Tuesday, December 8, 2009

Rest in Peace Larry Olsen

The sun sets on a kind soul
I have called my friend.
For what seems like forever,
and now it is.

They say running is a loner sport
but they are not runners
For if they were, they would know
that every excursion is a group run.

Our friends are there over our shoulder
to set the pace and keep us strong
to strive...to dream...to laugh...
to live...to run, today.

I now hear the hollow sounds
of my own steps in stride.
For a special one in thundering herd
is now more distant.

Thursday, December 3, 2009

Ambling Barefoot

Barefoot running has been around for awhile, but did not hit the national radar screen until the best selling book Born to Run by Christopher McDougall put a new face upon barefoot running interest. You know things are reaching a critical mass on this issue when non-runners start to bring articles about this to me in my office. Minimalist equipment, such as the Nike Free, Tera Plana, and more recently the Vibram Five Fingers (a glove for the feet) are gaining fans and market share.

This past week I received the following position statement from my National Professional Society:

APMA Position Statement on Barefoot Running

It is a very non committal statement leaning against unshod running. Some of the academy members were more critical: "Most of my patients aren't world class runners," adds foot doctor Stephen Pribut, DPM of the Academy of Podiatric Sports Medicine. "It wouldn't make sense for them to risk getting twigs and glass in their feet. And I think some soft surfaces increase plantar fascia and Achilles problems. Of course, what doesn't kill you might make you stronger."

Running surface conditions that are too soft can pose a risk to the shod as well as the unshod runner. Barefoot running can benefit the weekend warrior as well as the world class runner because I know of no class of abilities who doesn't want to have a smaller number of injuries. I only hope Dr. Pribut was quoted out of context. I see less plantar fascia and Achilles problems when bare feet meet the turf.

My first experience with barefoot running was at an AAU developmental track meet in Paramus, NJ. I was speaking with World Class marathoner Tom Fleming. My shin was stiff after winning a 3 mile race and he suggested that I warm down barefoot on the grass. I did so, but for some reason, never incorporated this maneuver into my routine. Now fast forward about 35 years. I am invited to participate in a semi-private thread by National Distance Running hall of famer Patti Catalano Dillon. I am there no more than a week and the barefoot running questions from Camille Herron get put to the foot doctor. I didn't have many answers so I did what any objective inquisitive runner/physician would do. I experienced it. Four years later, it has become an important tool in my running bag of tricks.

For the record, here is how I do it. I do not run barefoot on the extremes of surfaces, no roads and no beaches. I just gradually build up the barefoot miles to about half of my run. I find the best place in the urban/suburban environment is on AstroTurf. The consistency is perfect for running. The fields are swept of objects often with a "Zamboni" type contraption. Ironic, isn't it? The best place this lover of scenic trails runs to amble au natural is on an artificial surface.

There are some very compelling arguments for going shoeless, or at least wearing the least amount of shoe possible.

You may develop a more natural a fluid of gait. Sometimes I am so fluid, running takes on a Zen like enjoyment. This can only be proven in a subjective fashion by actually trying some unshod running.

It is the belief of this author that the biomechanics of running is cleaner. There is less errant eccentric and postural muscle firing during the gait cycle. Tendons have in excess of 90 percent energy return. Mid soles of running shoes have considerably less energy return so they impair rather than enhance function. Aging of the shoe materials causes even more loss of support and energy return.

So my national society feels there is a dearth of studies, abstracts, and reviews
available on shod versus unshod. It took me all of one hour to find a bunch. Here are some highlights:

Wearers of expensive running shoes that were promoted as correcting pronation or providing more cushioning experienced a greater prevalence of these running-related injuries than wearers of less expensive shoes (Robbins and Gouw, 1991). In another study, expensive athletic shoes accounted for more than twice as many injuries as cheaper shoes, a fact that prompted Robbins and Waked (1997) to suggest that deceptive advertising of athletic footwear (e.g., "cushioning impact") may represent a public health hazard. Anthony (1987) reported that running shoes should be considered protective devices (from dangerous or painful objects) rather than corrective devices, as their capacity for shock absorption and control of over-pronation is limited.

Michael Warburton: Running barefoot is associated with a substantially lower prevalence of acute injuries of the ankle and chronic injuries of the lower leg in developing countries, but well-designed studies of the effects of barefoot and shod running on injury are lacking. Laboratory studies show that the energy cost of running is reduced by about 4% when the feet are no shod. In spite of these apparent benefits, barefoot running is rare in competition, and there are no published controlled trials of the effects of running barefoot on simulated or real competitive performance.

