Peripheral Arterial Disease Ironman Therapy – Training Resumes With Psoriasis

Yes! I’m crazy, but I’m getting back after several weeks of Moderna COVID-19 Vaccine-triggered, psoriasis hell. Methotrexate is helping somewhat, but will have to increase dose of this anti-cancer drug. They say we are our own worst enemies, so I guess this is right for psoriasis, as our immune system attacks our skin. Two images taken today and presented with the training week, lower on blog post, show lesions starting to desquamate (peel) as the drug slows down the t-cell attack. This made it hard to train, as you might imagine. The training problems were due to painful hands, perineum (butt, on the bike), and feet.

Why do I do it? Because I love the sport and to save my feet from amputation by keeping peripheral arterial disease at bay, which is related to my genetic hyperlipidemia, that I’ve successfully corrected with Ironman training.

Peripheral Arterial Disease Therapy
This is when my foot troubles began, during the run of the 2014 Eagleman Half Ironman race. I didn’t realize peripheral arterial disease (PAD) was the cause. I assumed it was an under-training issue. Wrong! Tight right calf came next.

Disclaimer: I’m not telling anyone what to do, I’m just saying what I do. Having a veterinary medical and pathology research background, combined with extensive body movement (Feldenkrais, Pilates, Yoga, Continuum, Gyrokinesis, Jeet Kune Do, blah blah blah) and athletics training from great coaches, I may have something useful to offer, who knows?

Overview of My Peripheral Arterial Disease Therapy: It seems that growing collaterals (new blood vessels) is the only safe and effective treatment for the partially blocked blood supply to my calves and feet (popliteal arteries), based on the advice of my remarkable endovascular surgeon, Mark Farber.

My strategy, in a nutshell:

  • Just walking is not enough, and the induction of pain is a critical aspect of the work. Good pain, not bad pain. It’s the pain that tells your body it needs better blood flow, and your body is a highly adaptive machine. It works like magic to keep you alive.
  • You have induce claudication to trigger the growth of collateral arteries, it would appear, which requires some pain tolerance.
  • It is critical to relax into the pain, as a tense muscle is less likely to perfuse well. Just think softness around the affected muscle, or think soft feet in my case, too.
  • Each person has to first work to return toward their “base training level,” be it walking around the block or ultra-marathons. For me it’s what I love, full Ironman (2.4-mile swim, 112-mile bike, 26.2-mile marathon – Yes! All in one day.)
  • Sign up for an event – I did, Ironman Florida, November, 2021 – or find some other way to keep your feet to the fire, and on fire is how my feet feel like sometimes on the run.
  • Develop a strategy to help grow collaterals, while avoiding injury – not always easy – I’m using the following approach, and you can see the countdown of my ongoing workouts for the 2021 Florida Ironman at the bottom of this post:
  • Build Base Conditioning For Your Particular Sport Or Desired Activity – In my case: Swim to average 7-10 miles/week, Bike to average 200-250 miles/week, Run to average 20-30 miles per week (note on skill and pace, below), combined with regular stretching and weight training. I use a 3-week rotation of workouts, hard week, harder week, easy week.
  • Skill and Pace-or-Effort training is tailored to need for each sport. For the swim and bike, no problem as PAD doesn’t affect them, except for tough hill-climbs on the bike, which is why I chose Florida, for it’s flat course.
  • If you feel disheartened, remember past successes, take that energy and move on. In fact, make great music with the strings left on your fiddle.
Peripheral Arterial Disease Therapy
Whenever I doubt myself as a runner, I say, “Hell, Kevin, you ran the Boston Marathon, so you’re a runner. Now you’re a runner with PAD. Enjoy!”
  • Run training strategy – this is the real challenge with PAD. A low-impact running style helps, but what you really need with PAD is a zero-impact approach – best of luck with that, but I’m working on it – My approach -> (1) water-running for conditioning, up to easy 1-hour run (harder than you might think without a float aid), DONE. (2) treadmill running up to one hour without having to stop for excessive claudication. DONE. What is excessive claudication, you may ask? It’s not about pain, that you can handle. It’s about loss of optimal function. As soon as your feet start slapping the ground, stop, let blood into your feet/calves (boy, does that hurt), and then resume running when the pain is about 90% gone. (3) the road, Oh Boy:

My psoriasis was fixed by methotrexate. It does make me tired, but otherwise has permitted my return to full training. I have noticed, being older that I need longer recovery times, making fitting in all the training a challenge. That said, Ironman is always a challenge, so suck it up, Morgan. As Chris Haute liked to say, “This is training camp, not complaining camp.”

