Citizen Racer

Health Care: providers are more important than patients

2011-12-03T09:27:00.007-07:00

Bear with me, I am not a very good writer. But I am teachable so will hopefully improve as I do more writing.

Health care is a multi-faceted, complex space. It has been getting a lot more attention of late and from some very important people I might add. This is all good. The more people engaged in the issues of health care the better.

However, I want to mention one really important caveat. Providers need to be the center of attention when it comes to fixing health care. Not patients! I know (if anyone reads this) the likely readers of this blog will be patient-centric folks. And I also know that those words just written are anathema to them. Good. I want people to think and think very hard about the trajectory of reforms, changes, fixes and course corrections in health care. I will explain my rationale too.

Disclaimer:
Let me be clear, nothing about the broad descriptions of providers and health care should be construed as an attempt by me to glorify them or deny the reality that there are glaring issues, problems and failures in health care and that providers are in part to blame.

For starters, providers have all been patients but patients have not all been providers. Why should that matter? Perspective matters. Maybe kind of like @msuster. He has been on "Both Sides of the Table" in the VC world and it gives him a better perspective. I'll concede that this might be a minor point. But worth making.

Here's a major point, to me anyway. All providers have a duty from a combination of moral, ethical and legal confines to make the patients for whom they care the center and primary focus of their lifes work. Many also have an intrinsic, life-calling, mission to care for patients as well. I have had countless encounters with "newbies" in health care who tell me they are pursuing their career because, "I want to help people." This is something that is found in few other places and cannot be minimized in the least. Okay, addendum to disclaimer, I know there are providers who operate under none of those constructs rather, for their own selfish ends. However, here, as an example of the norm, is a link to a video (http://bit.ly/uV5Akc), which is a little long, where you hear first hand from someone who chose to protect patient's interests to the peril of his own career, on more than one occasion. Yet, he ultimately became very successful (for himself and millions of patients around the world). It is a great lesson, for us all. Chose to do the right thing, always, and success will follow.

Another very important issue, the education infrastructure for providers in this country is second to none. There are hundreds of thousands of great professors, instructors and teachers who provide the educational backbone for the medical professionals coming into the market place. I can think of many in my education who were not only exceedingly bright but were dedicated and "called" to do what they were doing. These that make our educations fun and exciting are an incredible asset, ultimately to patients.

Similar to and part and parcel to the educational system is the research system in this country. Part of what prompted me to write this blog was the posts I get in my twitter feed from @Life_Sciences. I don't read all the articles. Who could? But I read most of their tweets. It is impressive, to say the least, the volume of research going on. Also impressive, the nuance and granularity of research going on. Here are a couple of titles for you, meant to impress:

Targeting PDGFR-β in Cholangiocarcinoma

Results of carbon ion radiotherapy for skin carcinomas in 45 patients

Immunohistological pointers to a possible role for excessive cathelicidin (LL-37) expression by apocrine sweat glands in the pathogenesis of hidradenitis suppurativa/acne inversa

These are just the last three tweets from @Life_Sciences

So what is my point in all this? How does this diatribe conclude to supplant the focus from patients to providers? Alas, I have to drone on a little more. I know we (providers) are the ones you (patients) see when your appointment time got screwed up, your lab results didn't get sent to the hospital in time for your surgery or you had to wait 2 hours past your scheduled procedure time. But we are not your enemy! I can't say that emphatically enough. And I know that you know that. However, there is a tone in the patient centered movement that puts us at odds with you. This should go away immediately. Emblematic of this were the comments I heard from the CEO of a startup EMR provider at the Health 2.o conference in San Fran last October. The gist was that no matter whether we (providers) liked it or not we were going to have to adopt the technology that was being given to us by companies like his (I graciously am omitting the name of this CEO and company). And I have heard variations of this theme my whole career, "whether you like it or not!" It is a dangerous and destructive mindset. And it is a big reason we are in the situation we are in. Providers are your allies. We dedicate our lives, many times in a meat-grinder of circumstances to learn how to give you good medical care. We are bright, educated, dedicated, disciplined and altruistic. Who would stay up 24, 36 or 48 hours in a row to learn how to be an engineer? But then when we need tools to do our jobs more efficiently, safely, humanely, mercifully... we are told, "you'll take this and use it no matter whether you like it." We don't like and resist adopting dumb, broken, old, ineffective, obstructive, (insert descriptor) technology, tools or processes. Suffice to say, for many reasons - which will be another post, there is a huge, gigantic, epic disconnect between those of us doing direct patient care and those building the tools of technology we need to help us do our jobs. I was at the Healthcamp conference prior to Health 2.0, the un-conference, where the participants could create the breakout session topics. I put up my little sign for a session titled, "Take your developer to work day" in order to help explain the divide between developers, hackers and coders with the providers. Result - insert audio of crickets chirping. Not to sound elite, rather realistic, too few know what we do, how we do it and why we do what we do. This is why I gave the background info of the life path, educational and research paradigms. Health care is a world unique to all others for many reasons. The players who have not been leveraged (sorry for the catchy and overused word) are providers! Quite the contrary. We are suffering from autonomy and calling deprivation. No profession with the background of training and dedication has been leaned on as much as health care providers. We have some of the worst systems in which to do our jobs yet still find ways to give excellent care to millions of patients, keeping them safe and helping them get well. Sure there are problems (more disclaimer) and those are all well known - thanks a lot Michael Moore. By the way, when was the last time Michael Moore was healthy? I'll buy you a treadmill and a copy of "The 30 minute Vegan" cookbook and trade you that for your health insurance - but I digress, yet another post to write.

I emailed Fred Wilson, after his post about health care. I told him an analogy a colleague of mine recently used with a patient of his. We (providers) are taking care of sick patients, most of whom are suffering diseases from lifestyle choices (still another post topic) in a broken system. Yet we are responsible for an exponentially increasing complexity of knowledge and are expected to do our jobs flawlessly. It is like asking a pilot (the patient to whom my colleague was speaking) to fly a broken plane. The pilot would never do that. The system is broken, patients are broken and we have to fix them in a snapshot of time. Where's the sense in that?

Engage providers with real tools that work. Tools that don't become an end unto themselves - i.e. Government mandates, core measures, JCAHO accreditation, CMS guidelines, ICD-10, EMRs of all varieties, etc. Use the same business model of the current raging, hot fire of social networks - users (providers) are the value! I have said this before (no offense to Foursquare) and will say it again. It may be cool to be the mayor of a Starbucks in Palo Alto but having cancer sucks. If you understand the background of why that statement resonates then you are starting to understand the world we live in. There is technology out there that makes what we use in our daily lives seem laughable. It would be like playing pong next to someone playing Call of Duty on the PS3. I am not exaggerating. If you think I am then come with me to work some day. I will make that happen tomorrow!

Providers should be the primary focus in anyone's thesis for how to engage in the health care space. If we have help in improving the way we do what we do then you (patients) will directly benefit. You will get what you want - better care, cheaper price tag! To me, it's a no brainer!

How About Both Sides of This Table?

