How I Spent My Spring Break – Why I’m Not Afraid Of AI


Who is afraid of the big, bad AI wolf? Not this radiologist.

As a practice leader I spend about as much time at meetings and involved in other administrative activities as I do in front of my monitors. Thankfully I have partners who are supportive of the work I do and often render phrases of ‘encouragement’ such as, “…I’m glad I’m not in your shoes.”  Gee, thanks!

A few weeks ago during our spring break many key members of our department were on vacation. Sadly, I was not one of them. It was busy to say the least but weeks like that are good for me to remember what a highly skilled and dedicated team I serve.  Needless to say, my reading volumes and ‘monitor time’ were way up that week.

Aside from the RVU-shock I experienced during that week I was inundated with phone calls from all kinds of referring clinicians. I have a core group of providers that I consult with regularly but it seemed that everyone was calling me that week. Many of the conversations started the same way, “…uh…hi…I was looking for Dr. Jones but they said he is on vacation and they put me through to you…”

Many of these calls led to frustration for both parties as I struggled to deal with issues that were generally outside of my area of specialty but we managed to fumble through.  Thankfully, no one was harmed by my lack of facility.

I ended the week physically and mentally exhausted yet emotionally energized by what I had discovered. Despite the notion that some physicians like to promote that marginalize the contributions that radiologists make to the healthcare team, it was clear to me that the opposite was true in my practice. With each phone call requesting a consult, my sense of value for the part our doctors play in caring for our patients was solidified. Yea…my ego took a little blow knowing that I was the ‘second string’ choice; however, that was easily replaced with the pride of realizing that the doctor who they really wanted to speak with had succeeded in developing an important and valuable relationship.

The concept of artificial intelligence and machine learning is getting quite a bit of attention in radiology circles these days. For every radiologist (like myself) who is enamored by this technology there are probably 5 who are afraid of it. Some see it as a death-blow to our specialty. Others see at as a means to create efficiency and cultivate value. Wherever you might fall in that spectrum is immaterial because this technology is here and it will be used to some extent in our lifetime.

I recently had the opportunity to demo such a system for our practice. I was amazed as how this computer took a set of CT images and through several iterations of analyzing clinical and image data, arrived to the correct diagnosis with all of the skill of a third year radiology resident.  This is truly amazing tech and will undoubtedly transform our practice over next two decades.

But I am not worried. I am not planning an early retirement or rushing to enter into an administrative job. I am not worried because of what I learned during spring break.  I am not worried because I know our practice has demonstrated value to our organization. Every time the phone rings (and it rings a lot) we are blessed with the opportunity to add value to our referring clinicians and ultimately our patients. Every phone call, every email, every page, every Epic message is a physical manifestation of the deep and valuable relationships that exist between our radiologists and our referring providers. These relationships were not built overnight and they will not be immediately torn asunder by a CPU.

So next time you find yourself irritated by the ‘non-RVU-generating’ activities you are tasked with just remember one thing. These are precisely the activities that secure your seat at the table. These activities help to build the relationships that demonstrate your value as a living, breathing, feeling radiologist. So answer that phone with enthusiasm!  Of course if the party on the other line asks for “Dr. Watson” you may be in trouble.

Work-Life Balance: Why It’s Not Nonsense


What does ‘balance’ mean to you? One simple definition states that balance is “…a state in which opposing forces harmonize, equilibrium.” I like this definition both because of its simplicity and also because it is the definition that lends itself most well to the concept of ‘work-life balance.’
As a member of my organization’s wellness committee I am very much interested in the concept of work-life balance and try to work to help others in my organization achieve that balance. Recently I came upon a piece written by leadership consultant Jason Lauritsen.  The gist of Lauritsen’s message is this: work-life balance is artificial because too many people are working in jobs that they hate. Lauritsen’s view is that if we can just get people engaged in their work, then they wouldn’t find it so onerous and wouldn’t feel ‘out of balance.’

Lauritsen’s sentiment is echoed somewhat in a response by Michah Yost: Work Life Balance is Nonsense. Both Yost and Lauritsen entertain the concept that work-life balance equates to separating work from life. I think this is where the logic becomes faulty. Both contend that work is part of life and to try to separate the two is a futile endeavor. I would tend to agree with this but I don’t think that is what work-life balance is all about.

Lauritsen states that people who truly enjoy their work and are good at it don’t talk about work-life balance. They don’t need to. The concept is foreign to them. In my experience these are precisely the kind of people who are at most risk for being ‘out of balance’ when it comes to work vs. life issues.

I have friends and family members who I would consider to be ‘out of balance.’ They are ‘always on.’ Vacations are interrupted by cell phones and emails. School programs and sporting events are not attended due to travel and other work responsibilities. There is constant conversation regarding their work. They seem to take great pride in promoting the image of how important or successful they are in their careers. Money seems to be a great motivator and their never seems to be enough.

