How busy?

You never realise how much you do until you stop. This seems to be particularly true of training.

Skills swims, endurance swims, long runs, 800m track intervals, ME swims, easy bikes, cruise intervals, hilly bikes, long bikes, tempo runs, sea swims, maximum strength sessions, massage and foam rollers. When you stop all that a huge amount of time appears in your week. Not that you fill it with much. You kind of sit around a bit wondering what you should be doing. Is it only 9pm? What do I do now?

With a broken bone I guess I spend a fair bit more time sleeping (good for recovery and repair, lie-ins and early nights). I spend more time looking for things to read. I spent the first 3 weeks seriously levelling World of Warcraft characters (funnily, I want to spend more time in dungeons with a couple of them but those need 2-3 hour dedicated time slots and I'm now struggling to find any of those). I've been getting a bit of writing done, and I have more time to get work done in, but without the break part way through the day for training I find I'm a bit worn out by the mid-afternoon. So my productivity hasn't changed.

I've spent more time at home because I can't get myself about by bike or by car (would I be able to if I had an automatic?) So I rely on the generosity of others to get me to work and back. It has been great to spend a lot of time with Annabel (who has now climbed onto my chair and is hanging over my computer) and to see Jack when he gets home from school. Morning's haven't changed much. I'm not up at 6 and out the door as they wake any more, but everyone's in such a rush it's not much different.

I've got just under 2 weeks until my next fracture clinic appointment, at which I hope to be declared fairly fit and to have the plaster removed. The foot feels strong this week and there's no pain on walking or weighting it. I wouldn't like to go trampolining just yet though. I'll entertain myself for a bit by re-planning my training for 2010 in TrainingPeaks.com.

Neuroscience podcast no. 2

Another neuroscience podcast is out: Phil tells me why my weight is fairly stable, what happens in my brain when I get hungry and what changes when I have eaten. We talk about the adipostat, leptin, ghrelin and obesity, why we choose particular foods and how dopamine, opioids and (probably) serotonin are involved.

MP3: Neuroscience podcast - No.2 Neurobiology of appetite regulation.

iTunes: Neuroscience podcast - No.2 Neurobiology of appetite regulation (iTunes).

Week 4

My ability to walk and move is much easier three and a half weeks after breaking my foot, but the boredom isn't getting any easier to deal with. I really miss the feeling of movement, of running, swimming or cycling. Reading about it, or planning for the rest of the year doesn't help much (although watching it does, funnily enough).

I've ditched the crutches & I'm walking with a stick this week, which is causing much piss-taking. There's no pain when walking, but I wouldn't want to stand on tip-toes or run.

To make it worse, I missed my gym session today because of a screw up. Grumpy, bored, annoyed. I might have cut this plaster off with a dremel before I make it to six weeks.

X-ray at 18 days.

For interest. This oblique view is more telling than the A-P.

New neuroscience podcast!

Phil Newton (henceforth to be known as Dr Phil) and I have begun a new podcast series to help medical students and others in similar need learn about neuroscience. Phil intends the series to be complementary to the lecture series in Swansea, but it should be useful and maybe even interesting to students anywhere.

In the first episode Dr Phil teaches me about action potentials and how neurons signal other neurons. Its about 35 minutes long and you can subscribe to the podcast in iTunes or download the MP3s from this blog or Dr Phil's.

MP3: Neuroscience podcast - No.1 Action potentials and synapses.

iTunes: Neuroscience podcast - No.1 Action potentials and synapses (iTunes).

Counting the days

I'm back into fracture clinic tomorrow morning. The foot feels pretty good and is well supported by the cast.

As you can see from the image above, I've got counters running that count the days of healing and count down towards my major races this year. I won't be that fit for Windsor but I might be going well by Bala.

Going nuts

It's almost two weeks since I fractured the bone in my foot and I'm starting to go nuts. Kim's surprised I've not gone mad already. I'm trying not to think about it.

Six weeks in plaster and six weeks out of training is the least of it. As I can't put any weight on my foot I've no idea if it's getting better, and there's no change in the pain on that side of my foot. Healing bones is a fairly slow process. If I saw repair in an x-ray I'd be happier. Six weeks in a cast will be followed by around six weeks of limited run/walking, and that's if all goes well. It could be worse. When the cast comes off at least I'll be able to get in the pool, so maybe my swimming will become awesome. That's something I'm looking forward to, and I think five days a week in the pool or sea is a real possibility.

If I can at least get a cycling shoe on and spin on the bike I'll be a very happy cyclist. Having cycling replacing much of the running this year helped my running. I wasn't sure if this would happen but in January I was running easy at 7:15 min/mi pace, and 7 min/mi pace was at the upper end of zone 2. I only reached that pace for effort as I was approaching the marathon last year, so that's an excellent sign for under 50km of running per week. If I can get on the bike I'll be ok. There will be a lot of rehab for my left leg though so I've no idea how I'll perform.

