Can't afford healthcare? Rob a bank for $1 and reap the rewards in jail.

You've got chronic back pain, and nowhere to turn for relief. Thousands of American work their butts off day in and day out are turned down for insurance coverage despite paying their taxes and living civilly obedient. There are only two demographics in our country that are guaranteed health care, active military personnel and inmates (and even the lines for these groups is blurred at times). So you can either continue to suffer without health insurance or you can achieve coverage by joining the military or going to jail. That's what this guy did.  His plan was flawed, as you'll discover in the article, but the care he's receiving in jail is better than nothing.  The important point to take from this article is that a system that leads a guy to do this is clearly broken.  He's not lazy or worthless; he's sick. 

 Read the full article HERE (1).  and HERE (2)

Video:

TIA, bambo

I trust that you’ll

allow me the space

to share my thoughts

for a moment regarding

the uninhibited grace

of your tempt, Love.

The olfaction of

the trip has quartered

me in your arms.  The

sweet aroma of red dusted

roads runs miles through

my mind of memories past.

The sound of your straw

bristles across my stoop,

linens flapping in the breeze.

The warmth of your

beating bossom has grabbed hold

again with the site of your

barren landscapes.  I accept

your embrace, as in years past.

The smoky drip of your

charred flesh, the

gritty swig of your social circle,

a part of which I somehow belong.

With the wave of your hand

hesitation fades

revealing wholesome

sunrises burning like fires

speckling the horizon.

TIA, bamboo.  Welcome home,

my wayward friend.

Jeffrey Brenner's brilliant idea.

The majority of health care reform critics cited the assumed impossibility of reducing health care costs while improving care as reason to abandon efforts.  But what if we could have our cake and eat it, too?

Jeffrey Brenner is a physician in Camden, NJ.  He had a brilliant idea after analyzing crime data from the city, which revealed "hot spots" of crime in various parts of the city.  The presence of such a trend suggested that the deployment of police around the city to model these patterns of crime found in the data would both reduce costs and increase the effectiveness of the police force.  Naturally, he then considered applying the model to health care.

He crunched through some data and found that there were hot spots of sick people in Camden that were not only the sickest but also receiving the worst care.  If we took this population out of the hospitals and brought them into specialized clinics that would help them improve their health through lifestyle changes, could we save money systematically while indeed improving the the quality of care that they receive?

Thus far, Brenner's program - and similar programs that have popped up around the country - seems to be achieving what the critics thought was impossible.  Granted, they've only been in operation for a year or so, but, down the line, if the results are positive, Brenner may have uncovered a part of the solution to our nation's healthcare crisis.

A few points about his program that stand out to me:
-24-hour emergency hotline (would reduce costs by limiting calls to 911 in non-medical emergencies such as falling over and not being able to get back up)
-health coaches, recruited from backgrounds outside of healthcare
-morning meetings to get all of the staff on the same page about scheduled patients' recurring health problems and the barriers to their well-being
-constant nagging from clinical staff about patients' unhealthy habit: smoking, diet, exercise, etc.

Read the whole article ("The Hot Spotters" by Atul Gawande) HERE.

Petrichor-doux

After a long drought, I'm ready to rain down some sweet rain in the form of some blogging.

I’m finished with my first year of med school, which makes me 25% MD. At this point, we've adjusted to the idea of accumulating $250k in debt. There's no turning back now. We're all going to be doctors. What isn't clear is what the hell that actually means in the grand scheme of things.

The waters have been muddied by the biomedical scientific flurry of information that has been forced into our brains. Many fresh MDs admit that, during your preparation for board exams at the end of your second year, you will have the ability to recall greater fundamental medical details than you will for the duration of your practicing years.

But one thing that can't be instilled in us is a sense of purpose. Since my time on Semester at Sea, I've felt some calling to the world, though I still don't know where I'm heading. Other friends that pursued medicine have described how the process has beaten the altruism out of them. My friend at Harvard Dental - who also happens to have been on the Semester at Sea voyage with me - told me that he held an altruistic view of dentistry until very recently. Now, he merely hopes to achieve a comfortable life for himself while performing his job as best possible. This is coming from a guy that has devoted a great deal of his time over the past years to servicing the poor.

I'm on a path to change the way that we think about health. The current stream of thinking in society is that our bodies either work well or they don't, which, in my opinion, isn't really a terrible way to simplify things. On the other hand, take, for example, the study of epigenetics. A great deal of research is now focused on how factors in our environment – including pollution, diet, and exercise – affects the expression of our genome. All of these things can influence the way that we feel and perform.

Cancer is a dysfunction that arises from within the body itself. It deals with the uninhibited division of cells, a process that is highly regulated in a normal cell. This dysfunction is usually the result of damage to genes that regulate cell division. Free radicals or some DNA-damaging agent such as radiation causes this damage. While inheritance of certain cancers must be mitigated by our role as physicians, providing the tools for people to minimize this damage by reducing the stresses on our bodies that cause them. Epigenetics research has shown that these agents range dramatically…from the food we eat to the amount of time that we spend on our cell phones.

