Diabetes Stuff and Its Cost

Here’s my take on last week’s kerfuffle concerning the NY Times article about diabetes improvements and their high costs:

That’s all of my diabetes stuff . . . and that doesn’t include the pump and continuous glucose monitor (CGM) transmitter that I’m currently wearing. Over the last fifteen years, my insurance company, employer, and I have been a mint for pharmacies and corporations in the diabetes technology and biological pharmaceutical areas.

If you look closely you’ll see the “consumables” on the right-hand-side of the picture: test strips, infusion sets, reservoirs, CGM sensors, batteries, lancets (*ahem*), alcohol swabs, and various tapes and preps. In the left foreground are the “just in case” spares that I carry with me everyday: a pump, meter, reservoirs, infusion sets, syringes, and all of the things I might need to use these things—inserters and chargers mainly—whether I’m at home or away.

Everything else is just stuff. Maybe I used it once, but nearly as often it just came with something else as either a freebie (lancets with a new lancing device) or as something billed to my insurance company when I got a new device. I keep it because it’s useful once or twice a year or because (as a disease that can instantly demand your full, life-or-death attention) diabetes really encourages preparedness. But somebody paid for all that stuff, even if it goes unused.

The observant reader will notice two insulin pumps in there: the last Medtronic 512 I used before getting my Medtronic 522 about five years ago and the most recent 522 I wore before getting the 530G that I’m wearing right now. It’s been beneficial to have a second pump; the first one sometimes breaks, and I also use it along with my regular pump on days when I compete in triathlons. But why three? Unlike the 512, the 522 supported CGMS. Unlike the 522, the 530G supports the Enlite sensor. Otherwise, they’re pretty much the same with minor tweaks.

Is it medically necessary to have upgraded? No. Have the expensive technology upgrades improved quantifiable health metrics, such as A1c or the number of lows and highs I have? No. Have they improved my overall quality of life with diabetes? The 522 certainly did, since it brought me into the world of CGM; the 530G hasn’t been nearly as impressive or transformative. (In fact, it’s been a bit of a disappointment, but more about that another time.)

The meter story is similar, except my out-of-pocket expenses are higher, and each time I’m sent a “free” meter, the test strips fall into the ultra-premium, high deductible tier of my pharmacy benefit. So, I’m using the medium tier test strips which work with the meter that sends BGs to my pump. If I were a person of lesser means, I probably wouldn’t care enough about that integration to pay extra each month.

(By the way, this is just a small collection of the meters I’ve had over the years. I’ve lost some, broken one or two, and given away a half-dozen or more to coworkers who sent them home to type-2 parents in India, China, and Russia.)

The impact of cost probably holds just as true for insulin as it does for test strips. I get good results from Humalog, but it’s not the only insulin analogue out there, and Novolog costs less for some people. I would consider using it if it meant significantly lower out-of-pocket expenses. Of course, there is a lower-cost option currently available: “regular” (non-analogue) insulin. I know a couple of pharmaceutical insiders who lament that Humalog doesn’t have enough of a difference in action compared to regular to justify its higher price. But for me, their action curves are different enough in rapidity of onset and shorter overall action to be worth it.

If you were looking in from the outside—perhaps as someone who pays more out-of-pocket than I do or as a coworker who shares some of the shared burden of our insurance pool or as a health economist—would all of this seem like money well spent? I find that debatable. And I think that’s the point that’s been lost in the DOC about the NYT article. Sure, I disagree with it on the value of insulin analogues and CGMS, but I think it raises interesting points and questions that we can’t ignore:

  • New diabetes “improvements” often aren’t based in medical necessity or add only marginal value when you consider them based on clinical indicators. (This is sadly true for a lot of medical “innovation” these days.)
  • A lot of recent research and costly new developments—incremental changes to pumps, CGMS, test strips that use less blood, integrated devices, and better insulin analogues—are critical parts of various “artificial pancreas” projects. We’re developing a very expensive “cure.”
  • Many people with diabetes (type-1 or -2) have trouble affording the basics, and many more have large out-of-pocket expenses for the durable goods and consumables that comprise artificial pancreas solutions. Are we developing solutions that only some of us will be able to afford?
  • As people impacted by this disease, we naturally want all of the newest things that might make our lives easier, even if the research hasn’t proven its cost-effectiveness yet. How much can we really expect the other people in our insurance pools to contribute for this stuff? Where do lower cost options fit? Will we accept people suggesting that we reconsider or who flat-out tell us “no?”
  • How should we effectively communicate our need/justification for these things to people outside our community? And how can we handle pushback from people who justifiably question the value of the stuff that isn’t strictly necessary?
  • How can we in the community help drive down prices for the stuff we need and use?
  • What are ethical/legal ways of “redistributing” high-cost diabetes technology once you’ve upgraded or switched vendors?

