Jerks do not make good medicine. They foster a backwards atmosphere that degrades trust, tarnishes open communication, and promotes cover-ups. 

Creating a culture of respect is not just about feeling good, for its own sake. It’s better for patient care. 

Pointing out dysfunction is easier than solving it. The million-dollar question is: does it have to be like this? And if not, how can it be improved? 

Some medical programs are already taking steps to tackle disruptive interactions. A leader here, the David Geffen School of Medicine at UCLA, began to address the problem as early as 1995; they created workshops and training sessions, established a Gender and Power Abuse committee, and developed mechanisms to accept confidential reports of mistreatment. More recently, Massachusetts General Hospital in Boston developed a model for team restoration following disruptive interactions.

Programs to spot and eliminate disrespect work well with one-time instances of explosive behaviour. But from my experience, the worst offenders are serial offenders. That some have made it to the top of the food chain suggests there was no sufficient deterrent for behaving that way. That must change. Medical trainees are already evaluated on many qualities these days. The powers-that-be can prioritize respectful behavior on that list. If we evaluate and ultimately promote trainees on honest communication and keeping their egos in check, we’ll cultivate good behaviour from the start.

We can’t ignore a system that takes loads of formerly ‘nice’ people and churns out jaded, bitter, and gruff ones.

At the same time, change should emerge from within the hospital itself. Instead of looking away sheepishly when our colleagues are mistreated and apologising for bad behaviour with tired mantras, we should push back. Bullies have ripple effects. Medical students mimic the behaviour of residents who mimic the behaviour of attendings until a problem with attitude can extend from a few people to an entrenched culture. Instead of riding that wave, we could shun bad behaviour. This is easier said than done. But cultures change because people within commit to changing them; it won't come by decrees. A culture that shames bullying makes the bully look like the bad guy, rather than making the recipient look weak.

In a similar vein, we should put an end to the premium that the medical establishment places on saving face. This is a hazard. It feeds the egotistical environment that can lead to ignoring input and failing to ask for help. It creates doctors who value looking like they know what they’re doing at all times more than actually doing what is best.

Finally, we should be getting to the root of the behaviour. Why do people behave badly?  

Some are just jerks. Some imitate jerks. But we also can’t ignore a system that takes loads of formerly ‘nice’ people and churns out jaded, bitter, and gruff ones. We have to call attention to the external factors that can contribute. The lack of sleep. The poor hours. The system that overbooks and overworks. Environments such as these persist in part because of our unique vantage point in taking care of others at some of the worst points in their lives. How can I say ‘I’m tired’ or ‘I’m hungry’ or ‘He hurt my feelings’ in the face of such profound human suffering? Yet it’s hardly absurd to ask for better working conditions.  

When working in a system that treats us all humanely, we’re more likely to be humane to each other, and to our patients

Smaller Front Wheels Improve Aerodynamics (i.e., make the bike `faster')

Tim Brummer, a much accomplished engineer and owner of Lightning Cycle Dynamics, the fasted production bikes on the planet, discusses the misperception that taller  wheeled recumbent bicycles make a for a faster machine. He even shows that smaller sized wheels can make for an increase in speed……

 

Why Smaller Front Wheels Improve Aerodynamics

 

Keeping Busy On This Cosmic Spitball.

Even though it's `Arizona,' here, it still gets very cold and windy at 6,000 feet in the winter.  Riding through a snowy, cold winter sucks.  Indoor cycling more than sucks ... it creates a pervasive and depressing VACUUM of sucking. 

As disciplined and creative as I have been over the many years of cycling I have finally acceded to the wisdom of my numerous alternate personalities:

`Bad Dan' self:

"Daammmmmn, Dan!  It's gonna be all show and no go for 2 or 3 hours just to get in a good 35 mile, 3,400 ft of climbing ride today.  You're carrying three seasons of clothing, you'll be sweating, stopping, shedding wool, hitting a wall of cold mountain wind, stopping, putting that wool and a windbreak on again, dodging patches of black ice.  And half of the damned ride you'll be coasting downhill, wet, paralyzed by the wind chill. Dumb shit!" 

