Tuesday, June 27, 2006

thrillhouse's gym guide

Ars

A Brief Guide to Weight Lifting

A lot of people on Ars have asked me for advice on working out or particular lifting methods. I thought I’d finally get around to whipping up a bit of a guide.

Who is this for? This guide is for anyone from beginners to experienced fitness geeks. I’ve left out a lot of really advanced techniques, as they can be dangerous if not performed correctly, but I’d be happy to field any specific questions you may have.

I’ve also tried to include some exercises that require no gym or special equipment. I know actually going to a gym can be an intimidating experience or it can be expensive, so I want to offer up some things you can do in the privacy of you home. Eventually, you’ll probably work to a point where you’re comfortable in a gym and/or you want to use some of the equipment they offer.

I know this is long, but there’s a LOT to say about working out and general fitness. You’ll note that I don’t touch on specific cardio techniques or eating habits. There is a ton of advice in The Ars Weight Loss Challenge or Chugg’s thread…lots and lots of good stuff, so no need to repeat it here. You don’t need to read the whole Weight Loss Challenge, just skim a few pages and jump right in. There are lots and lots of experienced fitness geeks just waiting to answer your questions.

Also, I’ve described a lot of exercises here. I’m not a professional writer, so the description may be a bit off. Crossfit.com has videos of each of these movements, so if you have any difficulty understanding my descriptions, go there for help.


DISCLAIMER
The advice provided in this post is to be used at your own risk. I am not a doctor. I am not a registered ISSA personal trainer. I am a gym rat who has been lifting weights and playing sports for over 20 years, and have done some amateur personal training with great success. You should consult with your doctor before beginning an exercise routine for the first time.

SOME NOTES AND GENERAL TIPS

While I recommend beginners—true newbies—start out on machines (more on this later), eventually, you’ll progress to free weights. When you do, I recommend starting out with barbells for most lifts. The movement and load of free weights has a very different feel than machines. Dumbbells have a very different feel than barbells. Using dumbbells requires your stabilizer muscles to come into play, and machines minimize the impact weight lifting has on those muscles. A barbell allows your body to compensate for slight strength imbalances. Eventually, your skill will improve to allow you to incorporate and/or substitute dumbbells to help bust through plateaus and provide some variety in your workout.

  • Grip the bar tightly, almost squeezing it. This will increase your strength in the movement, and ensure that the weight doesn’t get away from you. The tensioning principle will also keep your stabilizers in play.

  • Most “Personal Trainers” are, quite frankly, either idiots or are simply not qualified to give you advice on how to carry your groceries, much less lift heavy weights. They’ll tell you they’re “certified” meaning that the gym they work at had them sit through a PowerPoint presentation for two hours one day…or the took a multiple choice test. If your gym foists one of them onto you, then remember that they work for you. Make them help you determine the heights and starting weights on machines or free weights. A general rule of thumb: sit where your body feels natural. Do not let them anywhere near a freaking exercise ball.

    I know this sounds harsh, but it’s not. If you think I’m overstating my case, go pick up a “Men’s Workout” magazine, where they have models doing really stupid exercises that are more dangerous than beneficial (such as overhead presses on an exercise ball)…then go to the gym and see how many “personal trainers” are making their clients do exactly the same thing.

    If you feel the need for a real Personal Trainer—and a qualified PT can make a world of difference—find one with a degree and an ISSA certification. Look for experience. Expect to pay a fair amount of money, but demand results. A quick rule of thumb…if they try to make you do an exercise that makes you feel silly, then it’s a gimmick, and they’re a quack.

  • Listen to your body! A dull ache in your muscles after you work out is fine…a sharp pain means don’t do that! Your body has certain limited ranges of motion. Any exercise that doesn’t follow those ranges naturally is dangerous. Your movements (the path the weight travels through the air) should almost always be directly away from gravity. Your body should typically be situated parallel or perpendicular to the floor. When doing presses, your upper arms should not go much past parallel; same for your thighs when doing squats.

  • Gym Etiquette: Always return your weights to the rack. Never bang your weights together at the top of a movement or let them fall to the floor at the end. You don’t look like some tough guy who just finished a powerful set…you look like a dork who’s trying to push more weight than he can handle. Do not wear tight clothing to the gym. No makeup. Guidos, lose the chains & jewelry. Be functional. Don’t wear dirty clothes to the gym. A towel should last one workout…two tops—then wash it (it’ll be loaded with bacteria anyway). Wipe down your equipment when you finish using it (even if it doesn’t look sweaty…it’s just polite). Never, ever walk between someone who is looking in the mirror while they’re doing their set—they’re using the mirror to watch their form. Be considerate of people. Don’t bob your head along with the tunes on your iPod…you’ll look like a dork. No grunting. No ogling the hotties, fellas. Feel free to look, but be discreet. Wink (That goes for you women of Ars, too!)

  • During your workout, work larger muscle groups first. There are several reasons to do so: you’ll work larger muscle groups (meaning you’ll be lifting heavier weights) when you have the most energy. Smaller muscle groups act as stabilizers during larger lifts, so pre-exhausting them by working them first means less overall strength on the more important (and dangerous) moves.

  • A word on hand placement. Many people are proponents of a “wide” grip, meaning that your hands grip the bar outside of your shoulder width. I personally find this to be an uncomfortable position, and advise that you find a grip you’re comfortable with. An easy way to find this is to take a barbell with no weights, lie on a bench and do a few reps with varying grips.

  • Use a Spotter on heavier lifts. Just ask some guy working out next to you for a spot. He’ll help you out. Always be ready to give a spot in return. When you spot someone, tell them ahead of time how you’ll spot them. For example, I always tell someone, “I’m not going to touch the weight unless you stop moving it.” That way, they know what to expect from a spot. Ask if they want a “lift out”, meaning you help them lift the weight out of the rack. When you do spot them, and the person can no longer move the weight by themselves, don’t just grab it and rack it. Use the minimum force possible to get the weight moving again…I usually just “finger” it up for them. A little force goes a long way on a spot, as they’re just trying to get the weight past a sticking point. However, be prepared to grab it and pull it up if they give out completely.

  • You’ll see a lot of people using straps, weight belts, and gloves. I recommend none of these. Both can be used to increase the amount you’re able to lift by stabilizing your core in the case of weight belts or minimizing a weak grip strength (straps & gloves).

    Grip strength is of critical importance; if you rely on straps, you’ll never get strong enough to perform the more important lifts. I spent years with straps before I lost the set I had when I moved. A few weeks without them, and I realized that my grip strength was terrible. I was barely strong enough to do a few pull-ups without them. I haven’t used them since, and my grip strength has grown in leaps and bounds. Gloves can be used to improve your “grip” by increasing the friction between your hand and the bar. I prefer the feel of the bar in my hand, unencumbered by the padding of gloves. YMMV, of course.

    My issue with Weight Belts is pretty simple. A lot of people use them for squats, thinking that it improves their squat lifting power—and it does, to an extent. It also neutralizes one of the greatest benefits of the squat; namely that it works the core muscles in addition to your quads, hams, and glutes. Build your core if you want a strong core. If you’ve had a hernia or lower back problems, then let your doctor advise you on whether or not to use a weight belt.


DEFINITIONS

  • Free Weight: Exercise consisting of a weight that is held. Range of motion is uncontrolled, other than by exerciser’s own muscles. Examples: Bench Press using Olympic bar & weight plates, Dumbbell Lunges.

  • Machine: Self contained workout unit; typically consists of a stack of weights and uses either a pin placed in the weight stack to determine the amount of resistance OR has holders for weight plates. Usually has pre-determined seating and pads in place to constrain movement to a certain range of motion. Examples: Nautilus machine, most machines found in “weight rooms” at apartment complexes and hotels.

  • Olympic Bar: Standard 7’ bar found in most gyms. Weighs 45 lbs (approximately). Found near benches & squat racks. Don’t forget to add the weight of the bar when calculating how much you’re lifting!

  • Dumbbell: Typically a fused, fixed weight unit (although several companies offer adjustable weight dumbbells) consisting of a handle at either end of which sits a weight.

  • Barbell: Long Bar with ends designed to hold weight plates. Examples include the Olympic bar and curl bar (straight bar with angled handles designed to make curls easier on the forearms).

  • Squat Rack: Parallel racks, usually bolted to the wall, with a slat running upward at an angle and notches to hold barbells.

  • Training Split: Refers to how you divide your training regimen; common training splits include Upper/Lower (in which your upper body is worked one day and your lower another), and Pushes/Pulls (Pushes—exercises where the weight is being pushed away from your body—performed one day, Pulls—exercises where the weight is being pulled toward your body the next). Some people prefer to isolate body parts, working one body part each time they go to the gym.

  • Repetition (rep): The movement of a weight from starting position to load and back to starting position.

  • Set: Group of repetitions.

  • Plateau: Point in training where no more gains are made. Plateaus can occur in weight lifting (I can only bench X amount of weight), aerobic activity (I can only run a mile so fast) or in weight loss/gain (I can only lose X pounds; I can only gain X pounds).

  • Core: Muscles of the trunk or torso; group of muscles from your crotch to your solar plexus. These muscles are responsible for stabilizing the body.


TRAINING SPLITS, FREQUENCY & RECOVERY

Throughout my weight training & athletic career, I’ve used more training splits and varied the frequency in more combinations than I can count. The best advice I can give is this: Find what works for your body and stick with it…for a while. The human body is highly adaptive, and you will find that it adjusts quite well to the stresses of exercise. As an experienced exercise wonk, I find that after about 4-6 weeks on a new program, my body simply no longer responds.

When this adaptation occurs, you have hit a plateau—it seems like no matter what you do you cannot make any progress. To work through a plateau, the best thing I’ve found is to completely shake things up in the gym. Do cardio first. Do cardio last. Take some time off. Take up a sport. Just do something new. My personal favorite plateau buster is to try a new split.

Training splits are as varied as the people who do them. I think I’ve done most of them at one time or another, and my personal favorite is a two-day upper/lower split, performed twice weekly. This means that I’ll do upper body on Tuesday, lower body on Wednesday, then upper body on Saturday, and lower body again on Sunday. It’s a fairly intense cycle, but it keeps me out of the gym during insanely busy times (Monday evening) and puts me in the gym when I have more time—the weekend. It works for me, but by all means, experiment and find out what works for you.

Many people recommend a full body workout. This is a great concept for someone who can only make it to the gym three days per week….but then only if they are religious about going. The problem with the three day/week routine is that you cannot easily miss a day, as the routine can’t be performed on consecutive days. I prefer a bit more flexibility in my workout schedule; if I can’t go on Tuesday, then I can push my workout back a day and do upper body on Wednesday, lower on Thursday, and still have plenty of time to recover before the weekend.

Now, a word about frequency and recovery. I am a very experienced gym rat, and I am blessed with a easy gainer’s body—meaning I make fast gains and recover very quickly. I highly recommend that when you’re starting out to not work out if you’re still sore from your previous workout. Muscle soreness is not a bad thing—in fact, it means you did something right. You broke down your muscle, and your body will rebuild it with longer, thicker muscle fibers. Yay! However, that soreness in your muscles means that your muscles have not yet recovered. Give them time. Contrary to what average guy may think, muscle growth does not happen in the gym. Yes, you may get pumped after a great set, but your muscles have not grown one micrometer. Growth occurs during rest, typically at night while your sleeping, and your body is repairing itself. This is why people “split” their workouts to begin with. Tear down a group, then work on something else while the first group repairs itself. As you become more experienced, you’ll learn to listen to what your body is telling you. Typically, I’d recommend at least 48 hours of recovery for a muscle group before you hit it again.

In any event, you’ll need to find a routine that allows you to balance your time in the gym with the rest of the demands in your life. Only have 30 minutes a day at lunch? You’d be a good candidate for a 5-day split working each body part once per week. Or perhaps you’d prefer the 3-day, full body workout; there is no right or wrong, just experiment and find what works for you.

That said, the remainder of this post will focus on a 2-day split. You can perform it once per week, if you’re time limited or if your body doesn’t recover quickly enough.


