photography : reflection : moconnor

The Remarkable Story of Two Remarkable Men

"But our chances really were a million to one." : Bob Dylan

Jim MacLaren

Jim MacLaren has no memory of being struck by a New York City bus. No memory of being thrown like a rag doll 90 feet in the air. No memory of the crushed legs, broken bones and pulverized organs, and, of course, no memory of being pronounced DOA at Bellevue Hospital. But, as the saying goes, the reports of his death were premature, and after 8 days in a coma he woke up in the intensive care ward with his left leg amputated below the knee.

My wife, Nancy, often speaks of her patients being "struck with a cosmic 2 x 4" and in Jim's case the 2 x 4 came in the shape of a bus. He had already dealt with a number of challenges in his life, progressing from being a fatherless child in a moneyless family to a Yale graduate who excelled in football, theatre and as an academic; not a bad trifecta. One night he was a handsome, intelligent Yalie dancing with debutantes, and the next thing he knew he was a one legged, disfigured unit of pain in a hospital bed. But it's hard to keep a good man lying down and Jim embraced the fierce pain of rehabilitation and got on with his life. His dramatic training led him to jobs on TV and stage and the beautiful girls didn't go away.

Rehabilitation meant reconditioning his body, and to avoid the pounding on his stump, Jim got back on his bike and rode, and dived into the pale blue waters of the pool and swam as though his life depended on it, and maybe it did. But we are bipeds and Jim felt the imperative not just to walk but to run. He entered a 10k race and his prosthetic rubbed the stump of his leg to a bleeding pulp. To most people this would have been a message to decrease the distance but to Jim it said, "if you can do 10k, you can do a marathon" and he did, first New York then Boston. Jim became not only the fastest amputee endurance runner on earth, but was better than 99% of able-bodied people. I've watched this happen before when someone works so hard to overcome a sickness or injury that they leave the rest of the human race behind. In my own experience, I know Mike Burton who started swimming at age 12 because he had polio, and who, in the thin air of Mexico City, won an Olympic gold in the 1500m event. The record NFL field goal of 63 yards comes from the clubfoot of Rick Dempsey. In our zeal to overcome a problem it's possible to surpass less motivated able-bodied athletes and non-athletes.

Jim dealt with his trauma mentally and spiritually as well as physically, and he resonated to the Buddhist philosophy that all pain comes from attachment. Therefore, we need to avoid building an attachment to anything in this universe that is impermanent, including our own fragile bodies. Hitching our identity to some perception of physical performance is a guaranteed path to misery, which is why a number of high level athletes go through a brutal period of decompression when they quit competition. However, as he pursued the elusive concept of higher consciousness Jim pushed his impermanent body to higher levels of physical performance.

The Ironman Triathlon was made with people like Jim in mind. He was now able to add a 2+ mile swim and 112-mile bike ride to his marathon running, and it was while competing in an Ironman in Mission Viejo that the inconceivable occurred.

Jim was leading a pack of cyclists when the policeman directing traffic had a brain lock and waved a van across the road straight at Jim MacLaren. Jim remembers this one: he remembers the grille of the black van that hit him, he remembers the screams of the crowd, he remembers the ambulance ride and going under the anaesthetic and he remembers waking up with a bolt screwed into the back of his skull and being told he was now a quadriplegic.

When Elizabeth Gilbert first called Jim and said she wanted to write about him for GQ, Jim's response was "GQ I don't really look the part these days. Armani doesn't make Velcro flies on their pants just yet." Elizabeth discovered that Jim is what is termed an incomplete quadriplegic, which means he has partial use of his arms and twisted hands and can move his legs a few degrees. This tiny range of movement means everything and is the margin between an independent life and round-the-clock caretakers. But with the sensation comes pain, which is the price Jim pays for his minimal allocation of movement. In his own words, "some days I wake up feeling as though I'm encased in wet cement with electrical currents running through it." During therapy the nights were interminable. Jim had a call button for the nurse but couldn't reach it, his body was a labyrinth of pain. "I was all body" he said, "I was too afraid to cry because the tear drops might leak into my lungs and throat and choke me to death." Coughing was not an option, as Jim had lost the use of his diaphragm muscle. Jim changed his Buddhist notion of "who am I?" to the more reductive "what am I?"

Jim was awarded 3.7 million dollars compensation, much of which was eroded by medical and legal expenses, but he was still left with a considerable sum of money. He retreated to Kona in Hawaii on the pretext of writing a book, but it was really an escape, a geographical solution to not letting old friends see his struggle. In Kona, he made some new friends, new friends who felt sorry for him and shared their cocaine, friends who would drink with him to help him dull the pain. Never one to deal in half measures, Jim MacLaren became addicted to drugs and booze, until he found himself one night, wasted, unwashed, crippled and alone on the Alii Drive, a famous stretch of the course of the Hawaii Ironman. Alii Drive became Jim's Road to Damascus as he screamed to the emptiness, "Why are you doing this to me?" There was no thunderclap, no flash of light, but somehow the cosmic tumblers shifted and within Jim's body/mind some long forgotten synapses were reconnected. Jim emerged from that Hawaiian night knowing that he has some choices. He discovered what Victor Frankel had found in the Nazi concentration camps, that the knowledge that you can make choices can save your life and ultimately set you free.

His first big choice was, "Live or die", and Jim was aware that the path he was on was leading straight towards death. (Here I quote directly from Elizabeth Gilbert's interview with Jim MacLaren)

"But I didn't want to leave this life," he says. "I was 33 years old. That's too young to say you're finished. I wanted to live. I didn't want to live as a fucking quadriplegic, but I couldn't change that. And since I couldn't change it, I knew I'd have to make some kind of peace with it."

Not some facile, life-is-beautiful, made-for-television, triumph-of-the-human-spirit peace but a true and sustaining and deeply personal peace. And the only chance he had for gaining any peace, he realized, was to start seeing things very differently. He needed a total change in perception, a paradigm shift. He wasn't sure exactly how to do this yet, but he knew one thing: If he couldn't start finding some serious blessings in all this disaster, he did not stand a chance in hell.

So he went inside. What else could he do? He took his intellect, his energy and his spiritual hunger and he turned it all inward, setting forth on a journey to find out all over again, but with a newfound humility, "OK, seriously now‚who am I? Who am I really?"

"The first thing I had to do was identify my absolute deepest fear about all this," Jim says. "What was it? What was the worst thing about having to spend life as a quadriplegic? Was I afraid of death? Not really. I'd had two near-death experiences already, with the white light and the tunnel and the whole deal. They were both amazing encounters, not scary either time. I knew that death no longer frightened me. Was I afraid of losing my sexuality? No. I knew as long as I had taste and smell and sensation, I could lead a sexual life. Was I afraid of helplessness? Not really. Managing on my own is a drag, but it's just logistics. Was I afraid of pain? No. I know how to deal with pain. Pain is a bitch, but I know how to beat it, how to wrestle physical pain to the ground. So, what was I afraid of? The answer was pretty clear: I was afraid of being alone with myself, with my mind, with the dark things that lived in me, like fear and doubt and loneliness and confusion. I was afraid of metaphysical pain."

Jim MacLaren knew he was going to have to spend much of his life in solitude and stillness. He was often confined to his bed for days at a time. As though wrestled to the ground by God Himself, he had been forced into his own company. This was petrifying, but now Jim faced this terror and wondered if he could learn to see it differently.

"Maybe, I thought to myself, this wasn't really a curse at all. Maybe it was actually the most exquisite blessing of my life. Maybe it was the opportunity for true catharsis, if I chose to make it one -- an opportunity to see my true self beyond all the noise."

Jim MacLaren? Meet Jim MacLaren.

Slowly Jim chose to see the blessings and to learn the lessons that would have eluded him as an able bodied man.

For the first time, he could see something most people go through their entire lives blind to -- namely, that we are not in charge of what happens to us in this lifetime. We are in charge only of how we perceive what happens to us in this lifetime.

"I started looking around and seeing people everywhere -- especially successful middle-class American men -- walking around in complete denial, smugly thinking to themselves I sure am doing a good job running my life here. But I could see now that their sense of control was nothing but a mirage. Safety, entitlement, power -- these are all fantasies. We don't drive our destinies. Not that way."

Jim realized, to his relief, that once you stop trying to control events you can't control anyway, you can drop all that wasted energy and focus on the one thing you are in charge of. As the teachings of Buddha and Socrates show, you have only one task as a human being: To know yourself.

"Look," Jim says. "I have honestly come to believe that I needed these accidents in my life. I completely believe that. Not in terms of paying dues or getting punished by God, but in terms of getting my attention and bringing me deeper inside myself to a place where I could find honesty and peace. Was it destined? Did I literally choose to have these awful things happen to me? No, not in so many words, I don't believe so. But I do believe this -- I believe I was born begging for experiences that would show me who I really am. And that's what I've been given."

