Patients

I work in a subacute rehabilitation facility with primarily geriatric patients. It is truly an amazing field. I have worked with people who couldn’t even stand up on day 1, and 2 weeks later they were doing full flights of stairs.

Therapy sessions can be as short as 30 minutes and as long as 75 minutes. Across 2 or even three disciplines, that is a lot of work for these people. Most patients are highly motivated and will work their butts off even though physically they are nowhere near 100%.

I then asked myself, “If these patients are asked to do 2-3 hours of therapy a day and they are motivated to do it on their own, what is my excuse for not exercising?” Crickets… In the past, I’ve written about having the wrong motivation for running, being externally defined and susceptible therein. That problem seems to have fixed itself.

One lesson I learned as a student at a phenomenal physical therapy center (ProCare Rehabilitation in Flemington, NJ): you can be the best physical therapist in the world, but if you can’t connect with your patients, all the skill in the world means nothing. With every patient and every session, I have this core value in my mind. Looking for opportunities to connect at every turn often starts with a patient asking me “How was your weekend?” and being comfortable to answer with a personal touch.

As my running rebound continues, I am conversing with patients at work, telling them my motivation for getting healthier is partly from them, and the results are mutually amazing! Many ask how is the running going, is the ankle holding up, and that I look “too skinny, eat more!” I have dropped somewhere around 12 lbs now, dipping into the upper 160 lb range more and more now with the goal to maintain in the 160s. Unfortunately, I bought new clothes at the high end of the weight scale, so now the pants are falling off without a belt. Good problem to have!

I am about 5 weeks into my turnaround plan, about to go over 40 miles of running this week if the rain and thunder ever stop here in NJ, with my eyes set on getting up near 50 again (my pre-ankle injury level). I just signed up for a race that I used to do every year, Miles for Minds 5K in Edison NJ in late July. I incorrectly mentioned that the race was in late June in a prior blog entry. I am actually excited to be preparing for a race again. I guess it just took some “patients”!

To my patients, thank you for motivating me!

Minutes, not Miles

I have been a licensed physical therapist assistant for almost 2 years now. My current position tracks therapy by minutes. And, my girlfriend has been using a time-based system to log her weekly exercise, based on minutes.

About a month ago, I decided to track what I was doing in a week, and I did 220 minutes of exercise in a week. Using 10 min/mile as a conversion, I did about 22 miles of running that first week. I decided I want to ramp up using the 10%/week rule, but easily got to 310 minutes in week 2, about 31 miles of running. The next week, I slowed it down a little and was about to 322 minutes, and this week am looking at 360 minutes, with a very strong 94 minute towpath run today on NJ’s wonderful D&R Canal towpath, a dirt path of ~34 miles used extensively by a local running club, RVRR, of which I was once a member.

Work and left ankle constraints — it only tolerates so much asphalt pounding — have forced me to modify my routine, but surprisingly I’ve had no issues as I climb that ladder towards my pre-ankle injury, pre-PEs mileage of 50 miles a week. I log one deepwater run per week, about 50% or more on dirt, and one trail run per week. With the correct shoes, my ankles are safe and fine on the trails at Watchung Reservation, a place at which I’ve run since 1992 (also introduced to the trails during an RVRR run that year).

I feel stronger and stronger and am incorporating fartlek training now once a week. I’ve dropped a real 7-8 lbs now, accounting for water weight changes. I am motivated to get out early in the mornings again (of course, warm weather helps my ankle mobility and the light helps my energy!).

I want to run a local 5K (Miles for Minds) at the end of June and see where I am. I don’t expect a blazing running speed, but I’d like to see where my pace is on a course I’ve done many times without the pressure of USATF, clubs, Grand Prix points or anyone who cares about how fast or slow I am.

 

I Know You Rider

Back in October 2016, I ventured over to a new Dicks sporting goods store that opened near my home. I browsed around, and found a pair of Mizuno Wave Riders in my size on the clearance shelf. Usually this shoe has a model number, but this pair didn’t. That should have been my first clue. The second clue was that they were on clearance and thus super cheap. I had good success with the much older Wave Rider 14 model and was looking forward to using the Wave Rider again. So I bought the pair at Dicks and excitedly got started running in them.

First couple runs with the new shoes were OK, but then things went south in a hurry. I did a run one day, using the same route and pace that I’ve done a million (well, many) times. Several hours later, I developed sharper and sharper pain in my repaired left ankle, so much so I contemplated going to the ER. The next day, I could put no weight on it without jolting stabs of pain. It slowly subsided over the next week or two.