When you run barefoot, your body precisely engages your vision, your brain, the soles of your feet, and all the muscles, bones, tendons, and supporting structures of your feet and legs. They leap to red alert, and give you a high degree of protection from the varied pressures and forces of running.

On the other hand, when you run in socks, shoes, inserts, mid soles and out soles, your body's proprioceptive system loses a lot of input. "This has been called 'the perceptual illusion' of running shoes," says Warburton. "With shoes, your body switches off to a degree, and your reaction time decreases."

So what are the risks? There is obviously less protection of the running bare foot. Ironically, my only pedal puncture wound ever sustained happened while running with running shoes on my feet.

So my society wants something conclusive? You cannot do a double blind study on something like this so results will always have some level of bias.

Abebe Bikila famously won the Olympic Marathon after discarding the shoes given to him before the race by a show company. Most Ethiopians I have treated have a "boxy" shaped foot. I am sure that the shoe company made he gaffe of giving him a shoe made on a traditional last for a western foot. The misfit was resulting in discomfort so Bikila went back to the known quantity or running barefoot like he had trained in his homeland.

Running barefoot is a healthy alternative to running shod. The educated runner will encounter minimal risks and great benefits. The funny thing is that if shoes met the individual needs of the runner in a better fashion, this whole shod versus unshod discussion would become a moot point. However, that is a whole other rant for another day.

Saturday, November 7, 2009

News Flash

I will be lecturing at the annual meeting of the Tri-Valley Frontrunners this Thursday in Milford, MA. The talk will take a fresh look at the real causes, the science, preventitive pearls and assorted treatments involving running injuries. My style is to entertain as well as to enlighten. I hope to see some of my blog readers there. Feel free to get in touch with me if you are part of a group or club that wants such a talk.

Sunday, May 24, 2009

Ilio-Psoas Syndrome

IP syndrome is likely the most underdiagnosed ailment in runners. The likely reason for such underdiagnosis is that both patients and clinicians tend to focus in on the effect (pain) than the cause. The syndrome, as it occurs in distance runners, starts as a loss of function with little to no pain. Then it shows up as secondary problems in other areas of the body. A common early complaint with this malady is that it seems more difficult than usual to get going in the early part of a race or workout.

The hip is a ball and socket joint which allows for 3 planes of freedom. Range of motion (ROM) of the hip includes approximately 120° of flexion, 20° of extension, 40° of abduction, 25° of adduction, and 45° each of internal rotation and external rotation. The resting position of the hip is considered to be 30° of flexion and 30° of abduction.

The ilio-psoas is actually two muscles. The psoas and iliacus muscles originate from the lumbar spine and pelvis, respectively, and are innervated by the first three lumbar nerve roots. These muscles converge to form the iliopsoas muscle. The IP inserts onto the lesser trochanter of the proximal femur. The psoas major tendon exhibits a characteristic rotation through its course, transforming its ventral surface into a medial surface. The iliac portion of this tendon has a more lateral position, and the most lateral muscle fibers of the iliacus muscle insert onto the lesser trochanter without joining the main tendon.

The iliopsoas muscle passes anterior to the pelvic brim and hip capsule in a groove between the anterior inferior iliac spine laterally and iliopectineal eminence medially. The musculotendinous junction is consistently found at the level of this groove. The iliopsoas muscle main function is as the prime mover of hip flexion. This is of utmost importance because hip flexion is the drive behind a distance stride. (Also, it is an external rotator of the femur). So when this muscle starts to lose strength, power or flexibility, the muscles that assist in these actions often feel the brunt manifesting in injury. Loss of hip flexion leads to hamstring injuries. Loss of external rotation leads to sciatica and associated hip injuries.

With all this anatomy, physiology, and kinesiology available, one would think that hip function would be utterly predictable and relegated to boring academic trivia. In fact, this is far from the truth. With each and every change in hip position, muscles change the force they apply on a joint. Sometimes even a small change in position can cause a hip muscle to have a completely opposite function. Put another way, a muscle can be an internal rotator of the hip. Change the position of the hip a few centimeters and it is now an external rotator of the hip. For this reason, it is not unheard of for seeming contradictory injuries including the knee, calf or even back problems to result from this syndrome.

