TGIF

Swam at Nitro with Eric and Lynne. David, Steve and Tom are tapering for Nationals and swam in the next lane.

4 x 200 swim/50 kick

10 x 50 drill/swim @ 1:00

10 x 100 @ 2:00, best possible average, went 1:06s and 1:05s, with a 1:04 on number 8; very tough set. Eric was faster than me on these, but I spot him nearly two decades and a few grams of growth hormone. Anyway, at the end he said he thought he was going to puke, so that made me feel better.

2 x 5 x 50 @ 1:00 race pace, held :31-:32 on the first 5 and :30-:31 on the second five

100 easy

Thursday April 30, 2009

Yesterday I received several nice emails from my teammates at Nitro and returned there for this morning's practice. Swam with Lynne, next to Jordan, David, and Jeff. Alex coached.

1000 warmup
10 x 50 drill/swim at 1:00
8 x 25 kick, no fins, @ :40
4 x 300 @ 4:00; I pulled these, held 3:37s
8 x 50 @ :40
8 x 25 @ :30
100 easy

Tomorrow is my daughter's 18th birthday. One of my favorite movie quotes comes from Things To Do In Denver When You're Dead: "Remember when you [were] a kid and you would spend the whole year waiting for summer vacation, and when it finally came it would fly by just like that? It's funny...life has a way of flying by faster than any old summer vacation."

Wednesday April 29, 2009

Swam at Life Time Fitness in the indoor pool, short course meters.

500 swim, 300 kick, 200 pull
8 x 50 drill/swim @ 1:00
4 x 200 @ 3:00, held 2:43
100 dolphin kick with fins
3 x 200 @ 3:15, held 2:40
100 dolphin kick with fins
2 x 200 @ 3:30, held 2:37
100 dolphin kick with fins
1 x 200, went 2:37, did not really put the hammer down on the last one; overall a good set
100 easy

Time for a change

Swam at Life Time Fitness this morning to try it out. They have two pools for lap swimming, an indoor and an outdoor. The outdoor pool was recently opened, but I was told the water was cold, so I swam indoors. The indoor pool has five six-foot wide lanes with good lane ropes and adequate depth. Water temp was perfect. I didn't realize it was 25 meters until I started the main set. More on that later. I coached myself and swam in my own lane.

400 warm up
Main set--an old favorite:
500 pull, breathing 3/5/3/7/3
5 x 100 @ 1:30; held 1:20. This is when I discovered the pool was 25 meters; I counted strokes to confirm this. Guess I wasn't paying attention during the warm up.
400 pull
4 x 100 @ 1:30; held 1:18
300 pull
3 x 100 @ 1:30; held 1:18
200 pull
2 x 100 @ 1:30, held 1:15
100 pull
1 x 100 went 1:12-1:13
100 easy

My daughter will be working out at Life Time this summer. It would be fun to swim together on the weekends...if I can keep up with her. She already has some of our old workouts on her laptop.

Old school

Called in at 2am again last night just as the thunderstorms were rolling into the area. Very challenging case with an occluded LAD (left anterior descending artery) which developed no reflow after implantation of a stent. There are few things worse than the sight of a stented artery without blood flow. After struggling for an hour with balloon catheters, thrombectomy devices, and the top shelf anticoagulants and antiplatelet agents which are part of our daily armamentarium, I reached back nearly twenty years and administered a thrombolytic ("clot busting") drug directly into the coronary artery. Within minutes blood flow had been restored. The tech turned to me and said, "That was old school," to which I replied, "I was enrolled in the old school."

Made it to practice a few minutes late after making sure that my patient was tucked in for the night. Grabbed an empty lane between the Masters swimmers and the age groupers. Swam next to Steve, David, Lynne, Eric and Tom. Clint was on deck, but I can't say he actually coached. Not us, anyway.

