What is a Physiatrist?

I've been trying to see a specialist from Hospital for Special Surgery (HSS) about my hip. The real question I need answered is "is there any hope of ever running again?" If I need/get the surgery, I'll be out for at least 9 months and most likely will never be able to run afterwards.

• First, I had to fill out a medical questionnaire.
• Second, I had to get all my medical records sent over.
• Third, I had to get the actual images from the MRI sent for the doctor to analyze himself.
• Today, they called and said I should see a physiatrist first. After that, the hip doctor will consult with the physiatrist to see if I qualify for an appointment. They gave me the names of three that they work with at HSS.

But what's a physiatrist? Basically, this type of doctor is supposed to find the root cause of my pain. Yes, the latest MRI shows I definitely have a hip issue (FAI). That same MRI also shows that I have degenerative disk disease in my lower back. This isn't a surprise since I had surgery back in the dark ages on my back for this as well. What hurts me most and is preventing me from doing most of what I can't do, though, is my knee pain. Yes, I've got a lot wrong with me but if the knee gets fixed, it'll be game on. Note that the knee pain may be sourced in my hip though.

Before I heard the latest news I made an appointment to follow up with a ART specialist/chiropractor with the hope that he could help if my knee is really ITB. Tomorrow I'll try to get an appointment for one of the recommended physiatrists. This hopefully will be the road to the miracle cure. Why does it have to be cobbles?

Snacks and Fruit

Very few snacks available in the snack machine are healthy so I decided to "seed" my office with healthier types of snacks. This picture is of a drawer in my desk that I filled with some better choices. Included in the stash are:

100 calorie Pretzel packs

Nuts

Various types of bars (mostly have been in my stash of bars for workouts that seem to not be in the most favored category)

Fig Newtons.

A pack of sugar free gum (a trick from the biggest loser) that I chew on when I have the mental munchies (note "mental munchies" are when you know you aren't hungry but need something to eat anyway. Why? Just the diet gods messing with you.)

In the never ending quest to improve my diet, this week I'm planning on branching out even more and stopping by the fruit stand outside my building. I’m not a big fan of fruit but I figured I would start introducing some into my diet and see what happens. I've tried a few fruit cups recently and have recently branched out with the previously mentioned newtons but this is going for the real deal.

First up, a banana. Not banana bread, banana flavored Gu or a banana split hold the banana with extra chocolate but a real "see light, push button, get banana" banana. I'm sure that a Snickers bar or a Reese's Peanut Butter Cup have nothing to fear but my palate may be irreparably harmed.

Wish me luck.

Saturday MacGyver ride

On the training plan this weekend was a short, less than an hour, L1 ride on Saturday with the goal really just to shake out my legs with no stress followed by riding the 100k course of the Nassau to Suffolk challenge on Sunday. I wasn't going to actually do the Nassau to Suffolk Challenge with the masses since my daughter had a tournament soccer game show up on the schedule with a 9AM Sunday start but I hoped to still do the ride. I also wanted to squeeze in a yoga session.

Unfortunately Sunday's weather forecast called for a washout. I came up with an option to ride a little longer and a little harder on Saturday, got BikeMike's blessing, and looked to ride with one of the Long Island Tri Coach (LITC) groups going out Saturday morning for their standard hilly 30 mile ride.

Typically when bike riders talk about the pace of the group they talk about the pace on the flats knowing that the group will slow down a bit (sometimes more than a bit) on the uphills and speed up a bit on the downhills. There was a group leaving at 6:30AM targeting 15-17mph and another leaving at 7:00AM shooting for 18-20mph. I seem to remember that these groups typically overshoot the pace so I decided to go with the slower group. Since I didn't really want to set nor push the pace, I dropped into 3rd postion to keep from getting accordianed off the back on the hills. The ride was going a little quick but about 7 miles in, my left crank came off my bike.

Let that sink in a while. My. Left. Crank. Fell. Off. My. Bike. The pedal was still attached to my shoe and the crank attached to the pedal, dangling. This never happened to me before and I really didn't know what to do. I'm not the most mechanically proficient nor am I the most mechanically inept. I carry a multitool in my saddle bag so I hoped I could use it to get the bike together again.