Diagnosis is best done with a clinical “hands-on” exam. X-rays are always negative for findings of IP syndrome. Sonograms may assist with diagnosis but are rarely diagnostic by themselves. MRIs are most helpful of any imaging tests. Hence, much of the needed information to determine treatment course is supplied through the clinical exam.

Treatment starts with the basics: Rehab the deficient muscle functions. If the muscle is weak, strengthen it. A type of crunch is a good tool. A common mistake is to do a traditional crunch which emphasizes concentric strengthening at the expense of eccentric strengthening. There are variations that can customize these exercises for distance runners and individual needs. If the muscle is tight, stretching is paramount. The lunge is an effect maneuver, so long as it done properly (many people stretch the psoas fibers at the expense of the iliacus fibers). Also, long standing cases need to have stretching and the scar tissue freed up before strengthening become effective.

Tuesday, April 14, 2009

The path less traveled

"TWO roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth"

One of life’s crossroads came in junior high school for me. My main extracurricular activity was band. I played in the band or at least was the source of the band conductor’s indigestion with my very mediocre performance. Only the best made Jazz band. My goal of saxophone in the Jazz band was just a pipe dream or should I say a reed dream. There was something about the blue note that struck a chord with me. My problem was the John Phillip Souza sour notes that blocked the way to that goal. I turned down the less traveled path of running that early spring over 40 years ago. My foot steps still grace that path.

Last week I went to the Cohasset by the sea Road Race. I cannot believe it has been 30 years of one race for me. It feels like I am living a remake of the movie Same Time Next Year. I guess life does imitate art. But, a good race has a way of drawing one back. The time of year kicks off my racing season (especially as I age and race less often). The course is beautiful. It goes by quaint inlets, spectacular ocean vistas, mansions of the rich and famous, and historical points of interest. The course is challenging. Challenge inspires my gumption more than a flat fast “PR” course. The race is well run year after year. Every turn is marked and every split is barked out loud, clear, and accurate. The post race festivities (food, times, awards, etc.) are prompt and efficient. Then there is the legacy effect. Each year insidiously adds to its momentum. It seems to add to the tall tail legend effect, as well. I noticed that I was being credited with “5 or 6 wins” when in fact it is more like 3. At this rate, I can expect to be credited with 42 overall wins when they run the 40th annual in 7 years.

About 1,500 runners lined up on this sunny but very breezy 57 degree day. While waiting for the race to start, someone tapped me on the shoulder and introduced himself. It turned out to be my paperboy from the early/mid 1980’s. I had given him a shirt I got from famed miler Steve Scott as part of his newspaper Christmas tip. I remember this young boy reacting like I had given him a leprechaun’s pot of gold. He went on to become quite a middle distance runner. I wonder if my gift had any influence on his path. He then says that he will be shortly entering the masters division. Now I just feel real old rather than philosophical.

I ran a time of 37:23, a respectable time for someone about to turn 55. I particularly enjoyed this years Cohasset by the sea 10K. I felt good. I also had the surreal experience of many past positive and memorable moments merging into one nostalgic point of time. I won the race three different times today. I was also top 5 a gazillion times more. I ran mid 31 minutes like I did in my heyday. My picture crossing the finish line graced the cover of the Cohasset phone book afterwards. It was 90 degrees. It was 33. It was raining cats and dogs. There were small dogs flying off the ground (one year a small dog not on a leash dashed out from the narrow funnel of people right at the finish line. The race director hooked it with his foot a half stride in front of me barreling down the chute, sending it back into the crowd. All I saw was the poor pooch come from the bottom of my field of vision and take off like superdog out the upper right of my field of vision. Dog was startled but apparently unhurt. The same was true for yours truly).

So, I look forward to next year at my annual rite of spring, the Cohasset by the Sea Road Race and hopefully many more.

I topped the day off by going to a monthly jazz concert in Weymouth. Don Altobello and his group put on a fine show at Hajjar’s restaurant. It is stellar music of the style I always wanted to play. For a couple hours, the musical idioms help me slip into a musical bliss. Time again becomes non linear. I revisit that fateful divergence on my life’s path all over again, one that has made all the difference.

Sunday, March 15, 2009

Ask Dr Bob (#3)

A reader writes: A friend of mine said I could be nailed by the USTAF for drinking Brigham Tea. It's just an energizing tea I buy in my local health food store. I say he's the one who's high for thinking I can be nailed for tea from a health food store.