2011-11-09T09:00:00.003-07:00

@msuster is a steady source of good info in my Twitter feed. His recent tweet with reference to a blog post about the purchase of Health Data Insights is fantastic news for him and his firm, http://t.co/Z0UJMdwl. I wasn't familiar with HDI so I read a little about them. It's fantastic that technology is rooting out fraud. As a taxpayer I couldn't be more happy. But there is another side to this coin. I don't know what the data is but I know there is a percentage of "fraud" cases in medicare and medicaid that are simply because providers, or their staff, incorrectly code or bill for the services actually rendered. The billing codes for procedures are very precise but procedures are not always very precise. Additionally, there are many other points at which a claim could be labeled fraudulent. If, for instance, an incorrect time, date, patient demographic, diagnosis code (there are about 30K diagnosis codes, soon to be over 130K codes with the implementation of ICD-10) or other important information is incorrectly entered into a claim form it could be considered fraud. The process to resubmit, sometimes multiple times, in order to correct a denied claim takes a lot of time from staff and adds cost to the system when in fact services to a patient were actually rendered correctly. I know there are two different things I am referencing here, incorrectly filed claims and fraud, but there is some overlap as I alluded to and admit that I don't have that data at hand.

In the private insurance world the billing process takes on some interesting twists and turns. The group with which I work was not paid for a single claim for months until each claim was resubmitted.. This was from the main insurance company we deal with (and with whom we have a contract). And the claims were submitted as our office staff has always done, for the last 20 or so years that the group and office manager have been in existence. My theory, pessimistic, is that insurance companies know a certain number of claims will disappear in this submission and re-submission process. It helps their bottom line while it hurts my groups' bottom line in two ways. First, we may forget to refile some of those claims and second, it takes more staff or hours of paid time from that staff to resubmit al those claims. You all can come up with a number of reasons from a non-pessimistic perspective why these kind of things occur. Maybe the truth is somewhere between.

Suffice to say though, the medical claim process is a huge pain point and ripe for innovation. There are some companies getting into this on the periphery (Simplee Health comes to mind) and of course HDI on the payer side. But few technological advancements are being made that help providers. Sure there are EMR and medical practice software providers who provide and electronic platform to enter the same data. But more is needed than a simple digital version of what we have always done.

Here are few questions for the tech folks brighter than me to help and answer/solve. Where are the algorithms on the provider side that recognize trends or at the very least gives cues for complex billing situations, or just cues to include all the pertinent data? Why doesn't billing software submit claims automatically to payers instead of having to go through a clearing house. Clearing houses are these entities which have grown up because billing software providers can't/won't integrate the idiosyncrasies of claim forms from all 1100 or so payers that exist in the U.S. and I don't think anyone in this industry has ever heard of and API. I contacted our practice management/billing software provider so our group could build its own app to get case and care data to our office via that app. Me: "Can I have your API?" them: "We don't have an API." Me: "So can I send digital data about anesthetic cases to our billing software?" Them: "config.sis, MS-DOS, $$$$$, archaic, re-invent the wheel, blah blah blah" (I paraphrased them).

Once again, I admittedly lack data, but extrapolate from the huge dollar amounts in @msusters post and know that the correlary situation occurs on the provider side. It is a maddening source of frustration for providers (good ones, not the tools that are really bilking the Feds) and our staff members. This is a pandemic across the U.S. so anyone who would like to solve some of these issues will probably get bought up for multitude millions! Good luck!

Collaborative Health Record

2011-05-23T16:15:00.002-06:00

Collaborative Health Record, CHR! Forget about the EMR, EHR, PHR. This is what is needed to change the landscape of health care, for good (double entendre)! Providers and patients need to connect in the context of the actual patient record.

I am just putting it out there so that I can be the first to come up with a new term. Unless, of course, someone else already has.

More later...

Simplee

2011-05-22T15:22:00.003-06:00

I recently came across a new company called Simplee (http://simplee.com). It is a site that you can sign up with for free and link your health insurance account to in order to track, organize and manage your health care costs. Although those are wonderful reasons for anyone to use Simplee, the real value is going to come through all the data they are gathering as a by product of their stated goals and use cases.

In short order, Simplee will be able to tell what the contract rates for all procedures and services for each provider and any given insurance company. That is huge. But that information is proprietary, according to the insurance companies and the providers. I am not sure if this will result in a legal battle if they attempt to make that information public. It seems that, although private, the information should be able to be shared openly by individuals, which is Simplee's model. Each person allows Simplee to have access to their online health insurance account. By doing so, the individual allows Simplee access to their explanation of benefits (EOB) forms. These forms are required to be given each patient, by law, from the insurance companies. So, how can information given to the public be proprietary. Legal fight?

The bottom line is this. If light is shed on who pays who how much, then hospitals can't leverage against insurance companies for exorbitant rates of pay and vice versa. Procedure rates vary wildly from hospital to hospital even within the same town. How and why this happens is a mystery hidden behind that proprietary veil.

The ePatient community should jump on this opportunity like a swarm of bees. It can be a huge avenue for cost containment in health care.

Another company, Castlight Health, is trying to do a similar thing. Yet I do not know how they are going about gathering their data.

I must confess though, this post was hard to put out there. I had this idea to "crowdsource" cost data from EOBs months ago and could not ever get it off the ground. Simplee has taken the same idea and done one better with their model. I hope they have more than a wildly successful company. It will definitely disrupt.

Traitwise.com Launch at Health 2.0 Conference

2010-10-10T14:38:00.007-06:00

The Health 2.0 conference in San Francisco last week was a great event. It is nice to see such attention being paid to the area of technology in health care. There were a lot of neat people and companies who participated. One in particular garnered the most interest from me. Trait Wise was one of the 10 companies choosing the Health 2.0 conference to launch their site. It is a fantastic concept and deserves our participation. If Trait Wise (www.traitwise.com) is successful the payoff will be greater than any of the other companies and concepts at Health 2.0. That is a rather bold statement but I will hopefully substantiate the assertion.

Reliable data about the infinite variables effecting our health has been impossible to produce. That's hopefully the past. Trait Wise is attempting to crowd source what they call the "phenotype" data of the human condition. "By 'phenotype' we mean all the aspects of the human condition that are not chemical -- the reactions to treatments, the feelings, emotions, actions, attitudes, and the environment, to name a few," to quote their website. By inviting participation from health care and the population at large they are hoping to build a database, which will reveal correlations, trends or other observations. This data can point the way for scientific research in order to bring personalized medicine into reality. Participants are encouraged to answer large numbers of questions and to generate questions. Instead of a select, minority of scientists bearing the burden of observing trends, the world's populace can participate. Then let the computers process the data.

As a health care provider (nurse anesthetist) who is not in an academic center, I have limited ability to spur research. Although, I have encountered thousands of patients over 24 years in health care, many of whom have caused me to have questions in my own mind. I have often wondered what variables in patients' lives have brought them to the state of health wherein I encountered them. Why does one person live a healthy life into their 90s and another not? What are the behaviors that will make me most healthy? We know some of the macro answers to those questions, like don't smoke, don't stress, eat lots of whole grains and vegetables and so on. But we don't know the personal, individual answers and until recently, we had little hope of ever knowing.

Creating a database of myriad questions, which myriad people need to answer, is the start of a great process whereby personal, individual medicine is possible. Once the database achieves significant power (let the statisticians figure those numbers out) then trends and correlations can be compared to genotype information. The genome and epigenome will point to many more cures than pharmaceutical R&D ever has. If an individual or group of individuals are known to be at risk for renal carcinoma, then there is likely some "phenotype" data to help them make choices to minimize the risk or avoid the cancer altogether. Basically, instead of being confused by the onslaught of consumer health information (e.g. one article says coffee is good for you and another says coffee is not good for you) this kind of database has the potential to let the individual know if coffee is good for that one person. All health data has to eventually be that personal and granular.

We have upwards of 80,000 chemicals in existence in the U.S. There are almost an infinite number of molecules in the food and beverages we consume. We make choices every day about life that also could lead us in an infinite number of directions. It is worth starting the process of revealing how all of those variables impact us. It is worth making sure we have the freedom that comes with knowledge specific to the individual. It is worth answering all the questions. It is worth asking all the questions. If we don't, we give up our freedom by omission and should take what comes our way with resignation.

