Thursday, October 23, 2014

Yes, You Can Workout Outside in Winter

First draft
Overcoming the Cold, Especially Hands and Feet

Depending where you live, it won't be long

A letter I recently received. 

Although it's author, a UK athlete named James from Guernsey, is not a triathlete, we have the same problem he does.  How to continue to train in an uncomfortable environment?

Hi John,

I think you could be the man I need to speak to!

I'm an open water swimmer from Guernsey in The Channel islands (off the coast of France) and I was really hoping I could get your advice after seeing that you once swam the Channel with Raynaud's?

I also have Raynaud's as you can see from the attached pics. The purple foot is the time I made the mistake of getting in a hot shower after a long cold swim.... You know that feeling....! The yellow foot is typical of all swims, and the same goes for my hands, but the hands had come back to life for the photo..

How did you get on with the channel? Was Raynaud's the biggest hurdle? My main fear is permanently damaging feet/hands with no blood circulation for such a long period of time.

Any advice will be greatly appreciated.

Yes, You Can Workout Outside in Winter

This is the time of year when many folks, the non-believers as it were, think we're nuts.  "What, you're going outside to run in this kind of weather, why you must be K-razy!" 

We spent the holidays in Chicago last year, and on Christmas Eve, when our 25 year old son went out for a morning run, at 0 as in Z-E-R-O degrees, Grandma was after him like flies on flypaper. "How about this wool hat?  Those gloves couldn't be thick enough.  Would you like this scarf?  How about wearing Grandpa's long johns?" etc."  She meant well.  But with a little trial and error, you can still run or bike outdoors providing the footing/traction is safe and visibility OK.  In the car vs runner arena, the car still wins most of the time.

It's been said that you heat up 10-15 degrees once you get going so that's in your corner. A friend tells me "there are no bad runs, only bad gear," meaning you don't need to be cold if you plan properly.  Many of us have other issues like Raynauds Syndrome.  For those readers who may not know (or who may have it and wonder), Raynauds Syndrome is the discoloration and numbness of the fingers that many adults see in response to cool/cold conditions or sometimes changes in emotion. The finger whiteness discussed above, sensory disturbance, and even pain, make them pretty useless when trying to type or any other fine motor activity. In a few minutes, as the fingers begin to warm, they turn blue then a purple-red with a "pins and needles" feeling before they normalize. This whole process can take from just a few minutes to an hour and can be quickened by immersing ones hands in warm water as noted above. Or stick them in your pants.   Women seem to get this more than men, 2nd to 4th decade of life. There are medical answers to this, and especially medicines to avoid, which might increase the frequency of attacks. 

But if you still have questions, head back to your local running shoe specialty shop. Probably not your generic sporting goods store.  But you don't buy your running shoes at a sporting goods store anyway.  Most likely the sales team is made up of runners.  Runners who've had their outdoor exercise for the day already  and would be only too happy to discuss cold hands and feet ,wool socks, mittens, and the like.  It's runners talking about running.  Doing the thing they like second best*.

Raynaud's is pretty common. Many, unknowingly, will have it as an isolated phenomenon and in others, it accompanies a more global process. Those affected will have more issues in the cold conditions than warm, their fingers will have decreased sensation and turn white, almost snow white, on occasion. When placed in modestly warm water for 2 or 3 minutes, the digits re-warm and turn every shade of red and purple you can imagine before simply settling on only mildly red. Once warm, starting a car is easy.

 A surprising number of athletes suffer from Raynaud's Syndrome.  Physiologically, it's a spasming of the small arteries in the digits, often when cold. About 5% of men and 8% of women have Raynaud's and it can affect ears, toes, and even your nose.

Note: I didn't mention that men can get frostbite of their private parts if they don't make allowances for it with their gear.  Take it from the voice of experience, the rewarming process "hurts big time!" Avoidance is best.

If you want to document the possibility of Raynauds, next time it occurs, start taking pictures with your cell phone, and save them for your health care provider. You will be asked about a family history of certain kinds of arthritis, bowel disease and the like. You may find that your complaints are the same (or different) but it's a good starting place.

