Sunday, May 21, 2017

Don't Tug On Superman's Cape. Or Ironman Head Ref Jimmy Riccitello


Jimmy Riccitello, Ironman Head Referee


You don't tug on Superman's cape
You don't spit into the wind
You don't pull the mask off that old Lone Ranger
And you don't mess around with Jim*

*If you happen to be in an Ironman triathlete that is!
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Before the blog, first this about the enormous good done by Jimmy's team. 
2014 Race Across America Team Intrepid Fallen Heroes


 From Intrepid Fallen Heroes web site:  June 27, 2015, Team Intrepid Fallen Heroes won their division in the Race Across America- a 3000 mile competitive endurance bike race- this year as a 4-person mixed team. Riding from Oceanside, CA to Annapolis, MD in 6 days, 13 hours and 49 minutes raising $640,000 to support American military personnel suffering the effects of traumatic brain injury (TBI) and their families.  

In June 2014, Team Intrepid Fallen Heroes participated in the Race Across America winning the 8-person team division and raising $650,000 to support our wounded military heroes suffering from traumatic brain injury. The team races again this year with a goal of once more achieving victory and raising even more funds for our wounded troops. Please join us in this great challenge.  http://www.fallenheroesfund.org

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Refereeing an Ironman

Several years ago, while on a rolling section of the Queen Ka'ahumanu Highway portion of the IMH bike course, one of the motor scooter bound bike refs was just itchin' to get someone. They sat off to my left rear. Lurking. Waiting. Like a mosquito on a hot summer day. There was a sizable group of athletes whose positions relative to the other bikes were totally dictated by the terrain. A spreading out occurred going downhill with the inevitable bunching up come the next short up hill. And that's when the ref struck nabbing a slew of folks allowing them a short "unplanned rest" in the penalty tent. I sent a note to the race office describing what I felt was just not the standard I'd
expect of an Ironman referee, unfair really, and the following year I saw no ref behavior of this kind. Thanks guys.

Fast forward to 2010 when I first met the Ironman Head Referee, Jimmy Riccitello, the man does indeed set the standard. Multiple times I saw him help out an athlete or aid in race conduct at that years event, never drawing attention to himself. On the Friday afternoon before the race, during bike check in, one woman's race wheels didn't make it to Kona and here's Jimmy, butt on the pier, stretching out some sew ups, which he helped this woman mount. All real casual like this happens every day. (Maybe it does.)

12 hours later, the transition area is a madhouse with 2100 nervous, fidgiting athletes, volunteers providing assistance, and bike mechs making last minute fixes. And where's Jimmy?  Helping an age group woman trying to figure out if her speed suit was legal for the swim. Sure you might say why would someone wait until an hour before arguably the most important athletic event of her life to figure this out. But he didn't. He researched the
question and determined that a short run of this particular suit was not legal, unfortunate for her - this was one of them - but she was able to follow the letter of the law with a clear conscience.

I have three kids, and, at the heat of action during the race, I asked Jimmy how many he had. "Two," was the answer. I told him I hope they married my kids if they were anything like their dad.  He just smiled.  Later, when recounting this interaction to an IM employee, she added, "I feel honored to have gotten to know him and work with him the last several years. I have also been with him and his children outside of our work worlds and can validate that he is a wonderful father…a better parent than many. He’s not just the good time dad."

There are other examples but these three illustrate the point. In 2017, where the national pastime is complaining, we are so fortunate to have this gentleman help us both follow the rules and have a successful day doing so.  Maybe he thinks of the athletes as his 2100 children. Who knows. Thanks, Jimmy. Thanks, Dad. But if you plan to stretch the rules, watch out, Jimmy's right around the corner behind you.

Images 1, 4 from Team Intrepid Heroes web site.

Sunday, May 14, 2017

Being Afraid. The Injured Triathlete, Possibly You?


Climbing Mountains, Being Afraid


The finish line, you can stop, your day is a success and it's not even 10am! Woot, woot!


    Although we as triathletes push pretty hard sometimes, we’re rarely outside our comfort zone in other than a physical sense.  In a previous blog, I briefly described hiking the John Muir Trail with my son Ben a couple years ago.  

This was a six day journey through wooded areas, over many creeks and streams, as well as some fairly steep mountain trails culminating in standing atop Mount Whitney, the highest peak in the lower 48, with it’s seeming 100 mile view.  It's hard to imagine doing something better with one of your kids.  On the third day, our longest, after traversing some pretty difficult to navigate terrain (since we were so early in the season and didn’t have the benefit of hikers before us marking the correct trail), we crossed one particular river and unbeknownst to us, were off the trail.  Way off the trail. We tried to back track to a known point, but we were lost.  Lost in billions of acres of land…with no GPS…no cell service…no plan “B”, no nothing.  The only way out of this was to think our way out.

