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It's A Repair Of The Heart
November 29, 2018 11:29 AM | Posted in:

In retrospect, I understand that the problem began last spring.

Since moving to Horseshoe Bay, MLB and I had gotten acclimated to running in the hills that give this part of Texas its name. We weren't fast by any stretch, but we were able to consistently run five miles or so along courses that had elevation gains of about 100' per mile without suffering too much.

That began to change - for me, anyway - in the late spring, as the heat and humidity of this region started to make their appearance. I found myself "hitting the wall" and having to walk up some of the steeper inclines. I chalked it up to the aforementioned weather conditions and was confident that it was just a matter of acclimation (there's that word again). To my chagrin, things didn't improve. 

Along that same time, something else began occurring more frequently. Over the past couple of years, I had occasionally experienced a racing heartbeat. It didn't last long, sometimes only a few seconds but never more than a minute or two, and it was infrequent...maybe once every six months of so. But starting earlier this year, that frequency increased to the point where I experienced it once or twice a week. It still didn't last long, and again I rationalized it away as just another age-related challenge.

I lost that rationalization on the afternoon of Sunday, September 2nd. My heart started racing...and it didn't stop. I laid in bed and felt it pounding. It's a disconcerting thing to be constantly aware of your own heartbeat. According to my watch, my resting heart rate (which, to be honest, has always been high) was in excess of 120 beats per minute. Despite all of this, I exercised my male pigheaded prerogative and never mentioned it to MLB, figuring this too would end and things would return to normal.

They didn't, and on the following Thursday morning, I told her that something was wrong and I needed to see a doctor. We drove into Marble Falls and I checked in at the generic medical clinic. Fortunately, I was the only patient in the waiting room and between that and my description of why I was there, I was almost immediately put in a room. A nurse hooked me up to an EKG machine and within two seconds of starting the test, she gave me a firm diagnosis.

"You have atrial flutter."

I had never heard of atrial flutter, but I soon learned all about it. It's the less serious cousin of atrial fibrillation (a-fib, which we ALL know about thanks to the endless drug ads on TV), and in effect, it's when the upper chambers of the heart lose their rhythm (insert white guy dancing joke here) and leave the lower chambers to do all the work. As the cardiologist later explained, it causes a horsepower loss of around 20%, although I felt like I was working at a lot less than 80% of normal. 

The cardiologist said that I could continue to do whatever I felt like doing, so we continued to run and bicycle. Cycling wasn't too hard on me, but running was an entirely different matter. I often walked as much as I ran, and never did more than 45 minutes of both. I was also continuously tired; if I could read a book for more than ten minutes at a time without dozing off, it was a small victory. Worst of all, I had to cut back significantly on dancing.

The next couple of months were filled with a series of tests to rule out any additional issues: echocardiogram, stress echocardiogram, thyroid scan (an abnormal thyroid can cause cardiac arrhythmia), more EKGs than I can recall. There was also lots of body hair shaving. I was put on the first longterm prescription meds of my life, a blood thinner and a blood pressure regulator. Along the way I picked up a cardiologist, an electrophysiologist (heretofore unheard of in my experience), and a personal care physician (PCP). I also finally realized the importance of an Advanced Directive and Medical Power of Attorney. And, last but by no means least, I experienced firsthand the total chaos and impenetrable arbitrary obfuscation of the medical insurance industry.

The latter merits a quick anecdote. In the process of getting a PCP, MLB and I both had blood tests. Our insurance paid for the blood tests themselves, but denied the cost of drawing the blood. I'd love to hear an explanation for that. (OTOH, it does beg the question of why the lab even separates out those charges.)

Muppet AblationThe end result of all of these tests was that everything about me was normal (insert "oh, yeah; let me tell you a thing or two about yourself" joke here) except for the atrial arrhythmia. Fortunately, atrial flutter is easily cured via a procedure known as radio frequency catheter ablation. That's just a fancy term for "burning to a crisp the nerve pathways that are causing the arrhythmia." They basically run an extension cord through your groin up to the heart, plug it into a wall socket, and flip a switch. After the smoke clears and the sprinklers shut off, you're cured. The procedure is extremely effective and low risk, and I was deemed an ideal candidate, and not just because I had insurance.

I also learned that ablation is extremely common. Almost without exception, people I talked to either undergone the procedure themselves, or knew someone (and often multiple people) who had. And in every case, the procedure had fixed the problem.

So, yesterday I checked into the Austin Heart Hospital around noon, went into the operating room at 2:30 p.m. and was back at home before 9:30 (the hospital is 50 miles from where we live, and we stopped for a quick bite of supper). As I write this, my heartbeat is comfortingly unobtrusive, although the true test will come in a few days when I'm able to return to exercising.

I can't say enough good things about Austin Heart Hospital. Its staff was without exception kind, caring, professional, and efficient. I'm willing to forgive their refusal to bring me a cheeseburger to lift my spirits before the procedure.

The other positive outcome from this experience was the touching outpouring of support from friends and family with whom I had shared my predicament. I'm pretty sure that God doesn't scale His response based on how many prayers are lifted up to Him, but those expressions of love mean the world to me.

In closing, I want to say something to those readers of the male persuasion who, like me, seem genetically predisposed to ignoring the blaring sirens and atomic-powered neon flashing signs that something is wrong. Don't be like me and wait months or even weeks to get it checked out. Some things will get better on their own, but others just don't improve when left untreated. The problem is that you really aren't smart enough to know the difference.