 My sister and I both have this to a greater or lesser degree and I think I'm the biggest local purchaser of chemical hand warmers at our local backpacking store. But, I ride outdoors all year unless there's snow or ice on the road. Outdoor swimming in winter, however, can present a certain challenge!  Fortunately most triathletes avoid outdoor swimming and the thought of cold water drives them positively - indoors!

The challenge of year round outdoor swimming in colder climates. Ice skates work better.

 That said, I've had it for 30 years, my Mom longer, so it's easy to follow long term. And mostly we just live with it. I use chemical hand and foot warmers biking in the winter, and when it's below freezing I have some Sidi rechargeable warming inserts for my winter biking boots (they're not cheap and don’t work all that well - read that unless they've markedly improved over those 5-6 years ago, don't waste your money). It's all just a matter of preparation. So, welcome to the world of Raynauds Syndrome, it's an inconvenience but not much more.

 A number of readers have had excellent posts about how to solve the cold hands problem that can accompany winter riding. Excellent suggestions have come forth about a variety of different types of gloves/mittens/socks, chemical hand warmers, etc. Some athletes have simply chosen to ride indoors until the bloom of Spring and give those Computrainers a work out. If, however, you want to stay outside all winter, depending upon your climate, some alterations may be in order to remain comfortable.

Seen on the pier in Kona 2014
So, to remain comfortable we have to remain warm. All it takes is a little trial and error. Well, maybe a lot of trial and error. I'd suggest you start by putting a thermometer outside your window to get an accurate temperature before you venture out. It's better than the Weather Channel as you may live a real distance from where they get their measurements. Then, get an idea of what gloves, layering of gloves, mittens and layering/lining of mittens you need at 50 - 55 degrees, 40 - 45 degrees, etc. If your mittens are so bulky that you may lose control of the bike, figure out something else. A reader from last year noted that the important thing was not to layer each digit as you might do with shirts and coats, but to provide a “den” for the fingers. Mittens, more than a single layer, with touching digits and some type of warmer seemed best for him. 

One thing that many over look is a product called Bar Mitts (they also have Mountain Mitts for your mountain bike.) These are sleeve-like neoprene that fit right over your handle bars and block cold, rain and snow...not that you'll be riding outdoors on 23 mm tires in the snow. I hope. You don't even need very thick gloves to stay toasty. I'll admit that they may look a little dorky but the bike group conversation will quickly move on to something else and you keep your hands warm. I'll attach a couple pictures from a local riders bike. 

 One follower offered  "I've found disposable hand warmers to be essential for winter running -- I start using them when the temperature drops below 50. For running races, I wear thin gloves, then hand warmers, and then socks over both. If I heat up too much in the race, I can toss the socks or even the hand warmers."

*Best, you ask?  Eating.

Sunday, October 19, 2014

Cross Training - Try SEAL Team PT in the Off Season


Birthday Push Ups

John Post, MD

As I hung up the phone, and my wife saw that dreamy, days of yesterday look in my eyes, she said, “You didn’t say ‘yes’ this time, did you?”  For the last six months, a younger friend, in great shape and finisher of three Ironman Triathlons, had been after me to join a morning workout group called SEAL Team Physical Training.  Once a month they had Bring a Friend Day.  I would later learn they say, only half jokingly, “Bring a friend on Thursday, lose a friend on Friday.”  And then they all laugh.  All except the new people like me that is. 

They won’t talk to you unless you’re in push-up position.  I looked around and saw several guys who could have been football players in college, or high level runners who may have lost a step, but not two, since then.  About half the group did not look like they were the a.m.  exercise type, a look I would very soon find  was deceiving when we went for our warm up run.  STPT was started in Richmond, VA several years back by a former Navy SEAL who had ideas on making those around him stronger and fitter.  And he needed a job.  It worked well enough that there are branches in Charlottesville and in multiple mid Atlantic locations so far.  They meet outdoors every weekday morning at 6:00 a.m., come rain, come shine, come whatever, and heaven forbid someone’s late.  It becomes an “opportunity to get stronger.”  The group pays for individual shortcomings - we get to do push-ups.  Only 10 or 20 if the instructor is in a chipper mood, 30 or more if not.

