*UPDATE* Psychological Effects of Heart Rate Monitor Use Study

12/21/2010: Preliminary results were reported at Indoor Cycle Instructor in October 2010. Manuscript in preparation. Once published, results will be made available on this site and at ICI.

Monday, February 7, 2011

Begin with a Purpose

It's been a long time. I'm two weeks away from the start of my last year of medical school (HOW did this pass so quickly?), currently knee-deep in snow and waist-deep in Institutional Review Board paperwork to get my next HRM study approved (yes, yes, I'll write up the first one eventually -- just as soon as I get the next one up and running: it's way more important, way more useful). Immersed in writing up specifics of a project I've adored and invested in for the past two years, one would think I'd be overjoyed. After 10 hours of writing various sections in an illogical order, with only one paragraph remaining to write of my 20-page protocol, I do not feel satisfied or proud or rewarded. All I feel is stuck, counting down the seconds until it's over, and taking absolutely no steps toward making "over" happen.

You know what part's left? The "Purpose" paragraph. The first paragraph of the document. I left the "Purpose" for the end -- and in the end, I have no steam left to define it.

I'm training another group now for the 11th Annual Special Olympics Vermont "Ride for a Reason," the 6-hour charity indoor cycling marathon event I help organize. It's an event that has meant a lot to me over the past three years. It was the first way I really connected with my new community after moving here from NYC for medical school. It afforded me the opportunity to bringing mentors and colleagues who inspire me (from all the chapters of my life) together all on one stage to co-lead the event with me. And while the novelty has surprisingly worn off as an athlete after banging out a bunch of these 6-hour indoor rides and a handful of outdoor Centuries, it's been a most rewarding experience as a coach to guide so many young athletes through their first endurance conquest. Life really doesn't get better than watching someone get their first taste of profound and utter pride.

Each year, I charge a small fee for riders to join a training group for Saturday morning endurance rides on a Spinner for a few months leading up to the ride: we start at 60 mins, then progress to 75, 90, 2 hours (we do weekly 2 hour sessions for a month), 2.5 hours, and 3 hours. This year, I decided to do it for free to inspire folks who'd never been on a Spinner longer than a 45-50 min class to give it a shot. I SO believed that I could take a group of newbie aspiring endurance athletes and teach them what they need to know in order to bang out 6 hours on a Spinner. The more I train people to do it, the more I gather their feedback on what works/doesn't, and -- of course -- the more of these events I ride myself, the more confident I am in knowing specifically what I need to teach people in order for them to be successful on Game Day.

I held my first training session this weekend. I have 6 riders in the group. One rode this event last year (his first 6-hour ride -- I was so proud that I decided to ask him a few months afterwards to marry me; just kidding... I was going to do that anyway!); two have done two-hour endurance rides with me before; the remaining 5 have never been on a bike - stationary or outside - for more than an hour. But you know what? They're taking on their first indoor Century with confidence.

As they filtered in and set up their bikes, I scribbled an impromptu list on my whiteboard. I've decided to share it here.

Top 10 Things You Need to Know in Order to Conquer a 6-Hour Ride
1. Begin with a purpose.

Yes, like I didn't do with my IRB paperwork. You know what? Six hours sweating on a stationary bike surrounded by 100 people doesn't make a whole lot of sense. Most of the time, it sucks: it's hot, it's wet, it's humid, it's uncomfortable, it's boring. It's not something one just does. It has to mean something. It has to mean something specific.

Why are you committing to this challenge? When you finish, what will you be able to say about yourself? What will you learn in the process? What will you remember? What will you now be able to do? How will your life be changed in some way? What does it mean to you? Now is the time to start developing answers to those questions -- you're the only one who can. Your answers may change over time, and that's ok. But you have to have SOMETHING in mind. Otherwise, why bother?

2. Learn how to sit: protect your crotch and protect your wrists.
Technical imperative #1. Multi-hour rides are great for helping you detect subtle imperfections in your form . During this weekend's 90 min ride, we obsessed over one specific aspect of form: directing your weight on the saddle. We talk about "not leaning on the handlebars" ad nauseum - but we all do it. I learned that while training for my first outdoor Century, when I lost motor function in my left thumb. "Handlebar-leaner? Who, me?" After six hours, your wrists don't lie. The mantra I've been repeating for my riders is: "Keep your wrists lined up with your thumbs." That alignment, if observed, tends to reflect that there is not excessive pressure on the handlebars. The other part to that is driving one's weight through your butt (where we all have more padding, like it or not) instead of the anterior pelvis -- AKA "front part of the crotch." I describe to my riders about thinking of a stake being driven through their tailbones. It's kinda weird, but it seems to conceptually "work" for people.

I concluded the first training session by asking my riders to close their eyes in the first few minutes of the cool-down and direct their attention to anything that hurt or felt stiff or sore. THAT'S the part of their form they'd focus on in the next ride. We can learn a lot from our pain.

3. Learn how to protect your feet: keep your feet off the insoles of your shoes.
Have you personally ever experienced "hot feet?" It's quite possibly the worst pain on earth. That's nerve pain, or "neuropathy" -- the same thing that happens to folks with poorly controlled diabetes (except theirs is with them all day, every day and very very very difficult to treat). Cyclists' neuropathy is a temporary problem caused by compression of the nerves on the bottom of the feet. Stiff-soled cycling shoes help to reduce that pressure, but they're not sufficient to overcome subtle imperfections in pedal stroke form over the course of 6 hours.

Even if you think you're not "mashing" downwards, you're probably doing a little more downward pushing than you think. I tell my riders to imagine there are firey hot spikes in the insole of their shoe -- if their foot touches the insole, they're going to get hurt. Their job is to keep their foot towards the TOP of their shoe -- either pushing up against the toe strap (if they're in sneakers) or simply lifting their knees up if they're clipped in. We do drills focusing energy on the upstroke (hip flexor action) synchronized with downbeats of the music (vs. the temptation to mash down on the downbeat), as well as the backwards wiping portion of the pedal stroke. These drills are great to combat the mental tediousness of long rides, too.

4. Learn how to breathe.
Breathing is key for a) controlling heart rate/conserving energy, b) psychological management of challenge, c) combating boredom. The first part is self-explanatory; the latter two, perhaps not so much.

I teach my riders that there is no better feeling in the world than experiencing true mind-body connection, feeling completely in sync with their environment, their breath, the way their body is moving, etc. We practice synchronizing breaths with music, with pedal strokes, etc. We close our eyes. We give ourselves permission to pay attention to all these subtleties, to get lost in it -- and in so doing, to find something magical.