These days Jim lives in Pasadena and is doing graduate work in the study of mythology and psychology at Pacifica Institute.

On good mornings, he can get out of bed, eat, clean out his bowels, attach his catheter, shower, dress and be ready to leave the apartment in just under three hours. Almost the same amount of time it used to take him to run a marathon, and nearly as physically grueling. It's painful, but he gives his body the time it needs, and then the rest of the day belongs to him. If the weather is nice and he feels strong enough and doesn't have a paper to write, he'll get in his wheelchair and head into the city's Old Town. He'll park at an outdoor café, order up a triple espresso and read in the sun, blissfully alone and blissfully comfortable with his own company.

Or sometimes he spends the day with his girlfriend. Her name is Alessandra. Jim calls her Ally, or Ally-mander, or Ally-cat. She's beautiful, blond, smart. They met in an Internet chat room and have been together for two years.

"People look at me and call me a saint for being with a guy in a wheelchair," says Ally, "and it's so insulting. First of all -- the idea of me as a saintä This makes both Jim and Ally laugh so hard that the conversation has to stop for several minutes.

"Anyway," Ally continues, wiping her eyes. "I'm with him because he's the most intelligent and sexy man I've ever known. Period."

As for the sex, yes, they have it. Maybe not the way you have it, but they do have it. Jim does have limited sensation in his penis, but he has to be careful because an orgasm could be a serious health risk. (It could put him into a state of hyperreflexia -- pulse goes down, blood pressure goes up; he could have a stroke or a spasm or even die.) So he expresses his sexuality differently now -- with his hands, mouth, voice, imagination and lots of time.

It sounds almost idyllic, the time to study and to think, the place on the California coast, the beautiful blonde girlfriend, a sort of academic beach boy existence. But there are other realities.

And it isn't always easy, because Jim still struggles. Jim MacLaren, let's be very clear about this, did not enjoy losing his leg, and he does not enjoy being in a wheelchair. He looks for the blessings where he can find them, and he tries to keep a sense of humor, but there are days when it's not funny and it's not enlightening. Days when he wakes up in so much pain he can't get out of bed at all. Days when he can no longer stand the endless battle over trying to control his bowels ("I'm more obsessed with my feces than the Marquis de Sade," he jokes darkly). Days when yet another infection lodges in his catheter incision and his testicles swell to the size of softballs. Days when he wonders how he's going to possibly survive this abuse for another forty years.

"There are moments when I realize all over again what happened to me," Jim says, "and it's still unbelievable. I mean, come on! Jesus Christ, for fuck's sake, how much can one person endure? But I can't stay in that place for long or I'll lose my mind. Instead, I have to ask, What is wholeness, really? What is a full life? What are my actual obstacles? And whenever I find myself frustrated with my handicap or looking with envy at an able-bodied man, I ask myself this: If I could get up out of this wheelchair right now and walk across the room, would that really get me there? I mean, would that really get me to the place I most want to go with my life? Because let's be honest hereãthe other side of this room is not my ultimate destination. My ultimate destination is self-knowledge and enlightenment. Do I have to get there on foot? Or can I find some other path?"

Jim McLaren (No. 2) The Man Who Refused to Die

How do you top the first part of this article? You don't, and yet there is another remarkable Jim McLaren out there and it's the matching names which was the initial impetus to write this piece. (There is no 'a' in the Mc of this McLaren, which his father said "saved a lot of ink over the years".)

People who know me accept the fact that I've had a 40-year Bob Dylan problem. There are others like me and Jim was one. I can remember my first visit to his house in the Vancouver suburb of Burnaby; it was like Aladdin's cave. For many years Jim had a tape of every Dylan concert from his seemingly never-ending tours of the planet. He had a vast network of fellow collectors who could always track down an illicit recording of each Dylan performance.

Jim McLaren is intelligent, generous, funny, aggressive and obsessive. He's the sort of person you want on your side in any situation. But it is the latter two characteristics which might have produced the kind of internal stress on which heart disease thrives. Jim recognized his capacity for anger at an early age when, on one occasion, he was furious with his mother because he was not allowed to attend the orphan's picnic. As a young man he channeled his energy and aggression into competitive sports and into a job in commission sales. Jim always felt in control of his destiny, always knew he could out work, out perform and maybe out fight his competition. Mortality was not a big factor in his lifestyle decisions and like many of his Irish friends and relations he drank a bit, smoked and grabbed whatever food was available. Marriage came and went but the stress and adrenaline were never far away. In many aspects of his work and life Jim wanted perfection in an imperfect world, a state that almost guaranteed ongoing internal strife.

December 1978 was probably his first heart attack; he was sick and dizzy and felt that he had a major stomach upset, maybe an ulcer. He didn't know that half the patients who have a first heart attack think it's gastric problems. He spent time in bed, got through Christmas and returned to work. In late 1980, he had his first official heart attack, with all its many splendored symptoms. In speaking with him, his cardiologist said, "When did you have your first attack?" Jim replied that he'd never had one, but was informed that indeed he had. Probably the stomach problem of 1978.

He was told that his heart and health made him unfit to perform a by-pass, and he would have to take some prescription drugs which would hopefully sustain him till he was fit for surgery.

Jim was now introduced to the games and Catch 22's of medicine. He was not fit for bypass surgery, which required him to be stronger and in better health. However, with his compromised heart he couldn't exercise, and found it hard to work. Nitroglycerine became part of his diet and angina was a constant reminder that his coronary arteries were barely functional.

Jim's ability as a games player and his aggressive self-advocacy is one of the main reasons he's still alive 25 years after his first 'event' in '78. He figured out that he might not be 'ready' for a scheduled bypass surgery and would probably die waiting, but that an alternative route onto the operating table lay through the doors of the Emergency Ward. The next bad angina attack, Jim called the ambulance and was admitted to hospital. Surgery was scheduled almost immediately and a triple by-pass was performed. The date of the procedure was April 1st but Jim's still unclear who the fool is.

Jim was now 'in the system' and although he didn't know it, hospitals and doctors would be part of the scenery for the rest of his life. During the surgery, they not only found blocked arteries, but an aneurysm, which would have been lethal had it ruptured. This was an early lesson in pushing hard for the treatment you feel you need. One of the things which often goes unmentioned about bypass surgery is that you sometimes have more trouble with the part of the body from from which veins are harvested that with the heart itself. True to form, Jim had a major staph infection in his leg. (I always liked the name of a local hospital softball team who called themselves The Staff Infections, Jim also told me of a group of heart transplants who formed a bowling team called the 'Straight Liners'.) It was time for rehab and Jim faithfully attended his 'Healthy Heart' classes. He began working out and did a very male thing, he did too much. This is a lesson I've never learned, and my need to run like I used to run and lift what I used to lift, has probably cost me thousands of dollars for physiotherapy and too often left me injured and frustrated. In Jim's case his strength training led to an umbilical hernia. The waiting list for surgery was about a year; a year in which Jim's recently acquired fitness slipped away. Old lifestyle habits returned and Jim went back to his work as the top commission salesman in his company.

But there was always dissonance and stress in his life, and his organs and immune system were struggling.

In 1984, Jim was back in hospital with pneumonia, possibly associated with earlier staph infections. When he was admitted he was delirious and hallucinating and the admitting physician suspected withdrawal from hard drugs. He woke to find himself with restraints on his arms and legs. He convinced the medical staff that he was not a junkie, but endured a debilitating sickness. His kidneys shut down and Jim lapsed into a coma, but dialysis and antibiotics brought him back to consciousness and he was released to rehabilitate again and go back to work.

The work-get sick-recovery routine was growing old fast and in 1986 he took a golfing sabbatical and became a golf bum. By the time he was ready to resume a working life, Jim's company had folded and he found himself on some sort of a black list as a bit of an agitator. But by 1988 the work issues were moot and a stroke sent Jim back to hospital and left him with balance problems, weakness of his right side and a sufficient loss of vision to make him ineligible to drive.

The world was now closing in and the rhythm of Jim's life was arrhythmic, as his heart had a mind of its own and alternately raced or slowed down. His flawed heart was a dominant factor in his life, though he still found pleasure in the music and poetry of Bob Dylan whom he wrote about under the pseudonym D. Babylon (an anagram of Bob Dylan). He was a regular on ambulance runs to Emergency when the pain was too excruciating or the cardiac storms too wild. The doctors responded with more drugs, stronger drugs, drugs to handle the side effects of the other drugs and new, experimental drugs which might just tame the erratic little pump in the center of Jim's chest.

