Monday, August 22, 2016

Alcohol in Triathlon. How Much is Too Much?

At one point, I held the record for longest time between 1st and 2nd Hawaii Ironman's.  I'm quite sure it's been broken since. 1982-97. Like Mike Reilly observed, like the  appearance of Halleys comet.  Thanks Mike.

Are you ready to drive following an injury or operation?

The following is an interesting quote from AAOSNow, 5/2015 put out by the American Academy of Orthopedic Surgeons.

"One of the most striking findings was that insurance companies and law enforcement agencies generally consider the patient to be the only person responsible for determining when he or she is fit to drive.  There is no "clearance" or "doctor's note" that can help if a patient is in an accident or receives a ticket."

How much alcohol is too much?

The thresholds for safe and healthy drinking change with age. Talk to your doctor about your limits.
No doubt you have heard that consuming alcohol in moderation—one to two drinks per day if you are a man—has been linked to better heart health. But whether an alcoholic
beverage is friendly or hostile to your well-being depends on two things: your current health status and how much you drink. A personalized approach is best.
"For some people, depending on what medications you are taking and other factors, even light drinking might not be a good thing," says Dr. Kenneth Mukamal, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. "For other people it could plausibly be beneficial."

Moderate drinking and health

Scores of studies have examined the association between moderate drinking and health, and many find a consistent connection. Observed in large numbers over time, moderate drinkers appear to suffer fewer heart attacks and strokes, less diabetes, and stronger bones in older age, compared with people who drink lightly or not at all. In this case, "moderate" means one to two standard alcoholic drinks per day for men and one drink for women.
Does this mean moderate drinking actively improves health? We are not sure. Perhaps moderate drinkers also eat healthier foods, exercise more, and control stress better. Or, people who don't drink may be avoiding alcohol because they are in poorer health or because it interacts badly with their medications. If so, this would tend to make the moderate drinkers look healthier in comparison.
At the same time, there is no question that excessive drinking spells trouble. In men, the health effects show up as increased heart disease, stroke, and certain cancers—although part of this traces to the tendency of heavy drinkers to also be smokers.

Common medical reasons not to drink

  • If you take the blood-thinning medication warfarin (Coumadin), alcohol can trigger unwanted bleeding.
  • If you are struggling to control your blood pressure, two drinks a day could noticeably raise your numbers.
  • If you have balance problems, be cautious about how much you drink. It puts you at risk of falls.

What's safe for you?

Two drinks a day may be safe, but only for the average man. "Two drinks a day is an average distributed across the population," Dr. Mukamal says. "There are inevitably going to be people in that population for whom that is not true."
For example, some research has found that people who limit alcohol to between two and six standard drinks per week have a lower risk of cardiovascular disease than people who drink more. That averages out to less than a drink a day. In fact, the American Geriatrics Society suggests that people over 65—both men and women—should limit themselves to one daily drink. Two drinks a day might cancel the benefit, but still do no major harm.
In the end, it is not possible to offer a firm recommendation because of scientific uncertainties and individual differences in background risk for chronic disease. Dr. Mukamal suggests a "personalized medicine" approach. The assessment starts with a conversation with your doctor about whether moderate drinking is safe and prudent for you. "That's a question well worth asking your physician," he says.
Of course, if you don't drink, don't start in hopes of helping your health. Instead, get regular exercise, eat a healthy diet, and of course don't smoke. These steps will enhance virtually every aspect of your health, from overall mood to sexual potency.
"For people who don't drink at all, the consistent message is don't start," Dr. Mukamal says. "There are so many other ways to make your health better that don't raise the complicated issues that alcohol does."

What is a standard alcoholic drink?

Some alcoholic drinks contain more alcohol than others. As with all matters nutritional, you need to consider the portion size. For
example, some cocktails may contain an alcohol "dose" equivalent
to three standard drinks.