So, dear readers, what do you think?

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On Sunday night, Lisa and I saw Emmylou Harris in concert. We’ve seen her in concert a couple of times before, but this time was very, very special. It was everything I had ever wanted in an Emmylou concert. Daniel Lanois opened for her and then came back on stage (along with Steven Nistor on the drums and Jim Wilson playing bass) as they played the entire “Wrecking Ball” album!

It’s safe to say my first listen to “Wrecking Ball” sometime around 2000 changed my musical world. I had heard Emmylou Harris sing “Goin’ Back to Harlan” on the first Lilith Fair album a couple of years earlier and loved it. “Wrecking Ball” was unlike anything I’d ever heard: beautiful, sad, and poetic with a huge sound that I would later realize was all Lanois. After hearing the album, I became an Emmylou devotee.

Being there as Emmylou Harris and Daniel Lanois (and Nistor and Wilson) played all of “Wrecking Ball” was more amazing than I could have expected. And when they played a perfectly rocking version of “Goin’ Back to Harlan”—much like that Lilith Fair recording—I was transported back fifteen years to that first encounter. All of those wonderful years of living with Emmylou’s music were compressed into five perfect minutes.

After recreating “Wrecking Ball” for us, Emmylou, Danny, and the band performed a couple of Lanois songs in the first encore (“Still Water” and “The Maker”) along with “Boulder to Birmingham” and “Calling My Children Home.” Emmylou and Lanois came out by themselves for the second (and final) encore, performing a couple older songs by Emmylou: “Pancho and Lefty” and “My Songbird.” That last song is one of my favorites, and I admit that I got a little misty for the second time in the evening, and it was a perfect way to end the show.

I can die a happy man now . . . although I’d prefer a few more perfect Emmylou Harris concerts first.

Here are some pictures from the show at Boston’s House of Blues.

Posted in 101 in 1001, General, This is who we are | 2 Comments

Slipping into Spring

Icy trail in Upton SF

“Jeff Mather, you are an idiot, and you’re compounding your idiocy with lunacy! Why don’t you just turn around now?”

I had a point. There was nothing good to be gained by continuing to run down this flooded, icy trail—the same one where I took one of my worst tumbles about 10 weeks ago—just to get to a road and then turn around. My knee was lightly bleeding from a previous slip, and my shins were scraped from running through the vines and saplings on the snowy, but less slippery, edges of the trail. After running through the dewy branches, the front of my shorts and jacket were as wet as the back; I had slid down a short hill on my butt after I lost my footing.

I took some snow to clean off my knee, tossed the red lump into the trees, and turned around.

Thirty minutes and two-and-a-half miles later, I was back at the parking lot. A woman was walking in a short loop around the parking lot. “It’s too icy out there. I walked down to the trail and turned around,” she said, demonstrating better judgment—or, at the very least, less stubbornness—than I.

“Spring will be here one of these days,” I replied.

Posted in Life Lessons, Running | Leave a comment

Breaking the Logjam

I’d better write something here before y’all forget about me. (If that hasn’t happened already.)

Ironman training is going well. Sometimes it’s hard to get all of the hours done. (How do I pad an hour-long strength workout at the gym with another half-hour? I honestly don’t know.) Other times it’s hard not to exercise. Previous training plans had me doing three swim, bike, and run workouts each week, but I’m only riding twice per week at this point in my training. I was seriously jonesing for a ride on Wednesday, and I’ve had to hold back on the bike to keep from going beyond what the plan calls for. The good news: I’m doing a two-hour ride on Sunday, which I might stretch a tiny, tiny bit.

And I’m going trail running again tomorrow. I can’t tell you how much I’ve been looking forward to getting into the woods, and it looks like most of the snow will be gone . . . finally! I’m hoping for just the right amount of mud.