800 swim for warmup
5 x 250 @ 4:00; in the middle of the second one I nearly collided with an age grouper who had entered my lane without warning, apparently (as I found out later) having been instructed to do so by the age group coach. At this point, I decided to hit the showers, but on returning to the pool deck to retrieve my pager, I was stopped by the coach and asked (somewhat rhetorically) if there was a problem. I was treated to a lecture on lane etiquette and the importance of sharing lanes. I listened intently, jotting down notes and asking thoughtful questions. Not. Anyway, as some of the fitness swimmers had vacated the lanes at the shallow end, I finished my workout.
16 x 25 @ :30, but I chose to swim 8 x 50 @ :40 and held :33s; felt pretty strong, considering the lack of sleep and a bad attitude
100 easy

If I am going to train without coaching and deal with swimmers jumping in my lane without a heads up, I might as well join Life Time Fitness and enjoy clean towels, a weight room and a smoothie bar.

Saturday April 25, 2009

The Nitro pool was set up for long course today.  Swam with Chuck, Larry, Anthony, Jeanne and Jordan.  Clint coached.

10 x 100 @ 1:45, felt slow today after a tough week

8 x 50 kick with fins @ :50, giving me about five seconds rest

400 swim, six beat kick on the 2nd and 4th 100

5 x 200 @ 3:30, went 2:47, 2:44, 2:45, 2:44, 2:44; felt easier last summer, but we have not been training long course

300 swim, six beat kick on the 2nd 100

4 x 50 @ 1:00 fast, tried to hold 200 pace, held :35s

100 easy

Plan to spend the day studying for the recertification exam in interventional cardiology which I will be taking in November.  The exam was first offered in 1999 at which time about 2,ooo interventional cardiologists were certified worldwide.  To maintain certification the exam must be retaken at ten year intervals; in addition, the Board requires documentation of an adequate volume of cases (150 in a two year period) to demonstrate competency.  For reasons that are unclear to me, board certification in interventional cardiology is not a prerequisite for hospital privileges to perform coronary interventions.  Go figure.  On the other hand, our practice, unlike most, does require board certification and will ask physicians to voluntarily relinquish their privileges to perform these procedures.

Back to basics

Lifted weights last night. Swam with a headache and shared a lane with Lynne, next to Steve, Tom, David and Kirk. Clint coached but spent most of his time with the fitness group.

1000 warm up
4 x 25 kick fast @ :35
800 swim, negative split at the 400; we all decided to pull, I split 5:06, 5:04
4 x 25 kick fast @ :35
600 swim, every fourth 25 fast; felt good on this one
4 x 25 kick fast @ :35
400 swim build to fast, went 4:52; might have been a bit faster but I had trouble seeing the clock
4 x 25 kick fast @ :35
300 swim, middle 100 non-free; I think I went 1:07 and 1:10 on the free 100s
4 x 25 kick fast @ :35
100 easy

I was called to the ER at noon for what was thought to be a STEMI (aka ST elevation MI, aka heart attack). The cath lab team had been summoned, and one of the nurses was about to administer an expensive anticoagulant. The patient was an older gentleman with COPD and pulmonary hypertension, a consequence of too many cigarettes for too many years. He required oxygen at home 24/7. He had been hospitalized many times over the past year, usually for management of his lung disease. His primary complaint today was that of swollen feet and a swollen belly. When I walked in the exam room he appeared comfortable and proceeded to tell me a few bad jokes which I will not repeat. Instead of proceeding on to the cath lab, I obtained a history from him, examined him, and reviewed his old records. His ECG was not diagnostic of a STEMI, despite the computer-generated (and often times incorrect) interpretation printed at the top of the initial tracing. The cath lab team was sent on their way and the patient admitted to the hospitalist who had discharged him earlier in the month. I suspect I saved him close to $20,000 in hospital charges.

Wednesday April 22, 2009

Swam next to Steve, David, and James. Tom coached.

500 swim, 300 kick, 200 pull
3 x 500 @ 7:00 descend, pulled number 2, went 6:29, 6:14, and 6:11
16 x 25 kick @ :35, no fins
5 x 100 @ 1:30, "moderate," held 1:07s. Very good set for me, felt strong, maintained my stroke.
8 x 25 @ :30, odds easy, evens fast
100 easy


Missed yesterday's practice because I was called into the hospital at 2am. Encountered two deer on 360; I missed the first one but hit the second and damaged the right front end of my car. Never saw what happened to the deer and felt pretty bad about it. Not sure that the patient (who arrived in cardiogenic shock) will be faring much better as the surgeons decided that she would not survive a bypass operation. All in all a pretty bad night.