Technology in Health Care

2010-09-15T13:15:00.007-06:00

Bad is the standard in health care technology. That is for certain. I am referring to the technology of data management, workflow solutions, provider networking, etc. Why is this so? There are a lot of reasons. But the one I would like to highlight in this post is the lack of good techies in health care. Let me explain and address the technorati as well.

Most of the cool tech tools and apps are coming from programmers and developers who see a problem or opportunity then set about solving or seizing. Not so in health care. Very few involved in direct patient care (where we desperately need current tech deployed) can write the lines of code, design UIs or do anything closely resembling the skills required to bring this needed tech to fruition. We (providers) are really good at health care, which you should be as stoked about as we are about kickstands on the Evo, credit card payments on your iPhone, the Starwalk app, Twitter, Google and so forth. We are not good at design, develop, deploy for stuff that we really need.

Buried within the situation I just described is the enormous complexity of the health care system. It is not an environment given to innovation, which can be quickly brought to the deploy phase. There are significant considerations not important to the general tech community. And I have come to believe that the best and brightest developers, programmers, entrepreneurs and VCs flee from this space like it is the Black Plague of death. But here is something the technorati all-stars need to realize, if you neglect this space YOU will pay for it personally and likely, deeply regret the neglect. I am completely confident in that statement, not because I am a prophet, rather because I know everyone on earth occupies a body which will at some point in time need health care. I see it everyday, suffering, pain, confusion, sadness, despair. These are not descriptors of the rare encounter with patients nor is it usual to certain populations. If you are 23 and healthy you have a legitimate reason for a big disconnect in what I am saying. But most people never tune into their health until it is too late. We need the tools of technology to help us help us all be healthy.

Typically we see giant projects deploying legacy software at huge cost with little ability to respond quickly to users ( patients and providers) needs. We need agile development with resonable costs. We need apps that work. We need UIs that either look like what we are used to or are such design miracles that we don't need hours of training to figure out how to use them. We need ways to gather the enormous amount of data that is generated during patient/provider interactions. We need good ways for patients to access their providers. We need good ways for providers to access each other. I could keep going, but I think you get the point.

What I am trying to do is light a fire that will cause some serious disruption in health care. There are some very exciting discoveries, which will have huge potential impacts on our health. We need good technology to help us. My personal favorite area of promise is epigenetics. If we only had good ways to collect massive amounts of data about us and our behaviors. Then we could make some serious headway in this promising field.

That's it. We need your help. It's cool to be the mayor of Starbucks in Palo Alto. But it really sucks to have cancer! Think about that for a while.

Health Provider Quality

2010-06-24T08:58:00.005-06:00

In the course of my 20+ years in health care, there have been times when I have had to cringe at the low quality care being given by a particular provider. It is a helpless feeling. For patients, I think there is an assumption that all providers are created equally. Or, in other words, if someone has the license as a medical doctor, nurse, physicians assistant, etc., then they have to be a good provider. Not true. And there is no credible way for the public to determine the quality (or lack of quality) any given provider brings to the table.

Certainly, one can perform an online search to see if their provider has been disciplined by his/her state licensing agency. Often, this data is state specific and doesn't include data from other states. It is possible for a provider to hop from state to state to try and avoid losing a license or avoid disciplinary action.

By and large, all those who practice with a valid license for their vocations are competent and provide adequate care. But the real data, patient outcomes, is like a vapor. It is not gathered, in most instances, and is far from being subjected to good analysis. To be sure (as if we all didn't know this) outcomes matter. And sometimes the least noticeable practice decisions can have the biggest impact. There is a massive, disjointed effort underway to gather more data with the implementation of electronic medical records. Most that I have seen, or am aware of, track what they are told to track. This mostly includes markers of "evidence-based medicine" and check box care. Care sometimes devolves into a cookie cutter routine. This "dumbs down" provider practice instead of elevating it, in my opinion. Most patients fall in the big fat part of the bell curve and do well with this kind of practice. But not every patient or every problem the patient has, fits nicely into this context. Additionally, evidence-based medicine is tenuous at best. There are myriad ways to contaminate data and recently there have even been allegations of outright fraud in establishing best practices (to wit Dr. Scott Reuben).

I think, in some ways, check box, evidence-based medicine protects the sub-par practitioners. Alas, the issue of unknown provider skill and competence level will continue to be a problem until we are able to establish good ways to track patient outcomes.

New Mexico Adventure Racing Club - Sprint Race #2, Fenton Lake State Park, NM

2010-05-19T14:51:00.001-06:00

Adventure Racing 101 video

2010-05-13T21:50:00.001-06:00

2010-05-12T11:34:00.000-06:00

R.I.C.E.

2010-05-04T07:03:00.006-06:00

In case you have ever wondered what happens when you don't head sound medical advice and known ways to minimize injuries, these pictures illustrate just that.

I was just over half way through a 10 mile trek/run in the Sandia Wilderness in Albuquerque, NM this past Sunday. I was on a trail, which is very familiar to me and moving at a very comfortable pace. I went with two guys from work who are probably not in quite as good shape as me. I wasn't feeling fatigued or nearing any kind of limit. We were on about mile 6 out of 10 when I rolled my right ankle. I felt or heard no pop or crack and after the initial painful twinge was able to move along relatively pain free. We finished the remaining 4 miles with a very mild combination of hiking and jogging. When I got home, I ate a snack then got on my spin bike in the garage and did a spin DVD for an hour. After spinning I changed out the tires on the front wheels of my mountain bikes. Then I worked on a friend's bike for a little while. Finally, about 5 hours after the injury I decided to rest and ice my ankle. I took the first picture just before I laid down. I slept for a couple hours.

After the nap, I got up and went to the store for dinner, made dinner for my wife and I and went to bed about 10:00. The second picture is just before bed. It was about 12 hours after the injury.

The next day I went to work at my usual time, leaving the house at 6:30 a.m. and worked a short day for me, until about 4:00 p.m. I had to make one stop on my way home and got home around 5:30 p.m. After looking at my ankle, I decided I had better get off it and built my nest on the couch for the evening. The third picture was taken just before I parked it on the couch.

I have these pictures to show the progression. The reason I started taking pictures is to text them to my friend, with whom I am supposed to race in 4 days (don't think I will be racing). Since I sent him the first one I kept taking pictures since it was getting worse. Thankfully, it is not really painful. It looks far more impressive than it feels.

And in case you don't know, the title of this post is an acronym for rest, ice, compression, elevation, which is the standard recommended treatment for any injury of this nature. I suggest you follow that advice.

Pretty Cool - iPad App, PadNotes

2010-03-19T16:18:00.000-06:00

Putting P90X to the Test

2010-03-19T14:00:00.002-06:00

I have been doing the P90X workout DVD series for about 6 weeks now. I must confess that I have only been about 70% consistent. Part of the reason the inconsistency with P90X, beside the fact that I have a >full-time job, is that I have to train in other areas for the upcoming adventure race season. But I want to give some thoughts on the series so far.