Running Asphalt With Peripheral Arterial Disease, My Case: For starters, always avoid running on concrete, PAD or no PAD. It’s too vicious. I’ve discovered three critical issues, (1) the first mile is the worst mile, as it is always, except with PAD it’s an order of magnitude worse, (2) pace will slowly increase, plus pain and stopping times will decrease, the further you run, which I think is due to the need to open up those collaterals. Use them or lose them seems to be the order of the day, (3) never run when you feel impaired function, when you feel your feet slapping the ground. This will create an even larger reverse impact pressure wave up your leg, further impeding arterial blood flow.

The study of body movement optimization can help a lot, by the way.

Be patient, systematic, attentive and aware (NO EAR BUDS), and who knows what you might achieve. Whether I will finish the 2021 Florida Ironman in under 17 hours remains to be determined, but I sure plan to try. In 2011, I proved to myself that I could finish an Ironman race with an abdominal aortic aneurysm stent graft, which was satisfying. Now I have a tougher goal.

Isn’t that what makes life interesting?

The first chapter of my book, “How To Train For Aging,” starts with a description of my experience of running with PAD at the track a while ago. Furthermore, Ironman training has saved my life a number of times, in different ways.

Below you will find my weekly countdown workouts for the 2021 Florida Ironman, because if people might be watching that might further help me to overcome the drag of entropy.



SUNDAY: Bike 28, Walk 2.5

MONDAY: Methotrexate rest day, Walk 4.0

TUESDAY: Bike 35, Walk 2.0

WEDNESDAY: Swim 0.5, Run 3.5, Walk 3.0

THURSDAY: Swim 1.25, Bike 5, Run 4, Walk 2.0

FRIDAY: Bike 50, Walk 2.0

SATURDAY: Rest day, Walk 2.0

TOTALS: Swim 1.75, Bike 118, Run 7.5, Walk 17.5


SUNDAY: No mojo, Walk 2.5

MONDAY: Post-methotrexate sick day

TUESDAY: Mojo returns: Swim 1, Run 2, Walk 1

WEDNESDAY: High morning pulse, congested upper and lower airways, temp 97.6, O2sats 97, Damn, cleared up midday. Allergy? Run 5.0, Walk 1.0

THURSDAY: Swim 1.0, WR 1.0, Run 2.25, Walk 2.0

FRIDAY: Run 11.0, Walk 3.25

SATURDAY: Swim 1.25, Bike 18, Walk 4.0

TOTALS: Swim 3.25, Bike 18, Run 20.25, Walk 13.75


SUNDAY: Bike 9, Run 1, Walk 2

MONDAY: Swim 0.5, WR 1, Walk 5.0

TUESDAY: Run 4.5, Walk 3.0

WEDNESDAY: Swim 1.0, Bike 5.5, Run 3.0, Walk 1.0

THURSDAY: Bike 26, Moderna Vaccine Booster

FRIDAY: Fever 100+, Walk 2.0

SATURDAY: Mild fever 98, Swim 0.5, Bike 10, Run 1.5, Walk 2.5

TOTALS: Swim 2, Bike 50.5, Run 11, Walk 10.5


SUNDAY: Run 9 (17:13), Walk 2.0

MONDAY: Bike19, Walk 1.5

TUESDAY: Bike 19, Run 3.0, Walk 2.0

WEDNESDAY: Bike 29, Run , Walk 

THURSDAY: Light walks, stretching, fixing tight glut minimus.

FRIDAY: ibid


TOTALS: Swim , Bike 6, Run 12, Walk 5.5

WEEK 13 (Recovery week after long run)

SUNDAY: Long Run (8 miles: av pace 15.56: 15.57, 14.52, 15.34, 17.00, 16.04, 15.21, 16.24, 16.13 slowed by sore right vastus lateralis not by PAD.)