Drugs, Sex, and Rock 0' Roll

Dear DSRR,

You can't get no satisfaction from me.

Your pal's right. I hope you didn't have a big bet riding on this one. Brigham Tea contains Ma Huang, which is Chinese Ephedra. It is a natural source of Ephedrine. If you drink that stuff before a USTAF event and you are a USTAF member, you can be subjected to a random drug test. It is not just my imagination getting in the way. The Ephedrine will show up on the test and put you in the banned in Boston. (and everywhere else) ranks along with Mary Decker- Tabb-etc-Slaney. While you're riding out your suspension in the Penalty Box, maybe you can meet her. She must be due for another hubby soon. Then she could become Mary-etc-Drugs, Sex and Rock '0 Roll. One consolation will be you be having fun, fun, fun after the USTAF takes your T-card away.

Ephedrine is not only illegal in organized running, it is also dangerous. Several heart failure deaths in the Boston-metro area have been attributed to Ma Huang in recent years. Now that's a stairway to heaven! Ma Huang is also the main ingredient in Mormons Tea,. Miners Tea, Bishops Tea, Teamster Tea, (so that's how they got rid of Jimmy Hoffa), and Squaw Tea. Similar (and also banned), substances are found in over the counter cold preparations. Some examples are Actifed, Drixoral, Dimetapp, Cantac, Allerest, Vicks Inhaler, and the beat goes on! Read labels! Phenylephrine, Phenylpropanolamine, Psuedoephedrine, Propylhexedrine, and Desoxyephedrine will all have you doing the Jailhouse rock. So, if your cold preparation contains any of these, you will be left out in the cold by the USTAF. You don't have to be on Cloud 9 to get banned from the long and winding road. Choosing a cold preparation you can use will be like stepping on eggs ... but its far better than UST AF getting into regulating Steppenwolf. Please don't ban my devil with the blue dress on. For if they start to regulate sex and rock 'n roll, we'll all become drifters from the sport.

Dr Bob (and the medicine show)

Sunday, February 15, 2009

Biting Winter

I have frostbite all over where the tope of my foot meets my leg. So basically, the skin is all dry and/or dead and it burns at times. Do you know how I can get my skin back to normal?-- Cold Feet

Dear CF,

There is no subsitute for a real examination. However, my cyber shoot from the hip pocket gut feeling is that it doesn't sound like frostbite. Bite makes me think of that Pennsylvania groundhog. If he sees his shadow, its 6 more weeks of winter. If he doesn't see his shadow, its an early spring. Well, Phil the groundhog bit the mayor, this year. I guess that means we are going to have a biting cold winter.

Considering that it really has been a biting winter, you probably have Chilblains (pernio). It is self-limiting problem that does not result in permanent damage. It sometimes becomes chronic (produces long-lasting symptoms) if you get hypersensitivity to temperature changes. No treatment is known other than trying to prevent the front of your ankle from cold exposure. Wear tall thermal socks and running pants that do not expose your ankles to the elements. Tapered pants or tights are effective thermal barriers. Leg warmers used by dancers are also very effective. If your condition does not improve as the weather moderates, have a medical examination.

Sunday, February 1, 2009

Millennium Musings

I would like to extend a belated happy new year to all my readers. I would also like to share an article I wrote for my running club newsletter written on New Years eve, 1999.