    It’s times like this that occasionally you don’t think terribly rationally.  Like during the run in a 70.3 or 140.6 mile race.  In the former, although you have a tent and food for a week, you don’t know where you are.  And, the in latter, you’ve trained for this for an awfully long time but are rapidly running out of energy and ideas at the same time.  You may have to…oh, don’t even think it…walk!  And walk a lot.

   But for me and Ben in Sequoia National Park, it was one of those times that, with no other option, no chance for help from any outside source, that with a little luck, you “just do it” as Nike would have you think.  You take the information you do have, think the problem through such as you might have done in a college course, and you’ll likely find your way back to the trail. With great relief I might add!

   Injuries to the triathlete can follow a similar path.  One can have a physical problem, seek help from a friend, an internet forum or local medical professional.  But in the end, you know vastly more about yourself athletically than any physician.  This would include the specific training load your body has seen including any recent overload situations, one of the most common sources of injury in my experience.  With just a little help pointing you in the right direction you can frequently come up with your own right diagnosis. 

Hardly a day goes by that I don't get some tri related medical question from an athlete.  I try to put myself in their position, likely one of simple lack of knowledge.  Sean Connery, in the movie finding Forrester asks, "You know what people are most afraid of?  That which they don't understand."  I believe he's correct.  Local triathlete Emily told me once that for her, one of the worst things about an injury is not knowing when it will resolve.  "Will I have this a week or six months?  It seems like you just don't know when you'll get back to regular training.  And your regular approach to each day.  Family. Job. Sport."  It's a pebble in your shoe, an alteration to your routine.  In my mind, both of these rather astute opinions are correct and descriptive of the injured triathlete.

 So how do we get to the next step?  Like being lost in the woods, you think the problem through.  Do what you need to accurately diagnose your problem, and from this diagnosis, the route though the woods back to your training path is revealed like the yellow brick road.
So, next time you find yourself injured, think it through.  Use your available resources, especially your own brain, and sometimes you’ll surprise yourself.  I’ve seen it happen. Sean and Emily would agree.


Good luck, Dorothy! 


Local triathlete finishes her first sprint triathlon.  Yea!!

Monday, May 8, 2017

All Triathlon Careers End Some Day. Is Today Your Day?





Maybe it's time to think that you may have packed your last special needs bag.  Put a different spin on your future.  But then, to one degree or another, don't we all think about the future?  Some of us more than others?

 There comes a time when we need to move on.  Triathlon becomes a less significant factor in life, less of a priority, and training becomes more an obligation than a challenge.  That early morning swim is a burden, not an opportunity to work on a race limiter. Drudgery sneaks in to your lexicon.  We don't intend to give up sport altogether but perhaps revert to predominantly being a cyclist or runner.  Get more sleep.  Spend more quality time with the family, the work mates.  Not be afraid tonight to watch the 4th quarter as Clemson and Alabama play for the National Football Championship because you're supposed to be at the pool at 5:30 am the following day. 
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 The sword of time will piece our skin,

It doesn't hurt when it begins,


But as it works its way on in,


The pain grows stronger, watch it grin.   

                                           Suicide is Painless, Johnny Mandel. M*A*S*H, the movie
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 I know a number of people who were in triathlon for a short while and out.  On to something else.  It was a fling, an accomplishment, but not a lifestyle.  They didn't own a power meter, never found out the answer to a question on Slowtwitch. They weren't certain of the date of the World Championship in Hawaii. (It is in Honolulu, right?)  In fact, they had more on their plates than triathlon. Work, family, hobbies, other passions, etc. were all part of the game and while important, tri didn't take front and center stage in their lives.

 Not so for the woman I met in Kona last year on Friday,16 hours before race start in Kona last year. This was bike check-in, on the pier, for what would be her 40th, that's right, fortieth Ironman distance race.  I'm no Psychiatrist but in discussing the importance of triathlon in her life, the word addiction would have to have entered the conversation somewhere. I got a very pleasant note a while back from an athlete who'd done her 91st IM.


 However, eventually the luster grows dull for the rest of us and we want to, or have to in many cases, secondary to chronic or recurrent injury, pass the torch.  Doesn't matter if you do more than the local spring tri or iron distance racing,  And you know what, it's OK when that day comes.  Really, it's OK.


