Friday, July 3, 2015

What if Your Race # is 666?


From Sports Illustrated    "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.


        In contrast, I was issued race number 666 for an early summer triathlon in Virginia Beach two 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. Later that day, when showering and washing off my race numbers, I learned that heavy Sharpie use works as an excellent sunblock.  Quite tanned from the race, I had quite noticeable, very white 666's on both arms, legs and hands, a fact that was pointed out to me repeatedly over the next couple days!  I wonder if it played a role in my performance.
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"According to the Wall Street Journal blog post, Cowboys games at AT&T Stadium can consume up to 10 megawatts of energy, more than is used in three hours by the 3.7 million residents of Liberia."  SI 12/30/13

Wednesday, July 1, 2015

Paleo Rebuttal From IM Age Group Champion: Moderation


The Non-Complaining Triathlete (That's you by the way)


Some races provoke howls of protest from many of the athletes.   But you don’t sucked into the controversy.  You just get over it. Someone has to have a good race.  There’s noise around every race about a swim course direction here or the transition area is too tight there.  The quicker you realize that and don’t worry about it, the easier it is to move in line with your game plan and that’s what you came to do.

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Paleo Balance

In the recent past, I've presented a pro Paleo blog and one that was somewhat less than supportive.  This final installment comes from a physician, Ironman Age Group Champion, and thinker of deep thoughts who takes a more middle of the road approach.



Paleo diet:  Well, moderation in everything seems to be the answer.  My main problems with the Paleo diet are:  There is plenty of evidence that man as long ago as 23,000 years ate grain on a regular basis. While they did not seem to grow more than a little of it, the photos are too grainy to tell, it was part of the diet.  I think you would agree that the data we have of Paleo man is pretty damn small.  Two, fruits and vegetables as we know them today did not exist 15,000 years ago for the most part.  They are a product of very selective breeding and cross breeding.  Three, the area you happened to live (15,000 years ago) had a very large impact on what you ate.  Four, there is pretty good evidence (as I understand it) that Paleo man ate a lot of rodents, bugs and small animals.  They also ate all of the animals (liver, heart, brain, kidneys, need I go on?)  You might enjoy this article from Scientific American. It's thoughtful and has lots of references.

Maybe the Paleo diet stumbles on to the fact that by reducing processed foods, anything that is modified in a significant way from its raw state by types of preservation is a good thing. Chips (and I hate to say this since I love a bag of Fritos now and again!), white bread, kid cereals loaded with sugar...that even adult triathletes eat, artificial cheese, some brands of packaged meats/cold cuts, etc. which have less fiber, iron and protein but overflow with preservatives and sodium are on the naughty list.

Anyway, to me it all comes back to moderation.  I would love to have a big steak or chicken breast for every meal but I still enjoy a good dish of pasta and a cold beer finishing it all off with a large bowl of chocolate ice cream!!



Images 1 and 2 from Google images



Monday, June 29, 2015

Knee Arthroscopy and Blood Clots; Do You Know the Risks?






Arthroscopy of the knee is the single most common orthopedic operation done in this country.  Even so, the risk of blood clots in the legs, also known as DVT (deep vein thrombosis) and subsequent pulmonary embolism has been hard to pin down. A recent study by Dahm and colleagues examined the files of 12,595 patients at their institution having knee arthroscopy over a 20 year period and identified 43 patients with symptomatic clots.  Of these, 5 had a PE, or a clot which travels from the leg lodging in the lung (these can be fatal.)  3 of the 43 would develop a PE at a later date.  The overall incidence of so called VTE, venous thrombotic events, was 0.34 percent.

"Classic risk factors" for post operative VTE include: 

Age greater than 65 years
BMI (body mass index) above 30
smoking
use of oral contraceptives or hormone replacements
chronic venous insufficiency
previous episode(s) of VTE
history of malignancy (cancer)

Although it may seem counter intuitive, the type of procedure performed on the knee did not seem to be a factor nor was the presence of coronary artery disease, diabetes, or type of anesthesia.  Also noteworthy, contrary to what was taught to me for years, the length of procedure or duration of leg tourniquet (wrapped around the thigh and inflated at the beginning of the operation to control bleeding and keep a clear visual field) did not seem to play a role.

