The talk of the town (in Anytown, USA) is "Evidence-Based Medicine". If you're in the health professions, I am sure you've become familiar with the phrase. The same holds for those in health insurance - and clinical research. "The evidence" is driving everything these days.

For the record - I am a true believer in the power of good clinical research. I do think that as clinicians we need to provide care based on true evidence-based medicine. We must hold ourselves to high standards of practice, and we must continue to challenge our thought processes and clinical reasoning skills - as uncomfortable a process as this may be. It involves reflection on our practice patterns and perhaps even challenging our belief systems - about our role in patient care or the methods we advocate.

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... I learned in kindergarten ... or at least that's how the book is entitled, yes?

Admittedly, Robert Fulghum gave us a delightful exploration of this in his 1986 novel. I read it after much cajoling from those around me. Friends said that it was a "must read" - but I always get a little conerned about the "must read" list because it usually involves some level of "pablum for the masses". Eventually, I read it - and it was definitely a necessary addition to my bookshelf.

Yesterday, I found myself wondering - if perhaps "all I really need to know" was something I learned in utero. Perhaps kindergarten was merely my graduate degree. If that were perhaps the case, then my PhD would be life-long learning. Of course, this evolved into the thought of "if PhD stands for 'Piled Higher and Deeper' then day-to-day life was definitely given me a doctoral dissertation"!

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There are moments that defy description. Words may not adequately describe them, and they could be fleeting at best - but you definitely know you're there when it's taking place.

This morning, I got to revisit one that I'd forgotten from years past - and again, although fleeting, was truly incredible.

There is a left hand turn at about mile 4 in the 3M half marathon course (which I've now run for the past 4 consecutive years). You're heading down Mesa, then you turn left onto Spicewood Springs. If it's a crisp, clear January morning (which it has tended to be over the past few years), you might arrive there around 7:30 am or so - just after the sun has started to rise. To this point, you've been in relative shade (and probably a little chilly). As the road starts to descend, your pace quickens, taking advantage of gravity as your legs unwind underneath you. Then - that turn - and this blazing sunlight just over the tree tops in the median. The sun's rays are warm and almost blinding - sunglasses barely help to protect you from the glare. It is a moment of beauty, one that reminds you of how great it is to be out running on a Sunday morning. It's almost as if the temperature rises while you face the sun, dropping down to the fifth mile marker.

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The phrase "Rhubarb Diaries" has had a rather intriguing evolution over time. In many ways, it started off as an off-hand commentary (that frankly, made no initial sense to me), but became something that is synonymous with "me".

How did this all come about?

I've been a writer-in-disguise (and musician, and photographer, and ...) for many years. The creative element has always existed in my world - maintaining a fine balance with the left brain, "scientific method" persona of my education and profession. Many of my friends - even those I have known for many years - really have no inkling that that person exists. Of course, I find this rather humorous (and fascinating). I guess it must be that sort of "quiet musician/artist and his work" thing.

At one point, I decided it was time to start sharing more of this creative element with the world. This website (and the book that will evolve within it) is a piece of that puzzle.

The first piece of writing I really shared with anyone was the report of my experiences training for Ironman. The feedback was phenomenal. I then had a discussion with a close friend of mine, John, when I was home in August 2005.

I need to preface this by saying that John has always had a dry sense of humor - which I have always appreciated!

Here is how the conversation goes ...

John: Thanks for sending me that race report. You're a really good writer.

Allan: Thanks! It's going to be the basis for my book someday.

John: Great! A book? That's great. You should call it "The Rhubarb Diaries".

Allan: (thinking "what the hell?") Ummm I don't think I understand.

John: Well, it's kinda like the "Motorcycle Diaries".

Allan: (now thinking that he needs to see "The Motorcycle Diaries", but assumes that John has some clue as to what he is talking about) Ok ... now what about the rhubarb part?

John: Remember when you won the rhubarb at that running race you did here a few years ago?

Allan: (thinking back to a long lost moment) Oh yeah ... funny you'd remembered that! (Yes, I won rhubarb at a running event - only in Brockville, Ontario does a slow 5K get you 3rd place in your age group and a rhubarb plant for your work - or lack thereof I suppose)

... and therein lies the basis for what you read (and see, and hear) on this site.

Now I best get down to watching that movie ...  

When I was last in this neighborhood, we were discussing the amazing adaptability of the human machine. Incredible as it may sound, human physiology and anatomy will consistently adapt to the world - and if unable to do so, will give us warning signs (such as pain) and then show us that it is unable to do so - by way of injury. 

Lest we forget, the body aims for homeostasis - which is, implicitly, "balance". So at any given time, we are in homeostasis and thus always "in balance" relative to the demands on the system at that given point in time. Homeostasis is a wonderful thing. Our cellular mechanisms are constantly seeking homeostasis. We are always trying to find a balance - between stimulus and response, between training and recovery.

But here's the twist ...

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To live on planet earth, humans are constantly adapting to the demands of their surroundings. As I am always saying (to anyone who will listen) - Form Follows Function. Our anatomical form evolves depending upon the functional demands that we face. Throughout the evolutionary process, the human form has changed to allow it to better adapt to the world around it.

Let's take a look at a few basic examples. An astronaut traveling to the moon adapts to the inherent decrease in gravitational force by having less muscle mass and a decrease in bone density. Why? There is no functional need for these - and thus the body adapts accordingly. On return to earth, there is a gradual return of bone density and muscle mass. Why? Because there is a functional demand placed on the body - and it adapts accordingly. Form follows function. Along the same lines, the average sedentary American, the "couch potato" if you will, has become very finely tuned anatomically to deal with the imposed demands of "couch-potato-dom" - a perfect slouch into the big puffy couch and very strong thumb musculature for the use of the TV remote!

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There were many years in which I truly believed that Hawai'i was probably one of the last places I wanted to visit. Commercialized. A tourist mecca. Haven for newlyweds and the like. Las Vegas of the Pacific -ok, well maybe not quite that bad (and certainly with a whole lot less polyester) ...

Then I made that fateful trip to the Big Island in 2002 - and my life changed forever.

I can look back on it now and chuckle a bit. I went purely for non-metaphysical reasons - to experience the Ironman World Championship (and as a coach no less). It was a short trip, and the intent was, admittedly, far from "self-discovery". But all it took was walking off the plane, onto the tarmac at the airport in Kona - and I knew it was a special place. There is a purity, a vibe, a power that emanates and pervades all existence on the Big Island. It is something that words can't truly describe. It's a bit mystical and other-worldly, but it was definitely something I noticed immediately upon arrival.

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