Asics Gel Blur 33

July 23rd, 2012

The “33″ in Asics so-named line-up of middle to lightweight running and racing shoes is in reference to the 33 bones of the foot.

20120723-194927.jpg

The Blur is a light middleweight shoe constructed with a combination of Asics’ gel, memory foam and solyte providing substantial shock absorption.

The heel cup has a layer of memory foam that conforms to the foot to provide a glove like fit.

The outsole, typical for the 33 line-up, reduces the coverage of the tough road going rubber in favor of weight savings.

In the picture above you see the orange is heavy duty rubber and the blue is lightweight EVA type material.

Uppers are excellent quality, ventilation is excellent for 90 degree days, flat laces.

In practical use I feel that the Blur seems to slot in between the lighter, firmer Neo and the plusher Excel. It’s a fast, comfortable platform that I’m able to log six mile runs without foot, leg or back pain. Foot bed friction heat is minimal but is occasionally noticed, but not to the extent of the Excel.

Overall this is an excellent middle lightweight run/training shoe that should hold up fairly well to mileage while maintaining good comfort and reasonable stability.

Warrior Dash Minnesota – Race Recap & Impressions

July 2nd, 2012

The Warrior Dash bills itself as not only the world’s largest running series, but promises you ‘the craziest day of your life’.  The former may or may not be true although Red Frog Events (the owner/organizer of the Dash) recently proclaimed a participant as the 1,000,000th runner.  The ‘craziest day’ claim?  I didn’t think the race was that crazy, nor would it likely qualify as the craziest day of a person’s life.  The Dash did however appear to be the most physically challenging day of many of the participant’s lives, at least to those whom I observed sitting or standing in the shade along the course route, cashed out, unable to proceed another step.

The race.

5 minutes before start, jammed into a starting paddock with about 500-600 other racers for the 10 AM wave.  Waves depart every 30 minutes.  The race announcer trying to get the racers fired up.  Give the person next to you a high-five, etc., etc.  Skip all that and let’s focus are my thoughts.  Let’s go.  Fireballs flaming from the top of the start arch key ‘Go!’

And we’re off..slowly..it’s a grand march across the bottleneck which is the starting grid electronic timer mat to read the computer chip on each person’s shoe.  There are chip readers all along the course, presumably to prevent people from cheating and cutting corners.  But why bother to pay $50 to do this if you’re going to cheat?

I’ve got plenty of time to turn and wave to my wife and kids!

Now through the starting gate and breaking into the open it’s a 400 meter climb up a modest slope, then a sharp left with a long downhill sweeping right through a water blaster and some light mud/running ground water.  Flat elevation up to the first obstacle which is a gauntlet of car and truck tires hanging from ropes.  You bash your way through the tires no problems really except for competitors running nearby inadvertently shoving a tire your way which can catch you off-guard.

Now comes the first of many uphill slogs.  A 10-12% grade winding slightly to the left, then at the top another obstacle, it’s a large A-frame structure standing ~25′ with about a dozen ropes hanging down that runners use to walk/climb up the wall, it’s easy, but don’t fling yourself over the top, as it’s a rack of 2×4 on the other side, widely spaced, which you must climb down, or risk falling through to the ground.  Finish the obstacle and it’s a short flat run ramping quickly into what is the first really intense, long climb, straight up a downhill ski run.  Not many are running or jogging all the way.  About half-way up, that’s it, I begin walking too, just in time for the first photography station.

At the top here’s another obstacle.  Termed ‘Barricade Breakdown’.  It’s a series of 4′ high walls inter-spaced with low barbed wire.  First you hurdle a wall, then scuttle forward hands/knees to go under barbed wire, repeat this about 6 times.  It’s easy enough to boost over the walls then go under wire, but repeating it over and over gets intense, especially after that uphill that preceeded, you leave this obstacle winded.

Off we go again, jogging lengthwise across the face of another ski slope, then we turn downhill for a modest running descent, what I’ll begin thinking of as recovery descents.  We round a corner, into a very steep descent at too fast a pace, recovering footing into the next obstacle, which are a series of narrow gang planks you must navigate up, across and then down without falling off.  At their peak they rise to about 6′ off the ground and are 8″ wide, spanning perhaps 25′.  The planks shake a little depending on who’s running in front, behind.  At this obstacle I hear a loud “Ouch!!” from a competitor.