A little background on me. I had a left sided, L5-S1 disc herniation with a free fragment about five years ago. Since, I have been on a continual quest to keep my back healthy. I have concentrated on functional or dynamic strength training and core strength. I mountain bike, trail run/hike, kayak, ski, snowshoe, orienteer, rappel and ascend on fixed ropes as I train, all for the purpose of adventure racing. I started doing P90X at my wife's behest and have really enjoyed the workouts. If one can say one enjoys such things! As my blog title implies, I am a citizen racer. I am not sponsored, nor do I go out expecting to win. Although, I would like to win. I am looking to stay healthy and be able to do the things I enjoy all my life. There is ample evidence to support the fact that core and functional strength improve overall performance in any sports discipline. So, the first test of P90X will be next weekend as I go to compete in the Adventure Xstream 12 Hour Adventure Race in Moab, Utah. I am competing as part of a two man team. We will mountain bike for about 35 miles, run 6 miles, paddle 12 miles and rappel a 275 foot wall. Last year, with a first-time racer, we finished this same race in 8 hours and 20 minutes. We look to be around the 7 hour mark this year.

I am hoping that the training I have been doing with P90X will allow the faster time while remaining injury free and not completely spent at the end. In the shorter, training rides around Albuquerque, I have felt stronger on the bike. The most notable area of improvement has been in trail running. I have been able to maintain my form and strength for longer runs with faster times.

The variety of exercises contained within the P90X series are enough to keep things interesting. One of my biggest struggles in my fitness has been to actually find enough strength routines to keep from getting bored and stagnant. P90X solves this problem.

The focus on core strength and flexibility is excellent. The workouts that I feel help me most are Yoga, Core Synergistics, X Stretch and Ab Ripper X. But all the workouts fit together seamlessly. I am sure the benefits of the upper body strength workouts will be put to the test this weekend too. I did mention that I had 12 miles to kayak but I didn't tell you it is in an inflatable kayak on flat water, like a stick in my eye. But remember kids, kayaking should mainly be about the core and your burning arms simply point out your (my) bad form.

The other very appealing feature of P90X is that you can do the workouts in your home. Cancel your gym membership, save time on driving to and from, no more stinky gym bags with sweaty clothes you forgot last week. My wife and I usually do them together, in the garage at 5:00 a.m. I love when I can do my workout before work too. Then when I have to stay later than expected I'm not chomping at the bit quite as much because I have to go train. And it really does save you time since you don't have to pack a change of clothes and stuff to clean up before work.

My recommendation to someone considering P90X, go for it. If this is your only workout then it will more than suffice. If you are using it like me as a supplement to other things, it should work very well for that too. I will give you an update in about a week. Maybe one of these days you can even look for me on the podium.

New England Journal of Medicine “Survey” On Doctors & Health Care Reform Was Posted On NEJMjobs.org

2010-03-17T17:09:00.002-06:00

The survey results were posted on this web page:

http://www.nejmjobs.org/rpt/physician-survey-health-reform-impact.aspx

They have since been removed and replaced with a statement and link to the medicus website. I still have the original tab open in Firefox. If someone can tell me how to save a screenshot I will post it.

Science and a Hunch?

2010-02-26T10:26:00.008-07:00

Unfortunately there is a lot of junk information that exists in the world today. The internet has proven a perfect breeding ground for some of it. It is difficult, as an ordinary citizen, to parse through the barrage of information and make critical life choices. From food, to health care, the environment, education, where to live, what to major in at college and every other conceivable item, we have the world wide web at our fingertips to help us, right? Google conquered search but they haven't come close to conquering what to do with all the data. In fact, search engine opitmization and sponsored link results seem to kind of taint those results for which we have googled.

So it is with optimism that I participate in an online community at hunch.com. The concept is that the information users supply to the system will make it smarter and more able to provide users with more targeted and helpful information about whatever topic. I hope the site is wildly successful and it allows them to parlay that success into bigger and broader areas.

In my particular field, health care, we are in dire need of this kind of data collection and analysis generated by patients and providers, "users." Of course, patient data is extremely important. No one would argue against that. Studies look at patient outcomes all the time. Research by scientists at academic institutions is not enough though. Because of technology and the web, we have the ability to harness data like never before. But first, let me explain why I think academic research is not enough. For starters, if you read the news, you know that research from trusted scientists and institutions has lately been in a bit of trouble. Pharmaceutical companies have been fined, taken to court and ruled against and a top researcher has recently revealed that his data was fabricated. I guess this is kind of like a Bernie Madoff scheme in clinical research. One of the biggest reasons this kind of thing happens is a lack of transparency in the process. Too often, collected data is protected from public view under the veil of "proprietary" claims. Full disclosure of financial arrangements are not so full. Also, clinical research is rarely an accurate reflection of medical treatments and practices in communities across the country. Clinical research definitely has value but it is just one piece of the puzzle.

As I alluded to earlier, another huge piece of the puzzle is provider data. The daily, recurring practices of clinicians throughout the country and possibly the world can be collected and evaluated. Not just to correct bad practice but to give credibility to those that are good practices, even if they don't fit within the context of any clinical research.

How in the world can actual patient and provider data be collected and analyzed? Well, we are supposed to be on a trajectory toward a comprehensive, interoperable health information and electronic medical records system. How's that going? Not so quickly. Full scale adoption of this kind of system has lots of hurdles to overcome. I still can't access to a patient record from a hospital across the street (even though that hospital uses the same EMR system my hospital does, huhh!?!). I know I am painting a dire picture of this without facts to back it up. But I think those are easy enough to find on the web. But suffice to say, penetration of EMRs are still very low. And none of the systems communicate fully with each other.

What can be done? Hopefully, a hunch-like system for "user" data generation can be brought to bear on health care. Actual data is extremely valuable, as is being found out in all the social media and networking websites. I look forward to the actuality of what is portrayed in this GE commercial. Subtly, at the start of the commercial narration, GE itself admits to the present reality and what could be in one of their frequently used words, imagine!

The word hunch implies a certain lack of scientific backing. If you go to thesaurus.com and look up antonyms for the word hunch, here are the results: proof, reality, truth. Yet, it is in this very word made into a website where I see a lot of promise for the exact antonyms of the word.

@ThatKevinSmith versus @SouthwestAir

2010-02-15T10:05:00.009-07:00

Two wrongs do not make a right. I am pretty sure that Kevin Smith is going to be okay after this whole scene blows over. But how are the employees at SWA who were involved going to fare? People who have a following and hold sway in the media should measure their responses to situations such as these. Let's just conceded that Kevin Smith was done wrong. To lash out at the employees who were, we have to assume, doing their jobs in good faith, is just as wrong as the incident prompting the response. Someone of Kevin's influence has to understand that he doesn't live in a vacuum. I think he understands that very well. Put it in perspective. Deal with someone in the company that would be considered your peer, say the CEO. And don't trash the people doing their jobs. Especially don't mention their names. Thank goodness no one gave you a last name. It's bad enough for those who may frequent the Burbank airport to be able to deduce who the players were let alone the entire world via the internet. I think the extent Kevin took this with the employees demonstrates either one of two things. Either he is a bully or he was really humiliated about the crux of the issue, his weight. He says that he is unabashedly sedentary and a processed food eater so I have to deduce he is being a bully.

The perspective he should put this in is one that stems from his privileged life. I am sure he is a millionaire. He has tremendous influence and following. He should take his lumps and understand that all the media attention on him is to his benefit. Not so for the employees of SWA. I hope no one loses a job over this unfortunate situation.

Dude! C'mon, give it a rest. Or duke it out with the SWA CEO. That would be a good fight!