Running Down the Rabbit Hole
March 10, 2017 3:14 PM | Posted in: ,

Wait. Is it really "down the rabbit hole," or is it "down the rabbit trail"? Or is it "bunny trail"? Hold that thought; it might become relevant later on.

I went for a run on Wednesday after work, the first one this year (in Midland). It know how sometimes you get into a workout and it starts out hard and you're feeling miserable but at some point you settle into a groove and it becomes almost effortless and you think you could just do it forever? This was nothing like that. It started out bad and basically stayed that way, until the point where it got worse. Which was almost immediately.

Visual contrasting the beginning of my workout with the ending
In all honesty, I didn't look this good at either the beginning or end.

In 45 minutes of running primarily on the trails around the neighborhood, I managed only a painful 4.3 miles, and I was dead tired when I got home. The next day, my legs — and my quadriceps in particular — were incredibly sore. I couldn't help wondering why running outside was so different than running on a treadmill, and why my frequent workout on an elliptical trainer didn't better prepare me for that run. Naturally, I turned to Mr. Google for answers, and he helpfully provided some potentially useful links.

The first one was a general discussion of the pros and cons of running on a treadmill, and the key takeaway is that there's really no difference other than the presence of wind resistance and the possibility of terrain changes when running outside. The article then offered this simple tip, via reference to a scientific study: set your treadmill on a 1% incline and it will provide exactly the same workout as running outside. Genius! Why didn't I think of that?

But I wasn't content to leave it there, so I followed some other links, including one on the respected Runner's World website. That article muddied the waters considerably, stating that the 1% guideline was "mostly urban myth." It in turn linked to this blog post by Dr. Casey Kerrigan. Kerrigan seems to be a fairly credible source, given her background as a distance runner, Harvard-educated physician, and noted researcher specializing in running biomechanics. 

With support from the National Institute of Health, she has done extensive studies on treadmill running. One of those studies demonstrated that there is absolutely no significant biomechanical differences in treadmill workouts done at slight inclines, declines, or when level. Her article also cited the results of this study concluding that treadmill workouts are more efficient than any other type of indoor exercise equipment (sorry, elliptical/stairmaster/rowing machine/exercise bike owners).

Winding my way down this rabbit hole (see what I did there?) made me feel better about running on a treadmill, but it did nothing to explain why that outdoor run was so challenging. So I have to offer my own theory. Neither the treadmill nor the elliptical can duplicate the challenges of running along a rutted trail where footing is often sketchy and the surface varies from sand to hard-packed caliche to loose rocks (and while it's a bit too early for this to be a big concern, later on I would be additionally distracted by the possibility of rattlesnakes in the road). I realized during the run that I was lifting my feet higher on the trail to navigate around and over the dips, ruts, and rocks, and I think this put a lot more stress on my legs than running indoors or on pavement.

In the end, it boils down to a simple rule - specificity of training. You can get aerobically fit by cycling...but cycling alone will not ensure that you can run a marathon. (The reverse is also true; running will not get you into cycling condition; your legs and lungs might be up to the task, but cycling stresses other parts of your body and you'll realize that after about 30 minutes on that narrow saddle). So, if I want to get more comfortable with trail running, I simply have to do more trail running.

30 Years of Persistence
January 1, 2016 1:46 PM | Posted in:

In 1985, I began keeping a spreadsheet-based log of workouts, possibly as a way of ensuring that my accounting degree wasn't an aberration but an actual affirmation of my personality. For the next thirty years, I maintained a daily log in varying levels of detail, but I've never actually gone back and analyzed the results. This snowy homebound vacation week between Christmas and New Year's Day has provided me with the time and restlessness to do a bit of that. 

I thought about posting a series of tables and graphs, but even I think that's sort of lame...and I can imagine how you mostly (completely?) disinterested readers would react, so allow me to hit the highlights.

  • I never had an explicit goal when I began to get serious about getting and staying in shape. I was in my early 30s; I've never had a weight problem - that's all genetics - but I did have some other issues that either arose from or were exacerbated by not being in good physical condition. But, at some point, I decided that I wanted to try to average thirty minutes per day of aerobic workout throughout each year. Why thirty? No reason, other than it seemed both challenging and achievable.

  • The "aerobic" qualifier was important, as was the "workout" piece. I didn't count walking, or hiking, or yard work, or paddleboarding, regardless of how many miles or hours were involved. I also didn't count any weight training, although that has always been an important part of my routine. No, it had to be something that got my heart rate up and kept it up. So...bicycling, running, elliptical machines, exercise bikes, etc. were all that got factored into the average.
Let's get to the bottom line, the actual numbers:

  •  Over those thirty years, I averaged 29.3 minutes per day of the above workouts. Yearly averages ranged from just over 40 minutes per day in 2002 to only 15 minutes in 1985, the first year of my record keeping.

  • I've bicycled the equivalent of 55,000 miles during that period, which is more than twice the circumference of earth. I use the term "equivalent" because 5,400 of those miles were accumulated indoors, on my trusty Cannondale mounted on a set of rollers. And if you don't consider that to be the equivalent of riding on the street, I suspect you've never tried rollers.

  • About 20,000 of those 55,000 miles were on a tandem bike - both conventional and recumbent - with my wife. Another 30,000 were accumulated on a series of single bikes, both conventional and recumbent. All the roller miles were on a conventional single bike.

  • Annual bike mileage ranged from a low of 640 in 1986 to a high of just over 3,000 in 2002. I've ridden more than 100 miles in a day on three or four occasions, and more than 75 on about the same number of days. (That was a long time ago, however.)