A couple of people stopped. I told them I would try to fix it and if I could I would catch up to them. If not, I would single leg drill back the 7 hilly miles to the car. I also had the faster group coming up behind me and if worst came to worst, I had a cell phone for a rescue call. I'm sure they left with the expectation of never seeing me again.

I channeled my inner MacGyver and somehow got the bike back together again. Do I head back or continue on? I decided to continue on figuring if I fixed it once I could fix it again. The course was an out and back so I wanted to catch up to the group but they had about 10-15 minutes now on me. How to catch them? It was "hammer time". It took me a while but I reeled them in at about the 14 mile mark. There were considering breaking into two groups since half wanted to add more miles. I was close to toast by now after a 7 mile sprint so I just wanted to get back (I also wanted to hit a 10AM Yoga class). We headed back but I was struggling. Even so, we were back at the car before 9:00. 34 miles, Norm power 225w. 16.0 mph.

Made yoga in plenty of time so then I did a 90 minute class. Got really tired watching the kid's afternoon soccer games. Also got the bike to the bike shop to make sure it wouldn't break again the next time I ride.

Angus MacGyver, watch out.

Honest Scrap Award

TriMommy from Going the Distance has bestowed upon me the "Honest Scrap" award. What this means, I really don't know, but I think I'm supposed to share some "honest" things to the blogosphere. Most of what I share on my blog is "honest" but occasionally some sarcasm (ok, maybe a little more than occasionally) sneaks through. So I had to think about what would qualify as "honest scrap" and decided that things that are confirmable "facts" or historical "events" don't make the cut in and of themselves. That left that I would focus on my beliefs and thoughts processes. Hope you enjoy!

• I believe that one of my biggest strengths is my ability to focus on long term goals. I may not be the most skilled (although I feel I'm not so bad in certain things) and it may take me a while but I'll get most stuff I put my mind to done. Adversity is something that needs to be worked through as much as possible.
• I'm very demanding and fairly competitive. I believe that I hold myself to high standards and I expect and hold others to those same standards.
• I often wonder if a lot of my injury is psychological. After all, doesn't everyone has aches and pains? I keep thinking if I'm just wimpier than most.
• I find it ironic that pursuing a healthier lifestyle has introduced me to more than what I consider my share of injuries. Yes, there are measurable changes (most notably in my body composition). Yes, I know this continues to be the right thing and that it will extend my life. Some doubt, of course, entered my mind when I was in the back of the ambulance after getting hit by a car while riding a few months ago.
• I think I rarely sleep through the night. A few years ago I was tested and diagnosed with sleep apnea. Now, since I lost weight, my wife says I no longer snore. One doctor recommended that I get tested again when I'm done losing weight to make sure it is gone.
• I believe my work persona is very different from private persona which is also very different from my blog persona.
• I tend to look more towards the future than to the past. I focus on opportunities to improve rather than on accomplishments themselves. I took a psychological test a while ago at work and was categorized as a "REFINER." Some view this as focusing on the bad rather than the good though. I have learned that "better" is often the enemy of "good enough."
• I don't like being a victim of anything. I believe that it is better to make a wrong decision and keep progressing towards "whatever" than to not make a decision and have it made for you. Of course, making the right decision the right way for the right reasons is often the best path.
• I believe that many people get caught up in too many things unnecessarily, myself included. Understanding why you are doing something or thinking of something as important often requires you to step back and revalidate goals, motives and tactics. It may be the right thing but you want to make sure you haven't lost your way and are sweating the small stuff.
• I generally believe I am fortunate to have a good life. There are tough parts but there are great parts too.

I'm not big on bestowing these things/obligations on others but feel free to pick up the challenge without the feeling of being picked on should you find this interesting. I do find it fun to see about how people do something as open ended as this (maybe that's something else I should have added to the list).

A weekend of training and rambling.

I was looking forward to training last weekend since it was the first time in a while that I was going to push up my training volume a little bit. There is still hope for a recovery from my "injuries" so I have to keep the mindset just in case I find the still elusive miracle cure.

I had a ride scheduled for Saturday morning and the original plan was go out with the Long Island Tri Coach group that normally is on the road by 6am. There are a lot of hard core athletes in this group and they have a tendency to push the pace a bit. I had 2 hours or so of "easy riding on hills" scheduled and I figured that I would easily be back early enough for a 10am yoga class. Their rides are getting longer since many of them are targeting IMLP in July. This week they had two groups going out Saturday and Sunday: 30 miles and 50 miles.