Monday April 20, 2009

Lifted weights last night. Swam next to David, Jeff, Tom, and Larry. Clint coached.

400 swim, 400 kick, 400 pull
4 x 400 @ 5:30; I pulled numbers 1 and 3, descended from 5:08 to 4:57
8 x 50 kick (no fins) @ 1:00, made 'em (but could not back in the day)
16 x 25 @ :30, odds easy, evens fast, averaged :13s on the fast 25s
100 easy

On call tonight for STEMIs (aka heart attack/transmural myocardial infarction/Q wave myocardial infarction/ST elevation MI). If a patient's ECG is interpreted as being diagnostic, I will be called to the ER along with the cath lab team to perform an emergent cardiac catheterization, opening the thrombosed coronary artery within ninety minutes of the patient's arrival (door-to-balloon or D2B). Nowadays workhours for residents are limited in order to minimize mistakes; we were trained to function when necessary on inadequate sleep because in the real world patients develop life-threatening problems at inconvenient times.

Long Course

Today the pool was set up for long course.  Swam with Tom, next to Steve, Kirk, and David on one side and Larry, Jeanne, Anthony and Chuck on the other.  Clint coached.

10 x 100 @ 1:50

10 x 100 @ 1:40 pull, averaged 1:19-1:20

10 x 100 @ 1:30, averaged 1:20-1:21; this was a good set for me, although the last few hurt and my stroke began to fall apart.  HR at the end was in the range of 175-180 (higher than my max. predicted).  Last summer I made 15 of these swimming behind Ron Orris (who is still off on maternity leave).

12 x 50 @ 1:00, held :37 which is 400 race pace, felt surprisingly strong--I believe that the weight lifting and endurance training is helping

100 easy

This summer I plan to make another assault on the 5:00 barrier in the 400 free.  Next meet will be in Belton on May 16, my last chance to swim the 500 this season. 

Walk on

Swam with Eric, next to Tom and Jordan, Kirk, James, and Jeff. Alex coached.


300 swim, 200 kick, 300 pull
8 x 100 left arm, right arm, catch up, and six beat kick by 25 @ 1:45
3 x 300 IM @ 4:30, averaged 4:12
4 x 150 IM (no free) @ 2:15, averaged 2:05
100 easy


Today my daughter received an email back from the coach at A&M telling her that her 100 breast time (1:09.88) wouldn't be fast enough to walk on to the team in the fall. This despite the fact that she dropped 13 seconds since joining Longhorn Aquatics just 18 months ago. Interestingly, although she had informed him that she was planning to train long course this summer with TXLA, he did not suggest a time that would place her on the team. Apparently at that level the coaches are not interested in developing a swimmer, which really should come as no surprise given the number of scholarships awarded (by state universities, no less) to foreign athletes of proven ability. Character, the kind reflected in hard work, commitment, and perseverance, does matter and in the end will serve her well regardless of what happens in the fall. I am reminded of a line from New York City Serenade, one of my favorite Springsteen songs: "So long, sometimes you just gotta walk on, walk on."

Wednesday April 15, 2009

Swam with James (Cotter, professional triathlete, and damn fine swimmer, I might add), next to David, Lynne, and Steve. Tom coached.

600 swim, 200 kick, 200 pull
8 x 75 @ 1:20 left arm, right arm, DPS
500 swim, six beat kick on every 4th lap
Main set:
5 x 200 @ 2:45 descend, went 2:28, 2:26, 2:24, 2:19 (where did that come from?), 2:23 (out too slow); solid effort for me at that interval, especially after Monday's and Tuesday's workouts
16 x 25 @ :20; we were supposed to break after 8 but Lynne and James kept going
100 easy

Tuesday April 14, 2009

A bit sore from weights on Sunday. Swam with Lynne, next to Kirk, David and Tom on one side and Eric, Jordan and Chuck on the other. Sharing lanes now that the age groupers are back in the water. Today was IM day, but Lynne and I did the free option. Alex coached.

500 swim, 200 kick, 300 pull
12 x 50 drill/DPS @ 1:00
Main set:
2 x 8 x 125; swam the first 8 @ 1:40 and held 1:32, swam the last 8 @ 1:50 and held 1:29 (one of my best sets of 125s; although I went 10 seconds back I still caught a bit of a draft)
100 easy

Monday April 13, 2009

Lifted weights yesterday. Swam with David, next to Greg, Steve, Tom and Eric. Clint coached.