The clock ticks methodically towards midnight on New Year's Eve. To some it is Armageddon of religious prophecy. To others, it's Silicon Valley Armageddon with Y2K bugs buzzing in civilization's ear. To me, it is just another night of lasagna and fine wine at home to usher in make-a-resolution-to-break-next-week day (or I will write the updated year on my checks day). I refused to bring in firewood from the woodpile for our fireplace. My better half said it had nothing to do with Y2K but that more drunks hit telephone poles on New Year's Eve than any other night. Well, she never had me bring in firewood on any other New Year's Eve. Still, I can't help but ponder whether my tension level should be higher than “Hey mon, don't worry…be happy.” I remember pondering about the year 2000 when I was a child, (jeez, I'll be old then), and what the world would be like. I also remember reading about Haley's comet, which would make its next pass near our planet around that time (neat, I really want to see that). I also vaguely remember being in a battle for my life at age 6. I had rheumatic heart disease twice by that time and spent most of my first grade hospitalized with a failing heart valve. My hospital stay at River Dell Hospital coincided with Dr. X, (as he was known on national news). This Doctor Death, as I called him, went around the hospital killing patients with curare. Fortunately, I missed his wrath but had the sequellae of my illness to deal with. Since I nearly died on strike two, strike three would be fatal. My parents were given instructions to have me take preventative antibiotics for the rest of my life and to not stress my heart. “His heart won't have the physical tools to handle exercise.” For a child that means no play. I penciled in a lot of Venus Paradise color by number pictures and read a lot of astronomy and geology books on a cot that was moved into the backyard on nice days.My life changed when a man who was deemed by the “wise men” of baseball to be too short, too stocky, and too slow to ever play professional baseball hit the scene. Spring training flash in the pan they said. He'll be gone before July. I remember seeing Pete Rose in the old Polo Grounds in New York City against the Mets. The game was won with a 10th inning homerun by Art Shamsky, (who?), but Pete kept his team in it with hits, runs, and plays that never end up in the box scores. In a post-game interview, he dispelled his critics by saying something to the nature of focus, a lot of practice and 110 percent effort can overcome a greater skill level. If this star baseball player could prove the experts wrong, so could I. So a journey of a thousand miles began with a single step. I first imagined I was playing baseball for Pete Rose's team by bouncing a ball off the back steps of our house. With each passing day, I threw the ball harder while running, diving and lunging for the increasingly errant bounces. Soon, the imagined game became real effort. No longer would I be denied exercise. My crazy play was exercise! I soon won my parents and doctor over to my side. This was good because I failed every team physical involving a stethoscope and needed letters from both parties to fight for my re-installment. By junior high school, I was ready to go out for a sports team. Basketball was my passion then but I chickened out with a steady barrage of too short, too thin, and too slow even though I out played some of the future team members in pickup games. I chastised myself for ignoring Pete's creed and vowed to go out for the track team (at least, nobody gets cut from that team).Our first meet ever was against local powerhouse, Bergen Catholic. Their team filled 3 school buses. They warmed up in a single file line one stride apart that was a quarter of a mile long. I was our second string miler (of 2 runners) lining up in 3 rows of BC runners. I don't know what got into me when the gun went off. I bolted for the front and “never looked back.” The first quarter was in 65 seconds, 10 seconds faster than my PR for that distance. Bets were flying on the sidelines as to how much further I'd go before I would double over in a heaving ball on the track infield. Well, it never happened. I held on to win in 5:04 by a 100-yard margin over the second finisher. We lost the meet 89-6. I went from bully fodder to celebrity but only Pete Rose and myself knew the real victory that was won that day.

It was cloudy every night of Haley's comet close pass to the earth. Still, I got up in the middle of the night to check the sky anyway. A boyhood promise had to be kept. On the last night it was to be visible with the naked eye, I woke up at 3 AM to a sky that was sparkling clear… and a blustery 8 degrees (a March 12 record). I bundled myself up and drove to Duxbury beach, a recommended viewing point. I arrived to disappointment. The only cloud patch in the whole sky was over the comet. Still I persevered. I'd stay till dawn if I had to. Then I heard a voice from the pitch-black beach. “Want to see the comet? My telescope has a special lens to see through clouds,” said some kind gentleman. I nodded and took a gaze. “It's not a great view. It kind of looks like a 30 watt light bulb in a dirty fish tank,” he joked. “It's great light to a six year old boy,” I replied to a now confused man.It was October of 1999 and I watched on TV as Pete Rose was honored for being chosen to the All Century Baseball team. The standing ovation he got outshone all of the other team members, including hometown hero Henry Aaron. I think this happened not so much for his accomplishments in his sport but to celebrate his moral victory. The man Pete bested for the hit record purposely sharpened his spikes to hurt people and was so bigoted that he should have worn a white sheet rather than a baseball cap. People have committed far worse deeds and atrocities. Putting a wager on his team to win pales in the face of murder, rape, and snuffing out the hope of our youth with drugs. Yet a man who gave gifts to groundkeepers and towel managers to show his gratitude for a kind word and a job well done is not even allowed in the parking lot of any baseball game.

Well, the first has come and gone. No bugs, no devils, no (computer) errors, and no terrorists left on base. But I knew that yesterday. Armageddon doesn't choose a nice round number. It's something we confront daily. It was there at age 6, in junior high and on that frigid dark beach. Through focus, practice, and 110 percent effort the greater skills of bad luck can be overcome making the goals we achieve so much more special. No, 2000 is just another step along that journey of a thousand miles.