5. Eat every hour, and drink more than you're used to.
'Nough said. I'm not kidding. You need to replenish glucose; otherwise, your liver will think you're in a fasting state and start catabolizing muscle to free up raw material protein for it to manufacture its own glucose. Bad. If you keep a low level of constant glucose on these long endurance events, you've got enough of a base substrate for good ol' fat metabolism to continue.

6. Keep your heart rate wayyyyy lower that you're used to. Try to stay below 80% of LT for most of the ride.
Also 'nough said. Granted, there's a lot of energy/adrenaline pumping during these big time events -- and lots of instructors trying to feed that. I remind my riders to empower themselves NOT to follow every acceleration, position change, resistance load, switchback drill, etc. that comes their way. Heart rate control is the prime objective. We spend most of our hours together practicing progressive loading drills (i.e., "Increase and Breathe...") so that they learn how to load resistance and load speed without affecting heart rate, by modulating the challenge with their breathing. And we also practice breathing heart rate down by extending the exhalation extra-long, to bring HR down faster. This way, if they're tempted to surge to LT in the middle of hour 1 of 6 on Game Day (ill-advised), they can get right back down and recover. But I also remind them to take responsibility for making their own choices and pacing themselves according to what they need.

7. Get comfortable being uncomfortable. Own your discomfort.
For me, this was always my #1 reason for riding 6 (or 8, in the cases of my outdoor 100-mile rides) hours on a bike. The idea that when you're up against something horrible -- like 36 hour overnight surgery call, or stuck in an OR standing 15 hours sans eating, peeing, etc., or stuck in a snowstorm with your car stuck in a snowbank, or your job is too stressful to bear, or you're too anxious to do something you know you want to do, or WHATEVER it is that you find unbearably uncomfortable... you remember that you've been uncomfortable before. And that you survived. That you didn't need to resolve that discomfort in order to function -- that you just kept going. Thus, you will always know that you can do it again. So here during this training, during this event -- treat it as though it would be ok if it lasted forever.

It's a concept that doesn't naturally occur to people: the idea of seeking out something uncomfortable for the specific purpose of getting used to being uncomfortable. I've written a lot about the merits of this concept, the underpinning for basically most of how I live my life. I incorporate this into my coaching cues whenever possible.

8. Develop coping mechanisms for boredom.
Six hours on a stationary bike gets boring, dude. Seriously boring. So you have to do stuff. Give yourself pedal stroke drills, breathing drills, HR games, etc. Develop strategies to re-focus, entertain yourself, simply pass the time, etc. Don't rely on the instructor (including me) -- with few exceptions, you'll be disappointed at least some of the time. Rehearse a plan for "what you do when you get bored." It may mean closing your eyes, focusing on an aspect of your form, focusing on a particular part of your pedal stroke. Whatever it takes. Plan it in advance so that, when the time comes, you expect it and remain in control.

9. Coach yourself.
A six-hour ride is such a deeply personal matter. You might here glimpses of inspiring insight from the person up front guiding the group -- but where the real inspiration needs to come from is within. You must always be talking to yourself in your head. Tell yourself the story of how things are, the way they should be. Coach yourself through your form, your breathing, your pedal stroke. Coach yourself through every movement you make. Envision how you want to feel and look and be at any given moment, and describe that vision to yourself. I've written a ton about this concept here.

10. Remember your "reason."
When you're exhausted and tired and sore and stiff and bored out of your mind, what's going to keep you going? The instructor at the front of the room? No. It's the reason, the purpose, you started with. Remind yourself of that. It sounds like a silly, trivial point -- but you have no idea what kind of difference it makes. And if you're not finding that it makes a difference, there's a good chance that your "reason" isn't meaningful enough to you. Find the one that keeps you going.

That's all for now. I feel like somewhat less of a blog-delinquent. Sweet...

Saturday, December 11, 2010

Pace Yourself (profile/music, too)

It's not that I was "too busy" to write for the past seven months. It's that I had nothing to say. For all my talk of cycling/indoor cycling as a transformational process to build generalizable skills to conquer all of life's challenges, my present life (2 months from the end of my penultimate year of medical school) is now such that cycling is no longer enhancing my life to the extent that it once did. I rode outside 4x this year total, and rarely ride a Spinner except for when I'm teaching. When I watch people die, or have people tell me they want to die, or watch people go home from the hospital thinking they're "all better" when, really, they're just going to die, how much control I had over my heart rate during my last training session doesn't even occur to me - let alone be meaningful. When I've slept 13 hours a week, or spent 16 hours a day standing in an operating room, or realize that I spend most of a given day counting down the hours til it's over, riding a bike is nothing more than riding a bike - and I simply don't want to. Nor have I been in any way motivated to write about it, despite how much I've appreciated so many people's email/Facebook encouragements to do so.

I've ridde
n hundreds of miles just to prove various thing to myself over time. I've crafted hundreds of IDC training sessions for my classes themed on creating such opportunities for other people. Hundreds of people have told me that they "get" it - and in those moments, the return on investment is huge. But lately, I throw my profiles/music (essentially, an assortment of the same 25 songs in different orders/combinations x 4 months) together an hour before class, spend five minutes thinking about my theme/purpose/introductory lines, and entirely wing the rest of my cues. I never repeat an old ride because it takes me longer to recall what I initially intended with an old profile than it does to just make a new one. The profiles are deliberately simply structured such that a) people perceive that it passes quickly, since they have fewer "different things" that happen, and b) the medical student in me is pretty good at retaining [anything] for an hour, such that I don't have to bother writing out my profiles. I scribble stuff during the creation process, and then I throw it out. Yes, it helps to have years' worth of stock "things I say" that I can get away with this. And I mean a lot of different "things I say." Experience is kind-of like cheating. This is not a practice I recommend, as even if people somehow tap into strokes of inspiration from my stale cues, I certainly don't inspire myself (which makes it really hard to self-motivate to even show up to teach). My cues have been very technical lately +/- stock "greatest hits" cues that I could spit out in my sleep (and probably do, for all I know - my fiance is a heavy sleeper... yes, by the way, since going AWOL from the blogosphere, I've gotten engaged!). Point is, very rarely have I talked about riding a bike as being anything more than riding a bike lately. I just don't have it in me.

nd you know what? nobody seemed to notice the difference. Was it because they already had the legitimately well-developed self-talk cues I'd taught them for years? Or was it really that they didn't care either?

night was to be my last class of the semester (I teach at a university, which structures its group fitness schedule around the undergraduate academic calendar despite 50% of my riders being graduate students or faculty). After 12 hours at the hospital, I came home 30 minutes before I'd have to leave to teach. I conceived of a profile on my 5 min commute home (a loop ride of long climb/6x accelerations x 2), and threw together selections of the aforementioned 25 songs + a few random additions. When I was done, I wasn't proud of it. It was boring, and I didn't even want to ride it myself.

