Saturday, July 28, 2007


This entry is on the eve of the final day of my toughest 2 week training block of the summer. Today we knocked off a 7 hour,160 mile ride to Wiggins, and I was happy to be just part of this group.

(see pic above, listed left to right: Marilyn Macdonald, Chris McDonald, my brother John, AJ Johnson, Gordo, Me, Dennis Meeker, Justin Daerr, Mat "the Intern" Steinmetz, Billy Edwards)

I'm drawn to people who are successful in reaching difficult goals, and Gordo certainly fulfills that criteria. I wouldn't bet against him in Canada; there might be those who have more "talent" (whatever that means), but there are few people I know who consistently live their commitment to goals in a logical, stepwise fashion.

Our group ride plan was to roll to Wiggins in a civil manner, take a short lunch break, digest for the next 25 miles or so, and then everyone was free to attack and ride as aggressively as they would like.

As Gordo rolled by after the attacks began, he said "18 months for these 50 miles..."

I would expect nothing less.

Following a protein shake, I went out for a 20 minute transition run. Needless to say, the boys reduced me to a run-walk session with our girls' dog, Luna. Ferocious little Shih Tzu!!!!

Transition Run

See post above for explanation.

Monday, July 23, 2007

Gradual Enlightment

"It is through understanding (wisdom) that he fully understood others' suffering and through compassion that he undertook to counteract it. It was through understanding that he himself crossed over and through compassion that he brought others across"

Ócariya Dhammapåla's description of Buddha’s wisdom and compassion

My last blog mentioned the importance of social support in attaining goals. I am fortunate to have a tremendous resource in that department. Erin is phenomenal in helping me achieve my goals and is an essential in achieving the goals I’ve set for my life. She was wonderful enough to drive ahead during a solo 5 hour loop to Fort Collins a couple of weeks ago and give me the occasional company and “keep going, honey”. Above are a few pics of the countryside she took along the way.

After avoiding my boss’ attempt to send me to a Leadership Seminar for a couple of years, I relented. My reluctance was not one of indifference towards expanding my education, but one of my uncertainty towards my ambitions as a leader in academic medicine. Furthermore, the participants of the course were company executives, not academicians.

However, the successful completion of the course ( changed my life. The unanticipated improvement in my personal relationships was tremendous, certainly equal to the gains I made in the workplace. Retrospectively, this is not surprising, as most of the obstacles we face in leading others are directly related to understanding ourselves and how we interact with those around us. Following this week, I initiated the process of nurturing the traits that I have that inspire others and eliminating those that discourage the learning process. I certainly have a long way to go, but I acquired the necessary initiation to self awareness.

Personally, I learned that my inner feelings of insecurity were often masked in an outward display of arrogance and indignation. As obvious as it is to me today, I didn’t realize that everyone else couldn’t “see” what I felt inside. Instead, I assumed everyone realized my deficiencies and insecurity and that my arrogance was in defiance of my shortcomings. Of course few people know you at that level and the unintended projection often created a barrier in getting others to respect my vantage point or consider my opinions. This made life very difficult as my primary role is teaching patients, medical students, and residents!

Equally important was the discovery that I taught through negative re-enforcement and public humiliation cloaked in a Socratic approach. This teaching method was likely a culmination of modeling my own education and a personal motivation to avoid public exposure of my deficiencies and insecurities. Realization of the demoralizing effect of this approach really hit home when we were given the exercise of considering how we treat employees/students and then applying whether we would want this same approach used on our daughters/sons or other loved ones. Whoa…this struck a chord as I contemplated the anguish and embarrassment my youngest brother might feel to be taught and treated in this manner as he was struggling to learn new concepts and information. I finally realized the importance of compassionate teaching. I'm sure both of my brothers wish I would have picked up on this concept earlier in life.

This reality check was what I needed to change the way I teach and continues today as I scrutinize the method in which I pass on information. I think many of us in an advisory role forget that our primary mission is to help others develop an understanding of concepts or ideas that we have already mastered, in a fashion that inspires and motivates. I find I often fall back into a tendency to subject my own twisted path onto those to whom I’m trying to relay information. I aspire to continually develop my role as a servant leader to help my students through enlisting methods they require to understand and learn concepts.

So, how does this pertain to triathlon…? I believe increasing one’s level of self awareness translates to better performance in racing and training.

When I look at many of those I’ve had the privilege of training with the past few years, there are two distinct groups. There are those who seem to achieve a significant proportion of their race goals at every event. Others, it seems, always have some mysterious event that derails their attempt. . How many times do you hear “I don’t know what happen today during the _____ (insert race, training session, etc), all of sudden I was ______ (insert trashed, sick, completely boinked).”

It takes courage to practice the humility to address weaknesses and insecurities. The old adage “what you don’t know can’t hurt you” does in, in fact, hurt you. Ignorance and the inability to recognize our weaknesses prevent us from fixing what is broken.