Posted in Cycling, Reluctant Triathlete, Running | 1 Comment

Runner, Interrupted

There was a great story, Runner, Interrupted, in last month’s Runner’s World about Kenyan/Alaskan runner Marko Cheseto, who was a stand-out collegiate runner before losing both of his feet to frostbite. RW‘s Joe Pugliese writes a compelling article about Cheseto’s path from rural Kenya to Alaska, the events that led to him collapsing on a snowy trail where he lay for 55 hours, and his return to running. It is likely that we will see and hear more about him in the coming years.

“When people face challenges in life,” he says, “they spend so much time going back to, ‘How did it happen?’ and ‘Why did it happen?’ They spend so much time trying to judge themselves on what happened instead of forging ahead, instead of thinking of ways of going through it an making life better. I still have to do things in my life and one of those is being a professional runner. Having had over 10 years of competing, I have that in me now. I need to compete again.”

Definitely check it out.

(One thing I learned from a postscript to the article: There are no distance running events in the Paralympics.)

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Olympic Ski Report

Have you been watching the Olympics? If not, you’ve really been missing some great events. I confess that I’ve watched the full replays of all the cross-country and biathlon events. There has been so much drama, and it’s too good to keep to myself. (Americans with cable/satellite service, you can watch all of them, too.)

As someone who is not as young as the average Olympian, it was wonderful seeing Norway’s Ole Einar Bjørndalen win the men’s 10k sprint biathlon on Day 1 at age 40. There’s still time for me!

Did you see the Russian cross-country skier with the broken ski so desperate to finish that he resorted to slowly double-poling around the whole course until the base peeled off his ski and he could go no farther? He ended up finishing his sprint semifinal after a Canadian coach ran up to him on the course to give him a spare ski. That’s the Olympic spirit right there.

This morning on the treadmill, I watched Charlotte Kalla of Sweden make up more than 20 seconds over the last leg to anchor her team to a win in the 4x5k relay. I might have cheered a little bit when I saw Kalla (in white) ski into the lead:

The star of this year’s Olympics is, in my book, Darya Domracheva from Belarus. After finishing 9th in the 7.5k sprint biathlon, she made up a 31 second deficit to win the 10k pursuit by almost 38 seconds. (In the pursuit, skiers are seeded based on how quickly they finish the sprint, with the winner starting first. Regardless of when you start, the first person to cross the line wins.) After her victory in the pursuit, she went on to dominate her other two events—the 15k time trial and the 12.5k mass start—winning by big margins. It was incredible to watch such talent.

I’ve greatly enjoyed watching biathlon. The biathletes make skiing and shooting look so easy. Watch closely, though, and you can see the results of thousands of hours of practice in every little thing they do. It looks a little like this:

What are your favorite moments from this winter’s games?

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Seen during today’s women’s 15km biathlon.

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Crash, Part Two

Am I Kris Freeman? Nope, pretty sure.

Am I in Vancouver, having just watched him go hypoglycemic during an Olympic race? I think this looks like my bedroom. Why would I be in Vancouver? Why wouldn’t I be in Sochi?

Why am I wide awake? Where is that weird feeling coming from? And What time is it anyway? Oh, it’s 2:30. I must be a bit hypo myself.

I started eating glucose tablets before I even tested, since the world was flashing in that particular way it does when my blood sugar is low. The result: 46 mg/dL (2.6 mmol/L).

It had to be the skiing.

Lisa says that I need to steer clear of hypnotists because my subconscious seems very susceptible to suggestion. But then again there has been a lot of skiing in my world recently, and it would make sense that it would sneak into my dreams. Saturday, I watched someone a year older than me win a gold medal in the men’s biathlon 10K. The next morning I watched the women’s race from Sochi while running long on the treadmill, and in the afternoon I watched the skiathlon, which combines classical and freestyle Nordic skiing. Then I waxed my own skis, which I used yesterday after work before going home to (among other things) watch more men’s biathlon. Some time in the evening, Lisa and I watched this short NBC profile of Kris Freeman.