Sunday, August 14, 2016

Plea For Thinking about hydration, not reacting to what you read

Losing is Good For You

As children return to school this fall and sign up for a new year's worth of extracurricular activities, parents should keep one question in mind.  Whether your kid loves Little League or gymnastics, ask the program organizers this: "Which kids get awards?" If the answer is "Everybody gets a trophy," find another program.* 


“Water, water, everywhere,
And all the boards did shrink;
Water, water, everywhere,
Nor any drop to drink.”

Although you learned this line in HS reading the Rime of the Ancient Mariner, written by Samuel Taylor Coleridge, who'd have thought that 20 or 30 years later it would apply to you?  The speaker is a sailor on a becalmed ship that is surrounded by salt water that he cannot drink. Perhaps the triathlete, surrounded by conflicting information understands the reference better than many.

If you're over 40 and concerned about race hydration read on. How many times have you, after a workout or race, found yourself thirsty as all get out needing hours it seems to get the tank filled back up?  Although you've calculated your sweat rate and understand current dogma that you should drink to thirst, you see it working for younger athletes, but for you, not so well.  Here's why.

Everywhere you turn there seems to be "10 Rules for Hydration"  or "Must Know Hydration Tips for Triathletes" type articles.  Do them or you're guaranteed to both have GI issues and fail at your event they tell you.

Let's take a different approach, one that say comes from science, experience and the potential that there may be no one size fits all.  If we think historically as little as 10-15 years ago where then current thought revolved around cramming as much fluid in you pre-race and then keeping it that way (potentially putting the athlete at risk for EAH, Exercise Associated Hyponatremia depending on conditions and athlete body habitus.)  We were told to carry a water bottle around with us for the last hour before the race, sipping constantly to fully tank up, urinate right before the gun, and we'd have the best chance at hydration success.

But we all get dehydrated at the same rate?  Perhaps more importantly, is the definition of dehydration the same for all athletes.  I suspect not.  Take the thoughts of two highly respected voices in triathlon, super coach Joe Friel and super nutritionist Asker Jeukendrup. The latter writes passionately that as little as 2% dehydration can affect some athletes performance while Friel has preached for years that the race's victor might be the most dehydrated in the event.  Apply this to your own experience, at the pool for example.  Why is it do you suppose that the folks in lanes 1-4 have their water bottles, suck on them in between sets, but the woman in lane 5 has never brought any sort of fluid replacement and seems to just fine.  In fact, perhaps her performances are better than fine.

It's my contention that the drink to thirst camp and the drink on a schedule are both correct, but in different athletes.  Take for example two Training Bible Coaches I know.  We'll call them Jim and Joan.  Jim's a little older, understands that one's sense of thirst, the feeling that you need to drink given a certain level of water loss, tends to diminish with age, especially once you hit 40.  Jim saw 40 a good while ago.  He can tell you about ending up the med tent after a 70.3 getting not one bag of IV fluid but 2!  "You know, it just didn't cross my mind till near the end of the run I was concentrating so hard on my competition knowing I was on the bubble spot for Kona."  He's always had a fluid replacement schedule since and keeps very accurate mental notes as to how much he's consumed and how it relates to the effort and the conditions.  Joan on the other hand has no particular goal in mind, waits 10-15 minutes after bike mount before drinking per the teaching of Dave Scott, but "just drinks when my body tells me to."  She drinks to thirst as espoused by renowned Tim Noakes. 

So the take home here is to practice, practice and write it down.  See if in other races simply drinking to thirst works for you and it just might.  But if find yourself taking a good long time before you need to urinate, or you drink, drink, drink starting with the water coming from the post-race shower head, then maybe you need to at least be prepared for a minimal drinking plan and be aware of the volumes of fluid taken in.  If you have trouble remembering how much you've consumed, I've seen some athletes put 10 pieces of black electrician tape on their bike, discarding one for each full water bottle.  Or you could develop a system of your own.
KONA CONDO  We still have space in our condo race week in Kona if you or a friend are looking.