At that point in October and November, I didn’t yet suspect the shoes, so I resumed running in them, and the same thing happened a couple times. It did not happen when I used my New Balance shoes, nor my tried and true (and super beefy = stable) Adidas Trail Response shoes.

My ankle does not tolerate the cold temperatures, so I laid off running in the winter, cross-trained and awaited warmer spring weather (and avoided running on icy roads due to the late winter storm we had on the east coast of the US). The rest allowed my sore ankle to fully recover.

I used the shoes once more this spring as the weather warmed; once again the sharp pain followed. As before, the pain did not happen with other shoes.

About a week ago in April 2017, I drove to Road Runner Sports nearby, and spotted the “Wave Rider 20” on the shelf. I put them on and took about 3 steps and knew these were good and bought them. Not cheap, about $114, but I knew these were the right shoe. They felt just like the classic and beloved New Balance 850s from long, long ago. I also bought some Wave Rider 19s on Amazon, basically the same shoe and they feel just as good (just cheaper since 19 is an older model).

I looked more closely at the four Wave Rider versions I now had. Models 14, 19 and 20 were very similar, despite the different model numbers. The suspect ones from Dicks did not have a model number, but instead bore some strange marking after the name. I also reviewed the base of the shoe. The suspect shoes were much thinner than the numbered models, and the distinctive Mizuno “suspension” was very flimsy. I wonder if Dicks had Mizuno build a cheaper version (or simply sold a cheaper version) of the Riders.

For once, I am resuming running cautiously with the mindset of coming off a major injury, and am approaching things slowly. I started with regular walking with my girlfriend. I recently introduced walk-runs (starting at 3 min walk, 1 min jog) and have been gradually ramping up the % and total time of running. I am now at 75% of time running, 35 min run time total, and am doing fine with the new shoes.

I am mildly sore for a couple hours after any run, but I think it is more from just resuming running rather than the injury’s flaring again. I ran two days in a row, something I thought was over for me.

Anyway, lesson learned. The 14s, 19s and 20s were more expensive than the pair from Dicks, but the numbered versions don’t leave me limping, considering the ER and on NSAIDs for a week.

Locus

So, a few weeks ago, I was pushing myself a bit in hopes to squeeze out some semblance of “better than slow” times in the last USATF-NJ team races of 2016. On a Sunday afternoon, I went out for an 8 mile run as I have many times. I got home and puttered around for a little while on the computer. I then got up and got hit with an incredibly sharp pain, so much that I fell back into the chair. The pain was exactly where it was before the ankle repair surgery of 4 years ago. I debated about going to the ER because it honestly felt like something gave way.

It turns out my ankle was slightly out of alignment during the run, and I pinched some of the scar tissue that formed following the surgery. Because of the healing process, the nerves in there are both hypersensitive as well as “report” abnormal sensation.

It resolved a few days later, but I scrubbed those races as a precaution. I simply could not and cannot reliably get the miles in now to be able to race and compete. Sure, I can pay $30 to plod through 3.1 miles at maybe 8:30 pace, but it is really a waste of money in my mind.

Looking deeper, I realized … I am done with racing. Physically … my body simply cannot do it anymore with even a remote semblance of being competitive. Days in pain can outnumber days of feeling good, and any given run can leave me limping for days, requiring time off from running. Mentally … there is nothing to really motivate me to race now.

But, I just did a 5.8 mile run and loved every step; having resigned from the idea of racing, I just run because I want to, because it feels good, because I choose to. There is no pressure.

I looked further into the “mental” aspect of being done with racing and realized this end began years ago.

Years ago, I ran with a running club. I had dropped a lot of weight. I was running well. Every race was a new PR, an age group award, and then became age group wins. I was suddenly in very fast company in every race. I was showing up in the placed members of our 40s mens team. I had a setback of a hernia surgery but regrouped and came charging back in the midst of this.

I went to the yearly banquet, and maybe this next part was my fault. I figured, hey maybe I will get an award for so much improvement, or coming back from surgery, or dropping so much weight or winning age groups (and almost entire races).

