Tuesday, June 30, 2009

Tuesday June 30, 2009

Swam at Nitro with James, Jeanne, and Eryn. The pool was set up long course. I've just about shaken off the last remnants of my cold. The water was a bit warm again; half way through I thought it was time to add the carrots.

400 swim, 100 kick, 300 pull
10 x 50 drill @ 1:00
15 x 100 2 1:45, odds rolling IM (fly/back, back/breast, breast/free, free/fly), evens free
200 easy

Next meet will likely be November 21 in Dallas (DAM short course meters). My Blue Seventy will still be legal. I will need at least a 4:45 in the 400 free to make the top ten list. Fortunately the pool at Life Time is 25 meters so I will be able to work on race pace (1:08/1:12/1:12/1:12).

Saturday, June 27, 2009

Saturday June 27, 2009

Slept through the alarm this morning and missed the 5:45 practice at Nitro. Swam at Life Time in the indoor 25 meter pool. The water was cool. Only a couple of other swimmers were in the pool.

400 swim, 200 kick, 400 pull
5 x 100 @ 2:00, 1 & 2 Twinkies, 3 easy, 4 & 5 Zingers
Main set, descending pyramids, 1:30 base
400/300/200/100, went 5:39, 4:09, 2:45, 1:20
300/200/100, went 3:06, 2:42, 1:19
200/100, went 2:38, 1:17
100, went 1:15
100 easy

I keep hearing that Michael Jackson's physician is a cardiologist. That may be what he calls himself, but he has never been board certified in cardiology. And according to the American Board of Internal Medicine's website, his board certification in internal medicine has lapsed. Wonder why he didn't accompany his patient to the ER at UCLA?

Friday, June 26, 2009

TGIF

I think I may have coughed up a lung last night. I actually fell asleep at one point, only to be awakened at 1 am by a call from an ER physician letting me know that one of the hospitalists wanted us to see a patient of hers sometime later in the day. I thanked him and promptly fell back asleep. Not.

Swam at Nitro (where the water was a bit warm) with Chuck, next to Tom, Steve, and Greg.

800 swim
8 x 50 kick with fins @ :50
8 x 200 pull @ 3:00, averaged 2:45; might have been able to make the 2:45 interval if I had gone without paddles
12 x 50 @ 1:00, odds easy, evens fast(er), averaged :37s on the fast(er) ones; had nothing in the tank today
100 easy

Wednesday, June 24, 2009

Breakthrough

Slept poorly due to a persistent cough, so I missed the 5:30 workout at Nitro. Since the morning was quiet, I slipped away around 10:30 to swim at Life Time in the indoor 25 meter pool.

500 swim
500 pull breathing 3/5/3/7/3
3 x 200 @ 3:15, averaged 2:47
3 x 200 @ 3:00, averaged 2:45
3 x 200 @ 2:50, went 2:40, 2:42, 2:41...my best set of short course 200s yet. I was joined on two of these by a former Masters swimmer named Wayne, 59, who swam for University of Washington and trains at Life Time regularly.
100 easy

Actually found time to write the first paragraph of Peer Review, then received a free smoothie from Jamba Juice courtesy of one of the pharmaceutical reps, so it turned out to be a pretty good day. As Tom Hanks said in Cast Away, "Who knows what the tide could bring?"

It was hot that summer, even by Houston standards. Years earlier, during my rotation as a third year medical student at Jefferson Davis Hospital, which for reasons that were never clear to me combined obstetrics with the city’s only tuberculosis ward, we were taught that everyone in Houston has night sweats (a classic symptom of the disease according to our textbooks). While I never learned why the Allen brothers decided, during the month of August no less, to build a city on the muddy banks of Buffalo Bayou, I do know this: when we first arrived in Houston from the Bay Area, my sister threw up.

Tuesday, June 23, 2009

Tuesday June 23, 2009

Lifted weights last night. Slept better despite my cold thanks to a most excellent cup of tea prepared by Trish. Swam at Nitro with Greg, Steve, and Tom. The pool was set up long course.