I don’t claim to be in perfect balance but I’ve been told by colleagues that they admire what I have been able to achieve in my own personal and professional lives to achieve balance. I have a demanding career but it is work that I enjoy. Do I enjoy it 100% of the time? NO! For the most part, my work is stimulating and gives me a sense of accomplishment at the end of the day. Still, when my work schedule keeps me from attending a school event, enjoying a holiday or getting exercise, I feel bad.

I have made choices in my career that have allowed me achieve a greater degree of balance between my work and family life. Some may view this as not reaching my potential. This line of thinking is short-sighted and underscores a fundamental problem we have in this society: WE IDENTIFY OURSELVES BY OUR WORK. If I turn down a leadership position at work in order to have time to volunteer in the community, coach my kid’s sports team or train for an Ironman does that equate to ‘not living up to my potential?’ I don’t think so.

We are not one-dimensional. We are complex beings. We are more than just workers, employees, or executives. The concept of ‘work-life balance’ is not dangerous, not artificial and not nonsense. It is essential to our very being and too often overlooked. To go back to our original definition, the components of our lives need to be in harmony and equilibrium. When I was working 100 hour weeks as a surgical resident my life was out of balance. Similarly when I trained for my first Ironman, my life was out of balance then as well. Just because someone who loves their job or other activities does not PERCEIVE their life to be out of balance does not mean that it is not.

Teaching Old Dogs New Tricks-The Benefits of Dyad Leadership

Kiki relaxing with one of her many charges

Last year my family adopted a seven-year-old great Pyrenees from a local rescue. This dog has been a spirited and welcome addition to our family. For those that are unfamiliar with the breed, the Great Pyrenees is a livestock guardian. It is often used as a working dog on farms and has the instinctual tendency to alert to potential threats. As house pets, Great Pyrenees often adopt small children and other animals in the house as their “flock.” Whether in the mountains where they take their origin, on farms or in our family’s backyard, their instincts remain strong.

We live on a golf course. So there are a lot of “threats” to our “flock.” We spent the entire spring, summer and fall listening to the sturdy bark of our new pet as golfers and maintenance workers make their way down the path along our back fence. This can be irritating. It is particularly irritating to my wife who spends more time at home than I do.

The other day she was wondering what steps we could take to quell the barking.   While annoying, especially at 3am, it is the dog’s instinct to alert to potential threats and I don’t think that she should be punished for that. We knew what we were getting into when we adopted this dog and we have to accept these traits  as they are even if they are somewhat disruptive.

This made me think about management in the healthcare realm and in particular, physician leadership. Too often we select individuals for leadership and management positions based upon their performance as workers. However, all too often very traits that propel somebody to the front of the pack can be undesirable in the board room.

As physicians, we are often bred/trained to act decisively and quickly assimilating large amounts of complex data and making decisions independently in order to protect our patients’ health and/or life. I have seen physician leaders, myself included, admonished for failing to consider all aspects of the situation before making a decision. What many people don’t understand about doctors is that we are trained to do this. When a patient is crashing in the ICU, there’s no time to assemble a task force or hold a committee meeting. A leader needs to step forward and ACT. Act quickly. Act decisively. Act independently.  Few decisions that the physician leader makes on an administrative level have that kind of urgency; however, it is sometimes difficult to turn off that ‘fight or flight response’ we developed throughout our medical training.

So how do we mitigate this instinct to act independently and sometimes rashly when confronted with a difficult decision?  Short of formal training or education in the business leadership or administrative disciplines this instinct is usually tempered over time. The physician leader will make a few mistakes, hopefully not catastrophic, and learn from those experiences.  We are, after all, exceptional students.  However, not all physician leaders are ‘retrievers.’  By retrievers I mean friendly, malleable and easily realigned.  Some, many, are more like the Great Pyrenees- intelligent, bold, stubborn but fiercely loyal.

One of the things we learned about the Great Pyrenees breed before we adopted was that they require a strong master.  Does this mean that physician leaders need a strong ‘master’ as well.  Well, not exactly,  but they can benefit from good partnership and mentoring.

Our organization utilizes a ‘dyad’ leadership structure that pairs a physician leader with an administrative leader.  While the strength of any dyad partnership is dependent on the individuals involved, for me, it has been extremely advantageous.  My administrative partner helps to temper some of the aggressiveness, boldness and sometimes impulsiveness that I have been rewarded for throughout my years as a medical student and physician.  When properly constructed, dyad partnerships are more than just complementary but rather synergistic with the value of the pair being greater than the sum of its parts.  Ideally, dyads will evolve into their respective roles together, each taking on the more desirable traits of their partners in exchange for the abatement of less functional attributes.