But the
n I had an epiphany. What's, like, the most important technical skill I teach people? What's the foundation of pretty much all of my training profiles, including this boring 2-climb loop? What is the single-most important drill that improves my clients' fitness, and generalizes to the rest of life (even if I'm too burnt out to think to remind people of such)? Progessive loading, obviously. "Increase, and breathe." That is, loading resistance so gradually that one's body has time to adapt and accomodate the challenge. Building up a hill so subtly that one might still be at 80% LT at the top. Accepting and committing to a challenge in such a way that it can be sustained, indefinitely. Mastering the way one's body responds to challenge through breath modulation. Really, the only reason I'm able to pull off halfway decent rides despite no longer investing hours of preparation, is that this drill is so damned good.

So what would be the most meaningful contribution I could possibly make to whoever showed up for this class, on a Friday night in the middle of a snowstorm? If I could REALLY, truly make them "get" it.

I took my loops a
nd broke them down. Each loop was ~ 18 minutes each. What if instead of guiding the class through random increments of "subtle adjustment," I gave them more structure? What if I gave them a starting point and an end point, and challenged them to create everything in between - thereby forcing them to internalize what it truly means to "load gradually." To pace themselves.

So, I did.

I explained the purpose of mastering the skill of progressive loading, and told them the mechanism by which we would attempt to do so. We would have two hills, where the steepness of each would be built up so gradually that they would be able to sustain their efforts without letting their heart rates get out of control/needing to take a break. Every minute for 18 minutes, they would load resistance. What that means is that it is up to them to decide how much they load (i.e., to define what "add a little bit of resistance" means to them). If they loaded a full turn or even a half-turn of the resistance knob, depending on the maintenance status of their bikes, that might be too much to count as "gradual," which is why I never coach resistance loading like that (and absolutely HATE when I hear other instructors coaching as such). In any event, their challenge was to load resistance so subtly that by the 18th increase, they'd be able to conquer two sets of 3x 30 second accelerations at the same level of resistance.

Intro Speech (one day, I'll write about how this is truly the most important part of a ride):
Last Dragon
Cues: See above

Fade to Grey - Wi

Cues: Fi
nd your breath, in through the nose, out through the mouth. Try to make the breath on the way in slightly longer on the way out. When you inhale, HR increases slightly; when you exhale, HR decreases. So if the exhalation is longer than the inhalation, the net effect is that your HR comes down. This is a skill you'll use later. Intensity should feel like the work is beginning but you can literally sustain this forever - not just all day, but forever. Shoulders rolled back and down, loose, elbows point down towards the floor. Knees come up to the center of the chest. Especially if your hips are tight, your knees want to flare out to the side - make every effort to bring them into the midline.

Higher Love - Safri Duo
n My Head - Jason Derulo
Pump It - Black Eyed Peas
nizer (Remix) - Britney Spears
Left Outside Alone (Remix) - Anastacia

I really, truly did
n't talk much - and I think it made for a better ride.
Every minute x 18 minutes, load "a little bit more resistance."
Remember to pace yourself.
(Assorted reminders of breath, upper body form, lower body form, pedal stroke, etc.)
If your mind starts wanderi
ng, close your eyes.
If your legs are feeli
ng heavy, slide your weight to back of the seat on the widest part of the seat, takes the pressure off the back and off the knees.
The more resista
nce you load, the looser your upper body needs to get. Give the momentum, the energy you create, somewhere to go... besides your joints.

After every 6th loading, I cued them that they were 1/3 and 2/3 of the way there. At the 17th increase, I reminded them that they had 2 sets of 3x 30 second accelerations coming after their 18th adjustment.

At the base of the hill, I told them that they should feel like they could carry on a perfectly normal conversation, like a light jog, "something they could sustain all day but not forever." For those with HRMs, 30 beats below LT.

1/3 of the way there, I told them that they should feel like they could carry on a conversation but that they would really need to pay attention to their breathing. Something they could hold most of the day, for several hours, but not all day. 20 beats below LT. "If you're past that, back off your resistance slightly, and find your breath again - in through the nose, out through the mouth."

2/3 of the way there, intensity should feel like you wouldn't want to have a conversation. You could get several words out, but you'd be distracted by how much attention you'd have to pay to your breathing. There should be no burning in the legs or tightness in the chest. 10 beats below LT. Breathing is still rhythmic. If you're past this, back off your resistance.

At the 17th loading, I remind them that even at the 18th adjustment, you're right below the point at which burning in your legs begins. Still no tightness in the chest, not gasping for hair. Still completely in control of that breathing rhythm. "In.... and out..." Breathing gets more purposeful, more deliberate. Forceful, long breath on the exhale, make room for a deeper breath on the next breath.

2 sets of 3x acceleratio
ns - 30 seconds each:
Place in Your Heart - Journey
Jukebox Hero - Foreig

Recovery (4-5 mi
All Eyes o
n Me - Goo Goo Dolls

nglasses at night (Remix)
nce You've Been Gone - Remix - Kelly Clarkson
b Can't Handle Me - Flo Rida (yeah, I play dance-rap now in my classes; it's ridiculously not me, yet I can't get enough)
n the Ayer - Remix - Flo Rida
n't Stop Believin' (Remix)

2 sets of 3x acceleratio
We Were
n't Born to Follow - Bon Jovi
ng Cars (Remix) - Tiesto

Hold on Loosely - .38 Special
This Ki
nd of Love - Sister Hazel (this is what will play when my wedding party walks down the aisle, as a point of useless trivia)
The Climb - Miley Cyrus

Afterword: This was, by far, o
ne of the most rewarding classes I've EVER taught (including comparisons to my crazy, surreal days of NYC when people used to rave of their various Spinning-induced epic life changes - the kind of moments that almost made me want to withdraw my med school applications back in the day, because coaching IDC was rewarding enough!). Since I mostly shut up and let people rock out/groove to the steady beats and mark their steady mini-goals, I could look around the room and watch people totally "in their zone." All this time, I thought I wasn't connecting because I wasn't saying anything epic.