Successfully navigate the planks and now it’s a gentle flat elevation run over a double-track into a forest road emerging to see the next obstacle, the Treacherous Trenches.  Here the goal is to choose one of four trenches topped with barbed wire to crawl 50′ through.  I picked the trench I thought would give me the least resistance.   Yes the barbed wire and logs overhead are low enough so you’ll have to wriggle through part way on your stomach.  I got zinged a couple times by barbs.  They are real, and plenty sharp.

Once through the trenches, we’re off and running, following a double track across the base of the ski resort, through another large power fan blowing water and some mud.  I now realize this fan wasn’t an obstacle, but meant to cool off runners in preparation for a wicked ascent zigzagging up, up and across another long downhill ski run.  Many, many competitors have cashed in their chips and are sitting in the shade along the sides of this ski slope.  Only one iron-man is attempting to jog up this steep beast, everybody else is hiking it.

Here’s another obstacle, a bunch of barbed wire strung between poles.  I crab crawled through this, the observer keeps yelling out ‘stay to the side if you can, there’s more room there!’  My advice: listen to him.  More room means less barbs poking you.

My son congratulating me on a finishing the 2012 Minnesota Warrior Dash. As you can see, I was able to stay out of the mud…

Now departing the ski slope we enter the forest and a single track, a mountain bike trail, going upward through a series of switchbacks, only room on this trail for one person, so it’s a huge bottleneck, a forced march..perhaps a good thing..until the single track opens up to reveal yet another obstacle.

It’s another huge A-frame, but without ropes.  You climb up both sides using 2×4′s with large openings that would be easy to fall through.  There is a negative camber at the top to climb over, be careful here.  From the top I see many are now walking around this obstacle, they are toast.

After decending the A-frame,we’re off again, the ski slope path opens onto a groomed gravel road, modest elevation, so some of us start running again.  This is pleasant run on a gravel road, up until the next obstacle which is a big cargo net climb.  It’s simply another of these enormous A-frames, but with cargo ropes going up one side and then down the other.  Easy enough, and fun.  Jumping down the last 5 feet on the back side, there are now a small group of us running earnestly again.  Sort of.  Here’s another obstacle right away, The Typhoon.  It’s two enormous wind fans blowing stinging sheets of water.  It’s welcome relief from the oppressive heat.  I stop for a moment.  My sunglasses probably saved me from losing a contact lens, it’s such a powerful gale.  Leaving the storm, now somebody yells out, it’s all downhill from here!  Those who have anything left are running again, and we’re going fast, we’re passing whole groups of people walking.  Now we’re really going downhill, and fast.  It’s borderline treacherous, this is a downhill ski slope in the summer, loose sandy loam, pot holes, somebody passes me at an insane bombing run pace.  Still none of us running lets off the gas.

Emerging from the descent, we’re into a slight looping right ascent crossing over a mild rise.  Now a precipitous downhill, more extreme than the last, here running with quick, short, choppy steps, and fast, no this isn’t a recovery descent, we’re pushing, we can see the next target, and in the distance the finish line.

Before me is the Petrifying Plunge.  It’s six slides made of thick black pond liner plastic, probably over bales of hay, with water spraying, it’s straight downslope about 75-100′ into what appears to be a mudpit.  I leap into a slide landing on my rear..and go nowhere.  I stand up, back up a little,  run and do a superman..Ouch!  But away I go like a rocket to the bottom, actually passing some more people.  I avoid the water slide mud pit by hitting the brakes and sticking the landing.  We are now getting close to the finish, you can see the fires, the crowds, and the real mud pit looming, but finally fatigue is creeping in, but still the drive to the finish line, one more kick, still passing people, many of these folks are the remnants of previous waves.

Now it’s leaping over the 3 or 4 flaming mounds they call The Warrior Roast, this is easy, okay  it’s warm but no chance of catching fire since I’m soaked.

The finish line is just 50′ away, yet between here and there is a deep pit of black slime strung over with barbed wire.  This is the final obstacle, a.k.a. Muddy Mayhem.  Going into the race, I had determined that I was going to go gingerly though that mud pit, so as to keep as clean as possible.