`Lazy Ass Dan' self:

"Right, you stupid moron!  You're going to go into that claustrophobic shed and ride the indoor trainer for an hour or two, juice yourself up with earphoniac drumbreaking music-qua-noise, delusional hallucinations, self-abnegating ruminations, and simplistic and shameful rationalizations as to the actual benefit of this insane torture. Dumb shit!" 

---

So, after almost 70 years of doing the same thing over and over again (... don't say it) I'm deep into a major training transition that may actually result in ... dare I say it? ... pleasure and satisfaction. 

This is a blog about Training.  Not bicycling.  Not self-abuse.  Not proof of masochistic cajones.  Training.  With the remaining hours, days or weeks I have on this spitball of cosmic insignificance I think I'll opt for door # 3,362,950,102.

• Running. 
• Rowing: Concept2 Indoor Rower (ergometer). 
• Bicycling (outside).  Only on a truly too tempting good day.

Running.  I started running when in the penitentiary (Remember: The first duty of every prisoner is to ... ESCAPE).

There were two `yards.'  The `big' yard where the stogie chomping and peglegged Mafioso (Mickey Cohen, etc) and wiseguys walked their laps.  And the `little' yard that nobody went into because it had nothing in it (no barbells, no baseball diamonds, no place to sit).  Just short grass and two huge fences with concertina barbed wire, punctuated by guard towers with armed and dangerous white Ozark farmboys and their essential drooping bellies. 

In the summer I'd just plod around and around for a few hours to burn off my wasting youth.  In the winter, when it snowed, I'd stomp out huge peace symbols in the snow in front of the guards just to show them that ... well, just to piss them off. 

When I got out of the `joint' I continued running.  It is a cheap sport.  Portable.  Cutoff jeans and a sweatband.  U.S. Keds.  And `I'm off.' 

I ran everywhere, all the time.  I ran so far and so long I'd sometimes get so lonely that I'd talk to myself to keep company.  I'd interview myself for ABC Sports. "So, Dan.  How did you get into the sport?" "Waaaall, I started runnin' in the penitentiary and ..." 

I'd pass other runners and they'd slow down to look at that sort'a crazy skinny guy who was talking to himself.  I'd even spook horses on the Chicago lakefront when they had horse trails.  I'd run 12 miles to work and 12 miles home.  I think I finished 8 or 9 marathons. 

But, then, in my forties things went south and I started to work 12 - 16 hour days.  After that I'd start and stop running, gained some weight, get an injury that'd keep me from running for 3 weeks.  And then the run-injure-stop cycle just put me out of action and on the bike. 

Now, I'm running again.  I weigh 50 lbs less than I did 3 years ago.  I'm only `pitty-patty' running at this stage.  Fifteen to 20 minutes.  Going very easy at the outset.  No pain.  But I do experience a mix of feelings. 

The first `complaint' that my body registered came from my left shin.  Very slight and it went away after I eased up on the pace and paid more careful attention to my foot plant.  Then I experienced an almost unbelievable sense of return to old form; like I was back in my 30's and my stride and landing were easy and `right there.'  Dangerously tempting to break out into a full-bore run.  NOT!!  As the time running increased I would feel my legs getting tight and heavy.  Experience has a way of improving even a dumb brute's judgment, so I stop before I feel any pain or strain. 

And that's where I am at the moment with running.  Pitty-patty, brief and within myself.  I will be disciplined about maintaining a very minimalist running plan.  Six months of not much more than 15 to 30 minutes of running.  Can I do more?  Sure.  Will I be able to avoid injury if I do more?  No. 

But I am having head trips about doing marathons again.  I'm even dreaming of it.

Same for the indoor rower.

Rowing.  I have always had absolutely no upper body strength.  A big burly, hairy chest.  But picking my nose has always left me winded and gasping. 

A few weeks ago I was moving the bike and pulled a back muscle that I later learned is the trapezius.  The damned bike is made of carbon fiber, f'crisake!  I was walking around like I had a crowbar up my keester for a week. 

Twelve years ago I bought the Model C Concept2 indoor rower.  I used it quite a bit but only as a barely plausible pretext for not going outside to ride the damned bike. 

Shame put me on the C2.  Guilt got me off the C2 and back into macho-masochismo biking in the snow and subzero temps.  (Sometime later I'll describe how I once rode in temps that were so cold I froze my `pawls' off.  That's not just a pun,)

So a bit over a week ago I decided -- made an actual conscious, deliberate decision -- that I was not going to put myself through the anguish and shame and guilt and pain and suffering this winter over the damned bike.  I decided to get serious-grave about the indoor rower. 