EXERCISES
Now, on to the fun stuff. I’ve grouped these exercises by body part. They can be performed with barbells or dumbbells, whatever is more convenient and/or comfortable for you. The percentages listed in the muscles worked area are not based on anything other than gut feeling. I have applied no science to this and it is merely to show you the different emphasis that a particular movement has. These should be interpreted like this: an incline bench press puts more stress on the front deltoids than a flat bench press. Nothing more, so don’t get too caught up on the numbers.

Also, you’ll notice that I’m a bit Old School when it comes to my workout recommendations. They generally involve multi-joint, compound exercises that work large muscle groups. I recommend very little to no isolation movement once your move past machine work. The goal here is to build strength and gain some size, and doing preacher curls with 10 lb. weights won’t cut it. You want the big lifts…your smaller muscle groups will be worked indirectly. There are thousands of exercises out there, and if you have questions on others not listed here, just ask. I’ll be happy to chat about them.

Chest

  • Bench Press
    Muscles worked: Pectorals (primary-75%), front deltoids (secondary-10%), triceps (secondary-15%)

    Movement: Lying on a flat bench, begin by lifting the bar out of the rack. It should be above your body, generally in the line with your nipples. Lower the weight to your chest slowly. Touch the bar to your chest lightly—DO NOT BOUNCE THE WEIGHT, and push the weight back up to it’s starting position. That’s one rep.

    Notes: Your feet should be flat on the floor and roughly shoulder-width or greater apart, whatever is comfortable. You will see people with their feet on the bench, do not imitate this. Your lower back will have a tendency to come up off the bench; keep your lower back ON the bench, flat. It is important that the weight be aligned properly above your chest. Aiming to keep the line of the barbell either directly above your nipples or slightly closer to your face will prevent you from dropping the weight on your solar plexus or pinning yourself to the bench at your throat, and will ensure that your pectorals receive the load.

    This exercise should be a staple in anyone’s workout. It is a multi-joint, compound exercise, meaning it incorporates several large groups of muscles, burning a lot of calories. No chest workout is complete without a bench press.

    This tends to be the Money Exercise for most guys. I’m telling you right now, every guy who lifts weights over time will let his ego get the best of him. He’ll load the bar up with too much weight and get stuck with 300 lbs on his chest. This has happened to me. More than once. Even worse, it happened to me in a gym at 5AM and I was the only person there. I had collars on the bar, so I couldn’t tilt the plates off, I had to roll the damn thing down my torso. It is VERY embarrassing, to say nothing of dangerous and painful. FIGHT YOUR EGO. Eight reps with perfect form at 200 lbs is FAR better and safer than four reps with bad form at 250. You’ll get there, just give it time.

  • Incline Bench Press
    Muscles worked: Pectorals (primary-70%), front deltoids (secondary-20%), triceps (secondary-10%)

    Movement: The bench should be set up to provide anywhere from a 35° to a 50° angle. You will be sitting up, at an angle from the floor. The movement of the weight is the same—namely, opposite gravity. Sitting on the incline bench, begin by lifting the bar out of the rack. It should be over your body, generally in the line slightly above your nipples (i.e., closer to your head than your abs). Lower the weight to your chest slowly. Touch the bar to your chest lightly—DO NOT BOUNCE THE WEIGHT, and push the weight back up to it’s starting position. That’s one rep.

    Notes: Your feet should be flat on the floor and roughly shoulder-width or greater apart, whatever is comfortable. I prefer to perform this exercise with dumbbells on a stand alone adjustable bench, as they provide a greater range of motion. If you do perform this with dumbbells, here’s a safe way to get the weight into starting position (shoulder high): Sitting on the incline bench, place the dumbbells on your knees. When you’re ready to begin the set, lean back (placing your back on the bench), and “kick up” your knees to help lift the weight up to shoulder height. Do one at a time. When you finish the set, raise your knees slightly and let the weight come down gently back to rest on them. Do NOT drop the weight on your knees or on the floor.

  • Dips
    Muscles Worked: Pectorals (primary-50%), front deltoids (secondary-20%), triceps (secondary-30%)

    Movement: On a dip machine (or any machine with two parallel handles), grip the handles, with your arms straight, supporting your weight. Bend your elbows, allowing your upper body to move towards the ground. Push back to starting position. That’s one rep.

    Notes: Are Dips a chest exercise? A triceps exercise? Short answer: both. A lot of people feel that if you lean your chest forward during the movement, you’ll focus on the lower range of your pectorals…OK. I have little opinion on it, as you can trout out a study showing that it’s primarily a triceps routine and that it does little for the chest…whatever. What I can assure you is that the dip is a great upper-body exercise, hitting your pecs, shoulders, and triceps.

    This movement can be hard on your deltoids, so be careful. If you cannot perform these, find a Dip Machine at your gym…they’re counterbalanced, so it lessens the weight you’re actually lifting, and you can work up to dips.

  • Decline Bench Press
    If you guys really want to know about this one, say so. I don’t really recommend it for beginners or even experienced guys. There are better ways to spend your time in the gym, IMO (like Dips!).

  • No Equipment Alternative: The push up
    We all know how to do push ups. They’re a fantastic way to build upper body strength, and there are endless ways to perform them…feet elevated, head elevated, wearing a weighted backpack, you name it. Essentially they are performed with your feet together, back straight, supporting your weight on your flat hands. Lower your chest to the floor, touching it lightly, then back up. That’s one rep. Do not bounce.

    Push ups are great for business travelers. I’ll often just take a backpack, throw a phone book or two in it, strap it on and do pushups till I can’t move.


Shoulders
  • Overhead Press (or Military Press)
    Muscles worked: Deltoids (primary-90%), triceps (secondary-10%)

    Movement: The starting position will find you sitting upright (on a fixed angle bench, or an adjustable set vertically—or slightly less than vertical), with the weights resting at shoulder height. Press the weights vertically above your head, then lower to starting position. That’s one rep.

    Notes: These can be performed with a special bench using a regular barbell with weights or dumbbells. I prefer dumbbells for their greater range of motion and easier setup.

    These should be a staple in anyone’s shoulder routine. It hits all three deltoid heads (front, side, and rear), and is a great overall shoulder developer.

  • Shrugs
    Muscles worked: Trapezoids (primary-98%), stabilizers (secondary-2%)

    Movement: Standing, grip the weight (dumbbells or barbells) with your hands hanging naturally at your sides (dumbbells), or slightly to the front (barbell). Contract your traps (make a shrugging motion) so that your deltoids move up towards your ears; lower the weight to starting position. That’s one rep.

    Notes: Do not roll your shoulders to the front or back. You’ll see many gym rats using straps, rolling their shoulders or using ridiculous weights and grunting. Don’t be that guy. Use good form and a weight you can grip unassisted. Don’t swing or sway your body or cheat with your legs to get the weight up—make sure your feet stay flat. Be very cautious when performing this exercise; it’s easy to use too much weight and pull your upper back or neck.

  • Dumbbell Raises (side or front)
    Muscles worked: Deltoids (primary, 85%, side or front depending on the movement), Trapezoids (secondary, 15%)

    Movement: (Side) Standing, holding the weight naturally where your hands fall, lift the weight out to your sides; lower to starting position. That’s one rep. At the top of the lift, your palms should be facing the floor. Don’t raise the weight much beyond shoulder height, as past that point, other muscles than your deltoids are working. (front) Same as side, except that the weight starts in front of your legs and lifts straight out in front of you.

    Notes: There are dozens of variations on this lift. You’ll see people doing them leaning on an incline bench backwards, or doing them bent over at the waist (trying to isolate their rear deltoids). Frankly, I think dumbbell raises as a whole are pretty much a waste of time, unless you’re desperately trying to etch details into your already-developed deltoids. Most people perform them incorrectly, rocking on their feet, leaning back or forwards, trying to use too heavy a weight, or using such a light weight that all they’re really doing is grinding their shoulder joints.

    If you still have energy for this lift after doing overhead presses, then either add more weight to your presses or add another set.

  • No equipment alternative: Shoulders are tricky to work with a body-weight only exercise, but It’s easy to improvise. Just lift something over your head. Take a jug filled with sand or a heavy book, and use it just like you would a dumbbell.



Back
  • Pull Ups
    Muscles Worked: Latissimus Dorsi (Lats) (Primary-75%), Biceps (Secondary-15%), Stabilizers, Upper back (Secondary-10%)

    Movement: Holding yourself up on the pull up bar, hands slightly wider than shoulder width, palms facing away from you. Contract your back, pulling yourself up. When your chin reaches the level of the bar, slowly lower yourself to starting position. That’s one rep.

    Notes: These are very hard to perform, and most people hate them. They are also wonderful multi-joint compound exercises that are awesome for back development. When you’re learning how to do these, you probably won’t be able to do very many. That’s OK. Pick a number, and do as many sets as it take to get there. Say you want to do five, but can only do two. Do two, rest, and then do another. Repeat until you hit your target. If you can’t do any, you can substitute Pull Downs (see below) until you’re strong enough, but I highly recommend training for these. Hate me now, thank me later. Wink Also, do not muck with the direction your palms are facing—you’ll work radically different muscles. Doing pull-ups with your hands facing you is called a “chin-up”. Also, some people will do them on parallel handles with their hands facing in toward the center of the body. Both of these exercises place a much greater emphasis on the biceps and are nowhere near as good at working the back.

  • Pull Downs (machine)
    Muscles Worked: Latissimus Dorsi (Lats) (Primary-65%), Biceps (Secondary-25%), Stabilizers, Upper back (Secondary-10%)

    Movement: Sitting in a pull down machine, there will be a bar hanging above you and a weight stack in front of you. Sit facing the machine (not out away from it), place your knees under the pads, and grip the bar slightly wider than shoulder width. The bar will probably have an angled grip on either end…I find that a bit wider than I like, but if it’s comfortable, go for it. Contract your lats, pulling the bar towards your chest. Return to starting position. That’s one rep.

    Notes: This is probably the second best back developer, even though it’s machine based. Keep your torso vertical as much as possible. You’ll see guys leaning back almost parallel to the ground…this is because they’re using too much weight. Don’t be that guy.

    Oh, also, adjust the seat so that when the weight is in it’s starting position, it’s slightly suspended above the rest of the weight stack. This will keep the muscles tensed, and prevent the weight stack from banging and making a racket.

  • Rows (Seated, Bent-Over)
    Muscles Worked: Latissimus Dorsi (Lats) (Primary-65%), Biceps (Secondary-15%), Stabilizers, lower/upper back (Secondary-20%)

    Movement: (Seated, performed on a machine) Sitting on the bench, the bar or handles will be out in front of you. Gripping the bar with your palms facing down, contract your lats and pull the bar or handles towards your chest. If the bar or handles can touch your chest, then great; if not, just pull them as far as your natural movement will allow. Slowly return the weight to it’s starting position. That’s one rep.

    (Bent-Over Row) Starting position is standing, bent over at the waist, with your arms hanging naturally towards the floor gripping the weight. Contract your lats, raising the weight up towards your chest; lift as high as is comfortable. Return the weight to start; that’s one rep.

    Notes: You will often see people perform the Bent-Over Row with dumbbells, leaning over a bench with one knee and hand up on the bench and the weight hanging straight down. This is the proper form when done with dumbbells. You can also do this with barbells. Either is fine…find whatever’s most comfortable for you movement wise. Do not sway your back. Do not swing the weight up. You should be lifting it opposite of gravity.
    Important: It is very easy to injure your lower back with this exercise by using too much weight or improper form. Be very careful, start with very light weights until you’re sure you have the movement down pat.

  • No equipment alternative: Find a tree. Do pull ups from low hanging limb. Almost any object can be used for rows.