We must understand what we are dealing with when we elevate physicians to leadership positions.  Any healthcare organization will benefit greatly with strong physician leadership; however, it is important that the tools and processes are in place to ensure that the proper choice is made initially and ongoing development is fostered.  Dyad leadership is not the answer for every organization but it can be a very powerful tool to keep physicians engaged in high levels of organizational leadership while ensuring that administrative leaders have the clinical data and expertise to make appropriate decisions.



Still Fond of Fondos-Getting Dropped By a Tandem Edition 

My friends and I just completed our second Rollfast  Gran Fondo Sunday in Carmel, Indiana. Once again, the race organizers put on a well run, well supported event with even more fried chicken this year.  A new feature this year was the opportunity to participate in a charity event the night before which featured the event special guest, professional cyclist and TV commentator, Bob Roll. The best part of the whole event, however, for me was the performance. If you would’ve told me a week ago that I would’ve averaged north of 19 mph for a century ride I would’ve asked you what you were smoking. However that’s exactly what happened. But as always, there’s a story behind it.

The event Saturday night was held at a local bike shop called Bike Line  which is a very well appointed and well stocked Trek house in the City Center of Carmel, Indiana. A relatively small group of patrons were allowed the chance to enjoy cocktails with Bob Roll. It was a fairly casual and low-key event. The event hosts did a great job of making sure that Bob got face time with each and every attendee.

Steve and Bobke signing autographs


After making his rounds and visiting with individual guests, there was a very entertaining Q and A session. During this time Bob fielded questions from the group ranging from such pressing matters as who does the laundry for the team to doping. This was by far the best part of the evening. Bob is a seriously funny guy and definitely has a gift for gab. He spoke of what a great rapport that he and his co-anchors on NBC have and how much fun it is to work there. However, he’s not above razzing as partners a bit. He does great imitations of Phil Liggett and Jensie.  Bob bragged that NBC provides the best coverage of the Tour de France in the entire WORLD. I don’t think this is just the company line, I think he truly believes this. And after his imitation of the German feed of the Tour de France, I hope I never have to watch the tour in Germany ever, ever, ever!  At the end of the evening, event  owner Matt Tanner presented Bob key with a custom made Silca floor pump. The proceeds from this event are to be donated to a local police charity.

Matt Tanner presents Bobke with a custom Silca floor pump 

Race day started with fairly chilly temperatures at the start. I was in three different layers on top which I never really shed throughout the entire ride. Full fingered gloves and a skullcap completed the outfit. Still, I was pretty cold in those first few miles. We met up with some friends from last year.  Our friend Brooke, undoubtedly the Queen Bee of the North Indy cycling scene, greeted us with enthusiasm.  We also met up with our pal Oscar who rode with us last year. Between us and their collection entourage, we had a good group in the making.  Brooke was going in a tandem this year with her boyfriend, Ed.  We have never drafted off a tandem before.  Cliff warned me this could get ugly.  And it did.

In contradistinction to last year, the new venue and mass star went quite a bit more smoothly. The pace getting out of town was steady and the pool time seem to be able to negotiate the roundabouts with more is this year compared to last. We found ourselves in a fairly large group to start. We were towards the back which made for fairly effortless peddling. Just a few miles in we lost Oscar due to a mechanical. That was the only dark cloud of the day.   By the time we reached the first rest stop at about mile 25, my average heart rate was barely in the 100s. After the first rest stop the large group began to splinter her a bit, and we found ourselves in a slightly smaller though still brisk group. We continued to average 19 to 20 mph.

At some point between the first and second rest stop, our friend Cliff fell off the back not to be seen again until the finish line. When we pulled in to the second rest stop I was still feeling pretty good but ready for some fried chicken. The event planners did not disappoint. There was more than enough fried chicken to go around and I certainly had my fill. Properly refueled on fried chicken, carrot cake and some fresh fruit we were ready to head out again for the second half.

The pace remain fairly brisk between the second and third rest stop. At one point at about mile 70, we missed a turn in a small town and the group splintered. I found myself having to sprint to catch up to the main group. When I finally caught up to the rear rider he apparently was suffering and before I knew it he dropped back several lengths from the main group. Now I had to play catch up again. This wasn’t going to happen. My friend Steve and I rode by ourselves for the next few miles until the 77 mile rest stop.

Heading out from the third and final rest stop, we vowed to keep the group together. Though with good intentions this wasn’t to be. I had spent a fair amount of time upfront pulling and my legs were starting to get tired. Some stronger roadies and triathletes in the group started pushing the pace to the 22–23 mile an hour range and I just didn’t have it in me. A small group of faster riders including our friend Brooke and her boyfriend on a TANDEM and my friend Steve pulled out in front not to be seen again until the finish line. There was a slower group behind me and I found myself more or less alone until a triathlete named Kathy appeared on my rear wheel.