But, really, all I ever had to do was shut up a
nd teach people a concrete skill. It didn't need to mean anything more than what it was at its most basic level. It was enough.

Saturday, May 29, 2010

Knowing When -- and How -- to Push.

I've been having syncopal (fainting) and pre-syncopal (near fainting) spells over the past two years, of yet-undetermined cause. I eat well, sleep well, hydrate well, train well, recover well, and all my labs are normal, as is a CT of my brain. Cardiovascular work-up has yielded a super-common congenital defect in my heart (25% of people have a patent foramen ovale) but it's unlikely that significant deoxygenated blood would start being shunted to my brain now -- there has to be something else also going on. It's most likely a problem with my autonomic nervous system, or an intermittent cardiac arrhythmia that is preventing adequate blood flow. To figure out which, though, is a horrifically expensive and inconvenient process (as is being whisked off by ambulance to a hospital in the middle of nowhere after having one of these spells whilst driving on the Interstate).

My episodes tend not to be exertional, though my doctor and I decided it would be important to do a "stress test" anyway. Stress tests, conventionally, involve jogging on a treadmill while hooked up to electrocardiogram (ECG, or more commonly known as EKG) leads. When the technician deems that the patient is working hard enough to represent a "maximum effort" (i.e., conditions where any electrical conduction abnormalities of the heart indicative of inadequate blood flow are most likely to be observed) the test is complete. For a well-trained athlete, it is easy to appreciate where this could go awry. My metabolically measured lactate threshold is 184 beats per minute. 106% of LT (i.e., something I can sustain for an entire 30 seconds where I do my regular weekly or bimonthly anaerobic interval training) is 196 bpm. If you want to see my heart at max effort, buddy, jogging on a treadmill isn't going to cut it. I decided, therefore, to do my own stress test. On the day that I had to wear a 24-hour continuous electrocardiogram monitor (Holter monitor), I decided I was going to go to a gym and push like I've never pushed before.

The mission was a total flop. But I learned a ton about myself as an athlete, and as a coach, in the process -- so I figured I'd blog about it...

Over time, I've gotten the endurance thing down pat. I've structured my world such that the people I train either specifically come to me because they already "get" it, or I enthusiastically convert them to "get" it. I've always made it a point to familiarize myself with the modus operandi of my colleagues wherever I'm teaching, and regularly reinforce to myself the importance of serving the unique role of giving people what they're not getting elsewhere. So it has become very important to me to deliver quality, aerobic training with the physical, psychological, and emotional tools to practice it.

I've written ad nauseum about various mechanisms for "self-coaching" through aerobic and even sub-max efforts, largely centered around themes of commitment, discipline, restraint, etc. etc. etc. But I don't write much about anaerobic work. Why? I'm not comfortable with it. I very rarely take large groups above LT. While working with a smaller group where I know everyone, I feel confident in explaining:
1) why we're doing it (to train Type II "explosive" muscle fibers)
2) how we're doing it (*BAM* push to 106% of LT for 30 seconds, then recover all the way back down to 70% of LT, then *BAM* hit it again)
3) how my coaching style is about to COMPLETELY change, reminding them that they have 100% permission to ignore me at all times.

I do this every two months or so (assuming they're getting high-intensity training elsewhere) so that they learn/remember how to do it effectively (i.e., an interval of sufficient intensity/length -- NOT overshooting, lest they set themselves up for failure and disappointment -- and corresponding recovery, so that they can actually reap the benefits of this kind of training), and remember how unpleasant they're supposed to be (i.e., how "can I go take a nap now?" is not the desired outcome of most training sessions). When I do it, I'm almost exclusively off the bike, and my cues are almost uncomfortably intense. They have to be. Pushing to 106% of LT is not natural. It's not something that people "fall into," and I find it really friggin' hard to take them there.

So here I was on the elliptical trainer with my Holter monitor, tasked with taking myself there.

I began by framing my purpose. I knew that when I felt uncomfortable, perhaps downright in pain, that I'd need to remind myself of the purpose with which I began. I was doing this for answers. This may be the only chance I have to "catch" whatever is wrong. This was my last chance, wearing the Holter monitor (which, thanks to my pathetic health insurance coverage common to most medical students, was costing me close to $1000); I couldn't afford to repeat the test. And because I couldn't afford to screw anything up, I decided not to even wear my HRM (the Holter consists of EKG leads hooked up to a recorder - there is no display of heart rhythms or rates, no feedback at all). For anyone who knows me, you'll understand how big a deal it is to take this on without a HRM: I'd have no idea how hard I was pushing, no idea if I were trying hard enough.

Armed with a playlist of my "greatest hits" of tunes with 30 second power choruses, I began. Warmed up for 10 minutes to an easy perceived exertion. Then, it was time. I closed my eyes, prepared to explode at the chorus. My self-coaching began.

You need to do this. You need answers.

I pushed. I pushed as hard and as fast as I could, until my legs felt like rubber and my chest became tight. You can do this. And when I felt my legs literally liquifying beneath me, I kept with it.

End of chorus. Recover. Breathe. Looooong exhales. Heart rate (by perceived exertion) comes way down.

Next interval. Ready... ready... NOW. I pushed. 5 seconds later, my legs slowed into a comfortable, steady cadence that in NO way approximated 106% of LT, HRM or not.

First, I made excuses. If I'd had my HRM, I'd have a concrete target to shoot for -- and immediate feedback to reinforce and direct my efforts. I'd know what I can safely sustain. I could assure myself. I'd know exactly what I need to do. Without that, I can't. I just can't.

"Can't?" That's not helpful. I launched a self-intervention immediately. I tried to reason with myself, to motivate myself to do this terrible, awful thing that I had absolutely no interest in doing.

This is your last chance for answers.

You're spending $1000, make it count! A little bit faster.

You're going to remember this. That time you promised yourself you'd push through your doubts, your fears, no matter how much it hurt. When you let this stand for something you know you'd look back on forever.

It was just what I'd told myself so many times before. At Mile 17 of my 2nd century, in the ridiculously miserable pouring rain in the middle of nowhere with a broken spring on my front tire. At Mile 85 of the same ride, at the bottom of a 10% grade hill. At Hour 6 of this year's Ride for a Reason, after my mentor told me he didn't like my ride the hour prior and I still had to get out there and coach again. At the bedside of a comatose man last week in the hospital, as I was tasked with assessing his brain function.