The “biggest comeback” award went to a woman who, and I quote, “ran on a sore knee against medical advice”. The “most improved” award went to a buddy of the one-man “committee” that selected the award. I won so many age group awards that year I lost count. I looked forward to the yearly ritual of a group photo for all the AG winners. Nope, banquet speakers went way over time, so it just became “come get your lollipops quick so we can move along” and we moved like herded cows.

Surely, I thought I would get mentioned for having contributed to our 40s teams crushing win over all other teams in NJ that year. Nope. Only 2-3 of the fastest runners got named along with “the rest of the team”, again with the rush because things were behind schedule.

I realized from that experience that my locus of running was completely in the wrong place. There is only one place to lay blame: me. I was racing to get the nod from people around me and when that utterly failed to happen, it all crashed and burned. I was focused on other people’s opinions and not my own enjoyment. In my rush to really get myself noticed, I pulverized my ankle and the end result nearly killed me.

My ankle no longer permits me to run the big and speedy miles. I am done. I hung up the racing cleats for good. There will be no “attaboy” team stuff (not that there ever was). I have no regrets about that.

But my run tonight … it felt good to push myself because, well, I chose to.

Lighten Up, Francis

After reaching a decade+ high weight of 182 lbs in early May of this year, the results are in. The weight drop to date: 16 lbs. It isn’t hard to believe I weighed in at 182. I just never show extra weight.

The staggering part is the 16 lb drop in 16 weeks (which is the correct rate of loss, from what I understand … a pound a week). I’ve normalized out the typical water weight changes, so that represents … a lot of flab!

There is no magic in what I did. As I prepped myself for longer hours in clinic with less time to eat, I began to adjust by eating less. That was the first part, and most basic. My diet had not really drifted bad as it has in the past, but I did cut out Balance bars. While their formula works for me, I lack control and just ate too many of them and at the end of the day, they are still a candy bar.

A diet review revealed, once again, I was coming up way short on chromium, necessary for insulin function (a biggie for me) and aids in many body processes (fat metabolism caught my eye). I upped my dose about 4 weeks ago, and as usual diet lags go, I am just seeing those results come in. Chromium is very safe, but I do maintain days off from it (after my first two weeks at every day).

I ran my long route at Watchung Reservation today. Early in the run, I had a hunch I was running better than I have in years as I ran the ~9 miles. Normally, my time comes in around 1 hr and 40 minutes. As the miles clicked by, I noticed I wasn’t really tired. Where I normally huff and puff in the later miles, or even walk the steepest hills near the end, today I was aggressively pushing up them on my toes. So, I pressed the pace even higher in the last 1/2 hour and knocked 11 minutes off my last time with ease today.

In fact, once I got done, I realized I had plenty left and probably could have pushed harder earlier on. But that is the hallmark of getting injured, so I am glad I didn’t do that. I have a long way to go to reach the insane 1 hr 12 min mark that I did long ago, but to be “only” 17 minutes off was pretty exciting. Actually, today was the fastest I’ve run on the current course since the 1:12 was clocked on a different course configuration.

In other news, I’ve resurrected some basic swimming drills this week with noticeable results already. A lot of people talk about “strengthening” a muscle. But in the physical therapy world, there is an additional notion. When people develop compensatory patterns, they often forget simply how to use a muscle. They develop a new neuromuscular sequence and the primary mover slacks off. These drills force me to not compensate and the result is striking.

I have a long way to go to get to any kind of competitive form in running again. But I’ve got 16 good reasons, and counting, to keep pressing.

Baker’s Dozen

Weight now officially down 13 lbs since May 1 of this year, from a hefty 182 now to 169 lbs, with the downtrend still in motion. I can feel the difference when I run, and more importantly, after a run. There are less aches and pains, and I no longer limp for 2 days after a run.

Based on the downtrend, I expect the bottom to come in around 165 or so in the next 8 weeks, almost back to my ideal racing weight plus a few pounds due to the upper body changes from swimming.

I’ve added back GTF chromium supplementation. I’ve been very deficient in natural and supplement intake of chromium, and for me, it is an important one. Being sugar-sensitive, GTF chromium is a highly effective means to reduce my sugar reactions and (I think) better manage the weight and cholesterol (which has been a tad higher than normal).

Petco Scam

Disclaimer: no running content.

I have been a long time shopper, unfortunately, at Petco, a pet-focused retail chain. I noticed some time ago that they were playing games on how they tax items being sold at reduced prices.

An example explains it best: if I buy $50 worth of regularly priced products from them, they will charge me sales tax on $50. So far, so good.