*You can read the rest of this well written piece from the NY Times by Ashley Merriman at .

Tuesday, August 2, 2016

Should Triathletes be Circumspect When Taking Antibiotics? You bet!

Triathlon brings out the best in us all

Before I did this blog a while back, I got fairly frequent questions from triathletes about the risk/benefit ratio of a certain class of drugs. "My doctor wants me to take this antibiotic but I'm not so sure," was the typical questioner.  And the concern was valid.  The reason you are seeing this again is that the FDA has recently placed its strongest warning on the box label for this product and it's one you should understand before potentially using this antibiotic.

So, first, the previous blog - it's quick - then a copy of the recent FDA warning with highlights.  At least it's not more bad news about the Olympics and the zika virus.

Antibiotics - we'll find ourselves in a real pickle if we're not careful.  As time passes, greater and greater bacterial resistance to antibiotics is developing.  Fewer and fewer new antibiotics are coming on the market.  If you were Big Pharma, given the potential of billions of dollars invested, would you want to sell a drug to lower cholesterol that once started,  a patient would take for life (generating big bucks for you and your shareholders)....or a new antibiotic they'd take short term.  You obviously see the issue here.

Several athletes have questioned the use of antibiotics lately, especially as it relates to potential complications. For this piece I interviewed pharmacists at: 1) my hospital, 2) a private drug store in the area, 3) a national chain drug store, 4) The PharmD Drug Information office at a nearby large hospital, 4) The Physician's Desk Reference (very big book), etc. to try to give the most well thought out answer.

 Before the discussion, however, we must continually remind ourselves that the days of simply going to the doctor with a problem and expecting to "Get something for it" are gone. Long gone. We as consumers are expected to understand that there are both viral and bacterial origins for a host of infections processes and that antibiotics are ineffective in cases of viral illness. The doctor is expected to know the difference. That said, on more than one occasion, I am quite guilty of giving out a prescription when I was certain that the patients problem was viral. It's what they expected and, particularly when working the ER, was the path of least resistance.

 Depending on your source, the 5 most commonly prescribed antibiotics are Amoxicillin, Augmentin, Penicillin, Zithromycin and either Cipro or Levaquin (also known as ciprofloxacin and levofloxacin). Most of the questions have centered around the last two, members of a family of drugs called fluoroquinolones. This class of broad spectrum antibiotics has been around since WWII coming originally from a drug used in malaria called Chloroquine.

 So, your physician had determined that you have a bacterial infection and needs to choose the "best" form of treatment. But the specific antibiotic chosen is a complex process taking into account the specifics of the patient and the illness, the cost of the different drugs, the insurance coverage and what out of pocket expenses will be, the dosing schedule (once a day, four times a day, etc.) and the likelihood the patient will adhere it, and...oh yeah, potential side effects. In the case of the fluoroquinolones, the potential for tendon problems is noted by the manufacturer as "Ruptures of shoulder, hand, Achilles tendon or other tendons that required surgical repair or resulted in prolonged disability have been reported.....(this risk is increased in patients taking steroids, especially the elderly.)" But simply watch any evening news TV drug ad, say for Viagra, and they quote a list as long as your arm of potential problems. I've heard that after the third one your brain shuts off. Has it stopped people from taking Viagra?

 If you go to the Peoples Pharmacy web site, there are over 100 posts from folks who report a host of problems which they attribute to Levaquin. But if you look at both the significant good that these drugs do and the enormous number of prescriptions written, the incidence of tendon concerns is pretty darn low. In fact, on Slowtwitch, Dr. Rod Roof noted that "The Achilles tendon is a bit overblown (based on the number of tendon issues vs. total prescriptions that is)" and a number of physician triathlete posters have both prescribed and personally used these medications without a downside.