  • My running mileage included time outdoors as well as indoors on a treadmill. Unlike many people, I'm fine with a treadmill, as long as I have some good music and/or something engaging to watch on TV. I've run almost 9,000 miles, and 75% of that has been indoors.

  • That works out to less than 300 miles per year. I realize that's pretty anemic, but I've never fancied myself as a serious runner. For one thing, I've had knee problems through the years which I've managed by not overdoing things. I've learned how frequently, far, and fast I can run and not damage myself, and I try to stick with that religiously. (For the record, that is now about 5 miles in 45 minutes, 3 times a the most.)
My workouts now consist of alternating 45-minute sessions of elliptical machine and running (indoors during bad weather or short winter days), and tandem cycling with MLB on the weekends. However, with our new work schedule, I hope we'll get in more riding during the week once the weather warms.

The 30-minute-per-day goal is still in effect, and that seems to provide the right balance of rest and healthy activity. I fight nagging aches and pains and motivational apathy just like most everyone else (I assume; forgive me if you don't struggle with those things at all), but I'm happy at where I am, physically, because I can do pretty much anything I want (granted, those "wants" have been tempered by age and wisdom). For instance, yesterday I ran five miles and then danced until midnight. OK, so I couldn't actually get out of bed this morning, but that's not the point.

I think the only important lesson to take away from this - and bless you if you've actually stayed with me this far - is that persistence is the key when it comes to getting and staying in shape. Find something you like - or at least tolerate - and (forgive me, Nike) just do it.

One last thing. I didn't mean to discount the value of walking, and in fact, I'm more aware of the benefits than ever. I keep a Fitbit Zip in my pocket or sock at all times and in the two years or so I've had it, I've accumulated more than 2,000,000 steps. I don't plan on logging that activity (for one thing, it duplicates my running mileage); on the other hand, Fitbit is doing it for me via their app. I won't promise that I won't do another boring post on my walking activity some day, but I'm not planning it.

Then again, in 1985 I didn't plan on someday having thirty years of workout log spreadsheets.

Getting the Old Shoulder
April 1, 2015 10:09 PM | Posted in:

So, the good news is that the tumor is benign. The bad news is that my right arm will perpetually hang limply by my side like a giant knackwurst. But, I could theoretically still win the Super Bowl.


Some of the above is true.


The pain in my shoulder began last October or November. I think. Maybe it was even before that. The point is, it didn't start with a specific something (probably stupid) that I did; it just got gradually worse. At some point, the pain became bad enough that I awoke several times every night trying to find a comfortable position. I finally had to admit that my self-healing superpower had finally failed me (curse you, Time!) and made an appointment with a specialist.

Well, I couldn't get in to see the actual specialist for another month, but I could see his P.A. almost immediately, and since P.A.'s do all the heavy lifting, medically speaking, I did that. She was quite thorough and thoughtful, and I came away with a set of x-rays and a wonderful shot of cortisone (which runs a close second to morphine in my book as far as Good Things That Work Almost Immediately). The diagnosis: Shoulder Impingement Syndrome, which I later learned is just fancy talk for tendonitis, or close enough to be synonymous. (If any medical professionals are reading this, feel free to avert your eyes.)

Ideally, an MRI would have been helpful in nailing down the diagnosis, but my insurance wouldn't spring for it (if any insurance professionals are reading this, feel free to stab yourself in the eyes). But the diagnosis was non-worrisome, so no harm done.

Then the phone call to my office, a few hours later. The P.A. said something along the lines of "I can't believe I forgot to mention this but you have a tumor in your shoulder. It's probably benign, but we should check it out just to be sure."

Ahem. Well, from my perspective, forgetting to mention to me that I have a tumor is akin to the navigator on the Titanic forgetting to mention to the captain that there's a big floaty white thing just ahead. And we all know how that turned out.

The upside was that surely now the insurance company would cover an MRI. And the Easter bunny will leave winning lottery tickets under the pillows of everyone who voted for Obama. Nope; the insurance company insisted that I still needed 3-6 months of physical therapy and THEN they would consider covering the MRI (I suppose they're betting that I might die before that and then it's my life insurance company that's on the hook).

Somehow, the doctor's office convinced the insurance company that an MRI was a legitimate need, and for that I'm grateful. And so I got to spend an uncomfortable half hour inside a joint of surface casing while extras from The Hobbit banged around with two-pound sledges, whereby was miraculously produced a Polaroid which showed that, by golly, there was a tumor in the arm bone.

The specialist's office made an appointment for me to consult with him, but they somehow forgot to tell me about it and so it was almost a month after the MRI before I could get an interpretation. In the meantime, while dancing with my wife I began to experience such pain that I couldn't raise my arm and we had to leave early, which normally occurs only in instances of severe death. The next day, I couldn't lift a coffee cup with my arm extended, and I began to fear that some scary corner had been turned.

A couple of days later though, the pain had substantially subsided...but a new phenomenon had surfaced. It was like my bicep had slid down toward my elbow. You know how some women complain about the deleterious effects of gravity on their chestal regions? I can relate, after a fashion. Also, flexing that muscle was both painful and unproductive. I felt like it was just on the edge of a perpetual cramp. 

I also think I lost the tiniest bit of muscle tone, not enough to notice, probably. Well, see for yourself:

Big and little biceps

MLB did some online medical research and her definitive diagnosis was a bicep tendon tear. All my symptoms supported that diagnosis, but I wanted to hear it from a real doctor.