 "Cal" is one of the best triathletes in our area.  Like a fool, I let him talk me into a workout at the pool a couple years ago, something different he said, just for fun (Cal's kind of fun obviously.) We'd swim 100 yards, jump out on to the pool deck and do ten push ups, and be back in our lane to push off for the next 100.  Can we do it on 2:00? Yes.   Can we do it 1:55?  And the 1:50?  Etc., you get my drift.  Yes, Cal we can.  I think we needed a funeral home consult after that work out.


 But, Cal's life has gotten more complex lately as his kids have gotten older and entered wrestling, travel wrestling, you name it.  Cal's moved away from tri despite having the ability to run a half IM sub 4:30 in the very competitive 45-49 year old age group.  (I'm certain that some of you read this as discarding a gift that you, or I for that matter, will never have.  I feel your pain!) In short, your day to step back from the sport will come.  When it does, it'll be just fine.  Honestly. I saw that day a while back, and it's just fine.






The race is run, how did you fare? How about those other pesky people in your age group?


Image 1, Google Images

Wednesday, April 26, 2017

Bike Crashes; If You Ride Long Enough....


The author with three elated 2016 finishers

"Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do." 

                                                                               H. Jackson Brown, Jr.
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Low back pain, pretty common in our group, is often treated with a non-steroidal anti-inflammatory drug, a skeletal muscle relaxant and a narcotic pain killer.  A recent study published in JAMA with 323 patients who suffered acute, non-traumatic (nonradicular) low back pain found that adding the muscle relaxant and/or oxycodone to the NSAID naproxen alone "did not improve functional outcomes or pain at 7 days' follow up."  

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       "A high school runner in Whitely County, KY was set to compete in a regional cross country meet when she was assigned the bib number 666, "the number of the beast" according to the Bible.  Thacker and her coach appealed unsuccessfully for a new number, so she decided not to race.  "I didn't want to risk my relationship with God," she said.  Sports Illustrated

        In contrast, I was issued race number 666 for an early summer triathlon in Virginia Beach a couple years ago,  prominently displayed on both arms, legs and hands following body marking.  It was a beautiful day to race, hot and sunny, leading to a tad of sunburn in most competitors. I was even lucky enough to win my age group so I might have stayed outside at the post-race party a little longer than usual. Later that day, when showering at home, washing off my race numbers, I learned that heavy Sharpie use works as an excellent sunblock.  Quite tanned from the race, I had noticeably white 666's on both arms, legs and hands, a fact that was pointed out to me repeatedly over the next couple days at the pool!  I wonder if it played a role in my performance.


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Have you ever had a bike crash that required medical attention?

This is a question we put to to the athletes who passed by our questioner following bike check in Kailua-Kona, HI for the 2015 event


Before sun up, a few last minute adjustments

I wondered what I'd find out if I polled the athletes at the top of our sport, mostly age groupers like you and me, about bike crashing.  I've written here before about it as the wider my circle grows the more this topic comes up.  It's hard these days to watch a single stage of a pro bike race or talk up tri at the local pool when somebody doesn't walk in with a swath of road rash running down their leg or shoulder.  Or how about your buddy with the femur fracture following a mountain bike accident?  In my Sunday bike group alone, over the course of several years we've had a hip fracture with surgery, facial fracture with broken jaw during an IM,  and a pelvic fracture mountain biking requiring hip replacement. Oh, and before I joined them, one guy tried to Evil Knievel his way up a ramp.  Bad news though, the bike just stopped and my friend broke his neck. Fortunately, no surgery was required and he's back riding.  

Of the 215 athletes in Hawaii who answered the poll, almost half admitted to serious bike crashes.  Of 149 men, 72 said yes.  And of 66 women, 28 had required a visit to the doctor or hospital.  Of these 72 men who were told to seek further medical treatment, not all did. Surprised?  No, probably not.  But, all 28 of 28 women in our survey who were advised further treatment did so.  One woman claimed 35 accidents.  That, to me, is long past time to find a new sport.

In short, approximately 48% of responders crashed hard enough that at least one care giver felt medical treatment was in order.  To me, this is pretty concerning. I believe we as a group need to be a little more attentive to the potential for injury when we ride becoming a little more selective about the riding surface, surroundings, fellow bikers bike handling skills, you name it to try and get this number to drop precipitously.


We all know someone seriously injured or killed on a bike. Sadly, some of us more than one! Make your Spring resolution one where you will assume further responsibility for your own personal bike safety.  If you need to stay home or ride indoors because of questionable riding surface conditions or it's just too dark with too many cars then so be it.  Better to alter your training...and still be able to train than the opposite.


