tag:blogger.com,1999:blog-51851903856882300482024-02-20T07:19:25.996-08:00Athletic seniorToward physical excellence -- for older people who are serious about fitness and training.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.comBlogger40125tag:blogger.com,1999:blog-5185190385688230048.post-11952844754816994612015-04-17T12:56:00.002-07:002015-04-17T13:04:37.356-07:00Podcast: NPR Fresh Air on longetivity -- listen while you are trainingI just listened to <a href="http://www.npr.org/blogs/health/2015/02/26/389261354/from-naked-mole-rats-to-dog-testicles-a-writer-explores-the-longevity-quest">an interview of Bill Gifford, author of Spring Chicken, a book on longetivity</a> on NPR's Fresh Air.
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The title of the book sounds a bit frivolous, but the book is well researched -- based on interviews of scientists and exceptional old athletes. Some of his advice, backed up with data: exercise, stay thin and avoid human growth hormone.
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I'm not sure if there is enough actionable information to justify reading <a href="http://www.amazon.com/Spring-Chicken-Young-Forever-Trying/dp/1455527440/ref=cm_cr_pr_product_top?ie=UTF8">the book</a>, but it has a 4.5 average rating on Amazon.
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeUmM1TNg82nKgvo0v2Ngl3Ojeml-REEbT3x4nA-ApeOBkH59pbqCjpNx8L6IP0co8R3S7RaJz2bGfwD3-mVoa8nLrvltw4Qj9xVzgEjAq1lcFrhrkzJ4w8m1IUJmydmY4Cr34G25fHOc/s1600/springchicken.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeUmM1TNg82nKgvo0v2Ngl3Ojeml-REEbT3x4nA-ApeOBkH59pbqCjpNx8L6IP0co8R3S7RaJz2bGfwD3-mVoa8nLrvltw4Qj9xVzgEjAq1lcFrhrkzJ4w8m1IUJmydmY4Cr34G25fHOc/s400/springchicken.jpg" /></a></div>
Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-2803662254689907702015-04-16T14:29:00.002-07:002018-02-06T12:10:35.092-08:00Inspiration for old atheletesSir Ranulph Fiennes <a href="http://www.bbc.com/news/uk-england-somerset-32260854">completes the desert race Marathon des Sables</a>, covering 156 miles (256km) in six days.
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyfIse7CoOs9W44aURwFE3Jo9VNheeyTOn9F-0nOzzb87yWpSAx8Hd9Q8nB9PJV1WvWZx2K8YETJ4YyF3YyhuXbI9ZP71eyw9CDEe4VYmz217sp13iR4zFDUcgOS4ubKmTs3G_ekSySFw/s1600/oldrunner.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyfIse7CoOs9W44aURwFE3Jo9VNheeyTOn9F-0nOzzb87yWpSAx8Hd9Q8nB9PJV1WvWZx2K8YETJ4YyF3YyhuXbI9ZP71eyw9CDEe4VYmz217sp13iR4zFDUcgOS4ubKmTs3G_ekSySFw/s400/oldrunner.jpg"></a></div>Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-4010399334004374922011-08-12T14:22:00.000-07:002018-02-06T12:11:36.029-08:00CBS News photos of old athletesCheck out these <a href="http://www.cbsnews.com/2300-204_162-10008936.html#ixzz1UqJa9fiT">photos of old athletes</a> in action.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com3tag:blogger.com,1999:blog-5185190385688230048.post-3380423054131980602011-03-07T05:10:00.000-08:002011-03-07T05:19:55.037-08:00McMaster University: Exercise compensates for mitochondrial DNA damage in miceThe mitochondrial theory of aging postulates that the lifelong accumulation of somatic mitochondrial DNA (mtDNA) mutations leads to progressive decline in tissue function. To what extent can exercise slow that decline?<br />
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Using mice that were genetically engineered for elevated mtDNA mutations, researchers at McMaster University found that 45 minutes of treadmill exercise three times a week stopped the expected rapid aging. The genetically modified mice that exercised on a treadmill three times a week, were comparable to healthy mice, while sedentary mice aged rapidly, becoming bald, gray-haired, weak, socially isolated an less fertile.<br />
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The abstract of the article reporting on the research is <a href="http://www.pnas.org/gca?allch=&submit=Go&gca=pnas;1019581108v1">here</a>, but the article is behind a pay-wall. You can, however, see the <a href="http://www.pnas.org/content/suppl/2011/02/21/1019581108.DCSupplemental/pnas.201019581SI.pdf">detailed supporting material</a> without paying. The supporting material includes four movies that show the effect of exercise. Check this one out:<br />
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<a href="http://fhs.mcmaster.ca/pediatrics_research/sivideos/video_s3.mov">Click to play the movie</a><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLly7JIOb-N8XdPLDfTc60VX4OmMJmlePuwfbk3WHvSX-MA7erFO7FHUMNi_x9bLH9pvnEVbySrUrBlcidgOWL3dz3BaUscAoIVmCIdz0eTaO31igCP4Zc8D-a1mJye2mW8BrtiWto8tE/s1600/treadmillmice.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLly7JIOb-N8XdPLDfTc60VX4OmMJmlePuwfbk3WHvSX-MA7erFO7FHUMNi_x9bLH9pvnEVbySrUrBlcidgOWL3dz3BaUscAoIVmCIdz0eTaO31igCP4Zc8D-a1mJye2mW8BrtiWto8tE/s200/treadmillmice.png" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Mice on a treadmill -- which one works out?</td></tr>