Earlier this week, my appointment rolled around. The doctor came into the examining room, pulled up my x-rays and MRI, and began questioning me about my shoulder. I answered all his questions and then told him that there was one new complicating factor.  I pulled up my sleeve, and he instantly confirmed our cyber-diagnosis: I've had a complete tear in the long head of the tendon that attaches my bicep to my shoulder. Interestingly enough, because of the mysterious way the human body is put together, the initial pain in my shoulder likely contributed to the tendon tear, but once the tear occurred, it relieved the pain in my shoulder. 

"What about the tumor?" you ask. Good question. Turns  out that it's called an endochondroma, a cartilage tumor that occurs inside a bone. The doctor said I may have had it for years. They're almost always benign, and rarely cause any symptoms. But in my case, it's a complicating factor. 

A torn biceps tendon can be surgically reattached, with generally good results (i.e. complete recovery of arm strength), but the technique requires drilling into the bone to provide an attachment point. However, since there's a tumor inside that bone, the doctor was very hesitant to recommend drilling into it and potentially releasing those cells - which are now benign but which apparently have a tendency to get drunk and do stupid things once freed from their bony prison. He said that even without the surgery, I could expect to recover up to 90% of the strength (the short head of the tendon is what allows most of the strength of the bicep, and it's extremely rare that it will tear), and the biggest downside would be cosmetic...a Popeye-style muscle that, frankly, looks pretty weird. Fortunately, I realized long ago that I had no cause for vanity, so that's not an issue for me.

Oh, and the Super Bowl thing? The doc pointed out that the year John Elway won the Super Bowl, he had the exact same injury to his throwing arm. While I suspect his medical attendants were a bit more focused than mine, that still provided more reassurance than you might think that this is something I can cope with.

In the end, I'm feeling blessed that it wasn't something more problematic. More importantly, I get to keep dancing with my wife. It doesn't get much better than that.

Running Thoughts
September 24, 2014 8:35 PM | Posted in:

Some random observations arising from yesterday's run...

It's amazing what a 10° difference in temperature makes. A week ago, with temps in the low 90s, I was struggling after only a couple of miles. Yesterday, I made almost five miles (I stop at 45 minutes regardless of distance) and felt good.

OK, "good" is a relative term, of course. In this case, it means "I didn't eagerly desire the comfort of death."

About half of the distance was on unpaved roads and trails that wind through the pastures around our neighborhood. Conventional wisdom tells us that running off-road is easier on one's joints, but our trails are pretty hard-packed and/or rocky, so I'm not sure there's much benefit from that respect. But the almost complete absence of traffic and the frequent appearance of wildlife are indisputably positive factors.

T-Rex, sort of
Typical West Texas wildlife.

I also have my own theory that running on uneven surfaces has physical benefits like improving coordination and strengthening joints and muscles due to the continuous changes in direction required to avoid ruts, mud (yes, we occasionally have mud), cactus, and other obstacles. 

I like running because it's a minimalist activity. Although cycling is my preferred form of outdoor exercise, the equipment requirements are steep. That's not to say that I don't have my own requirements for running gear. I'm very picky about shoes, and I'm now running in a new pair of New Balance Fresh Foam 980 trail shoes - the red, yellow, and black version (think coral snake). They look a lot faster than I am, but the main advantage besides being comfortable is that they don't pick up gravel in the soles that can scratch wood flooring after a run.

New Balance trail shoes
Mesmerizing, isn't it? IRL, the shoes don't float. Pity.

I don't wear a watch when I run, but I have the MapMyRun app going on my iPhone. It records my route and associated statistics, and I have it set up to alert me every quarter mile so I'll know why I'm feeling so bad. It will also play music from my iTunes collection if I ask it to, but I prefer the rhythm of the blood pounding in my brain in syncopation to my raspy breathing.

MapMyRun screenshot
Ran uphill a total of 30' over 5 miles. Leadville, here I come.

I did have two pleasant surprises during the run. First, there were occasional sprinkles of rain to help keep things cool, without being heavy enough to create mud (I'm not into shoe cleaning). Second, Berry Simpson rode up on his mountain bike and we chatted a bit (he's remarkably skilled at slow-motion maneuvering). I don't normally like to run with anyone else - my wife excepted - but his company was a welcome, albeit brief distraction.

Mud run
I would hate to have to clean those shoes.

Berry is one of those guys who thinks deep thoughts and wrestles with philosophical and theological issues and writes entire books while he runs. I, on the other hand, focus mainly on questions of more tangible import. You know, things like, "what are the symptoms of a heart attack?" and "would someone find my body before the coyotes?" and my theological musings are limited to making deals with God if He'll let me survive and the only things I mentally compose are addenda to my will.

Berry commented that we needed to enjoy the trails while we could because they would probably soon be developed into neighborhoods. He could be right, but the more oil wells they drill, the more reluctant developers are going to be to build houses. And my run took me within a quarter mile of two well sites, one recently drilled and one with a rig still on it.

I'm not very fast, but at least I don't run very far. I've been running for 30 years, and for much of that period, 8 minute miles were the Holy Grail of Pace. But now that I suffer from an incurable condition known as RBS (Receding Birthday Syndrome), that goal is now a foggy dream.

On the other hand, every time I set out on a run (or a ride, or even a walk), I offer a prayer of thanks for the ability to do whatever it is I can do on that particular day. I don't take my health or fitness - however diminishing it might be or become - for granted. Every step is a blessing.

Most of Texas was blessed last week with some of the best rainfall we've had in months, and lake levels across the state reflected the results of that bounteous precipitation. However, one lake that didn't get much benefit was Lake Travis, outside of Austin, as you can tell in the photo below.