Biceps
General Advice & Caveats: Biceps are a tricky one. Again, this is a Money Exercise for most guys, because they want big guns. OK, I can help you there. One thing to remember though: biceps (and triceps) already get a LOT of work from doing pulling movements and pressing movements, respectively. If you want big arms, you’re much better off focusing on heavy lifting in your major lifts (bench press, pull ups, pull downs, or rows); your arms will be forced to grow. I’m not recommending ignoring them completely, but you’ll see people devoting hours to arm training, and frankly, I think that’s a huge waste of time. Why spend so much time on a muscle the size of a grapefruit (if you’re lucky)? Lift big, throw in some heavy incline curls, and I guarantee you your arms will take care of themselves.


  • Seated Incline Dumbbell Curls
    Muscles Worked: Biceps (Primary-98%), Stabilizers (Secondary-2%)

    Movement: Seated in an incline bench, start with your arms holding the weight hanging naturally down on either side of you. Curl the weight upwards, toward you shoulders. Do not swing the weight. Lower the weight slowly. That’s one rep. Alternate reps between arms (right then left or vice versa, but one at a time).

    Notes: I recommend Seated Incline Curls over other curls due to their greater range of motion. If you want to be strict about it, turn your hands so that your palms face somewhat forward. This will help keep the bicep a bit tense, and should help eliminate rocking to get the weight up. Don’t lean to one side or the other when performing a rep.

  • Standing Barbell (or Dumbbell) Curls
    Muscles Worked: Biceps (Primary-90%), Stabilizers (Secondary-10%)

    Movement: Standing, holding the weight so that your palms face forward, curl the weight toward your body. Return to start slowly. That’s one rep. With dumbbells, you may alternate hands or perform them both together.

    Notes: Keep your torso straight throughout the movement. A lot of people will preach “cheat reps” on these, but I don’t recommend them for less experienced weight lifters.

  • No Equipment Alternative
    Pull ups! Chin Ups! Fill a jug with sand. Lift your kid. Curl a bag of mulch. The sky’s the limit.

    There are a million ways to work your biceps, but I’m only going to cover these here. If you have questions about others, or are looking for more variety, I’d be happy to give some pointers.


Triceps
General Advice & Caveats: See above. Again, guys devote tons of time to training a tiny muscle that gets tons of stimulation from other exercises. Fine to work them, but I wouldn’t spend too much time. I’m only going to cover push downs here, as IMO they’re about the best exercise for triceps available. You’ll see a lot of guys doing the one-dumbbell-over-the-head press, but those can be dangerous, and for even experienced lifters, it’s hard to get enough weight in place to overload your muscles. Kickbacks (bending over a bench and extending your triceps behind you holding a weight) are a good option too, but they’ve fallen out of vogue.

  • Push Down (Press Down)
    Muscles Worked: Triceps (Primary-95%), Stabilizers (Secondary-5%)

    Movement: Stand so that you have a weight stack & handle setup facing you. Grip the handles, bending slightly at the waist. Pull the weight down to where it’s pretty much in front of your face, and the weight stack is suspended in the air. Now, keeping your elbows at your side, press the weight down towards the floor. Return slowly to starting position, keeping your elbows close to your sides. That’s one rep.

    Notes: I tend to go heavy when I work my triceps, but using the strictest possible form. You’ll see people do these with ropes, flaring their wrists out at the bottom of the movement, but they almost always go to far…this actually reduces the load on your triceps. Rather, keep your hands in pretty much the same angle from start to finish, and you’ll keep the stress where it belongs.


Quadriceps
  • Squats
    Muscles Worked: Quadriceps (front of legs), Gluteus Maximus (rear end), Hamstrings (back of legs), Stabilizers

    General Advice & Caveats: Squats are one of the best overall muscle developing exercises there is, if not the best. They work your entire lower body and your trunk. They will strengthen your core, improve your balance, and are calorie intensive. They are the number one exercise to perform for legs, assuming you’re medically fit. If I had to pick only one exercise for lower body, this would be it. They can be performed without weights, dumbbells, or barbells.

    Movement: Load a squat rack with a barbell and weights at a height roughly around your upper chest/neck. Facing the squat rack, step under the bar so that the bar rests across the back of your shoulders—not your neck! Place your hands slightly wider than shoulder width on the bar. Now, stand up, taking the barbell with you resting across your shoulders. Back up slowly to where the horizontal bars are under you. This is the starting position. Now, squat down so that your rear end lowers toward the ground. Don’t let your thighs go much past parallel to the ground. Stand back up to your starting position. That’s one rep. To rack the weight at the end of your set, simply walk forward and place the barbell back in one of the notches.

    Notes: Squats can be very dangerous, so be careful. Don’t let your knees go much past your toes. I’ve found that it helps to imagine that I’m pushing all the weight through my heels; this keeps me from letting the weight come too far forward. I would also recommend that beginners use collars to keep the plates in place, as this can be an awkward movement to get used to.

  • Leg Extensions (Machine)
    Muscles Worked: Quadriceps (front of legs)

    Movement: Sit in a leg extension machine so that the backs of your knees rest on the edge of the seat and your feet hook around the pads. Bring your feet up; return to resting position. That’s one rep.

    Notes: I really hate this exercise, but enough people do it, so it bears mentioning. Theoretically, it is supposed to isolate the quads, but I find that it just hurts my knees by making them the rotation of the weight bearing unit rather than a larger joint like the hip. To each his own, I suppose, but I think there are much better ways to spend you time working your legs.

  • Hack Squat
    Muscles Worked: Quadriceps (front of legs), Gluteus Maximus (rear end), Hamstrings (back of legs), Stabilizers

    Movement: The hack squat is basically a squat performed seated. Find the hack squat machine and add weights. Sit in it, placing your feet up on the metal pad in front of you. It’s kind of like getting ready to give birth. Wink Brace the weight by straightening your legs out, then turn the safety knobs out. Squat by allowing the weight to come toward your chest, then pushing it back to the starting position. That’s one rep.

    Notes: If you can’t comfortably perform a regular squat, this is my second most recommended exercise. It incorporates most of the same muscles as the squat, but is generally safer to perform. Given that it’s a machine based exercise, it won’t help strengthen your stabilizers the same way a free weight squat will, but it’s still a fantastic exercise.

  • Lunges
    Muscles Worked: Quadriceps, Gluteus Maximus, Hamstrings, Stabilizers

    Movement: Standing normally, step forward with one leg. Bend that leg so that your trailing leg’s knee drops toward the ground; straighten back up and return to stand. Perform same exercise, but switch legs. That’s one rep.

    Notes: I’ve included lunges in the “Quads” portion of the guide, but it is really a total lower-body exercise.

    This exercise can be done with or without weights. You can use a squat rack to place a barbell (with light weight) across your shoulders, then perform the lunge. You can simply hold two dumbbells and perform the lunge.

    You’ll see a lot of people (mostly women) doing “Walking Lunges” where they hold dumbbells and some Personal Trainer has them doing lunges across the gym. Guys, NEVER do walking lunges. I’m sorry to be a bit sexist here, but there are certain exercise guys should just never do (see also: adduct/abduct machines). :razz:

  • Deadlifts
    Muscles Worked: Quadriceps, Gluteus Maximus, Hamstrings, Stabilizers (especially lower back)

    Movement: With Deadlifts, the weight begins on the floor. Squat down, gripping the bar in front of you. Now stand up, keeping your back straight. Squat down, return the weight to starting position. That’s one rep.

    Notes: I’ve included Deadlifts in the “Quads” portion of the guide, but it is really a total lower-body exercise. It takes some practice to get right. I highly recommend watching some of the videos or slide show at Crossfit.com for the proper movement.

    Your head should be up and facing forward the whole time. Your back should stay straight throughout the movement. Remember, you’re lifting with your legs here, not your back.

Hamstrings

  • Stiff-legged Deadlifts
    Muscles Worked: Hamstrings (back of legs), Gluteus Maximus, lower back.

    General Advice & Caveats: Stiff-legged Deadlifts are another great multi-joint compound exercise. They can be performed with dumbbells or barbells (or anything really). This movement can be tricky, but when performed correctly is one of the best ways to build your Hamstrings.

    Movement: Holding the weight naturally in front of you, bend over slightly, bending your knees slightly. This is your starting position. Lower the weight almost to the floor, bending at your waist. Stand up again to starting position—that’s one rep.

    Notes: Keep your back straight and your head facing front. If you round your back, you’re shifting the emphasis of this movement from your hamstrings to your lower back. The best way to prevent that is to do this movement in front of a mirror and keep you head facing forward, watching yourself the whole way. Also, the weight does NOT need to touch the floor, but it’s OK if it does. How far down the weight goes will depend on your flexibility and the size of the plate you’re using. You’ll know that you’re performing the exercise correctly when you feel the stretch in your hamstrings.

  • Leg Curls (Machine)
    Muscles Worked: Hamstrings (back of legs)

    Movement: Situate yourself in the Leg Curl Machine so that your knees rest just off the pad and your ankles are under the pads on the back of the machine. Curl your ankles toward your rear end, then lower the weight back to starting position. That’s one rep.

    Notes: I share a personal dislike with this exercise, akin to my dislike for Leg Extensions. It makes the knees the rotation joint, isolates a large muscle group, and ignores your stabilizer muscles. I mention it because I see a lot of people doing them. If you like them and get results, then great…I just think there are better alternatives.


Calves
Muscles Worked: Calves (back of lower legs)

Movement: No matter what machine or method you use to work calves (and there are tons), the basic movement is the same. Place the balls of your feet on the edge of a surface; push up onto the balls of your feet, then lower yourself back into position. That’s one rep.

Notes: Calf training should be approached like almost any other muscle group, with a caveat. To put it simply, your calves get a lot of work just moving you around. They tend to respond to higher weight training than most muscle groups. I tend to prefer the leg press for working calves, as it doesn’t stress your joints by having your legs support tons of heavy weight over your body.

No Weight Alternative for Legs
  • Burpees
    Muscles Worked: Chest, Triceps, Core, Quadriceps, Gluteus Maximus, Hamstrings

    Movement: Standing normally, drop down into pushup position. Perform a pushup; after the pushup, bring your feet up to under your chest. Leap upwards, extending your arms high. Land in starting position. That’s one rep.

    Notes: OK, this one goes against the “feeling silly” rule from before. However, all of the movements are natural, it doesn’t require any special weights, and can be done just about anywhere. Need a quick workout, but only have 10 minutes? Go into your back yard and do three sets of 10 Burpees, and you’ll be DONE. These are much more difficult than they appear, and are a fantastic full-body exercise. Trust me, you will be sweating after these, and it doesn’t take many reps to get your blood pumping.


Abs & Core

General Advice & Caveats: Ah, Abs. There has been SO much written on the subject that I’ll just hit the highlights here. The biggest caveat is this: you won’t see your abs with a layer of fat covering them…but that does not give you an excuse to skip working them. A LOT of people, experienced weight lifters, skip abs training or take it very lightly. Common excuses: “I’ll do them when I get my body fat down—you can’t even see them right now.” “They already get worked out from everything else I do.” “I don’t want my waist to get bigger.”

Look, abs are just like any other muscle group. They respond to progressive load training. Yes, the are in use all day, along with the rest of your core, keeping you vertical. They still need to be worked, if you ever hope to see them. Your abs & core form the foundation of your body. You cannot build a strong house on a weak foundation.

  • Sit Ups
    Muscles Worked: Abdomen, lower back

    Movement: Lying on your back with your knees bent roughly 90°, hands touch (lightly touching) the back of your head. Contract your abdomen, moving your head and elbows up to touch your knees. Lower back down slowly. That’s one rep. Don’t bounce, and don’t raise your rear end trying to get leverage.

    Notes: Sit Ups have a bad rap, I know. There is a LOT said about how bad they are for you and how crunches are better; I won’t even go into the whole hip flexor debate. The biggest problem sit ups have, in my opinion, is that most people do them wrong. They use their hands to pull their head up, or their head is resting on their chest (straining their neck), or they try to do them as fast as possible (incorporating all the bad movements). There is a reason why those military types do lots and lots of sit ups…they work. When done properly, they are a great abs/core strengthening exercise.