   There’s also a curious little ritual I would learn about called birthday push ups as today was the birthday of a bouncy young woman named Rachel.  After hearing this, knowingly the members all went back into push up position (anybody getting tired of push ups yet?) as Rachel jogged to the front. “Everybody ready?” she bellowed in her sweet, young voice. “And…down one, down two, down three…” until we got to twenty four.  “And one for good luck.”  A whispered voice from behind let us know that this is how the group celebrates birthdays.  By doing push ups, naturally.  Don’t you?   One for each year of the birthday celebrant.  But by now, with the work out only 5 minutes old, I was push up-ed out.  So to keep up, I went to my knees and did “girl push ups.”  I’d shortly be informed that, no, sir, they’re not girl push ups but members simply going to their knees regardless of sex.  Got it?  As it turned out we were lucky that the birthday girl was young.  It can be a real bear when one of the older members age up.

Then they go for a warm up run.  Often times it’s the old indian file which I hadn’t done since high school.  And that was a long time ago.  The instructor, looking like he could do 1000 push ups, or looking like he’d just done 1000 push ups, had us line up according to running speed.  Everyone made for the middle, except the high level boys as they loped like Usain Bolt to the head of the line.  Although I’ve lived here for 30 years, and been to this particular park many times for kid’s soccer games, I’d never really given much thought to the neighborhood across the street.  It seems now that maybe I should have been more curious.

If you haven’t run it recently, indian file is supposed to group runners of near similar ability running in a line one behind the other.   The tail end runner sprints to the head of the line, tucks in front, then says “Go” to the new tail end guy or gal and they then sprint to the front.  I was familiar with the concept but the pace was just a tad faster than I could tolerate. Oh, and it was slightly up hill. 

Preparing to cross the road at the park gate, and enter the opposite neighborhood, very fortunately for me we stopped momentarily at the red light.  Long enough for me to catch my breath, sort of, and focus on our intended route.  It was up hill as far as I could see.  “Dear God, we’re not going indian file up there are we?” I thought as the light turned green.  Yes was the answer.

But the Olympics were coming, and I had this image of Roger Bannister rounding the Iffley Road Track at Oxford, head held back, flying over the cinders, as he headed for destiny with Chataway and Brashers falling back out of camera focus, spent, their pacing duties complete.  I put my head down, realized the group had pity on the new guy, and the pace eased just a little as we continued the run.

As it would later turn out, this would be the only time I would nearly drop out of an exercise.  We approached the half way point on the hill as the climb steadily and quickly increased.  Audible breathing spread group wide as my 5 file-mates worked under the strain of the ever increasing effort.  And they were used to this while I was aching for a full breath.  Think iron lung short of breath.  Or as Gilda Radner on SNL playing Roseanne Rosenannadanna frequently uttered, “I thought I was gonna die!”  Ah, I see you’ve been there.

I was literally this close to my last step, forming the words, “I have to stop,” prior to actually speaking them, when the person behind me said, “I have to stop, you all go ahead.”  But we didn’t go ahead.  In what I would soon learn is a signature move at STPT, we all stopped and walked. A guy named Steve said, “We’re not leaving anyone behind,” as if it were a daily occurrence.  Indeed it is a daily, or at least weekly, occurrence.  They never leave anyone behind, even new guys like me.  If the exhausted teammate had waited one-half second longer before confessing his exhaustion, he’d have been encouraging me instead of the other way around.

Later, after enough  bear crawls to have you wondering if that Icy Hot pad was still in the drawer at home, sit ups, more push ups,  crab soccer tag, sprints, and, oh yeah, some more push ups,  the hour workout mercifully came to a close.  Your suffering is complete for today.  You have the mental image of your hot tub at home and a glass of cold iced tea.  That is if you can walk erect long enough to make it to your car.  The group of 50 or so has had a great work out, smiles all around, and my friend asks, “So, did you have fun?  Are you coming back?”  It’s one of those instant decisions that change the path of your life.  “Uh, sure, why not?”