Due to the craptastic weather forecast, they cancelled Saturday's rides and were only hitting the roads on Sunday. I decided that I would ride solo on Saturday if I could. Unfortunately, the forecast was right - Saturday morning was grey, windy, cold and raining. So I improvised. Plan B was to go to the 8AM yoga, give the weather a chance to improve and ride later that morning.

Yoga was yoga. When I left the yogatarium, while it still was miserable and dreary, it wasn't raining any more. Quick change into bike clothes and I was off in 45 degree dryness thinking I was smart. The mist started almost immediately, the drizzle after a few miles, and the real rain returned in force just in time for the hill work. I realized then I wasn't that smart after all. I was slipping and sliding on the bike (even going uphill) so I headed home to be safe. It was shorter than the plan but I figured 75 minutes in the rain had to count for something. Of course, the rain stopped as soon as I pulled into my street.

Then it was off to Amanda's soccer game in the cold, raw weather. Home for a few minutes and then into Brooklyn with Courtney to see her cello teacher perform a concert while my wife took Amanda to see Itzak Perlman perform locally. While music obviously is important in our household, late night concerts don't really help early morning training.

There was a triathlon expo in the big city Sunday morning and there was a 4m NYRR race scheduled in Central Park beforehand. Somehow the race wasn't sold out so I decided to register the morning of the race, "walk" the race to get credit for another or the 9 to guarantee entry into the 2011 NYC26.2 and then go to the expo with EagleCary who was doing the same deal. My plan was to jog a bit, walk a bit, and repeat until done. My Garmin was out of battery so I decided to do the race more on feel than anything else. I did have an old school Timex watch but figured 12:00/m was where I wanted to be while running.

My first mile went out in 11:45 (including a walk break). I thought that was a little quick. I then realized I was dressed for walking, not running (too many layers). The second mile went by in 23:05 (11:20 with a walk break) - way too quick. I decided I was a moron so made myself walk the whole third mile (went by in 38:00 (14:55)) to prevent my injuries from wreaking havoc with me. Jogged in the last mile (11:30) for a finish of 49:30. I was happy as I was sort of recalling the feeling of running but we'll see how long it takes my injuries to ruin my happiness. Meanwhile, EagleCary crushed a PR.

The expo was small and the only thing for follow up was on Infinit nutrition (thoughts anyone?). I got a free swag bag that the highlights were a Spinerval DVD (Troy Jacobson was presenting later at the symposium) and an Endurance Nation DVD. I needed to hustle home since we were having the extended family over to celebrate Amanda's birthday.

After the party I was supposed to get on the trainer for some cycling. The party ended late and decided it better to get some sleep than to stay up late training. I woke up feeling better than I have in a long time pain-wise but my muscles were complaining that I asked them to do something they weren't used to. To ask a little more, I rode the stationary bike for 45 minutes and then hit master's swim class.

In retrospect and with all this rambling, I realized I did a decent amount of training for someone who is injured and can't really do much. Next weekend, 100K bike ride on the calendar. If that goes to plan, I'm positioned well for the miracle cure.

At the gym

I lived a charmed life especially as it comes to work out venues. Until recently with my injuries, I haven't been to a gym in years. The closest I got to a gym was going to the aquatic center to swim from time to time but last year we got an endless pool at home so even that was becoming less frequent. I also used to be a regular at spin class (until I started doing most of my indoor cycle workouts on the trainer/power meter in the basement instead) but the spin studio was just a back room off a karate dojo dedicated to spin so that didn't really count as a "gym."

This has changed recently. I'm still the new guy at work so I'm putting in a ton of hours. Since there is a gym onsite and I knew I would be tight on time, I joined up. I have been successful in being able to zoom down to the gym if and when I get a hole in my schedule. I also had the some new experiences of going to the hot yoga studio. The main thing that is new to me is dealing with the other folks that are supposingly working out.

When I go to the gym, I have my workout plan, just simply get the work done and leave. I am not there to gawk, I am not there to hang out. It might be due to how I work out but I do not view it as a social opportunity. In fact, if anything I'm antisocial. I don't want to spend a minute longer than necessary at the gym.