The take home here, as noted by Dr. Dahm in performing a retrospective study, is that "we are most certainly underestimating the true incidence of VTE."  So if you may be considering a scope and have one or more of the above risk factors, especially if you have two risk factors, you should consider chemoprophylaxis post op. This is already done after hip or knee replacement routinely and should be discussed by you and your physician.

I can tell you first hand that getting paged to the ICU a couple days after what you and the patient both feel was a highly successful ACL reconstruction to find her with an IV drip in her arm and the diagnosis of pulmonary embolism is surprising to say the least.  The time to figure this out is before the arthroscopy.

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Haven't done an obstacle course race yet?  They're lots of fun.

Muddy but very happy!
  Image 1, Google images




Friday, June 26, 2015

Death in Triathlon Part Two, Athlete Responsibilities



This is part 2 of a two part series dealing with this topic, part one was two days ago.

What are your responsibilities as the athlete?

USAT would say the following. (read each slowly to make sure you understand USAT's actual intent.

Athletes Responsibility

Show up for the race healthy, fit and prepared.

Visit your doctor for a physical examination with an emphasis on heart health before participating.  Unrecognized heart problems are the primary cause of sports-related sudden cardiac death.

Consult with your doctor about any warning signs during training such as chest pain/discomfort, shortness of breath, light-headedness, or blacking out. Your health, fitness level, and preparation should guide your selection of an appropriate race or event.

Your race plan should be consistent with your health, fitness level, and preparation.

Choose an event because it places an emphasis on athlete safety, and is sanctioned by USA Triathlon.

Practice and prepare for open water swim venues. Race day must not be your first exposure to an
open-water swim competition.

Thoroughly review the race’s website and all pre-race communications so you are knowledgeable on the timetable for race day arrival and preparations.

Utilize all checklists and information from the event, USA Triathlon and your coach to mentally prepare for the competition.

Make certain your equipment is safe and working properly. Make
certain your wetsuit fits properly.  Get your bike checked before the event.

During the event, STOP at the first sign of a medical problem such as chest pain/discomfort, breathing difficulties, light-headedness, or unusually high heart rate and seek medical attention. Your life may depend on it. This is particularly important during a race swim, in which rescue poses unique
challenges.

During the event, tend to a fellow athlete who has a medical problem.

Learn CPR and be prepared to use those skills when needed. Ask your family and other supporters to
do the same.



Visit usatriathlon.

Wednesday, June 24, 2015

Death in Triathlon Part One, Surviving the Swim

And I wanted the pride that comes with saying I had qualified for, and finished, the Ironman World Triathlon Championship in Kona. One problem, however.  At the time, I had never competed in a triathlon.  With no background whatsoever in swimming, biking and running, my getting to Kona seemed just about as likely as my chances to pilot the next space shuttle into outer space.

                                                              Raymond Britt, Qualifying for Kona
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Considering Obstacle course racing as a change of pace from triathlon? I highly recommend it.  You can do it with your spouse and/or older kids


Many donate their shoes after events like Tough Mudder

Even the clean up shower can be muddy after one of these fun events

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Lawrence Creswell is a terrific swimmer and physician. As a thoracic and cardiothoracic surgeon, he may be especially qualified to comment on an article first published in Bloomberg.  Like me, he is interested in keeping the sport safe for all regardless of age or experience level.  Below is a reprint of one of his recent posts but first a few words.


I first became interested in death in triathlon once it was sensationalized by the media.  As a swimmer, seeing that the deaths were listed as drowning, I took particular interest in the swim portion of the race and why we as a group of smart people didn't have a better handle on causes and cures of this issue. 




What's  really happening here?  Well, some would have us believe it a 50-50 proposition that we make it to the finish line alive.  But, sadly, there are those who, in fact, do not make it, participating in a sport they love.  They usually do not make it through the swim.


 When observing any mass swim start like than of an IM, people starting, people stopping, swimming over, and getting swum over by fellow entrants, who can say that triathlon isn't a contact sport?  But that's not what we want.   Even in wave start events like the 2011 NY tri, a 64 year old gent was pulled from the water, cause of death listed as heart attack.  Also in that race, a 40 year old mother of three, and stated to be, "in great shape, swam the course the day before," succumbed, her autopsy inconclusive.