3 x 200 @ 3:30
3 x 200 kick @ 3:30
3 x 200 pull @ 3:30, breathing 3/5/3/7
6 x 100 drill/swim @ 1:45
6 x 100 free @ 1:40, averaged 1:19-1:20, last one was 1:17
100 easy

Received a call from one of the quality assurance nurses at the hospital because the discharge summary for the patient with gallstones (who underwent successful surgery) listed heart attack as one of her final diagnoses. She promised to contact the physician who had dictated the summary so that it could be corrected.

Monday, June 22, 2009

Seventy per cent

Coincidentally, this figure not only represents how I felt this morning but also, on the basis of a recent Dartmouth study, the amount of health care in the U.S. which is thought to be appropriate. It has been postulated that eliminating the 30% of inappropriate (unnecessary) care would pay for a comprehensive national health plan several times over. An article in the New Yorker describes the abuses occurring in McAllen, TX where nearly twice as much is spent per capita than in other regions of the country; notably, the patients in McAllen are no sicker and fare no better than their cohorts living elsewhere. This article is now required reading on Capitol Hill. But this is hardly news. I am reminded of the scene in Casablanca when Claude Rains says, "I am shocked, shocked that gambling is going on in here." In point of fact, I see it on a daily basis. I see patients undergoing annual stress tests without a clear indication. I see stents implanted in insignificant vessels or in arteries lacking a severe stenosis. I see young women with atypical chest pain undergoing multiple cardiac imaging studies. At a recent department of cardiology meeting at our hospital, two of the cardiologists expressed their desire to be removed from the ER call roster as hospital work was interfering with their lucrative office practices. As health care reform moves forward, the excesses in imaging will be targeted, but indiscriminately so, as it is no easy task to separate those of us who are using the technology appropriately from those who are not. The expected impact is a 25% pay cut for cardiologists. Could we as physicians have policed ourselves better? Perhaps. The reality is that it is very difficult to reign in the practioners who have evolved into imaging mills or those who deploy stents inappropriately without being accused of stifling competition. Peer review has become a frustrating, politicized process.

Swam at Nitro with Tom, Chuck, Eric, and Jordan. The pool was set up long course. Mondays Coach Mike Koleber, who writes our workouts, serves up a big helping of endurance work, what he likes to call our vegetables. Today I wasn't up for more than soup and crackers, since I am still struggling with the remnants of my bronchitis, but I did what I could.

300 swim, 300 kick, 300 pull
10 x 50 @ 1:00, odds streamline kick, evens teechnique
Main set, a choice of 5 x 400 descend or 20 x 100. Steve, Greg, and David were going to do the 400s on 6:00, so I stayed in my lane thinking the 100s would be easier. Eric led and (to my surprise) went on 1:30. We took a break at 10, then I swam six more and warmed down. Held 1:24s.

Friday, June 19, 2009

TGIF

Missed the last two days while I tried to fight off a cold, without much success. Still not 100%, but I thought I would try to swim this morning anyway. The Nitro pool was set up long course. Shared a lane with Tom, Steve, David, Greg, Anthony, Erin, Jordan, and Larry. Reminded me of long course workouts at Dad's Club back in the late 70s. Coincidentally, one of the new Nitro age group coaches is Gary Tuttle, who swam at Dad's Club then also.

500 swim, 300 kick, 200 pull
Main set, three times through, no break:
300 pull, breathing 3/5/7 @ 5:00
200 swim, broken 5 seconds at the 100, negative split, @ 4:00; averaged 2:41
100 build @ 1:30, averaged 1:16
10 x 50 swim with fins, odds easy, evens fast with six beat kick; went :34s on the fast ones
100 easy

Tuesday, June 16, 2009

Tuesday June 16, 2009

Swam at Nitro. The pool was set up long course. Warmed up with Steve and Melanie then changed lanes to swim the main set with Greg and Tom since we chose the freestyle option.