As it turns out, Kathy was training for Ironman Louisville- a kindred spirit. We spent the last several miles riding together and talking about the race. This is to be her first Ironman so I was able to give her some of my perspective on the course in the race in general. She was telling me that in addition to adding another 10 miles to her ride upon completion of this century she was planning to do a brick run. I mediately had flashbacks to my Ironman training days and I began to feel nauseated. I wished her luck as we crossed the finish line together and she went on her way and I turned back to City Center.


My “After”

 Back at City Center, I rested my legs, ate some pizza, drank some great beer from Sun King Brewery and listened to live music. I was fortunate enough to win one of the great door prizes offered by the race. Steve and I hung out and waited for Cliff to cross the finish line.

All in all it was a great day.  The weather, though a bit brisk at first, was really quite nice by mid morning.  I was very pleased with my performance…other than getting dropped by a couple on a tandem.  But I digress.  We will be back next year.  This is a great event and I would encourage all cyclists within a few hours drive of Indy to give this a try next year.  I hear the special guest might be someone equally as special as Bobke!

From Left to Right:  Cliff, Me and Steve 




Collaboration Versus Competition

The other day my wife and I were attending a parent information night at our daughters’ school. Our girls attend a small private school that utilizes a well-known alternative teaching method. During the course of the presentation, the teacher spent some time outlining the guiding principles of this alternative method. On this list of teaching philosophies was a bullet point that caught my attention. It read “collaboration versus competition.”

As a medical educator, this struck me. I’ve been reading a lot lately about what is wrong with medical education these days. It seems there are many who  feel there needs to be more emphasis placed upon “soft skills” rather than hard science. It is felt that enhancing these skills trains better physicians with greater ability to relate to patients.

I cannot say that I completely disagree with this idea. Having come up through a traditional medical school model and post-graduate medical training, I can see in my own self the changes that occurred  which can more or less be attributed to the system. This system breeds an ultra-competitive environment. As college undergrads we compete fiercely for GPA and MCAT scores to gain entrance to medical school. While in medical school we compete with our classmates to gain acceptance to coveted residency programs. While in residency, we work hard to distinguish ourselves among the group so that we can gain access to highly sought after fellowship training programs or practice opportunities.

It would be nice to say that the competition is limited to the educational and postgraduate training years but unfortunately it is not. Practicing physicians having gone through years of competition cannot shed this attribute easily. They often go into practice and continue to compete only this time for development of patient panels, income/compensation and now the increasingly important patient satisfaction scores.

Now more so than ever the practice of medicine has truly evolved into a team sport. Delivery of care that is compassionate, high quality and cost efficient will require adherence to the other “C – words.” These are communication, connectivity and collaboration. In order for the healthcare team to function effectively, the individual needs to be de-emphasized and the collective team approach should be championed. The good of the patient needs to be put in front of everything and failure to meet the needs of the patient should constitute a failure of the entire healthcare team.

I am fortunate in that I have the ability to participate in the development of a brand-new medical school campus. As a medical educator this is perhaps the most exciting prospect of my career. I see this as an opportunity to help create a new environment that rewards collaboration over competition. This would only make sense as this medical school is being born out of the collaboration between a major University and a private hospital. Furthermore, this new medical school, much like my daughter’s elementary school, will be an alternative educational venue. The school will be developed to marry the disciplines of medicine and engineering. The concept of collaboration is at the very crux of the development of this new institution. I can only hope that this spirit carries forward into the teaching methodologies of its future students.

I’ve been in practice for nearly 13 years. During this time I’ve seen rapid changes occur in the practice of medicine. It is essential that medical schools and postgraduate training programs adapt quickly to these changes. It is important that we are equipping the young men and women who carry our profession forward with the right tools to succeed.

I am not naïve enough to think that we can completely eliminate the competitive nature of medical education. There will always be some element of it being a “numbers game.” However, I don’t believe that there is a medical educator out there who can refute the idea that we all can do a better job of preparing our students to function as effective members of the healthcare team. This means more emphasis on developing communication and interpersonal skills. Perhaps medical students need to participate in more group project type activities like business school students. However,  it is incumbent upon us as the educators to lead by example. We ourselves need to change. We as educators and practicing physicians need to model the type of behavior that we expect in our students.

In closing, think about this. Many times when the healthcare system fails a patient, it is not based upon a cognitive or technical error. Often times is the result of a poorly functioning team and lack of effective communication. We’ve done a reasonable job over the years in teaching our students the hard skills needed to become physicians. However, we now need to expand this, to foster an environment of cooperation and collaboration. This will ensure that our students will thrive in the profession throughout the years to come.