You know, plan it out, a steady, consistent training program that would improve my upper body strength, my cardiovascular function, my pulmonary respiratory function, anaerobic capacity, stamina and endurance.  Yeah.  All 'a them things. 

For some reason I don't feel the mind-dissolving boredom on the indoor rower that I experience on the indoor bike.  I think its because I'm using both my upper and lower body.  But I'm not sure.  Time passes much faster.  I actually enjoy it. 

Seven hour sessions by March.  Competitive indoor rowing, f'sure.

Climbing Impossible Courses on the Recumbent

D2D (Death 2 Dan)

Start / End at my front door. 26.9 miles. 3,235 ft of climbing. Avg ft climbed per mile 120.5.  Many sections > 20%.

http://ridewithgps.com/routes/6519567

I've completed all sections of this course in little dribs and drabs.  But I've never put them all together as a single training course. 

I'll probably build up to it for the early Spring.  A good incentive to drop more weight, down another 15 lbs to 160. 

Why Is That?

I've been accumulating questions about cycling with the intent of a few posts with possible answers and responses.  But I've not gotten around to actually writing anything in the way of answers or responses. 
 
So I'm just listing a few of the questions: 
 

Is cycling mostly a mental thing?

On long rides my emotions and mood sometimes changes a lot.  Why is that?

I ride alone a lot.  Am I an introvert?

I rarely ride by myself.  I try to ride with others as often as possible.  Am I an extrovert?

Are `ultra' cyclists different from other kinds of cyclists?  If so, how?

In the `off season' I'm more edgy, my mood is different.  Why is that?

If I had to stop cycling would my mood change?

How can I keep from going bonkers during the cold and snowy seasons?

I'm an average cyclists but I buy bikes and gear worthy of a pro.  Why is that?

My work, family and social life suffer because I spend so much time cycling.  Why is that?

I prefer to ride alone.  Does that make me an introvert?  Is that a good / bad thing?

When I cycle with others I find that I try to go faster and harder, even if it offends other cyclists.

I'm a `binge bicyclist.'  Why is that?

If I'm an introvert should I make myself ride with others more?

I `dump' all my frustrations, tension, anxiety into bicycling.  Is that good?

I often find myself suffering from `overtraining.'  Why is that?

What are the symptoms of `overtraining?'

I set goals that I don't fulfill and find myself losing motivation.  Why is that?

I can't stand it when I don't meet my performance expectations.  It bums me out.  How can I handle this better?

I actually worry that I'll `explode' if I didn't have cycling.  What's going on there?

Why do I cycle?  Especially if it tires me out, interferes with other things.   Feel free to offer your own answers or responses.

Doctors With A God Complex II

(Oct 2014)

I wrote the blog post about the doctor with a god complex in May of 2012.  Since that time I've met many physicians who more than favorably balance the equation.  That is, they are humble, conscientious and place a premium on listening.  I'll lead with a recent New York Times interview with one of them:   Dr. Laurie Glimcher

------------------------------------------------------------------------------------------------------

(May 2012)

New to this area I sought out a doc just to have one on hand in the event I needed one. This guy came well recommended by some acquaintances. I met with his Nurse Practitioner a few weeks ago Monday. She takes my history (did a decent good job) and set me up to see the doc himself that Friday.

You know the drill. They get you undressed and cloaked in a butt exposed `gown.' This of course, has nothing to do with setting the scene so that the doc is top dog and the patient is a vulnerable sot. -;

The guy comes in, doesn't even look at me. Sits at a little table and opens his laptop. Starts barking numbers and concludes: "We're gonna put you on a diet. Your BMI is too high." I tell him I lost 20 lbs in the last six months, ride 200 miles and climb 18,000 feet on a bike every week, that muscle is heavier than fat (Beyond BMI), that the BMI is a 19th century metric, that I no longer eat meat, and refer him to the BodPod results I submitted when I met with the NP.

He ignores that and keeps looking at his laptop. Then he says that the prostate exam and full urological workup I had just last May (biopsy that showed NO evidence of enlargement or cancer) was worthless and that nothing is as good as ... and then he just sticks his index finger in the air and waves it.