So all the races I'd planned this summer will be for fun and experience. I enjoy the complexity of multisport and I love to compete. If I can complete the early races I'll be doing well. A couple of weeks after the cast comes off I think I'll start my training all over again, starting the long endurance building period from scratch before I add real intensity. My long term goals require endurance, and that takes years to build so I don't want to short change this one. At least my high mileage weeks should be in the summer rather than March!

Trying to plan the months ahead is a little depressing, particularly when I think about the uncertainty of it all. I need to find something to focus on to take my mind off it all.

Podcast episode 23

A new podcast is up on iTunes and the medicine page of my blog. Rhi and I finish talking about our list of things med students really should know about the anatomy of the pelvis. We include the vas deferens and the urethra, the os, the organs of the female pelvis and their ligaments, and sensory innervation from external genitalia.

Links:

- Subscribe in iTunes

- Download the MP3: Episode 23: 10 things you should know about the anatomy of the pelvis (part 2).

Spiral fracture of the distal shaft of the fifth metatarsal bone of my left foot

After a very brief assessment in fracture clinic this morning (and all that was needed) I had a load bearing cast wrapped around my leg, ankle and foot to replace the weekend's temporary backslap plaster cast.

The verdict: 6 weeks in a cast, no load bearing for 2 weeks, expect 8-12 weeks before walking with little pain. That rather dulls the 2010 racing season for me.

It is what it is and there's no point crying about it. I'll sit down and look at the year I had planned. I'll probably add a half-marathon to the end of the year (Cardiff maybe) to extend it and try to get under 80 minutes, and remember my long term goals. Races up to July will have new goals of "finish the race" and "learn". Training to that point and from July to October is unplannable at this stage. I'll get into the gym & work on the rest of my body, although walking on crutches is already helping that. I think I may be able to come up with some lightweight elastic band exercises but I can't exercise my left calf muscles at all, and I have to be careful of damaging the cast.

It is what it is.

X-ray

Well, there it is.

Broken

Oh dear. I broke my foot this morning. I foolishly left too much crap in the hall downstairs, and when I ran downstairs to answer the door I was looking at the stuff instead of where I was placing my feet. I missed the bottom step, landed heavily and inverted my left foot. I couldn't walk it off and a rather nice haematoma had appeared by the time I took my sock off a little later, so I spent the afternoon in A&E/X-ray/fracture clinic. I have a spiral fracture of the shaft of my 5th metatarsal.

I've got plaster on for the weekend & will get reassessed on Monday. I'll probably get a walking cast put on then.

Bugger. I guess I'll level all my World of Warcraft characters to level 80 then.

Polar to Garmin

Like me, my Polar heart rate monitor, chronometer, speedometer and sole training partner (other than my shadow, but he hasn't been out much lately) has been struggling recently. His memory failed this week after getting a little water inside his case, and he's never really recovered. Sorry buddy, but it's time for a replacement.

Polar have gone weird since I bought this S625x many years ago. Their cheaper models are crippled so that you can't get all your data off (but instead are only given the amount of time you spent in certain heart rate zones - useless for reviewing intervals and tempo work) and their expensive models are super expensive (and no longer competitive). They seem to have dumped their software development and keep hinting at new technologies using new standards (i.e. their stuff will only work with their stuff). Sod that, I thought. The move to Garmin gives a device with Mac software so I don't have to keep rebooting into XP just to get my data every day, clever online software so I can upload from different machines and still get the original data out to use elsewhere, ANT+ connectivity so I can use devices from a bunch of other manufacturers, and built in GPS. Their accessories are sensibly priced too.

The Forerunner 305 has also been around for some years now, but people have been very, very happy with their 305's and the price is awesome for the features (around £135 on Amazon). OK, this thing is a massive chunk of plastic on my wrist, which I wasn't too impressed with. I would have gone with the smaller 405 but I'm a little lean in the wallet after Christmas, kids' birthdays, the exhaust falling off, tax returns, etc. Really, as a wannabe triathlete, I should have bought the Garmin 310XT - it's the only device like this in their range that is waterproof. You can't swim with the 305. The 310XT has a bunch of extra features that makes its price of twice that of the 305 worthwhile. I'm not going to be racing with this chunk on my arm though, so I decided I'd take the cheap option. I don't want all this data when I'm racing but I do want it for training (as much for studying after as for during). I'll try to pick up something cheaper and smaller for racing (time, laps, HR and waterproofing will do me).