Last year, skiing didn’t go very well. I managed to fall a lot during my lessons, injuring my left shoulder. So I was rather nervous about giving it another shot. But then again, there’s a huge stubborn streak in my constitution, and I was looking forward to doing better this time around. Yesterday, my first time skiing this season, I just wanted some time on the snow. I needed a chance to work on my balance and get a little confidence back. If that meant double poling for the better part of an hour, then so be it. And that’s pretty much what I did: sticking to the parallel ski tracks for about two miles, while occasionally throwing in some really ugly-looking V1 when no one was around. I did fall a couple times in the same spot on a downhill turn—clearly something to work on—but I wasn’t hurt and consider this a successful outing.

The only really bad thing which happened is that I managed to pull out the infusion set which delivers my insulin. I don’t think it was from the fall—although that might have helped—or because my abs look like this:

I don’t, for the record, look like either of them. Nor do I put my infusion set on my chest. (Ouch!) I have enough of a spare tire that I can usually find a place in my abdomen, although I do occasionally find muscle when starting a set, which hurts like you would not believe.

Anyway, when I put my new set in yesterday, the tape was a bit wrinkly, and as I smoothed everything out, I must have loosened the cannula, which is supposed to sit under my skin. Sometime as I skied it worked itself free, meaning that no insulin was going into my body. An hour after eating dinner I discovered the problem, but by then my blood sugar was ridiculously high (500 mg/dL, or 28 mmol/L). There was nothing to do except change the set, take extra insulin, drink lots of fluids, and wait . . . and wait. I couldn’t be sure how long I had been insulin-free, so I gave myself a lot of it. When I went to bed I was still quite high, so I dosed even more, which combined with all of the skiing and caught up with me four hours later.

Tomorrow’s weather looks pretty good, and I think I’ll head back to the ski track after work. Let’s hope for better balance and blood sugars.

Posted in Diabetes, Skiing | 1 Comment


I’ve been gathering all of my diabetes related data for more than a year now: carbs, boluses, BG readings, CGM traces, exercise data, insulin changes, etc. Almost all of this data is automatically generated and captured through my pump/CGM, and I don’t have to do much of anything to aggregate it. Making use of it is another matter entirely.

Collecting all of this diabetes data is just hoarding unless I actually use it to make my diabetes better. And do I ever need to make improvements. For reasons that I’m trying to figure out, the last six months have not been kind to my BGs, and the last three have been even worse, giving me my highest A1c since I was diagnosed with diabetes almost 15 years ago. Tomorrow morning I will meet with my endocrinologist, and I know the question of “What changed?” is going to come up. In order to answer “What?” I’m first trying to answer the question “When?” How have my BG readings changed throughout the day compared to six months ago? Looking at that information, I can move on to the question of “What’s different at those times of day?”

Here are the statistics from six months to three months ago, and then from three months ago to yesterday (when I had my blood drawn).

There’s a lot of data there, but you can see that I’m lower overnight and slightly unchanged during the first half of the day, but then the rest of the day is up, with the afternoon and evening readings quite a bit higher. All of this combined to raise my overall BG average by about 20-25 mg/dL (1-1.4 mmol/L). The variability is more or less unchanged, so if we subtract the mean and median values from these sets of data, we can see the changes more clearly.

And that is pretty much what I know. Tomorrow the trial-and-error phase of figuring out what to change begins, but at least we can start from the data.

Posted in Data-betes, Diabetes | Leave a comment

Jet Lag and Swimming Anxiety… Saturday 5:30AM

It’s a bit after 5:30 on Saturday morning as I type this by tapping away on my phone’s little keyboard. Jet-lag has been working its power over me for the last hour and a half. Its mojo is strong this morning, and–as an accomplished sleeper–I feel it acutely. Part of me wishes I’d stayed out later last night… Going to bed at 10:30 felt right but was probably a mistake. It also didn’t help, I wager, that my CGM woke me at 1:30, throwing off my internal clock even more.

I’ve been in San Diego since Thursday for a business meeting (along with almost 3,000 other employees) and the time change has caught me with a vengeance. Yesterday, I was tired but mostly awake when I went for a run along the Embarcadero. Today, I’m just awake and waiting out the time before starting my “free day” with a group swim in La Jolla Cove.

I alternate between excitement and anxiety about the swim. I’ve never swam with these coworkers before or in this place. The locals say we’re “in for a real treat,” which fills me with hope. Nevertheless, I’ve been anxious all week. Where will I put my stuff while we’re swimming? What will I sight on? What if I can’t keep up? Will my BGs behave themselves? What if the water is rough? Etc. Etc. Unhelpful etc.

