Tuesday, September 18, 2012

The Barefoot Contestant- "Toeing the Line" Part IV

“There are many paths to the top of the mountain but the view is always the same”.
-Chinese Proverb

    I embarked upon this journey because I was seeking an end to my running pain. I had no intentions of joining a cult or of becoming some sort of running evangelist.
I have tried my best to keep an open, honest perspective, while reporting back the full range of my trials, trails and tribulations with the crazy toe shoes, known as Vibrams.

{Catch up on  Part 1Part 2 and Part 3}

Funny thing is, once I put them on my feet, people took notice.  Suddenly I was forced into a role akin to a clergy member.  Folks apparently felt free to unburden their questions and confessions upon me, a perfect stranger, regarding my feet, and in particular, my shoes. 

People would look down and ask, “Hey, are those things comfortable?”  “They look funky!”

“Yes, they are comfortable,” I would say enthusiastically, playing the role of the accidental advocate, regardless of what I was feeling about them at the moment.

It’s not like I had a choice.  What could I have said? 

“Oh, these things you see on my feet?  Pieces of crap actually, I hate them.”  I’m miserable in them and they have totally screwed up my training schedule and so on….

Of course not. 

Nor did they truly want to hear the full list of pros and cons I’d managed to tally up to this point.  The shoes merely caught their attention and they were responding to them.
“Wow those are cool shoes!  My daughter has been asking me to get her a pair, would you recommend them for a teenage girl?”

It required superhuman effort to suppress my overwhelming snark reflex at this moment.  While silently conceding my role as an involuntary Vibram promoter, I did NOT reply with the first thing that popped into my head:

“You mean, you want to know if they would serve as a fashion accessory for some ditzy, Justin Bieber fan? Why no, no I don’t recommend them at all.  Lock her in her room and let her  watch Twilight movies until she’s 21.  These are shoes for serious runners with a solemn commitment to the freedom and performance that comes from unleashing one’s more natural potential…”

Sadly, all I DID is say, was, “Uhmmm, well they come in some pretty cool colors, she would probably like them,” and walked away very quickly.

On other occasions, people would point at my feet, nudge their companions and proceed to  talk about me and my shoes, in the third person, utterly indifferent to the fact that I was standing right there, listening to every word.  

“Will you look at those things? I don’t know how she walks in them, I’d be afraid to step on something and get my toe cut off.  They can’t be good for her! I don’t know if I could wear anything with all that junk between my toes…”

It happened more than once.

More running savvy folks would ask better, more specific questions but they were all pretty much the same.

Frequently  I heard various versions of:

 “I’ve seen those shoes around and even thought about getting a pair, do you think I should? What about support?   Don’t your feet need some kind of support or cushioning or something?”

Vibram and Mr. McDougal should both be paying me commissions for my replies to these people.  I found myself explaining the entire theory behind why artificially supporting the natural structure of any arch weakens its inherent strength, both architecturally and anatomically speaking.   I’d mention the book, the research and refer them to the Vibram website, all as part of the “experiment.”  I repeated myself so many times, that I  started to feel like a broken record; while many of you reading this will not know exactly what that means, I felt that way just the same.

Despite the distractions,  I managed to increase my long run mileage up into the double digit range.  As the mileage increased, I found that I kept a constant pain or soreness in my left Achilles. It required a great deal of stretching and massage therapy to keep me on track for the Talladega Half.  I’m also quite a bit slower on the long distances. I am unsure if it is still a matter of acclimation to the shoes or if this is as good as it’s going to get for me.

 If I could meet with him, I’d like to ask McDougal  how long acclimation is supposed to take.  My calves are no longer cramping up, I can cover the distances, but after every long run, I’m still left with the same, achy soreness.  I can stretch and it eases up somewhat, but any time I sit still for any length of time, the soreness returns. I know “they say” that the Vibrams will convert me to being a toe or mid-foot runner but it still hasn’t happened.
Additionally, I have serious reservations about whether or not many runners would be willing to sacrifice the mileage from their regular training schedules and scale back to the extent that I have, merely to experiment with a new shoe.