  • Crunches
    Muscles Worked: Abdomen

    Movement: Lying down with your hands either across your chest or lightly touching your head, knees bent roughly 90°, contract your abdomen so that your upper back & head rise off the floor. Lower gently to starting position. That’s one rep.

    Notes: A lot of people make the same mistakes with the crunch that they do with the Sit Up. They’ll pull their head with their hands, or bounce to get leverage. Crunches are a concentration exercise…think about your abs while you’re doing them. Focus on contracting them—your upper body will rise as a consequence.

    Crunches can be performed with or without weights, or on a decline board to increase resistance. If you do these, make sure your feet are securely under the pads at the end, or you’ll fall on your head. A lot of people do them on an exercise ball, believing that it “works the core”, and they’re not entirely wrong, but I prefer them on a level surface. Increasing the range of motion leads many people to use other muscles or their hands. Be careful.

  • Leg Lifts
    Muscles Worked: Abdomen, lower back, hip flexors

    Movement: (Lying) Lay with your legs extended out naturally. Gripping something (edge of a bed, a bench, your workout partner’s ankles), raise your feet up so that your legs & torso form a 90° angle. Slowly lower your feet to starting position. That’s one rep. (Hanging, either from a Pull Up bar or supporting your weight on your elbows in a machine of some kind) Raise your feet up so that your legs & torso form a 90° angle. Slowly lower your feet to starting position. That’s one rep.

    Notes: You’ll see some people do these hanging, and they’ll abbreviate the movement by bringing their knees up rather than their feet. This is akin to doing Push Ups from your knees rather than your feet…it lowers the resistance. Some believe that it works your “lower abs”, but so does a full range of motion leg lift.

  • Cable Crunch
    Muscles Worked: Abdomen

    Movement: Kneeling in front of a cable rack, gripping the rope or handle to your chest, contract your abs so that your upper body moves toward the floor. Slowly return to starting position. That’s one rep.

    Notes: This is a pretty easy way to add resistance to Ab/core training. It’s a bit awkward at first…you’ll tend to hit your head or not find a comfortable position for the cable. I don’t like it because many people will use their arms & back to pull the weight down, minimizing the impact on the abs. I’d much rather see someone do crunches on an decline board while holding a medicine ball or weight plate to their chest.

  • Ab Machine
    Muscles Worked: Abdomen, lower back

    Movement: Find your proper seat placement in an Ab Machine. Typically, it’ll be where the pads hit your pecs. Set your weight with the pin. Now, with the pads tightly against your upper body, contract your abs so that your upper body curls toward the floor. Return slowly to starting position. That’s one rep.

    Notes: Flat out, I don’t like this machine. Most people perform this exercise with poor form. The movement encourages you to “push down” on the pads with your upper body, and often will strain the lower back. I’ve seen people bounce their chest against the pads to jump start the weights moving. Ugh. Most people just don’t perform this one strictly enough to really reap the benefits, so I recommend other alternatives. If you do them right, really focusing on contracting your abs, they it’s a great exercise.
PUTTING IT ALL TOGETHER

OK, so now you know how to perform the basic exercises. How do we put it all together? How many reps should I do? How many sets? What exercises? The simple answer is that it depends on YOU.

How much time do you have? What are your goals? Bigger muscles? More “tone”? “Tone” is a bit of a misnomer—what people really mean is they want to see their muscles. This will involve losing fat and gaining muscle.

Some guidelines for general fitness:


  • Warm up with 5 to 10 minutes of light cardio. Walk briskly on the treadmill, skip rope, climb some stairs. The object here is to get your body moving--get your blood flowing to your muscles. This is very important for avoiding injury.

  • Keep your rep ranges in the 8 to 12 reps per set.

  • Generally perform three sets.

  • If you want to gain muscle size & strength, lower your rep range from 5 to 8; keep your sets around three, but lift much heavier than you otherwise would.

  • Do not hit the same muscle group on consecutive days. This includes Abs.

  • Mondays and Tuesdays are the most busy days in the gym. Everyone’s trying to undo the damage they did to themselves over the weekend. Mondays are notorious chest days, Tuesdays are leg hell. Be aware of this phenomenon and adjust your routine accordingly if you don’t like waiting for equipment.

    If you need to double up your workouts (since you have limited time in the gym), work opposite muscle groups…for example, chest & back on the same day. This will prevent you from overworking your stabilizing and secondary muscles. In other words, when you work chest, you’re working your pectorals, deltoids, and triceps. None of those muscles are significantly involved when you work your back.

  • If you are new to resistance training, start out using machines. For the first four to six weeks, you don’t get to use the free weights. Get your body used to lifting weights in a controlled environment. Learn your body’s and an exercise’s range of motion. Also, when you do get ready to move on to free weights, you’ll have some kind of idea as to how much weight you can use…although it’s only a ballpark idea, as free weights and machines have a VERY different feel to them.


WHAT exercises should I do? How many Sets & Reps? Increase the weights each set or not?

As a guideline, each set should be heavier than the previous one. I won’t get into the physiology behind the progressive training principle…Google away if you want to know more. However, you have to be careful. In general, don’t increase the weight more than 10-15% between sets. On machines, I’d just go down a peg in the weight stack.

So…if you start on the bench press at 135 lbs. (2 45lb. plates and the bar), your next set should be about 15 lbs heavier (add a 5 and a 2.5 to each side). Your third set should be 15 lbs. again heavier, but this time remove the 5 and the 2.5 you just added and put on a 10 and a 5 to each side. I always try to have the heaviest plates possible on the bar…it’s purely psychological, but I’d much rather have one 10 lb. plate on the bar over four 2.5 lb. plates. But that could just be me.

That said, here are some ideas as to which exercises to do. Feel free to be flexible, but keep the main lifts (bench press, squats) in the routine.


    Chest
  • Bench Press, 3 sets of 8 reps (3x8)
  • Incline Bench Press (3x8)
  • Dips (3x8)


    Back
  • Pull Ups (if you can) or Pull Downs (3x8)
  • Rows (3x8)


    Shoulders
  • Overhead Press (3x8)
  • Shrugs(3x8)


    Arms (Biceps & Triceps)
  • Incline Curls (heavy) (3x5)
  • Barbell Curls (3x8)
  • Push Downs (heavy) (3x8-10)


    Legs
  • Squats (3x8) (can substitute Hack Squats)
  • Lunges (3x8)
  • Deadlifts (3x8)
  • Stiff-legged Deadlifts (3x8)


    Abs and Core
  • Sit Ups or Crunches (3x12)
  • Leg Lifts (3x12)
  • Weighted Crunches on Decline Board (3x8)


WHEN should I do them? How frequently?

A lot of this depends on you. What does your schedule allow? How often do you want to work out? Tinker with these to your heart’s content, but so long as you don’t work the muscle group on consecutive days. If your recovery will allow you to only hit each body part once per week, try one of these:

If you can work out 5 days per week, you spend a day hitting each body part.
Monday: Legs
Tuesday: Back
Wednesday: Chest
Thursday: Shoulders, Abs
Friday: Arms
Weekend Off

If you can only work out 4 days per week, you’ll need to double up on some days.
Monday: Legs, Abs
Tuesday: Arms
Wednesday: Chest, Back
Thursday: Shoulders
Friday: Off
Weekend Off

If you can only work out 3 days per week, you’ll need to double up even more.
Monday: Legs, Abs
Tuesday: Off
Wednesday: Chest, Shoulders, Triceps
Thursday: Off
Friday: Back, Biceps
Weekend Off

I’m not a fan of the Full Body Workout because it doesn’t really allow a lot of flexibility in your schedule. You are pretty much limited to a Monday-Wednesday-Friday or Tuesday-Thursday-Saturday. Some people love them.

In any event, with a full body workout, you’ll probably need to focus more on the big lifts, and less on isolation exercises. You want to do more multi-joint compound exercises, as these will involve all your muscle groups. I’d do something like this:

Full Body Workout
  • Bench Press (3x8)
  • Pull ups if you can, otherwise Pull Downs (3x8)
  • Overhead Press (3x8)
  • Dips (3x10)
  • Incline Dumbbell Curls (3x8)
  • Squats (3x8)
  • Stiff-legged Deadlifts (3x8)
  • Crunches


You’ll note that I omit specific triceps work…they receive plenty of stimulation from the bench and overhead presses. Also, if you enjoy doing a full body workout, you can do this on Monday, but then on Wednesday, substitute out some exercises. Say Incline Presses instead of Bench Press, Barbell Curls instead of Incline Curls, and Leg Lifts for Crunches. Keep your body guessing.

Now, I’ll wrap this up by including my workout. It’s really very intense and uses scary things like compound sets and push-presses that I didn’t cover here. The reasoning is that these are advanced movements, and they can be dangerous if you’re not experienced. I’d be happy to chat about them if you’d like to know more.

Thrillhouse’s Workout

I use a 2 day, upper/lower split, performed twice per week.

Tuesday, Saturday: Upper
  • Bench Press and Pull Up Compound Set
    Set 1: Bench Press (8 reps at 255), then 8 Pull Ups
    Set 2: Bench Press (8 reps at 270), then 8 Pull Ups
    Set 3: Bench Press (8 reps at 285), then 8 Pull Ups

  • Incline Bench Press (Dumbbells) and Incline Curls Compound Set
    Three sets: Incline Bench Press (8 reps with 100 lb. Dumbbells), then Incline Curls (5 reps with 60 lb. Dumbbells)

  • Overhead Dumbbell Presses
    Three sets (8 reps with 85 lb. Dumbbells)

  • Clean & Press and Bent Over Rows Compound Set

    The Clean & Press is performed by holding a barbell naturally in front of you across your thighs. Then you flip your hands upward so that the weight is resting across your upper chest & shoulders; you then press it up over your head. Lower the weight back to your chest, then flip it down to your thighs. This is a very intense move, requiring a lot of power. I do them with moderate weights in a compound set with Rows. All sets are performed with the same weight:

    Three sets: Clean & Press (100 lbs.), Bent Over Rows (225 lbs.)

  • Cardio: 30 Minutes of High Intensity Interval Training on the Elliptical Machine



Wednesday, Sunday: Lower
  • Squats: 3 sets of 8 (225, 240, 275)
    I don’t use a lot of weight on squats, preferring to use extremely strict form.

  • Stiff-legged Deadlifts: 3 sets of 8 (135, 160, 185)

  • Hack Squats & Calves Compound Set: 3 sets of 8 (315, 405, 495) Calves: sets of 15
    Make sure you put the safeties in place before doing calves.

  • Cardio: 45-60 Minutes of Cardio (stationary cycle or rowing machine)


Again, this isn’t for everyone. It’s very intense. I move from set to set. My total upper body workout (without cardio) is about 45 minutes. The lower body (less cardio) is about 30 minutes.

Sunday, June 25, 2006

Warren Buffet to donate most of wealth

Fortune
Interview
Beneficiaries

Warren Buffett gives away his fortune
FORTUNE EXCLUSIVE: The world's second richest man - who's now worth $44 billion - tells editor-at-large Carol Loomis he will start giving away 85% of his wealth in July - most of it to the Bill & Melinda Gates Foundation.
FORTUNE Magazine
By Carol J. Loomis, FORTUNE editor-at-large
June 25, 2006: 1:42 PM EDT

NEW YORK (FORTUNE Magazine) - We were sitting in a Manhattan living room on a spring afternoon, and Warren Buffett had a Cherry Coke in his hand as usual. But this unremarkable scene was about to take a surprising turn.

"Brace yourself," Buffett warned with a grin. He then described a momentous change in his thinking. Within months, he said, he would begin to give away his Berkshire Hathaway fortune, then and now worth well over $40 billion.

This news was indeed stunning. Buffett, 75, has for decades said his wealth would go to philanthropy but has just as steadily indicated the handoff would be made at his death. Now he was revising the timetable.

"I know what I want to do," he said, "and it makes sense to get going." On that spring day his plan was uncertain in some of its details; today it is essentially complete. And it is typical Buffett: rational, original, breaking the mold of how extremely rich people donate money.