In 1990, the inevitable occurred in the form of another heart attack. The news was all bad, and, as one doctor tactfully put it, he might not need to buy Christmas presents this year. (A variation of the 'don't buy too many green bananas' theme.) This, of course, inspired Jim to buy generous Christmas gifts for everybody and he was determined to be around to give them out personally. He got through Christmas but felt like Townes Van Zandt when he wrote his song "Waiting around to die" or Bob Dylan who had his own brush with death after a coronary event and subsequently wrote:

Sometimes my burden is more than I can bear
It's not dark yet, but it's getting there.

I can hear their hearts a beatin'
Like pendulums swinging on chains
When you think that you've lost everything
You find out you can lose a little more
I'm just trying to get to heaven before they close the door.
From Time Out of Mind

From many medical conversations two phrases lodged in the McLaren mind. One was that he would never again run 100 meters and the other referred to the possibility of a heart transplant, which the physician said, "Would be like giving you AIDS" referring to the rather crude immune-suppressing drugs they were currently using.

Jim McLaren was waiting to die so he spent his remaining funds on friends and family and thought of Bob Dylan's song "Restless Farewell".

Oh all the money that in my whole life I did spend
Be it mine right or wrongfully
I let it slip gladly past the hands of my friends
To tie up the time most forcefully
But the bottles are done
We've killed each one
And the table's full and overflowed
And the corner sign
Says it's closing time
So I'll bid farewell and be down the road.

The early 90's saw Jim still alive and fighting with various levels of government for a livable disability pension. He managed to beat down a fair bit of bureaucratic resistance but it seemed like a phyrric victory because in 1994 the heart attack hammer struck again. One thing was becoming obvious about Jim McLaren, he was one stubborn son-of-a-gun who just might be worth saving with the help of modern technology. His heart had gone from atrial fibrillation of around 250 beats per minute to 18, but it didn't stop. Maybe a pacemaker would be the solution to all his problems, something to keep his errant heart from beating to a different drummer.

In short form:

1. Pacemaker number 1 failed.
2. The surgery involved in installing pacemaker number 2 resulted in another staph infection.
3. Pacemaker number 3 was a state-of-the-art piece of technology which included a cardiac converter, pacemaker and an automatic defibrillator should the heart ever stop.

Initial trials were promising and on a Saturday, Jim got a pass to leave the hospital to have lunch with a friend. Within a few hundred yards of the hospital, he felt he'd been punched in the chest, the defibrillator had misfired. Jim grabbed some railings and was hit again, sending his friend Rene running for the ambulance.

Then things became Pythonesque; nobody knew how to control the pacemaker except the surgeon who installed it. He was reached on his cell phone while Jim lay absorbing a series of Tyson like jolts to his heart. When the surgeon arrived, the equipment was locked in some sort of classified cupboard to which no one could produce a key. They ripped the door off and finally had a device to turn-off the defibrillator. Jim had been defibrillated 12 times which should have been more than enough to kill him. But, as Sonny and Cher noted, sometimes "the beat goes on." (Although no longer in Sonny's case.)

Jim now entered a space where his life was in the balance. He was dying and the doctors had pretty much exhausted their bag of tricks. The problems with his heart could not be bypassed, drugged or controlled with a pacemaker. There was only one possibility left, and that was a new heart. This sounded like the 'faint hope' clause to which lifers cling in jail. But the concept of a transplant had to be explored, which meant that Jim had to be evaluated.

Jim was examined by cardiologists, physiologists, psychiatrists and even social workers. He knew he was under the microscope and felt like an old dog in a dog show, somehow trying to impress the judges; or more accurately, like an old dog in the pound, who, if he's not selected by someone looking for a pet, faces a death sentence.

He was told the odds were against him; he had a history of stroke, compromised lungs, previous kidney failure, a susceptibility to staph infections, he was over 50 and his body had been ravaged by the sicknesses associated with a failing heart. However, Jim McLaren doesn't quit and he proceeded to give a performance worthy of an academy award. He was Mr. Sunshine, thinking about the future and what he'd give back to society, he joked his way through the endless testing and put a positive spin on every set-back or situation. One thinks of the old song, "Smile" sung by Nat King Cole

"Smile though your heart is aching Smile even though it's breaking When there are clouds in the sky, you'll get by If you smile through your fear and sorrow Smile and maybe tomorrow... You'll find that life is still worthwhile If you just smile."

Click the notes... Nat King Cole will croon you some of the lyrics.

I'm sure his attitude was a factor and it's likely that the evaluation team recognized a life force that defied probability and that didn't necessarily show up in standardized tests. The decision was to accept Jim as a candidate for a transplant and he was given a beeper which, when it sounded, would tell him a new heart was on its way.

The single biggest challenge in Jim's 25-year battle with heart disease had been overcome. Jim was now waiting around to live instead of to die. He was beeped while on a routine visit to his doctor and, as he was being transferred to hospital, his new heart was being flown to Vancouver, packed in ice.

As he was being wheeled into the operating room, he heard some family members saying, "Goodbye, Jim." Jim stopped the gurney, had it wheeled back and made a second pass. He said he would accept, "see you later", "take care" or "au revoir" but not "goodbye".

The operation was textbook, just over 2 hours, much faster that his original bypass. The day after the operation all the reasons which made Jim a bad risk manifested themselves. He lapsed into a coma, was trachiotomized and given paralytic drugs to spare his new heart as much as possible. Last rights were given, then given again and again. The odds against him surviving were long, but never bet against Jim McLaren. He made a slow but almost complete recovery; he had some neuropathy on the right side of his body, which gave him a drop foot, which was gradually correctable with a splint. But for the first time in nearly 20 years Jim had a strong, functioning heart. The McLaren machine had a new engine.

Jim McLaren quickly became Gym McLaren as he finally had a heart that would deliver sufficient oxygen so that his muscles could work hard. He rebuilt wasted tissue and then,even with his foot problems, took himself to the track to run the 100 meters that had been declared out of reach many years before. It took him 33 seconds and he could almost hear the Chariots of Fire theme as he shuffled/jogged the track. A year later by the summer of 1997, Jim's time was down to 21 seconds and, given a 50-meter start, he'd have been a close 2nd to Donovan Bailey. He set his sights on the World Transplant Games in Sydney, Australia that fall. It would have been great if he'd been able to do a personal best time, however, he was a last minute substitute for the volleyball team and pulled a hamstring which kept him out of the 100 meters. But that sort of thing happens to athletes and Jim McLaren was now an athlete.

Back in Canada, Jim became active in his church and used his guitar and voice to give thanks for a second chance. As it says in psalm 150, "Let everything that hath breath, praise the Lord" and Jim now had plenty of breath. You can hear Jim's "A Recipient's Prayer" and some of his transplant friends singing the song "Living Proof" from a CD titled "The Gift of Life".

Sponsored by an unrestricted grant from Fujisawa Canada and the BC Region of Canadian Transplant Association This CD is also available for $10 pick-up or $12 by mail from Canadian Transplant Association c/o Maria MacKenzie 7916 Goodlad St., Burnaby, BC V5E 2H9 phone (604) 524-2457

Click the butterfly for an mp3 of 'A Recipient's Prayer'

If all this sounds a bit too much like a Hallmark card I should add that Jim McLaren is still the same feisty, fractious and funny man he always was. He has diabetes. He battles with the bureaucracy associated with organ donation; he's frustrated with the politics of health care and sometimes feels exploited as a hard working volunteer. He feels the voices of the organ recipients are often not heard by those who make decisions, which will affect those who have received transplants in the past and those who will need transplants in the future.

Unlike the stories I've heard from people such as Deepak Chopra, Jim didn't suddenly acquire different tastes, possibly reflecting those of his heart donor. (Who is unknown to Jim). But I suspect that the donor was not a big Bob Dylan fan because, of late, Jim is far too involved in other things to spend much time obsessing about Bob.

Heart Transplants From the Beginning

As a graduate student in physiology from Stanford, I had a part-time job in the pulmonary function lab in the medical school. A lot of our testing seemed to involve emphysema patients who all seemed to be past or present smokers. There was excitement among the technicians when they were told that some of the work they were doing was on potential heart transplant recipients who were patients of Dr. Norman Shumway. Dr. Shumway had many animals living with second hearts and was preparing to do the world's first human transplant. In fact, Christian Bernard beat him to it, but the methodical Shumway, who pioneered the technique, quickly followed with the first US transplant.

What I realized was that, in many ways, the initial recipients were not good test cases, in that they were very sick and had developed complications that could not be quickly fixed with a new heart. Much better recipients were two of my physical education students at the University of Victoria. Both young men were in good shape but both had a viral infection which was destroying their cardiac tissue. Simon Keith was a top soccer player who, after his transplant in England, went on to play soccer for Canada. Tony Beeftink was a good all-round athlete who is a schoolteacher and has run many marathons since receiving his new Canadian heart.