My biggest concern has been my upper body. Two weeks ago I fell a few times on a run and ended up with core muscles that until yesterday were still quite tender when I did a lot of the swimming motion. I swam about 300 yards after the meeting just to see how well my new goggles fit, and it was the first time that my stroke was pain-free since the tumble on the trails. (You can see now why I decided to spend my time working on flip turns rather than actual workouts.) I was actually a bit concerned that I would need to bow out of the swim that I helped organize. Fortunately, it doesn’t look like that will be necessary.

Well, now that I’ve gotten that bit of crazy off my chest, I’m feeling a little better. I still have a couple hours before I need to walk to a neighboring hotel to meet the group, but at least I’ll be more mellow in the meantime.

Posted in General, Life Lessons, Swimming | 1 Comment

How Glucose Works

I want to talk about glucose a bit. People with diabetes (and our caregivers) think about it all the time, but we’re usually just thinking about blood glucose. That makes sense, because that’s the part we’re most actively trying to manage. But what about the other kinds of glucose in the body? What is it there for? How does it affect blood glucose?

As I wrote last month, a body stores energy in many forms, and blood glucose is dwarfed by muscle and liver glycogen and fat. We’ll leave stored fat out of the picture for now and just focus on glucose and glycogen.

When you eat, much of the energy content of the food—especially the carbohydrate part—is broken down into glucose, which enters the blood stream as—you guessed it—blood glucose. Insulin (either from a working pancreas, an insulin pump bolus, or an injection) reduces the amount of glucose in the blood, but have you ever wondered where it goes?

Insulin, our favorite hormone, acts as the doorman for glucose at two main kinds of cells: muscle cells and the liver. If your muscle glycogen is low because you’ve been exercising, glucose will enter the muscles, getting them ready for the next time you’re active. It can take upwards of 24 hours after a multi-hour endurance activity to restock your muscle and liver glycogen stores. Also, people who exercise more often can store more glycogen in their muscles, making them capable of working longer. This is a key part of the so-called “training effect,” and it’s also why people with diabetes tend to be more insulin-sensitive when starting a new kind of activity: New muscle groups are getting their own training effect and storing more glycogen.

At the same time, insulin is opening doors (big, BIG doors) in your liver. In people without diabetes, insulin flows directly from the pancreas to the liver, causing much of the glucose from food to be stored as glycogen there, too. (This is one of the reasons to bolus before eating; it gives subcutaneously dosed insulin a chance to get into the bloodstream, preparing the liver to receive glucose and prevent post-meal spikes.)

When your muscles and your liver are full, the extra glucose gets converted to fat and stored away for winter . . . or whenever. This is normal, even desirable. Almost 100% of the energy stored in a body is in the form of fat. Glucose burns efficiently and right next to where it’s needed. We need glucose, but it takes up a lot of space. Fat is more energy dense and still convertible to a form that cells can use. Think of it as the difference between your car’s gas tank and the underground tanks at a filling station.

“What purpose,” you might ask, “does liver glycogen serve? If glucose is there for cells to use, why put it in the liver?” That’s a great question, my dear readers.

Most of the time even the most active of us aren’t doing much. We’re sitting. We’re sleeping. We’re digesting. We’re thinking. Maybe we’re doing a low-level of activity: cooking, typing, standing, walking from one room to another, talking, etc. All of these activities use glucose. Muscles have stored most of what they need internally as glycogen, and when they use some of it, they dip into the life-sustaining river of blood glucose and basal insulin flowing past to replenish it. Other cells, such as nerves, don’t need insulin at all and just suck glucose in via osmosis. [1]

As the cells slurp up glucose from the blood, insulin levels drop and glucagon production increases—at least in people without diabetes. This stimulates the liver to release more glucose into the bloodstream. Voilà! Homeostais. Basically, the liver is (among other things) a giant blood sugar battery. It gets charged when you eat, and it slowly discharges as your cells do something. Blood glucose is the internal wiring, continuously moving small amounts of energy around to wherever it might be used.

That’s probably enough of the story for now. I foresee several more posts demystifying how the body makes and uses energy, all part of helping us athletes (with or without diabetes) understand how to optimize our training and racing. Feel free to ask me your questions, and I’ll do my best to answer them.