Buffett has pledged to gradually give 85% of his Berkshire stock to five foundations. A dominant five-sixths of the shares will go to the world's largest philanthropic organization, the $30 billion Bill & Melinda Gates Foundation, whose principals are close friends of Buffett's (a connection that began in 1991, when a mutual friend introduced Buffett and Bill Gates).

The Gateses credit Buffett, says Bill, with having "inspired" their thinking about giving money back to society. Their foundation's activities, internationally famous, are focused on world health -- fighting such diseases as malaria, HIV/AIDS, and tuberculosis -- and on improving U.S. libraries and high schools.

Up to now, the two Gateses have been the only trustees of their foundation. But as his plan gets underway, Buffett will be joining them. Bill Gates says he and his wife are "thrilled" by that and by knowing that Buffett's money will allow the foundation to "both deepen and accelerate" its work. "The generosity and trust Warren has shown," Gates adds, "is incredible." Beginning in July and continuing every year, Buffett will give a set, annually declining number of Berkshire B shares - starting with 602,500 in 2006 and then decreasing by 5% per year - to the five foundations. The gifts to the Gates foundation will be made either by Buffett or through his estate as long as at least one of the pair -- Bill, now 50, or Melinda, 41 -- is active in it.

Berkshire's price on the date of each gift will determine its dollar value. Were B shares, for example, to be $3,071 in July - that was their close on June 23 - Buffett's 2006 gift to the foundation, 500,000 shares, would be worth about $1.5 billion. With so much new money to handle, the foundation will be given two years to resize its operations. But it will then be required by the terms of Buffett's gift to annually spend the dollar amount of his contributions as well as those it is already making from its existing assets. At the moment, $1.5 billion would roughly double the foundation's yearly benefactions. But the $1.5 billion has little relevance to the value of Buffett's future gifts, since their amount will depend on the price of Berkshire's stock when they are made. If the stock rises yearly, on average, by even a modest amount - say, 6% - the gain will more than offset the annual 5% decline in the number of shares given. Under those circumstances, the value of Buffett's contributions will rise.

Buffett himself thinks that will happen. Or to state that proposition more directly: He believes the price of Berkshire, and with it the dollar size of the contributions, will trend upward - perhaps over time increasing substantially. The other foundation gifts that Buffett is making will also occur annually and start in July. At Berkshire's current price, the combined 2006 total of these gifts will be $315 million. The contributions will go to foundations headed by Buffett's three children, Susan, Howard, and Peter, and to the Susan Thompson Buffett Foundation.

This last foundation was for 40 years known simply as the Buffett Foundation and was recently renamed in honor of Buffett's late wife, Susie, who died in 2004, at 72, after a stroke. Her will bestows about $2.5 billion on the foundation, to which her husband's gifts will be added. The foundation has mainly focused on reproductive health, family planning, and pro-choice causes, and on preventing the spread of nuclear weapons. Counting the gifts to all five foundations, Buffett will gradually but sharply reduce his holdings of Berkshire (Charts) stock. He now owns close to 31% of the company-worth nearly $44 billion in late June - and that proportion will ultimately be cut to around 5%. Sticking to his long-term intentions, Buffett says the residual 5%, worth about $6.8 billion today, will in time go for philanthropy also, perhaps in his lifetime and, if not, at his death.

Because the value of Buffett's gifts are tied to a future, unknowable price of Berkshire, there is no way to put a total dollar value on them. But the number of shares earmarked to be given have a huge value today: $37 billion.

That alone would be the largest philanthropic gift in history. And if Buffett is right in thinking that Berkshire's price will trend upward, the eventual amount given could far exceed that figure.

So that's the plan. What follows is a conversation in which Buffett explains how he moved away from his original thinking and decided to begin giving now. The questioner is yours truly, FORTUNE editor-at-large Carol Loomis. I am a longtime friend of Buffett's, a Berkshire Hathaway shareholder, and a director of the Susan Thompson Buffett Foundation.


A conversation with Warren Buffett
FORTUNE EXCLUSIVE: Editor-at-large Carol Loomis speaks with Buffett on why he sped up his plan to give away his money and why he chose the Bill & Melinda Gates Foundation.
FORTUNE Magazine
By Carol J. Loomis, FORTUNE editor-at-large
June 25, 2006: 12:48 PM EDT

NEW YORK (FORTUNE Magazine) - Coming from you, this plan is pretty startling. Up to now you haven't been famous for giving away money. In fact, you've been roundly criticized now and then for not giving it away. So let's cut to the obvious question: Are you ill?

No, absolutely not. I feel terrific, and when I had my last physical, in October, my doctor gave me a clean bill of health.

Then what's going on here? Does your change in plans have something to do with Susie's death?

Yes, it does. Susie was two years younger than I, and women usually live longer than men. She and I always assumed that she would inherit my Berkshire stock and be the one who oversaw the distribution of our wealth to society, where both of us had always said it would go.

And Susie would have enjoyed overseeing the process. She was a little afraid of it, in terms of scaling up. But she would have liked doing it, and would have been very good at it. And she would really have stepped on the gas.

By that you mean that she always wanted to give away more money, faster, than you did?

Yes, she said that many times. As for me, I always had the idea that philanthropy was important today, but would be equally important in one year, ten years, 20 years, and the future generally.

And someone who was compounding money at a high rate, I thought, was the better party to be taking care of the philanthropy that was to be done 20 years out, while the people compounding at a lower rate should logically take care of the current philanthropy.

But that theory also happened to fit what you wanted to do, right?

(He laughs, hard.) And how! No question about that. I was having fun - and still am having fun - doing what I do. And for a while I also thought in terms of control of Berkshire.

I had bought effective control of Berkshire in the early 1970s, using $15 million I got when I disbanded Buffett Partnership. And I had very little money - considerably less than $1 million - outside of Berkshire. My salary was $50,000 a year.

So if I had engaged in significant philanthropy back then, I would have had to give away shares of Berkshire. I hadn't bought those to immediately give them away.

Even so, you and Susie set up the Buffett Foundation way back in the 1960s, which means you obviously expected to be giving away money sometime. What was your thinking back then?

Well, when we got married in 1952, I told Susie I was going to be rich. That wasn't going to be because of any special virtues of mine or even because of hard work, but simply because I was born with the right skills in the right place at the right time.

I was wired at birth to allocate capital and was lucky enough to have people around me early on - my parents and teachers and Susie - who helped me to make the most of that.

In any case, Susie didn't get very excited when I told her we were going to get rich. She either didn't care or didn't believe me - probably both, in fact. But to the extent we did amass wealth, we were totally in sync about what to do with it - and that was to give it back to society.

In that, we agreed with Andrew Carnegie, who said that huge fortunes that flow in large part from society should in large part be returned to society. In my case, the ability to allocate capital would have had little utility unless I lived in a rich, populous country in which enormous quantities of marketable securities were traded and were sometimes ridiculously mispriced. And fortunately for me, that describes the U.S. in the second half of the last century.

Certainly neither Susie nor I ever thought we should pass huge amounts of money along to our children. Our kids are great. But I would argue that when your kids have all the advantages anyway, in terms of how they grow up and the opportunities they have for education, including what they learn at home - I would say it's neither right nor rational to be flooding them with money.

In effect, they've had a gigantic headstart in a society that aspires to be a meritocracy. Dynastic mega-wealth would further tilt the playing field that we ought to be trying instead to level.

From the fact that you've given your kids money before to set up foundations and are planning to give them more now, I gather you don't think that kind of flooding them with money is wrong.

No, I don't. What they're doing with their foundations is giving money back to society - just where Susie and I thought it should go. And they aren't just writing checks: They've put enormous thought and effort into the process.

I'm very proud of them for the way they've handled it all, and I have no doubt they're going to keep on the right track.

So what about the Susan Thompson Buffett Foundation and what all this means for it?

As you know, because as a director you've seen it close up, Allen Greenberg, the foundation's president, has done an excellent and thoughtful job of running it. His results-to-cost ratio is as good as I've ever seen. And he'll keep on that same path now, not just with Susie's money, but with mine too.

Actually, if I had died before Susie and she had begun to distribute our wealth, this is the foundation that would have scaled up to a much bigger size - right now it has only five employees - and become her main vehicle for giving. And the foundation anchored my plans too. Until I changed my thoughts about when to give, this was to be where my fortune would go also.

And what changed your mind?

The short answer is that I came to realize that there was a terrific foundation that was already scaled-up - that wouldn't have to go through the real grind of getting to a megasize like the Buffett Foundation would - and that could productively use my money now.

The longer answer is that over the years I had gotten to know Bill and Melinda Gates well, spent a lot of time with them having fun and, way beyond that, had grown to admire what they were doing with their foundation. I've seen them give presentations about its programs, and I'm always amazed at the enthusiasm and passion and energy they're pouring into their work. They've gone at it, you might say, with both head and heart.

Bill reads many thousands of pages annually keeping up with medical advances and means of delivering help. Melinda, often with Bill along, travels the world looking at how well good intentions are being converted into good results. Life has dealt a terrible hand to literally billions of people around the world, and Bill and Melinda are bent on reducing that inequity to the extent they possibly can.

If you think about it - if your goal is to return the money to society by attacking truly major problems that don't have a commensurate funding base - what could you find that's better than turning to a couple of people who are young, who are ungodly bright, whose ideas have been proven, who already have shown an ability to scale it up and do it right?

You don't get an opportunity like that ordinarily. I'm getting two people enormously successful at something, where I've had a chance to see what they've done, where I know they will keep doing it - where they've done it with their own money, so they're not living in some fantasy world - and where in general I agree with their reasoning. If I've found the right vehicle for my goal, there's no reason to wait.

Compare what I'm doing with them to my situation at Berkshire, where I have talented and proven people in charge of our businesses. They do a much better job than I could in running their operations.

What can be more logical, in whatever you want done, than finding someone better equipped than you are to do it? Who wouldn't select Tiger Woods to take his place in a high-stakes golf game? That's how I feel about this decision about my money.

People will be very curious, I think, as to how much your decision - and its announcement at this particular time - is connected to Bill Gates' announcement in mid-June that he would phase out of his operating responsibilities at Microsoft and begin to devote most of his time to the foundation. What's the story here?

I realize that the close timing of the two announcements will suggest they're related. But they aren't in the least. The timing is just happenstance. I would be disclosing my plans right now whether or not he had announced his move - and even, in fact, if he were indefinitely keeping on with all of his work at Microsoft.

On the other hand, I'm pleased that he's going to be devoting more time to the foundation. And I think he and Melinda are pleased to know they're going to be working with more resources.

Does it occur to you that it's somewhat ironic for the second-richest man in the world to be giving untold billions to the first-richest man?

When you put it that way, it sounds pretty funny. But in truth, I'm giving it through him - and, importantly, Melinda as well - not to him.

Some people say the Gates foundation is bureaucratic, and bureaucracy is just about your No. 1 dislike. So how do you react to that charge?

I would say that most large organizations - though Berkshire is a shining exception - are bureaucratic to some degree. Anyway, what some people really mean when they claim that the Gates foundation is bureaucratic is that big decisions don't get made by anybody except Bill and Melinda. That suits me fine. I want the two of them to make the big calls.

What is the significance of your going on the board of the Gates foundation?

Not much. The biggest reason for my doing that is if they were ever to go down on an airplane together. Beyond that, I hope to have a constructive thought now and then. But I don't think I'm as well cut out to be a philanthropist as Bill and Melinda are. The feedback on philanthropy is very slow, and that would bother me. I'd have to be too involved with a lot of people I wouldn't want to be involved with and have to listen to more opinions than I would enjoy.

In philanthropy also, you have to make some big mistakes. I know that. But it would bother me more to make the mistakes myself, rather than having someone else make them whom I trust overall to do a good job. In general, Bill and Melinda will have a better batting average than I would.

Did you talk this huge decision over with other people before deciding to go ahead with the plan?