This isn't about money, politics, economics, or health care policy. This is a throw back to what makes life possible. We must do our best to preserve our bodies. It’s the only way to optimize our wellness in spite of a poor genetic hand. The food, sleep levels, stress levels, and activity that we constantly expose our bodies to can and will affect gene transcription, and thus alter our mood, energy levels, focus, and general well-being.

A recent lecturer suggested we decide now where our interest lies in medicine: taking care of sick apples or preventing apples from getting sick in the first place. While care for already sick patients is critical, I think that we as medical professionals owe it to society to begin taking prevention more seriously. Considering the potential of epigenetics, this battle is not solely against obesity. It’s a battle to preserve our wellness and morbidity by devoting more resources and energy to mapping out an optimal way of life most appropriate for maintaining the integrity of our genome.

What is Crossfit?

For the past five months, I've aimed to do four or five Crossfit workouts per week.  Crossfit is a very unusual fitness program that I would highly suggest to anybody who is easily bored with their normal gym routine and who likes to see results in everything from flexibility to strength to cardiovascular fitness.  But it's a little bit hard to explain...

First of all, let me give you an example of one of my mornings while attending Crossfit South Hills.  I would wake up at 6:30, mix up a protein shake, grab an Accel gel, and race over to the gym. The warm-up consists of the following:

3 rounds of ten reps each of the following exercises:
-dislocates (PVC pipe raise above head and rotated down to the lower back then back up and in front, etc.)
-overhead squats (again using PVC)
-dislocate + lunges (PVC)
-back extensions
-sit-ups
-push-ups
-pull-ups

Then, we were required to do a "Buy In", which is usually to practice a skill-based movement. But it could also be a sprint (400m, 800m, or mile), max rep body weight exercise, or a mini-workout.  You never know!

After the buy-in, there's a Workout-of-the-Day (WOD), which is normally a nightmare.  After that, you complete a "Cash Out", which follows the same formula as a Buy In, only it normally works the same muscles focused on in the WOD, so it's extra hard.

Here's is an example of a typical workout routine at Crossfit South Hills:

-Buy In-
Max Effort Burpees For A Minute

WOD
21 Renegade Rows
Row 250M
12 Knees To Elbows
15 Renegade Rows
Row 500M
12 Knees To Elbows
9 Renegade Rows
Row 750M
12 Knees To Elbows

-Cash Out-
25 Strict Chin Ups

 The idea here is to complete the workout as fast as possible.  The beauty of most of these WODS is that they don't take very long.  Sometimes, the WOD only lasts for 6 minutes.  Other times, you might be grinding through it for a half hour.  Every session is an hour or less, though.  So if you switch to Crossfit, those constant, drawn-out sessions at your local Bally's will be history.  Crossfit four or five times per week, and your body will thank you.

Another great part of Crossfit - and probably the key to its incredible results-producing regimen - is that when you walk into your Crossfit gym, you are totally surprised by the workout.  Indeed, their slogan is "unknown, unknowable". While those who program the WODs do have a formula in mind to keep their athletes balanced over the long haul, you  have to be prepared for anything when you walk into the gym.  You might work the same muscles multiple days in a row (this is body-building, it's general athletic preparedness!); likewise, you may go a week without doing any ab-concentrated movement, for example.  Some WODs include tire-flipping, rope-climbing, or pushing a weighted sled across a parking lot.  We use jump ropes, kettle bells, medicine balls, and sand bags.  Like I said, Crossfit WODs are murder, but you see results quickly in all areas of fitness.

Here's another example of a WOD:

"Fran"

21 Thrusters (95 lbs.)
21 Pull-ups
15 Thrusters
15 Pull-ups
9 Thrusters
9 Pull-ups

This one takes more elite athletes less than three minutes to complete, but it's a full body workout.  

Olympic lifting and virtually any exercise that uses a long barbell will engage your core whether you like it or not (you like it, trust me).  Because most Crossfit WODs include a barbell movement, every workout does something for your core.  

A lot of people are critical of Crossfit because they see it simply as a strong man competition because of its frequent resort to Olympic lifting.  Here's a WOD that displays the type of cardiovascular workout that you can get from Crossfit:

2 power cleans on the minute (205 lbs.) for 15 minutes

For the remainder of the minute, do as many double unders as possible.  

Keep a running total of double unders.

This workout requires both strength and cardiovascular fitness to finish with a good time.