Sunday, April 23, 2017

April is National Donate Life Month. Might You Have the Need One Day?


"I been up, I been down. Take my word, my way around.  I ain't askin' for much."         ZZ Top


Volunteers, the life blood of any race.
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Organ, eye and tissue transplants offer patients a new chance at healthy, productive and normal lives and return them to their families, friends and communities.






Nearly 120,000 men, women and children currently await lifesaving organ transplants and hundreds of thousands more are in need of corneal and tissue transplants.  On average, 22 people die each day because the organs they need are not donated in time.  Fortunately, one donor can save or heal the lives of more than 75 people.

Registering as a donor is a gift to your family, giving them certainty of your decision to help others in need.  It is also a symbol of hope to those awaiting a lifesaving or healing transplant.

Facts About Organ, Eye and Tissue Donation




People of all ages and medical histories should consider themselves potential donors.  Your medical condition at the time of death will determine what organs and tissue can be donated.

All major religions support donation as a final act of compassion and generosity.

Donation should not delay or change funeral arrangements.  An open casket funeral is still possible.

There is no cost to the donor's family or estate for donation.

In the United States, it is illegal to buy or sell organs and tissue for transplantation.

Living donation is an opportunity to save a life while you are still living.  It is not covered by your donor registration.  Living donors can provide a kidney or a portion of their intestine, liver, lung or pancreas to a waiting patient.

Triathletes are giving people.  This is just one more way.

This information courtesy of DonatelifeVirginia.org   

Sunday, April 9, 2017

"Why is it That the One Who Snores Always Falls Asleep First?


The federal Centers for Disease Control and Prevention calls sleeplessness a public health concern. Good sleep helps brain plasticity, studies in mice have shown; poor sleep will make you fat and sad, and then will kill you.  Where we're concerned, it'll help make you the athlete you want to be.

One of the negatives of being a triathlete, or having the personality that gravitates toward triathlon, is that each of us wants to get six things done in the time allotted for four.  Something has to give; frequently that's time in the sack.  The old, "I know it's bedtime, I'm almost done with ______________"  When you have a couple minutes, this is a good read.  Sleep is the New Status Symbol  http://nyti.ms/2oTpSzj
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While on a Sunday bike ride recently, the topic of snoring came up. I ride with an older group, several of whom will have wine or beer with dinner most nights or maybe something 
later in the evening and that snoring was becoming more of problem.  Two agreed that it was considerably worse on weekend nights after a race.




I'd remembered a couple of things from med school that could contribute, one being alcohol that can overly relax the upper airway tissue.  The other was having a fat neck, not much of a concern in the bike group. But I was sure there were other contributing factors of which we should be aware. The piece from Harvard below covers the subject pretty thoroughly, isn't overly "med speak"  and could be a big help if one is interested.  My thanks to the folks at Harvard.

Snoring solutions

Simple changes can help to turn down the volume.
If your wife or sleep partner often seems bleary-eyed and resentful in the morning, you may be one of the millions of adults who snore habitually—a condition that affects twice as many men as women. Snoring occurs when your upper airways narrow too much, causing turbulent airflow. This, in turn, makes the surrounding tissues vibrate, producing noise.
Snoring is a sign that there is a really narrowed space,” says Dr. Sanjay Patel, a sleep disorder specialist at Harvard-affiliated Beth Israel Deaconess Medical Center. “That happens either in your nasal passages or in the back of your throat.” Some men are snorers because they have excess throat and nasal tissue. Others have floppy tissue that’s more likely to vibrate. The tongue can also get in the way of smooth breathing.
Once the source of the snoring is identified, you can take appropriate steps to dampen the nightly din. These include not drinking alcohol at night, changing sleep position, avoiding snore-inducing medications, and addressing causes of nasal congestion.