Water in West Texas ditch

Sad, isn't it? OK, just kidding*.That's actually what's left of the standing water in a ditch (of unknown origin and purpose) just south of our neighborhood. On those rare occasions when we get enough rain, this ditch becomes a magnet for pickup trucks driven by teenagers (or full grown men who wish they were teenagers) to go mudding.

I took the photo this afternoon during a run through the pastures surrounding our neighborhood. We normally have a dance class on Thursday nights, but our teacher canceled on us - I think she can take only so much of our ineptitude - and so I had an unexpected opportunity for a workout. It was the first time I'd been out on the trails, and I figured I should give it a try before it got too hot (today's temps were in the upper 80s).

Running on trails is more entertaining than running in the street. I have to focus more on the terrain and foot placement (as well as being attuned to the possibility of rattlesnakes), and thus I don't dwell quite as much on how miserably out of running shape I am. It did occur to me, however, that trail running is sort of like riding a conventional road bike in that you spend most of your time staring at what's immediately in front of you instead of taking in all the surrounding scenery (as we can do on our recumbent bike).

Anyway, I also think that running on dirt is easier on my aging (aged?) legs and feet, and navigating the varying terrain is also good for my balance. All of these benefits are somewhat offset by the continuous feeling that I'm going to keel over and die at any moment due to the effects of unfamiliar exertion, but, is a risk, right?

Seriously, no matter how many cycling miles you get, no matter how many hours you spend on the elliptical, no matter how much iron you pump...the only way you get into running shape is to either go back in time forty years, or, you know, run. The former approach is desirable but unfortunately just out of reach, and the latter takes time and energy.

Nevertheless, it was a good run, if depressingly slow. But I'm at the point where it really doesn't bother me to record 9:30 miles, especially if I can rationalize them by pointing out that trail running is inherently slower than street running. Plus, as I said before, this was like a free workout so it's all good. Now, we'll see if I'm singing that tune in the morning when I fall out of bed.

I didn't spot a lot of wildlife - a few Texas spotted whiptails, a couple of cottontails and one jackrabbit, several pairs of quail, and zero rattlers. Barn swallows were swooping over the ditch water shown above, and I heard a few mockingbirds making fun of my running style. I also thought I caught a whiff of skunk at one point, but it was later in the run so it was probably just me.

By the way, for the benefit of any local runners who might come across this, here's a map of the route around Woodland Park; it's a little less than four miles.

Route map

Those zig-zags are simply mileage extenders...some dirt roads going in and out of the undeveloped part of the neighborhood.

If you think you'd like to try off-road running, I recommend getting some use-specific shoes. I really like my New Balance 910s - dumb name but great shoe. They're stable, work well with my orthotics, and I never have to worry about trapping gravel in the treads that could scratch our hardwood floor. They look like a kid threw up eight flavors of cotton candy on them, but I can live with that.

*Well, actually, that photo isn't all that far from reality for Lake Travis.
Hardly a day passes that I don't hear a news report or see a post on social media or talk to someone who complains about the high cost of insurance and/or medical treatment. I guess I've been somewhat naive about the reasons, but something happened to me today that brings it into crystal clear focus. 

Me, a pawnFirst, a little background. More than a year ago I had a diagnostic procedure performed locally, at the recommendation of a surgeon. I was told upfront that my insurance wouldn't cover the procedure; despite the intense pain I was experiencing and the absence of a diagnosis, I would first have to undergo weeks of physical therapy - even though the therapist wouldn't know what he was treating, only the symptoms - before I could have the tests that would diagnose the cause. Makes perfect sense, doesn't it?

The procedure was expensive, and the surgeon's office kindly directed me to the lowest cost provider they knew, although I wasn't told upfront what the cost would be. But when it came time to pay, the clerk told me that no payment was due; my insurance would pay. I was puzzled, but happy. I assumed that the doctor had managed to convince my insurance company of the medical necessity of the procedure, and all was good.

Imagine my surprise when, more than six months later, I received a bill from the clinic in the amount of about $5,000. Perhaps the doctor wasn't such a good negotiator after all.

I immediately called the toll-free number on the face of the invoice to speak with someone from the billing department, and I was connected to Julia (not her real name). I explained the situation to Julia, emphasizing that her clinic (I assumed that she was affiliated with it, and not just an outsourced billing department) had expressly told me that my insurance would cover the bill, and that I had never received any communication from my insurance company regarding the claim. She agreed that seemed odd, and when she pulled up my file, she had a good explanation: a claim was never filed.

I asked if they would file one, because I was getting conflicting messages from them. On the one hand, yes, insurance will cover it; on the other, a bill for $5,000, without ever checking with the insurance company. She agreed to do that. 

But, in addition to asking for an actual claim to be filed, I noticed on the bill they sent that there was a 50% discount if it was paid within 14 days. That's quite a savings, and I assumed it was designed to stimulate payment and avoid the expense and hassle of a collection agency. I asked for and got Julia's assurance that if the insurance did indeed reject the claim, I would still be able to take the 50% discount (bringing the bill down to $2500 - I don't doubt your arithmetic prowess, but keep that number in mind).

This commenced several months of back and forth that I won't detail except to say that Julia didn't follow-up with the insurance company, and I began to receive additional invoices, now stating that if I didn't pay up, a collection agency would be called in. Oh, and the mention of the discount was absent. Each time, I called Julia and she promised to work things out, to put the account on hold pending a final answer from the insurance answer that wasn't coming because someone obviously wasn't asking a question.