The only way to experience the benefits of Crossfit is to try it out for yourself.  Affiliate gyms are located virtually everywhere nowadays.  Despite all of the perks to your health and body, the community fostered in these gyms is unbeatable.  You would be hard-pressed to find a group of Crossfitters that wouldn't welcome you whole-heartedly into their gym and cheer you on while you improve your fitness.  I consider my coach and colleagues at Crossfit South Hills some of my dearest friends.

I can also testify to Crossfit's effects on my performance as a triathlete.  In July, I competed in the Steelhead 70.3 half ironman.  I broke my personal records in the swim, bike, and run distances (1.2 miles, 56, and 13.1 respectively).  My times: 32:57, 2:48:55, and 1:33:11.  My training reached about 15 hours per week, but five of those hours were dedicated to Crossfit training, meaning only 10 hours per week of swimming, biking, and running.  Most triathletes at this level are training anywhere from 15-20 hours in swim, bike, and run.  At the race, I was particularly strong in my transition from bike to run, which is normally considered the hardest part of the race. I also required virtually no recovery time.  In fact, I had to jump in the car and drive straight back to Pittsburgh after the race in order to be in Philadelphia for classes less than 48 hours afterwards!  After having crushed the triathlon and then driving for 7 hours back to Pittsburgh and NOT having any stiffness or sore muscles, I can only attribute my great experience and times to Crossfit South Hills (and my adherence to the Paleo Diet, but more on that in the next post...)

Try out Crossfit.  Most gyms will allow you to work out a few times for free!  And all you have to do is show up ready to sweat.  I suggest Crossfit South Hills if you live in Pittsburgh.

Have fun getting the body you have always wanted, sleeping better, buying new clothes, making new friends, and freeing up some time in your schedule due to the brevity of Crossfit sessions!

Barefoot running and correcting your stride

As a FIT professional at Fleet Feet, I receive an increasingly greater demand for "barefoot running shoes" (how's that for an oxymoron?). Normally, customers are specifically looking for Vibram Five-Fingers, but the Nike Free is still a popular choice.  Most commonly, people saunter into a "Chi Running" class or read something featuring the "Pose Method" of running, or, my personal favorite, read Christopher McDougal's book Born to Run,, then coming looking for shoes that will help them apply what they have learned.  If you think I'm going overboard with links, then I accomplished my goal!  There is a ton of writing being done on the topic of barefoot running as well as methodologies that claim to make running easy, pain-free, and even comfortable!  

The truth of the matter is that running is a natural movement with which we have fallen out of touch.  Over millions of years of evolution (in case you haven't been able to tell from past posts, I love evolutionary biology!), the environment selected for minor tweaks here and there to our bodies.  As a result, we developed the ability to walk upright, freeing our arms to carry stuff (or pump to help us move our legs faster); an extremely complicated structure known as the foot; and a perfect arrangement of tendons, ligaments, and tissues that enabled us to walk or run whenever we needed to escape danger, hunt, move stuff, or have fun.

This is the barefoot runners' argument: evolution gave us a body that was not meant to wear shoes!  Many indigenous tribes and communities around the world have maintained near-barefoot practices.  The Tarahumara are a group of Mexican indians that lives off of ultra-distance running and booze, and they are virtually injury-free.  McDougall's book (mentioned above) centers around this tribe of amazing athletes who insist on wearing no more than a piece of leather and straps.

http://isiria.files.wordpress.com/2009/04/tarahumara.jpg

While this is true, evolution never intended for us to walk around on uniform concrete all day long.  The many bones in the foot enable it to adapt to uneven, rough terrain, meaning modern barefoot people - who wore shoes for the first 30 years of their lives - are probably doing more harm than good by diving into barefootedness.

Having said that, many people find that (slowly!) transitioning to barefoot running (or at least using as minimalistic a shoe as possible) helps them become not only a more efficient runner but also less prone to injury.  The reason can be found if we look at the evolution of the running shoe:

1832 - Englishman Wait Webster patents a process wherever a thin, rubber sole can be attached to a canvas upper
1860 - A croquet shoe is developed using Webster's process.  These shoes are noiseless when worn, hence "sneaker".
1890s - These shoes quickly began very popular as children's shoes.
1917 - The first popular sneaker is released in the U.S.  The company is called "Keds", which is likely a combination of "Kids" + "peds". Also, Converse introduces it's high-top basketball shoe.
1964 - Phil Knight and Bill Bowerman found Blue Ribbon Sports.  They begin selling Onitsuka Tiger shoes out of Knight's car at track meets.  Onitsuka Tiger eventually becomes Asics.  BRS eventually becomes Nike.
1974 - Bowerman experiments with waffle irons and creates the waffle sole.  He markets a new shoes called the Waffle Racer.