1 — This is the main reason why diabetes complications affect nerves so much. Cells that get their glucose from the blood by osmosis without insulin’s help can’t rely on low insulin levels to keep it out. When BG levels go up, more glucose enters those cells and changes their internal chemistry, modifying their proteins (called glycosolation). These protein changes damage the cells and make cellular repair more difficult. It also causes changes to blood flow, further damaging the tissues.

Posted in Diabetes, Fodder for Techno-weenies | Leave a comment


Céline’s post about medals the other day got me thinking about the subject.

(1) I have kept medals from all the events which gave them out. For a while they were being held on the wee, stubby arms of Melvin the Dinosaur. Alas, they were tipping him over. We had to move most of his Mardi Gras beads to his tail to keep him from falling over. (Yes, he’s a very popular dinosaur on Fat Tuesday.) So we decided to move them somewhere. But where . . . and how? Eventually we settled on coat hooks on a spot behind the door in the office.

As you can see, I’ve kept my medals and there’s room for more. Some of them—such as the NYC Triathlon, Rev3 Maine, and Around the Bay medals—are quite handsome.

(2) I’ve only “won” one of these medals. It was for a second-place age-group “podium” at a local 5K. It was given to me by one of the Special Olympics kids, who were benefiting from the race entry fees. It’s one of the least branded and simplest medals I have, but it meant a lot, as it’s my only top-three age-group placing ever. Another of the medals: for the B.A.A. 10K came at the end of a very difficult race (diabetically speaking) where I knew I could have easily run several minutes faster. I almost didn’t accept that medal, and I’ve never worn it. As soon as it was handed to me, I wadded it up and stuffed it in my shorts pocket. In fact, it took me a long to decide whether I was going to keep it at all.

(3) The only event I’ve ever done where I knew there would be a finisher’s medal was the Timberman Ironman 70.3. It was also my toughest race (diabetically speaking) and I wanted that finisher’s medal so badly. I would probably have finished the event without the prospect of a trinket, but it was a very tangible motivator. I could see myself getting it, feeling its weight around my neck. When I was running out of things to hold on to, it was something real to keep me going.

(4) I’ve received finisher medals at events where I didn’t expect to get one. I was 37 years old when I received my first medal of any kind, and the majority of the triathlons and smaller running races I do won’t give them out unless you’re “good enough.” Even when I was younger and better at running, the most I could hope for was a colorful ribbon. The aforementioned B.A.A. 10K gave out thousands of medals as if we had just finished running the Boston Marathon. I was surprised. I’ve also received medals for finishing century rides. Nowadays a 10K or century is just another thing I can do. When I think about what constitutes a “big deal” for me, I have to go for something a bit bigger.

When it comes right down to it, I think there are a lot of medals given, but that doesn’t mean there are too many handed out. My medal for completing a noncompetitive event is another person’s major accomplishment. The Timberman medal that I aspired to achieve is just another bit of race swag for somebody with loftier ambitions. So who am I to say whether getting or giving medals is done too often or for too many people?

Of course, if it has a number on it, that’s a different matter altogether. If I’m lucky, I’ll get a few more of those in the coming years. But then again, as with any other medal, I’m not going to expect one or take it for granted.

Posted in Reluctant Triathlete, Running | 4 Comments

Skiing Around the House

How does one ski in the living room? It looks a bit like this.

I didn’t actually use my poles in the living room. Those things are sharp and wouldn’t be too friendly for the rug or hardwood floors. Mostly it’s just me moving from side to side without poles, from one ski to the other, finding my balance and realizing in the safety of a snow-free environment when I had gone too far.

Now if only it would snow again.

Posted in General, Skiing | Leave a comment

Fun Fun Fun

Fun links apropos nothing at all:

Nothing to see here, Lisa. Nothing to worry about. Carry on.

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Shenanigans… Or the one about falling down

A year ago I took a couple of cross-country ski lessons. It had been over twenty years since I skied in high school, and I was never really good at it. Nevertheless, I figured that I could just jump back in and signed up for the “intermediate skate” class. The first lesson was a bit icy, and I fell a lot. The next week it was unbelievably cold and windy, and—despite falling less—I cut my part of the group lesson short because I couldn’t feel my fingers anymore. I was disappointed with how the experience turned out, and I was determined to try again this year (but without the almost separated shoulder).