I didn't respond because this was so stump stupid on his part that I was (believe it) speechless.

I tilted my head, smiled, got my Irish up and said "... and then what? A biopsy and blood work that I just had 6 months ago?!"

He then slammed down his laptop and said: "I'm not accepting you as a patient. I'm not going to argue with you."

I was, again, taken aback and surprised at the crude arrogance. Then he tells me to get dressed and a nurse will tell me what to do next.

I left a few minutes later and pondered deeply as to what this meant. Finally, I found another doc. A few days later I sent this idiot the following letter:

---

Dr. X:

I understand your prerogative to decline accepting patients.

I am in agreement with you that it is better that you recognized what would certainly have been apparent at a later time. Being most generous in my description there is an incompatibility between us.

Candidly, I was surprised and am mildly distressed at your behavior.

Having been the Clinical Director of a psychiatric hospital for abused and neglected children and adolescents I have many, many times been reminded of the importance of listening to my patients and staff.

It is my conclusion that you emphatically failed your profession in this regard.

---

So, my advice to all of us: don't be intimidated by physicians who are so arrogant that they suffer from a God complex.

From a psychological perspective such people lack confidence in their ability to maintain a interactive and candid relationship with the client / patient.

More, several recent `gold standard' research reports conclude that arrogant and self-absorbed physicians have a much higher `fail' rate and more malpractice allegations than others.

Word to the wise.

Characteristics of Emotional Maturity

An admired acquaintance recently experienced a complicated and painful cycling accident.  He is an avid and accomplished cyclist in his 50s.  The effect of such injuries requires that he (we) call upon our experiences and capacity for managing (sloppily, we all admit) stress, `dead' time, handling boredom, too much self-reflection, overthinking every damned thing. 

So here is something I have read and re-read to remind me (and hopefully others) of what it means to be a grown-up.

--------

Maturity: noun. 1. a being full-grown or ripe, 2. a being fully developed, complete, or ready, 3. a becoming due (Webster's New World Dictionary).

1. The ability to experience and understand our own deepest feelings and needs, and to be able to act on and express these feelings and needs in appropriate and constructive ways. This is opposite from "acting-out" our needs in unconscious, destructive patterns of behavior. This aspect of maturity includes the ability to experience and tolerate especially intense feelings - which inevitably occur in life - and to be able to appropriately express these feelings, or contain them until an appropriate and responsible means for expressing them is available.

2. The ability to act on and react to life circumstances with intelligence, sound judgment and wisdom. This aspect of maturity is opposite the tendency to act impulsively, without taking the opportunity to think through our actions or consider their consequences. (Wisdom: having the quality of good judgment, learning and erudition, soundness.)

3. The ability to recognize, empathize with, and respect the feelings and needs of others. This is opposite from a selfish and chronic preoccupation with our own needs, with no awareness of, or sensitivity to, the needs of others.

4. The ability to delay the immediate satisfaction of our own needs, so that we may attend to other more pressing needs or actions. This is opposite from a condition in which our immediate needs always take precedence over all other needs.

5. The ability to love - to allow another's needs, feelings, security, and survival to be absolutely paramount - just as if these were our own.

6. The ability to adapt flexibly and creatively to life's changing circumstances and conditions. This is distinct from the tendency to respond to life's challenges in rigid, outmoded behavior patterns that are no longer particularly effective or appropriate.

7. The ability to channel our energy, both positive and negative, into constructive contributions to ourselves, to others, and to our communities.

8. The willingness and ability to be responsible and accountable for our own circumstances and actions in life, and the ability to differentiate our responsibilities from those of others. This is distinct from blaming others and seeing ourselves primarily as the victim of other's behavior, or from maintaining a sense that we are somehow responsible for the happiness and well-being of all those around us. Responsibility arises from a stance of strength and competence; it does not include pronouncements of blame, shame, guilt, or moral inferiority/superiority, as all these are judgments added to the basic condition of responsibility.

9. The ability to relate comfortably and freely with others, to like and be liked by others, and to maintain healthy and mutually satisfying relationships.

10. The ability to choose and develop relationships that are healthy and nurturing, and to end or limit relationships that are destructive or unhealthy.

©Maryland Institute, 1998