After writing this article I met with Jim (or James as he now prefers to be called) to do some proof reading. It was a typical cheerful lunch and we quickly got off on a tangent of heart disease songs, which included:

1. The biopsy song -- "Take another little piece of my heart."
2. Transplant songs -- "I left my hear in San Francisco" and "There goes my heart and here am I."
3. Artificial heart song -- "Wooden Heart".

We swapped lawyer jokes and I'm sure it never occurred to the waitress who served us that one of those cheerful old men was a medical miracle.

Jim suggested that I include a few sentences on the importance, not only of organ donation, but also of blood donation, without which his surgery could not have taken place.

He also said it was important to remind people that while some heart disease is unavoidable, the majority of people can avoid the trauma of sickness and surgery by the simple practice of exercising regularly and eating sensibly. I say 'Amen' to that.

Dylanologists that we are, we decided to give Bob the final words and Jim provided the perfect quotation that he still uses on his email.

"And I'm still carrying the gift you gave
It's a part of me now, it's been cherished and saved
It'll be with me unto the grave"
 ~ From "In the Summertime" from Shot of Love

Contact the British Columbia Transplant Society at 1-800-663-6189 for information on how to register on the BC Organ Donor registry or visit their website www.transplant.bc.ca transplants are not possible without blood donors. please visit the canadian blood services site aor call 1-888-2-donate. in the US, contact the american red cross at www.redcross.org/.

Elizabeth Gilbert I was unaware of Elizabeth Gilbert, the writer, until I read her article on Jim MacLaren in G.Q. I was sufficiently impressed to get a copy of her new book, "The Last American Man", which confirmed my initial impression that she not only writes well, but is insightful and a delight to read. One cannot help but think of Thoreau when reading her story of Eustace Conway, although the writing of John Irving also comes to mind. She seems to have a passion for getting behind the eyes of the rugged individualists be they a Jim MacLaren, Eustace Conway or "Stern Men" of Maine who are the lobstermen. I hope to read this book while I'm in Maine on my forthcoming trip to speak with the educators of the State who may not be quite rugged enough for Elizabeth Gilbert. As usual, Amazon has great prices on both books:

What if there was a program or product that had a positive, measurable impact on nearly every student's academic performance? And what if that same program or product could help reverse the epidemic of childhood obesity and had side effects such as enhanced health and self-esteem? Surely every School Board, teacher, parent and politician would want it featured in every school.

The program is Physical Activity. The product is Physical Fitness.

Look carefully at the following 3 graphs.

The graphs are based on measuring nearly a million California school children in grades 5, 7 and 9 in six measures of physical fitness (using the Cooper Institute Fitnessgram) and in their performance in mathematics and reading in standardized tests. In simple terms, the results show the fitter the child, the better their academic performance.

Graphs such as the above show correlations not causes, but it is the remarkable consistency of the correlations that jump from the page. Whatever the grade level and whatever the gender, the higher the fitness scores the better the scores in math and reading. The remarkable aspect of this information is that is does not come from some special interest group looking for more physical activity in schools, but from the California Department of Education. There are two other features that makes these data very robust and meaningful:

1. Over 950,000 children were tested.
2. Fitness was actually measured and not reported, assessed or guessed at.

If it were something other than physical fitness that seemed to boost academic performance everyone would be clamoring for it. If it came in a package, if is was convenient, if it saved a few short-term dollars, if it was a quick fix, if it could be used as a fundraiser or perhaps if it was novel, high tech and trendy, the movers and shakers in education would be demanding its place at every grade level. But physical education is not new, the Greeks saw it as an integral part of a balanced education 2000 years ago and built gymnasia and palastrae where their boys and young men (they still had gender problems) could exercise and discover the harmony of body, mind and spirit and strive for 'arete' or excellence. Throughout the centuries, enlightened societies have realized that a key part of the human potential movement is movement itself.

We don't need what's new for our children, we need what's best, and in order to be at their best as fully functioning human beings children need to be physically educated. They need a vocabulary of movement skills and they need physical fitness.

Intuitively, we know that we are vigorous, active animals who do well when we are able to move, and regress when we are sedentary. Chess players work out physically in order to maintain their mental acuity, Dickens claimed that the length of his walking was the length of his writing, Goethe told us that great thoughts begin in the muscles and marathon races feature numerous academics and professionals as the people of the book go back to their bodies.

Yet knowing this, we are allowing too many of our children to grow up soft and unchallenged without an awareness of what it is to be in peak condition. I've watched the erosion of physical education in my own province of British Columbia where all the major school districts used to have Physical Education supervisors who could act as a resource or reference for inexperienced teachers, today there are no such supervisors and teachers have to go it alone.

Throughout the United States and Canada most schools no longer have high expectations for the physical performance of their students. They have surrendered their responsibility to educate the whole child to cost cutting and convenience and thus become a major player in the obesity epidemic. Schools often compound the problem by becoming recruiting grounds for junk food and soft drink consumption. There are exceptions such as the State of Illinois, which still requires daily PE and kudos to the State of California for introducing fitness testing so they can at least measure the physical condition of their students. In 2004, LA School District is banning the sale of junk food and soft drinks in schools indicating that not all education administrators have their heads in the sand. However, the sort of expectations in my home province of British Columbia are more typical of the norm in North America, with an almost 'why bother' feeling about physical education.

PE "Suggestions" for British Columbia

1. Kindergarten - grade 3. Teacher's discretion!! Now there's a ringing endorsement for the importance of the early acquisition of physical skills as a part of neuro-muscular development.
2. Grade 4 - 10. Recommended allotment of 10% of instructional time. This represents about 100 hours per year if students get this "recommended" time allotment and many don't. Why 'recommended' and not mandatory?
3. Grades 11 - 12. No required PE!!

The guidelines are littered with weak words like 'suggestions', 'discretion', and 'recommended' all of which provide loopholes for lazy teachers and administrators to duck their mandate of educating the whole child. It's remarkable that there is something that enhances health, self-esteem, academic performance and weight control, but the curriculum planners cannot acknowledge its importance. Shamed by the complete lack of a PE requirement in grades 11 and 12 the provincial government has come up with a new token program for the future. Students will have to record 80 hours per year of physical activity of some sort for their Graduation Portfolio. The message is that physical education is not important enough to be part of the formal curriculum, but a little outside play will be fine to meet their graduation requirement. I wonder how many students will miss graduation because they haven't recorded their 80 hours of "physical activity"? I suspect zero.

In justifying this, Ministry Document 001/04 says, "The proposal to add grades 11 and 12 Physical Education to the graduation requirements resulted in the strongest opposition from students, educators and parents. (for example, over 90% of Internet responses)."

But when the National Association of Sport and Physical Education (NASPE) surveyed parents they got a very different type of response. (Survey results released April 29, 2003).

• 95% of parents think regular, daily physical activity help children do better academically.
• 76% of parents think more school PE could help control childhood obesity.
• 95% of parents think PE should be part of a school curriculum for all grades K - 12.

I guess it all depends on which questions you ask and to whom you ask them. (I suspect that you'd get a good Internet response from students to removing math or high school itself).

It will take belief, effort and an act of professional and political will to make fitness and physical education a vital part of the curriculum. Consideration must be given to:

1. Quality daily physical education at least through grade 9.
2. Physical education in every grade K - 12.
3. Specialist physical education teachers at every grade level. It is particularly important that children acquire appropriate movement patterns at a young age.
4. Standardized testing:
   1. body composition
   2. strength
   3. flexibility
   4. cardio-vascular endurance
5. Interesting and creative physical education programming. I love the Ontario high school who have changed their gym to look like an adult health/fitness club.
6. Graduation recognition. I like the concept of a BC high school that issued each student with a S.P.A.R.C. (student physical activity record card) when they joined the school. The SPARC recorded their growth and physical development and was presented to them along with their graduation certificate as an indication of the importance of the mind and the body.

Unless public schools offer challenging and comprehensive programs of physical activity, more and more families who want a complete education for their children will send them to independent schools who offer a wide range of physical education, athletics and outdoor recreation.

The truth about physical fitness and its relation to overall performance and health is self-evident, but too many educators are saying, "go away, I'm looking for the truth".