Triathlete take home. Print this and save it somewhere. Next time your doc recommends an antibiotic for your bacterial infection, talk to him/her about it, particularly your knowledge and concerns. And, if after reading this you feel you'd like to stay away from this class of drugs until other options have been exhausted, say so. If you do end up on one, it would seem prudent to first ensure you're not taking a corticosteroid like Prednisone, and to back off the training for a while. In the unlikely event you should experience tendon difficulties, stop the drug and call your doctor. But, again, the incidence seems pretty low and if it were me, this is the thought process I'd use and probably take the drug.  But I'd do so from a position of strength and knowledge.


The New Warning

ISSUE: FDA approved changes to the labels of fluoroquinolone antibacterial drugs for systemic use (i.e., taken by mouth or by injection). These medicines are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient. As a result, FDA revised the Boxed Warning, FDA’s strongest warning, to address these serious safety issues. In addition, FDA updated other parts of the drug label including the Warnings and Precautions and Medication Guide sections.
FDA has determined that fluoroquinolones should be reserved for use in patients who have no other treatment options for acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated urinary tract infections because the risk of these serious side effects generally outweighs the benefits in these patients. For some serious bacterial infections the benefits of fluoroquinolones outweigh the risks, and it is appropriate for them to remain available as a therapeutic option.
FDA is continuing to assess safety issues with fluoroquinolones as part of FDA’s usual ongoing review of drugs and will update the public if additional actions are needed. See the FDA Drug Safety Communication for additional information, including a Data Summary and Additional Information for Health Care Professionals and Patients.
BACKGROUND: The labels of fluoroquinolone medicines already have a Boxed Warning for tendinitis, tendon rupture, and worsening of myasthenia gravis. The labels also include warnings about the risks of peripheral neuropathy and central nervous system effects. Other serious risks associated with fluoroquinolones are described in the labels, such as cardiac, dermatologic, and hypersensitivity reactions. After FDA’s 2013 review that led to the additional warning that peripheral neuropathy may be irreversible, FDA evaluated post-marketing reports of apparently healthy patients who experienced disabling and potentially permanent side effects involving two or more body systems after being treated with a systemic fluoroquinolone
RECOMMENDATIONPatients must contact your health care professional immediately if you experience any serious side effects while taking your fluoroquinolone medicine. Some signs and symptoms of serious side effects include unusual joint or tendon pain, muscle weakness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion, and hallucinations. Talk with your health care professional if you have any questions or concerns (see List of Serious Side Effects from Fluoroquinolones in the FDA Drug Safety Communication).
Health care professionals should not prescribe systemic fluoroquinolones to patients who have other treatment options for acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTI) because the risks outweigh the benefits in these patients. Stop fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course.

Sunday, July 24, 2016

8 Ways To Improve Your Night's Sleep


I'll admit. I've been terribly lax at locking my locker at Earlybird swim.  Just like you I suspect. There are all the usual reasons, "Who's going to get up this early to rifle thru lockers?"  Or "they all have to go by the front desk to get in right?"  

One local swimmer locked her wallet in her car - just like I do - and a determined thief, came into the pool locker room, extracted this woman's car keys from her locker, unlocked the car and swiped the wallet out of it.  The bad news?  They were heading out on vacation and had several hundred bucks in the wallet.  Ouch.  That doesn't include the replacement of driver's license, credit cards, insurance cards, whatever you else you find in a wallet.

So my suggestion to you is an inexpensive combo lock kept on the strap of your swim bag. It's easy, quick and solves all those temptation issues.  Getting a new license and credit cards is a pain you can avoid.

Triathlon is all about attitude.  The right mindset.  You hear it over and over.  This little poem was written in the 19th century and although the wording is a little out of step with our times, the sentiment rings true.

If you think you'll lose, you're lost;
For out in the world you'll find
Success begins with a fellow's will;
It's all in a state of mind.

Full many a race is lost;
Ere even a step is run.
And many a coward fails
Ere even his work is done.

Think big and your deeds will grow,
Think small and you'll fall behind;
Think that you can and you will-
It's all in the state of mind.