Proprietary Information

2010-01-21T08:35:00.003-07:00

This morning I learned that the American Meteorological Society was concluding its annual meeting today. This was from an NPR story I listened to on my way into work. During the story an attendee from Great Britain was interviewed. He was asked how the climate change community might gain back some credibility after the embarrassing "Climategate" email leak. His primary solution was a proposal to make all the data surrounding the leaked emails available to everyone. What a concept! But alas, the reporter went on to state how this would not be possible since the data concerned is proprietary. What? How in the world can data collected from the planet's weather patterns be proprietary? (Don't comment trying to tell me the answer to that question either)

This is not intended to be a post about climate change. I mention that story to illustrate the fact that the argument against release of data is eerily similar to that which the pharmaceutical industry uses to hide their data too, "It's proprietary." Nonsense! Again, how can data collected in clinical trials of humans be proprietary? It's not. Regrettably, legally speaking it has become so. This is all too familiar a refrain from big institutions and gives the appearance that there is something to hide. Within recent memory there have been pharmaceutical companies rebuffed for wrongly representing data about a product.

Like open source projects enlisting the help of millions of programmers world wide, data which holds the potential to alter lives as significantly as drugs people take, which could endanger their lives, should be wide open for review like open source code. There are literally millions of physicians, scientists and other health care providers whose eyes should be reviewing the data of pharmaceutical and medical device companies. Basically, the data needs to be crowdsourced.

Original data is not always included in studies. A lot of the data seen in the "peer reviewed" journals has already been washed by the statistical analysis deemed appropriated by the researchers. One of the most damning issues of studies is the lack of the appropriate statistical "power." In other words, the data pool is too small to give an accurate representation. The lower the likelihood of something occurring generally means a larger pool of study subjects is needed in order to make accurate statements. Often, power analysis is either thrown by the wayside or not mentioned by the researchers at all. One day, current technology will come to health care and we will be able to collect massive amounts of data and it will all be available for review, to everyone. At least that is my dream. Then no one can cry "proprietary" in order to protect their market share. The company or companies that get this first will be on a trajectory far above all their competitors.

The Worst Mutant - Health Care

2009-10-31T09:26:00.003-06:00

It seems fitting that I happen to be writing this blog on Halloween. Mutants are celebrated today. So let's celebrate the mutant, which happens to be dominating the news and national conversation, health care. And to be sure, we are witnessing another massive mutation of the already grotesque beast right before our eyes. Well intentioned, and not so well intentioned, congressional leaders and the President are in the process of grafting new appendages and organs to the beast. Make no mistake, this will be the most hideous of all beasts we know of today. If you think otherwise, with all due respect, you are completely out of touch with health care. I suggest you read this well written, very insightful piece by David Goldhill. It is simply the most comprehensive, succinct review of health care I have read to date. Forget about whose side you are on, Democrat or Republican. To my amazement, I have read positive remarks about Mr. Goldhill's article from individuals on all sides of this debate. He has done what no one else has been able to do, dispassionately dissect the mutant. His article should be required reading for the entire Congress, all their aids, those writing the bills, the President, pundits, "experts" and all who have commented, blogged or in any way chimed in on the debate. Basically, any American who can read, should read his article. In the meantime, as children and adults get ready to dress up as ghouls, goblins, zombies and the like, let's realize what a freakish creature we have and prepare ourselves for the even worse freak show to come!

Health Care Exodus?

2009-10-29T19:18:00.003-06:00

I just missed getting vomited on this afternoon. It has happened before and much worse, to be sure. In fact, I have been bitten, spit on, bled on, pooped on and had all manner of bodily gunk on my person. There are pathogens of the worst sort in the blood and body fluids that I have been exposed to in my almost 25 year career. Some of the worst are hepatitis C, HIV, MRSA (methcillin resistant staphylococcus aureus) E. coli and C. diff. (Clostridium difficile). I routinely miss lunch or have to eat in 10 minutes or less. Sometimes when I need to go to the bathroom it is not possible. I am also routinely up in the middle of the night. My workday finishes when the last case is finished, which could be 5:00 p.m. or 9:00 p.m. BTW, my workday starts around 7:00 a.m. In addition to all of that, health care workers are routinely exposed to radiation, toxic chemicals, horribly non-ergonomic work spaces, noise pollution, extremes of temperature, psychologically stressful situations and the constant stress of knowing that our decisions have potentially deadly effects if incorrect. And lastly, there is the overarching threat of litigation that could result in serious emotional stress or economic disaster, or worse, for us. Whew! So what? You may ask. It is all just part of my job in health care, right? No one forced us to do what we do. And you are exactly right. But remember, no one is forcing us to stay in health care either. In fact, right now, I am plotting my escape. And if the environment of the health care workforce changes for the worse, it may well be that many others will follow suit. There are instances of great satisfaction in what we do. But there is also a tipping point at which some will leave (physically) and I am sure many others will leave emotionally, which could actually be worse for patients.

Workforce issues arising from the impact of reforms have not been adequately studied or addressed. Please read this recent New England Journal of Medicine article. And there is this study from the National Academies in 2008, which paints a sobering picture of current workforce issues before any fallout from the reforms being proposed. Reimbursement rates for providers are going to trend toward Medicare rates, possibly even Medicaid rates. Either of which will force many providers to make some difficult life or practice decisions. Chicago Tribune editorial writer, Steve Chapman, has written about some of the potential monetary impact of the now resurrected public option in this post.

There may be more patients to take care of and that, it could be argued, may sustain a provider’s income. My belief is that providers will make career or practice changes, which will further worsen the workforce issues that are known. If providers bail out altogether there will be even fewer providers for the “Baby Boomers” and all the newly insured patients. If providers decide on practice changes then you can be sure that few will work more than 8 hours a day. Lack of access will be the outcome of either scenario. No one is prepared for this. And did I mention how much I hate to be vomited on?

Plan Plan Plan

2009-08-30T17:44:00.002-06:00

You can scroll through my old posts to see what I had to say last summer after I completed the epic adventure race known as Primal Quest. One of the things I did, along with my planning OCD teammate Steve, was plan. I (we) planned everything I could possibly think of and it paid off in huge dividends. So why am I telling you now. Well there are frequently people who I encounter that marvel at what I have done and continue to do in adventure racing and endurance athletics. They often make comments like, "I could never do something like that." The fact is they are wrong. It really doesn't matter who you are or what you want to do, barring extreme circumstances, you can do what you decide to do and what you need is a plan.

Here is the good news. Plans are easy to come by especially in the arena of physical fitness. I bought a pre-made training plan on www.trainingpeaks.com. They offer a free basic membership, which is all I used, and then I bought the plan of trainer Danny Suter who is an accomplished adventure racer and seasoned trainer. It worked great. I still have access to the plan on their website and I refer to it when needed. There are myriad other plans on Training Peaks alone not to mention the other websites for fitness and endurance junkies.

Make the commitment to do what you have always wanted to do by finding the right plan for you. It doesn't matter if you want to run the Atacama Crossing next year in Chile. If you plan for it you can do it, and do it well!! Who knows, if you let me know I may see you in Chile.