Sometimes they have specials like “buy one, get the second at 50% off”. So, let’s say I buy the first item at $20, and the second at $10, totaling $30. So, they should charge me tax on $30, right?

Nope.

In the example above, Petco charges tax on the $20 for the first item, on the original price of $20 for the second item, and then applies the 50% off. That is, they are taxing based on the full price of items [$40 + (tax on $40) – $10) instead of the sale price [$30 + (tax on $30)]. Doing this, they essentially collect extra revenue and my suspicion is they pocket the difference.

I made a scene (and then returned all items) last night. A store manager told me this is “standard practice on sales tax” in retail, as in “everyone does this”.

A friend’s wife is an accountant and indicated that tax can only be charged on money that “changes hands”. I mean, we don’t pay sales tax on the sticker price of a car. We pay tax on the actual purchase price.

I searched via Google and this complaint shows up across the country. How is this even allowed? Why haven’t they been caught?

Rant over. Back to running content, I promise.

Water Water Everywhere

I am a geek. I am an engineer.

Confessional done.

As I try to manage my weight downward such that the range stays below 170 lbs, I have learned some things. I am almost to the point that I have formula for weight loss based on time running and conditions.

For example, on a hot humid day like today in NJ, I estimated I lose 35 g/minute of running. So, my 77 minute run should have resulted in a weight loss of about 6 lbs. Post-run weigh in indicated a weight loss of 6.8 lbs. Given how inaccurate my scale is, that to me is a pretty darn good estimate.

But, I have to increase the per minute rate to about 40 g/minute in these disgustingly hot and humid conditions.

As I write this, NJ and much of the east coast of the US are under a heat wave. As luck has it, our central AC in the house decided to give up the ghost (air handler motor failed), so whether I am running outside or sitting inside (like now), I am heat training constantly.

As I recall, as one gets more heat acclimated, the body will respond with some interesting changes. Core resting body temperature will actually decrease a little bit. While I haven’t measured it directly, anecdotally I believe this to be true. Sweat production rates actually go up a bit, and based on a 6.8 lb weight loss in 77 min, I would say this is true.

Where this stuff become interesting is in learning how to discern water weight changes from true body weight (fat/muscle) changes. Additionally, for endurance events, it becomes an indicator for just how much fluid one needs to sustain a long event. A rate of 40 g/min implies about 320 g/mile at an 8 min mile, so that kind of number is insane and not sustainable. Or, paces and intake have to be moderated so the body can absorb sufficient amounts.

Anyway, time for a drink.

Nothing Up My Sleeves

I used to swim a lot years ago, when I was in a triathlon and Ironman mode of life. While I was never a superb swimmer, I did typically clock around 70 mins for the 2.4 mile Ironman swim, with one swim at 66 minutes.

I did lots of time in the pool back then and some of my numbers looked like this. I used to take about 15-16 strokes per length of pool (25 yards). I could swim 100 yd free usually under 1:30, and with sprinting, closer to 1:20. Nothing spectacular, but there you go.

After my left ankle repair in 2012, I lost considerable ROM in the left ankle. For swimming, I lost easily 10-15 degrees of plantar flexion, necessary for the flutter kick. I can’t point my toes. I was never very good with the flutter kick, and this loss of ROM made it worse by far. Because of the loss of ROM, the left foot drags a lot in the pool even when I try to point my toes, leading me towards lower leg cramps and so on.

I am very strong on breaststroke, thanks to the natural mechanics of my legs (before and after the 2012 surgery) and some excellent coaching long ago. I have almost gotten back to similar speeds in breaststroke now as years ago, mostly from constant tinkering with mechanics combined with new PT-based adjustments based on my better understanding of the spine. Yes, head position changes can completely make or break a slow stroke like breaststroke. Most people lift the head when they breaststroke, which will … ta da! … drop the hips and drag. I keep the head down and forward now (minimal lift for breathing).

Anyway, those swim parameters were from the late 1990s and early 2000s. So, they aren’t too relevant as I am 16 years older now.

Nonetheless, I have noted that I now require 19-20 strokes to cover 25 yards, a pretty big jump from 15-16. For months, I played around with completing each stroke’s “pull” by the age old trick of brushing my thumb along my side at the end of each pull, just before that arm lifts out of the water. This got me down to 19 or so, but still, it didn’t seem right.