When racing, many of us are uncomfortable with the level of commitment to fitness, the priority that it takes in our lives, or our physiologic make up. Therefore, on race day we try to outperform what is realistic based upon the decisions we’ve made. When our bodies try to tell us otherwise, we ignore these signals of eminent demise. We drive ourselves to failure and prevent our best race day outcomes. Of course, those around us see it clearly and so would we if we were observing someone else. Developing self awareness allows us to avoid self destruction. It isn’t easy…we have to be humble enough to accept the perceptions of those around us to visualize the truth. As I’ve been able to incorporate others visualizations of my performance into signals that that I recognize, my ability to perform has slowly improved.

Many of us lack self awareness in many aspects of our lives. I see this in myself more clearly with time. Hopefully, the road to enlightment will be gentle as I continue to proceed down its path. Resistance only makes the road more bumpy.

Wednesday, July 18, 2007

July 17-18 Training Data

No new exciting swim info, but corroborates G-mans data.

Lap// Avg hr ///Time
1//// 130////// 14:55
2//// 140////// 14:51
3//// 143////// 14:55
4 ////146////// 14:57

All bilateral breathing.

My limiter is top end strength/speed, but my endurance is reasonably solid. Not really flashy in group activity, but fortunately Ironman is an aerobic engine contest.

That said, I am working a bit on my top end this week. I find this challenging, both physically and mentally, as my self preservation instinct is constantly governing the high efforts.

3:19 ride yesterday with 2 x 20 min best avg output with 10 min rest.

Set// avg hr// power //maxhr
1 ///166////// 212 ////171
2/// 163////// 190//// 169
total 128////// 150

The run was 3 laps around the res
Lap 1 45 min
Lap 2 46 min
Lap 3 50 min

Switzerland Run
56:40 to peak, avg 143, max hr 157
final time~1:56

Sunday, July 15, 2007


Last week was an “easy” week of training and a busy week at work. I went back to my clinical practice in Winston-Salem and put in a solid week. Not much training occurred. After 3 days of call, 20 surgical cases, 2 days of clinic and the usual handful of meetings/dinners, I was a bit weary and wondering how I ever trained in the past while working full time.

I ended the week with MAP test on the track. This was a welcome indicator that my fitness is continuing to progress and the plan is working…thanks, G-man! Here are the results since starting the plan in November.

MAP Test
Date // Avg Mile // Splits
11/20/06 // 8:40 // 8:38/8:43/8:39
12/23/06 // 7:32 // 7:31/7:31/7:34
01/28/07 // 7:45 // 7:46/7:47/7:43
02/23/07 // 7:23 // 7:25/7:21/7:2
07/13/07 // 6:57 // 7:01/6:56/6:56

When talking about progress, I often think of that made by the residents in my program. This is a group of unbelievably intelligent and hardworking individuals. I’m commonly humbled by their natural ability and feel fortunate to have the opportunity to observe them progress through 5 years of residency. It’s funny that I’m the “teacher”…these people possess more talent than I ever dreamed of having.

I place a lot of responsibility on the residents at an early stage of their career as I think this engages them in the surgical cases. Otherwise, I often find they become “innocent bystanders” and their learning suffers.

One of my residents, Beck, and I were re-capping the prior days cases. He asked me for a critique of his performance the day after our cases. During the discussion, I brought up that we do pre-op conference in order for me to evaluate what he knew and how comfortable I was with him helping during the case. My philosophy is that when the residents are placed in a position to begin cases, it forces them to really think through the process of positioning, organizing the necessary equipment, and other necessary requirements to initiate the case. He commented how much preparation it took for him to get ready for a case and how much that differed from his father, a practicing neurosurgeon, who had told him that much of his decision making was done “during the moment”.

I couldn’t agree more. As I reflect on my progress as a surgeon, I recall the inordinate amount of preparation it took for me to feel that I was going to do an adequate job. As time passed, I found that intuition slowly took over and I was less reliant upon the roadmap provided by textbooks and what others had to say. In fact, I like his father, found that preparation and adherence to convention often restrained me. Today, I find that my best results occur when I allow myself the opportunity to improvise. This approach allows exceptional results which are not constrained by preconceived ideas.

I see triathlon in much the same way. I think we often feel the need to drill ourselves senseless to feel comfortable that we trained adequately. This is likely our inexperience driving us to over-compensate this feeling. I’ve now had the opportunity to now see the far end of the learning curve in triathlon where more intelligent training achieves even greater success in sport. I’m confident that our training group leader, the G-man, and many of us benefit from this experience.

Just a little note to the intern…much of what I’ve seen in my residents I’ve seen in you. Keep the faith; I’m learning as much from you as you are from us. You, too, will be a “Professor” some day.


Sunday, July 8, 2007


As many know, I have Ironman Canada as my “A” race for the year. Shortly after deciding to do this race, I set out to determine a worthy race goal. Since then, many people have inquired about that goal. My goals are usually lofty and take a fair time to accomplish, so this created a bit of a self-inflicted dilemma. This was complicated further by my expectation that my sabbatical opportunity removed many of my prior obstacles to train and raised the bar further.