Yes, I talked to my children and Allen Greenberg, and to four Berkshire directors, including my son Howard and Charlie Munger. I got lots of questions, and some people had qualms about the plan initially because it was such an abrupt change from what they had been anticipating.

But I'd say everybody, and that certainly includes Allen - who knows what a bear it would have been to scale up the Buffett Foundation - came around to seeing the logic of what I was proposing to do. Now all concerned can't wait to get started - particularly me.

And frankly, I have some small hopes that what I'm doing might encourage other very rich people thinking about philanthropy to decide they didn't necessarily have to set up their own foundations but could look around for the best of those that were up and running and available to handle their money.

People do that all the time with their investments. They put their money with people they think are going to do a better job than they could. There's some real merit to extending that thought to your wealth, rather than setting up something to be run after your death by a bunch of old business cronies or a staff that eventually comes to dictate the agenda.

Some version of this plan I've got is not a crazy thing for some of the next 20 people who are going to die with $1 billion or more to adopt themselves. One problem most rich people have is that they're old, with contemporaries who are not at their peak years and who don't have much time ahead of them. I'm lucky in that respect in that I can turn to younger people.

Okay, now what does that mean for Berkshire?

I'd say virtually nothing. Anybody who knows me also knows how I feel about making Berkshire as good as it can be, and that goal is still going to be there. I won't do anything differently, because I'm not capable of doing things differently. The name on the stock certificates will change, but nothing else will.

I've always made it clear to Berkshire's shareholders that my wealth from the company would go to philanthropy, so the fact that I'm starting the process is basically a nonevent for them. And, you know, though this may surprise some people, it's a nonevent for me too in some ways.

Ted Turner, whose philanthropic activities I admire enormously, once told me that his hands shook when he signed a $1 billion pledge. Well, I have zero of that. To me, there's just no emotional downside to this at all.

Won't the foundations that are getting your stock need to sell it?

Yes, in some cases. The Buffett Foundation and the kids' foundations will have to sell their stock relatively soon after they get it, because it will be their only asset - and they'll need to raise cash to give away.

The Gates foundation will have more options because it has lots of other assets, so it will have some flexibility to choose which it should turn into cash. Bill and Melinda will make the decisions about that. I'm going to totally insulate myself from any investment decisions their foundation makes, which leaves them free to do whatever they think makes sense.

Perhaps they will decide to sell bigger portions of other assets and hang on to some Berkshire. It's a great mix of businesses and wouldn't be an inappropriate asset for a foundation to own. But I won't tie the foundation up in any shape or form.

So it could be that all the shares you give annually will be sold in the market?

Yes, that may well happen. And naturally people are going to be interested in whether that selling could weigh down Berkshire's price. I don't think so in the least - and that's true even though the annual turnover ratio for Berkshire has been running only about 15% a year, which is extremely low for large-cap stocks.

Let's say the five foundations sell all the stock they get this year. If trading volume continues as it has, their selling will raise turnover to less than 17%. It would be ridiculous to think that much new selling could affect the price of the stock.

In fact, the added supply could even be beneficial in increasing the stock's liquidity and should make it more likely that Berkshire would eventually be included in the S&P 500.

I'd say this: I would not be making the gifts if they would in any way harm Berkshire's shareholders. And they won't.

This plan seems to settle the fate, over the long term, of all your Berkshire shares. Does that mean you're giving nothing to your family in straight-out gifts?

No, what I've always said is that my family won't receive huge amounts of my net worth. That doesn't mean they'll get nothing. My children have already received some money from me and Susie and will receive more.

I still believe in the philosophy - FORTUNE quoted me saying this 20 years ago - that a very rich person should leave his kids enough to do anything but not enough to do nothing. [The FORTUNE article was "Should You Leave It All to the Children?" Sept. 29, 1986.]

Remember I said that way back when I was buying Berkshire, I had less than $1 million in outside cash? Well, I've made a few decent investments with that money in the years since - taking positions that were too small for Berkshire, doing some fixed-income arbitrage, and selling my interest in a bank that was split off from Berkshire.

So I'm glad to say I've got quite a bit of cash now. Overall I can - and will - use all my Berkshire shares for philanthropic purposes and will have plenty left over to provide well for all those close to me.

How Buffett's giveaway will work
FORTUNE EXCLUSIVE: The mind that built the fortune also came up with a complex plan to hand it off.
FORTUNE Magazine
By Carol J. Loomis, FORTUNE editor-at-large
June 25, 2006: 12:50 PM EDT

NEW YORK (FORTUNE Magazine) - Warren Buffett holds only Berkshire Hathaway A stock (474,998 shares), but his gifts are to be made in Berkshire B stock, into which each A share is convertible at a ratio of 30 to 1. He will convert A shares to obtain the B shares he needs for his gifts.

Buffett is earmarking a set number of B shares for each of the five foundations he has chosen to receive his gifts. In 2006 he will give 5% of the designated shares to each recipient. Next year the gifts will be 5% of the residual shares, and so on for every year until either Buffett's death or until certain conditions are no longer met at the foundations.

At Buffett's death, his estate will distribute, in a way not yet definite, the remaining earmarked shares.

Here are the recipients and the number of B shares to be allocated to them.
Bill & Melinda Gates Foundation: Ten million shares

This foundation, the largest in the world, has around $30 billion of assets right now and has given away $8 billion in its 12 years of existence. Most of its money (typically funneled through partners) has gone to world health programs and to U.S. education.

Buffett's gifts to this foundation will continue only as long as either Bill or Melinda Gates is alive and active in its work.
Susan Thompson Buffett Foundation: One million shares

Once called simply the Buffett Foundation and renamed in 2004 for Buffett's wife, who died that year, this foundation has $270 million in assets. Most of its funds came from the estate of Susan T. Buffett, and $2.1 billion more is expected from that source. This foundation has focused on reproductive health, family planning, and pro-choice causes, and on preventing the spread of nuclear weapons.
Susan A. Buffett Foundation: 350,000 shares

This philanthropy is named for and chaired by Buffett's daughter, 52, who lives in Omaha (and who has also chaired the Susan Thompson Buffett Foundation since her mother's death). The daughter's foundation, which today has $118 million in assets, has funded early education for children of low-income families. With her father's new gifts, Susan Buffett expects to continue that work and expand into public-education and foster-care grants.
Howard G. Buffett Foundation: 350,000 shares

Now holding $129 million in assets, this foundation was set up by Buffett's older son, 51, who farms 840 acres outside Decatur, Ill., and is on several corporate boards, including Berkshire's. (His middle name, by the way, is Graham - for famed investor Ben Graham.)

This foundation's giving has been very international, taking in 42 countries and often aimed at conservation goals such as the protection of African wildlife habitats. But with its new money, the foundation plans to move much more heavily into clean-water projects, food relief, the plight of children entangled in illegal immigration, and other humanitarian areas.
NoVo Foundation: 350,000 shares

Named for the Latin word novo (meaning "I alter"), this foundation is run by Peter Buffett, 48, a musician and composer, and his wife, Jennifer, who live in New York City. Currently holding $120 million in assets, it has focused on funding individuals and organizations working to open up education opportunities, reverse environmental degradation, uphold human rights, and improve understanding and respect among various cultures and ethnicities.

Diagnosis: Rocky Mountain Spotted Fever

NYTimes

October 9, 2005
Sleuthing a Rash
By LISA SANDERS, M.D.

1. Symptoms

"I always heard that when your palms itched it meant you were coming into money." The patient smiled faintly as the doctor entered the examining room. "No money so far," she continued, "but lots of fever." The doctor eyed her attentively. He'd known the patient for years and despite her playful tone, today she looked really sick.

She'd been well until a few days earlier, she told him. She had a little pain when she went to the bathroom, which made her think she had a urinary-tract infection, and she increased her fluids. When that hadn't helped, she had come to the office and seen a different doctor, who started her on an antibiotic and a painkiller. She didn't get better; in fact, that's when she first noticed the itchy palms. The next morning she was so achy she could barely get out of bed. That night, she had shaking chills and a fever of 102.

The rash appeared the following day. It started on her arms, her face and her chest. She stopped taking the painkiller, thinking the rash could be an allergic reaction to it, she told him. But the rash just kept spreading.

Dr. Davis Sprague was worried. The patient was 57, and other than a back injury a few years ago and some well-controlled high blood pressure, she had always been healthy. Not today. He was glad she was the last patient of the day because he could tell this was going to take time.

On examination she looked tired, and her face was flushed and sweaty. Her short, dark hair lay plastered to her scalp. She had no fever, but her blood pressure was quite low, and her heart was beating unnaturally fast. The rash that now covered her body was made up of hundreds of small, flat red marks. The newest ones, those on her legs, were like red-colored freckles. The ones on her arms and chest were larger - maybe the size of nickels - and less well defined. The rash didn't itch or hurt. The palms of her hands were itchy and reddened but rash-free. A urine sample showed no evidence of bacteria or white cells but was positive for blood. That might have been a result of the fever, or it could indicate kidney damage.

2. Investigation

"You need to go to the emergency room," Sprague instructed the patient. "You may even need to be admitted to the hospital. I'm not sure what you've got, but I am pretty sure that you're sick." If she had developed an allergy to one of the medicines she was taking, he explained, it could be serious and might even require other medications. What he was really worried about, though, was that she had some sort of infection that was spreading throughout her body. In the E.R. they would be able to test her blood and get a better sense of what was going on.

The doctor in the emergency room ordered what seemed like an endless stream of blood tests as well as a chest X-ray. But when all the tests came back normal, he decided she was well enough to go home. It probably was an allergic reaction, he told her, and gave her a different antibiotic. She should follow up with her doctor in a couple of days.

Two days later, she was back at her doctor's office. She did feel a little better, she said, but she was still having fevers, and now she felt short of breath with even minimal effort. "What do you think is going on?" she asked.

Sprague wasn't sure. Maybe the E.R. doctors had been right, and it really was an allergy - she was a little better since they'd changed the antibiotics. But the shortness of breath started after that. He was still worried about infection. Fever and rash were common symptoms. It could be a viral illness - coxsackie? West Nile? Or was it bacterial? These symptoms, he told her, were so nonspecific they could be found in everything from garden-variety Lyme disease to something really exotic like Rocky Mountain spotted fever. "We may never figure it out," he confessed. But since she was getting better, he was willing to give her a few more days. If she was still spiking fevers then, he'd send off some blood work to try to find an answer.

At home, though, the patient continued to worry. That night she sat down at the computer to do a little research of her own. "Rash, adult, fever," she Googled.

When you Google a set of symptoms, you don't get the most common or the most likely diseases; you get the diseases with the greatest number of links from other Web sites. Her Google search brought up dozens of fairly unusual, but well-linked, illnesses: coccidioidomycosis - a fungal infection most common on the West Coast; dengue fever - endemic to the tropics and near tropics; measles; scarlet fever.

But the patient immediately focused on the first result: Rocky Mountain spotted fever, which her doctor had mentioned. As she read about the disease, she began to feel a little panicky. The description of the symptoms, she said, fit her perfectly: the rash, the fever, the muscle aches. The rash, she read, can involve the palms of the hands, which is pretty unusual. She didn't have a rash there, but her palms were red and itchy. Also, the disease is transmitted by dog ticks - she had a dog. It's most common in the summer - it was August. Though it's rare, it is more commonly seen on the East Coast than in the Rockies, and she was in upstate New York. People can die from this disease, she read. It's the deadliest of all the tick-borne illnesses.

She called the emergency room where she had been seen. Had they tested her for Rocky Mountain spotted fever? No, she was told, why would they? They had never seen a single case in the area. She hung up feeling somewhat relieved. They didn't think it was Rocky Mountain spotted fever; Dr. Sprague didn't think it was. Chances are that it wasn't.

Over the next few days, the patient started to feel almost normal again. The rash was fading - though now it itched like crazy - and her energy was coming back. But she continued to have fevers at night and still occasionally felt short of breath. She returned to Sprague's office one more time. "I'm glad to hear you're feeling better, but these fevers worry me," he said. "I want to send off some tests." He would recheck her blood count - an elevated white-blood count would suggest an infection. He would check her liver and kidney functions. And he would send off a test for Lyme. It's a disease that can present in many ways, and it's common in the area.