Fellowship among adults is not often easy.  Easier when you’re part of a big company I suppose, or perhaps a member of a Navy helo squadron with lots of other pilots your age.  There’s always a softball game or touch football on Sunday afternoons.  But on the outside, friendship is not guaranteed.  In fact, it can be quite a surprise to those used to, for example, the camaraderie of the hospital doctors lounge or the frat house.  I remember quite clearly the comments of a friend who was quite comfortable with his senior medical position at the hospital carrying over to his community life, easy recognition and great service at the establishments in town.  But when he retired and moved to a new community, he was most dismayed to report that at the barber shop, “I was just the next retiree in line.”

But Seal Team mitigates that.  There are faster and slower runners, faster and slower paddlers on boat days.   I forgot.  They have those rubber zodiac boats you see in the war movies as John Wayne lands at Anzio in search of the enemy, his shirt still starched nicely thank you.  We race.  Most of the time it looks like Wrong Way Peach Fuzz from Rocky and Bullwinkle fame is steering the boat or that the helmsman is way over the legal limit of .08 as we careen across the lake counting stokes as a group.   “One, two, three, one two, three.”  With just a little practice, however, we learn quickly how to work as a group.  The races can be very close, competitive and exceptionally exciting.  They’re usually best two out of three, for the Championship of the Free World level importance, as you might expect.  Both the victors and the vanquished take enormous pleasure from the effort.  But, as the real Navy SEALs say, “It pays to be a winner.”

Everybody’s friendly.   As a physician, I see people from all walks of life in my office, many who’ve discarded any sense of commitment to exercise.   Here at Seal Team, for an hour a day anyway, is a group of folks, 16 – 65 years old, white, black, you name it, who vote with their feet, and paddles, and show up at this always outdoor exercise class regardless of the weather.   Quarterly, we do the Navy Physical Strength Test to get some idea of where we stand.  It’s pull ups, push ups, sit ups, and a mile and a half run for time.  What’s really encouraging in this self-paced work out is that there are all sizes and shapes of “former athletes” some of whom can still run a sub 7 minute/mile pace and others, who, when they start the class, are unable to do even a single sit up.  On the days we do the PST, virtually everyone can see personal improvement.  A sincere effort is made to recognize this improvement in each individual, identifying them by name and accomplishment.  And boy do they improve!  And boy do they smile!

I’ve been with these people, people who have now become friends, for over a year now and even my fitness has improved.  But my birthday’s just over the horizon.  Celebrating it Seal Team PT style would prove to be a tall order for certain given the fact that I was already practicing surgery before a good percentage of the others were even born.  Inside, I was pretty sure that I just couldn’t do it.  I hadn’t in many years.  I couldn’t equal my age in push ups and that it would prove a bit of an embarrassment.  The old man can’t keep up, can’t “chew the leather” as Al Pacino would so famously point out in his Academy Award winning performance in Scent of a Woman.

But I practiced, worked on it, until B-Day arrived, the anniversary of my birth, and they knew it was coming even though I didn’t mention it.  Blame Facebook I guess.   I was called to the front of the group.  More than one smile along the way.   “Everybody ready?”  OK, here goes nothing, I thought.  “And….down one, down two, down...”   We easily passed through twenty, and thirty but by 40 I was beginning to tire.  “Let’s pause and shake it out,” got us, well me actually, a ten second break.  As we got to 50, a voice from the back yelled out in not a little pain, “So how old are you anyway?”

That voice did 15 more push ups, and one for good luck.  And so did I.

These days, when my wife does the laundry, washing the work out clothes, she says, “I put a little vinegar in to get out the stench. And you better hurry up.  I’ve got a big salad and fresh fish on the stove.  Gotta get you ready, you’ll be having another birthday before you know it.”