Friday, January 9, 2009

Battle at Wounded Knee

Dear Dr. Bob

I'm hurt. My left knee was bothering me all week, but as soon as I started running it would be fine. The pain would come after a run, and I just put it down to the hard hills of America's Wild West. However, after a particularly grueling uphill run on Saturday, it hurt like crazy all night and the following morning. Sunday I lasted about two strides. Walking down stairs is particularly difficult. I put ice on it last night, and will continue to do this throughout the week. I'm sure I need new shoes but wonder if I have done some lasting damage? With my past experiences, I've lost some trust and faith in doctors and tradition medicine

Kneed Help

Dear Kneedy

It was one of those unceremonious events of "How the West was Won." Broken trust and empty treaties fueled the human darker side and led to a Nazi style genocide on that late December day where men, women, and children lost their lives in a hail of machine gun and rifle fire. Some were pursued as far as two miles then run down in this "police action." One hungry infant was found trying to nurse from her lifeless mother's bloodied breast. The soldiers were given the Congressional Medal of Honor for this embarrassing chapter in our history.

As for needing my help, it sounds like you have patellofemoral syndrome (previously called chrondromalacia or common name, runner's knee). As with all running injuries, it is not the name and location of the injury but identifying the underlying causes and tailoring the treatment to address those causes.

The most common factors contributing to this injury are:

1. Tight muscles (specifically the quads, hamstrings, IT band and the gastrocnemius). Mr. KH, I have seen your quads in person, so I know they are so tight they look like you have been using Viagra ointment instead of Ben Gay. I don't care if they have always been tight. All I know is that your quads are pathologically tight. Maybe they have always been tight but became even tighter repeatedly running the hills of Corbett Canyon.

2. Weak muscles (quads, hams, and IT band). An interesting thing happen when you are forced to rest. Muscles atrophy with disuse. When the quads become shrinking violets, the lever arm of the IT band decreases, making the muscle unit overwork. The end result is IT band tendonitis or patellofemoral syndrome. Either injury will get worse rather than better with rest.

3. Bad biomechanics. For example, if the subtalar joint is too pronated while the foot is on the ground. This causes the talus to go down and in. Since the ankle joint is mostly a one plan hinge joint, the whole leg rotates inwards to compensate. This translates to an improper tracking of the kneecap. This discongruency of the knee is measured as a high Q angle...and no, I did not say you have cute angles.

4. Bad running shoes. This can be poorly designed shoes, defective shoes, worn out shoes or ones that are plain not a match for your foot.

5. Previous damage to knee structures. You are walking in the city and a voice says "stick 'em up!" You know Tae Kwan Do so you deftly swing your elbow back but contact nothing but air. Then a midget blows off your kneecap with a Saturday night Special. All kidding aside, a meniscal tear, a Baker's cyst, genetically inherited ligament laxity and an old untreated ligament sprain are common causes in this category.

I may sound like a parrot here with this repetitious phrase, "awwwwk, Polly want a treatment?" However the best treatment is to focus on alleviating the cause. The treatment may include straps, braces, foot supports, and a multitude of stretching and strengthening exercises. Conservative care is by far the best answer. Surgical shaving of the back of the knee cap has an extremely poor success rate (about as good as outrunning the midget's bullet).

First and foremost, develop a trustful relationship with your health care provider. The practitioner should be worthy of this trust if he/she takes a detailed history of your problem, does a thorough examination focused on the appropriate systems, and informs you of the findings before ever commencing treatment. Sometimes the cause is obvious. Sometimes these factors are more occult and take multiple visits. Work with your doctor. Bring notes. Bring all your shoes and any gadgets you use. A good one will take to the challenge the same way you look at an important road race.

KH, you remind me of a guy I'll call George, who went to church every day and prayed to the Lord to win the lottery. After 6 months of this routine, his faith and trust were ebbing. He prayed again, questioning why if He existed, the Lord of the Universe would not answer his prayer. Then, all of a sudden, there was a brilliant light and a booming deep voice, "George, I hear your prayers, but can you just do me one small favor?""Anything, Lord!" George replied."George, could you at least buy a lottery ticket?"

KH, your lottery ticket is forming a positive relationship with the professional that is trying to help you. Do so before you become a modern day victim of the Massacre at Wounded Knee.