September 5, 2009

Moved the Needle

Posted in Life, Technology tagged , , , , , , , , , at 11:52 am by lindaslongview

One year ago, as a result of a running hip injury and a prior history of a hip stress fracture (running), my doctor recommended a bone density measurement even though I am young, active, and have no significant risk factors for osteoporosis.  Obediently, I went for a DEXA measurement.

Shortly after, my doctor informed me that the good news was that I had not lost any height, but the bad news was that I had osteoporosis.  I was shocked.

bone

This diagnosis was opportunity to adjust my lifestyle to improve my long-term skeletal health.  As with any significant emergent problem, the long view response is similar:

  1. Assess priority – does it merit long view investment?
  2. Define improvement/success metric(s)
  3. Create a plan for improvement/success
  4. Execute:  drip, drip, drip…
  5. Measure improvement/success
  6. Reassess priority  (Celebrate improvement/success)

Establishing priority was easy.  To ensure my long-term skeletal health, I was immediately committed to aggressively battling this silent disease.  Complacency was never an option for an Off-the-Scale-Futurist.

Defining the improvement/success metric was also easy.  I needed to increase my bone density to greater than -1.5 spinal t-score (low end of the normal range) as measured by DEXA.

With my doctor, I created a threefold plan for bone density improvement/success:

  1. Increase mineral availability:  take calcium supplements 3×600 mg/day.
  2. Decrease demineralization:  add drug therapy, Boniva 1x/month.
  3. Increase mineralization:  add load-bearing exercise.  This required a remix of my athletic lifestyle.  My typical regimen of swimming, biking, running, and an occasional cardio machine provided limited load-bearing.  Only running counted as load-bearing, and it only loads the lower skeleton.  So, I reduced swimming and biking in favor of weight-lifting 2x/week, along with my usual running.  After a bit, I realized the combination did not give me the joy of athletics to which I was accustomed, so I went in search of new load-bearing sports. I tried both yoga and rock climbing, both of which provide whole skeletal loading.  Although I liked yoga, it didn’t like me (rhomboid strain).  I loved rock climbing – it is so addictive that it became the clear winner!  🙂  I now mix a combination of swimming, biking, running, and rock climbing throughout the week, along with weight-lifting 1x/week.  I still have joy, but I increased the amount of load-bearing exercise.

Since DEXA bone density is measured no more frequently than annually – I committed to a full year of execution.  Keeping the faith, I impatiently and anxiously awaited my next DEXA results, drip, drip, drip, …

I recently received my results and I moved the needle!  I went from a -2.6 spinal t-score to a -1.6 spinal t-score; a full standard deviation of change.  Woohoo!  Although I didn’t quite reach a number greater than -1.5, I certainly made a significant gain.  Time to celebrate!

Because load-bearing is now integrated into my lifestyle, I no longer need aggressive focus.  Time for a new adventure…

What are you doing to ensure your long-term health?

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April 26, 2009

Heeding Warnings

Posted in Life, Technology tagged , , , , , , , , , at 11:27 pm by lindaslongview

warningtriangle

All too often, we hear “warnings” but proceed without heed.  Sometimes it is a small voice inside one’s head that says, “things do not add up,” sometimes it is a real warning (do not use lawnmower as hedge trimmer or bodily injury might result), and sometimes it is a recitation of all possible observed “rare events,” such as on drug labels.

Two weeks ago, my doctor prescribed me the antibiotic levofloxacin for a sinus infection.  As he prescribed it for me, he hestitated because I am an avid athlete and he said that it was known to be associated with spontaneous tendon rupture.  Although I was warned, once I felt better I did not think about that warning as I returned to my regular repertoire of sports.  Last Thursday morning, as I perilously dangled after I lost my footing on a V2 bouldering problem, I had to strain hard to regain my footing and overgripped my left hand/arm to finish the route.  Later that afternoon, I could no longer open my car door with my left hand and the previously faded memory of the “tendon rupture” warning had resurfaced.

When faced with warnings, there is a tendency to discount that which causes us to deviate from plan.  As busy humans (never enough time!) we are risk averse especially to the loss of time. We have an ability to proceed with any number of justifications:  the probability is small (rare event), the concern does not apply (no associated risk factors), and/or the risk is overstated, because we have not deliberately considered the unfavorable outcome’s impact on time.

Deliberately planning for undesirable outcomes based upon “warnings” is the long view approach.  By including contingency for the unexpected, we are more objective in dealing with risk.

