The Race is O’re…

The race was Saturday. After hints of rain earlier in the week, the day turned out to be absolutely beautiful. It was dry, about 60 when we started and 70 when we (well, I) finished. A little over 1100 in the half marathon, so the traffic wasn’t too heavy, but there are always people around you. A flat, flat, flat course, but at about 4500 feet altitude.

It all went pretty well for me. No problems (except for too little speed training and too much age). I was really happy that I was over 4 minutes ahead of my schedule at 5 miles, and a little further ahead of schedule at 10 miles. My downfall was the last 5k (a half marathon is 10 miles plus a 5k). I really slowed down in the last 5k, and lost the 4+ minutes I had banked at the beginning. The final result was a finish that was right on schedule: 2:37:30.. Just to show how bad the slow down was, I talked with a woman I had been running with in the first half of the race. She picked up in the second half and finished around 2:23. That’s a big difference

Overall, I was still pretty happy with my performance. I finished 4th in my age group. I’m still pretty unhappy to realize that I was running 2:10 less than 10 years ago. But, abdominal surgery and age took care of that.

I’ve largely accepted the age related decline I’m experiencing. But there is still that voice in the back of my head that says “more training and you’ll be back where you should be.” Another case of high expectations meeting reality, I guess.

Do you notice age-related declines in performance or ability? How do you deal with it?

Training Schedule

I’m doing a half marathon at Duke City, now just two weeks away. This will be a group affair: my wife, who walks, and her walking buddy will be doing it as will my oldest daughter. It feels like a group effort even though we may not see each other after the start. Just knowing they are out there somewhere means I’m not doing it alone. You may well ask how one could feel alone when in the midst of all those thousands of people, and I can’t answer except to say that you can.

I’m still serious about how I perform despite being as slow as I have become. I’m not going to win. I probably won’t even win my age group, although I’ll come a lot closer, but my time and performance are still important. So, like most serious runners, I have a training schedule that I am trying to follow. It’s like most such schedules: shorter runs during the week; longer runs on the weekend; background runs a few months ago; more speed oriented more recently; extensions to longer mileage on the weekends. Pretty standard.

One of the things the running mags and books don’t talk about much is what to do when the plan doesn’t work. Last Saturday, I went out to run 18km (16km=10mi, so 18 is 11.25). I had had a flu shot on Friday, but felt no after effects and I expected no problems. I had been extending 2km each week (I’ve omitted mention of rest weeks, but I do know about them), and my experience was pretty uniform: the additional 2km felt pretty bad, but the next week it was fine. Last week’s run didn’t work that way. At the beginning, I felt good. By 8km (5mi) I was minutes ahead of schedule. I was still well ahead at 9km, the turn around point. By 14km I was right on schedule. By 15, I was out of gas and could not continue running. Walking back to where I started was a major disappointment. I took that failure badly, and it took much of the week to get over it.

What do you do to recover from a failure like that? How do you get back on track? My approach to that is to repeat the week. The previous week wasn’t completely lost. I did cover the distance, just not as fast as I had hoped. So, I did it again this week. Busy and stressful week at work, and I missed one of the mid-week runs. But, this morning I felt good. Back down by the river because it’s the first weekend of Balloon Fiesta and they usually fly along the river–500 balloons in the air at once is quite a sight. Unfortunately, they go where the wind takes them, and today the wind took them elsewhere, so no low flying balloons overhead. Much of the run was like last week. At 9km I was way ahead of schedule. By 14km I was right on time, having slowed down and burned through those minutes I had banked in the early going. But, this time I didn’t run out of gas at 15 and successfully finished the planned 18km. I’m still unhappy about last week’s failure, but this week’s success has improved my mood. On to the race.

Running as You Age

Recently, I read an interesting article in the NY Times called Why Runners Get Slower With Age by Gretchen Reynolds. Several reasons were listed including core and leg strength and reduced endurance capacity. But, I was particularly drawn to the statement that a runner’s speed and stride length decrease as the runner ages. I’m skeptical about the reported 20% per decade reduction (6 decades and you are effectively no longer moving; yes, I know each 20% is smaller, but after 6 decades your stride would be 26% of what it was originally; if I started at 36″, that would be 9.4 inches; my feet are longer than that), but convinced that it happens.