1000 swim
5 x 100 kick with fins @ 1:45
500 pull breathing 3/5/3/7 by 25
Main set:
4 x 300 @ 4:00, descended these 3:43, 3:41, 3:40 and 3:39; this was my best set of 300s on this interval
2 x 8 x 25 @ :30, odds easy, evens fast
100 easy

Quality

Swam next to Lynne, David, Steve, Jeff, Tom, Larry and Chuck.  Mike and Clint coached.

10 x 100 @ 1:30

  8 x 100 @ 1:25; pulled these

  6 x 100 @ 1:20, wanted to hold 1:10 but wasn't feeling that great, HR around 150

  5 x 100 @ 1:15, made 'em

  4 x 100 @ 3:00 from a dive, went 1:03, 1:03, 1:03 and 1:02, maintained a long stroke, got touched out by Chuck on the first one, but he faded a bit after that; this was a solid effort

100 easy

Quality is easily measured in the pool but more difficult to quantitate in healthcare.  The government and third party payers plan to use quality metrics as a way to reduce costs.  In other words, physicians and hospitals will be paid less if they fail to achieve pre-specified benchmarks ("pay for performance").  The reality is that many facets of what we do elude quantitation.  The cath lab, for example, is a black box whose contents are poorly understood by referring physicians, their patients, and even many general cardiologists.  The American College of Cardiology uses procedural volume as a surrogate marker of competency, but many high volume operators lack formal training in interventional cardiology and are not board certified in this subspecialty.  The basic technical skills required to implant a stent in a coronary artery can be learned quickly, but acquiring the judgment to properly select cases and the experience to recognize and properly deal with the unexpected is a much longer and more complicated process.   Even with formal training, the variability in these skill sets between operators is striking.  

Good Friday

If it's Good Friday, I must be working, and it is the usual circus. Swam with Greg, next to Steve and David, Tom and Eric. Clint located Dora for me and coached.

200 swim, 200 kick, 200 pull 2x through
12 x50 @ :50 drill, alternated Popov and catch up; Clint actually pulled one of the newer swimmers over to watch (I asked him if he was using me as an example of what not to do)
3 x 25/50/75/100 (@ :30 base) 100/75/50/25 (@ :20 base), moderate going up the pyramid, fast coming back down; held 1000 pace going up (1:10) and 500 pace going down (1:06)
100 easy

Peer Review

Went to a peer review committee meeting after practice, one of several hospital committees I serve on. More on that later. Swam next to David, Larry, and Anthony. Tom coached.

800 swim
2 x 8 x 25 kick (no fins) on :30; Larry commented on my use of the lane ropes, but if Michael Phelps can do it, so can I
200 pull easy
Main set:
4 x 400 on 5:30, pull or swim; I swam 1 and 4, pulled 2 and 3 (buoy, no paddles); went 5:09, 5:03, 5:02, and 4:57 (tried to save room for dessert)
10 x 50 at fastest possible interval; I knew I couldn't make 10 on :35, but :40 didn't seem challenging enough, so I tried :38 and made 'em (digital pace clocks are great)
100 easy

Electronic medical records will eventually improve patient care, but the current technology has primarily served to turn health care providers, both doctors and nurses, into data entry technicians. Nurses spend more face time with the terminals than with their patients. Pointing and clicking using a standardized template "doesn't tell a story," as another physician once told me, and free texting is time consuming. But it is always a relief to learn from the record that the patient feels safe in their home environment.

For peer review purposes, trying to recreate events from an electronic chart is frustrating. And in the end, the focus is on revising existing or developing new protocols and pathways rather than exercising clinical judgment. We have a sepsis protocol, but apparently we need another one for "almost but not quite sepsis."

Tuesday April 7, 2009

The age groupers are back, so we had to share lanes. Swam with Lynne, next to Steve, Kirk and Jeff. Alex (Fedorov, 12 time all-American backstroker from Auburn) coached. Couldn't find Dora.