Wednesday, October 15, 2014

Thoughts on Tires, Ironman and Mama’s Fish House

The Setting Sun Highlights the Kailua Pier and Transition on the Eve of Ironman World Championship

Ready for this?  On Saturday at the Ironman World Championship I watched an athlete in the pre dawn hours of race morning pump up his tires.  He had deflated them the previous day following the antiquated custom of “letting some air out of them so they don’t pop” in the afternoon Hawaiian sun.  He was using his own pump from home not one of the ones supplied by WTC.  But the pump was broken.  Had been broken for awhile.  The needle on the gauge was broken off so he chose to pump the tires up until they felt right.  When I discussed this technique with one of the panic mechanics on the pier, a gent who works in a bike store and does this every day, he mentioned, “Once the pressure gets to 90 or 95 psi I can’t tell if it’s 195.  I doubt he can either.”
The basic importance here is the hopeful elimination of race flats.  But if on race day, with the adrenalin flowing, tires get over (or under) inflated, the athlete is risking not only malfunction and lost time, but an accident should the tire deflate when descending a steep hill at 40 mph .
A second and somewhat sad observation the mech offered was how “ill prepared and ill equipped” some of the athletes were.  In Kona, not only are you expected to be able to handle routine bike maintenance issues, the eager race volunteers are instructed not to mess with your bike or wheels.  They can hold the bike or pump and the rest is up to the racer.  You’d best be ready. 
So many are not.  When it comes to their own equipment be it tires, tire pressure, valves clogged with sealant just to name a few, experience is lacking.  According to my new friend the mechanic, “These people would have a lot less stress if they’d just take the time to understand how their race wheels work.”   (Think Normann Stadler melt down as defending Kona champion after his second flat in so many hours which lead to heaving his not inexpensive bike off the side of the road into the lava fields melt down.*)  This experience comes from using race wheels in training such that when an issue arises, they’ve dealt with it before.
We’re entering the offseason.  Why not see if your local bike store offers a 3-4 lesson course on basic bike maintenance.  If not, ask for a private one.  This is what these folks love to do.  When you show interest in their trade they’re usually most enthusiastic about sharing what they know.
Give yourself the gift of knowledge.  You’ll thank yourself one day.

Restaurant Intentionally blocks cell signal

Mama’s Fish House – the day after the Ironman I flew to Maui to teach a course on office orthopedics to a large group of primary care docs.  On the way back to the Kahului Airport for the flight home to Virginia, first of three flights actually, I had a meal at Mama’s and the food was exceptional.  I’m sure I’ll go back one day if I ever get to Maui again. When I made an off handed comment to the waitress that we were “7 miles from a major airport yet I had no cell service,” I was told, “Yep, we like it that way.”  In fact, it’s intentional.  The restaurant owners want guests to have an exceptional dining experience, not one constant interrupted by non urgent electronic communication, so the building was constructed in such a manner that it's without cellular service. It might also explain why they have free valet parking for all guests.  At first blush it sounds odd, and some of us who are welded to our devices might think mean even, but I enjoyed both the meal and the casual conversation.  Looks like maybe not being connected for an hour two is OK and that the owners were correct.  Nary a cell phone ringing was heard.  Have the Wasabi Fried Calamari if you go.

Saturday, October 4, 2014

Will Arthritis Slow You Down? Maybe Not.

Male and Female Brain Development Report from National Institutes of Health

     All babies start out with the same number of cells, which over nine months, develop into a complete female baby. The problem occurs when cells are instructed by the little chromosomes to make a male baby instead. Because there are only so many cells to go around, the cells needed to develop a male's reproductive organs have to come from cells already assigned elsewhere in the female.

     Recent tests have shown that these cells are removed from the communications center of the brain, migrate lower in the body and develop into male sexual organs. Now the brain is sort of similar to a full deck of cards, so this means that males are born a few cards short, so to speak, and some of their cards are in their shorts.

     This difference between the male and female brain manifests itself in various ways. Little girls will tend to play things like house or learn to read. Little boys, however, will tend to do things like placing a bucket over their heads and running into walls.

     This basic cognitive difference continues to develop until puberty, when the hormones kick into action and the trouble really begins. After puberty, not only the size of the male and female brains differ, but the center of thought also differs. Women think with their heads. Male thoughts often originate lower in their bodies where their ex-brain cells reside.