 Unlike marathons where those who die seem to do so in the final mile, partiularly males, in our sport it's the swim.  Some lake, some ocean, some olympic, some half, some IM.  Many of these athletes are both experienced and adequately trained...just like you!  A cardiologist would tell you that the stress of the swim is more like likely to produce a rhythm disturbance of the heart, or fluid collecting in the lungs.  It's called pulmonary edema.  Add to that the anxiety the swim produces which can be significant, the difficulty being spotted in the water if in trouble, lack of ability to rest, and so many of us coming from a swim-bike background, and at least a series of possible partial explanations comes forth.


There's a lot more to this discussion but suffice it to say that a lot of people are looking at it, and although I didn't think so for the longest time, you and I should be one of them.   So to summarize, at present, deaths are rare but they do occur.  When they happen, it's in the swim, cause(s) unclear.  Arrhythmia and pulmonary edema are being studied the most, heart disease in the older athletes.  The USAT Report can be read in it's entirety at  A quick summary to enhance your understanding.
file:///C:/Users/Owner/Downloads/USATFinalReport_24OCT12%20(1).pdf
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From Dr. Larry Creswell


@athletesheart


Cardiothoracic Surgeon, Jackson, MS

Last week, Bloomberg published an on line article by Natasha Khan and Shannon Pettypiece, entitled "Men Over 40 Should Think Twice Before Running Triathlons," that opened with the line, "For men competing in triathlons past the age of 40, the grueling slog to the finish line could be their last."

I can tell from inquiries I've received and from on line and Twitter chatter that this article received a lot of attention.  Of course, there are a lot of male triathletes older than 40!

I don't ordinarily think of Bloomberg or BusinessWeek as a source for information about personal health.  That Bloomberg would publish this article speaks to the current general interest in the intersection of health and endurance sport.  And men older than 40 must certainly be an important demographic for Bloomberg.

At the outset, let's agree that the headline and lead sentence--probably furnished by an editor for the sole purpose of garnering attention--are sensational.  The rest of the article is more balanced, though, and there's a fair amount of factual material that should interest male athletes.  Let's take a look:

1. A personal account.  As a jumping off point, the article shares the sad story of 55-year-old business executive and triathlete, Michael McClintock, who died of cardiac arrest after a training session.  When athletes die at high-profile events like marathons or triathlons, the incidents capture the public's interest.  When athletes die on the treadmill, the high school track, or the local swimming pool, they receive little attention.  A handful of athletes die at running races or triathlons in the U.S. each year; several thousand athletes die each year in non-race settings.  The story of Mr. McClintock is typical.  One of my heart surgery partners died on a hotel treadmill a while back.

2. Sports-related sudden cardiac arrest (SCA) is truly much more common in adult male than adult female athletes.  Like the article suggests, men older than 40 should think twice about exercise.  Men in this age category should due diligence, with their physicians, to their heart health and any potential risk of participating in an exercise program or training for and competing in events like triathlon.  That's only common sense.  Sports-related SCA can happen with any sport, regardless of how strenuous it might appear.  But other forms of heart disease are common in athletes and non-athletes, alike.  Prevention is worthwhile. Finally, it's important to remember than women and younger men are not immune from the problems of SCA or heart disease in general.

3. Triathlon swim.  In triathlon, the greatest risk for SCA does indeed occur during the swim, for reasons that are not entirely clear.  The article mentions one potential theory related to the body's neurohormonal systems that has been proposed by British physiologists.  I've written about this possibility here at the blog.  This is just one theory.  The truth is that we don't yet know enough about SCA during the triathlon swim.  USA Triathlon prepared a checklist that may help athletes reduce their risk.

4. The experts are triathletes.  It's nice to see the article quoting expert cardiologists who also happen to be triathletes.  Dr. James O'Keefe is a very capable triathlete and Dr. Andre La Gerch is an exceptional runner (think 1:10 half marathon) and triathlete (think ~4:10 half Ironman).  Perhaps some extra credibility on these issues!  Their advice is sound.  In particular, Dr. La Gerche reminds us to pay attention to warning signs of potential heart disease:  chest pain/discomfort, difficulties breathing, palpitations, unusual fatigue.

5. The long-term.  Dr. O'Keefe introduces the concept of some sort of "sweet spot" for exercise and the idea that "more is not necessarily better."  We know very little at present, but there may well be important heart risks associated with prolonged involvement in endurance sport.  We should pay careful attention as new information becomes available.