Top 5 Reasons Why The Beach Is Better Than Disney World

The bulk of my vacation time is spent in Florida either at Walt Disney World or on the beaches of South Walton.  I am just going to come out and say that I hate Disney.  I only indulge a WDW vacation for the sake of my wife and kids who are Disney aficionados…not Disney Geeks…but aficionados.  But I feel the need to back up my disdain for the swampy resortland that is WDW.  As I sit on my balcony with a cool gulf breeze tickling my head stubble, sipping a pomegranate-citrus mojito I have had a chance to organize my thoughts as to why this is the case.  SO….here are my top five reasons (in no particular order) of why the beach is better than Disney.

1.  COST.  I don’t care whose mouse butt you’ve been kissing, there is no such thing as an affordable Disney vacation.  Whether it is lodging, meals, park tickets or all the extra crap, a WDW vacation will be sure to send you into debt snowball hell and cause Dave Ramsey to vomit incessantly on your behalf.  Forget all the talk of special deals, meal plans, etc., WDW vacations are expensive beyond belief and I honestly don’t know how most people afford them.  The beach on the other hand is about simple pleasures.  The only parades you will see at the beach are of cosmetically enhanced southern women trying to be sexier than their teenage daughters.  But I digress.  We don’t need theme parks or nightly firework/lightshow displays to be happy.  Give us the crashing waves and a nice walk on the beach.  The other day we rode a roller coaster that had to be pushed by the attendant by hand to get started.  No joke!  The scariest thing was wondering whether the whole thing was going to come crashing down.  The only castles you will see are built by hand…by children.  Nobody is a princess (except for those southern women) or prince…everyone is a dude.  That is what is good for the soul…and the bank account.

Hunting For Shells on the Emerald Coast-SIMPLICITY

2.  LINES.  I am admittedly one of THE most impatient beings in the entire world.  If I had to wait in line to get into Heaven I would opt for purgatory or Hell just to avoid the line.  That said, WDW is a special kind of hell for me.  Where else can you spend ridiculous amounts of money to spend probably a third of the time waiting in line.  It’s egregious.  Sorry folks, the Haunted Mansion ain’t worth a 90 minute wait!  And FASTPASS my ASS!  These are not the answer.  They are too restrictive.  What WDW really needs is a VIP pass that gets one to the front of the line ALL DAY LONG- no restrictions.  I would actually pay good money for this as I would actually be able to get my money’s worth out of the theme park instead of waiting in line all damned day.

3. FOOD.  Everywhere you go there is food and not the good kind.  My wife and I are fairly health conscious but ferchissakes one can only resist a Dole Whip or Mickey Ice Cream Bar for so long.  And don’t get me started on those turkey legs.  Damn!  They look and smell so friggin’ good but my wife has threatened me with divorce if I ever ate one in public….so.  WDW is not the place for healthy eating. At the beach it’s all about freshness.  We have twice weekly farmers’ markets, fresh seafood and fish tacos….I repeat… FISH. F&^%ING. TACOS.

4.  PHYSICAL ACTIVITY.  Not only am I eating like a king at WDW but I’m deprived of my most basic of human needs…a WORKOUT! I am a triathlete so I am pretty versatile in how I can exercise but WDW seems to have a way to prevent me from doing pretty much everything.  The resorts are land locked by insanely busy highways which make running or cycling outside difficult at best.  There is not a pool anywhere in the greater Orlando area that is remotely hospitable to lap swimming.  I suppose I could avail myself of a spin class at the resort health club but that’s about as lame on vacation as it is in real life.  I’ll pass.  In contrast, the beach begs me to be active.  I can run, ride my bike, swim in lap pools or the gulf.  Hell, just playing out in the surf with my kids for a few hours burns enough calories to entitle me to snow cone or two.

Me and Da Gubna

5. SCHEDULES.  I spend my entire working life getting up early, working late, tied to my desk. I have meetings, lectures and other commitments.  Oh and let’s not forget all the scheduled family activities such as sports, etc.  Vacation is supposed to be break from that.  So explain to me how getting up at 6am so I can be at a 7am character breakfast and in the park by 8am is the least bit relaxing.  I much prefer ‘beach time.’  You get up whenever.  Maybe you go to the beach.  Maybe you go to the pool. Maybe you ride your bike.  You wanna crack a Dale’s Pale Ale at 10am…go ahead.  There are no schedules at the beach.  It’s five o’clock somewhere…all….the…time…at the beach.

OK…so there it is.  Maybe you agree or disagree.  Maybe I secretly long for a ride on the Rockin Roller Coaster.  I’ll never tell.

A Real Pain in the Ass for Cyclists



My  legs have been pretty heavy this past week. My runs have been tough and my last road ride on Friday morning left me with some soreness that I’ve not experienced before. I knew I was going to be in the car all day Saturday so I was looking forward to a day of rest.

Apparently 14 hours in the car wasn’t exactly the kind of day off that my legs needed. I woke up Sunday morning with a terrible pain in my left hip, buttock  and shooting down my left leg. By now, most of you are probably thinking that I have a lumbar disc/ sciatica problem. While that is a good thought, I’m here to tell you about what I think the real problem is: Piriformis syndrome.