That brings us to this afternoon, when I called once more, only to find that Julia was out of the office, but Maria (not her real name) was covering for her. I dreaded having to start from scratch, but Maria quickly came up to speed on the situation. She promised to call the insurance company immediately and let me know the outcome.

"Immediately" was actually a couple of hours, but Maria did call and said that she had called the insurance company and they were denying the claim. I then asked about the discount, pointing out that Julia had consistently promised me I'd be able to take it.

Her quite unexpected response? "Oh, I think I can do better than that."


"Oh, really," I replied.

"Oh, yes...we can offer our self-pay discount."

"And...what would that be, exactly?"

I could hear her doing the math. "You would owe us $1,100. That's a better deal, isn't it?"


"Oh, yeah, I think I can swing that."

Let's recap, shall we?

  • My insurance company insists on treatment for an undiagnosed malady before I can get a diagnosis.

  • The cheapest alternative for the diagnostic treatment (and trust me when I tell you it was nothing exotic) still costs as much as a decent used car.

  • The diagnostic facility misinterpreted my insurance coverage, and then never followed up to confirm it, until I pressed the issue.

  • And once we resolved the insurance issue - and only then - they offered me a 75% discount on what they were planning to charge the insurance company*. 
Our entire medical system appears to be a huge game between healthcare consortiums and insurance companies, the rules of which seem to change arbitrarily and illogically, and the playing out accompanied by a series of knowing winks, with the patient caught in the middle, hapless and clueless. In this case, the system worked to my advantage (I think; perhaps I just have lowered expectations), but no wonder Americans are increasingly cynical about the the whole thing.

And the sad thing is that no one has the solution, and if they did, they wouldn't have the will/power to implement it.

*As my wife pointed out, had the insurance company agreed to cover the procedure, it's a sure bet they would have negotiated a significant discount with the provider. Nobody ever pays list price...except those who don't know any better.
Your grandfather probably doesn't have a pedometer, but if he does, I'll bet it's not a Fitbit. Photo - Fitbit ZipDebbie and I both acquired a Fitbit Zip via our participation in a wellness program sponsored by BP, in which the company is challenging employees and retirees (we, of course, fall into the latter group) to rack up a million steps over the course of a hundred days. That works out to 10,000 steps a day, and it's been interesting to see how wearing the tiny device acts as a motivator to try to achieve that goal.

I was initially skeptical. We're regular exercisers, and a normal workout is either a five mile run, 45 minutes on a stationary bike, or a twenty mile tandem bike ride, and I would categorize our lifestyle as "active," especially when you add in the dancing. So I figured it would be a breeze to get 10,000 steps in a day, but I also thought that I'd quickly decide that a pedometer was a lame idea and set it aside after a short time.

But the Fitbit unit itself is just a piece of the entire system, and it's the system that makes the program attractive. The unit automatically tracks your daily steps, mileage, and calories burned (based on your height, weight, and age), and resets itself to zero each 24 hours (but still counts the calories that a normal resting metabolism consumes even during sleep, which is a nice touch).

It then periodically syncs with your smartphone, tablet, and/or computer, and provides a "dashboard" that provides a nice visual status report of how you're doing. Here's a screenshot of my dashboard from a couple of weeks ago.

Screenshot of Fitbit Dashboard
Notice how I cleverly picked a day where I did good?

In the live Dashboard (which, by the way, is very nice piece of programming...very responsive), you can mouse over the bar graph to see the actual number of steps recorded for a given time period, and I find it interesting to see how activity level varies throughout the day. June 2nd was a Sunday, and other than walking around church and going to the grocery store, we didn't do much until about 3:00 p.m., when we went for a four-mile walk through the neighborhood. A normal day at the office yields 2,500-3,500 steps for me, depending on how many trips between floors I have to make via the stairs.

Even if you're not a walker or a runner, you can get credit for your activities by manually entering them via the website. The site also provides a section for tracking your diet, although I haven't done anything with it. And if you're the competitive type, you can hookup via Facebook with other Fitbitizens to do the social thing. Again, not my bag, but it may be a motivator for some.

I didn't expect that putting a Fitbit on my belt or waistband would change the way I perceive normal everyday activities, but it has. There's something satisfying about knowing that mowing the yard, or walking to the mailbox, or vacuuming the house is not only accomplishing a task that needs to be done, it's also contributing to the achievement of a goal.

It can get a little silly, though. Last night, just before bedtime, I was getting ready to retire the Zip for the night and I saw that it read 15,905 steps. I'm just OCD enough to not be able to let that go, and so I made a few laps around the living room and kitchen in order to break the 16K mark. So I've got that going for me.

There are more expensive Fitbit models; one purports to track your sleep habits, although the reviews are mixed regarding its effectiveness. Another model is in the form of a wristband, but it lacks the display of the Zip.

Having lived with the unit for a month, I would gladly pay the purchase price to have one. The basic model is $60. But BP thinks highly enough of the potential to improve health that it provided the units to employees and retirees for free.
An Elliptigo requires a rather significant investment, and the next best thing to actually trying one out is to read some unbiased reviews by owners of the machines. I think I posted a pretty objective and semi-detailed report here, but I barely scratched the surface compared to what this guy is doing.

When I first visited ElliptiGo Galveston, it took me a while to figure out that the writer wasn't really a dealer. It's one of the most thorough product review websites I've ever seen. I can also relate to his experiences regarding the [literal] pains of traditional bicycling for men of - how shall we put it? - a certain age.