MONDAY: Swim 1.0, Bike 19, Walk 2.5

TUESDAY: Walk 4.0

WEDNESDAY: Walk 4.0 (fix sore quad)

THURSDAY: Swim 05, Bike 15, Run 3, Walk 1.5

FRIDAY: Walk 0.5 fixing tight glut minimus

SATURDAY: Walk 2.0

TOTALS: Swim 1.5, Bike 49, Run 11, Walk 15.5


SUNDAY: Swim 1.0, Bike/Run 18/7, Walk 3.0

MONDAY: Swim 1.5, Bike (52), Walk 1.5



THURSDAY: Swim 2, Bike 6, Run/Walk 1/4

FRIDAY: Bike 93, Walk 1.5

SATURDAY: Walk 2.5

TOTALS: Swim 4.5, Bike 169, Run 8, Walk 15

WEEK 15 (marathon training begins)

SUNDAY: Bike 51, Run 1.0, TM 3.0, Walk 4.5

MONDAY: Swim 1.25, Walk 2.0

TUESDAY: Swim 1.25, Walk 3.0

WEDNESDAY: Run 5 (15:50 pace), Walk 10

THURSDAY: Swim 1.5, Bike 15, Run (2), Walk 2.5(2.5)

FRIDAY: Swim (1.0, Bike 70, Walk 2.5


TOTALS: Swim 4.0, Bike 137, Run 11, Walk 28

RACE COUNTDOWN WEEK 16 (Units miles)

SUNDAY: Swim 1, Bike 51, Run 2, Walk 2 (3)

MONDAY: Bike 21, Run 3, Walk 6.0

TUESDAY: Bike 19, Walk 5(2)

WEDNESDAY: Swim 1.25, Bike 51, Run (4), Walk 2.5(4.5)

THURSDAY: Bike 17, Run 0.5, TM 1.5, Walk 3.5

FRIDAY: Swim 1.0, Bike 19, Run 1.0, Walk 4.0

SATURDAY: Swim 0.75, Bike 22, WR 1.0, Run 1.0, Walk 1.5

TOTALS: Swim 4.0, Bike 200, Run 12.5, Walk 22.5


SUNDAY: Bike 35, Run , Walk 0.5

MONDAY: Swim 0.5, WR 1.0, Walk 6.0

TUESDAY: Bike 51, Walk 1.0

WEDNESDAY: Run 0.5, Walk 3.0

THURSDAY: Swim 0.5, WR 1.0, Walk 4.0

FRIDAY: Swim 1.0, Walk 3.0

SATURDAY: Bike 27, Run 1.0, Walk 6.0

TOTALS: Swim 2.0, Bike 112, Run 3.5, Walk 23.5


SUNDAY: Walk 2.0

MONDAY: Swim 1.25, Bike 10, Run 2.0, TM 1.0, Walk 2.5

TUESDAY: Bike 19, Walk 3.0

WEDNESDAY: Run 0.5, TM 3.0, Walk 2.5

THURSDAY: Run 0.5, TM 4.5, Walk 3.0

FRIDAY: Bike 18, Walk 2.0

SATURDAY: Bike 34, TM 3.5, Walk 3.0

TOTALS: Swim 1.25, Bike 82, Run 14, Walk 16

WEEK 19 (Still fighting Moderna Vaccine-triggered psoriasis from hell)

SUNDAY: Bike 12, Run 1.0, Walk 4.0

MONDAY: TM 1.5, Walk 3.0

TUESDAY: Swim 0.5, WR 1.0, 


THURSDAY: Swim 1.0, Run 1.0, Walk 3.0, Weights/Stretch

FRIDAY: Bike , Run 2.5, TM 2.5, Walk 0.5

SATURDAY: Swim 0.5, Bike 6, Run 1.0, TM 0.5, WR 1.5, Walk 4.0, Weights/Stretch

TOTALS: Swim 2.0, Bike 18, Run 11.5, Walk 11.5


SUNDAY: – unable to train, skin lesions

MONDAY: – unable to train, skin lesions


WEDNESDAY: Clear improvement, much reduced pain in hands, headed for the pool: Swim 0.5, WR 1.0, Walk 4.0

THURSDAY: Swim 0.25, WR 1.0, Walk 2.0

FRIDAY: Run 1.0, walk 3.0

SATURDAY: Swim 0.5, WR 1.0, TM 1.0, Run 1.0, Walk 1.0

TOTALS: Swim 1.25, Bike 0, Run 6.0, Walk 7.0


SUNDAY: TOTAL rest day, not even stretching

MONDAY: Swim 0.5, Bike 27, Run 1.5(WR), 1, Walk 0.5

TUESDAY:  Bike 14, Run 3.0, Walk 

WEDNESDAY: DAMN, PSORIASIS WORSE, preventing bike and run, Swim 0.5, WR 1.0

THURSDAY: Walk 2.0


SATURDAY: – unable to train

TOTALS: Swim 0.5, Bike 41, Run 5.5, Walk 0.5


SUNDAY: Run 1, antibiotic nausea, Walk 4

MONDAY: Run 3.0, Walk 1.5

TUESDAY: Bike 19, Run 3

WEDNESDAY: Bike 60, Walk 1

THURSDAY: Swim 0.5, 1.5 WR, Run 2×3.0

FRIDAY: Bike 24, Walk 1.5

SATURDAY: Bike 34, Walk 1.5

TOTALS: Swim 0.5, Bike 136, Run 14.5, Walk 9.5

WEEK 23 (Run focus)

SUNDAY: Run 3, Walk 2

MONDAY: Strained right Vastus medialis, active recovery (Walk 1), + upper body weight training.