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This study is great news if you are a genetically engineered mouse, and it may offer a partial explanation of aging and the benefits of exercise in some humans.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-8777373741850966512010-01-26T06:45:00.000-08:002018-02-06T12:12:05.808-08:00"It's not what you once did that counts the most, but what you keep doing."This quote is from <a href="http://en.wikipedia.org/wiki/Johnny_Kelley">Johnny Kelley</a>, an Olympian who went on to run 61 Boston marathons.<br /><br />I found it in runner-writer <a href="http://en.wikipedia.org/wiki/Joe_Henderson_%28runner%29">Joe Henderson's</a> excellent <a href="http://joehenderson.com/archive/">Running Commentaries</a>. Henderson publishes a new commentary every Friday, and I'm a long time subscriber.<br /><br />He also has a <a href="http://joehenderson.com/">web site</a> where you can subscribe to his commentaries and read some of his books.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com3tag:blogger.com,1999:blog-5185190385688230048.post-78653924143992037892009-12-15T14:26:00.000-08:002009-12-16T20:03:56.817-08:00How fast do running and swimming records drop with age?Yale economist and marathon runner <a href="http://fairmodel.econ.yale.edu/">Ray Fair</a> has analyzed record data in running and swimming to estimate the rate at which our ability drops with age.<br /><br />As you see below, records decline at a relatively steady rate between the ages of 35 and 70-75, then the rate of decline picks up rapidly.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEC9agxo66RXLDDvW2JHTEo1N1hftuOf53lfBxWwQ_UXqtllaQ5XODOXaUbpCW5lbj-Y8gUc4VCT5nzCozCSzuzVj896xXgKyfrHpc7ixjvNSx0mXWyCNf7TXLyqgjv-8lihYw4Qc-yQk/s1600-h/faridropoffcurve2.png"><img style="cursor: pointer; width: 400px; height: 306px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEC9agxo66RXLDDvW2JHTEo1N1hftuOf53lfBxWwQ_UXqtllaQ5XODOXaUbpCW5lbj-Y8gUc4VCT5nzCozCSzuzVj896xXgKyfrHpc7ixjvNSx0mXWyCNf7TXLyqgjv-8lihYw4Qc-yQk/s400/faridropoffcurve2.png" alt="" id="BLOGGER_PHOTO_ID_5415980528533977906" border="0" /></a><br /><br />We see that distance running and swimming drop off faster than sprinting, and Fair notes that women drop off a bit faster than men. Chess declines are much slower than the physical activities.<br /><br />Fair has calculated age factors like those graphed above for men running and high jumping, men and women swimming, and chess. For example, here are the age factors for short races -- 100, 200 and 400 meters -- by men:<br /><br /><table border="1" cellpadding="5" cellspacing="0"><tbody><tr align="center"><td align="left">Age</td><td>35</td><td>40</td><td>45</td><td>50</td><td>55</td><td>60</td><td>65</td><td>70</td><td>75</td><td>80</td><td>85</td><td>90</td><td>95</td><td>100</td></tr><tr align="center"><td align="left">Age factor</td><td>1.00</td><td>1.03</td><td>1.06</td><td>1.09</td><td>1.13</td><td>1.16</td><td>1.19</td><td>1.23</td><td>1.27</td><td>1.32</td><td>1.47</td><td>1.77</td><td>2.30</td><td>3.25</td></tr></tbody></table><br />Using the table, you can see that if, for example, you ran 100 meters in 12 seconds at age 35, Fair would predict that you would have slowed to 1.23 x 12 = 14.8 seconds by age 70. (His tables use age 35 as a reference point).<br /><br />If you have a time from an age other than 35, you can compute a predicted time using the ratio of the the two age factors. For example, if you ran a race in 20 seconds at age 50, you would expect it to take 20 x 1.23 / 1.09 = 22.6 seconds at age 70.<br /><br />You can download a <a href="http://bpastudio.csudh.edu/fac/lpress/athlete/fairagefactors.xls">spreadsheet with all of Fair's age factors</a> or use his online calculators to make your own estimates:<ul><li><a href="http://fairmodel.econ.yale.edu/aging/short.htm">100, 200, or 400 meter track, men</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/runoth.htm">All other running, men</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/swimm50.htm">Swimming, 50 meters or yards, men</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/swimm100.htm">Swimming, 100 meters or yards, men</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/swimm200.htm">Swimming, over 100 meters or yards, men</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/swimw50.htm">Swimming, 50 meters or yards, women</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/swimw100.htm">Swimming, 100 meters or yards, women</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/swimw200.htm">Swimming, over 100 meters or yards, women</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/field.htm">High jump, men</a></li><li><a href="http://fairmodel.econ.yale.edu/aging/chess.htm">Chess</a></li></ul>This paints kind of a grim picture for me -- I am just turning 70 -- but there are a few "outs." For one, I spend more time weight lifting than running or swimming. I wonder what the age factors for weight lifting records are? A second possibility sounds like wishful thinking, but maybe record holders decline faster than the rest of us lesser athletes. Testosterone is another variable. To what extent are these results a function of diminished testosterone levels, and can testosterone supplementation slow the decline? (We have to talk about the efficacy and safety of testosterone supplementation in a later post).Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-89495839723469801112009-11-25T11:07:00.000-08:002009-11-25T18:38:18.954-08:00How long can we expect to remain active and how acive can we remain? How fast will our capacity diminish with age?I just read a blog post that <a href="http://www.timegoesby.net/weblog/2007/11/on-fear-of-agin.html">takes a shot at working out</a>:<blockquote>A lot of people (boomers?) seem to be convinced that if they lift one more weight or run one more mile, they will never get old. Even if you don’t succumb to cosmetic surgery or spend too much money on expensive anti-aging creams that don’t work, there comes a day, I think, when it’s too much effort any longer to keep up the pretense.</blockquote>Fear of aging and death are obviously not the only reasons we lift weights or run, but I'm not deluding myself that this will go on forever -- how long can we remain active and how active can we remain? How fast will our capacity diminish with age?