And so, for the next 30 minutes, this sort of dramatic self-dialogue continued. I called up the most potent memories I could muster -- some of them proud, some of them utterly painful. Flash to a snapshot on the side of the road after my massive bike accident last year, the sound of my head hitting concrete, helmet shattered -- along with my confidence -- swearing I'd never be able to ride again. What it felt like to be so truly afraid.

I defined each push somehow to serve as coping with whatever I called up to fight against. And you know what? It worked.

If I weren't in the middle of my 6 month Spinning hiatus, I'd totally have made a ride about it.

In the end, my fake stress test was probably a bust. I have no idea if I pushed hard enough to truly tax my heart sufficient to see "anything." I have no idea if there's even anything to see.

But I did learn that the stuff I so regularly advocate in endurance coaching has JUST as much power for anaerobic efforts. Letting it stand for something, letting it mean something.

Pushing for a purpose, as a mechanism for conquering whatever needs to be conquered.

Friday, May 21, 2010

Touching Lives?

"We touch people's lives in ways we may never know."

For my first two years of medical school, I spent most of my free time at an inspiringly amazing family practice clinic in rural Vermont. The clinic's founder and director is a mind-blowingly brilliant physician who is one of the most globally impressive people I've ever met. Uniformly adored by patients, colleagues, politicians and the general public at large, every word out of his mouth is precise and utterly impactful. My interactions with him have been very carefully selected -- I've had to balance my propensity for stuttering/blabbering/otherwise embarrassing myself with how friggin' much I learn in a few minutes of conversation with him, most of which truly stays with me (assuming I have the presence of mind to "breathe my heart rate down" long enough to encode it). But the quote above, which he said to me on one of my very first days at clinic, that stayed with me for sure.

I remember being a kid and dreaming of "making a difference," "touching lives," blah blah blah, all that vague, generalized do-gooder stuff. Initially, that translated into local community service projects and general attempts not to be a jerk towards others. As I got older, I started seeking out professional opportunities to be involved with stuff that had lasting consequences, and found that I found the concept of being attached to those consequences rather rewarding. Doing stuff with consequences almost, in a sense, had a built-in feeling of purposefulness and meaning. I suppose that deciding to become a doctor is much of the same.

When I became a Spinning instructor in 2007, however, I had none such lofty ideals. I got certified purely "for the heck of it" - more curiousity than anything else; I didn't even plan to teach. When I did decide to audition to teach for a prominent nyc franchise, my expectations were quite concrete: plan training session reflective of scientific soundness --> play music that doesn't suck --> set a good example of projecting positivity and self-care --> done. I never imagined, 3 years later, that I'd have had unbelievably intense relationships through this program: people I've taught, people I've trained, people who have taught and trained me. I never thought I'd author a blog read by hundreds of people. I never thought I'd change the way I saw myself, how I saw the world. Or that, nearly exclusively through the course of my new role, that I'd carve out a way to balance my quest for "consequence" and meaning.

Simply put, I never thought I'd touch anyone. I wasn't trying to.

Yesterday, I got a
n email from a fellow fitness blogger who has impressed me over time with her upbeat, enthusiastic, soul-pouring posts, and with her generosity with her seemingly endless energy and creative ideas for fitness instruction. She told me a story of how something I'd written a year or so ago had inspired her to step outside her comfort zone and teach an endurance ride in a very risky setting (i.e., pressures to pack the room). To be honest, it took me a while to "register" what she was talking about. I'm on an away-rotation at a hospital in Maine, and have been so far removed from this part of my life. I haven't coached since February, haven't written for this blog (or ICI - I promise, 4 weeks til this rotation ends! My next medical column will be about use of blood pressure meds in exercise), haven't even been training myself (for medical reasons that I'll ultimately describe on ICI - it's a useful case study in how hard it is to provide good medical care for athletes). I've just been so completely disconnected from stuff that, prior to a few months ago, was such a hugely life-defining realm of my world. Somehow, I actually kind-of forgot about it. It's no wonder I've been feeling so useless, tagging along like a puppy in a white coat around a miserable, cold, chaotic place that would be the LAST place I'd want to be if I were really sick (i.e., The Hospital).

It's humbli
ng to think that stuff you do has larger consequences than you intend, sometimes. My sidebar of my other blog, describing how its URL earned its name, says it all. Truth be told, what this person accomplished had very little to do with what she read here -- it's all about serving as the spark that "clicks" people into shifting their own paradigms.

never know what's going to set people off, get them thinking. You never know what's going to truly speak to people at the very specific place where they're at, to inspire them to choose the direction they want to go. My boyfriend teases me about my redundancy - I speak the way I write, and I write the way I coach (both athletically and medically - and, yes, I do continue to see my role as a physician-in-training as such) -- delivering messages in multiple different ways, with the hope that one particular fragment of one of those messages will be the one that "carries the day" for someone. Because if it doesn't, then what's the point?

Of all the times a
nd contexts in which I've suffered from burn-out, I can honestly say that I've never had this experience as a coach. Sure, there have been times when I'm tired or cranky or sad and want to stay home and nap instead of getting up in front of a room and kicking into "positive life presence mode." But that's not burn-out. Burn-out is being so drained that you temporarily forget your purpose. And if your purpose is to connect with people, to reach them, to share your expertise and passion for the things you believe in -- do it. Even if you don't think it's working.

You're always touchi
ng lives, even if you never know it.

Thursday, April 8, 2010

The Dangers of Not "Training for SOMETHING"

Sigh. (Again). I'm 6 weeks into my third year of medical school (i.e., inpatient rotations), living in a new city away from my home, my Spinner, my indoor cycling classes, and the life I've very deliberately carved out for myself. I wake up at 5AM, spend all day til after dark at the hospital, where I am treated to some of the gloomiest, most depressing scenes and stories, and feel absolutely helpless in contributing anything to the lives of the very very sick, very very lonely people who have very little choice in allowing me to learn from them. I do my best to stay out of the way of the medical team I follow around, who reward me by "pimping" me (asking me questions in front of a huge group of doctors, often for purposes of fulfilling a rite of passage under the guise of "teaching") on various topics. At night, I come home, "dump" a version of my crazy day to my boyfriend (4 hours away, back home in Burlington) by telephone while I eat frozen food, read for a few hours about arbitrary, self-selected vague medical concepts I think might potentially help me with the next day's "pimping," then sleep for a few hours, snuggled up with a heating pad for my aching neck that's been weighed down for 14 hours with my overloaded white coat and stethescope.