Forget it.  I back dove in.  Forget about keeping clean, just try and avoid swallowing any.  Surprisingly it didn’t really smell.  It was 3+ feet deep and had the texture of pudding.  Lots of crunchy stuff deep down under knees and feet which I believe may be activated charcoal, but who knows.  The woman behind me says ‘just don’t kick’!  No problem, kicking wouldn’t have resulted in any forward movement anyway.  Progress through the morass was made with a sort of doggy paddle/crawl on the knees, emerging finally, stumbling out of the pit, loaded with black mud to cross under the finish banner like an off-kilter rhino, or perhaps a wildebeest, emerging from it’s wallow.

Summary?  The most challenging aspect of Warrior Dash was, without a doubt, the terrain of Afton Alps.  Repeatedly ascending downhill ski slopes isn’t easy, not by half.  It’s simply hard to train for that type of cardiovascular event.  Next?  The heat.  It was hot, 87-degrees at race start.  There were plenty of water stations with cold bottled water.  The obstacles were all benign enough, fun factor, with just a little hint of danger should you blunder and fall off or get poked by barbed wire, or yell an occasional “Ouch!!”  I know could have pushed a little, or maybe a lot harder out there, but I didn’t need to get heat stroke.  I had seen two ATVs go by with folks stretched out in the back while I was on the course.  I wasn’t looking for a ride.

I ended up finishing in 36 minutes, placing 362 out of 6600 competitors.

My main goal was just to get out there, have fun, and see what this series was all about.  I think I accomplished all three.

Next time I’ll know how to train.  Hill repeaters, and hill repeaters and hill repeaters.  Or maybe I won’t, since this really a just ’fun run’.

Logistics.

I drove, along with my fan base – my wife, my 5-year-old son, and 2-year-old daugher from Minneapolis to the designated parking lot, a farm/gardening center near the Afton Alps Ski Resort.  Parking was at the garden center, with school buses ferrying folks to and from Afton Alps, the event location.  The parking fee was $20 per car, outrageous particularly since there are no other options readily available.

I ran in the 10 AM wave, on Sunday.  It’s the less expensive of the two days, and getting there early I hoped to avoid the crowds.

There were no problems loading a stroller and the kids onto the bus, the bus ride was 5-8 minutes to the event site.  The wait to get on busses was about 5 minutes.  Once at the site, registration and packet pick-up was efficient.  There was a nice shaded area in the fan/observer paddock where the wife and kids were able to watch the proceedings out of the heat and sun, which at 10 AM was already in the high 80′s.  It’s a 3-mile course winding all over the ski resort and only the final two obstacles (mud pit and fires) were visible from the spectator area.  The race village housed a large registration tent, food vendors, a beer garden, and live rock music played from a stage at the other end of the race village.  Porta potties, the big pile of post-race shoe donations, and the wash down were all behind the stage.

The wash down consisted of two large fans blowing water (just like the Typhoon) and a man running a firehose.  Crowds of muddy people stood in the howling wind and water which peeled off most of the outer layers of muck, but you’ll still want a change of clothes for the ride home, and a few towels to sit on.

I am a 41-year-old male, 5K and 10K race competitor, who regularly runs 20 miles per week, mostly not ever on ski slopes or in 87 degree weather.

The overall winner on Sunday was a 54-year-old man, with a time of 23:11 minutes:seconds.

 

 

 

 

 

 

Case Study: Foot pain in an avid walker/runner.

June 19th, 2012

Patient is a 57-year-old previously asymptomatic female, avid runner/hiker/walker who developed moderately intense pain in the bottom of her foot/arch that worsened with distance, weight bearing and improved slightly with rest.

General exam observed a slender female 5 ft 4 in, 132 lbs.

She exhibited a mild walking gait deficit that was clearly due to foot pain. Lower extremity examination found a normal ankle and Achilles tendon. The toes were normal without anatomical defects. All three arches were intact with the primary arch being moderately high.

Inspection of the sole identified a prominent marble-size, painful, firm, non-mobile nodule in the mid foot, along the arch. The skin overlying the nodule was reddened.

Compressing and to a lesser extent manipulating the nodule immediately recreated the patient’s presenting pain.

The patient was diagnosed with plantar fibromatosis, which is a fairly uncommon, slow-growing, thickening of connective tissues deep in the sole of the foot. It is a non-malignant condition that is often hereditary.

Bilateral involvement is observed in 25% of cases. Although asymptomatic in the other foot, when checked, indeed a less prominent nodule was identified.

The progress of fibromatosis is quite variable but often is dormant for many years until ‘activated’ by repetitive abrasion and microtrauma from walking and running activity by footwear or lack of footwear that increases pressure on the nodule to the point of pain and nodular growth.