<br /><br />There is no comprehensive answer to these questions, but there are hints and anecdotes. For example, we can estimate the optimistic upper limit by profiling outstanding people of various ages. We can also analyze speed records and other performance measures as <a href="http://home.roadrunner.com/%7Ealanjones/AgeGrade.html">Alan Jones and his colleagues have done for running</a>. And, although it may not be politically correct, we can look at the affect of drugs and supplements like testosterone -- do they slow our losses? Are they safe?<br /><br />I will look at each of these -- unusually fit people, data analysis and drugs and supplements -- in future posts.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-92400427664006152009-11-14T09:35:00.000-08:002009-11-15T05:13:28.913-08:00One in eight people 65 and older exercise "vigorously" at least five days a weekAccording to a US Department of Health and Human Services report on the<br /><a href="http://www.google.com/url?sa=t&source=web&ct=res&cd=1&ved=0CA0QFjAA&url=http%3A%2F%2Fwww.cdc.gov%2Fnchs%2Fdata%2Fseries%2Fsr_10%2Fsr10_230.pdf&rct=j&q=Health+Behaviors+of+Adults%3A+United+States%2C+2002%E2%80%9304&ei=yPP-SubtD5KcswPo9PmHCw&usg=AFQjCNFsqi2GSRnfUrkOO5kvRXbetZjmxQ">Health Behaviors of Adults: United States, 2002–04</a> 13.8% of people 65 and older exercise vigorously at least five days a week. A breakdown of the data shows that men are more likely to engage in frequent vigorous exercise than women and young people are more likely than old:<br /><br /><table border="0" cellpadding="3" cellspacing="0"><tbody><tr align="center"><td style="font-weight: bold;" align="left">Age</td><td style="font-weight: bold;">Men</td><td style="font-weight: bold;">Women</td><td style="font-weight: bold;">Both</td></tr><tr align="center"> <td align="left">18-24</td> <td>21.6</td><td>12</td> <td>16.8</td></tr><tr align="center"> <td align="left">25-44</td><td>14.7</td><td>10.9</td><td>12.8</td></tr><tr align="center"> <td align="left">45–64</td> <td>12.3</td> <td>9.6</td> <td>10.9</td></tr><tr align="center"> <td align="left">65-74</td> <td>10.2</td> <td>7.5</td> <td>8.7</td></tr><tr align="center"> <td align="left">>=75</td> <td>7.9</td><td>3.3</td> <td>5.1</td> </tr></tbody></table><br />The authors of the 85-page report present other interesting data. For example, they found that the rate of vigorous exercise rises with income and education (which are correlated with age). They also observed differences based on race, region of the country, marital status and whether the respondent is from a metropolitan area, central city or smaller town.<br /><br />The study defines a "vigorous" activity as one lasting at least 10 minutes and causing heavy sweating or large increases in breathing or heart rate.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-37202207852647929982009-08-17T20:32:00.001-07:002009-08-17T20:53:28.907-07:00Sore knees -- use them or lose them -- recovery time from an injuryI had a freak bicycle accident about ten weeks ago. For about four weeks, walking was quite painful and running impossible. I spent four weeks as a couch potato. I began walking after that, but then took a three week cruise. By the end of the cruise, I was able to walk fairly well, and had begun doing some upper-body weight lifting.<br /><br />I began jogging about two weeks ago, and my legs were quite weak and my knees were stiff and sore. I had expected to be weak, but was surprised by the pain and stiffness in my knees. I had assumed they would have benefited from the rest, but was completely wrong. It is as if some lubricant had dried up as a result of inactivity. There seems to be some feedback mechanism -- perhaps hormonal -- that "decided" I was old and would not be using my knees any more.<br /><br />After about two weeks of jogging, shooting baskets and doing leg presses, my knees feel about the same as they did before the accident. (I am still weaker than before, but improving).<br /><br />My knees came back faster than my leg strength, but this seems to be a clear case of use it or lose it.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-79597692848625471312009-08-17T20:26:00.000-07:002009-08-17T20:31:24.257-07:00Short term effects of fatty foodsEveryone knows that a fatty diet causes one to gain weight, form arterial plaque, etc. However, <a href="http://well.blogs.nytimes.com/2009/08/13/fatty-foods-affect-memory-and-exercise/">new research</a> shows that fatty foods have a short term effect -- adversely affecting both memory and the ability to exercise.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-67198386944311116472008-05-23T09:48:00.000-07:002008-05-24T06:45:33.711-07:00Questions to ask before starting to work out with weights<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuQXQm8BkuJ-gD1KwSxakX0FEhbuejL9mvMAFsWJfLKIn3A3c2MLVV01Iu486ERlvJD3L9zHcqKsG5WqIsOm0t2fseRU7Y1v3xV_1RYMHWqh0-68W2IlYlRoNDdXHvxLNNDpiml8zXDkY/s1600-h/anatomy.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuQXQm8BkuJ-gD1KwSxakX0FEhbuejL9mvMAFsWJfLKIn3A3c2MLVV01Iu486ERlvJD3L9zHcqKsG5WqIsOm0t2fseRU7Y1v3xV_1RYMHWqh0-68W2IlYlRoNDdXHvxLNNDpiml8zXDkY/s400/anatomy.jpg" alt="" id="BLOGGER_PHOTO_ID_5203616811005764066" border="0" /></a>A friend recently asked me to help him get started with weight lifting. He trains regularly on a treadmill, but has never done strength training. My first impulse was to invite him to follow me around while I showed him various exercises, but, on second thought, he needs to answer two questions first.<br /><br /><span style="font-weight: bold;">Which muscle groups do you want to strengthen?</span><br /><br />These pictures show the main muscle groups. Don't worry about the formal names -- "abs" will do for "<span class="blsp-spelling-error" id="SPELLING_ERROR_0">rectus</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_1">abdominus</span>" -- but set some priorities. Do you want to strengthen your legs? Chest? Arms? It would be nice to say "all of the above," but you probably don't want to spend as many hours a week in the gym as the folks in these pictures.