Salomon XT Wings

2009-08-18T16:37:00.004-06:00

I finally wore out both pair of my Inov8 Roclite 320 trail shoes and decided to go back to Salomon. I bought a pair of the new XT Wings (size 13). Here are my impressions after some serious and not so serious mileage put on them.
The XT wings offer ample support. Last year I was having issues with my IT band and I kind of boiled down the cause, in a very unscientific way, to my shoes. That may or may not have been the cause. However, when I was having IT band problems I temporarily switched to wearing a pair of Montrail Hardrock shoes. These were by far the most supportive shoe I have ever worn. Along with some other treatment modalities for my IT band, all of my issues resolved. The Montrail shoes were a bit too supportive and I finally landed on the Inov8 shoes. They were supportive but extremely light and did not have much rock strike protection in the soles. I think the Salomon shoes are a happy medium for what I need; support and sole protection.
My heel sits down nicely in the heel cup and I don't feel high up off the ground. This is very important if you are on rough trail or bushwhacking (off trail). Uneven ground lends itself to rolling an ankle. If your heel sits as low to the ground as possible then you are less likely to injure you ankle this way. The Inov8 shoes sit down lower still. The Montrail shoes were the highest at the heel by far.
Comfort is huge. The shoes have to feel good. The lack of comfort with the Montrail shoes were the real reason I ditched them. The superior support cost a bit in sheer comfort. The Inov8 shoes were so comfortable they needed no breaking in. In fact, I had a pair with a few miles on them which I wore at the start of Primal Quest 2008. They were a size 12. A few days into the race they were trashed and my feet were a bit swollen so I had a brand new pair, size 12.5. I took them right out of the box and immediately put 200 miles of harsh mountain trekking on them, in race conditions. I had no issues from them being out of the box. I think I could have done the same thing with the XT Wings. The first time I wore them was on a grueling mountain run which I do fairly regularly. I had no issues with rubbing and probably would not have had blisters or hotspots if I had been in them all day.
My only complaint with the XT Wings is the relative lack of traction grip on rough, steep terrain as compared to the Inov8 shoes. The Salomon website describes them thusly, "The perfectly balanced combination of two opposing concepts- cushioning and agility. The XT Wings provides unparalleled speed and power making this our most balanced achievement thus far." They really fail to mention anything about traction or performance on rough terrain. If I asked Salomon they would probably have steered me to the XA Pro 3D Ultra shoes. But I bought the XT Wings for the added protection of the carbon plate in the midsole. You can see the edges of this layer on the outside of the shoe and curiously the Salomon website makes no mention of this feature. The only thing they mention is the mysterious "triple density EVA." Who knows what that is?
All in all they are a good shoe. I give them a 4 out of five stars overall. I just wish they had a bit better traction on rough, steep terrain.

Specialized Trail Crew

2009-08-18T12:30:00.002-06:00

Here we go... So I am not the most prolific blogger in the world. Here is what I am. I am a 42 year old, avid mountain biker in the midst of a frenetic life. I work 50 to 60 hours per week at my real job, am happily married (my second job), am starting a health information technology business, am working on two patent applications, am president of the New Mexico Adventure Racing Club, speak professionally for a pharmaceutical company, and STILL find time to ride my mountain bike, HA! I do it all so that one day I can ride and ride and ride and ride.
On top of all that, last year I trained and competed in Primal Quest Montana 2008. My teammates and I were all amateurs and we finished 26th in a field of 56 teams. A top half finish in one of the most grueling endurance competitions is nothing to scoff at. Here we are crossing the finish line. We are the third picture from the top and I am on the far right (link). Not to brag or anything, but I work more hours than any one of my teammates yet I trained harder and more than any of them and as a result I was the team mule. I literally towed my teammates on our mountain bikes (one at a time) for probably upwards of 100 miles. I had rubber tubing tied around my waist and the teammate in tow would attach the other looped end to an open carabiner zip tied to their stem. I loved every minute of the biking, even the towing, even at 2:00 a.m., even after a 30 hour trek through the Crazy Mountains!
I love to ride and I find any time and most conditions don't faze me. Sometimes with my job I am up all night without sleep and the thing that clears my head more than anything is a nice cruise through the 'Footies' (our local trail system). I am blessed to live in a town, Albuquerque, where you can ride year round.
I would write more, but I was up all night last night and need to clear my head. If ya know what I mean!!!!

Bontrager Jones ACX Tubeless Ready

2009-06-10T08:27:00.002-06:00

My new and not so new tires are working out very well. I have been a devoted fan of the Panaracer Fire XC Pro Tubeless 2.1 tires for quite some time now. However, my local dealer, Performance Bicycles, did not have the Panaracers in stock when I was there a few weeks ago. I didn't have time to check their website, since I was heading out of town for an adventure race the next day. So, I stopped by my local Trek dealer and picked up a new Jones 2.2. It has a very similar tread design to the Panaracer and I had another one which was in pretty good shape that I had taken off the bike when I bought new tires for Primal Quest last year. I put the old one on the front wheel and the new one on back. I have been very pleased with their performance and will probably continue to buy them even though they are more expensive ($10 more per tire). The big upside is that the Bontrager tires weigh 175 grams less per tire! That is a lot of grams for only 10 bucks!

Palm Pre

2009-06-10T06:10:00.001-06:00

Well...it is the best phone on the planet. And Apple's big announcement, speed. Ho humm!

Check out this link. I couldn't agree more with the favorite things.

Long Time No Post...

2009-05-04T19:44:00.002-06:00

I just want to give a shout out to my peeps who made my bike. TREK! I got an unusually good deal on a full suspension Trek Fuel 100 Team Issue bike from a friend whose brother works for Trek. The bike came to me in almost mint condition and I think those fellas thought the bike was broken because it had a flat or something...haha. There were less than a thousand miles on the bike, no visible scratches and the crank arms were pristine. I have beaten it to death compared to what is was like when I got it and man is it fast. The entire frame is carbon and even parts of the front fork are carbon. It is an XL sized frame and the entire bike weighs 24 pounds! The wheel set is the Bontrager Race X Lite and it is full XTR front to back. It climbs like a goat and descend like one too. If you are looking for plush don't go here. But did I mention it was fast!?!
The long and the short of this, Trek makes good bikes. And this is one of them. I would love to buy the new version with all the updated suspension and tricked out new stuff. But I got such a good deal on this one that I will ride it until the wheels fall off!

Garmin Forerunner 405...hohum

2009-02-12T10:20:00.005-07:00

Garmin, known for innovative products, laid an egg this time. The newest member of the Forerunner family, the 405, brings one real improvement to the table: slick, smaller design. The rest of the newly tooled Forerunner 405 lacks the pizazz which came with the new, smaller design. This is too bad. And Garmin's support person, who quickly emailed back, explained that the 405 wasn't intended to be a new version of the 305 but its own "distinct" product, huh? Then why does it share the name of all the other Forerunner's?

Here is what Garmin should do for the next Forerunner. They should focus on increasing the battery life. The should get rid of the new touch bezel which was another new feature of the 405. They should allow the user to completely power down the unit. The new 405 watch feature is always on, which constantly drains the batteries. The "distinct" 405 can also be used as a daily wear watch. If I wanted a daily wear watch I would buy one that doesn't have to be recharged and has a battery that lasts months or years! Also, Garmin should focus on useful features like being able to read altitude in real time, on-the-fly, instead of when you are at home looking at the uploaded data. This would help them gain more market share from others like Suunto and Highgear. I wonder if the developers at Garmin have gotten out much? Of course, altitude is not that important when you live in Kansas (Garmin HQ).

You are probably asking why I bought a 405. Well, my 305 battery died (after 3500 miles) and when I returned it to REI I was able to "upgrade" to the 405. I should have looked into the new model a little more. I may return it for a 305...in fact, yes I will!

Score one for net neutrality!

2008-08-02T11:16:00.004-06:00

Everyone should cheer this victory for net neutrality. Here is a link to an article about the issue on the NY Times website.

Fastkayak.com

2008-07-24T08:43:00.002-06:00

When I went in search of a wing paddle for kayaking, a google search led me to fastkayak.com. The owner, Lloyd Reeves, helped me find the right paddle for me. His products are as good as any I have seen, used or heard about but the price is far less than most others. Don't be fooled by the spartan website and go with his "in house" paddles if possible.

Ibis Mojo

2008-07-16T11:05:00.000-06:00

Overall grade: A+

The Ibis Mojo is a revolution in mountain bikes. Just as it was beginning to look like a rider was going to need a different bike for all occasions here came the Mojo. Put away the cross country racer, the all mountain and the trail bikes and pop for a new Mojo. With the Mojo you get all you need for almost every riding situation. Need something light weight, the Mojo. Need something with big travel for that technical single track, the Mojo. Need a bike for an adventure race, the Mojo. Did I mention the Mojo.