If you think you're outclassed, you are;
You've got to think high to rise.
You've got to be sure of yourself before
You can ever win a prize.

Life's battles don't always go
To the stronger or faster man;
But, sooner or later, the man who wins
Is the fellow who thinks he can.

We all know the importance of rest.  But besides leaving our cell phones in another room and turning the alarm clock's red numbers facing away from the bedside, what else can we do to ensure the best chance getting a good night's.  This came out a couple years ago but it's simple enough to be applicable.

Nutrition-wise blog

For your health make it a habit to get adequate sleep

By Katherine Zeratsky, R.D., L.D. and Jennifer K. Nelson, R.D., L.D. May 29, 2014
Throughout 2014 we're talking about the 12 Habits of Highly Healthy People, and this month we will discuss getting adequate sleep. It may be obvious that not getting enough sleep makes people irritable and unable to concentrate. However, there are numerous reasons besides a bad mood that makes sleep an important lifestyle factor.
Sleep is vital for good health and wellbeing. Adequate sleep is important for appetite and weight management — a key to preventing many chronic diseases, such as diabetes and heart disease. Stress is a major contributor to disrupted sleep. In addition, as we age sleep becomes less efficient, lighter and often less restful.
More than 35 percent of adults report getting less than 7 hours a sleep a night. People who don't get sufficient sleep are at greater risk for chronic chronic health problems, as well as from cancer, increased mortality and reduced quality of life.
Try these tips to improve your sleep:
  • Be consistent. Stick to a regular bedtime and wake time.  Consistency reinforces your body's sleep-wake cycle. Try to go to bed and get up at roughly the same times every day, including weekends and holidays.
  • Keep your room dark and quiet. Daylight, other lights or noise can disrupt sleep. Eliminate these disruptions with window coverings, and by closing doors and windows.
  • Be physically active. Regular physical activity helps you fall asleep faster and enjoy deeper sleep. If vigorous activity within 2 hours of bedtime stimulates you, try exercising earlier in the day.
  • Enjoy the early morning sunlight. Consider having your breakfast in a sunny spot. Avoid bright lights 2 to 3 hours before bedtime. This can help regulate the release of melatonin, a hormone that helps regulate your sleep.
  • Watch what you're drinking. Caffeine and alcohol can disrupt your sleep, especially when enjoyed too close to bedtime. Stay hydrated with plenty of water throughout the day, rather than just in the evening, to avoid too many middle of the night trips to the bathroom.
  • Shut off your mind. If you find you wake up at night bothered by thoughts, get up and write down your ideas, read or do another quiet activity to slow down your mind.
  • Unplug. Keep your bedtime routine free of television, laptop and and other portable devices.
Opportunities to explore:
  • Check with your local clinic or health center regarding healthy sleep classes or information.
  • Review your daily schedule, food and beverage choices, and bedtime routine to see what factors might be helping or hindering your sleep.

Take steps to improve your sleep and your health. Strive for 7 to 8 hours of sleep each night. What do you believe are the benefits of a good night's sleep? What is your routine? Or what have you changed?

Thursday, July 21, 2016

When Would You Consider a Cortisone Injection?

"I need more than just words can say, I need everything this life can give me."  Van Halen

DEAL WITH IT the tattoo reads.  Pretty easy to say when you're 30 years old, in perfect health, after a morning practice swim where everything goes well.  But how about the rest of us?  What about those of us with shoulder bursitis, a touch of arthritis in the knee, plantar faciitis, those of us whose training - and therefore performance - are limited by injury or age?

With age/pain/injury/wear and tear occasionally comes the visit to the doctors office, and when deemed appropriate the physician may recommend a cortisone injection.  Should you find yourself in this situation, this piece may help you work with your medical team to determine if this is the best treatment for you.