A question that comes up all too often is the athlete who wants to compete but due to a medical condition beyond his or her control they find themselves to be "former triathletes."  I've always found this to be a troubling definition as the person is, in one sense, allowing themselves to be defined by a sport when they have so much else to offer.  I suppose we're all former somethings. But like Julie Andrews says in Sound of Music, "When the Lord closes a door, he opens a window somewhere."  I firmly believe that when confronted with a situation like this, opportunity is knocking somewhere else in your life and that before too long, you'll open the door where this knocking occurs.

The following is a letter I received recently that may reflect this approach to life:

Dear Dr. Post,
I'm a 51 yo former triathlete who can no longer run due to an arthritic knee that is "bone on bone." I had my last of 3 surgeries in May 2011 and have not been able to run more than 3 miles without increase in pain. This is after a series of 5 sinvisc (sp) shots. They lasted 3 months , but after that back to the pain. I currently swim 15k a week and ride 6 hours w/o too much discomfort save for a hilly , hard ride, then it starts to hurt. The next step is partial or full knee replacement. Can you tell me if there is a chance of running after such a surgery and is there a criteria/series of questions to help a patient decide to have knee replacement? Thank you for your blog, Chris

This is a slight modification of my response.

Chris - this is a big problem that faces many triathletes. As you scan the number of entrants in each age group at your local triathlon, as we age the number of folks in each older group is less than the one preceding. And you know that there are a bunch of former triathletes (like you) who'd like nothing better than to be at the starting line but can't because of arthritis such is present in your knee or some other medical issue.

I'm sitting at the airport having just taught an Orthopedic course to a couple hundred primary care docs this morning and this is what we discussed. Arthritis of the knee comes in many flavors. Some have worn through the cartilage over a wide area while others have a smaller lesion surrounded by normal tissue. It sounds like you're in the former category and replacement, if it's just killing you, may be a surgical option. But, at 51, if you can modify your activities such that you can put off any kind of surgery as long as possible, that might be the best path. If you have such pain that the above is not an option, the partial replacement, Unicondylar Knee Arthroplasty (UKA), is a good option if your disease is predominantly over only half of the knee. It's a smaller operation than a replacement, no ligaments are cut and motion down the road tends to be better. I like it.  Some of us are candidates for an operation called an osteotomy where the knee is slightly realigned redistributing the pressure.  In the right person, these can lead to a pain free joint without putting any hardware into the joint.

As far as running after artificial joint implantation, I don't think you'd find a manufacturer that would support it. But that isn't to say that some haven't done so quite successfully.  I am writing this in the San Francisco airport on the way to Kona.  While you look up when you walk down the street in Hawaii, I look knees, looking for scars and "new friends" to make when they tell me all about their knee surgery and activity level since.

In the global picture, you want whatever is done to last the rest of your life, if possible, and if you have a lot of life left, you'd want this to survive as long as possible before you undergo surgery again. Golf, doubles tennis, light aerobics, hiking, etc. are all on the recommended list.  Running is usually not.  In short, if my brother had a UKA, I would encourage him to be a biker-swimmer-hiker, etc. but to wear his running shoes when he cuts the grass. I suspect that your best advice will come from your surgeon who knows your knee better than any of us. And, while you may on one hand be a former triathlete, I'll bet you're a present something else that will ultimately be even better.  It's only a sport and you're so much more than a sport.  We're pulling for you.  Good luck!

From Michael J. Fox - "It may seem hard to believe, but it's catastrophe that offers the most promise for an even richer life."

Thursday, September 25, 2014

Do Athletes Urinate in the Transition Tents?

Apparently so.

Something's happening here
What it is ain't exactly clear.
                                                                    Buffalo Springfield

No it's not clear, it's yellow.....and it's gross!  

This rule is in effect, it's in the athlete pre race information, but it still happens.

Scenario #1  You're in the men's changing tent at the World Championship.  The race is less than an hour old.   The pros have just come thru like a herd of horses and you've been part of the team that stripped them of their speed suits, tagged the suits, and saved them for later inspection by the officials to make sure they all follow the rules.  (You quickly remember a pro from a few years back who wore a two piece speed suit, but unfortunately he doubled up on the pants part for a little extra flotation and likely heard about it later.)  