My usual coping mechanisms for navigating the challenges of my day seem not to apply here. I'm not blogging (occasionally, I splatter collections of inarticulate, partially processed stories onto my "life blog") -- not blogging meaningfully, at least. I'm not regularly exercising. I'm not reading anything that inspires me. I'm not "creating" anything - an experience, an example. I'm flat.

But there are moments that make all of "this" worth-it -- subtle moments that lend perspective, purpose, and meaning. A patient dying of renal failure tearfully telling me that I made her life better. Another patient getting out of bed for the first time in 3 weeks. An email from my mentor back in Vermont, validating the concerns and reflections I've shared about how cold and callous inpatient medicine turns out to be. A Facebook Wall post from someone who reads this blog, telling me that some verbose rant or another had somehow contributed to their ability to communicate with and guide other human beings. Traveling back to Vermont to co-lead a 6-hour charity endurance ride to benefit the Special Olympics, sharing the honor with Master Instructors who have mentored me (including Jennifer Sage, flying all the way out from Colorado -- no way!) I VERY regrettably cannot make time to write about this life-altering experience (at least for a few months til I get my first break) - but Jennifer wrote about it on ICI: click to read.

It's these moments where I remember that, only weeks ago, I was adaptive, fulfilled, and happy.

Why? I had an epiphany as to why. And, finally, I was motivated to write.

I used the word "exercise" above. I very rarely use that word. When I expend physical activity, I refer to it as "training." I am always training. I always have an overarching goal for which I am "in training": whether it be to prepare physically/mentally for my next Century ride, to increase my lactate threshold to x bpm, to lower my resting heart rate, to be able to climb x hill at y heart rate, to be a more "automated" breather, etc. etc. For every given training session, I have specific objectives to achieve these goals: specific heart rate parameters, a specific plan, and specific issues on which to focus with specific reasons for doing so (i.e., "today I am going to focus exclusively on perfecting my wrist alignment -- because when I ride outside, I re-injure my old wrist ligament injury even when I'm not grossly leaning on the handlebars"). When I get uncomfortable or tired or discouraged or otherwise tempted to quit, I remind myself of my goals.

I've written ad nauseum about the importance of "training for something," and of encouraging my riders to identify what their "something" is. When I train people, I educate them and empower them to make choices consistent with their values -- with their "something." They always know "why they're riding," because they set out with specific goals and priorities from the onset. It means something to them.

On my first rotation, nephrology, I didn't show up with any specific goals. I showed up "ready to learn how to become a doctor." That's kind-of like showing up to the gym "to exercise." I would never DO that. Armed with my uber-specific goals and sub-goals, not to mention my heart rate monitor, I'd have WAY more purpose than that -- merely walking into a gym. Why was I not approaching my career the same way? Had I had specific objectives and strategies, perhaps my days would have at least had the illusion of greater structure and purpose. When a patient on my service died every few days, maybe I could have remembered what I'd identified as my reason for being there. Maybe not. But maybe.

Last week, I started my psychiatry rotation. I'm on the dementia unit, which is truly as sad as end stage renal disease. I'll write on my other blog eventually about the important differences between these experiences -- but the one noteworthy for now is that I started with specific goals: 5 things about psychiatry that I wanted to see, understand and internalize to best enable me to serve people in primary care (I'm going into Family Medicine). I thoughtfully developed them, ran them by my mentor back in VT (a family doc), and hit the ground running.

This changed everything. I show up every day with purpose, move through my day with a specific agenda -- and in the process of so doing, actually end up being more useful to both my team and the patients for whom we care. It's still a largely discouraging experience being surrounded by so much brute hopelessness. But in defining a purpose, it's easier to restructure one's attitude and outlook. Having a specific goal allows one to experience those "moments" that make it all worth-it, moments one chooses to create and structure. I'm finally training for something, something of which I can remind myself every time it gets tough. And when I've learned what I've set out to experience, I won't merely feel like I "survived." I'll feel like I actually accomplished something.

As on the bike, as in life... as per usual.

Tuesday, February 9, 2010

"Game On": The Ride, The Mindset

Sigh. I didn't mean to go this long without blogging, here or on my "life blog."

So much has happened in the past month that I was really supposed to capture, process, and "re-structure" in some sort of meaningful way. I testified before a state legislature (I now live in a state where one can just up and go talk to The Government). My classmates presented me with an award so overwhelmingly meaningful to me that I bawled in front of 100 people like a buffoon. I secured a "yes" from ICI Master Instructor Jennifer Sage to join our instructor team for the Special Olympics benefit endurance event I've helped organize and co-lead the past two years (Sunday, March 21: 6-hour "Ride for a Reason." If you're in New England or thereabouts, you should come!). I've led a bunch of two-hour Spinning classes, where I somehow pulled off keeping people engaged while entirely seated at 70-80% LT the entire time. I created a bunch of really quite creative Spinning classes that I reeeeeeeeeeally should have written up. I taught a bunch of really, truly lousy Spinning classes that I should have reflected on and shared, too. Wrapped up in gauze-like constraints of distraction, doubt, pride, joy, despair, and utter burn-out, I've learned a ton. Both concrete and not-so-concrete.

I didn't write about any of it. Instead, I sat at my kitchen table all day long eeeeeeeevery single day taking thousands of practice questions for Step 1 of my U.S. Medical License Exam (for which I sit a week from today), remembering a time where I had such a good system for documenting and reflecting the experiences of my day in the various realms of my world.

Until today.

Background: I've been training a group of new indoor cycling instructors, helping them develop and practice various stylistic skills above and beyond the technical stuff they learn through certification. Today while giving them critical feedback on demo rides, one young woman whom I've been mentoring for almost the past two years actually moved me to tears. Ours is a unique relationship: I've been training her since her very first indoor cycling class. I've been with her through her entire journey: first, cycling shoes -- then, a heart rate monitor (not to mention her first LT field test) -- then, her Spinning certification. Ever since she decided to 'pursue her calling' to share her passion and knowledge with others, she has spent hours developing herself and her craft -- reading, writing, practicing. The first time I observed her demoing a class, she was a total natural. But now just a few months later, she was an entirely different person "up there." Confident, poised, completely owning the room. Describing with great specificity the "experience" she was skillfully creating. And though there was no mistaking the source of many concepts that passed her lips, that's not why I cried. I cried because her presentation was unmistakenly, distinctively "hers." She owned every word of it. This woman is going to change lives.