So this thing is a chunk of tech. It's not ugly, but it ain't pretty. It's light enough so that you don't really notice it when running. Just like the iBike though, when you start using it and you see the huge range of data collected, stored and displayed you see the thing's worth. Using GPS and tracking your route instills a feeling of flexibility (maybe I'll nip down that path & I don't have to remember the route later, it's all going to be collected) and confidence in its accuracy. If it can see a bunch of satellites and show you which side of the road you ran on it has got to be pretty damned accurate for pace and distance. Running with a footpod (an accelerometer that calculates pace and distance from the movements of your foot) is fairly accurate once you've calibrated it, as long as you run in the same shoes and don't change surfaces too much. It puts you off exploring off-road trails if you want to collect your data somewhat obsessively like me. Running tempos or intervals downhill gave bizarre speed readings with the footpod, but I expect the GPS to be more useful here. We'll see.

This morning's complicated run gave it a good test, although on snow and ice I could only guess that the pacing was about right from experience. The next few months should give it a strong test though. It's already feeling good to be able to access my data on my computer and not be forced to reboot into Windows.

Week 121: Skull, the temporal region

This week we made it all the way up to the head. To look at the anatomy of the head, we need to start by looking at the bones. Different stations looked at different parts of the skull and teeth, and I spoke about the temporal region.

The temporal region (or as laymen may call it, your "temples") lies superior to the zygomatic arch and within the edges of the temporalis muscle. You may see curves on the skull around the edge of the temporal fossa that correspond to the attachment of the flat temporalis muscle. There is a depression here in which a few superficial structures lie, and this is the temporal fossa.

The bones here are the parietal bone, the temporal bone (it has squamous - flattened - and petrous - lumpy/rocky - parts) and the sphenoid bone. Use the skull bone images here to see these. Note also the frontal bone and the zygomatic bone. Spend some time in the lab with a coloured skull and a detailed skull (the numbered ones are best) to be clear on the shapes of these bones.

We talked about the nature of sutures linking the bones of the skull, which are fixed in the adult and contribute to the aim of the skull to protect the brain. There are some sutures that you should be able to name and you can also see these in the skull images (here). Note also the bregma (where the coronal suture meets the sagittal suture) and the lambda (where the sagittal suture meets the lambdoid suture).

These points correspond to where the anterior and posterior fontanelles were at birth. The bones of the skull are able to slide over one another to some extent to aid passage through the birth canal, and this is known as moulding. The bones are not fixed by sutures at this time, but are linked by softer membrane-like connective tissues. After birth the anterior fontanelle is known as the soft spot and can be an important diagnostic indicator. The fontanelles also allow the bones of the skull to grow.

Back to the temporal region: the sutures linking the parietal, frontal, sphenoid, and temporal (squamous) bones join here to form an H-shaped group of sutures known as the pterion. This potential weakness in the skull is made weaker by a thinning of the bones here (you can often see this on real skulls in the lab, but not on plastic skulls). To make matters even worse, the middle meningeal artery runs inside the skull, deep to the pterion. A fracture here is likely to tear the middle meningeal artery, causing blood to pool between the bone and the dura mater, pressing on the brain. This is an extradural haemorrhage and can be fatal (and in fact, dural venous sinuses may also be involved).

The temporal fossa has a few superficial structures of interest passing through it. The pulse you feel in your "temples" is the pulse of the superficial temporal artery, a branch from the end of the external carotid artery. The superficial temporal vein, draining a similar area of the scalp, is nearby. The superficial nerve here is the auriculotemporal nerve. This nerve carries sensory information from this area, and is a branch of the mandibular nerve, which itself is a branch of the trigeminal nerve, also known as cranial nerve V (CN V). I have a feeling we will be meeting this nerve again in the future when we start adding more detail to our head and neck anatomy and look at the infratemporal fossa. For example, this nerve also carries parasympathetic nerve fibres from CN IX to the parotid gland (that tell it to secrete saliva).

Fun, eh? The anatomy of the head and neck can be very detailed, delicate and intricate. It's a fascinating region anatomically, and by building up your knowledge bit by bit over the next 18 months or so you should develop a solid understanding of what's going on in there.

RIP Polar S625x

I thought I'd revived the little fella with a new battery and a little TLC, but it looks like its days of partnering me when training are over. It has had a tough life.

After its last new battery a couple of years ago it misted up when swimming in Africa and has been a little dodgy every since. As a heart rate monitor, speed and distance meter, altimeter and chronometer it has been superb. It has been battered and dropped, soaked in sweat and chlorine, and used daily for 4ish years. OK, it's getting a bit clunky and it's not perfect or 100% accurate, and OK, Polar are failing to update their software, ignoring Mac users and creating their own standards (dodgy USB-IR and no Ant+?) but it worked hard, and it worked tirelessly.

I guess it's time to jump to Garmin and take advantage of GPS, ANT+ and Mac-compatible software.

He who looks after my legs

The bloke that looks after my legs has just got a website:

swanseahealthsolutions.co.uk

Recommended.