Over the last few months, I’ve been accumulating the stuff to ski again, mostly at good sale prices. By Friday I had everything I needed, and Saturday evening I put on my new boots for the first time and clipped into my skis . . . in my living room. The day’s 60°F (15°C) warmth had melted almost all of the snow, but I figured that every bit of work I could do on my balance before getting on the snow would only help me when I get there. So I spent about fifteen minutes moving from one foot to another, picking up one (still unwaxed) ski and balancing, and shifting my weight from ski to ski as I might while doing V1. Balance, I hope is a trainable skill. It was tiring, and I realized that a lot of my difficulties might be coming from weak stabilizing muscles in my hips, which are also important for triathlon. We triathletes spend so much time moving only in a forward direction, that we need to work moving side-to-side. Yay cross-training!

Sunday morning I finished up the first full week of Ironman training with a long run; 1.5-2 hours, according to the plan. Since distance wasn’t a concern, I figured I would hit the trails. Last month I realized I could run from Upton State Forest to Whitehall State Park completely on trails, so I hatched a goal to do one of my long runs later this year completely on trails: four to six miles within Upton SF and then another seven or eight around the reservoir. This was a first attempt to run part (but not all) of the “Forest to Park” loop. It was perfect running weather—about 40°F (5°C)—and I hoped that the previous day’s unseasonable temperatures had cleared off the trails, which had been too icy for running a week before.

When I arrived at the forest, a couple of guys on mountain bikes warned me about the slick trail conditions. “It’s really slick in some places,” one of the riders said. “Once you get past the trail from the parking lot to the main trail, though, it’s pretty good.” His friend seemed a little dubious of the other’s assessment. “There are actually a lot of dicey places out there.”

I thanked them sincerely and headed to the trail. If two guys on mountain bikes can navigate the trails, I shouldn’t have much problem. And then, just out of their view, I slipped while walking down the trail. The recent warmth was no match for a fortnight of arctic chill, merely smoothing out the accumulated snow that had been soaked by a monsoon overnight and then flash frozen; it was like an ice rink. I’ve never experienced black ice on a trail before. Most of the loop in the state forest was pretty good, but there were places that whenever I saw anything that looked like ice I just started walking, since it was deceptively slick.

I had only fallen once getting to the state park turnoff, and it was (ironically) after descending a very steep, moist trail. You see, I love trail running, especially technical trails where I have to pay attention to footing. Somehow I can just put my feet right where they need to go—between two rocks and then on top of a gnarly root all while hitting the correct part of a banked switchback—to keep a smooth, fast gait going. For someone with limited depth perception and questionable balance, even I’m impressed by this. But evidently once it gets easy again, such as the wide, flat, open area where two trails meet, I lose focus, take a simple icy turn too quickly, and realize that I’m picking myself up off the ground after rolling. Nothing hurt too badly, I thought.

The trail across Tamarack Farm from the state forest to the park was a little icy, but I discovered that if I stuck to the snowy side of the trail, I could actually run it. Of course, it also meant that occasionally I was grabbed by a thorny bush or vine. One run-in snagged the bit of insulin pump tubing that was sticking out of my pocket. My shins and ankles got the worst of it, but it wasn’t that bad, and after all, I was running.

The trails at the state park were almost completely ice free, probably because they’re so steeply up and down that water can’t accumulate anywhere. I was feeling great and ran out about a mile until my watch said it was probably time to head back. Just before leaving the park, I had a lapse of concentration and forgot that the small wooden footbridge over a stream was wet. BOOM! I hit the bridge with my foot and then my chest. All things considered, I knew I was lucky not to have hit the edge of the bridge, but I could tell that I was going to feel it later.


And then a funny thing happened. I got lost. While paying extra attention to the icy trail, I missed the turnoff back to the state forest and looped back to a T-intersection where I turned right and found myself going past a very familiar looking pond with a beaver lodge after going down a very unfamiliar looking trail. Except the beaver dam was on the wrong side for me to be going back to the parking lot. Running back the way I had come, I couldn’t figure out where I had made the wrong turn. After about fifteen extra minutes of running (but not too much freaking out) I got myself back to a place where I had to make a decision, hestitantly made the opposite choice as before, and finished up my run without incident.

Here’s hoping that I’ve gotten all of the falling and getting lost out of my system for the winter. I’m really excited about skiing once we get some more snow. I could just do without any of the other shenanigans.

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