600 swim
6 x 100 kick with fins @ 1:30
6 x 100 pull (with paddles) @ 1:15, held them all under 1:10 (some warm up!)
Today was IM day, but I chose the free option:
8 x 125 @ 1:45, descending 1-4 and 5-8 (slowest was 1:31, fastest was 1:27
24 x 25 @ :40; pretty tired at the end of this set, HR was in the 160s
100 easy

Glory Days

Went to see the Boss last night at the Frank Erwin center, so I slept in this morning. Fantastic concert. All of the original members of the E Street Band were there with the exception of Danny Federici who died last year from melanoma. He still puts on a great show and played for nearly three hours. Of course back in the day he would have returned for a second encore, then done it all over again the next night and the night after that. Wonder how many more times I will hear Born to Run performed live.

The first time I saw him in concert I was a freshman in college, just a year older than my daughter is now. The last time I saw him Trish and I were still engaged and living on a sailboat. I told her last night that it was like a date, except that she had brought her children. She reminded me that they were my children too. Speaking of which, our son is a big Springsteen fan, which reflects either genetic memory or good parenting.

Saturday April 4, 2009

On call this weekend covering four hospitals, which becomes both physically and mentally challenging. When we were assigned 9 x 500s last fall, I focused on one repeat at a time rather than the entire set. I use that same approach to get through a call weekend.

Swam with Dora, who is becoming a real inspiration, next to Lynne, Jeff, Steve, Greg, David, and Tom. Mike and Clint coached. Clint actually found Dora on the other side of the pool and brought her over to my lane.

500 swim, 200 kick, 300 pull
10 x 75 @ 1:15
4 x 75 @ :55, held 50s
10 x 50 @ :45
4 x 50 @ fastest possible interval, tried :34 and made 'em (first time at that interval); felt strong
4 x 5 x 25 @ fastest possible interval, left on the :18 knowing that Steve was planning to swim them on :20 but also knowing that he would follow me (and everyone else would follow him); felt very strong on these
100 easy

Yesterday I remembered a coach (Robbie Orr, perhaps) once telling us to swim within ourselves. Good advice; some days (which are becoming more noticeable if not more frequent) I just don't seem to have it, at least early on in the workout. Best approach is just to take what the pool gives you that day. And sometimes you surprise yourself.

Friday April 3, 2009

Swam with David, Steve, Kirk, and Eric. Clint coached.

4 x 200 swim, 15 sec rest after each
8 x 50 kick (no fins) @ 1:00
400 pull
Main set:
500 build to 80%
500 fast, went 6:09, which wasn't that fast
300 build to 80%
300 fast, went 3:33, felt strong
100 build to 80%
100 fast, went 1:02
100 easy

Thursday April 2, 2009

Swam with Steve, Tom, David, Jeff, and Anthony. Alex coached.

4 x 200 swim/25 kick
9 x 100 pull, with paddles and buoy: 3 @ 1:35, 3 @ 1:25, and 3 @ 1:15
Today was IM day; thought about doing the free option again, but my daughter tells me that I need to swim other strokes.
Main set, twice through:
300 IM drill
200 IM negative split each 50
100 IM for time from a dive, went 1:14 and 1:11
100 easy

Wednesday April 1, 2009

April 1 has always held special meaning for us, as for some reason we have bought and sold houses and boats on this date in past years. To my knowledge we are not involved in any major financial transactions this year. The New York Times is reporting that boats are being abandoned in waterways along the east coast by owners who cannot afford the maintenance costs and loan payments. Some have sunk their vessels to collect the insurance money. Fortunately we sold ours before moving back to Texas, but I hope she has not met a similar fate.

Lifted weights last night. Swam with Eric, Steve, and David. Tom coached.

600 swim, 400 pull (with paddles)
5 x 200 @ 2:45, averaged 2:30, trailed Eric and David. Steve swam this round on 2:30
3 x 50 kick for time @ 2:00
3 x 200 @ 2:45, averaged 2:25, held off Eric on these
2 x 50 kick for time @ 2:00
2 x 200 @ 2:45, averaged 2:24, stayed even with Eric
1 x 50 kick for time @ 2:00
1 x 200, went 2:18, split :32/:34/:36/:36, should have tried to negative split this one, but this workout was really tough
100 easy