Not since the advent of suspension on mountain bikes has there been a better leap forward. Not only does the Mojo look like the coolest bike on the planet and weigh next to nothing but you can get this frame for a song. Maybe a couple of songs, but suffice it to say that just because this is a carbon frame Ibis did not put on a carbon price tag. You can increase your carbon footprint without going bankrupt.

The bike I took out on demo was set up with all Shimano XT gear, good stuff but nothing to write home about. However, this bike rode like a $7000 snooty bike with all the highest of high end components. The Fox fork (32 Float RLC) and rear shock (Float RP23) were excellent. Neither required any additional tuning other than what we did at the LBS. I did not even use the prodedal on the rear shock maybe because the DW-link suspension really works. All in all, I had no issues whatsoever with the Mojo on a 30+ mile ride. Buy one immediately! No, buy two!! Just make sure on them is the Mojo SL.

In the Fishbowl

2008-07-15T14:19:00.000-06:00

Part and parcel to doing an adventure race which requires going without sleep are the effects of this deprivation. The most commonly used description for what racers deal with in this regard is "sleep monsters" which I might add is kind of lame. But it is all we have had until now.

My teammate during PQ Montana, Steve, inadvertently coined a new term after his struggle with sleep deprivation. As we were riding on a 93 mile mountain bike ride, about 70 miles in at midnight, I looked over and Steve's head was hanging ever lower toward his handlebars. I asked him if he was okay and his sloooow, slurred response, "I'm kinda' sleepy," may have been the understatement of the year. He looked like a pasty corpse. My lame, Matt Foley motivational speaker, attempts at getting him out of his stupor did not work. I was trying to get him all pumped up. "COME ON STEVE! PEDAL THAT BIKE LIKE YOU MEAN IT. QUIT WIMPING OUT MAN! COME ON!" After about ten minutes of this Steve said it was working and he felt awake...until about a minute later when his head started sagging again. So we pulled off to the side of the road and slept. I didn't even have my pack off when I heard Steve snoring. About 15 minutes of sleep did it and we were off to finish the rest of our ride.

After we got going again Steve described his stupor so aptly. When we were talking to him and yelling at him he said he felt like he was "in a fishbowl." We were knocking on the glass and talking to him and he really couldn't hear us, just the muffled sounds as you could imagine. So the term was born. For the remainder of the race we tried our best to stay out of THE FISHBOWL!

Inov 8 Roclite 320 trail Shoes

2008-07-14T20:22:00.000-06:00

Overall grade: A+

This trail shoe is the bomb. Inov 8 really gets it right with the Roclite 320 shoes. I used two pair during Primal Quest Montana and will continue to use these shoes for other adventure races I do in the future. They required no break in period and I used a brand new pair out of the box (one half size larger) after about four days of racing in Primal Quest. The only thing I would do differently is use the gortex version, the Roclite 312 GTX, since there was snow and water everywhere in Montana. One of the most appealing features of the Roclite 320 shoes is that your heel sits lower or closer to the ground than most trail and certainly most road running shoes. This gives you a much more stable platform and less likelihood of twisting an ankle on the uneven surfaces of trail and off trail use.

Crossfit

2008-07-14T12:53:00.000-06:00

For those of you not familiar with Crossfit you should become familiar with it! I am definitely a "newbie" to crossfit so please read the material on their website to get the most information. I can endorse their system of strength training since I just completed Primal Quest Montana (210 miles of extreme mountain trekking and 300 miles of moutain biking) and sustained no injuries, not even a twisted ankle. For endurance athletes crossfit is basically the best way to "injury proof" (my friend's quote) yourself. It is a strength training regimen but endurance athletes take note...this is not a bulk up regimen. Crossfit utilizes multi-joint, dynamic strength training as its basis and can be adapted to individual needs and integrated into your existing training.

Gear Review: REI ultralight carbon compact trekking poles

2008-07-14T12:42:00.000-06:00

Overall grade: B

The REI ultralight carbon compact trekking poles are some of the lightest poles out there. They served me especially well on the epic treks I did during PQ when 30 hours of trekking with a heavier pole would certainly make a noticeable difference. They are compact, as they are also named, which make them easy to stow and carry. However, they are not the sturdy, resilient poles which can take lots of abuse. I used these poles for about half of PQ until one of the poles locking mechanisms came detached from the pole itself. Basically, the pole broke. I think this was a result of overtightening the locking mechanism though. I promptly returned them to REI and of course got a brand new pair. I reserve a little criticism for now unless they break again. I will be more careful how tight I twist them using only the minmum to keep the poles extended. Look for updates on this blog. I am going to use them during a rim-to-rim trek in the Grand Canyon in October. We will see how they do then. Otherwise, these are good to go and if they break...take 'em back to REI!

Gear Review: Inov 8 Race Pro 30 pack

2008-07-14T09:33:00.000-06:00

Overall grade: C

Inov 8 seems to be a company that is floundering a bit and not getting the market exposure they need to make their products widely known or accessible. I had to special order this pack from mpgear.com. In addition to the initial difficulty in actually buying the pack I had to order the bladder separately at additional cost of course. Hey Inov 8, Camelbak includes the bladder!

The main attractive feature about the Inov 8 Race Pro 30 pack is it's weight of only 590 grams. Not bad for a 30 liter pack. Esthetically, the pack looks pretty cool and has reflective accents and a nice bright yellow and black colors. However, the appeal of this pack ends about here. The fit of the pack is average with others I have used. And here are the features Inov 8 really needs to improve upon. Their horizontal bladder system at first glance seems like it would really be easier to deal with. It is not. When filling the bladder you have to try and get all the air out which is a pain. Also, when the bladder is full it is difficult to get it into the pack and if your pack is not completely full the pack collapses between the shoulder straps and the bladder leaving only a small area of contact with your back. There are pockets built into the waist strap which are bigger than most packs. One of these pockets is made of mesh and it ripped on a branch the first time I used the pack. The side mesh pockets on the back of the pack are basically open to the outside and anything stored here seems (didn't actually happen to me) like it could fall out. The pack has very limited capacity for strapping other gear onto the outside. It does not have any daisy chain or outside straps. Inov 8 includes a very small diameter elastic cord to run through four very small loops which can accommodate a pair of shoes at the most. If you have to attach any other gear you're going to have to get extra cordage and rig something up.

Long and short, if you want a 30 liter, lightweight pack then chose the Salomon Raid Revo 30! It made it all the way through PQ Montana without any issues at all. I had snowshoes, hiking poles and water bottles all on the outside of the pack with the inside completely full.

Primal Quest Montana

2008-07-11T16:21:00.001-06:00

My team, New Mexico Red or Green, finished Primal Quest Montana 2008 in 26th place. Not bad, considering our goal was simply to finish. We are an amateur, co-ed team of four people (Vicky is the sole female on our team) and we started preparing for this expedition length adventure race almost a year ago. Little could we have imagined we would have done so well. Vicky is the only one on our team who even had multi-day race experience prior to going into PQ! Instead of rehashing the whole race this blog post is going to highlight what helped us successfully pull off this epic adventure race and do it with such a highly ranked finish for us.

First, prepare to plan ad nauseum. Two of my teammates are engineers and their process oriented approach to over thinking every last detail spilled over into the whole team. I think we were all a little prone to being OCD so it didn't take much for us to plan and plan and plan. This planning touched every area and those will be discussed.