So, first, what is cortisone?  It's a corticosteroid, a natural hormone made by the adrenal glands.  OK, so what's an adrenal gland?  Humans have two adrenal glands, or supra-renal glands as they're sometimes called, secondary to their being located on top of the kidneys.  This would be near your 12th rib in your back.  Like the thyroid, pituitary and pancreas, the adrenals are part of the endocrine system.

Credit for initial synthesis of synthetic cortisone goes to an African-American researcher named Percy Julian.  He accomplished this almost 80 years ago.

Cortisone, like aspirin and Advil (ibuprofen), functions as an anti-inflammatory agent.   When these drugs are taken orally, the effect is systemic, seen in the whole body.  Even when injected into a joint cavity there can be a systemic distribution of the substance.  The advantage of injectable cortisone is obvious in that when a particular inflammatory condition is diagnosed, a high concentration of the anti-inflammatory medication can be placed at the identical location.

I'm always asked if these injections hurt.  Well, it is a needle but if your skin is "numbed up" first, you hardly feel it.  I've been told countless times "That wasn't so bad" by folks who were prepared for the worst.  And, the educated triathlete also asks about the potential for side effects and yes there are a few.  Although quite rare, infection following a cortisone shot could be quite serious.  However, your physician will thoroughly cleanse your skin with alcohol and betadine to reduce this possibility.  Folks with an iodine allergy are cleansed differently.  If my office is an example, I'd estimate that I  give almost 2,000 of these injections each year, and have for a number of years, but have never had one get infected. Not only that, I know of none occurring in patients of my peers at our hospital.  Diabetics should be told that they may see a short term rise in their blood glucose and it's been reported that very occasionally patients with darker complexions can see a whitening of the skin at the injection site.

The most common negative would be what's called a cortisone flare, a short term painful reaction which spontaneously resolves in a day or two.

So, who is a candidate for a cortisone shot?  In my practice, the most common indication is arthritis, particularly of the knee (see previous blog), followed by bursitis of the shoulder.  It's also used very commonly in Tennis Elbow (see previous blog), Morton's neuroma of the foot, carpal tunnel and trigger fingers just to name a few.  Also, they can be repeated if required although again the intelligent athlete thinks before acting.  In my office, except for knee joint arthritis in the elderly where the plan includes eventual replacement, the limit is usually three.  More than this and you actually run the risk of doing more harm than good by sometimes weakening the soft tissue of softening the joint lining cartilage.

So, the take away is that cortisone injections are not an instrument of the devil and when used judiciously with the right indications and diagnostic acumen, they can be quite beneficial to the triathlete.

Finally this quote:  You never get tired of winning, thus you should never get tired of what it takes to win.

Sunday, July 17, 2016

Prevention of Shoulder Injuries In Aquatic Sports

"I take my children everywhere, but they always find their way home."        Robert Orben

Warm up swim in Kailua Bay, Kona, Hawaii

I've had, as one of the tenets of this blog, "if you don't break it, you don't have to fix it."  I truly believe that over enthusiasm, dreaming, the ground work for "too much too soon" keeps people like me in business.  This is no more true than in high school Cross Country in about two months.  So many young people have not done enough over the summer to prepare their bodies for the rigors of the new season and they get injured.  Add to that the actual physical changes these growing bodies see and it's a set up for problems.

Translate this into triathlon and now with three sports to consider, the negative possibilities increase, especially in a population that doesn't typically find swimming as their favorite leg.  Triathletes are always looking for an edge, free speed, or as bike technology seems to be heading, not so free speed.  We are a community of what's known in Marketing circles as early adopters, one's who are willing to be first on the block to try a new technique or product, even if it hasn't been proven 100% effective (yet) but shows promise.  How else can you explain the myriad of supplements, compression devices, etc., some of which might work well, but many, how shall we say, work less well.