I have found, though, that I seem to be in the minority. I feel like a voyeur spotting these other folks but I've "observed" all of this in my short time while in the gym:

• A 40 something year old guy who is a cross between Mario Batali and John Belushi as Samurai Yogadude thinking that he is 25 years old again and hitting on the high school girl showing everyone the new tattoo on her left boob while she solicits recommendations for her graduation present (you guessed it, a tattoo for her right boob - should it match or be complementary?).
• The guy who probably has never sweated in his life (note that the standard gym issued uniform of cotton grey shirt/blue shorts show all upper body sweat immediately) hitting on the girl who is spinning up a storm on the stationary bike. In response, she stares off into space and raises the volume on her ipod. I try to estimate how long it will take him to sulk away. A new work record: 7 minutes!
• The girl with enough bling on to compete in Mr.T look alike contest talking to the guy that looks like an oompa loompa due to a tanning session gone wrong. Actually, it must have been more than a session, perhaps a 20 pack. Neither, again, actually exercised.

Maybe I'm lucky but maybe this is the norm. In any event, I'm going to keep doing what I'm doing and hopefully my amusement will continue.

PS: There is hope for some outdoor training this week but the weather gods are threatening (yet again). I've got 5 hours in the saddle and doing it all in the rain will suck but I think it would still be better than doing it at the gym.

Comfort Foods

Last weekend after my gut tried (and mostly succeeded) to impose it's will upon me, I had a dilemma. Namely, what to try to eat that would give me the best shot of progress from a gastrowreck to some flavor of normal. This was more complicated since I was on the road in a hotel with no kitchen around.

I called my wife and she recommended chicken soup with perhaps some crackers. I immediately dismissed that and dove right into the comfort food section of choices of my mind. Over the next few days I tried:

• Turkey sandwich (fail)
• Five guys cheeseburger with fries (I had to leave fries behind!)
• Ham sandwich (fail again)
• Wendy's Baconator (needed some sodium in me)
• Copious amounts of gatorade (somewhat of a success)
• A different salad (hair of the dog perhaps?)
• A piece of pound cake (to soak up what ever was rumbling around in my tummy)
• A chocolate chip muffin (there was no more pound cake left)
• Pretzels (generally a win)
• Some nuts (try going paleo for about 10 minutes and failed)

As of yesterday I finally realized the true appreciation of being able to trust a fart again. I'm back to eating my normal food and I also started up the workouts with a gentle stationary cycle in the gym. Today I stepped it up a bit with a more intense workout and a yoga session at night. I think I'm fully recovered but it took a while.

Maybe next time I should try the chicken soup. What comfort food to you eat to calm everything down?

The case study.

I'm back from Baltimore where I took the USA Triathlon Level 1 Coaching Certification clinic. The clinic itself was good, but there were some "issues." Fortunately the issues didn't ruin the weekend (although they sure gave it a shot).

One of the earlier sessions was on nutrition and one of the subtopics was gastric distress. Unfortunately I learned too much about this topic first hand last weekend. I'm blaming the salad (see what healthy eating can do to you!) I had for dinner down at the inner harbor Friday night as my weekend turned into a gastro-intestinal case study. Before I was even back to the hotel after dinner my tummy was rumbling. I crawled under the covers and Friday night turned a nightmare. I was the sickest I've been in a very long time. I couldn't sleep since I was shaking from the chills but I was getting my workout in by doing many 10 foot sprints to the bathroom all night long.

Saturday morning gave me some relief but not nearly enough. If this was a normal work day it would have been a sick day (or at least a "work from home" day). I thought I'd give the seminar a shot and was glad that I did since the meat of the course was on Saturday. I lasted 3 sessions then had to miss the fourth go to my room to sleep. I woke up after a 3 hour nap, considered going to the ball game, reconsidered and went back to sleep for another 10 hours. Sunday I got up at 5:30 (normal time) and felt mostly better. I finished the seminar but I thought it wise to skip riding the Eagleman bike course since even driving home felt like it would be a challenge.

I made it home and feel now that I'm almost all better. I'm able to successfully eat food again (yeah miracles). I considered squeezing in a little workout tonight but then figured I should just go to bed to chase the rest of this out of me. Tomorrow is another day.