6. Competition changes. The article mentions the recent initiative by World Triathlon Corporation (WTC), called SwimSmart.  I've written here at the blog about this initiative and a corresponding initiative by REV3 Triathlon designed to improve race safety.  It's encouraging to see major event producers work to promote better race safety.  WTC just introduced a terrific short video about swim safety narrated by acclaimed triathlete, Paula Newby-Fraser.  It's worth watching.

In part two we'll look at the responsibility of the athlete.

Thursday, June 18, 2015

Can You Walk the Entire Run Portion of Your Race?

Ron Clarke Dies

In today's New York Times you'll find the obituary of 78 year old Australian runner Ron Clarke, former holder of many running world records in distances from the half mile all the way up to the full marathon.

It also recalls one of the greater acts of sportsmanship in modern Track and Field history:

Clark was involved in what has been called one of the great moments of sportsmanship. In the 1956 Australian championships, he was leading halfway through the mile when another runner clipped his heel. Clarke fell, and the world-record holder John Landy, trying to hurdle over him, cut him with a spike.

Landy stopped, went back, helped Clarke to his feet and apologized. Clarke said he was fine and urged him to keep going. Landy, by then 30 yards behind, resumed the chase and, in a tremendous burst of speed, caught the rest of the field and won.

Landy's reaching out to help Clarke up was memorialized in a bronze statue of the two that stands at the entrance to a sports-and-entertainment complex in Melbourne.


To read the very well done obit, go to:  http://nyti.ms/1Blw33y
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Walking in Triathlon


Walk/running in T2.
I think at some point, every athlete is forced to walk in an event.  Sometimes, just a little, sometimes a great deal.  I heard an un-thinking athlete once utter, "I'd quit before I'd walk."  My sense is that he just hasn't been entered in enough contests to come across one that possibly through injury, abdominal issues and cramps, or any of a number of other reasons, alters the original race plan.  You know, the one carefully and painstakingly planned to the smallest detail that now goes completely out the window.  In short, everyone needs a plan "B."  That's everyone from Ironman Champion Tim O'Donnell all the way to the ploddingest age grouper, one day the bottom will fall out of your race and improvisation will be the next step.

When it comes to walking, the answer to the title question is "probably."  In a sprint tri there's usually less need. But even here, for athletes not yet in peak race condition who kill it on the bike on a hot day, more than one will be forced to back off a time or two before the 5K is completed.  In a longer event like a 70.3 or full distance Ironman where time cut offs exist, the likelihood goes up.  In fact for many, especially the first timers and more "seasoned" (read older - like this author) athletes, it becomes an actual probability.  In Kona a few years ago one athlete, a nurse from AK if memory serves, suffered a foot fracture of some type between the race in which she qualified and the World Championship in Hawaii.  Her doc said she could still go the distance on the Big Island if she wore one of those knee-high plastic walking boots.  She did, walked 26.2 miles with a smile on her face, and is a finisher today.

So how exactly does one do this and still make the various time cut offs?  When I asked one Ironman veteran, the quick response was, "find a cute guy to walk with you!"  Although it's generally accepted that you can walk 4 mph, usually this isn't attempted after swimming 2.4 miles and biking 112.  Most of us wouldn't be walking if we hadn't some time ago run out of gas so it might not be easy to maintain that pace.  But a goal pace as close to 4 mph should be chosen and adhered to if possible.  As noted above, finding a partner in crime may be the most important piece, however.  Believe it or not, when you're this tired, sometimes it's just plain hard to think and having a like-goaled individual with you can be a big help.  The other significant benefit to a walking partner is that no matter how exhausted or close to dropping you may be, the encouragement of another aching tired athlete will almost always get you to the finish.  The longest recorded split for an Ironman run that I was able to uncover was a gent named John Bales 9 hour and 54 minute "torching" of the distance.  Of course he managed this lightning time in 1981 prior to the addition of time restrictions.  You don't have that luxury!