So, if you're undecided, or just seeking some additional input or resources about the bikes, I highly recommend spending some time on the site.

Life with the new Elliptigo
June 2, 2012 7:11 AM | Posted in: ,

We've had our Elliptigo for about two months, and the Gulfstream recumbent tandem for almost a month, but we still have surprisingly little experience with either one. This is due to a combination of travel schedules, weather, assorted family issues, and, you know, just life in general playing hob with our leisure plans.

I have been able to take the Elliptigo out for a couple of extended rides, one for 10 miles and another for 12, plus a handful of shorter cruises around the neighborhood, and I can share a few observations for anyone who is contemplating an investment in this peculiar form of transportative exercism.

  • The Elliptigo has the aerodynamic precision of a dumpster (I almost compared it to the south end of a north-bound dump truck, but I guess there could be wind-cheating dump trucks somewhere in the world). The tiny wheels and inherent pedaling motion guarantee a workout in any conditions, but add a little headwind and you'll empathize with the Tour de France cyclists laboring up Alpe d'Huez.

  • The bike is not well-suited for rough pavement, or unpaved trails. The aforementioned small wheels, high-pressure tires (100 psi), and stiff frame transmit every bump and hole to the rider. The bike feels solid for the most part, but it's not something you'd want to jump curbs with.

  • Photo
    Not me. And not Midland.
    I'd pay to see a circus act featuring someone skilled enough to ride an Elliptigo hands-free, because I don't think it can be done. The handling is plenty stable if you have a good grip on the bars, but "squirrelly" is an understated adjective for riding with one hand. The rake (or trail? I always get 'em confused) of the front fork combined with the exaggerated "pedaling" motion is such that you need to concentrate on what you're doing. Now, I'm sure this will be less of an issue with practice, but it's never going to disappear. 

  • One important implication of the preceding observation is that a hydration pack is almost essential for rides long enough (or in hot enough weather) to require water. This assumes that you won't pull over for a drink...I've never seen anyone serious about exercising who's willing to do that. The act of extracting a water bottle from a cage with one hand, taking a drink, and returning it to the cage requires skill and balance that's beyond me, and I think I'm fairly competent in both areas. Plus, there's really no good place to mount a water bottle cage other than on the handlebar.

  • I'm not sure whether I've dialed in the proper riding position; the user guide is so intent on warning you about all the ways you can die on the bike that it neglects to talk much about ergonomics. Although, really, there are only a couple of adjustments you can make: the position of the handlebars and their height. The latter is the more important of the two. I think the first time I went for a long ride, the handlebar height was too low and I experienced some back pain as a result. I raised the bars for the second ride and that helped.

  • Did I mention that riding the Elliptigo provides a good workout? As in death-march-brutal-slog-cry-all-the-way-home good? Sure, you can coast (which turns out to be surprisingly uncomfortable until you find the sweet spot of body position relative to foot placement), but if you have only 30 minutes for a workout and you don't want to suffer through a boring indoor routine, this device will git 'er done. It stresses body parts that don't get much attention during regular cycling or running workouts, not to mention providing a powerful aerobic routine. [Disclosure: I've never been an aficionado of stationary elliptical trainers, so I didn't come to the Elliptigo with a relevant base of fitness. In other words, I have no muscle memory to help me; your mileage and/or pain threshold may vary.] 

    It does give one a deeper appreciation of what this guy is accomplishing:

  • For what it's worth, I averaged about 13 mph for the two longer rides. Both were on fairly windy days, which is par for the course in our neck of the desert. I haven't mounted a computer on the bike, but the MapMyRide iPhone app does a great job of keeping track of the important stats.
I realize this seems to be a lengthy laundry list of Things I Don't Like About the Elliptigo, but in reality, I think it's both a lot of fun, and an efficient way to get some exercise at your own pace. I like not having to wear special shoes or workout-specific clothing. But it's an expensive machine, so it's important to understand as many pros and cons before making the investment.

By the way, if you decide to buy one, please treat it as a regular bicycle when it comes to the rules of the road. Ride with traffic, not against it, and wear a helmet (which I do faithfully, despite what you saw in the video). And be prepared to return many smiles of passing motorists...even if you can't take your hand off the bars to return their waves.

And speaking of bicycles, I'll have a similar report on the Gulfstream soon. We've had some interesting challenges with it.

Elliptigo Bike: First Report
April 6, 2012 6:02 PM | Posted in: ,

We took delivery of our Elliptgo bike last Wednesday and we finally had some time today to play with it a bit. Here's a video of our trial runs up and down the cul-de-sac in front of our house.

I found the bike very easy to master; after about ten minutes, I felt completely in control. Debbie is having a somewhat steeper learning curve, but that's because she's been accustomed to riding on the back of a tandem bicycle for the past twenty years and hasn't had to worry about minor details like steering, shifting gears, and braking. But, as you can see in the movie, she's doing just fine.

The bike definitely provides a vigorous workout, which shouldn't surprise anyone who's used an indoor elliptical trainer. The motion is identical, although the bike has regular handlebars so you're not getting an upper body workout. (The thought of adding those moving bars to the bike is downright frightening.)

The bike itself is well-made, with quality components. The welds are thick and uniform, probably equal to the standards you'd find on a good mountain bike. The 8-speed gear systems shifts easily and reliably and the brakes are scary good.

Photo - Roller and railOne slightly disconcerting feature is the noise of the bike, caused by the rollers attached to the "pedals" sliding up and down channels (see photo at right). I can't think of an alternate design that would eliminate that noise, but you probably won't need a handlebar bell to let pedestrians know you're coming up behind them.