There was disappointment in the trip but the information that I got from the class I found interesting and valuable. Most valuable wasn't the course material per se but more of the passion of the lecturers and the stories that they told to illustrate their points. I'm still glad I went and I expect to look back at this weekend as a positive experience.

I need to be more careful on the salad front though.

PS: Good job Cary on the Tour of the Battenkill last weekend!

Off to Baltimore

After work today I'm driving down to Baltimore to attend the USAT Level 1 coaching clinic. Mapquest says it will take me a little less than 4 hours but I expect to stop for dinner somewhere along the way. Even though I'll probably be the fattest person there, I'm looking forward to this class and have high hopes of actually learning something.

Lunches are included during the 3 day class (I'm imagining something healthy with a class of triathlon coach wannabees and the class itself including sessions on nutrition) but I have to fend for myself for dinner. Fortunately on Saturday night there is a baseball game nearby at Camden Yards so I might have to stop by to find some stadium grub while I check out some baseball. My wife mentioned that she used to think amazing that whenever I travel a baseball game just happens to get in the mix. "Used to" are the operative words.

I'm bringing a bike and my Computrainer. I hope to do a small ride in the hotel on the trainer one night and if everything works out I may swing by Cambridge, MD on the way home to ride the 56 mile Eagleman70.3 bike course on Sunday afternoon. That will tell me where I am at physically more than anything else.

After this weekend I'll have to take and pass a test to become a USAT certified coach. There is a time limit on completing the test (it is a take home test - yes!) but I normally take tests well (as long as there isn't a threshold running test involved). I'm not really doing this for the certification but I figured I should get it if I can since one never knows, do one?

P.S.: I wonder if there will be any questions on the test about the dinner options at the baseball game?

Miscellany

Here is a bullet list of are variety of topics bouncing around my little brain:

• Last Friday night, one of my daughters friends called her up (actually called rather than the preferred teenage communication modality known as texting) and asked if she wanted to go mountain biking the next day. My daughter said yes and then remembered that she had track practice early on Saturday morning, She decided to go biking anyway after track since most of the track practices during Easter Break weren't that taxing and girl friends that think biking is cool is getting rarer as they get older.
• Since I had to get 75 minutes in the saddle I decided to break out my mountain bike for a little up and down through the trails of Bethpage State Park. While we rode the same trails, they went their way and I went mine. Here is a little mountain bike porn of my Specialized Epic Mountain/XC bike to start your day:


• The Hospital for Special Surgery doctor who is one of the so-called experts in repairing injuries of my type wants me to send all of my test results/x-rays/MRI reports to him. Someone will evaluate these tests to see if "he is the right doctor for me." I sent the stuff and am waiting for him to turn it around. I hope he isn't cherry picking cases with the best chance of success but if he is I hope that I'm one of them.
• There is a good video on my injury that could be found here
• Isn't Nickelback great to listen to while training?
• I got my swim form "recorded" for posterity after my mountain bike ride. Once of the coaches that teach/lead the masters class that I go to from time to time was doing the filming. A good sign is that he wasn't laughing or crying as I swam. He took under water views from a variety of angles and above water views. I'll get the analysis soon.
• In case you were wondering, mountain biking uses a different set of muscles than I've used on my road and tri bikes. My glutes and hamstrings have made sure to remind me of that fact often since this ride.
• I've done a few workouts in the gym at work. It is odd doing a bike workout based on heart rate rather than power. I miss my power toys.
• It is also a little eerie when everyone working out is dressed the same (wearing the workout clothes of blue shorts and grey shirts provided by the gym). Every once in a while someone doesn't "conform" and wears their own clothes.
• The New York Metropolitans are still in first place. That won't last.
• I couldn't get my new Bosu ball to inflate. I called up team Bosu and they sent a replacement right away that worked fine. They also sent UPS to pick up the defective one. While I never like when things don't work right, Bosu did the right thing and did it quickly. Well done, Bosu. Now I have to start using it.
• Also, a big well done to Duke (although it pains many UNC fans to say that).
• Thank goodness there are no more Cadbury Eggs or Reese's Eggs left in the house. I wonder where they went? I'm sure I'll stop wondering when I step on the scale again.

Opening Day!

Today (or tomorrow based on where you are) is baseball's opening day. A magical day for many, a spiritual day for some. A day that at least should mark a milestone on the calendar.