Here’s the effect. Suppose you used to have a 36″ stride and it has shortened over some number of years to 30″ (that’s less than 20%). A 3′ stride means 1760 steps in a mile. With your new 2.5′ stride, it now takes 2122 steps to cover a mile, and those extra 352 steps take time. How much time? Suppose you started with a 10 minute per mile pace. Then each step took .34 seconds. If you kept the .34 sec per step rate (unrealistic since your pace also slows), then those 352 steps would take 120 seconds—suddenly your pace is 12 minutes per mile.

I don’t like to admit it, but this is just what has happened. Some of the reasons, like reduced endurance capacity and reduced oxygen uptake and lung capacity are annoying because I don’t know how to do anything about them. I like blaming core strength and leg strength and stride length because, with my running experience, I know exactly what to do about them.

I started running at the beginning of my first year in high school. That would have been mid September in 1956. So, another thing that happened last week was that I finished my 59th year of running–enough experience to know what to do about those small issues.

In the last week, I’ve been stretching my stride just a little. You do that by dropping your hips a tiny amount and lifting you knees a little more. Tiny adjustments, not exaggerated adjustments; a 1/4 inch, not 3 inches. Darned if it doesn’t work. Substantial improvements in my (still very slow) pace and nice reductions in my 8 km (5 mile) time. Even old folks can improve–it isn’t all down hill all the time.

Primary Health Care

Today’s New York Times had an interesting article featuring Iora Primary Care, a startup with a business model more like Starbucks than your current primary care facility (except that you can’t walk in off the street and buy a cup). You can read the article, A Starbucks for Medicine, in the Business section.

Iora is a subscription service that only works with employer partners (not with individual patients), so your company has to buy in. The value proposition to the partner is lower costs that are more or less fixed. The value proposition to the patient is more individualized customer service, and, sometimes, service that goes well beyond what we have come to expect from primary health care providers.

One of the features of their model is a “health coach”, a much lower cost person than any of the medical staff, whose function is to help the patient with not-necessarily-medical, peripheral issues, such as transportation, diet, exercise and advocacy—at least within the practice office.

Iora is a startup, and there are still many issues to be resolved. They aim for a large number of practices instead of the one, or a few, that most innovators expect to have. Some things in the model scale well, such as knowing what to stock when a new practice opens. Some things scale poorly, such as the CEO interviewing most of the new staff. It isn’t clear yet whether they will actually be able to reduce costs for employers (mostly by trying to provide care that will head off trips to the hospital and ER, I think). On the other hand, the kind of care described in the article seems attractive from the patient point of view, and finding ways to move in that direction has got to be good.

From the provider’s point of view, they aim at far fewer patients per provider, allowing the provider more time with each patient. And, (here’s a note for you Victo) they have a staff of about 20 engaged in building their own proprietary EHR system. On the one hand, that means that individual providers will have more input into how it works, and more influence when it doesn’t. This could also be a cost reduction idea—EHR/EMR systems are already a very big business. On the other hand, as the number of small practices increases, this effort may be hard to sustain—another area that doesn’t scale particularly well.

On the surface, Iora looks like a good idea. I currently get primary care through a corporate entity. While I like and respect the providers and other staff, the corporation stands in the way of getting to them and pretty much controls what I get from the providers. I admit I haven’t yet had much interaction, and so far, I’m glad because the interactions have been painful or at least irritating. I’m interested to hear what others of you think of the Iora idea or other innovative delivery ideas, particularly those in the health care industry.

Prostate Cancer

ColdHandBoyack posted a Public Service Announcement (pun) about his elevated PSA and prostate cancer biopsy. Fortunately, he did not have prostate cancer—congratulations to him.

Been there. Done that. Results not as good. As you pointed out, I had no concept of modesty left after the biopsy. The nurse did the ultrasound, the doc the biopsy. When the ultrasound was done, the doc was busy with something else, so I had to wait with the probe in place until he finished his coffee and danish. Of course, the nurse waited with me—she wouldn’t have wanted me to pull the damn thing out.

If you have cancer, the next step is figuring out what to do about it. There are 3 main treatments: surgery, radiation, and seeds. The problem is that the treatment outcomes don’t diverge until after 10 years. In practical terms, that means there is no objective way to choose. I had the good fortune (for me) to know a man who had had prostate cancer 10 years earlier and had chosen radiation. Then 10 years later, it had returned. Because the radiation causes collateral damage in the vicinity of the prostate, he could no longer have surgery. There was nothing to be done for him, and he died. I chose surgery. That was almost 8 years ago, and I am still here, and my PSA is still 0.0—woohoo.