The bike comes with a owner's manual chock full of warnings and alerts about the dangers of riding this contraption. There are at least six stern warnings about the fact that you are very tall when astride the Elliptigo, putting you in danger of "serious injury or death" should you forget your height and attempt to ride under short things like power lines or taxiing aircraft. As you can tell in the video, I take those warnings seriously, donning my protective Fire Ant Gazette Anti-Trauma Baseball Cap. Don't be like me, kiddies; wear a helmet.

The Elliptigo owners community appears to be a large and active one, judging by its Facebook page. The sport is now spawning support industries, such as elliptical biking shoes (although as far as I can tell, they're just repurposing some athletic shoes for this type of riding).

I don't think this will supplant our regular biking equipment, but it will certainly be a viable cross-training (and pleasure cruising) alternative. It's especially welcome for those inevitable times that running is out of the question due to injury, something I'm dealing with right now.

Bottom line: the Elliptigo bike is cool enough, fun enough, and practical enough to warrant getting another one so that we can "ride" together.

Ill Feelings
October 14, 2011 11:19 AM | Posted in:

So, the doctor says I have a "touch" of bronchitis. Sounds so delicate and gentle, doesn't it? That's not really how I'd describe what I felt last night after midnight, when I was still up, coughing. But at least we have something to treat now, instead of the elusive, generic "allergies."

Got a steroid shot, meaning that I've had two shots this week, the other being a flu shot on Wednesday. I can't remember the last time I had an injection...or the last time I was sick enough to require a visit to the doctor. 

I blame it on work. I never caught anything from my computer when I was home with it. On the other hand, at least I can afford a visit to the doctor. Also, today is my day off, giving me plenty of free time to sit in a waiting room. So, I've got that going for me.

On the other other hand, I actually feel pretty good, for a sick person. I have enough friends who are really ill right now that I have no problem keeping things in perspective.
You know that bit of dialog in Joe vs. the Volcano, where the chauffeur, Marshall, (played by Ossie Davis) is giving Joe (played by Tom Hanks) some fashion advice? It goes something like this:

Marshall: What kind of clothes you got?

Joe: Uh, they're like these I'm wearing.

Marshall: So you got no clothes.

That exact line of conversation applies to Midland's bike paths. Technically, we have 'em (although they're just called "routes" and are indistinguishable from "streets") but from a practical perspective, we have no bike paths.

I suspect that if you were to poll all the bicyclists in Midland about their wish list for making the city more bike-friendly, the ability to safely ride from north of Loop 250 to south of the Loop and back again would be at the top of the list.

Of the nine major intersections along Loop 250, only three (Thomason Drive, Tremont, and "A" Street) are generally safe for cyclists. The Garfield intersection is dicey, depending on the time of day, and all the others are accidents waiting to happen. Loop 250 presents an almost insurmountable barrier to anyone wanting to commute by bicycle to a destination that's on the other side of that highway.

I've been giving this some thought and there's a simple solution: create a bike/hike path that connects intersection of "A" Street and Loop 250, and Airpark Road just west of the Claydesta Post Office. I chose "A" Street because it's the only "3-way" intersection with the Loop, meaning that it's got much less traffic, generally speaking, than the others. Plus, there's a pretty logical route extending from that point that has absolutely no intersections with traffic.

Having trouble visualizing how that would work? Here's a map:

View more details regarding the Proposed Airpark Bike Path.

The blue line represents the proposed route. It basically parallels the fence line of Midland Airpark. I'm sure there will never be any other type of development along this route as long as Airpark is operational, so that space seems perfect for a six or eight foot wide path.

I said the solution was simple; I didn't say it would be cheap. This route is almost exactly one mile in length. Depending on who you believe, the cost for a bike path is $50,000 - $1 million per mile. I suspect ours would be closer to the lower end of the spectrum due to the relatively flat ground, but that's still some serious change. And that doesn't include the required bridge over the drainage channel at the intersection of "A" and Loop 250.

On the upside, I assume that the City already owns all the property over which this route runs, as part of Airpark. If that's the case, the project would involve potentially messy easement negotiations.

I have no idea whether this project is feasible, or how one would even get it off the ground. I'm sure there are grants for this sort of thing. It just seems to me that opening up a safe conduit past Loop 250 for cyclists and hikers would be something the city would want to pursue, and it would finally allow us to rightfully claim that we've got a useful bike path Any thoughts or ideas you have would be appreciated; leave 'em in the comments.

And, as long as we're brainstorming and thinking big, consider how this could be the first leg of a path that would extend around the entire perimeter of the Wadley/Garfield/Loop 250/"A" Street square. This 4-mile stretch could become a real showcase for Midland's commitment to improving recreation and alternative transportation opportunities for its citizens.
The web is abuzz today about the passing of Jack LaLanne at age 96. The guy was the human equivalent of the Energizer bunny, and he's probably doing jumping jacks in his specially-modified jumpsuit (slits for angel wings, right?) as I type this.

In memory of the world's first "fitness guru," here's a YouTube video of the first episode of his television show, which began in 1951 (one of the few things on the net that was broadcast before I was born, by the way).

Link via Neatorama

Couple of things strike me about this broadcast. First, the ballet slippers; no "fitness trainers" or running shoes existed in those days. Second, the cool workout music: a Hammond organ played offstage. Did LaLanne also pioneer the use of music as a backdrop for exercise?

We may mock his fashion sense and manic sincerity, but the fact is that many of his ideas have stood the test of time and have been scientifically validated.

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