<br /><br />These pictures were taken from Bodybuilding.com, where you can see them with <a href="http://www.bodybuilding.com/fun/anatomy.htm">links to diagrams of each muscle</a>. You should go there and familiarize yourself with the muscle illustrations, because, when you do an exercise, you need to be aware of which muscle you are training, and focus on isolating it.<span style="font-weight: bold;"><br /><br />How many days per week will you work out and how much time will you spend each day?</span><br /><br />When I worked out at a gym that was far from my house, I went three days a week, and worked my entire body each time. Now that I am working out near my home, I go 5 or 6 days per week, and do different body parts on alternate days. For example, you might do arms and chest one day and legs the other.<br /><br />If you choose to go only two or three days a week, you will want to spend enough time to do your entire workout. If you do that, alternate body parts, for example biceps and quadriceps, within the workout.<br /><br />I've never experimented with two-day per week workouts, but I just found <a href="http://www.ncbi.nlm.nih.gov/pubmed/17313289">one study</a> indicating that it might be as effective to do a long workout two days a week as doing a short workout three days a week. (The study was of relatively young men and (mostly) women). It would be interesting to find more research on the topic and to do some personal experimentation. I doubt that one day per week would do much more than make you sore.<br /><br />After you get used to the exercises you like for each muscle group, you will see how long it takes and you can adjust your workout accordingly. And, if you get hooked, you can increase the time you spend in the gym.<br /><br />I've got some good news regarding time -- the time you spend in the gym pays dividends. Your energy and endurance will increase, so you will get more done during your time outside the gym. You can also use a portable audio player to listen to music or words while working out. I listen to a mix of professional conference presentations and NPR programs. Others may prefer books on tape or music. Regardless, it is making dual use of your time in the gym.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-55763762511943091252007-09-07T05:25:00.000-07:002007-10-17T21:15:34.096-07:00Why subjective experience is important -- an exampleThere is an online community of 1,493 retinal detachment <i>patients</i> at <a href="http://groups.yahoo.com/group/detached-retina/">http://groups.yahoo.com/group/detached-retina/</a>. I emphasize "patients" because there are no eye-care professionals in the group. If my cataract surgeon had been reading the group, he might have shown me "<span class="blsp-spelling-error" id="SPELLING_ERROR_0">Catmaster's</span>" recent post stating:<blockquote>My second RD looks just like the photo (below). While the first RD stayed, the second would disappear. I was hoping it was an artifact from the cataract surgery, but it was not.</blockquote>His second RD was like mine -- a sub-second black spot. Had I read it, my detachment would have been detected at least a week before it was -- before the fleeting shadow became a permanent blotch. Perhaps I could have avoided the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">scleral</span> buckle. Perhaps I could have avoided the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">vitrectomy</span>. Perhaps there would have been less retinal damage. Perhaps the odds of a recurrence would have been lower.<br /><br /><p align="left"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNxlpFVLV3VFEnI-WPHAQ38QS5EacnuWIhXuhFxgLIadGEICVThuL0gTZ8tgR5hSBU3C8h8FNI25LPEyk4D9gIEEifk967McW5EWUC5hneIgHWJ7I7GOtAfZjjgoiayqDEzft-5dk4xNU/s1600-h/rdveil.jpg"><img id="BLOGGER_PHOTO_ID_5107438739834586274" style="margin: 0px; float: left;" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNxlpFVLV3VFEnI-WPHAQ38QS5EacnuWIhXuhFxgLIadGEICVThuL0gTZ8tgR5hSBU3C8h8FNI25LPEyk4D9gIEEifk967McW5EWUC5hneIgHWJ7I7GOtAfZjjgoiayqDEzft-5dk4xNU/s400/rdveil.jpg" border="0" /></a></p>Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com5tag:blogger.com,1999:blog-5185190385688230048.post-21168550963053935962007-09-03T21:15:00.000-07:002007-09-03T21:30:17.588-07:00We need detailed descriptions of subjective experienceOur symptom vocabulary is very poor. We need detailed descriptions of subjective experience. I have been told to watch for "floaters," "light flashes," and "curtains" and heard about "flickers." But, since my surgeon has never had a detached retina, she is not able to elaborate on what, say, a light flash looks like, how long it lasts, how often they appear, how large they are, the feeling, if any, that accompanies them, etc. I am worried that the "dots" I mentioned in the previous post might be "flashes."<br /><br />Only patients can provide us with detailed verbal and drawn descriptions of the symptoms. For example, I did a Google search for a drawing of a floater. I found many diagrams of eyes, but no artistic patient seems to have drawn a floater and posted it on the Web.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-77575063271766302902007-09-03T20:50:00.000-07:002007-09-03T21:47:28.082-07:00Small white dots moving at random in my field of visionMy vision continues to improve, but on August 31, I noticed what looked like a swarm of very small white dots darting about in the center of my field of vision. They moved in a pretty random fashion -- like the traces in particle accelerator photos. They were very faint, and I only noticed them when working on my laptop when the backlit screen was white. <br /><br />During the last couple of days, they have increased in number, and now cover a greater area in my field of vision. I can now see them when looking around at light colored objects, but that may be due to increased attention on my part. They are still quite faint, and do not impair my vision in practical terms. However, they are worrisome since they remain in the center of my field of vision, perhaps indicating a macular problem. I've sent my surgeon a couple of emails, but have not heard back so perhaps she thinks it is unimportant.