While, philosophically, I agree with living more in accordance with our Paleolithic origins, I just don’t know that everyone’s anatomy is designed to run the exact same way.  The wear pattern on the bottom of my Vibrams still indicates I’m using my heels quite a bit.  

  There is one caveat regarding this experiment. Over 35 years ago I had a serious injury to this same left ankle.  It was badly broken in a skateboarding accident, and it required surgery to repair.  Then, several years later, I had a nasty sprain while waterskiing.  I had thought I’d recovered reasonably well from those injuries, and I’d never experienced ankle or Achilles issues from running before.  If the previous injuries constitute a part of my adjustment issues,  I’m not so sure that I’m grateful to the Vibrams for eliciting these particular muscle memories.  

I think I should also mention here that in the 5 months that I’ve owned the shoes, I have not yet washed them.  Not unusual perhaps, for a pair of running shoes, but for sock-like shoes??? They are fairly filthy at this point and yet, I’m afraid to wash them because it seems as though they’d fall apart.  Within the first month of wearing them, all the ornamental stripes and accents either came loose or fell off and the material inside the toe compartments  began to fray.  The inside sole has gotten worn and rough and sometimes it’s hard to tell if I have a rock in my shoe, or if it’s merely one of the jagged edges that is now a permanent part of the bottom of my shoe.

My experience with the Vibrams has led me to believe that, while Born to Run is a wonderful book and motivating story, I am not fully convinced that it qualifies as the ultimate, running “gospel.”  McDougal also made a few hopeful leaps; a bit of theorizing that didn’t exactly fit with some the science he was attempting to explain, but I will let that slide, if only because he at least got us all thinking about the subject.  I also refuse to become a convert to the belief that Vibrams are THE definitive running shoe for all people, in all situations, at all times.  They aren’t.   Since I’d like to remain true to the original product testing spirit that gave rise to this series of articles, here are the pros and cons as I see them:
1.     Great for sprinting, track events and short road race distances-- (in dry weather only!)-- I will probably continue to wear them for 5k’s, maybe 10k’s depending on the terrain.  For the future, I will consider them a training tool and perhaps use them for speed work while training for half and full marathons. However, I will probably not be wearing them on any trail or long distance runs.

2.     Great for any sport that requires agility and lateral stability-- I will definitely continue to wear them for plyometrics and agility training.  When it comes to box jumps and ladder drills, the extra control imparted from the flexibility of the shoe and individual toe compartments is very reassuring.

While I have not personally tried indoor or outdoor court sports such as tennis and racquetball, I suspect that the Vibrams would be good for those types of activities as well.   

1.     Need to avoid any situation with water--Puddles, mud and river crossings are not your friends with Vibrams unless you like pruned toes.  Many paddlers will also find them unsuitable for use on the water for the same reasons.

2.     Trail running--I’m sure Vibram makes a trail specific shoe, but as for me and my feet, I want more protection than any “toe shoe” can offer.

3.     They may not be suitable for all foot types--This includes people with Morton’s foot, ( a common anatomical variant where the second metatarsal is elongated and creates a situation where the second toe is significantly longer than the first toe) or people with range of motion issues dues to scar tissue or previous injuries.

4.     Not for triathlons…I’ve seen other folks wearing them at tri’s, so maybe I’m just a klutz, but it still takes me a while to get my feet in them.  I’m much better these days, after 5 months of practice, but I would end up cursing and fumbling around the transition area if I was in a hurry to get them on.

As with any philosophy, there will be varying degrees of orthodoxy.  I’ll buy into the theory that a low, or zero-drop, shoe is more natural for our feet.  I will concur with the concept than the constant flexion of our Achilles tendon, caused by shoes angled like jacked up muscle cars, be they running shoes or women’s high heels, is not healthy.    I’m not, however, sold on the idea that a little padding on our soles, or protection for our toes, is such a bad thing. And as far as being more “in touch with our Paleolithic origins,” I have yet to see any cave paintings depicting the virtues of compartmentalized shoes.

Addendum: Written after 9/16/12-Race Day!