Fortunately, Erin cares enough to take my incessant triathlon ranting seriously and has been patient enough to remind me of my long term goal of continual improvement while the sport remains challenging and fun.

So my goal…run faster than I have in the past. I feel that I likely can run 3:15 off the bike and so my plan is to do what it takes to get there. One may expect a faster swim or bike considering the training I’ve been able to do, but my goal is to do the swim and bike that allows me to run 3:15. It is possible that it may only be same or slower than swim/bikes that I’ve done in the past, but I’m confident that running faster is the next step for me to continue to improve.

So with that, I will leave you with some thoughts about achieving goals.

Over the past 8 years, a large portion of my practice has been caring for children with cerebral palsy. There is a large spectrum of intellectual and motor impairment in these children, ranging from children who are completely cognitively impaired to those who have normal intellectual capacity but an ability to walk limited by tightness in their legs.

Treatment of this latter group of children has perplexed me. Many of these children have seemingly similar potential based upon their intelligence and physical handicap, yet there is huge difference in their functional abilities. As a surgeon, it is frustrating that I can do the same operation in 2 different children who have a similar apparent handicap, yet end up with dramatically different results.

As I have scrutinized my surgical outcomes in these patients, I’ve realized that the perfect surgery isn’t all it takes to get these patients walking. Instead, I define three factors that determine their ability to gain ambulatory function. These are: ability, social support, desire. I can improve “ability” by surgically correcting biomechanical imperfections, but without adequate social support and an appropriate desire, the patients will not achieve the ability to walk.

Over time, I’ve realized these factors predict success in any endeavor. Each of them performs a different role and importance that is unique to each undertaking and person. The interplay of these factors is what makes undertaking challenges exciting.

If triathlon victories relied purely upon genetic ability, then the guy with the highest VO2 max would win. Although this may occur, it isn’t the only factor. That individual still must have adequate desire to train himself sufficiently to utilize his genetic gifts. That said, those with less ability can have tremendous desire to overcome their lack of ability. Although I don’t know Obree’s physiologic numbers, the tremendous desire to break the hour cycling world record allowed him the ability to train sufficiently to overcome any talent deficit he might have had.

As far as I was concerned, I had two arms and two legs, and that put me on a par with Moser, and any other shortfall would be made up by my ability to push myself harder than any other human being who had ever lived. Graeme Obree

In helping young children with a disability to learn to walk, social support is imperative to provide an environment that is conducive to this goal. This support can come in a variety of forms…encouragement, driving to the physical therapist, helping them stretch, and financial assistance are all different examples.

In sport, surrounding oneself with adequate support is critical as well. Creating the necessary infrastructure facilitates your goals significantly. That can come in many forms as well. It can be as simple as having a partner who encourages and believes in your goal. It can be someone who provides the financial support that allows you the opportunity to train without this added stress. It can be your training partner’s motivation, your coach’s inspiration, finding the job that is conducive to training.
I believe that one has the opportunity to improve each one of these factors…that is the beauty. My thoughts on that I will save for another day.

Monday, July 2, 2007

What Got Me Here

This is my introductory blog. I know it has been some time coming, but wrapping up some work obligations takes precedence. Also, I didn’t want to be a distraction to the Cour de Alene crew…I know how someone’s training log can derail your own, and you guys have been rolling well.

On that note, a big congratulations to all the finishers at Cour de Alene. The swim times reflected the rough water conditions. My knowledge of this years training has been peripheral, but I know you guys prepared well and it shows (including the beer tent boys…your continued enjoyment of the sport persuades me that the lifestyle I’ve chosen is a healthy one far beyond the competitive racing period-Thanks). I saw a slowtwitch post the other day relaying an 8 and 4 minute slower average swim and bike time in comparison to a very difficult last year, so you guys should be proud of those finishes.

A bit about what I’m doing in Boulder. As most of you know, I’ve become pretty passionate about endurance training. I’ve learned a lot in the 4 years since my first Ironman and this has allowed me to help others as well. Though I’ve made slow progress personally, I’ve felt deficient in helping those around me achieve their personal fitness and training goals. As the desire to improve my knowledge base occupied much of my thoughts, my chairman, Gary Poehling, had a vision to start a human performance institute at Wake Forest. Coincidentally, Gordo Byrn likewise was starting a similar program in Boulder. This proved mutually beneficial as Gordo was kind enough to share his knowledge of fitness/training and business savvy with me in return for any medical expertise I could provide him during the formation of his business. In the fall, the Orthopaedic Department at Wake Forest intends to start feasibility plans on a human performance institute in Winston-Salem. I have affectionately termed the project, WHIP. Wake forest Health sciences Institute for human Performance. Stay tuned as the year progresses.

So the title of my first blog may sound a bit like a title to a sad blues song, but it is intended to reference the one person who has given me the courage to pursue my dreams. My hope is that I’m able to make her personal sacrifices worthwhile.