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-60423518882322109022007-08-22T18:34:00.000-07:002007-08-22T18:46:06.606-07:00Subjective experience two weeks after surgery<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0FQTFyrHrB9e2RejfRFbVyrZ-q-U1SfCut_9TvUoBzCOuAvgsW9psk3rbydM75EPOVW5mNaxUjubG_o-3pkv_o6VXOJZsXaWqqPbCqe2tUG-vEmc_IpmGcg8ACq_6nG1LtA49wShjNN4/s1600-h/retina2weeks.gif"><img id="BLOGGER_PHOTO_ID_5101706092365792402" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0FQTFyrHrB9e2RejfRFbVyrZ-q-U1SfCut_9TvUoBzCOuAvgsW9psk3rbydM75EPOVW5mNaxUjubG_o-3pkv_o6VXOJZsXaWqqPbCqe2tUG-vEmc_IpmGcg8ACq_6nG1LtA49wShjNN4/s400/retina2weeks.gif" border="0" /></a><br /><div>A. The remaining gas bubble. The bubble appears to be opaque (black) around edges, and that tapers off pretty rapidly to a <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">somewhat</span> greenish-grey translucent center. It is now small enough that, if I hold my head parallel to the ground, it becomes a circle in the center of my field of vision and I can see all around it. It shrinks noticeably every day. (One notices the difference after sleeping).<br /><br />B. The sides are relatively clear; however, there is a milky white haze relative to my left (good) eye. Focus is poor, but I could easily read the larger letters on the eye chart.<br /><br />C. The central area above (from my perspective) the bubble is similar to B in focus and color, but adds reflections as if being viewed under a little water. I suspect that is reflection from the bubble and that once the bubble is completely gone, my vision will be like area B.<br /><br />As the bubble recedes, I see some very faint floaters -- particularly if I jiggle the bubble -- for example in brushing my teeth or walking. The surgeon is not concerned -- no need to panic, but check with your surgeon if you see any.</div>Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-3017159840486753312007-08-18T07:03:00.000-07:002007-08-18T10:52:08.755-07:00Check out Joe Henderson's weekly commentary on running<a href="http://www.joehenderson.com/">Joe Henderson</a> writes about running and life in <a href="http://www.amazon.com/gp/search/ref=sr_adv_b/?search-alias=stripbooks&field-keywords=&author=Joe+Henderson&select-author=field-author-exact&title=&select-title=field-title&subject=&select-subject=field-subject&field-publisher=&field-isbn=&amp;amp;node=&field-binding=&field-age=&field-language=&field-dateop=before&field-datemod=0&field-dateyear=2009&chooser-sort=rank%21%2Bsalesrank&mysubmitbutton1.x=46&mysubmitbutton1.y=13">books</a> and as a columnist for Runner's World magazine. He also publishes a weekly commentary which you can subscribe to by email. Joe has been around long enough that much of his writing is about older athletes.<br /><br />For example, the <a href="http://www.joehenderson.com/archive/home.php?article=2124">current commentary</a> is on author <a href="http://www.amazon.com/gp/search/ref=sr_adv_b/?search-alias=stripbooks&field-keywords=&author=Paul+Reese&select-author=field-author-exact&title=&select-title=field-title&subject=&select-subject=field-subject&field-publisher=&field-isbn=&node=&field-binding=&field-age=&field-language=&field-dateop=before&field-datemod=0&field-dateyear=2009&chooser-sort=rank%21%2Bsalesrank&mysubmitbutton1.x=49&mysubmitbutton1.y=8">Paul Reese</a> who ran into his 80s. Another <a href="http://www.joehenderson.com/archive/home.php?article=1394">commentary</a> is a tribute to <a href="http://www.amazon.com/gp/search/ref=sr_adv_b/?search-alias=stripbooks&field-keywords=&author=George+Sheehan&select-author=field-author-exact&title=&select-title=field-title&subject=&select-subject=field-subject&field-publisher=&field-isbn=&node=&field-binding=&field-age=&field-language=&field-dateop=before&field-datemod=0&field-dateyear=2009&chooser-sort=rank%21%2Bsalesrank&mysubmitbutton1.x=59&mysubmitbutton1.y=12">George Sheehan</a> who ran competitively and wrote eloquently about it until age 74.<br /><br />(It seems that some old runners are also inspiring writers. Does running induce reflection? Do thoughtful people tend to turn to running for exercise?)Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-26385728440828014442007-08-17T21:57:00.000-07:002007-08-18T11:35:29.967-07:00Recovery beginsThis blog has been hijacked by my detached retina. Time to change the subject.<br /><br />I walked 2.4 miles today. I walked slowly, kept my head down a lot, and kept an eye on my eye. Pretty lame, but it was my first exercise since this began.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-6254650988696764682007-08-17T21:46:00.000-07:002007-08-18T08:21:13.343-07:00Obsessive observationsThe surgeon asked me to report changes, and I spend a lot of time observing my vision. I hope this diminishes with time.<br /><br />The gas bubble in my eye now covers about half of the field of vision. The transparent portion has a distinctly white haze over it relative to my good eye. I don't think it is getting denser, but cannot be 100% sure. I wonder if that is caused by poor focus, the clouding of the back of the lens that I have read about or something else. Will it pass?