I have been reluctant to work on shoulder roll too much, as I worried that this would cause me to wiggle hips side to side, which is very inefficient. That is, the shoulders will rotate around the long axis of my body. Stand tall, and just rotate one shoulder forward and the other goes back. Nothing complex.

So this led me to swim with very flat shoulders in the water. And in hindsight, this position was probably leading me to do MORE of the dreaded hip wiggle, rather than less.

Just this week, as I swam 20 strokes per 25 yards, an idea hit me. Maybe it was something someone said and came back, maybe not. While I had worked on completing each stroke’s pull, I never worked on completing the recovery phase. Which is, arm goes into the water and the shoulder flexes/reaches forward, and then the pull phase begins.

Midstroke, I said, “How about I try to fully extend my arm into a tube in front of me as it enters the water, and then pull?” So I did. On the first length, the stroke count dropped to 16, and it felt effortless.

Here’s how it works: in a sitting position, keep shoulders square and reach one arm straight away from you, parallel to the ground. Now, pretend like you are reaching your arm into a tube further out and do exactly that: reach the outstretched arm into an imaginary tube. The shoulders will rotate (one forward, one back) and the reach increases a lot.

In the crawl stroke, this has the pull phase on an arm beginning further out in front, and completing further behind since the shoulders roll in both directions. In other words, the pull phase is lengthened and enhanced by torso rotation, creating less work for the arms! And I just realized during the recovery, the torso / shoulder rotation will clear the shoulder above the water automatically, making the recovery easier.

I did not think, at age 50, that I would be so astounded by something so simple!

800 and 170 or Bust!

I was self taught in IT, teaching myself advanced programming and database techniques. I did well, but the “self taught” aspect created issues. I was dubbed the “sheriff” in one job because I became especially adept at digging out subtle programming and performance bugs. Nonetheless, I was usually intimidated by the computer science and similar people around me, always believing everyone around me knew more than me. It created confidence issues which were discernible. And in the backstabbing world of IT in the financial sector, that didn’t work so well.

When I made the decision to go to physical therapy, I addressed that confidence issue from day 1. I had several reasons for this. First and foremost, I want to be armed with as much knowledge and insight as possible when working with patients. That is discernible. Some of my classmates were content with just meeting the minimum passing grade of 75%. That tells me there is 25% of the physical therapy domain they don’t know. Yikes. Second, I wanted to know that I know my stuff and people working with me would also know. That is the confidence aspect.

I finished the program with a 4.o out of 4.0 GPA, and was selected and recognized by the college for academic excellence.

Part of the process in getting licensed was a national licensing exam, which I took on July 6 of this year. My goal was simple: I wanted to achieve the highest possible score of 800. My initial goal was to get the highest score in the country, but they do not give that level of information, so I settled for working for the 800 🙂 I studied for 9 weeks on my own, laying out a detailed review and practice exam regimen. I studied over 200 hours, read nearly 1000 pages of review material, and did over 1500 practice questions. I “avocado loaded” for several days before the test, as I believe avocado has amazing properties for physical and cognitive performance boosts.

The score results arrived on July 20th: 800. Boom! Mission accomplished!

My weight has steadily climbed since my peak running days of a few years ago. Back then, I was a lean low 160s kinda guy. In late April of this year, I was tipping the scale over 180, to about 181-182. I was in clinic many hours, so that reduced free time to exercise. I have been swimming and cycling a lot more, both of which tend to cause a bit of weight gain. One factor has been excess salt combined with not enough water drinking. So as best I can, I have been trying to reduce salt intake and drink more. With my weight that high combined with the “running impact multiplier”, that 15 or so pounds translated to 45-60 lbs of extra force on the lower leg, ankle and feet. The repaired left ankle clearly reacted, as a single run would leave me unable to run for usually 1-2 days.

Mostly, though, I am working on eating better, eating less but still getting enough. So, today, about 12-13 weeks after that visit over 180 lbs, I clocked in at 168 lbs again, breaching 170 for the second time now. I just ran 10 miles, a little slow because I wanted to cover the distance. Normally, the ankle would be locked up by now and I would be taking some sort of NSAID for a day. I only feel a little muscle fatigue combined with a general sensation of “I just ran 10 miles” all over.

For those that wonder, I don’t look at one single weight. I look at the ranges, as in my experience, the swing range tells me a lot more about what is going on than just a static measurement. The trend line is clearly in the down direction.

Works for me.