So a walked marathon at 4 mph is about 6+33 in duration if you don't count aid station stops, bathroom breaks which there surely will be, re-tying a shoe or two, talking with the roving med team reassuring them you're just fine.  Seems like we're at or maybe over 7 hours here.  (At 3.5 mph you're looking at a time approaching 8 hours.) As long as you're off the bike and out of T2 moving by the 10 hour mark of the race (9 hour for a 3.5 mph wayfarer), this should be something you can do knowing that you'll be cutting it awfully close to the maximum time allowed.  Even Cinderella's coach turns into a pumpkin at midnight. 


Tuesday, June 16, 2015

Why T2 is So Important






Aren't people nice? I had a root canal done about 15 years ago and got a call from the doctor's office telling me that he was doing a study and would I possibly be available for a follow up xray.  Reluctantly, I agreed having been in that position before putting together lectures and am always grateful when patients will go out of their way to help out. When I got there this morning, he mentioned, "I think about you almost every day."

"Right, I believe that!" I replied.  "No, really I do. You taught me that copious irrigation, really washing out surgical wounds, would decrease my infection rate.  And you were right.  So whenever I operate on a patient, I think I'm doing the John Post wash out."
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While I thanked him very much, my suggestion was hardly original.  But if I saved any patients from an infection, then it was more than worth it.

The same thing is true in triathlon.  How often, say before a race, are you just sitting in transition waiting, and you see another athlete with different tires, or a funny transition area set up and you ask her, "say, why do you do that?"  People are very willing to share this information with you.  If fact, they consider it a true compliment of that you wish to emulate them.  So for the remainder of your tri career, every time you set your transition area up like you learned that day, you could tell that athlete, "right, I think about you almost every race."


Slow transition? Whadya mean my transition is slow?
T2 - A Place to Regroup

I've always thought that T1 and T2 served different functions in longer races.  In a sprint, my goal is to have the absolute fastest transitions, both of them, in my age group.  If you've read this blog previously, you know that I preach repeatedly that giving away time in transition is just plain dumb for the serious triathlete.  I enter the race thinking, "how close to 1 minute can I make each of these discipline changes?"  And just like practicing flat tire changing, rehearsing transitions before ever race is just plain smart racing.

But, in a 70.3 (when did the half ironman get that title?  When WTC wanted to corner a larger part of the long distance market. Charlottesville, VA attorney and 2004 Kona finisher Mike Hemenway said "nobody wants to do a half anything.  They should call it 70.3.")

  So in a 70.3 or 140.6 race, the transition areas take on a whole new significance.  Especially at the Iron distance

In these longer duration contests, frequently larger races, fewer athletes may be aiming for the podium. The remainder of us just want to finish with a respectable performance and the ability to maintain a near normal gait pattern the next day.  T1 after a 1.2 or 2.4 mile swim is the same.  Animated chatter with the volunteers, see how fast can you get into biking mode after a refreshing morning dip with 2500 of your closest friends, and get a heaping dose of sunscreen to head for your waiting 2 wheeled steed.

112 miles later, with dried salt on your bike outfit, a nutrition plan that may or may not have worked as well as planned, maybe a little less enthusiasm or brightness than upon completion of the swim, you enter T2.  For some, like T1, it's continued press. Push, push, push. But for the remainder of us, T2 can be race changing.  It can be a big contributor to race success.

On one hand, especially for first timers, Iron distance racing may now seem a whole lot harder than last winter when filling out the entry on line with one of your kids in your lap.  It's supposed to be.  But with this brief interlude, like the mango sorbet you get between courses to cleanse your palate at a fancy restaurant, you can clear your brain of the past few hours and focus squarely on the upcoming run.  For some it can be almost spiritual as they blast out of T2 teasing the volunteers who are putting even more sunscreen on you pointing toward the transition exit and the first steps of the marathon.  Even those athletes who may have experienced self doubt and possibly considered turning in their chip feel this rejuvenation. Stimulation is a good thing.

This will sound odd, but for those of you who've been around for a good while, you'll remember that T1 in Kona was on the pier and T2 was at the old Kona Surf Hotel some 7 miles to the south in the golfers locker room.  What made this T2 cool was that you were encouraged to take a full shower in the golfers shower room before your run.  Soap on a rope anyone?

Then you remember why you signed up for this crazy adventure, and another athlete pulls up along side you smiling. "Care to run a little?" you're asked. "Why sure," you answer.  The finish line may be a good ways away, but a journey of a thousand miles begins with.....



Image 1, Google Images