After the introduction of the Waffle Racer, the running shoe industry exploded.  Shoes became more complicated as time went on.  Currently, it's nearly impossible to buy a regular running shoe without a big chunky rubber heel, which enables us to land on our heel with each step.  To strike on the heel, you must lengthen your stride.  Don't believe me?  Try it yourself.  Go find an empty sidewalk and take off your shoes.  Walk a few paces, paying close attention to your feet.  You will notice that your natural walking pace is programmed for a mid-foot strike, not a heel strike.  Now, mark off about 20 yards on the sidewalk.  Jog first with your shoes on between the markings, counting every stride.  Repeat barefoot.

If you are indeed a heel-striker, you will count more paces during that drill barefoot than while wearing shoes.  Without the plushy heel, we naturally correct our gait by shortening our stride, transitioning our body weight forward over the feet, and landing on the mid- or forefoot as opposed to the heel.

Mastering this technique will make you efficient without losing the running shoes.  My buddy Dustin runs in Vibram Five Fingers occasionally, and, while he'll be the first to let the good vibes roll regarding minimalistic shoes, he confesses that the thin soles allow even the tiniest stone to jab into your plantar fascia. So I still like to wear my shoes.  A longer stride is inefficient because it is often accompanied by locking out of the knee.  When you land on a locked out knee, it acts to break your forward momentum.  There's no fluidity to this motion, as you'll see in the video below:



The alternative is to lean slightly forward at the hips and allow your body to almost fall forward. Your feet are forced to shuffle forward in order to keep you from falling on your face. That's pretty much it! If you watch elite runners, their heels never hit the ground because they don't over stride. They land on their mid- or forefoot, and their cadence is very fast (90-98 strides with each foot per minute!)

Another benefit to running (or just walking around your house) barefoot is that it strengthens the many muscles in your feet.  The 26 bones of the foot are controlled by a bunch of muscles that are required to do very little work from the day we begin walking due to our over-reliance on shoes.  Allow your feet to breathe, and I think that you'll find that you'll be less prone to injury.  Decreasing stride length = eliminating heel strike = lower impact running. By the way, flip-flops don't count!  There's still a nice chunk of rubber under your foot! 

My suggestions for improving your running are simple:
1) Slowly transition through very short distances if you wish to begin barefoot running.  If nothing else, go to a high school football field and run a few lengths of the field without shoes on after your workout.  Practice shortening your stride and landing mid- to forefoot.
2) Once you understand the basics, don't over think running.  The beauty of the motion is that it should feel natural. As Matt Fitzgerald says, Run Unconscious!
3) Take your shoes off around the house and in your yard.
4) Aim for a higher cadence rather than a longer stride when you're trying to go faster.  If you already are running with a high cadence, check out some of Joe Friel's writing (blog linked below) for drills to increase your stride length while maintaining mid- to forefoot striking.

Some more resources:
http://www.therunningfront.com/natural-running/beware-of-barefoot-running-injuries/
http://www.joefrielsblog.com/
http://running.competitor.com/
http://www.runningbarefootisbad.com/
http://www.barefootrunning.fas.harvard.edu/
http://therunningbarefoot.com/
http://www.mediafire.com/file/3zj3ndtddje/minimalist
http://thedianerehmshow.org/shows/2010-07-12/running-america

Happy running!

Send me questions if you got 'em: m.aspiration@gmail.com

Developing the "kick"

In 1983, Jeff Smith was leading the New York City Marathon at mile 26.  Rod Dixon, in second place, had been closing in on him since mile 20.  At mile 26, Smith looked over his should, only to see a possessed Dixon speeding past him.  At mile 26!  In the ensuing 0.2 miles, Dixon's legs churned, taking him straight to the finish line, increasing in speed the whole way.



This incredible drive by Dixon at the end of the marathon is something I like to refer to as "the kick". Developing the kick takes time and patience in your training. It's normally the result of regular fast, explosive workouts that focus on building anaerobic endurance.

Jeff Dixon is historically a miler, meaning he was a short-distance racer turned marathoner. Through regular speed work sessions, he managed to maintain his anaerobic engine in addition to improving his long course endurance.

Anaerobic work ranges from heavy weightlifting to short-distance sprints. If you're a runner, this obviously means running sprints. But you can build the kick in swimming or cycling in similar fashion - short, powerful repetitions.

Anaerobic work has benefits beyond developing the kick, a useful component of endurance sports competition. It also revs up your metabolism and builds muscle. As a runner, if you were to focus your time primarily on speed work at the track, you would look more like exhibit A as opposed to exhibit B:

Don't get me wrong. I don't think one body type is better than the other, but, physiologically speaking, the anaerobic giants tend to have more muscle mass, and aerobic runners, who would observe decreased performance from extra, heavy muscle mass, tend to be thinner.  Long-distance guys don't need the explosive power garnered from big muscles.

Anyways, "the kick" is one of the most incredible things to watch in sports.  When you see somebody turn on the jets at the end of a long event, you can't help but admire them.  It's so hard to develop the kick, but the result is well worth the price.