My Talladega Half Marathon results were nothing to complain about.  In fact, my time was 1:49:32   Good enough for first place in the 45-49 age group!!!  I also got to give Bill Rogers a hug and had him sign my race result printout, thus making it “official”.
I was ecstatic about the race results but I attribute my recent improvement not so much to the Vibrams, but to my strength and agility workouts. In fact, I think I did well in spite of the Vibrams rather than because of them.  On the course, there was one stretch of a gravel road that I had to pick my way through carefully.  The small gravel was not an issue, but there were fist sized chunks that I knew I did not want to step on.  My ankles and Achilles were sore afterwards, as they typically were, during my long training runs.  Additionally, while this never happened in training, I not only “blistered up the track” with my new found, blazing speed, but I “blistered up on the track”.  Maybe it was because I raced faster than I trained, but I had to gut out the last 2 miles with some nasty blisters that formed in odd spots.  The undersides of both big toes, at the first joint.  In other words, the soft spot, in the bend of the toe, that would never normally even contact a shoe, was rubbed raw, in the Vibrams.  All the more reason for me to reiterate the fact that I will no longer be attempting any long distances in them.   

It’s been a great run and an interesting experiment for me.  I’ve learned a great deal about the shoes, but mostly about myself.  Thank you for following along with me on the journey.

Along the way I was frequently asked if I would recommend the Vibrams to others.

 My answer :
If you are enduring pain that no one can figure out how to fix, and are willing to cut back on your training, give them a try.  They may be exactly what you need.  For some people, they are a perfect fit.  We are all designed just a little bit differently, and life has taken different tolls on each of us, in different ways.

 If you aren’t in pain and you are merely seeking to improve your running performance, I would  suggest you cut down on your running and vary your workouts to include strength, agility and plyometric training.  It’s worked wonders for me; your mileage may vary.

What I do recommend for everyone is to do as Bill Rogers once suggested:

“This sport is the sport to see what you are made of, so use those expert’s advice, but be free to be your own champion runner, picking and choosing advice you enjoy and that works best for you”.

Friday, September 7, 2012


A Radiology Fairy Tale...


 - Adventures in Professional PACS Training and Customer Satisfaction

For my non medical or non imaging friends out there…
PACS stands for:
Picture Archiving and Communication Systems-PACS refers to all of the equipment and systems involved in viewing and storing your digitally acquired, medical images. (think Xrays, Ultrasounds, CT scans, MRi’s etc... )

 ON the viewing/clinical side we have the radiology technologists who generally acquire the images, while working in conjunction with the radiologists who subsequently interpret them. 

On the Archiving/Storage side of the equation, we have the IT/Computer/Technical folks who do their part to make the miracles of filmless viewing, virtual colonoscopies and 3D reconstruction a reality. 

Both sides of the house need each other and both sides often drive each other crazy while attempting to pull off the seemingly impossible. 
It should be noted however, that while it is common for individuals to transition from the clinical side of the house to the more technical, storage side, it is extremely rare for anyone innately technical, to make the clinical transition.

This speaks to the personality types involved, as well as the theory that data centers are probably similar in construction to The Hotel California…

Here we go with our story:

Once upon a time, there was a PACS.  This PACS was one of the finest in the entire kingdom.  Radiologists and technologists alike, spoke of it in hushed, reverent tones.  They were enchanted by its ability to enable physicians and healthcare professionals to manage, access and visualize multi-specialty medical content across the enterprise using advanced visualization tools, clinical content management and clinical workflow through a dynamic user interface.

As wonderful as this particular PACS was, it was also well established throughout the kingdom that the epoch of implementation, as it was referred to, was, at times, fraught with obstacles.  Many of these obstacles had nothing to do with the beauty and efficiency of the system.  Nay, it was often puzzling to the many Knights of the Implementation Council that the very radiologists who wanted and needed the system, were oftentimes, themselves the source of the conflict.  Many roundtable discussions were held in order to solve this mystery of conflict and customer dissatisfaction.