I’m convinced that prostate cancer is something that every male who lives long enough will get. It’s a matter of when, not if. If you are over 50 or so, get a PSA along with your other blood work. All you have to do is ask for it. If the biopsy shows cancer find someone else in the club to talk to while you are deciding what to do. Despite the intimate nature of the problem, I have found others who have been through prostate cancer surprisingly willing to talk.

Entertaining Stories

I’m going to invite everyone to re-blog, tweet, and otherwise share this post today. We all wish our posts got that much love, but this one is important. If you are a man, love a man, or maybe both, this post is important.

I debated long and hard about sharing this at all. It involves personal information, and I like to keep a bit of privacy. I had to weigh the fact that my mother reads this blog, along with at least two co-workers, against the possibility of helping someone else. Someone else won.

Popular rumor holds that a man should have certain things checked medically once he turns 50. In typical male fashion, I waited until I was 53 and 8 months to schedule my colonoscopy. This is a degrading procedure that involves shoving a camera into places that aren’t visible by design. I thought it was degrading, but…

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Family Running/Walking

Our youngest son arrived on Friday for a short visit. Saturday he and his mother did the Cupid’s Chase 5k, an informal race. He is an Iron Man veteran who hasn’t run much lately because of the constraints of his job and also because he lives in the east coast snow belt. But, he ran and his mother walked. I needed more distance, so I went off to do 16k while they were doing that.

Yesterday, our oldest daughter and her family showed up—pretty full house what with son, daughter and her partner, 3 grandchildren, and us. This morning son headed off to visit other relatives for the day and the rest of us went off for some exercise. We headed for the bike/pedestrian path along the river. Grandson (16) needed a “medium” run, which eventually translated to about 10k, so that set the tone. We set the time limit at about 45 minutes and off we went. Grandson is the fastest (he runs about 5 min. miles in races—not bad for someone who lives at over 7000 feet). He was followed by his sisters (14 and 10) and their mother at somewhere around the pace I was running 6 years ago (in the neighbor of 10 minutes/mile). I followed them at my new, slow pace (but again faster than I have been going for the 4th run in a row), and behind me were my wife and daughter’s partner who were walking. (For any of you who might be doing the calculations, I did not do 10k in 45 min. I didn’t need to go that far, so I did 6k. He did the 10k, but it didn’t take him 45 min.)

Didn’t see much of Grandson until he passed me on the way back, but I was able to see the others for much of the time. I think events like this are one of the reasons I keep doing this. It is such a joy to go out with the kids and grandkids and share in the experience even if we don’t all run together. So much better that staying at home and badgering them with stories about how I used to do that. My wife and I usually do our long weekend exercise together, and I feel the same way about that—even though I run and she walks and we don’t see each other along the route, I feel much better when we start and finish together than when I go by myself. The joy of shared experience.

14k

Weekends are for “long” runs, especially when you are building up for a race. It was about 30 F this morning when we left for our exercise, but clear and promising to become warmer. Today’s course was out and back on an asphalt bike path. Pretty flat but trending upwards from start to turn around, rising about 600 feet. You might not think of a 600 foot rise as flat, but I live in mountains, and I think that 100 feet per mile is dead flat, so 600 feet in a little over 4 miles is “pretty flat.”

I do everything in metric distances, which works out great for a half marathon (21k). The half is easily thought of as 4 x 5k plus a 1 k finish. I don’t really pay attention to the 5k splits, but I do pay attention to the 8k splits because 8k is 5 miles and my 8k time is just about an hour. So the half is 2 x 8k plus 5k. I’ve slowed down as I age, and my pattern today is run-walk with a walk break every 2k (1.25 miles). My times would be better, of course, if I didn’t take the walk breaks, but not much. After a break I start running again at a pace that is faster than when I stopped, so I tend to make up the lost time. The walk breaks at the end of the race are the expensive ones, so I’ll try to eliminate at least one in the final 5k.

The program today was a 2k every 15 minutes (12 minute miles), so 14k comes at 1:45. I was a couple of minutes behind that, so not too bad. The idea of writing the running plan and putting every outing on the calendar seems to be working, too. I do a lot of calculating while I run: am I ahead or behind? can I make up what I just lost? if I keep this up, what is my time for the next 5k? 8k? 10K? half? Even if you are slow, you can still have a lot of fun and get a sense of accomplishment doing this. My head knows that. My heart is still a little off the pace.