Piriformis Syndrome, or PS as I will heretofore refer to it as, is the condition usually afflicting athletes such as runners or people who sit a lot. I know…damned if you do….damned if you don’t!  It’s caused by inflammation of the piriformis muscle which is a hip stabilizer deep in the buttock region. When this muscle becomes inflamed it can actually impinge upon the sciatic nerve causing symptoms that are very similar to lumbar disc degeneration.

When I palpated my ass through my lycra spandex cycling kit this morning I could feel a knotted muscle and there was a definite trigger point that caused shooting pain down my leg.  Otherwise, most of the time the pain is nagging and seems to be aggravated by lateral hip and thigh movement.  Sunday afternoon I was out in some moderate surf playing with the kids at the beach and I could tell every time the waves shifted me to the left and required resistance.  It hurt.  Not terribly but noticeable.

So why am I pouring all this out in my blog.  Trust me, I’m NOT  looking for sympathy.  It’s more of a PSA.  Judging by the number of lumbar spine and hip films I read each week, these are common presenting complaints by patients to their doctors.  A suspicion of lumbar disc disease usually exists and an imaging workup will ensue.  This could involve xrays, CT scans and even MRIs.  This is expensive and involves radiation exposure.

I know, I know…I shouldn’t be discouraging medical imaging.  After all that is how I make my living.  But I actually care just a  little about you guys.  So here’s the deal.  If you are an active dude or dudette and have these symptoms keep this diagnosis in the back of your mind and mention it to your doctor.  If he/she is not a sports medicine physician, then they might not be keyed into it and will go down that path of lumbar radiculopathy.  That can lead to expensive diagnostics and treatment.

It seems the treatment for PS is actually pretty conservative.  It is recommended that the offending activity be curtailed first and foremost.  REST.  Ah…well….if you are reading this you might be an endurance athlete and we don’t do rest well, do we?  Anti-inflammatory medications might also help in acute flare ups.  Direct massage of the affected area can be helpful.  Sometimes the piriformis muscle can be palpated as an over-contracted ball of muscle in the buttock region.  Direct massage or using our great friend the foam roller could help.  There is also some stretching that can be done to alleviate the symptoms.  If you are not comfortable massaging your own ass you can always call this guy.



Otherwise some alternative forms of treatment such as osteopathic or chiropractic manipulation might be of use.  I can tell you that 5 minutes of self massage really provided me some relief before my ride this morning.  The point of the all this is that if PS is really what you are dealing with and not lumbar disc disease then you shouldn’t need a bunch of expensive tests and treatment.

Anyway, I hope my sore ass and thigh have helped you understand a little about the little known entity that is Piriformis Syndrome. Keep it mind (or your doctor’s mind) if you are having butt pain and shooting pain down your thigh and leg. Stay well my friends!

With My Left Hand Free…

No.  I’m not paying homage to Alt-J but I love that song and love the band.  What I’m referring to is my new life connected to my Garmin Vivoactive smart watch activity tracker.  I’ll explain.

First off, this is the best activity tracker for endurance athletes.  Aside from tracking your steps it has built in GPS (doesn’t require your phone) and comes loaded with widgets and apps for various activities such as swimming, biking, running, walking and treadmill workouts. There are smartwatch features as well.  At less than $250 it’s a great value.  It’s slim stylish and lightweight.  I love it.  But don’t take my word for it.  Check out this most excellent in-depth review from our good friend DC Rainmaker.

I bought the Garmin Vivoactive for a couple of reasons. First, I am, after all, a fitness metric junkie. Any activity worth doing is only worth doing with a GPS device. Second, like many of you, I’ve seen the research that talks about the dangers of the sedentary lifestyle. I was quite dismayed to read that even though I log many miles of running, swimming and biking each week, my cardiovascular disease risk is elevated because for most of the day I am sitting at my workstation pounding through x-rays, CT scans and MRI scans.   It is quite easy for me on a busy day to sit at my desk for hours at a time uninterrupted. For this reason alone, having an activity tracker that vibrates and tells me to get my ass out of the chair every hour or so will pay great dividends to my health  down the road.

So let me tell you little bit about how wearing an activity tracker changed my behavior and is improving  not only my physical health but all my also my professional well-being.

The hourly reminder to get up and walk is very useful to me. Admittedly, sometimes I can’t get up and walk when the Vivoactive tells me to but for the most part I try to leave my chair and at least do a lap around the department if not longer. Aside from the obvious health benefits of leaving one’s chair and walking a little bit several times a day, the Vivoactive has improved my professional standing as well. Something funny happens when you get up and walk around at work. You see people. You talk to people. When you’re in a position of leadership like I am, people tell you problems that they expect you to act on.