Fitnessgram and Activitygram Fitnessgram was the instrument used to measure student's health related physical fitness in the California study. It is the product of years of development and has been administered to over 10 million children. Acitvitygram is a module within the Fitnessgram software that helps children and adolescents self-monitor their personal physical activity patterns. I spent some days with the Fitnessgram Advisory Board at a retreat in Santa Fe (see Well Summer 2000) and was impressed by the level of expertise and the commitment of the Board members. I unreservedly recommend the use of Fitnessgram in schools. For more information click here for an acrobat article (.pdf) and here is the Cooper Institute page on the fitnessgram/activitygram and here is another article from the Wellness Center.

**Please refer to the first Sigma Topman article in Spring Well 2003

Note from Martin
We have received 3 emails from Sigma Topman who is becoming a bit of a 'blogger' (for the uninitiated this is someone who describes their life on line in the form of a web log.) I've edited down his communications but have tried to retain the essence of his struggles since the Spring newsletter.

Dear Dr. Collis,

So my nom de plume is Sigma Topman, I can live with that; although given the state of my life there's a certain irony in the 'Topman' designation. Thank you for the encouragement and for the pedometer, fitness ball and books, all that's needed now is for me to put them to good use.

The past couple of months have not been what I hoped for, or expected. I have discovered how hard lifestyle change is and developed huge admiration for people who lose large, or even modest, amounts of weight. The reality is that I weigh 2 lbs. more than when I first wrote to you. I am now fully aware that to do what you've always done and expect to be something different is a form of insanity. I stayed with my recreational eating at hotels (see previous letter) and have not done sufficient exercise to burn off the buffets that accompany every major convention. When I do eat in the apartment, I use a hot-plate, which is probably the saddest appliances in the world, to heat up canned spaghetti, canned chili, alphabet soup and other suicide foods.

There have been a number of notches on my failure gun in the past few weeks. It took me a month to even program my pedometer and a bit longer than that to have my exercise ball inflated. I realized that I had a kind of self-destructive arrogance or pride that became a rationalization for not doing the practical steps it takes to break the habits that have me bound like an Egyptian mummy. My thinking went, "I'm an intelligent, educated man who can take charge of my destiny by myself. I don't need gadgets, programs and other people, I just need some will power and common sense." In one of your previous newsletters, you quoted the home spun wisdom of Roger Miller:

All you gotta do, is put your mind to it
Knuckle down, buckle down, do it, do it, do it.

This sounds so simple and empowering, but like Nancy Reagan's "Just say no" campaign the slogans roll smoothly off the tongue but don't lead to action. As TS Eliot told us,

Between the idea
And the reality
Between the notion
And the act
Falls the shadow.

I made some moves in the direction of more movement. I used a little subterfuge to get a staff card to get access to a local university activity complex. So far it has not been a success. I allowed logistical problems to defeat me, things like getting a lock for my locker, (then forgetting the combination), getting goggles for the pool, feeling embarrassed about everything, my body, my swim suit, my total lack of knowledge about exercise equipment, and my age. What am I, Sigma Topman, doing amongst these young students who all swear, mostly have tattoos and have an easy familiarity with everything from squash to weight training, from Pilates to Stairmasters?

The realization has enveloped me that outside the ivy covered walls of a private school, I'm pretty useless. No longer able to strut my stuff in the classroom and pontificate about this and that, no longer the John Houseman-like presence with my black gown, red suspenders and rounded belly, and no longer the fount of wisdom. My self-confidence has evaporated in the face of fiscal failure, family breakdown and my futile search for an identity outside an audience of schoolchildren. I feel like the Wizard of Oz when the curtain was pulled back and he was exposed as a fraud.

The arthritis in my knees has flared up to add to the discomfort in my left ankle and hips and despite my promises, I rarely manage 10,000 steps a day. I feel undignified, like a beached whale when I try to exercise on the fitness ball. I watch TV but it brings no comfort and neither does food, but I eat it anyway.

I'm down here in the bottom of a pit full of snakes, but at least I'm trying to identify the snakes and put them into groups. I knew that I needed help and I felt that it had to be personal, so self-help books were not the answer. I'd like to tell you that I did a lot of research on the net to find the ideal program for my needs, but that's not the way it was. I needed some ant repellant from a local shopping center and saw a 'Weight Watcher's' outlet. My old self would have smiled at the thought of heavyset women buying into the blandishments of Sarah Ferguson and Monica Lewinski, and walked on by, but Sigma Topman is someone else who knows he's in trouble.

The Weight Watchers setting is awful. Once inside the door you are in a rectangular box, with a drop ceiling, fluorescent lights, cheap mottled carpet and a bunch of molded, plastic chairs. A few motivational posters and some appalling art are tacked haphazardly on the walls. A plastic ficus tree sits in a plastic pot and the counter at which I stood was cheap and chipped. It is hard to imagine a room more bereft of beauty. But the women who spoke to me were kind and well informed, and I signed up for the 'one week at a time' program. (I didn't have faith enough in myself to commit to 8 weeks). In my prior life, I'd have sneered at Weight Watchers, but looked at through the eyes of a fat, lonely man this is a program that offers structure, personal support and hope.

Hope is the thing with feathers
That perches in the soul
And sings the tune
Without the words
And never stops at all.
    ~ E. Dickinson

I've been to two Weight Watchers meetings and they're something like Alcoholics Anonymous but the stories tend to be less dramatic, involving Haagen Daaz and Sarah Lee rather than 2 pints of Wild Turkey or a week-long bender on Southern Comfort. But I sit there in that ugly room and I listen to the courage of women (they're virtually all women) who've chosen to lose weight in the face of a culture that pushes calories at them almost every waking hour of their lives. Unlike alcohol, which you can give up entirely, you've got to face food at every meal.

This is not the usual success story that one reads in "Well", but I am wearing my pedometer and I lost 1 1/2 lbs. in my first week at Weight Watchers (though that still leaves me heavier than when I first wrote to you). Their system of points makes sense to me and when you set out on a journey you never know where it will lead. Mine led me to a bland room in a shopping mall and right now I can accept that. Steven Covey says that if you want self-respect, "Make a promise, and keep it." My promise by the next issue of "Well" is to lose 10 lbs. and average 10,000 steps a day. For me, a great journey begins with 10,000 steps.

Nancy Wardle is a brilliant speaker who delivers powerful and practical presentations on mind/body medicine, stress resiliency and living well in the face of changing conditions. She is a physician with a background in theatre and performance, which gives her a unique ability to communicate complex concepts in an accessible and entertaining manner. Finding balance within our lives is one of the keys to Nancy's presentations. In her own life, her scientific studies in medicine have been complemented by her studies of Buddhism, yoga, meditation, and by her involvement in the visual and performing arts.

Dr. Wardle received her M.D. from McMaster University Medical School in Ontario, where she subsequently served as a tutor. Upon graduation, Nancy worked as a G.P. and an emergency room physician in Ontario. Nancy studied under the supervision of Dr. Herbert Benson at the Mind/Body Institute at the Harvard Medical School. She has relocated to British Columbia to specialize in her private practice of mind/body medicine. Dr. Wardle also worked as a physician at the Center for Integrated Healing, the first clinic devoted to a combination of conventional and complementary care for cancer patients. Nancy continues her involvement in working with the management of pain, chronic illness and other medical crises at specialist clinics and in workshop settings. She is also working with an obesity and health management clinic.

Nancy is first and foremost a healer, she helps individuals in her practice, but she is able to heal audiences and organizations with her wisdom, empathy and sense of serenity. Thousands of people now turn to her 'Calm Down' CD to be guided by Nancy from a state of agitation to relaxation through the use of her breath focussed meditations.

Click the album for an mp3 cut from Nancy's CD

Nancy is a Renaissance woman with a love of literature, film, design, art and food. She is a wonderful chef and has been known to join the chefs in some Vancouver restaurants for some impromptu cooking. She loves the outdoors and has led many women's groups on healing journeys in Northern Ontario and the South of France. She is also Martin's wife. They met when Martin heard her speak 5 years ago in Vancouver and loved everything he saw and heard.

This doctor makes conference calls!

Keynote addresses and conference presentations

Calm Down -- the Balancing Act
Increase your stress resiliency resources by:

• Learning how to use the breath to release and relax in 3 minutes
  
• Acquire strategies to restore in order to perform
  
• Access the 'calm beneath the waves' for health and well-being
  
• Experience 'deep-ease' instead of 'dis-ease'
  
• Staying well in the face of 'busy-ness'
  
• Learning the art of choosing to respond versus choosing to react
  
• Discover your mind/body potential for being in charge of your life

Mind/Body Medicine -- the Practical Magic of Living Well
Based on Harvard Medical School research practices

• Integrate the healing powers of your mind and body
  
• Shift your beliefs and take charge of your health
  
• Learn practices that prevent and/or manage illness
  
• Excellent for health care professionals and anyone dealing with a medical crisis

The Whole She-Bang! -- The Well Woman

• Exploring myths of women's wellness
  
• Learn how to put into practice what you already know about stress, fitness, nutrition by accepting and practicing the wisdom of 'enlightened self-interest'
  
• Healing the 3 questions: 'Why don't I trust myself?', 'Why don't I know what I want?' and 'Why do I try to please so many others, especially unpleasables?'