Treatment in this case was straightforward. I instructed her to outline the nodule(s) with a marker and while the ink was still wet, stand in her running shoes. The resultant outline on the shoe’s insoles was cut out to leave a gap allowing the patient to run or walk without the nodules being abraded or compressed.

Early relief was significant, with the patient eventually resuming running and walking without pain.

A two month recheck did not find any significant reduction in the size of either nodule although they remained asymptomatic as long as the modified footwear was worn.

It was later discovered that the patient’s mother had a related nodular formation in the palm of her hand, but none on her feet.

Incidentally the patient went in for a general massage and the masseuse refused the patient’s request to leave the nodule alone, massaging the bottom of the foot to the point of discomfort which persisted for about a day.

Plantar fibromatosis does not respond to massage.

he prognosis is good. I do not expect the size of the nodules to decrease but with good protection the growth rate and pain should be minimal to nil.

20120619-114654.jpg

20120619-114721.jpg

First impression: Gel-Excel 33′s

May 31st, 2012

Four and a half miles on city streets and sidewalks left me a favorable overall first impression of the Gel-Excel shoes, part of Asics’ new “33″ series.

Construction is lightweight and not at all overbuilt with Asics’ Solyte midsoles the predominant feature with durable rubber outsole only in areas where the rubber meets the road.

There is a stiff plastic Asics “trusstic” reinforcement device visible in a horseshoe configuration from midsole to forefoot.

Uppers are well ventilated with high quality lacing and snug fit.

Asics’ gel is visible in the mid and heel and combined with the Solyte and what must be a memory foam type insole the first 1000 meters or so are a mixed experience. Very plush and grippy initially but at the same time seem to absorb a lot of forward momentum. They come into their own by mile 1 and are snappy but minimize excessive shock. These promote forefoot strike rather than heel, good. Notice excess insole heat being generated by mile 2 with moderate hills. Not terrible though. Ride remains comfortable in terms of absorbing shock throughout. Pace 7:45 min/mile for 4.5 miles. No foot, ankle, leg or back pain. Toe box plenty roomy. Next run will lace a bit tighter to see if insole friction is decreased.

These shoes would work well for anyone less than 185 pounds seeking lightweight daily training shoes that promote forefoot rather than heel strike.

UPDATE (@125 miles).  Excellent shoes.  Have broken in very nicely.  Strongly recommend.

20120531-191407.jpg

Chia Seeds, superfood or hype?

April 25th, 2012

Chia seeds are gaining popularity as a dietary superfood, but are they really special?

Chia is an ancient grain, cultivated by cultures such as the Aztec thousands of years ago, and a significant portion of their diet. More recently in the 1980′s, these are also the same seeds grown to sprouts on Chia Pets.

Nutritional Analysis of 1 ounce (28 grams):

Calories 137
Total Fat 9g (1g saturated)
Cholesterol 0mg
Sodium 5mg
Total Carbohydrate 12g
Dietary Fiber 11g
Protein 4g

Minerals of note:

Calcium 177mg (18% DV)
Phosphorus 265mg (27% DV)
Manganese 0.6mg (30% DV)
Zinc 1.0mg (7% DV)

Touted superfood benefits which we will analyze one by one:

Weight loss: Chia seeds swell and form a gel when added to water. This effect may be filling and blunt the appetite. However there isn’t any research to back up claims of direct weight loss. It’s also worth noting that an ounce of seeds packs the same number of calories as a thick slice of bread, and a tablespoon of chia is worth 70 calories.

Reduction of cholesterol: Chia seeds contain fiber, fiber helps to reduce blood cholesterol levels. So, yes they are helpful to reduce cholesterol.

Control of blood sugar: again, it’s about the fiber. So, yes chia’s fiber slows absorption of sugar into the bloodstream during and after a meal.

It’s worth noting that chia is a complete protein and has an excellent omega-3 fatty acid profile (57% alpha linolenic).

My analysis finds that chia really isn’t extraordinary or a superfood. However it is a healthy, good quality food. It lends the same heart health benefits of many other seeds and legumes. Flax, chick peas, oatmeal, quinoa, black beans come to mind.

What you may want to do is a cost analysis. How much is a half pound of chia? You may be paying a premium for hype, Chia has been around for thousands of years and there is precious little research to back up any claims that it’s better than widely available healthy grains and legumes.