3. Resolution

"What about Rocky Mountain spotted fever?" the patient asked. She confessed that she had looked it up on the Internet and thought the symptoms were close to what she had. The doctor thought for a moment. "I don't think that's what you have, but let's add it." He had heard doctors complain about their patients surfing the Web for diagnoses, but he didn't usually mind. He had never seen Rocky Mountain spotted fever - maybe she was right.

The results came back a few days later. "You're an internist's dream," the doctor sang out as he entered the examining room. "It really is Rocky Mountain spotted fever, and I would have completely missed it if I hadn't listened to you." He started the patient on Doxycycline - the antibiotic of choice for this bacterium. Her body seemed to be fighting off the illness without it, but he wasn't taking any chances.

I spoke to the patient not long ago. She is still recovering from the infection. The fevers are completely gone, and even her palms are improving. I asked her how she felt about her doctor, who had come so close to missing this diagnosis. "But he didn't miss it. He was the first to think of it. And he sent off the test - even though it could prove him wrong. He just wanted to figure out what was going on. He listened to me. That's exactly the kind of doctor I want."

Diagnosis: anticholinergic toxidrome

NYTimes

May 21, 2006
Diagnosis
Flower Power
By LISA SANDERS, M.D.

1. Symptoms

Dr. Jon McGhee, a second year E.R. resident, casually greeted the patient and her fiancé as he entered the darkened hospital cubicle. "So, what's going on?" he asked the patient, who was also a doctor and a friend. The two had suffered through their internship year together — an experience that is the start of many enduring friendships.

She looked O.K., the resident thought to himself, a little relieved. But her heart was racing — 150 beats per minute. Her blood pressure was high, and she seemed anxious. But she didn't look sick. Then she began to speak. A wild river of words poured from her. Random words, meaningless sentences. There were snatches of sense scattered throughout, but they were drowned in the rushed torrent. McGhee looked at the young man, who nodded. This was why they had come.

The patient had been fine all day, the fiancé explained, but after dinner she started saying that she felt queasy and lightheaded. Within an hour, these symptoms began to worsen. She felt weak, she told him, sick and hot. Then she began crying uncontrollably, and when she spoke, she made no sense. That had really scared him. +

The patient was 27, had an athletic build and no significant medical problems. The year before, she fainted a couple of times, but an extensive cardiac work-up hadn't revealed anything. She was taking an antidepressant, Paxil, and occasionally used another antidepressant, Elavil, to help her sleep. She didn't smoke, rarely drank, never used illicit drugs and jogged daily.

When the doctor turned on the light to examine the patient, she cried out. The light had been bothering her since they got there, her fiancé told him. McGhee turned the lights down and began to examine the patient. She had no fever. Her mouth was dry, and her skin was quite warm though not sweaty. The rest of her exam was normal. An EKG showed no abnormalities beyond the rapid heart rate.

2. Investigation

McGhee thought carefully about his friend. For almost anyone with a change in mental status, illicit drugs had to be on the list of possible causes, as unlikely as it seemed in this case. In addition, she took Elavil, which could cause many of these symptoms when taken in large quantities. Could she have taken an overdose? That could cause the rapid heart rate and confusion. But the most dangerous side effect of an Elavil overdose is dangerously low blood pressure. Hers was dangerously high. Perhaps the patient was bipolar and had moved from depression to mania? Or could it be something different? Could she have too much thyroid hormone? The thyroid is the flesh-and-blood version of a carburetor, regulating how hard the body's machinery works. Too little of this hormone, and the body slows down. Too much, and it speeds up.

He questioned the patient's fiancé. Had she shown signs of mania? She had a history of insomnia, and sleeplessness was one sign of both mania and thyroid overload. How was she sleeping? Until this evening she had been fine, he insisted. She had been depressed, but not since starting the Paxil. And her sleeping was no worse than usual. He paused. There was one other thing: after dinner, he had felt a little funny, too. Not as sick as the patient, but his heart had been racing, and he had felt nauseated and jittery, though he felt fine now. They had eaten some lettuce from their garden that night. Could their symptoms be related to that? The resident immediately thought of a recent patient who had almost died from pesticide poisoning. He had been delirious like this patient, but had not had the elevated heart rate or blood pressure and had been sweating profusely. Still uncertain, the doctor ordered a few routine blood tests to look for the presence of an infection or an abnormality in her blood chemistry or thyroid hormone. He also ordered a urine test to look for illegal drugs and Elavil, the medication she used for sleep.

As he waited for the results, the patient became more agitated. She kept getting out of bed and walking into the chaotic hub of the emergency room, putting on gloves and picking up charts as if she were at work. At times, she seemed to hallucinate.

Over the course of the night, the patient's test results trickled in. The blood tests were normal. Her thyroid hormone wasn't too high. The drug screen was completely negative. What was going on?

By dawn, the patient's blood pressure came down. She was less confused. Her speech cleared. But she was still far from normal. Was this part of some underlying illness? Could it be linked to her earlier fainting spells? Was she having tiny strokes? Was she showering her lungs with little clots? Her symptoms weren't typical of any of these, but they didn't seem typical of anything else either. Her cardiologist and a neurologist were consulted. She had an M.R.I. of her brain to look for a stroke and a CT of her chest to look for tiny clots. Normal. After four days, the patient recovered, and she was discharged, her diagnosis still unknown.

3. Resolution

At home, the patient worried about her brief descent into madness. That afternoon, she wandered out to the garden to do some weeding when her attention was drawn to an uninvited guest growing there. Among the green and purple lettuce she had planted were several strikingly beautiful white and yellow flowers. Blossoms that hadn't been there before and that she was certain she had never sown. Before it had flowered, could this plant have been mistaken for lettuce and ended up in her salad? She pulled the plants up by their roots, put them in a baggie and drove to a nearby nursery. As she pulled the plants from the bag to show the owner, the woman exclaimed: "Don't touch those! They're highly toxic. That's jimson weed." Also called the devil's trumpet and sometimes locoweed, this plant has been known for centuries to cause a temporary kind of madness, the woman explained.

The symptoms caused by this class of plant are well known, and a mnemonic is taught in medical school to identify them: Mad as a hatter, blind as a bat, dry as a bone, red as a beet. As it turned out, the patient had had all the classic symptoms. The plant's toxin affects the eyes because it dilates the pupils and makes them very sensitive to light. She was also quite flushed, according to her fiancé, though both these symptoms were missed by McGhee, it seems, because he had turned down the light for his friend's comfort. He noted that her mouth and skin were dry and the madness was clear, but alone they weren't enough. By the time the other doctors saw her, most of these symptoms had resolved themselves.

The doctor was being kind in keeping the lights low, but I think there's more here. McGhee didn't insist on being able to see — the way he would have insisted on drawing blood or getting the CT scan — because in this age of high-tech medicine, I think we no longer really believe that the physical exam can be an important diagnostic tool. Too often we simply go through the motions, never imagining that what we can observe will provide the kinds of answers that our machine-driven tests routinely do. Ultimately, that loss of faith can become a self-fulfilling prophecy.

In this case, the patient did fine without a diagnosis. She figured it out herself. I asked her recently why she thought she had been so much more affected by the jimson weed than her fiancé. "I'm not really sure," she answered. "Maybe I ate more of it. Or maybe it was the plant plus the Paxil. Antidepressants can cause some similar side effects." She told me that she hopes to publish her story as a case report in a medical journal.

Diagnosis: Broken Heart

NYTimes

June 18, 2006
Diagnosis
Heart Ache
By LISA SANDERS, M.D.

1. Symptoms

"I'm not going to lose my mom," the young man's voice cracked with feeling. Beside him a half-dozen men and women in scrubs swarmed around the gurney rolling the woman into a cubicle in the I.C.U. The patient's face had a deathly pallor, her light brown hair was dark with sweat, her mouth was open and her chest heaved as she struggled to breathe. "We'll do our best," the doctor assured him, as he observed the woman and the monitors that showed just how sick she was. The young man, who was in his mid-20's, grabbed the doctor's arm as he turned to follow the patient. "No — you have to save her," he answered fiercely. "You have to."

His mother had been fine that morning, the young man told the doctor. She went to work just as she did every day. But then the phone rang, and she learned that her husband of more than two decades had been killed in a crash. She rushed to the site, found his body and collapsed next to him, sobbing and shouting his name as if she were trying to wake him. She lay next to her husband, cradling him in her arms until his body was taken away. Two hours later, she collapsed again, and this time she couldn't get up.

The son paused and roughly rubbed the tears from his face with his sleeve. When she got home, his mother told his sister that her chest hurt and that she felt as if she couldn't breathe. The ambulance rushed her to the nearest hospital. "The doctors there told us she'd had a heart attack," the young man continued, "and that she was fixing to have another one." He and his two sisters were terrified. They had already lost their dad — they just couldn't lose them both. They decided to have her transferred here, to the regional hospital with a specialized cardiac-care unit.

The doctor in the I.C.U. glanced through her chart and turned his attention to the patient. She was 45 years old and a smoker. She had recently been told she had narrowing of the arteries that carried blood to her legs and feet — called peripheral vascular disease — but otherwise she was healthy. She took no medicines and worked full time now that her children were grown up.

2. Investigation

On examination, she appeared younger than her 45 years. But her tanned, unlined face was shiny with sweat, and her pale blue eyes were open and unfocused. Her heart was beating rapidly, and a blood-pressure cuff that inflated automatically beeped its warning that her pressure was dangerously low. An oxygen meter on her finger showed that although she was breathing rapidly, she wasn't getting enough air. Her skin was clammy to the touch and pierced by thick intravenous needles delivering saline and medicines to raise her blood pressure.

It was clear that the patient's heart was failing. She was young to be having a heart attack, but she was a smoker and had a history of clogged arteries in her legs, which put her at risk of having the same problem in her heart. A heart attack occurs when one of the arteries supplying blood to the heart gets blocked. Without blood, that part of the heart dies rapidly. Her EKG was abnormal, and blood tests revealed damage to the heart cells — all consistent with a heart attack.

Dr. Conard Failinger, the cardiologist on call, was worried by the grainy images of the sonogram that showed the patient's heart in motion. Her heart was pumping with only a fraction of the expected strength. In fact, most of the heart muscle wasn't pumping at all; the patient was dying. The only way to treat her would be to quickly find and clear the blockage so that blood could flow once more. There are chemical clot busters that can do this, but a more effective way is to thread a tiny catheter into the affected artery, locate the blockage and then use the tiny tube to blast the vessel open. Done quickly enough, this process, known as cardiac angioplasty, can save the heart muscle and save the life. The patient was quickly transported from the I.C.U. to the "cath" lab.

Once there, Failinger watched another doctor rapidly thread the tiny catheter through a large artery in the patient's leg into her heart. He carefully placed the catheter into one of the major vessels of the heart and pressed the plunger of the attached syringe, which shot a tiny amount of contrast dye into the artery to determine the site of the blockage. On a monitor, the cardiologists stared in wonder as the arteries brightened, lighted by the dye flowing through them. There was no obstruction. The doctor manipulated the catheter again, moving it to another vessel. Again, the dye flowed through the artery, completely unimpeded. Several more tries produced the same result. There were no blocked arteries. The patient was not having a heart attack.

What else could cause such profound heart muscle weakness? Alcohol can do this, but the patient had no history of heavy alcohol use. A number of drugs — most commonly those used to treat certain cancers — can cause this type of damage, but this patient had never been exposed to any of those medications. Infection could do this, but the patient reported no symptoms other than those caused by the failing heart itself.