Nancy has presented from Bermuda to British Columbia, from Seaside to Surrey and from the North Shore of Vancouver to New Hampshire. Her audiences have included health care workers, government groups, educators, library workers, and a variety of companies and organizations who are seeking balance and health in fast changing times.

Every presentation that Nancy gives draws powerful, positive feedback and we receive many letters and comments at Speakwell with typical examples shown below.

"Nancy provided an enjoyable and practical package to use in my own practice. The audience and myself loved the breath control activities."     ~ Pacific Dental Conference "[Nancy] your presentation was excellent, so good to hear a presentation with constructive advice about a difficult problem...your speaking style radiated great warmth."     ~ Royal College of Physicians and Surgeons Canada "A relevant and perceptive presentation, with excellent use of case studies. Dr. Wardle, we look forward to hosting you again."     ~ Bermuda Ministry of Health "Today's presentation was a delight. Humor, gentleness, great balance of factual information with applied demonstrations. All afternoon I've been feeling very mellow and relaxed!"     ~ British Columbia Ministry of Community, Aboriginal and Women's Services

painting : favorite reader : jim daly, 1987

Ball Bearings Written by Jeff Compton, Stefan Scott and Matthew Tyler Some time ago I was sent an advance copy of Ball Bearings and I was delighted with its lay-out, illustrations, practicality and clarity. I certainly stand by my comments, which appear on the back of the book.

"This is quite simply the best guide on exercise ball use that I've seen. If you own, or intend to own an exercise ball, you will multiply its value many times by using Ball Bearings!"

I also endorse the comments of Trish Scott, who is a Fitball® Master Trainer.

"Two thumbs up! User friendly, comprehensive and not a body part missed. Finally a book of ball exercise that challenges the mind and body and gives endless progamming ideas. Just what we needed. Thank you!"

Ball Bearings is written by a personal trainer, a professor and a physiotherapist and I think they achieved something we always strive for at Speakwell, namely, taking solid scientific information and presenting it in an accessible and interesting manner.

Every time I read part of Ball Bearings I want to get on a fitness ball and try some of their ideas. Another thing which endears Ball Bearings to me is it is written with wit and humor, and you could actually enjoy the book if you didn't do the exercises.

As the book notes, Ball Bearings can help improve your

We are very selective about the books and products that we make available on 'Well Mart', but this publication we happily endorse and is one that complements the fitness balls that we market.

Ball Bearings is published by Trafford Publishing, Victoria, BC and can be purchased through the Ball Bearings web site for $34.99. Speakwell will also be carrying Ball Bearings in the Well Mart section of our web site.

    By Trina Rickert

you seen an exercise ball in a magazine, at a gym or at work? Are you thinking about buying one or you've purchased one and you are not exactly sure how to use it. Now is the time to get on the ball!

Exercise balls are one of the most enjoyable, affordable and versatile pieces of exercise equipment available. They can be used by all types of people (non-exerciser to elite athlete) and all ages. To name just a few of the many physical benefits, the ball is commonly used to improve coordination, reaction time, righting reflexes, joint mobility and pain control.₁ It's also commonly used for stability, strength, balance, posture and it's even been incorporated into the work place as a desk chair. Getting started is as easy as sitting down on the ball and users can progress to a plethora of exercises and activities ranging in function and degree of difficulty. Something as simple as sitting on the ball is an excellent exercise and a challenge to maintain your balance and proper posture. Approximately 80% of the adult population will experience back pain in their life₂ and maintaining optimal posture and exercising are keys to preventing low back pain.

To Start With

First, make sure you have a ball that fits you so that when you're sitting on it, your hips and knees are at 90-degree angles. Depending on your height, there is a ball size especially for you.

Your Height

Recommended Ball Size
Under 5'2	55 cm ball
5'3 to 6'0	65 cm ball
Over 6'0	75 cm ball

Secondly, practice sitting on your ball with optimal posture. This can be done by sitting up on the ball as straight as possible. Now imagine that a string is attached to the top of your head and it is pulling your head up towards the ceiling. Try to keep your ears over your shoulders and your shoulders over your hips. This should be your optimal (neutral) spinal posture. While sitting with a neutral spine, with your feet on the floor, try to maintain your stability while lifting one leg.

Increased Difficulty

There are a number of ways to increase the level of difficulty with ball activities:

1. Decrease the base of support or degree of stability (e.g. while sitting on the ball with your feet on the floor, lift one foot off the ground and balance)
   
2. Increase the range of motion performed (e.g. increase the distance traveled when moving the ball)
   
3. Increase the number of repetitions or length of time you hold a position (e.g. once you're comfortable doing 10 sit-ups on the ball, try doing 15 sit-ups)
   
4. Add resistance (e.g. add free weights, tubing when doing exercises)

General Safety

Here are some general safety instructions:

1. Keep the ball away from sources of heat or direct sunlight for extended periods of time.
   
2. Check the area and clothing for sharp objects that may puncture the ball. (Most balls claim they are "burst proof." Avoid confusing this with "puncture proof.")
   
3. Provide unobstructed space so furniture or other objects that could cause injury aren't in the immediate area.
   
4. Maintain optimal posture while bouncing. Do not combine bouncing with bending, twisting or rotating the spine.
   
5. Perform exercises slowly and with control
   
6. Bare feet are recommended when exercising, however, if feet are slipping, rubber soled shoes are advised.
   
7. Wear comfortable clothes that allow full range of movement. Bare skin may stick to the ball and cause discomfort.

Things to keep in mind

You may find it enjoyable to bounce or stretch on the ball and this can be done while you're talking on the phone or watching tv. For general safety however, do not bounce while bending, twisting or rotating your spine. When first trying new exercises, it is a good idea to sit or exercise on the ball close to a wall or chair that you can hold onto when you need to regain your balance.

It's surprising to learn that most stretches and exercise you do on the floor can also be done with a ball. For a fun and challenging activity, get on a ball! To order an exercise ball go to Well-Mart

More information

For another WELL article on exercise balls check out: Size Matters! by Guy LeMasurier.

For a guide to ball exercises I would highly recommend the newly released Ball Bearings -- The Complete Illustrated Guide of Ball Exercisesby Jeff Compton, Stefan Scott and Matt Tyler. This is an excellent resource for both the beginner and the advanced ball user. Highlights include an introduction to using the ball, stretching, strengthening, balancing, stabilizing and bouncing exercises, and workout sheets for the beginner, intermediate and advanced ball user. Visit their site for more information.

1. Compton, J., Scott, S., & Tyler, M. (2003). Ball Bearings. Trafford Publishing.

2. Posner-Mayer, J. (1995). Swiss Ball Applications for Orthopedic & Sports Medicine. A Guide for Home Exercise Programs Utilizing the Swiss Ball. Ball Dynamics International Inc.

I thought you would be interested in hearing about the program with which I am involved. I work at the Dorothy Garske Center in Tempe, Arizona. Dorothy Garske, after whom the center is named, was an innovator who looked at the concepts of aging and retirement very differently from most. Fifteen years ago her retirement communities featured computers and computer education, and where other retirement centers might offer a kidney shaped lounging pool; Dorothy built a lap pool. Dorothy felt the key to successful living for seniors was health promotion and that ongoing physical activity was the most significant factor in successful aging.

We created a program called WalkArizona! of which I am the project Director. Other programs have been born and continue to flourish under the WalkArizona! umbrella including the 'Get Fit-Stay Fit Challenge', which has recently celebrated its 10th year. WalkArizona! promotes all types of aerobic & non-aerobic activities and to be regular with whatever activities one chooses.

Many parts of Arizona can be looked at as being unfriendly to walkers. The sun can be punishingly hot, and most communities are designed for cars, not pedestrians. A drive around Tempe, Mesa, Phoenix or Scottsdale will not reveal many people on foot. Moreover, people are becoming increasingly concerned about their personal safety. All these concerns are multiplied for seniors.

My challenge was to get my seniors out of their cars and off their golf carts and using their legs. In previous decades and centuries, walking was just a natural part of staying alive, it wasn't something you had to plan for or promote. But times have changed, and I found people were much more likely to move if we created a cultural and social environment where walking and exercise were supported and acknowledged.

I will use anything that works to promote movement. We use slogans and poems, we create awards and recognition, we set targets and goals, we encourage people to record their mileage and use pedometers and we do everything we can to make the experience enjoyable and fun.