How to alleviate snoring

Here are some factors that contribute to snoring and what you can do to alleviate them.
Alcohol. Alcohol, a muscle relaxant, can slacken the tissues of your throat while you sleep. “We see this all the time,” Dr. Patel says. “Spouses say the snoring is tolerable except for the nights when their partner has had a couple of beers.”
Body weight. Extra fat tissue in the neck and throat can narrow the airways. Losing some weight could help to open the airways if the person is overweight or obese, although many people who are lean also snore.
Medications. Medications that relax muscles can make snoring worse. For example, tranquilizers such as lorazepam (Ativan) and diazepam (Valium) can have this effect. In contrast, antihistamines may actually alleviate snoring by reducing nasal congestion.
Nasal congestion. Mucus constricts the nasal airways. Before bed, rinse stuffy sinuses with saline. If you have allergies, reduce dust mites and pet dander in your bedroom or use an allergy medication. If swollen nasal tissues are the problem, a humidifier or medication may reduce swelling.
Sleep position. When you lie on your back, slack tissues in the upper airways may droop and constrict breathing. Sleeping on your side may alleviate this. You can also try raising your torso with an extra pillow or by propping up the head of the bed a few inches.
Smoking. Men who snore are often advised not to smoke, but the evidence this will help is weak. Needless to say, there are already plenty of other good reasons to quit smoking.

Anti-snoring products

Many products claim to help with snoring, but few of them are backed by solid research. One potentially effective option is wearing an anti-snoring mouth appliance, which pulls the jaw (along with the tongue) slightly forward to open the upper airway. An appliance made by a dentist can cost around $1,000. Do-it-yourself kits cost much less, but may not be as well tailored to your mouth.
Nasal-dilating strips are inexpensive and harmless, and some small studies suggest they may help reduce snoring. You apply these adhesive strips across your nose at bedtime to help to open up the nasal passages. Breathe Right is one well-known brand, but there are many others available at relatively low cost.
If you are unsure what to do about snoring, a physician can advise you and also make sure your snoring is not related to an underlying sleep disturbance, common in men, called obstructive sleep apnea. “The louder the snoring, the more likely it is to be related to sleep apnea,” Dr. Patel says. “Not all men who snore have sleep apnea, but if the snoring is frequent, loud, or bothersome, they should at least be evaluated.”
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Sunday, April 2, 2017

MRI's Are Good, But Are They Good For You?




So, after putting your bike on the rack on the car after today's ride, you accidentally step back off the curb and roll your ankle. This is pain, big time pain, as you reflexively flop around on the pavement in agony. As the intensity slowly dissipates, and your bike buddies encourage you to get up if you can and get out of the traffic, you find that you can hardly walk on it and wonder now what? If this is serious, everything's going to change from your scheduled track work out tomorrow to the trip to Disney World next week (you hope not that one, the kids have been looking forward to this for weeks.)

When you get home, you visit you favorite tri forum, post the injury looking for direction from the knowledgeable, but often anonymous (and not so knowledgeable) audience.  The call for an MRI or two, the foot and the ankle, to "see what's going on in there" is heard more than once.

Some time later, rroof (a noted Sports Podiatrist from Cincinnati - and not anonymous) posts, "uh, well maybe you need an examination and a diagnosis first, perhaps an x-ray if indicated." Of course he's right.


This scenario plays out every day on tri forums, in athlete to coach communications, and simple every day life. Those of us in medicine get pushed every day to "take a look" with an MRI when a more appropriate course, and perhaps a less aggressive course, is correct. (MRI - nuclear magnetic resonance - produces images of the molecules that make up a substance, especially the soft tissues of the human body. Magnetic resonance imaging is used in medicine to diagnose disorders of body structures that do not show up well on x-rays.*) Noted researcher Jennifer Hodges has found that, "If they're not the ones paying for the examination, they'll be much more likely to request that it be performed."

Jack Wennberg of Dartmouth’s Center for the Evaluative Clinical Sciences is often quoted as having said: "…up to one-third of the over $2 trillion that we now spend annually on health care is squandered on unnecessary hospitalizations; unneeded and often redundant tests; unproven treatments; over-priced, cutting edge drugs; devices no better than the less expensive products they replaced; and end-of-life care that brings neither comfort, care, nor cure."

It's also interesting to note that this is not just a patient driven phenomenon. In a recent study in the Orthopedic literature, it was found that with physician owned MRI scanners, there was a higher likelihood that a study would be ordered than if the doctor had no financial interest in the unit. Makes you think doesn't it. And these are my peers.



The take home lesson here is that, with MRI examinations that are sometimes billed at over $3000 each (thus the consideration of an ankle MRI, and foot MRI as suggested above, could be billed in excess of $6,000,) some measure of restraint is needed. "Fiscal restraint on the part of both parties," says Hodges. If there's a diagnostic unknown between the doctor and the patient, ask the question, "Would my treatment be changed/enhanced with an MRI? Would we use the information from the scan, positive or negative, to make a decision in my care?" If the answer's no, or perhaps not right now, maybe another treatment entity is appropriate at this time.  Plus, the time you'd be using in the scanner may be used by someone who's really sick or injured and needs it badly.