<br /><br />The clear area is full of reflections -- like being under water -- which I hope will clear up when the gas bubble is gone. The gas bubble also jiggles whenever I move, even when I brush my teeth.<br /><br />I also noticed that when my face is parallel to the floor -- so I am seeing through the bubble -- and I have a patch over my eye, I can see a faint discoloration where the detachment was. It shows up a bit stronger when I move my eye or take a step. This is a subtle change, but, as I said, I am kind of obsessed for the time being.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-74077539331360022182007-08-16T15:42:00.000-07:002007-08-16T16:10:19.944-07:00The long term looks good, but for now I remain a couch potatoI saw the surgeon today, and she says the retina is attached and doing well. She also assures me that I can go back to heavy training at the end of the process. I mentioned things like dead lifts and leg presses on a machine where one's feet are elevated, and she said "no problem."<br /><br />For the next three weeks, I am to remain a couch potato. I am slipping rapidly out of shape. The only good part of that is that I will get a chance to see how fast <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">and</span> how completely I can recover.<br /><br />Her advice is to do nothing that will elevate my heart rate. I guess I will start taking some long, slow walks.<br /><br />I asked her what the risk mechanism is -- is she afraid of elevated blood pressure, temperature, intra-ocular pressure, acceleration, etc., but got no answer -- just repetition of the admonition to keep my heart rate low. I think I could be a more effective and less worried patient if I had a better understanding of her model of the eye and healing process, but the system does not allow her time to teach me.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-58586937444299571902007-08-15T08:48:00.000-07:002007-08-29T00:23:36.230-07:00Can I remain "athletic?"My vision is still very blurry, but I am assuming that is due to correctable focus problems, not retinal disease. So, my attention is turning to the future -- will I be able to remain "athletic?" The following questions come to mind:<br /><ol><li>Given the nature of the detachment and its cause, is my right retina more likely to detach now than it was before?</li><li>Will there be some time period after which detachment is no more likely than before?</li><li>I was told that the risk of detachment from cataract surgery was less than one in one thousand. Assuming that that is the overall rate, what is the rate for someone my age, with my degree of myopia and level of physical activity? (I have even <a href="http://www.emedicine.com/emerg/topic504.htm">read</a> that being of Jewish descent increases the probability of retinal detachment).</li><li>It has been a couple of months since my left eye was operated on. Is my risk of retinal detachment still elevated? Will it ever be as low as it was before the cataract surgery?</li><li>Is it certain that walking home from UCLA did not precipitate the second detachment? Is it safe to walk now? At what rate and for what duration?</li><li>What are the mechanisms through which various forms of exercise cause detachment -- jarring, straining, physical contact, etc? Specifically, I am interested in the risks of heavy weight lifting, running, swimming and hard bike riding. What about a sport injury such as a bike crash?</li><li>Are some weight lifting exercises more dangerous than others -- for example using a squat machine in which one's legs are elevated or dead lifts where one lifts a weight from the floor?</li><li>Have there been studies of masters athletes, for example members of national track or swimming associations or senior Olympic competitors?</li><li>Are there warning signs that I could watch for during exercise, and, if so, would immediately stopping be sufficient?</li><li>Are there warning signs that can be detected during a retinal examination? If so, would it be possible to resume vigorous exercise and have regular (quarterly? monthly?) retinal exams?</li><li>I was told there was close to thirty percent chance that the capsule behind my implant would cloud over. If that occurs, would fixing it be likely to detach either retina?</li><li>What sort of fluid will fill my eye and what is the effect of that? Might it reduce/increase traction -- lower viscosity? greater velocity when accelerated? Are there fluid dynamic models of the inner eye? Have ophthalmologists collaborated with mechanical engineers on this?</li><li>What is the effect of the scleral buckle on the likelihood of recurrence?</li><li>Why have my physical restrictions been less stringent than anticipated before the surgery? Does that indicate a lower likely hood of re-detachment?</li><li>I have been told that there are several types of cataract procedure, each with differing levels of retinal risk. If this is the case, what are those alternatives, and which did I have?</li><li>Has the vitreous gel in my left eye shrunk away from the retina, and, if so, what are the implications of that?</li><li>Before the cataract surgery, there were more floaters in my right eye than my left, and they were larger and darker. Did that indicate more risk for my right eye?</ol>Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com3tag:blogger.com,1999:blog-5185190385688230048.post-16483359950804203062007-08-14T09:37:00.000-07:002007-08-15T20:21:42.439-07:00A non-problem, but let's use the NetPost-operative patients are a bit compulsive, noticing every change. Yesterday, I noticed that if I stood up fast, slightly diminishing the flow of blood to my head, my right (bad) eye went black for a few seconds. I was afraid that might be the signal of a vascular complication, and called the doctor just to be sure. Her secretary called back about 20 anxious hours later saying it was to be expected and not to worry. <br /><br />That was a relief. But, what if it had been a problem? How long did it take for my message to get to the surgeon? How long did it take for her to reply? Shouldn't we use the Internet to speed communication between a surgeon and her currently convalescing post-operative patients?Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-9595262307036583802007-08-12T10:13:00.001-07:002007-08-12T10:24:13.375-07:00How it looks from in here<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaiX1aEUhcUcqktNok_HrmLw-kYUs5TGsyo3Ld7Fy3loUuPaZkZWDppjqBdSlTakn8m_zyrgOTz-eOvKdq12jNVy4X8DzM8EHl6VmpV2PZn87pTjYlpMhVGzqCooJOkFZpO16huL043G8/s1600-h/retina.gif"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaiX1aEUhcUcqktNok_HrmLw-kYUs5TGsyo3Ld7Fy3loUuPaZkZWDppjqBdSlTakn8m_zyrgOTz-eOvKdq12jNVy4X8DzM8EHl6VmpV2PZn87pTjYlpMhVGzqCooJOkFZpO16huL043G8/s320/retina.gif" alt="" id="BLOGGER_PHOTO_ID_5097863743364239458" border="0" /></a>The problem began with a milky, irregular shape in the left-lower quadrant. After the first surgery, that area was regular and opaque (a). Just before the second surgery, the opaque area had grown (b). After the second surgery, there were two translucent areas (c). Today there is only one translucent area (d).Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-84339849437938796332007-08-12T09:11:00.001-07:002007-08-12T09:25:51.836-07:00My retina seems to be healingI can only see very blurry colors and shapes -- can barely count the fingers on the hand in front of my face -- but I believe the retina is healing. While the dark area of the bubble remains translucent, the previously opaque area where the retina was detached is nearly transparent now.<br /><br />Furthermore, I have an eye shield with small perforations. When I look through those perforations, things are a bit sharper, indicating that the problem is in focus, not the retina. Finally, at about 2.5 inches, I can resolve considerable detail -- I can read black letters on a white background. Since I am using drops that dilate my eyes, have swelling, have had the shape of my eye distorted with a scleral buckle, have a lot of liquid on the surface of my eye, etc., it is not surprising that things are out of focus. I wonder what the long term effect of having had my vitreous gel removed will be? What is replacing it?Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com1tag:blogger.com,1999:blog-5185190385688230048.post-11994504182699908362007-08-12T08:52:00.000-07:002007-08-12T09:10:04.548-07:00Something positiveI've been complaining like crazy -- time for something nice. During my second surgery, I was sedated, but could hear the surgical team converse. The highlight for me was hearing them discuss a recent journal article in the context of my surgery. I've been seen by doctors who struck me as non-intellectuals who practiced handbook medicine and probably got most of their continuing education from drug companies. Doctors who had not read the articles I had found on-line, and were not interested in my sending them copies. These young physicians are involved professionals.Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0tag:blogger.com,1999:blog-5185190385688230048.post-91515806893942542322007-08-12T06:07:00.000-07:002007-08-18T09:56:39.170-07:00MistakesI should not have had the cataract surgery on my right eye in the first place. The cataract on my left eye had grown quite bad, and really did need to be removed, but my right eye was not so bad. After the first surgery, I could see well with my left eye, and my right eye was myopic. I could read, work at the computer, drive, etc. just fine. I should have questioned the surgeon's assumption that the right lens should be replaced.<br /><br />Prior to the operation, the risks were outlined in message <a href="http://www.jsei.org/miller/prep_surgery02.html#">video</a> taped by the surgeon. In the section of the tape labeled "Risks and Complications" he states:<blockquote>Cataract surgery is surgery, and there is a small chance that things can go wrong or not turn out the way we want them to. The two most significant risks of cataract surgery are infection and retinal detachment. The numerical odds of those problems are in the one in a thousand range. In my hands the actual risk of infection has been lower than one in a thousand and the same for retinal detachment, but they are in that range and they are real serious problems. If they occur, we have to take care of them, there is no option. We cannot sort of sit on them and watch them, we have to manage them. And even with a complication we can get good results.</blockquote>I understood that there was a risk of detachment with cataract surgery, but was not told that the risk increased with age and degree of myopia. What is the detachment rate for 67 year-<span class="blsp-spelling-error" id="SPELLING_ERROR_0">olds</span> who are as myopic and physically active as I was? I still don't know.<br /><br />The video mentions several other possible complications including "the capsule behind the implant clouding over -- in fact that one is almost a 30 percent chance and that is a simple thing to fix." I wonder if that fix, if necessary, will risk re-detachment of my retina.