I have since learned that strenuous sports activities predispose patients to quinolone-related tendon rupture [Gold and Igra, “Levofloxacin-Induced Tendon Rupture: A Case Report and Review of the Literature,” The Journal of the American Board of Family Practice 16:458-460 (2003)].  Yikes!  Had I been sufficiently deliberate to more fully understand the potential for tendon rupture and had planned for a twelve week (or more!) tendon recovery, I would not have been bouldering on Thursday morning.  Swimming would have been a much better long view choice!

The good news is that my elbow pain is already better (probably unrelated to the drug concern).  But, nevertheless, now that I know the full implications, I will not be placing high loads on my tendons while taking levofloxacin again!

I am duly reminded to take the long view and plan for contigency in order to be more objective in dealing with risk.  I hope you are too!

March 14, 2009

Unexpected?!

Posted in Uncategorized tagged , , , , , , , , , , at 12:49 am by lindaslongview

As a veteran of understanding complex systems, it is not terribly surprising that sometimes the unexpected occurs. It is not so much that humans have poor intuition, it is more that we 1) oversimplify (we focus on a specific element and not the whole), 2) we underestimate the affect of randomness, 3) we do not account for a changes in underlying assumptions of our mental models, and 4) we overvalue the expected outcomes because we become emotionally attached to the outcome.

As a trivial example of the unexpected, I am whining about my sore hands after having returned to running and climbing after a month of ankle injury hiatus (the climbing calluses on my hands receded and my hands became soft). So even though I expected to be most challenged by my ankle, it is actually my hands that are unexpectedly sore — I did not anticipate the whole picture.

As a really BIG example of the unexpected, the core of the financial mess that the world is currently experiencing can be traced to an oversimplified quantitative model that failed to account for changes in market assumptions – see Wired (March 2009): “A Formula for Disaster.” (Very interesting yet short article).

My experience in managing complex systems coincides with all of the wisdom and experience of others before me — take the long view: pay attention to the capacity constraint of the system, be wary of process steps with similar capacity to the constraint either upstream or downstream (they could easily become the constraint), and stay aware of external factors that can impact the system. The most important advice is to assume that Murphy exists and plan for managing it. To that end, if you do not have good intuition under different scenarios and want to build it to plan for it (for example, recovery from disruption), I recommend discrete event simulation with Simul8.

I am sure that there are other reasons than the four (4) I listed for the unexpected to occur. I invite you to add reasons 5, 6, 7….

March 3, 2009

Body like Business?

Posted in Business, Life tagged , , , , , , , , , , , , , at 7:01 am by lindaslongview

Each of us only gets one body.  From an early age we are trained to care for ourselves — brush & floss our teeth, eat right, exercise regularly, and rest appropriately after illness or injury.  Although most of us do all of these things regularly, it is the last one that can be the most vexing. It is challenging because injury and illness are inherently unplanned, undesirable, and unintended.  Recovering from injury or illness requires expenditures of time and effort to recover that would not be required if everything had “gone to plan.”  So there is opportunity to be bitter and angry.  The reality is that there is risk in sports (one cause of injury) and being around others (one cause of illness transmission). It is the payoff: fun in sports or the creation/nurturing of a social/professional connection, that makes the risk worthwhile.

In an analogy to business, routine care is required for operations  — develop products, purchase raw materials, manufacture products, sell products, account for the flow of money and products, and take time to recover from setbacks.  As in illness or injury, setbacks require expenditures of time and effort that would not be required if everything had “gone to plan.” Similarly, there is risk in business — if it was easy, it would not be a long-term business.  It is the payoff:  money (in a for-profit business), that makes the risk worthwhile.

In both cases (body or business), routine care requires planning, precautions, and prudence.  Yet these cannot prevent all setbacks; they minimize the severity, duration, and frequency.  Thus, in order to be truly successful, we need to take the long view and be disciplined in our recovery from setbacks.  We must expect setbacks, plan to expend time and effort to recover (relative to the risk of the payoff), and not be negative or rushed in our recovery execution.  One way is to buffer projects from uncertainty by realistic planning, disciplined tracking, and adequate resource deployment for recovery using Goldratt’s Critical Chain, all the while staying, persistent, passionate, and positive!

On a personal level, I am working hard to recover an ankle sprain (a moment’s inattention to a pothole in a running trail left my ankle discolored, swollen, and sore).  Since I want to enjoy the wind in my face (from running) for as long as I live (the long view), I am in rehab (toe-raises, gentle stretches, and swimming).  Only nine (9) more days until I can run on my ankle again!  But who is counting?!