Quick comments on New Balance 650 “Pulse”

January 3rd, 2012

I was going through my 2011 shoe demos here at the end of the year when I found this pair of New Balance 650′s in the back of the training room closet.

I put around 45 miles on these and two 5K races around mid-summer, one of which was the Minnesota Heart Institute road race on the streets circling the Braemar Golf Course in Edina, MN.

What characterizes these shoes are a rather firm sole and little by the way of external foam or shock absorption. The outsole is attached directly to the shoe body with any shock absorption thus coming from the internal sole structure.

In use, the shoes are very firm with little shock absorption, not quite on the order of track flats/cleats but nearly so. Combined with the hard rubber outsole, they were quite noisy, too.

At the same time they are not outstandingly lightweight.

Around the 2 mile mark the shoes tended to build up internal friction and the sole became somewhat uncomfortably warm on most every run.

Overall these would be reasonably fair short distance racing shoes at moderate cost, but I would not recommend them.

New Balance 650 “Pulse” @ 40 miles:

20120103-214401.jpg

60 miles with Gel Nimbus 13

January 3rd, 2012

We are firmly into the winter/indoor running season and I’ve put 60 miles on a pair of Asics Gel Nimbus 13 over the last three weeks. This is 100% treadmill mileage and the results have been spectacular in terms of comfort.

Granted, a large component of indoor running comfort belongs to the treadmill platform itself, but the Gel Nimbus 13′s are excellent all the way around. Highly stable and all mileage thus far with zero hip, knee or foot pain. They have been comfortable on my ACL injury as well.

They run neutral with good forefoot landing comfort and a very comfortable stride. The laces have good bite, I’m running them a bit loose but they’ve not come undone during a run. Internal friction is mild with little heat build up and no foot numbness noticed at distances up to 6 miles.

Quite light for a training shoe. These aren’t ultralight or minimalist by any stretch, but for a serious mid distance training shoe, look no further.

Asics Gel Nimbus 13 @ 60 miles:

20120103-204307.jpg

Chronic Neck and Back Pain – a Case of Over “Self-Treatment”?

September 29th, 2011

Recently a 23-year-old female patient with no prior history of trauma or related medical conditions presented to the clinic with primary complaint of persistent neck pain and stiffness, headaches and upper-mid back pain, recurring over the last 3-4 years.  She was self-employed, and spent the majority of her day in front of a computer. 

 She had tried PT and massage which were ineffective.  She was working with her family MD on an ongoing basis, had been prescribed a low dose of Flexeril to be taken on the ‘bad’ days.  The MD had recommended an MRI scan of the neck, then referral to a chronic pain center.  However the patient has a large insurance deductible, so could not afford this route.

Examination revealed an otherwise healthy appearing young adult female of normal weight, but with very chronic-appearing, ropy, nodular muscle tissues palpated bilaterally from the upper neck down to the mid-back between the shoulder blades.  The tissues were particular rigid and tender along the lateral and posterior neck, yet the neck range of motion was entirely normal.  Misalignments of the spine were identified, particularly in the upper back, yet the bony segments of the neck were found to be somewhat hypermobile. 

Radiographs obtained from the MD were essentially normal.

Summary:  This patient’s situation is seen with uncommon frequency.  An otherwise young, healthy, non-traumatic patient, but with chronic pain and stiffness.  Further history revealed that the patient had an ‘addiction’ to frequently stretching and pulling on her head and neck to get the bones to ‘pop’.  In fact, the patient reported that as she sat in front of the computer working, it was not uncommon for her to pull on her head and neck every 5-10 minutes.

She was diagnosed with self-induced cervical strain/sprain.  In essence the patient gave herself a mild form of whiplash and was suffering from chonic inflammation and low grade spasm of the muscles, tendons and ligament.

I recommended that the patient immediately decrease the frequency of her self-treatments over time, with a goal of stopping entirely, by explaining that she was damaging her neck tissues by the repeated yanking on her neck.  I advised her that she will likely go through a withdrawal period, of sorts, during which her neck will be even more symptomatic.  To heal her injuries, we initiated her on electical muscle stimulation treatments, along with adjustments of the upper back to the segments that were misaligned.  I briefly considered placing her in a neck brace, but the patient declined.  She was given strengthing exercises.  The outcome of treatment is pending, and much depends upon her own compliance.