<br /><br />I went for a two-week follow up examination after cataract surgery on my right eye. I told the surgeon that my vision was significantly worse -- blurrier and less bright -- than the left eye, and had been plateaued since a few days after the surgery. I suggested that this might be due to manufacturing variance in the implants, which he said was extremely unlikely. My relative inability to read the eye charts confirmed that my vision was both dim and out of focus. I told the surgeon that I was not able to read using the drugstore reading glasses he had recommended. He was puzzled by that, but did not follow up. Was that an indication that the problem was not due to a faulty lens or swollen eye, but the retina? I also mentioned that I thought I was catching "glimpses of my nose" in my peripheral vision. <br /><br />The surgeon said the poor vision was probably caused by inflammation and prescribed different eye drops. He shrugged off the mention of seeing my nose -- said he had never heard that one before. In retrospect, that was the start of a detached retina. Should he have been suspicious and sent me for a retinal exam?<br /><br />The surgeon's reaction to my "seeing my nose" or not benefiting from reading glasses reflects inattention to the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">patient's</span> subjective state. He has never had the subjective experience of a retinal detachment. Did his training attempt to convey that experience to him? He should have read descriptions of retinal detachment by patients. He should have looked at <span class="blsp-spelling-error" id="SPELLING_ERROR_2">patient's</span> drawings of what it looks like.<br /><br />Cataract patients should read the same accounts and see the same drawings. Like the surgeon, we are unfamiliar with the subjective experience of a detached retina until it is too late.<br /><br />Why didn't my poor vision worry the surgeon? I suspect that is a combination of hubris, "knowing" the statistics, and inattention exacerbated by the fact that he does many operations each day, and schedules only about five minutes for the two-week post operative examination.<br /><br />One or two days after my two-week follow up, I woke up seeing a watery-opaque area in the lower-left quadrant of the field of vision in my right eye. I went to the clinic, and received an emergency <span class="blsp-spelling-error" id="SPELLING_ERROR_3">scleral</span> buckle. Since then, I have <a href="http://www.kellogg.umich.edu/patientcare/conditions/detached.retina.html">read</a> that a <span class="blsp-spelling-error" id="SPELLING_ERROR_4">scleral</span> buckle may be accompanied by the draining of the fluid from behind the detachment and the injection of a gas bubble into the eye. Would one or both of these steps have prevented my second surgery?<br /><br />I went for an early-morning post operative exam a few days later. The surgeon was worried about the lack of improvement. She contemplated injecting a gas bubble at that time, but decided instead to wait two days. When I asked her whether I could walk home or should call my wife to pick me up, she replied that there would be no harm in walking as long as I did not exert myself to the point of elevating my heart rate. I walked home (downhill) very slowly. Might that have caused the detachment to spread?<br /><br />A few hours later, the opaque area extended into the upper left quadrant of my field of vision, and a second emergency surgery was performed. Could that have been avoided by injection of the gas bubble earlier in the morning?<br /><br />The first night after the second surgery, I was instructed to lie on my stomach with my face parallel to the floor until I returned the next day for a post operative examination. That is a very uncomfortable position, and maintaining it all night was very difficult. But I was able to do so with the help of some foam rubber cushions my daughters picked up at a drug store. It would have been impossible otherwise. Why didn't they give me such a cushion when I went home after the surgery? They would have given me a crutch if I had a broken leg wouldn't they?<br /><br />The patch was removed from my eye the day after the second surgery. The area that had been opaque -- the left side of my field of vision -- was improved. It was still discolored, but translucent, not opaque. However, a second translucent area had appeared across the top of my field of vision. That scared the shit out of me. I told the surgeon, but she said she could see nothing wrong and told me not to worry. (Right). The next day, the original area showed some improvement, but not the new area on top. I called and left a message to that effect. Many hours later, another doctor called to say that I should quit worrying. The next morning I made a subjective discovery. The darkened area was not fixed at the top of my field of vision -- it moved to the side if I tilted my head. It was the gas bubble! That was a great relief, but why hadn't I been told that in the first place? I don't think the surgeon was being insensitive. I think she had not been trained on the subjective experience of the patient. I am better trained to support post operative patients than she in some ways.<br /><br />I have also encountered a small "catch-22." I was frightened after the second surgery, and worried that I might not be able to sleep well. I asked the surgeon for a sleeping pill prescription, but she said I would have to ask my general practitioner. The general practitioner also refused, telling me to ask the surgeon. I ended up taking a Tylenol PM. Who is my "physician?" I wonder how Paris Hilton gets her drugs?<br /><br />Every day, many people have retinal detachments repaired. We are experts in the subjective experience. The Internet excels in providing a meeting place for communities of common interest. Why was I not given the address of an online patient-support group before I agreed to cataract surgery? Why was I not given the address of an online patient-support group once my retina was detached? Why doesn't the surgeon use the Internet to stay in contact with the dynamic group of currently convalescing post-operative patients?Larry Presshttp://www.blogger.com/profile/14903269871983592883noreply@blogger.com0