A Promotional Poem

Too hot? Too cold? Don't want to exercise at all? If the weather doesn't suit you then walk in the mall!
If you're going some place, that isn't far, use your feet and not the car.
Each day you go, make the distance longer. Before you know it, your body will be stronger!
Remember, feed your body, food is your fuel. But mealtime seconds, is not the rule.

You want to be healthy, you want to live life, yet we face each day with some stress and strife.
Your mental attitude is your power play. Feel good about yourself, each and every day.

Listen to your body, take care of all the parts. Walk each day and do your part.
By taking care of yourself, you'll live life with zest! Each day you wake up, you will be your best!
So don't put it off, no more excuses or talk, -- do it right now, Take Yourself for a Walk!

• Under the umbrella of WalkArizona! is the Get Fit‚Stay Fit Challenge. This year, the Challenge celebrated ten years of helping participants to start or maintain a habit of regular physical activity.
• Get Fit‚Stay Fit Challenge program is enthusiastically received by senior adults who participate in various exercise activities, three or more times a week, during six months to qualify for incentives, group awards and individual prizes.
• The Challenge has grown from 500 participants in 13 senior adult communities to over 7,350 participants in 61 communities.

The Gold, Silver and Bronze awards we give are very meaningful to most of our participants. When you think of it, people get awards for bridge, golf, flower arrangements and cooking contests and are delighted to receive recognition that they are looking after their personal fitness.

One program, which has been a great success, is to relate the cumulative walking people to do a specific distance or trail. We've had people "Hiking the Canyon" (ie the Grand Canyon), "Along the Arizona Trail -- border to border for better health" and "Hike the Superstition Wilderness".

We feel we must be doing something right as the number of participants is increasing each year and the program itself has received awards from the Arizona Public Health Association, the Health Promotion Institute of the National Council on Aging and the Arizona Governor's Council on Health and Physical Fitness.

Everyone wants to know about cost and there is no registration fee. We're told that "there's no such thing as a free lunch", but there is a free activity program in Arizona.

Senior communities and groups receive a Challenge Leaders Kit and materials to implement the Challenge in their community. The Challenge can be modified for Work groups, school programs, and communities outside the state of Arizona.

At Dorothy Garske Center, we are continually inspired each year, as we learn about success stories of weight loss, health improvement, strength gain, overall improvement on mobility and living independently. Participants tell us that physicians are blown away by the renewed fitness and vigor of some of their patients.

For additional information about Dorothy Garske Center and the programs we offer, check out our website.

Keep Fit -- Stay Healthy -- Keep Walking!

Contact Katie Stone, B.Sc. CHES Project Director, WalkArizona! 480-966-2675 email: kt@dgcenter.org Write: Dorothy Garske Center 2140 E. 5th St. #8 Tempe, AZ 85281

Why the Pedometer is becoming one of the fastest selling fitness aids of 2003

There is a consensus among fitness and health professionals that the ancient art of walking is still one of the best, cheapest and safest ways to maintain or develop health/fitness, help stabilize or lose weight and to manage the daily stressors of life. The single best stimulus to walk, other than the pleasure of walking itself, is the pedometer. The pedometer allows you to be an informed walker by counting your steps, calories burned and distance traveled.

Research by Stephen Blair and others has shown that moderate activity such as brisk walking promotes a variety of health benefits. You can literally walk away from diabetes, heart disease and stroke. The old Whitehall studies conducted by Jerry Morris et al. looked at the amount of walking involved in their subjects' daily commute and found that the more they walked the less likely they were to have a heart attack. Walking is low cost, low impact and accessible to almost everybody. In 2003 the pedometer has walked through the door in style. Recently it has been written up in the June 2003 edition of Oprah's magazine, the July 2003 edition of Chatelaine and endorsed by Dr. James Hill who created and maintains the National Weight Control Registry. Dr. Hill points out, "a step counter is an incredible motivator. When people use one, they tend to stick with the program." Moreover, many professionals, researchers, educators and lay people are also convinced that one of the biggest motivators to help you keep walking is the pedometer. Oprah has endorsed the pedometer by saying "Smart move for everyone, it's walking season. To start, get a pedometer and count how many steps you take each day." The American Cancer Society promotes the use of pedometers and makes them available as a way of both treating and preventing cancer.

And now I am sharing the secrets of using a pedometer to increase daily walking in my book Manpo-kei: The Art and Science of Step Counting. Based on my own research conducted in Canada and the U.S. since 1997, the book presents the straight-forward methods for taking back our naturally active lifestyles using the simple and inexpensive pedometer. This pedometer-based lifestyle even includes its own unique glossary of terms, some of which are included at the end of this article.

Just give me the facts

The child like questions of "are we there yet?" and "how much further do we need to go?" are very relevant for today's walker. In order to be realistic, people need accurate feedback about their performance. One of the characteristics of people who lose weight and keep it off is that they weigh themselves frequently. Virtually every survey and piece of research in which people self-report estimates of their caloric intake, physical activity or fitness level is questionable, as people invariably overestimate their performance (to put it bluntly, they lie to themselves and the researchers). The pedometer brings reality to the world of movement. With a pedometer you know how many steps you have taken, how many calories you have burned as well as how far you have walked or jogged. Significantly, you can TRACK this behavior from day to day to help make healthier choices.

What are pedometers and how do they work?

Pedometers are simple and inexpensive gadgets ($20-50) that attach to your clothing or belt, just above your hipbone. They have an internal lever mechanism that detects the up and down movement at the hip while walking (or running) and translates this into steps taken. They are considered by researchers to be acceptably accurate for assessing typical walking behaviors (see Well Article Summer 2002).

How many steps per day do people typically take?

We can expect active children to take 12,000-16,000 steps/day and healthy younger adults take 7,000-13,000 steps/day. Healthy older adults typically take 6,000-8,500 steps/day and those living with chronic illnesses or with disabilities take 3,500-5,500 steps/day. So the burning question for you the reader is, "How many steps per day should I take?"

How many steps per day should I take?

Although the popular goal of 10,000 steps/day can be traced to the Japanese nickname for a pedometer ("manpo-kei," which literally means "10,000 steps meter"), that number of steps/day may be too low for active children and can be challenging for sedentary people embarking on a new lifestyle. However, as Michaelangelo so eloquently stated, "The problem is not that your hopes are too high and you fail to reach them, it's that they're too low and you do." In my book Manpo-kei: The Art and Science of Step Counting I recommend a more individualized approach to goal-setting and tracking using a pedometer. The primary concept is to take more steps than before...that is more steps per day than at baseline, prior to any lifestyle change. Although I suggest strategies for increasing your daily steps, the best ones come from you as you practice your new lifestyle. The book provides guidance, including work sheets to help you select your personalized strategies and achieve your goals.

One realistic approach that accommodates the public health recommendations is to find out how many steps per day you are taking now and gradually increase it by an amount that is equivalent to 30-60 minutes of brisk walking. For example, depending on your walking speed, people will take approximately 1000 steps in 10 minutes. You can personalize this even more by determining exactly how many steps you take in 10 minutes while wearing your pedometer. Then in order to find out how many steps you take in 30 minutes or an hour, just multiply your 10 minute number by 3 or 6 respectively. Based on your own personal goals and schedules you can now accurately assess how much time and distance it will take to increase or modify your step total. You don't have to increase your activity by this amount all at once; you can always build yourself up by increasing 10 minutes one week and 20 the following week until you are comfortable with your new active lifestyle.

How do I find out how many steps per day I take?

By wearing a pedometer for a full week without altering your usual activity, you will have a valid baseline that can later be increased if needed. During this first week, take special note of what you do differently on days when your steps per day are higher and lower. For example, you might discover that the days when you go shopping, walking on the beach, or to the park with your child are higher than the days you stay at home or travel long distances in the car. You will find this information useful when you subsequently try to select effective STRATEGIES to maximize your steps per day.

How do I work on increasing my steps per day?

Once you have a STEP GOAL (your BASELINE plus a STEP INCREMENT or the amount you want to increase by) focus on working towards this goal one day at a time. Look at your pedometer frequently throughout the day to find out where you are and what you need to do to meet your day end goal. Pay attention to what strategies you practice that elicit the most number of steps and repeat these as often as you can. For example, parking farther away from stores might seem to produce relatively few extra steps, but the more you practice this strategy the more the steps will add up.

Another approach that I promote is to include SPIKE DAYS to your week. This is an advanced technique of GOAL-SETTING an elevated step goal, above your usual step goal, a self-determined number of days/week. For example, say you usually try for 8500 steps/day. Twice a week you may try to get 15,000 steps/day so that your weekly average is actually over 10,000 steps/day!

Is there a single best STRATEGY?