During these Roundtable discussions, legends and tales from Implementations throughout the land were shared in order that they might consult with one another to decipher the lessons contained within, such that quality solutions to problems could be revealed.

It was once upon a particularly illustrious Roundtable discussion, that the tale of the Mouse and the Keyboard was first told:

Legend has it, that it was during a session whereupon one of the Knights of the Implementation Council was bestowing upon a radiologist the wisdom and understanding of the PACS, that one particularly startling incident occurred.  

The PACS configuration contained 4, Grayscale, Resolution of the Highest Monitors, of the House of Siemens, in combination with a Color Monitor, descended from the Lordship of the House known as Dell.  It was this Dell, whereupon the exam list was displayed and the private healthcare information of the subjects’ of the PACS was made known. 

The cursor, which was the onscreen representation of the relative location of the mouse upon the desktop, had to travel vast distances across the 5 monitor expanse. 

{From the University of Rochester’s website}: http://www.urmc.rochester.edu/smd/Rad/nevents05.htm
Here is what a typical workstation might look like:

 The critical moment of this story occurred when the radiologist, who had been disregarding the amount of desktop space necessary for mouse movement, caused a collision of the Mouse, upon the Keyboard.  The cursor, which he desired to situate upon the patient list,was trapped upon the landscape of monitor number 4.  No further leftward movement was possible due to the keyboard’s impedance upon the mouse’s leftward most pathway. 

Observers gaped in amazement at the transgression, yea, many fled the room, in fear of witnessing what horrors might befall the ensnared cursor. 

The radiologist registered a customer dissatisfaction issue with the Knight of the Implementation Council that such behavior was an unacceptable feature of the PACS, and that it would need to be corrected by the Knights of the Engineering Council before he would ever again lay his hands upon the PACS. 

Silence fell upon the darkened room. 

All eyes were upon the Knight of the Implementation Council, whereupon, she most bravely and fortuitously reached towards the keyboard, with utter disregard for her own personal safety, slid it forward, in such a manner, as to disrupt the keyboard’s negative interference upon the Pathway of the Mouse. This swift action created more usable surface area, whereupon,the Mouse and the Cursor were then both easily returned to the first monitor, that of Dell.  

The radiologist nodded in satisfaction and the Project Manager, He of the Highest Order, confirmed that the solution was one of both quality and genius.   
The PACS was saved and the Dominion of the PACS Company prospered ever after. (Until such time as it was sold and the name was changed)

There are many notable and almost seemingly comical stories and fairy tales in the world of PACS Implementation.  The above story, while thematically framed, recalls an actual incident and challenge in the field. 

All fairy tales have something to teach us.  The mouse and the keyboard were functioning properly; there was nothing wrong with the application.  The doctor merely ran out of mouse manipulation room and did not know that he could simply pick the mouse up, move it several inches to the right, and recover his cursor. 
To those of us familiar with computers, this seems like such a simple and intuitive thing to do. It was not intuitive for this doctor. Covering for his embarrassment, he lashed out at everyone in the room and declared the system a failure. Immediate intervention was required, in order to convert a potentially sales killing, customer experience, to a more positive encounter.

The lessons in this, and the challenge to all of us, is to be prepared to take a creative approach, in order to be able to train people to utilize any system, regardless of the current level of computer literacy in which we find them.  

There have been times when I have had to start from the beginning and teach a radiologist how to point and click with a mouse.  I would start them off with solitaire and work my way back to the medical applications.
Conversely, many radiologists are very skilled and comfortable with computers and have presented me with different sorts of challenges.  Hyper-light speed mouse clicks, borne of impatience and the need for rapid throughput, can create unwanted situations and give the appearance of poor system performance as well.

 “Semper Gumby”- Always Flexible has been my guiding philosophy in this arena.

While I maintain a general lesson plan that I like to follow in order to ensure thoroughness, oftentimes the needs of the radiologist will dictate that the script needs to be abandoned, and spontaneity becomes the order of the day.  The less we, as trainers, regard this not as a threat, but more as an opportunity to shine, the greater the likelihood of high, customer satisfaction, regardless of industry.