The irony is that this profound moment of appreciation came at the start of my last week teaching Spinning for the next 6 months (with the exception of Ride for a Reason). After I take my Boards, I move to Portland, Maine to start my inpatient rotations. I'll be back to Vermont in the early summer, but won't re-pick up any classes until the Fall. But the thing is, though it's not by my design exactly, I'm ready for the break. From newbie cyclists riding six-hour rides, to people finding self-efficacy and confidence through heart rate training, to guiding now seven enthusiastic, empowered young women on their instructor development paths, I've done something with this chapter of this realm of my world. Now it's a matter of reapportioning my energy to the other realms of my life that, while not been neglected per se, have not been attended to as they need to be.

But not for another week.

This week, my last week here, is also my last week til this uber-important, life-altering exam. When I came up from my books for air, I asked my roommate (who also parks herself at the kitchen table all day) what my ride should be about tonight. She often responds with something completely absurd ("the enzyme ALA dehydrogenase"), but it's easier for me to re-structure her joke-contributions into a concept of relevance to the masses ("That enzyme may be irrelevant to me -- but not to the guy who's deficient in it and can't make red blood cells! This is a ride about defining what skills are important to you...") than to think from scratch these days. Today, she responded: "About how the Boards suck, and we hate our lives and everything is miserable."

That would quite possible be THE worst possible ever theme for a ride, ever. Game over.

Then, it hit me. "GAME ON!" Staking out a challenge, embracing it as opportunity, developing an arsenal of positive self-coaching, and committing to it til the finish line.

What this translated as was as follows: a 40 minute seated climb at 95% LT.
"Game on!" indeed.

Warmup - 4 minutes
9 minutes - transition from 80% LT (4 mins) to 85% LT (3 mins) to 95% LT (2 mins)
Think about a challenge in your life that you've not yet taken action achieve. Identify the obstacles that have stood in your way, and continue to obstruct you. Connect with your breathing, with the way your body is moving. Feel at peace. Feel strong. Feel confident. Connect with the thoughts and images that empower you, that you can call upon when you need them.

"The Challenge" - 40 minutes
3 minutes: gradually transition (progressive resistance loading) from 80% LT to 85% LT to 95% LT. Find it and commit.
35 minutes: Seated climb at 95% LT
Last 5 minutes: 2x 1.25 min surges to LT

I unfortunately can't make time to write up eeeeeeeeeeverything I talked about (I only allotted myself 40 mis of writing time, then must get back to cramming.) But I'll mention a few concepts I covered with my class -- and this actually might be more helpful to just take the "buzz words" and expand them into something that's "you":
* Investing in yourself
* Establishing comfort with discomfort
* Using breath as fuel
* Choosing to suffer through adversity vs. re-frame your attitude - embracing opportunity to improve, to learn, to grow
* Improvement for the sake of improvement alone
* Patient, self-discipline, focus
* "Let every aspect of your experience contribute to your ability to do this -- your form, your pedal stroke, your breath, the way you're talking to yourself"
* "Perfecting your ability to husband all your resources upon this one task"
* Owning the challenge

Now it's time to husband all my resources upon my task, my challenge. My opportunity to demonstrate the insane number of synapses I've created over the past year and a half, some of which may actually prove to help human beings.

Game on.

Sunday, January 10, 2010

2010: A Ride, and a Year, of Focus

I've had grandiose visions of epic year-end blog posts - The Best Year-End Blog Post Ever, guaranteed to bring tears to the eyes of readers near and far. When that didn't happen, I consoled myself with a promise of The Best Year Kick-off Blog Post Ever, inspiring the masses to charge forward into 2010 -- and in so doing, re-focus myself. That's why I write anything, ever, after all. But that didn't happen either.

Life's not how it used to be. I'm 4 weeks away from Step 1 of my U.S. Medical Licensing Exam, 6 weeks away from moving to Portland, Maine to start my inpatient clerkship rotations as a (gasp) 3rd-year medical student. Hundreds of thousands of "factoids" rush into my consciousness day in and day out: Indistinguisable viruses, contextless drugs, obscure medical eponyms -- all of them a blur, encoding themselves in chalk into my memory. And I haven't been carving out time for all of my go-to brain-decluttering mechanisms (i.e., writing, mindfulness practice, training), and haven't been utilizing any of the skills I've developed over time -- through coaching Spinning, no less -- to give my world a sense of order. I used to, if anything, be "imbalanced towards balance" -- now I'm just so unbalanced, and so unmotivated to do anything to re-balance myself.

This came to a head two weeks ago, when I closed an important chapter of my life: I taught my last New York City Spinning classes (once I start inpatient rotations, I can no longer travel back/forth from Vermont to stay active on payroll). On this final visit to My Old Life over the holidays, I had two very opposite experiences. At the start of the week, I taught a double that was chock full of my old "regulars." I looked out at the crowd and took in the multicolored array of heart rate monitors and cycling shoes. I watched them close their eyes and feel something. And I got tearful. I did all that. I made that impact. What I'd done here mattered, it meant something. But a few days later, when I taught my very last class -- a double at a club where I rarely even subbed and never had any permanent classes -- to a room full of strangers. I'd prepared a ride themed on the concept to which I've dedicated my entire coaching career: "Increase and Breathe" (see description of the concept/training drill on the right-hand side of my other blog). I didn't use the phrase once; nobody would have recognized it. This momentous occasion for me, the final farewell to the final dangling piece that kept me in any way tied to My Old Life, meant nothing. It was empty. I guess it needed to feel empty in order to feel "over." It was so "over" that I wasn't even motivated to blog about it -- or about anything else, for that matter.

But a few days ago, I had an epiphany. What if I just changed the narrative? What if I told myself that the past 2 months were a "recovery" from my life -- as if had been scheduled, like a recovery block in a periodized training calendar (like I wrote about a year ago and, in so doing, kicked off the fluke popularity this blog now enjoys). Just as recoveries from athletic training, this break served the purpose of identifying the life activities/influences that are true requirements for my functioning.

That changed everything.

I taught my first Spinning class of 2010, themed on Committing to Focus (profile will follow).

2009, as you may know from following this blog and the other, was my Year of Commitment. I themed SO many Spinning classes on it, both technical (i.e., committing to specific heart rates by adjusting resistance, speed, position to accomodate continuous self-observation; committing to specific aspects of form and pedal stroke) and abstract (i.e., committing to analysis of self-talk and self-coaching; committing to short-term, specific goals). I inhabited commitment as a concept for myself outside of my Spinning classes: as a medical student, as an athlete (i.e., three Centuries for a first-time outdoor cyclist), and then created Spinning rides as a mechanism for processing the reflections I thought might make a useful structure for others to evaluate their own states of being. It was a great system: Live it, think about it, write about it, make a Spinning ride about it, have total strangers tell you how creative you are, and pat yourself on the head for being useful out there in the world.