TUESDAY: Rest Vastus, stretch hips, Walk 4.5

WEDNESDAY: Swim 0.5, BR 11/1(A), Run 1(WR) 2(A), Walk 3.0

THURSDAY: Run 4.0, Walk 1.0

FRIDAY: Swim 1.0, Brick 32/2, Walk 1.5

SATURDAY: Bike 19, Walk 1.0

TOTALS: Swim 1.5, Bike 62, Run 13, Walk 13

WEEK 24 (General conditioning continues)

Units are in miles, and I started recording these workouts from week 29 pre-race day.

SUNDAY: Resting pulse high -> back off, rest.

MONDAY: Swim 1.25, Bike 51, Run 1.0, Walk 1.0

TUESDAY: Bike 11, Run 4.0, Walk 3.0

WEDNESDAY: Brick 1/51/1, Walk 1

THURSDAY: Walk 2.0

FRIDAY: Swim 1.25, Bike 35, Run , Walk 

SATURDAY: Swim 0.5, Walk 2.0

TOTALS: Swim 4.0, Bike 148, Run 6, Walk 12

WEEK 25 (Easy Week)

SUNDAY: Bike 42, Run 2.5, Walk 1.0

MONDAY: Swim 1, Run 1.5, Walk 5

TUESDAY: REST DAY, sports massage.

WEDNESDAY: REST DAY Swim 1, Walk 1.5

THURSDAY: Bike 41, Run 1.0, Walk 4.5

FRIDAY: Bike 17, Run 2, Walk 3

SATURDAY: Run 1.5, Walk 5

TOTALS: Swim 2, Bike 100, Run 8.5, Walk 20

WEEK 26 (Steady for distance)

SUNDAY: Brick 20/2, Walk 6

MONDAY: Bike 32, Run 2, Walk 6

TUESDAY: Bike 32, Run 2.5, Walk 3

WEDNESDAY: Swim 1.0, Walk 6.0

THURSDAY: Bike 15, Run 3.5, Walk 1.0

FRIDAY: Swim 1.0, Walk 1.5

SATURDAY: Bike 18, Run 3, Walk 4.0

TOTALS: Swim 2, Bike 117, Run 13, Walk 26.5

WEEK 27 (Active Recovery)

SUNDAY: Walk 3.0

MONDAY: Bike 34, Run 1.25, Walk 3.0

TUESDAY: Bike 15, Run 2.50, Walk 3.0

WEDNESDAY: Weight training, Walk 1.0

THURSDAY: Brick 21/1.5, Run 1.5, Walk 2.0

FRIDAY: legs need a rest day, tight psoas.

SATURDAY: Run 2.0, Walk 2.0

TOTALS: Bike 70, Run 8.75, Walk 17.0

WEEK 28 (First bike/run brick)

SUNDAY: Swim 0.5, Walk 6.5

MONDAY: Bike 40.00, Walk 5.5

TUESDAY: Swim 0.5, Bike 34.0, Walk 1.0


WEDNESDAY: (Recovery day), Walk 1.0

THURSDAY: Run 2.0, Walk 3.0

FRIDAY: Run 1.0, Brick 26/1, Walk 5.0

SATURDAY: (Recovery Day) Walk 4.0


Swim 1.0, Bike 100, Run 4.0, Walk 26

Count Down WEEK 29 (gentle conditioning)

SUNDAY: Bike 30.5, Walk 2.0

MONDAY: Swim 1.0, Bike 34.5, Walk 2.0

TUESDAY: Swim 1.0, Run 1.0, Walk 1.0

WEDNESDAY: Swim 0.5, Run 1.0, Walk 2.0

THURSDAY: Swim 1.0, Run 3.0, Walk 2.0

FRIDAY: Swim 0.5, Bike 14, Run 1.0, Walk 3.0

SATURDAY: Swim 1.0, Bike 21, Walk 2.0


Swim 5.0, Bike 100, Run 6.0, Walk 14

peripheral arterial disease therapy
Grey is muscle, white is fat, clear ring around the central white spot (bone marrow) is the femoral bone.

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.