The simple act of getting up once an hour and making a lap around the department has connected me with my physicians and staff. Admittedly, there are certain areas of the department that I will avoid because I know if they see me it’s going to turn into an hour-long sufferfest pity party.

But there’s no denying the fact that donning an activity tracker keys me into my activity and lack of activity. It gets me out of my office and into my department actually talking to people while improving my health. I realize this seems simple enough but trust me on a daily basis this was not happening. Now when I sit for more than an hour my watch buzzes and I have to get out of my chair in order to reset it. Sometimes I can do this, and sometimes I can’t. However, I try my best to obey the watch’s promptings and I’m doing better. Let’s face it.  Modern living has made us lazy, fat and sedentary. There would be no need for these devices if that were not the case. Even somebody like me who is considered very active but works in a sedentary job will benefit from this device. If you haven’t taken the plunge and bought an activity tracker, I would highly suggest checking one out. There are many on the market and depending on your needs and level of activity there should be a right purchase for you. For the endurance athlete who likes to swim, bike and run, the Garmin Vivoactive is really the perfect fit.

Ha!  But I forgot to explain the title of the post and the biggest change in my behavior that can be attributed to my new watch. You see in order to track the steps the watch has to detect a swinging motion. And since I wear the watch on my left hand I have to keep my left hand free. If I’m carrying coffee or walking the dog and my left arm is in swinging, my steps to get counted efficiently. And you know me, if I’m wearing the watch then my stats have to be counted and my data must be uploaded to Garmin Connect.  I’ve got to beat my peeps…that’s what its all about!

Sharing the Road

I’m noticing more hostility towards cyclists these days.  I’ve logged thousand of miles on city streets and country roads and have rarely been harassed by motorists. Lately that seems to have changed. Just last week our group has had angry words, close passes and some dude traveling the opposite direction down the road lay on his horn angrily because we had the audacity to be riding the other direction, on the shoulder, not obstructing traffic. Sorry for existing, asshole!

There seems to be a war of words of sorts brewing in our community.  A collection of editorial letters to the News-Gazette have argued both sides of the issue of cyclists on the roadways and support for cycling infrastructure.

At the heart of it all is the local community effort to re-purpose abandoned railroad tracks into a multi-use path. The so called Kickapoo Rail Trail has been many years in the planning stage but is finally starting to come together. The funding is from a combination of private donations and state/local grants.

Any time public funds are used for something that doesn’t involve automobile related infrastructure, storm water drainage or public safety you know there will be some dissent. The first blood was drawn with this letter to editor back in June. This was rebutted by this well written though apparently not entirely accurate missive by my old riding buddy, Rich McClary.

Let me just go on the record as saying that I can see both sides.  As a cyclist I am a strong supporter of the Kickapoo Rail Trail project. The trail head will be less than two miles from my home and I look forward to sharing many miles on the new path with my family and friends away from the threat of speeding cars and poorly maintained road surfaces.

However, as a taxpayer, I can see the other side too. Every year I write checks to the county to support public schools that my children do not attend, a library we rarely patronize, buses I never ride and police/fire protection that thankfully we have never needed.  But I am not complaining.  This is part of being in a community and supporting infrastructure and services that add value to the community.

The Kickapoo Rail Trail can certainly be considered an added value to Champaign and Vermillion Counties. It is not a “bike path.” It is a multi-use path. If one looks at the health and wellness benefits alone it is worth it. Our current poor state of public health can be almost entirely attributed to poor diets and lifestyles devoid of adequate physical activity. On either end of the Kickapoo Rail Trail there are ample recreational resources, the nearly 25 mile stretch of the multi-use path will give citizens in unincorporated areas of our two counties access to a safe venue for physical activity whether it be walking, running or cycling. There is no good argument against investing in our community health.

I am more than happy, as Mr. Hildreth suggests in his letter,  to pay an annual license fee or even a nominal surtax on bicycles and related gear if that money were used for the sole purpose of supporting cycling infrastructure and educational/safety programing. I would also expect such arguments against these projects to be silenced since we cyclists would be paying our fair share…perhaps more as we would be subsidizing the runners and dog walkers who will utilize the trail.  But, hey, fair is fair, right?

Despite the controversy, I think it is safe to say that cycling will continue to grow both for recreation and a means of transportation. The miles of bike lanes in cities large and small continue to grow. Certain large cities such as Chicago, Minneapolis and Washington, D.C. have invested heavily in cycling infrastructure and these resources are heavily utilized. If you’ve ever driven in Chicago or D.C. you would know why.

In closing I would like to offer of glimmer of hope. While it seems there is so much hostility towards cyclists on the road these days sometimes you find friends in the most unlikely of places.  This past Sunday a couple friends and I were on long ride heading south and east from Urbana. About 35 miles or so into the ride we were in need of fuel. After some jogging around to avoid fresh gravel and parked freight trains blocking the road (yes we were that far out of civilization that trains just block the road) we ended up in the burg of Newman, Illinois.