Until the commitment-philia of 2009 reached a point where the commitments I made to myself outstripped my resources. So in 2010, that will change. As the demands on my brain and my time continue to pile up to unfathomable heights, I have to focus solely on the commitments that directly keep me functioning. 2010 will be all about identifying distractions, rehearsing coping mechanisms for reigning in attention, and husbanding all resources upon simple, concrete tasks.

So that was what my ride was about.

COMMITMENT TO FOCUS (90 min endurance ride)

Warm-Up (5 minutes)
I shared with my class that my brain is mush - that I'm so unbalanced and unfocused and unproductive, that I've forgotten to go back to the basics that I teach them about all the time: breathing through challenges, using breathing as a mechanism for focus, and identifying specific micro-details of their experiences to practice husbanding their resources upon a given task. After all, creating opportunities for themselves to demonstrate their ability to do this on the bike will give them the confidence that they can do it off the bike.

Part 1: Preparation (15 minute climb)
Connect with your breathing - in through the nose, out through the mouth. This is your base for focus. Any time you get distracted, close your eyes and again connect with your breath. Synchronize your breathing with your pedal strokes - create your own rhythm, perhaps breathing in for 2 strokes, out for 3-4 strokes.

10 minutes at 80% LT (RPE 5). Are you in complete control over your breath? Your form? Your thoughts?

5 minutes at 88% LT (RPE 6). How does this compare?

5 minutes at 95% LT (RPE 7). How does this compare?

What distracts you? What gets in your way? Inhabit those distractions. Ask yourself how they invade your consciousness. Ask yourself how they succeed. What would it take to get on top of them once for all?

Identify the intensity at which you have most control over your breathing, where you feel most in your element. Most alive, most at peace. Where you have the greatest clarity of mind to empower yourself to make important choices, choices that are going to mean something to you.

Part 2: Committment (60 minute climb -- no, I'm not a sadist)
Take the next 3 minutes to progressively load up to your chosen intensity. From there, commit to it for the next HOUR. Pay careful intention to how your body responds to changes in the rhythm, changes in your breath. How your form shifts over time without careful attention. Continue to make the micro-adjustments you need to maintain your consistent target intensity -- when you drop, load resistance; when you exceed, back it off. You have complete freedom to climb as you need to - in the seat, out of the seat - whatever you need (note: my riders know better; they know that this means "stay seated unless you absolutely have to, then sit back down immediately" -- I don't even need to say it anymore).

Your job is to apply the coping mechanisms you anticipated being able to use to combat distraction, that you spent time rehearsing during Part 1. What does it take to reign your attention back in? Appreciate the power in your ability to direct your thoughts, to take control over what you hold important. What can you learn? What will it mean for you?

Note: At the 40 min mark of Part 2 (which was the 60 minute mark of the ride), I encouraged them to take the next 3 minutes to eat their snack that they'd been encouraged to bring to replenish their glycogen; otherwise, they would be biochemically unable to continue to burn fat, even at aerobic intensities. We need a base-level of glycogen present at all times, since we are always burning it (at low intensities, we use mostly fat as fuel - but we still burn glycogen, too), but also as a pre-requisite for fat metabolism itself. So if we deplete it, our hormone cortisol begins to break down muscle to free up amino acids for the liver to use to create its own glucose. Want to prevent this? Consume glucose every 60 minutes during endurance training, and within the hour of training completion (ideally within 15-30 minutes). After the snack, back on the bike - re-load to target, hold another 17 minutes.

Part 3: Charging Forward with Focus (15 minutes)
Two sets of 3x surges (30s, 30s, 1 minute) --> (30s, 30s, 2 minutes)
It's probably been a while since I described how I use the word "surge" with my riders - it's a change in the music (i.e., a chorus) where I empower riders to set it to be the symbolic equivalent of some challenge in their lives off the bike. Thus, they choose how to meet the challenge -- with a change in resistance, in speed, in position, in intensity, or no change at all. The way they choose to meet the challenge is something that is personally meaningful to them -- something that is going to stay with them when they leave the room, something that they're going to think about long thereafter. Something that's going to make them feel strong, self-efficacious.

Each surge is an opportunity to build on the strength, the patience, the determination you've demonstrated to yourself for the past 75 minutes. What have you learned about yourself and your abilities? Where will you take it? For some of you, the challenge you need is that of self-discipline: holding true to your target, even if that's still 80% LT. For some of you, you might need to surge to LT and feel something different. For most of you, it's something in between. Make each surge stand for something you'll remember. Something that will remind you that, no matter what, you have complete control over your choices and your performance. Something that will etch in your mind that, yes, yes you can.


I rode this with my class, after 2 weeks of passive recovery (I didn't purposefully plan it like last year, even though I should have -- and when I remembered that I'd planned this last year and how many incredible benefits '2 weeks entirely off' had for me as an athlete, I again "changed the narrative" and re-defined my laziness as "responsible training." And turns out, yet again, I lost NOTHING cardiovascularly - LT was exactly the same, my resting heart rate dropped 7 beats, and I felt fantastic. Go back and read my old post on the rewards of recovery if you're a non-believer). But most significantly, presenting this ride put me back in a position of balance, focus, and confidence that everything in the world is as it should be.

All I have to do is keep my standards for "should" in check. I'm a medical student 4 weeks away from my Boards. It's ok that my Spinning life takes a back seat for a while. I'll still teach. I'll still write (both here, and for ICI/Pro -- read my latest article on exercise-induced headaches and listen to the podcast interview I did with John MacGowan and Jennifer Sage on how to psychologically train yourself to 'own your awkward' and effectively teach off the bike -- note: the latter requires ICI/Pro subscription -- sign up for free trial to listen, and then seriously consider maintaining it: it's such a phenomenal resource!). I just need to accept that mere mortals don't blog whilst cramming for their Boards, is all. And that's ok.

** EXTRA NOTE: ICI/Pro has extended the offer for a free 7-day trial subscription -- if you register by Jan 15, you can check it out and evaluate the value-added of the (special content, profiles and free music) to your life beyond all of the wonderful free content and podcasts at ICI). I have a feeling that once you see it, you'll stick with it...
Plus, you have access to 0.2 ACE continuing ed credits as an ICI/Pro subscriber. (Come to think of it, I should probably tend to that eventually, myself...)