Then the age groupers start coming in, slowly at first, and almost before your eyes the changing tent is an absolute mad house!  There are athletes and volunteers helping them just everywhere.  But it's working, and working well as two volunteers direct each new "resident" to a seat of his own with a waiting volunteer to make the visit as brief as possible.  As things start to slow a little, you move to the front of the tent, not far from the exit, to trade places with a guy directing traffic, and you look to your right where this athlete is just standing, a couple feet from the exit from the tent...and he's peeing in his pants.  Well, his tri suit to be more accurate.  And he's doing this standing 15' from a urinal.  Fifteen feet! A whole wall of urinals.  WTF?  Is it worth the 20 seconds gained to leave your urine on the changing tent floor cause you're to friggin' stupid, lazy, careless, worthless to deposit it where it belongs?

Scenario #2  You've flown from the east coast to Kona to volunteer at the Big Dance.  It'll be one of the highlights of your year. When you sign up at the transition tent, they give you your first choice.  The women's changing tent.  It'll be a zoo, it'll be intense, but it will be great.  You have friends who've done it before and they rave about the experience.  You show up at 4:30 am on race day, your special Transition Team ID and brightly colored volunteer t-shirt lets you on the Kailua Bay pier. There are people absolutely everywhere! You meet Sue, your boss in the tent, and learn your duties once the racers start to come in.  It's important to you to get this right.  It's important to the competitors too.  As in the story above, once the pro women are out, and there's a break before the age group gals arrive, having had the first taste of the action you are way ready for some more.  First one, then two then ten and the tent is alive with 100 women moving sort of in the same direction...out of the tent on to the bike.  But when one athlete left her chair heading for her bike, she also left a puddle of urine....for the next athlete to sit in.

Although the details have been altered somewhat, don't be that guy!

Tuesday, September 16, 2014

Thigh Pain (Burning), Meralgia Paresthetica

Through early morning fog I see 
Visions of the things to be 
The pains that are withheld for me 
I realize and I can see.    Johnny Mandel

You know these words as the theme song to M.A.S.H. but it could just as well describe some racer's thoughts as they sit in the transition area waiting to slip into their wet suits and make their way to race start.  It might also be a good time to walk back and forth from the water to your bike, and then from your bike to the run exit. What landmarks do you see?  You need to know the exact path in the heat of the race and others are only guessing.

Natasha, the Swiss Miss, exiting transition. She knows the way by heart.

Burning Thigh Pain (Meralgia Paresthetica)
The nerves in your body bring information to the brain about the environment (sensory nerves) and messages from the brain to activate muscles (motor nerves). To do this, nerves must pass over, under, around, and through your joints, bones, and muscles. Usually, there is enough room to permit easy passage.
Swelling, trauma, or pressure can narrow these openings and squeeze the nerve. When that happens, pain, paralysis, or other dysfunction may result.
A painful, burning sensation on the outer side of the thigh may mean that one of the large sensory nerves to your legs--the lateral femoral cutaneous nerve (LFCN)--is being compressed. This condition is known as meralgia paresthetica (me-ral'-gee-a par-es-thet'-i-ka).
  • Pain on the outer side of the thigh, occasionally extending to the outer side of the knee
  • A burning sensation, tingling, or numbness in the same area
  • Occasionally, aching in the groin area or pain spreading across the buttocks
  • Usually only on one side of the body
  • Usually more sensitive to light touch than to firm pressure
During a physical examination, your physician will ask about recent surgeries, injury to the hip, or repetitive activities that could irritate the nerve. He or she will also check for any sensory differences between the affected leg and your other leg. To verify the site of the burning pain, the physician will put some pressure on the nerve to reproduce the sensation. You may need both an abdominal and a pelvic examination to exclude any problems in those areas.
X-rays will help identify any bone abnormalities that might be putting pressure on the nerve. If your physician suspects that a growth such as a tumor is the source of the pressure, he or she may ask for a magnetic resonance image or a computed tomography (CT) scan. In rare cases, a nerve conduction study may be advised.
Restrictive clothing and weight gain are two common reasons for pressure on a nerve. Your physician may ask if you wear a heavy tool belt at work or if you consistently wear a tight corset or girdle. He or she may recommend a weight loss program. Another reason may result from a seatbelt injury during a motor vehicle injury.
Treatments will vary, depending on the source of the pressure. It may take time for the burning pain to stop and, in some cases, numbness will persist despite treatment. The goal is to remove the cause of the compression. This may mean resting from an aggravating activity, losing weight, wearing loose clothing, or using a toolbox instead of wearing a tool belt. In more severe cases, your physician may give you an injection of a corticosteroid preparation to reduce inflammation. This generally relieves the symptoms for some time. In rare cases, surgery is needed to release the nerve.