We have as part of our training plans, time built in for dry land exercises, weights, and cross training to both make us stronger as well as potentially diminish the chance of injury.  And make us smarter.  The video below was put together a couple years ago by FINA. It takes 15:00 minutes so if you're looking for the 90 second You Tube experience that will change your life, this isn't it.  This presentation talks about the anatomy of the swimming shoulder, how it works in the aquatic environment, and exercises that are pretty easy to incorporate into your daily routine. I'd ask that, maybe one day this WE, you put a few minutes aside to watch the video, and see if there isn't something in it for you.  I say this with a certain amount of prejudice as the triathlon swim is my favorite part.  But it wasn't when I entered this sport.  It's only been through trial and error (lots of error), and videos like this, that I've come to feel the way I do.  A knowledgeable triathlete is a faster triathlete.

Wednesday, July 13, 2016

How to Solve Butt Pain on Your Bike

"Truth hurts.  Maybe not as much as jumping on a bicycle with a seat missing, But it hurts."  Leslie Nielsen, Naked Gun 2 1/2

If you've never had this ailment you are most fortunate.  It can really be a "pain in the butt."


Those of us, and there are many, who ride a good deal not infrequently find ourselves with irritation of the buttock which, if we're not careful, can progress to full fledged saddle sores.  And if that doesn't slow you down....

Obtaining the best saddle-rider fit can be a process which takes months if not years for optimum results.  With different materials, contours, sizes, levels of firmness, etc. it wouldn't be unusual for a rider to go through five or more saddles before the best fit is obtained.  And even then, you may not be absolutely pain free. Bicycle shorts or bibs with any one of a number of chamois (butt pad) shapes and densities, chamois creams, etc. can be variables to assist in solving comfort issues.  For an excellent discussion of this, see Jim Lampley .  He is open to contact and enjoys helping solve your seating requirements.

First off, Buttock deterioration is graded in three stages from simple abrasion of the skin all the way to the open, and sometimes infected, sores that can require surgical drainage when severe.  So here are a couple rules to live by to keep this problem at bay.

 1.  Friction is your enemy.  Anything you can do to keep it to a minimum will benefit you.  Examine your bike shorts ensuring that there's no seam or pressure point where there are bumps or ridges.  Consider experimenting with various types of chamois cream.  I've tried many chamois creams over the years (most recently DZ Nuts, supposedly from Dave Zabriske) and always come back to Assos even though it, and everything else they sell, is so expensive.  Plus it's very water soluble and easy to wash out your cycling gear.

                                Assos Chamois Creme -- Saddle Sore Preventer
2.  Cleanliness is next to godliness.  If you had this problem, then it's clean shorts with chamois cream every ride, removing the shorts immediately and showering.  If the skin begins to break down a  bit, a lot of folks use pimple cream, anything with 10% benzoyl peroxide available OTC (as per the directions on the box) short term.  Occasionally one of the antibiotic gels like erythromycin (Emgel) is needed.

3.  Change bike seats for a while, different brand, just to change the pressure your rear end sees. While riding, if you can move around on the saddle, stand, coast downhill putting weight on the pedals, shifting around can be helpful.  Just change.

4.  Is your saddle height correct?  This is key.  They say if it's too high, even a little, that side-to-rocking can contribute to imbalance and.......... and it's easy to fix.

In short, patience is a virtue that really pays off when it comes to comfort on your two wheeled steed.


Kona 2016 - Any chance you'll be there accompanying a family member or friend?

Volunteer for the race as it could be the highlight of your vacation.

It takes about 5,000 people to put on this race and you could be one of them.  There are openings helping inspect bikes, assisting athletes rack their gear and bikes, giving out food and water at the aid stations, just about anything you could imagine.  You need to be 16 to register on line but many of the run aid stations in particular encourage family participation.  All of my kids have done it as have many of the participants of the Primary Care Sports Med Course I used to chair in Kona. Check it out at.  Do it today.

It's funny how the national converstaion changes.  This is Sportswriter of the Year multi[ple times, Rick Reilly, fcrom ESPN less than 4 years ago.