We had four major areas of focus; fitness, nutrition, skills and team work. Let's start with fitness. First, we found a training plan which was tailored to the exact event we were planning for. The plan we chose was developed by Danny Suter of Boulder Performance Network. Danny has completed numerous expedition length adventure races and is a personal trainer. His resume fit exactly with what we needed. We bought his plan via trainingpeaks.com and were able to log our own workouts and track teammates workouts for the added accountability, although not much was needed. In addition to the training plan we contacted Danny and went to Boulder for additional training with him. The whole team bought into not only his training plan but his race strategy as well. Danny includes much of his race strategy into the training plan as additional documents. Let me just say that we often quoted Danny and totally did what he told us to during the race. We started "embarrassingly slow" as Danny told us to and eventually we overtook teams that didn't race smart or with such good advice. Prior to starting Danny's training plan we were all responsible for achieving a base level of fitness. I used the advice and plan of a local trainer, Patrick Morrisey

Nutrition is the next major area of focus and this is very individual so I will share my own experiences here. I am 6 feet 3 inches tall and I struggled to maintain my normal weight of 170 pounds. In fact, when I left for PQ I weighed 168 pounds. For those of you who are not of this body type, some of this may not apply. When I trained at home I relied heavily on Hammer products. This company provides probably the best all round healthy supplement line around. Their focus is on higher intensity sports but their products can be used for any sport both in the training period and during the event. During training I was able to approximate how many calories I needed per hour. I bought most of my product directly from Hammer and joined their "autoship" program. For the most part they are good to deal with but the terms of the "autoship" program, which provides free shipping, are a little confusing and can be cumbersome. I chalk it up to them being a small, growing company without all the kinks worked out.

My diet in general would probably be classified as "Mediterranean" which included lean protein (poultry and fish), lots of whole grains, nuts, etc. I am not a nutritionist so you can find a lot more information about this in other places. I did supplement every night before bed with "Hammer Whey" protein and this did help me maintain my weight.

During the race nutrition is a real challenge and here is what I learned. You can't eat as much as you burn but try by eating early and often!! We were given the idea of making 12 hour food bags by team Salomon/Crested Butte. The food bag will contain anywhere from 200-300 calories per hour for a 12 hour period depending on the caloric needs of the racer, which you should determine during your training. This was helpful in a couple of ways. One, it eliminates any decision making when grabbing food for the next leg you are doing in a race and two, it allows you to more easily quantify how many calories you are taking in. During some of my longer training sessions I determined that what worked best for calorie intake was real food. Hammer and other product lines that are similar have limitations in longer, lower intensity races. So, my food bags had a variety of food. The one downside to having real food is the weight of the food itself...after all you have to carry this stuff with you. However, I would eat the heavy stuff early then all I had to carry was the trash. Some of my favorite foods on the trail (much more non-Mediterranean) were Cheetos, barb-b-que potato chips, pop-top spaghettios, beanie-weanies, plantain chips, any snack foods from Trader Joe's, tuna salad in a pop-top with crackers, pop-tarts, cheese nips, etc. Also, be sure to include sources of protein in whatever form. This is a hard thing to come by while racing and according to the experts you need protein for any activity in excess of two hours.

Adventure racing is a multi-sport activity and as such there are numerous skills which need to be learned and mastered to some degree. One of THE most critical skills in adventure racing is navigation! You can have a VO2 max greater than Lance but if you can't navigate then you will move faster than anyone else in circles. The best way to learn navigation is to practice. Usually there are ample opportunities for this. Our local club, the New Mexico Adventure Racing Club, has a sprint race series every year. These sprint races are usually 2-6 hours in duration and at least in our club are very low key and have a small number of racers. Since one of the club's main focuses is to educate the community about adventure racing there is ample help in learning whatever the skill. Check you area for clubs, sprint races and the like. Another source of practice navigating is local orienteering clubs. Our local club is the New Mexico Orienteers Club. Our local REI has some good classes also. There are online resources for some of the basic classroom type information you will need. I cannot emphasize enough though the need for actual practice navigating. So seize all opportunities! And if you have the chance to go do this with people who are good at it, jump on those chances also!!

There are a whole host of other skills which you need to possess. Two of the most basic skills are biking and trekking, or moving per-ambulatory as fast as possible given the terrain. If you don't know how to ride a bike you may want to find another pursuit but all things are possible. So rest assured that if you can do these two things you have the majority of the skill set in hand. You can always learn more about them and get better at them also especially the mountain biking. If you don't have a bike or need to upgrade then let me suggest some tips. First, don't get in a hurry. Keep in mind that your local bike shop (LBS) is like a used car lot. Often they are not interested in selling you the right bike for you but the right bike for them. Ride a lot of bikes. My teammate bought some nice new wheels and kept telling me he was going to take his time and ride a lot of bikes. He kind of took his time but to my knowledge he only rode a couple of bikes. I think he got a good bike that suits him but I think he over spent for what he got...sorry Steve. But all in all this is a very personal decision also so I defer to the man who is going to ride the bike. You should be measured for your mountain bike just like they do for the road bikes. If a shop won't do this for you move on to another one. You can also do this online at www.wrenchscience.com for free. Doing all of these measurements gives you a starting point and with impartial advice from experts you can tailor the information to what you need. If you are going to spring big bucks for a bike, something in excess of $3500, you should increase you carbon footprint...carbon fiber is the way to go. I have a carbon Trek fuel which is a cross-country bike but when I upgrade it will be the Ibis Mojo SL. In the Mojo you get the light weight of a cross-country bike but the big travel of an all-mountain ride. It is the supreme weapon for the all round riding required in adventure racing. Ride a demo at the closest shop you can. Enough of this, get a good bike!

Trekking is a skill which you can improve upon. We all need practice walking. Trust me, Steve the billygoat, used to woop me and I closed the gap a little when we went to PQ. The gear item you need to put some thought into here, shoes. I tried a few. I finally settled on the Inov-8 Roclite 320s. These are great shoes but again this is a personal decision so find your local shops and try on a bunch. Don't go to the Albuquerque New Balance stores, they sold me the wrong size and wouldn't give my money back after I had worn them. Not too many shops carry Inov-8 products so try zappos.com since they have free shipping to and from you if you want to return them. As an aside, I shouldn't really be pimping Inov-8 since I asked them for sponsorship and they didn't send me as much as a free t-shirt or a bumper sticker...you guys missed a golden opportunity to have a sponsored team at PQ! But a good product is a good product. I am not as impressed with their packs though. You need some real racer experience and feedback Inov-8. They have some really cool gaiter sock but they are not so good for longer races, think sprint, 12 and 24 hour races.

You other skills, white water and flat water paddling, riverboarding and fixed ropes ascending and rappelling require specialized training and expertise which I do not possess. However, I will tell you who we used for our training. For riverboarding we trained with Shane Bolling at Rip Boards. Shane not only trained us but we bought his boards which I think are the best. We did our ropes training with Allan Aiken who works for Suntoucher Mountain Guides here in Albuquerque. Allan rocks (pardon the pun)!

Lastly, but certainly not least is teamwork. This is probably the single greatest area of failure for teams outside of injury and illness. There is no room for egos on an adventure racing team. Everyone has to become selfless for the better performance of the team. We all have our issues but maturity must prevail. Things that seem trivial annoyances while training can become race ending disasters. Train as much as possible together so the team can work out all of those issues. I must say, since we did not get a chance to train as a whole team ever, the maturity level of my teammates was high. Except for a couple of very minor issues we work so well together. I was impressed.

I hope you find these thoughts helpful. Feel free to comment. I welcome them...most of them anyway.

Citizen Racer