Nestled on US-36 in Douglas County with less than 1000 residents, Newman was the kind of place that if ever I thought people would be inhospitable to cyclists, this was it.  Boy, was I wrong. We arrived at the local filling station just after it opened at 8am.  Some locals were already starting to fill in.  As I was parking my bike and getting to go inside to drain my bladder and fill my belly a burly dude walked up and greeting me offered  the parting words of “safe travels.”  After I got my Gatorade and Starbucks Double Shot Mocha extravaganza I was outside getting loaded up. At this point a group of three older gentlemen probably in their 70s or 80s walked up and talked to us. They were quite impressed that we had ridden our bikes all the way down from Urbana and that we were riding back!  They chatted with us for a minute before wishing us well and heading inside for their coffee.

When we make our mid-ride pit stops it is rare that we are engaged by locals.  Usually we just get strange and unfriendly glances from people because we are, after all, a bunch of grown men in tights.  But here we were in the seemingly most inhospitable locale for for a road cyclist and the locals were actually friendly.  What  a pleasant surprise.

This episode last Sunday gives me hope.  I now realize that despite the negative interactions I have had recently with motorists, the vast majority respect my right to occupy the road and treat me as such.  I’ve also learned a little about judging without knowing. Perhaps the next time there is a southerly wind we will find ourselves back in Newman and perhaps grab a bite at the Country Junction or Pizza Man.  They’re good people those Newmanites.

Veggies…From Side Dish to Main Course

My wife is always saying that she is ambivalent about meat. She will eat it because that is what I cook but in the end she would probably be happy eating a non-meat diet.

Last summer while visiting Chicago we happened to be at Eataly during the lunch hour. If you haven’t been to this place I don’t even know how to begin to explain it other than it is a foodie’s wet dream. It is gourmet grocery, wine shop, butcher, fish monger, cheese shop, cafe and multiple restaurants rolled into one. We decided to stay for a bite.

We were looking for something light, maybe a nice salad and a glass of wine as we had already and would likely continue to be eating our way through the Windy City. The pasta, pizza and heavier offering of most of the eating venues did not appeal to us.

Then we ended up at Le Verdure, the vegetarian restaurant. I ordered the Verdure Alla Piastra which was a seasonal blend of flat top grilled veggies with farro finished in a light vinaigrette. The dish was AMAZING especially when paired with a bottle of Peroni.

As I finished this dish, immensely satisfied, it dawned on me: this is what happens when you elevate vegetables from an afterthought to the main course. This dish, really this whole restaurant, was dedicated to doing just that. This is what it takes to eat and really enjoy a plant based diet!

We’ve been bombarded with the messages from the Pollanists and Food Incans that meat is bad and veggies are good.  OK, I get it. We all need to eat more plants in our diet. However, I am overcoming decades of what can best be described as systematic oppression of vegetables.

I’m sure my experience is quite similar to others of my generation in that fresh vegetables were not a staple at our dinner table. Our cupboards were full of vegetables…in cans. Our freezers had their fair share too. I just don’t remember eating many fresh vegetables other than the crisp iceberg salads dripping with bleu cheese dressing and covered with croutons on steak nights. Oh, I almost forgot the most popular fresh ‘vegetable’ in the Midwest: sweetcorn! That marvelous ‘vegetable’ sweetcorn, roasted to perfection on barbecue nights, the kernels on the edge browning ever so slightly with carmelized goodness. But I digress.

I go to the supermarket and carefully choose the ribeye steak I will eat for dinner. I look it over from every angle from behind the butcher case glass. I check for marbling and color. I assess the thickness and compare my object to her brood. I want the best steak.

Contrast the above ritual to my hustle through the produce section. I grab and go. I have been known to come home with peppers that have noticeable mold on their undersurfaces only I never noticed because I didn’t care enough to look.  It’s a vegetable ferchrissakes!  It is an afterthought.  Garnish.  Nothing to put any thought whatsoever into. Well…that has been the problem.  And I suspect many treat their vegetables in a similar manner.

In the months that passed since our visit to Eataly, my wife has incorporated more veggies into her diet. Our cupboards are full of all kinds of stuff…some things I have no idea what they are. She cooks these veggies in such a way that I am sometimes tempted to put down my steakknife and indulge. They are good. They satisfy. They are interesting.  Why? Because she gives them the attention they deserve.

I guess our relationship with food can be likened to that of our interpersonal relationships.  The more satisfying ones come from attention, devotion and caring. You get out what you put in. So maybe it’s time to give our vegetables a bit more attention.  Give them that 50% of the real estate on your plate. Try an interesting recipe. GASP!  Go meatless on occasion!  Perhaps we will all be better off.

Watch this!