Although I reveal a number of research tested strategies that have worked for others in my book, the single best strategy that has consistently emerged is: include others. Social support is perhaps one of the best strategies for increasing your steps per day. Show family members your pedometer and get them interested in increasing their own walking behaviors.

Schedule walks with your friends. Get your coworkers involved in going for a walk at lunch hour. Phone someone and ask them how their walking is going. Take your dog for the walk he/she deserves. Not only will you benefit from the support you derive, but you will also be passing the gift of wellness onto others.

Conclusion

In Oprah's words, "Walk It Off! The absolutely surest, safest, most painless way to lose weight." Today, more and more people are taking an active approach to the monitoring of their wellness. However, this idea of using an instrument to count the number of times you step in a day is nothing new. Leonardo DaVinci considered such an instrument in his quest for a distance-measuring device to construct maps. With the arrival of modern pedometers just after the Tokyo Olympics of 1964, the Zen of pedometers has remained a part of Japanese life ever since. Today, the top 5 reasons to wear a pedometer are:

1. The pedometer gives you credit for all those short activities you would never remember or bother to record.
2. You get instant feedback on your activity level throughout the day.
3. The pedometer can motivate you because you get credit for every extra step you take.
4. The pedometer is effortless. Just clip it on and it does everything automatically.
5. By wearing a pedometer you will take more steps in your life. These "active" steps will help you lower your risk of heart disease, cancer and diabetes, in addition to giving you a sense of daily well-being.

*Adapted from: Smart Stepping Student Guide by Robert Sweetgall and Robert Neeves, 2002.

So there it is. The road to an active lifestyle can be as easy as putting your best foot forward (followed by the other one of course).

About the Author

Dr. Catrine Tudor-Locke is an Assistant Professor of Health Promotion in the Department of Exercise and Wellness at Arizona State University East. Her research is focused on understanding and addressing the problems associated with sedentary lifestyles in a range of populations including youth, older adults, and individuals with Type 2 diabetes. She developed the First Step Program, a novel daily physical activity intervention and capitalizes on a simple and inexpensive pedometer as a self-monitoring and goal-setting tool. Dr. Tudor-Locke is the author of a self-help book based on the First Step Program titled Manpo-kei: The Art and Science of Step Counting (2003 Trafford Publishing). She monitors her own physical activity daily with a pedometer and averages 14,000 steps per day.

Manpo-kei is available through Amazon in Canada

We have received unanimous positive feedback from people who have purchased the Omron HJ-105 pedometer and are delighted that we are now beginning to get orders from schools. We have had to reorder these many times to keep pace with demand. Speakwell road tested many pedometers in the lab and on the street. Based on a number of criteria, including accuracy, reliability, price, size and ease of use, we chose to offer the Omron HJ-105 on our website or call our office toll-free at 1-866-721-6940 for details.

Manpo-kei Practitioner's Glossary (adapted from Manpo-kei: The Art and Science of Step Counting)

Baseline - usual steps/day level before behavior change.
Goal-setting - a process of identifying a desired state or behavior (e.g., Step Goal) that you can work towards.
Manpo-kei - a Japanese word originally referring to a pedometer as a "10,000 step meter," the term now refers to an individualized approach to increasing physical activity through a pedometer-based program of goal-setting and self-monitoring.
More Than Before - a desired state when current steps/day is greater than Baseline
Spike Days - an advanced Manpo-kei technique of setting an elevated Step Goal (above the usual Step Goal) a self-determined number of days/week.
Step Goal - a number of steps you want to attain by the end of the day.
Step Increment - any number of steps you add to your Baseline Level or Current Steps/day to obtain a new Step Goal
Strategies - the behaviors you practice to meet your Step Goal.
Tracking - a process of self-monitoring.

"My uncle in Texas thought that a vegetarian was someone who ate vegetables with their meat." ~ Joe Ely

"A classical education is great because it gives you contempt for the money it prevents you from earning." ~ Anon

"Disbelief in magic can force a poor soul into believing in government and business." ~ Tom Robbins

"There must be more to life than having everything." ~ Tom Robbins

"What if the worst of us gets the best of us?" ~ Anon

"My mother used to say that there are no strangers, only friends you haven't met yet. She's now in a maximum security twilight home in Australia." ~ Dave Barry

"Don't play for safety -- it's the most dangerous thing in the world." ~ Hugh Walpole

"It's hard to fight an enemy that has outposts in your head." ~ Sally Kempton

"Opportunity is missed by most people because it's dressed in overalls and looks like work." ~ Thomas Edison

"To play the game is great,
To win the game is greater,
To love the game is greatest."
 ~ Anon

"I don't blame the government, if I had trillions of dollars at my disposal I'd be irresponsible too." ~ Dave Barry

"The cure for boredom is curiosity. There is no cure for curiosity." ~ Ellen Parr

"The creator of the universe works in mysterious ways. But he uses a base ten counting system and likes round numbers." ~ Scott Adams

"Tears will get you sympathy, sweat will get you change." ~ Jesse Jackson

"If it weren't for the rocks in the bed, the stream would have no song." ~ Carl Perkins

"Running is one of the contexts I've created for myself, one of the things that orders my life, that fills it with metaphor and meaning. The point of running for me is not to cover ground more quickly; for that I could use a motorcycle. The point has to do with seeking out my limits, centering my attention: finding out who I am." ~ Bill McKibben

painting : the favourite poet : sir lawrence alma-tadma

If People Disapprove of You

Make being disapproved of your hobby,
Make being disapproved of your aim.
Devise new ways of scoring points
In the Being Disapproved Of Game

Let them disapprove in their dozens.
Let them disapprove in their hordes.
You'll find that being disapproved of
Builds character, brings rewards.

Just like any form of striving.
Don't be arrogant; don't coast
On your high disapproval rating.
Try to be disapproved of most.

At this point, if it's useful,
Draw a pie-chart or a graph.
Show it to someone who disapproves.
When they disapprove, just laugh.

Count the emotions you provoke:
Anger, suspicion, shock.
One point for each of these and two
For every boat you rock.

Feel yourself warming to your task --
You do it bloody well.
At last you've found an area
In which you can excel.

Savor the thrill of risk without
The fear of getting caught.
Whether they sulk or scream or pout,
Enjoy your new-found sport.

Meanwhile all those who disapprove
While you are having fun
Won't even know your game exists
So tell yourself you've won.
   ~ Sophie Hannah

Morning Exercises

I wake up and say: I'm through.
It's my first thought at dawn.
What a nice way to start the day
With such a murderous thought.

God, take pity on me
- is the second thought, and then
I get out of bed
And live as if
Nothing had been said.
   ~ Nina Cassian

The Flaw in Paganism

Drink and dance and laugh and lie,
Love, the reeling midnight through,
For tomorrow we shall die!
(But, alas, we never do.)
   ~ Dorothy Parker

Saturday Morning

Everyone who made love the night before
was walking round with flashing red lights
on top of their heads ‚ a white-haired old gentleman,
a red-faced schoolboy, a pregnant woman
who smiled at me from across the street
and gave a little secret shrug,
as if the flashing red light on her head
was a small price to pay for what she knew.
   ~ Hugo Williams

Sometimes

Sometimes things don't go, after all,
from bad to worse. Some years, muscadel
faces down frost; green thrives, the crops don't fail,
sometimes a man aims high, and all goes well.

A people sometimes will step back from war;
elect an honest man; decide they care
enough, that they can't leave some stranger poor.
Some men become what they were born for.

Sometimes our best efforts do not go
amiss; sometimes we do as we meant to.
The sun will sometimes melt a field of sorrow
that seemed hard frozen: may it happen to you.
   ~ Sheenagh Pugh

Weather

Because of the menace
your father opened
like a black umbrella
and held high
over your childhood
blocking the light,
your life now seems

to you exceptional
in its simplicities.
You speak of this,
throwing the window open
on a plain spring day,
dazzling
after such a winter.
   ~ Linda Pastan

Long time friend and former student Rob Dyke (on right with friend, Ian, at Everest base camp) has a catalogue of physical triumphs to his credit and has now added to his resume with a remarkable journey by land and water across India and Nepal and a long way up Everest itself. I hope Rob will describe his odyssey in a future edition of 'Well'.

Roxy, the Speakwell cat, who is now 20 years old on an all-meat diet.
(Maybe Dr. Atkins was on to something).

17 Syllable Exercise

Some Cat Haiku's (Origin Unknown)

You must scratch me there!
Yes, above my tail!
Behold, elevator butt.

The rule for today
Touch my tail, I shred your hands.
New rule tomorrow.

And one non-cat haiku from Martin:

To write a haiku
For your fiftieth birthday
Is very diffic.