Opening day is more than providing the regular opportunity for a family to drop hundreds of dollars at the ball park. It is more than hoping that the mighty Casey might not strike out yet again. It is more than singing, mostly out of tune, "Take Me Out to the Ball Game" with thousands of strangers and liking it. It gives you the opportunity to explain to the youth of America all that is good about Cracker Jack (starting with what it actually is since they probably don't know) and all that is wrong with the designated hitter rule. Don't even get me started with the condiment of choice for hot dogs: Mustard or Ketchup (in case you were wondering I'm completely in the Gulden's spicy brown camp - as all of you should be as well. Don't get me wrong, ketchup has its place in the world but that is only on cheeseburgers and fries, not on Sabrett's finest).

Opening day is about beginnings - it is the de facto start of spring. Some may argue that Easter is the unofficial date of spring sprunging or the Sunday of "The Masters" but neither, while they have their own place in the calendar, compares to the sound of the first fastball hitting leather, the first crack of a bat, or the first roar of the crowd. All the teams are in first place and all of them are in last place. Hope springs eternal.

But, gasp, as hard as it may be to believe, Opening Day not an official national holiday. It is clearly in the second tier of holidays where most don't get off from work but all should (other examples include St. Patrick's Day, Valentines Day, Halloween, my birthday - you get the point). I'm sure I am not alone in believing that we all should at least get a national floating holiday for this event. After all, what do many think are the last two words of the anthem?

Play ball.

PS: No, "the home of the brave" has nothing to do with Chipper Jones since he named a child after a stadium, Shea, that doesn't exist anymore. Really.

Focus on Can.

The lack of training recently has been messing with my head while I'm feeling like my physical fitness is degrading by the minute. I have been keeping busy with yoga and other stuff but realized that if I had any hope of doing Eagleman70.3, even as an aqua velo (assuming that my body lets me do it physically), I need more training focus to succeed at this event (it is about 10 weeks out). A recipe for success probably, at least for me, doesn't include doing no actual training and then nailing the taper (even though tapering is my strength). The concern is that I don't know what I can do vs. what I can't, I don't know if my limiters are frequency or intensity, and I don't know how I will feel any given day as is almost seems random. I may also just have a limited time that I'll even be feeling OK before the shot that I got in my hip wears out.

I decided I need to focus on what I can do, not on what I can't. Red says in Shawshank, "Get busy living, or get busy dying." While dying may be a bit of a stretch, I've decided to start living more and see what happens. I had stopped having BikeMike craft the workouts for and coach me a while ago due to my injury but we restarted together today with a different set of objectives:

• I'm 95% doing Eagleman as an aqua velo (assuming I can ride effectively).
• I'd like to still be able to give the NYC Tri in July a shot. Any running attempts would be deferred until it matters for this race(this could give my body a chance at recover if rest has a play here). 10k can be walked and as it is much shorter than a 1/2 mary there is more of a shot for success.
• I'll probably mix in a few long rides (Montauk Century anyone?) here and there. Perhaps a field trip up to Lake Placid to ride the IMLP course for a weekend in May with Larry's FiremanIronman camp would help me physically and mentally.
• Ultimately I want to do more formal cycling events but I'm not at the point where I feel I could be competitive even at the lowest levels so I need to build up my cycling skills to get at least think I've gotten close to that point.
• I haven't seen any issue riding long yet and will keep more on one of my road bikes rather than my tri bike.
• A short term goal for this year, assuming I'm healthy, is to be able to ride with any of the local organized faster cycle groups. If I can't hang with them, then most racing is beyond my capability. Some groups I have no issue hanging with now but I want to move up the food chain while gradually adding more difficult terrain.

The biggest challenge is I have no idea of what will hurt and what won't. It may turn into a constant reassessment on a workout by workout plan. BikeMike's coaching agility may be challenged probably like he has never been challenged before. Can you say "high maintenance Rock Star?" I might even have to really listen to my body for a change rather than yelling at it to shut up and suck it up.

It was good to look at TrainingPeaks and see my weekly workout plan populated. It was good doing 2x20 on the trainer L3 as a test the other night. It was good to see the weather is supposed to be good this weekend and I have two rides to get done.

It is good to focus on can, not can't.