Tuesday, September 9, 2014

Yes, It's OK to Walk, Maybe Even Stop For a Bit, During an Ironman

Lava Java...where the elite meet to eat.  Well, everyone in Kona eats there some

"Superman where are you now? Phil Collins, Land of Confusion

30 years ago I ran my first Boston with two friends from Miami.  We vowed to do it 25 years later.  And 25 years older!  Second time around, when the gun started the field of 25,000 in Hopkinton at noon, it was 87 degrees.  It was hot!  Especially for marathon running. 

I've written before that when I got to 20 miles, overheating and way behind on fluids, I made one of the worst decisions of my racing career.  I got on the bus, a yellow school bus, and was driven to the finish. In a vehicle! I was transported like a helpless person to the finish. I was a DNF (a DNF for gosh sakes!) in the famed Boston marathon.  What a dip!

At a lecture by noted Triathlon Coach Joe Friel, he once compared the running boom of the 70's and 80's to the growth of triathlon today. (If you'd been told 20 years ago that someone would pay $40,000.00 or more to get a slot at Ironman Hawaii, you'd thought them clearly insane. Yet, we find ourselves clearly there. The annual Ironman Foundation auction, puts up 4 entries to the race to the highest bidder/donator, the profits going to the Ironman Foundation Charities. This branch of IM donates a significant sum each year to a host of deserving Kona organizations like the rescue squad, various help agencies, etc.

Friel's story went something like this. In the 70's, folks would have a friend convince them to go jogging, like it, and progress to running.  And then strange things would happen. It might start out with a local 5K race, they'd get hooked, and after smoking too much Runners World Magazine, they'd be convinced they could begin marathon training.  And some could. Their lives became consumed with running and a myriad of details until they found themselves running the first 10 miles of a 26.2 mile experience. All went well until mile 18, when they found themselves with shot quads, over heated, and out of ideas. (Oh, I see you've have been there.)

Compare the above scenario to triathlon where it seems easy to tackle the local sprint tri, maybe even an Olympic distance race...and then you start to dream...and a friend of a friend is doing IM Lake Placid...and, "With just a little more training, I could be an Ironman." Well, maybe.

But what happens when you get to mile 95 on the bike, are beat, rethinking how you might have hve been overly aggressive for the first 56 miles and would like to call it a day.  But you're not even off the bike - and there's some running to do shortly.  As Joe Friel says, "You have to have a plan B; you need alternative alternatives."  And simply get on the bus isn't one of them.

In other words, it's OK to stop at a bike aid station and sit in a real chair while taking on fluids for 5-10-15 even 30 minutes.  No one will penalize you or draw a red slash through your race number. It's OK to ask the medical people for a little help, they're not going to take you out of the race unless you're a danger to yourself or others. It's OK to walk. Well, it's ALWAYS OK TO WALK. Or to sit at a run aid station to collect your wits. Then you can proceed at your pace if that's what it takes.  It matters little down the road what your time was, only that you had a plan B and you finished.

You have a full 17 hours to finish this thing. No harm in using all seventeen of them.  If you've thought these potential problems through ahead of time, then during the press of the event where folks don't always make the best of decisions, you'll not decide something in haste that you'll come to regret.

Just think about it. It's been a decade since I DNF'd and I still feel stupid.