3. Resolution

Failinger immediately realized that it was none of these. He recognized what it was, though he had never seen it. He had read about it a short time before in The New England Journal of Medicine. This was stress cardiomyopathy, also called "broken-heart syndrome." First described by the Japanese 15 years ago, this disease occurs when an emotional trauma causes the brain to release high doses of stress hormones. This hormonal blast paralyzes the muscle cells of the heart, preventing them from working to pump the blood. Typically only one section of the heart is spared this devastating paralysis — the part closest to the aorta so that with each heart beat only the upper portion contracts and the heart looks like a narrowed-necked vase. The Japanese called it takotsubo after a type of trap that is used to capture octopus and has the same vaselike shape. For reasons that no one understands, this mostly affects post-menopausal women.

There is no cure. There is no clot to bust, no bugs to kill. Like its metaphorical counterpart, the only treatment is support and the passage of time. The initial burst of hormones subsides and the patient must be kept alive until the heart recovers. For those who survive long enough to reach the hospital, the prognosis is good. Once she made it to the hospital, this patient needed additional oxygen and medicine to keep her blood pressure up. On arrival at the hospital, her heart was able to pump out only 5 to 10 percent of the blood it contained (normal is 50 to 60 percent). After several days, it was pumping well enough for the doctors to stop the medications that increased her blood pressure. By the end of the week, her heart's capacity had doubled. Just days later, it was nearly normal.

"If anyone had told me that you could die of a broken heart," the patient told me recently, "I'd never have believed it. But I almost did." Reflecting on those couples you hear about, when one dies and the other one follows a few days later, she said, "I bet their hearts were broken, just like mine was."

It's an interesting idea: perhaps the metaphors we use to speak of devastating loss grew out of physiological truth. But if love lost almost took this patient's life, she says she believes that it was also love that brought her back. "I remember when I was in the hospital, I was in the most peaceful rest," she told me. "I didn't see any light or anything, but it was just as beautiful and peaceful a rest as I could ever imagine. I just wanted to stay there forever. But then, way off in the distance, I heard my kids calling to me, and I knew I couldn't stay. They're the ones who really saved my life.

Sunday, June 11, 2006

Employers using online info to reject candidates

NYTimes

June 11, 2006
For Some, Online Persona Undermines a Résumé
By ALAN FINDER

When a small consulting company in Chicago was looking to hire a summer intern this month, the company's president went online to check on a promising candidate who had just graduated from the University of Illinois.

At Facebook, a popular social networking site, the executive found the candidate's Web page with this description of his interests: "smokin' blunts" (cigars hollowed out and stuffed with marijuana), shooting people and obsessive sex, all described in vivid slang.

It did not matter that the student was clearly posturing. He was done.

"A lot of it makes me think, what kind of judgment does this person have?" said the company's president, Brad Karsh. "Why are you allowing this to be viewed publicly, effectively, or semipublicly?"

Many companies that recruit on college campuses have been using search engines like Google and Yahoo to conduct background checks on seniors looking for their first job. But now, college career counselors and other experts say, some recruiters are looking up applicants on social networking sites like Facebook, MySpace, Xanga and Friendster, where college students often post risqué or teasing photographs and provocative comments about drinking, recreational drug use and sexual exploits in what some mistakenly believe is relative privacy.

When viewed by corporate recruiters or admissions officials at graduate and professional schools, such pages can make students look immature and unprofessional, at best.

"It's a growing phenomenon," said Michael Sciola, director of the career resource center at Wesleyan University in Middletown, Conn. "There are lots of employers that Google. Now they've taken the next step."

At New York University, recruiters from about 30 companies told career counselors that they were looking at the sites, said Trudy G. Steinfeld, executive director of the center for career development.

"The term they've used over and over is red flags," Ms. Steinfeld said. "Is there something about their lifestyle that we might find questionable or that we might find goes against the core values of our corporation?"

Facebook and MySpace are only two years old but have attracted millions of avid young participants, who mingle online by sharing biographical and other information, often intended to show how funny, cool or outrageous they are.

On MySpace and similar sites, personal pages are generally available to anyone who registers, with few restrictions on who can register. Facebook, though, has separate requirements for different categories of users; college students must have a college e-mail address to register. Personal pages on Facebook are restricted to friends and others on the user's campus, leading many students to assume that they are relatively private.

But companies can gain access to the information in several ways. Employees who are recent graduates often retain their college e-mail addresses, which enables them to see pages. Sometimes, too, companies ask college students working as interns to perform online background checks, said Patricia Rose, the director of career services at the University of Pennsylvania.

Concerns have already been raised about these and other Internet sites, including their potential misuse by stalkers and students exposing their own misbehavior, for example by posting photographs of hazing by college sports teams. Add to the list of unintended consequences the new hurdles for the job search.

Ana Homayoun runs Green Ivy Educational Consulting, a small firm that tutors and teaches organizational skills to high school students in the San Francisco area. Ms. Homayoun visited Duke University this spring for an alumni weekend and while there planned to interview a promising job applicant.

Curious about the candidate, Ms. Homayoun went to her page on Facebook. She found explicit photographs and commentary about the student's sexual escapades, drinking and pot smoking, including testimonials from friends. Among the pictures were shots of the young woman passed out after drinking.

"I was just shocked by the amount of stuff that she was willing to publicly display," Ms. Homayoun said. "When I saw that, I thought, 'O.K., so much for that.' "

Ms. Rose said a recruiter had told her he rejected an applicant after searching the name of the student, a chemical engineering major, on Google. Among the things the recruiter found, she said, was this remark: "I like to blow things up."

Occasionally students find evidence online that may explain why a job search is foundering. Tien Nguyen, a senior at the University of California, Los Angeles, signed up for interviews on campus with corporate recruiters, beginning last fall, but he was seldom invited.

A friend suggested in February that Mr. Nguyen research himself on Google. He found a link to a satirical essay, titled "Lying Your Way to the Top," that he had published last summer on a Web site for college students. He asked that the essay be removed. Soon, he began to be invited to job interviews, and he has now received several offers.

"I never really considered that employers would do something like that," he said. "I thought they would just look at your résumé and grades."

Jennifer Floren is chief executive of Experience Inc., which provides online information about jobs and employers to students at 3,800 universities. "This is really the first time that we've seen that stage of life captured in a kind of time capsule and in a public way," Ms. Floren said. "It has its place, but it's moving from a fraternity or sorority living room. It's now in a public arena."

Some companies, including Enterprise Rent-a-Car, Ernst & Young and Osram Sylvania, said they did not use the Internet to check on college job applicants.

"I'd rather not see that part of them," said Maureen Crawford Hentz, manager of talent acquisition at Osram Sylvania. "I don't think it's related to their bona fide occupational qualifications."

More than a half-dozen major corporations, including Morgan Stanley, Dell, Pfizer, L'Oréal and Goldman Sachs, turned down or did not respond to requests for interviews.

But other companies, particularly those involved in the digital world like Microsoft and Métier, a small software company in Washington, D.C., said researching students through social networking sites was now fairly typical. "It's becoming very much a common tool," said Warren Ashton, group marketing manager at Microsoft. "For the first time ever, you suddenly have very public information about almost any candidate."

At Microsoft, Mr. Ashton said, recruiters are given broad latitude over how to work, and there is no formal policy about using the Internet to research applicants. "There are certain recruiters and certain companies that are probably more in tune with the new technologies than others are," he said.

Microsoft and Osram Sylvania have also begun to use networking sites in a different way, participating openly in online communities to get out their company's messages and to identify talented job candidates.

Students may not know when they have been passed up for an interview or a job offer because of something a recruiter saw on the Internet. But more than a dozen college career counselors said recruiters had been telling them since last fall about incidents in which students' online writing or photographs had raised serious questions about their judgment, eliminating them as job candidates.

Some college career executives are skeptical that many employers routinely check applicants online. "My observation is that it's more fiction than fact," said Tom Devlin, director of the career center at the University of California, Berkeley.

At a conference in late May, Mr. Devlin said, he asked 40 employers if they researched students online and every one said no.

Many career counselors have been urging students to review their pages on Facebook and other sites with fresh eyes, removing photographs or text that may be inappropriate to show to their grandmother or potential employers. Counselors are also encouraging students to apply settings on Facebook that can significantly limit access to their pages.

Melanie Deitch, director of marketing at Facebook, said students should take advantage of the site's privacy settings and be smart about what they post. But students may not be following the advice.

"I think students have the view that Facebook is their space and that the adult world doesn't know about it," said Mark W. Smith, assistant vice chancellor and director of the career center at Washington University in St. Louis. "But the adult world is starting to come in."

Wednesday, June 07, 2006

JD Power Car quality ranking

June 7, 2006
Toyota Dominates 2006 Quality Rankings
By THE ASSOCIATED PRESS

Filed at 11:04 p.m. ET

DETROIT (AP) -- Toyota Motor Corp. held onto its dominant position in annual vehicle quality rankings, which were revamped to highlight design and layout problems that can irritate consumers as much as defects.

Toyota and Lexus, the automaker's luxury brand, took the top spot in 11 out of 19 vehicle categories in the survey released Wednesday by J.D. Power and Associates. Porsche AG came in first in the overall ranking of brands, averaging 91 problems per 100 vehicles. That compared with an industry average of 124 problems per 100 vehicles.

The study, in its 20th year, was revised to isolate consumers' concerns about design flaws, as distinct from defects and malfunctions. The change in methodology makes year-to-year comparisons impossible.

However, a parallel survey conducted using the old methodology found that as a whole, the industry improved 8 percent from 2005, said Joe Ivers, executive director of quality and customer satisfaction research at J.D. Power.

Lexus came in second in the overall nameplate rankings, with 93 problems per 100 vehicles, while the Toyota brand was fourth with 106. The two brands scored particularly well on the defect side of the equation.

''They're the closest thing to defect-free,'' Ivers said Toyota and Lexus.

On the other hand, Porsche's top ranking had a lot to do with good design: It had the least number of design problems of any brand, but was behind Lexus when it came to defects and malfunctions.

The design issues that tended to irk people most were those having to do with ergonomics and the integration of technology into a vehicle, Ivers said.

A prime example was BMW AG's BMW brand, which had an average of 142 problems per 100 vehicles. It ranked among the best for defects and malfunctions, but took a beating from survey respondents in the design area. In particular, Ivers cited BMW's iDrive system, through which many different controls are operated by a single knob.

Bob Lutz, vice chairman for global product development of General Motors Corp., criticized ''systems where you gather everything under one control and then you are asked to scroll through menu after menu trying to do things.

''We are used to having certain vehicle controls in certain places,'' Lutz said Wednesday at an auto interiors show in Detroit prior to the release of the J.D. Power results.

BMW spokesman Dave Buchko defended iDrive, saying customers expect cutting-edge technology from the brand.

''New stuff is new,'' he said. ''It takes a bit of time to gain some familiarity with it.''

But Ivers argued it is possible to integrate new technology in a way that doesn't make a vehicle less user-friendly. ''Porsche has all the functions but none of the complaints,'' he said.

Even Toyota and Lexus could improve when it comes to technology and ease of use. Jim Lentz, group vice president for Toyota's U.S. sales division, said some complaints focused on use of the handsfree system for cell phones and even the clocks in vehicles.

In vehicle segments, Toyota had five winners, including the Corolla for compact car, the Camry for midsize car, and the Sequoia for large sport utility vehicle. Lexus had six top vehicles, including the IS 250 and IS 350 for entry premium car, the SC 430 for premium sporty car and LX 470 for large premium SUV.

Of the Big Three domestic automakers, General Motors made the strongest showing. Its vehicles won in two segments: large pickup (Chevrolet Silverado LD) and large car (Pontiac Grand Prix).

DaimlerChrysler AG's Chrysler Group had a hit with the Chrysler Town & Country, which was the top-ranked van. Ford Motor Co. also won a segment with the Ford Ranger for midsize pickup.

Hyundai Motor Co. scored a sleeper hit with consumers, with the Hyundai brand coming in No. 3 with an average 102 problems. The Hyundai Tucson took the top spot for compact SUV or crossover.

J.D. Power, based in Westlake Village, Calif., collected responses from 63,607 purchasers and lessees of new 2006 model-year vehicles after 90 days of ownership for the study. This year's survey included 217 questions, up from 135 in previous years.