Saucony’s Kinvara 2 Running shoes

September 21st, 2011

The Kinvara 2, released in 2011 by Saucony, is best described as a semi-minimalist running shoe. If moving from a high-end standard shoe such as a Ride 4 or Gel Nimbus 13, the first thing you will notice is that the Kinvara 2′s are, by comparison, feather light. Second will be the low heel to toe ratio, which will move the foot strike toward the forefoot from the heel, which is generally a good thing to neutralize hip and knee gait related pain. Technically, it’s classified as a neutral shoe, for those with under/over pronation problems, keep that in mind.

The upper is entirely a screened mesh, extremely breathable. The screen mesh keeps rocks and sand out, but not dust/dirt. The sole is nearly 100% foam, without a continuous hardened rubber outsole. The fit is spot-on, the heel fits nicely in the cup, the inner sole is balanced, and the laces firm up the support comfortably.

They run “nice”. I’ve put 80 miles on this pair, give or take, maximum of 5 miles per outing. There is a decent foot strike, neutral handling, comfortable inners, good energy return on push-off, traction is perfectly adequate, and of course the weight, or lack thereof, should improve your mile times. It’s quite close to running barefoot, without the bruises and cuts. I suppose one could forget your are wearing shoes, they are that light.

As “nice” as they are, I’m not convinced this is the best everyday training shoe. Barefooters and minimalists will likely disagree, but the Kinvara’s minimal structure and weight may work against being an everyday running shoe for those with stuctural or injury issues. Right off, these are not highly durable, with a primarily foam sole, so with mileages above 20 per week, expect to replace these a lot more often. Secondly, heavier or taller folks, or those with joint injuries may not get enough impact absorption from the shoe.

I’m 175-lbs with a ‘bad’ (ACL) knee. The Kinvara 2′s are acceptable for training, although I did have a bit more anterior knee pain than usual; so there are better daily training shoes out there, such as the aforementioned Gel Nimbus 13, or Grid Raiders, etc. Where the Kinvara 2′s have found their niche for me are competition shoes. There is nothing like a featherweight shoe if you’re trying to trim seconds off your mile time.

Overall, the Kinvara 2′s are surprisingly stable, absorbtive, lightweight (~7 oz) minimalist shoes. They run really great on road, gravel and mixed surfaces, too. Go get your own pair!

Coming soon will be my thoughts on the Saucony Exodus 2.0 trail running shoes, and if there is enough time left in the outdoor running season we’ll analyze the outcome of Lisa’s experience with Asics Lady Gel Nimbus 13′s as it pertains to her moderate chondromalacia patellae (knee cap cartilage degeneration).

Saucily Kinvara 2 @ 80 miles (about 30 of that on gravel trails):

20120103-212236.jpg

Case of the Week – Severe low back degeneration

August 15th, 2011

55-year-old male patient presents with significant numbness of the outside of the left lower leg and foot, history of falls, mild lower back pain.  Surgical history notable for a disc surgery 20 years in the past, due to lower back and left leg pain. 

MRI and X-rays find severe degenerative arthritis and disc space loss at the two lowest levels in the patient’s lower back, as well as degenerative arthritis in the left knee. 

Physical examination is notable for a man who walks with a very pronounced hitch in his left leg gait.  Also notable for loss of sensation to pin prick and light touch over much of the lateral calf, the outside of the foot and the big toe.  Knee and ankle reflexes are both diminished.  Measurements of the left calf girth confirm loss of mass comparative to right (atrophy).

Referrals are made to neurology for further work-up.  In the meantime it is decided to embark upon a course of conservative care with the stated goal of potentially slowing the progression of the lumbar degenerative disc disease, the resulting atrophy and loss of sensation.

Six visits are scheduled with treatment measures including mild manual (doctor-assisted) traction, massage, mechanical chiropractic adjustments, along with instruction in exercises, diet and stretching.  The patient was advised to lose 10-15 pounds.

Current progress: Now into the third week of care, four visits, the patient has reported feeling intermittent pain in a formerly numb area of his left foot.  His left leg continues to feel week, but he has been able to ride an exercise cycle and is walking 3-4 blocks daily without falling.  These are positive signs. 

 The patient will consult with neurology as recommended, to see what they suggest, but in the meanwhile is gaining strength in his weak, atrophied leg, appearas to be maintaining his health, as well as showing a glimmer of restored sensation, even if it is ‘pain’.