8 x 100 @ 1:45
400 kick with fins
8 x 50 pull @ :45
16 x 100, odds free @ 1:30, held 1:19-1:20, evens drill @ 2:00
100 easy

Monday, June 15, 2009

Back to work

Returned to Austin last night after a week in the Bay Area. Didn't swim at all but got in some body surfing at Big Sur where the water temperature was in the low 50's. Shared a lane with David and Tom, next to Kirk and Eric. The pool was set up long course.

400 swim, 100 kick, 400 pull
Main set, 4 x through:
150 @ 2:30, held 2:06
100 @ 1:40, held 1:22
2 x 50 @ :40, made 'em
400 easy, even 50s six beat kick

Saturday, June 6, 2009

Back to basics, again...and again

Swam at Nitro with David, Tom, Jeanne, and Anita. Clint coached. Steve wore scuba gear and shot underwater video of us. Crikey, mate! Watch while I wrestle a giant age grouper! The pool was set up long course.

500 swim
6 x 50 kick @ :55 with fins
500 pull
Main set, 2x through:
400 @ 7:00, went 5:48 amd 5:40
2 x 200 @ 3:30, held 2:47s
4 x 100 @ 1:45, held 1:21-1:22
100 easy

Didn't get alot of sleep last night as I was called in at 2:00 for a STEMI transfer from Georgetown. Once again, the computer's interpretation of the ECG was incorrect, but identifying a patient as a "Code STEMI" by the transferring physician sets in motion a cascade of events that engulfs everyone in its path. I interrupted the process in the ER long enough to take a history and complete a physical exam, in the process discovering that the patient had abdominal but not chest pain and was tender in her right upper quadrant. An ultrasound confirmed the presence of gallstones and an inflamed gallbladder (aka cholecystitis). A CT scan, apparently ordered to exclude an aortic dissection (which would have been a second, unrelated diagnosis), confirmed the presence of cholecystitis. I received a call from the ER physician later that morning to let me know that the cardiac enzymes, which he'd sent to rule out a myocardial infarction (aka heart attack, a third unrelated diagnosis for those of you keeping score at home) were elevated (falsely, in my mind). Now the general surgeon declared that he could not operate on a patient who was suffering a myocardial infarction (which she was not). So later in the day I took her to the cath lab where we found that her coronary arteries were entirely normal. She is awaiting gallbladder surgery.

Friday, June 5, 2009

Friday June 5, 2009

Swam at Nitro with Tom, David, and Lynne. The pool was set up long course. Clint was on deck helping fitness swimmers/triathletes in the lessons pool. The posted workout was identical to the one we swam Monday, so our lane wrote our own.

400 swim
5 x 100 drill @ 2:00
400 pull (breathing 3/5/3/7)
4 x 100 @ 1:30, held 1:22
300 pull (breathing 3/5/7)
3 x 100 @ 1:30, held 1:21
200 pull (breathing 3/5)
2 x 100 @ 1:30, held 1:19
100 pull
1 x 100, went 1:14
4 x 50 @ 1:00, first one moderate, second easy/fast, third fast/easy, fourth fast--went :35
100 easy

Wednesday, June 3, 2009

Wednesday June 3, 2009

Swam at Nitro (short course yards) with Steve, Eric, and Chuck. Tom coached.

800 swim
8 x 25 kick @ :25; I used fins to make the interval
8 x 100 pull @ 1:30, held 1:10
8 x 125 @ 2:00, swim 50/kick 25/swim 50, held 1:40
2 x 4 x 75 @ :55
100 easy

Monday, June 1, 2009

Belton 500

video

Monday June 1, 2009

Swam at Nitro with Steve, David, Tom, Lynne, Jordan,and Eric. The pool was set up long course. Clint coached.

1000 swim
800 pull, breathing 3/5/7/9
600 pull, breathing 3/5/7
400 swim with fins, six beat kick
200 IM
100 easy