Monday, May 2, 2016

Flying Planned After Your Tri? - DVT Blood Clots May Be A Risk


"I think it is just terrible and disgusting how everyone has treated Lance Armstrong, especially after what he achieved, winning seven Tour de France races while on drugs.  When I was on drugs, I couldn't even find my bike."  
                      
                                                                       Willie Nelson

(I think Willie must live near here.  He was billed to be on stage downtown at Friday's after 5 downtown Charlottesville.  Wouldn't it be great if at age 84, you were still doing what you loved?  I heard he didn't make it though.) 


Perhaps Willie has a flight plan of his own.



Many of us fly some distance to an event, do the race, smile, get a finishers medal - or better if we're lucky - pack up and head to the airport.  This can be a dangerous strategy.  Despite being in peak condition, we may be little dehydrated (or a lot dehydrated in some cases - ring any bells here?) and this puts us at risk for developing deep vein thrombosis (DVT), or blood clots in the deeper veins in our legs.  Although these may cause us mild pain or leg warmth, occasionally there's calf swelling, but in many cases little to no symptoms at all. According to WebMD, When you have a deep-vein thrombosis (DVT), you need to treat it to avoid a life-threatening complication: a pulmonary embolism. A pulmonary embolism (PE) usually happens when a blood clot in the leg breaks away, travels to the lungs, and blocks a lung artery. It can damage the lung and other organs and lead to low oxygen levels in the blood. It can even be fatal!


In short, DVT can be a big deal, and like the other medical issues you had no knowledge of prior to starting this sport, like hyponatremia, understanding how to avoid DVT and it's related problems is the winning way.

First, start that rehydration in earnest before leaving the race course and continue until you are urinating again and it's light yellow.  Experienced competitors already know that depending on the conditions this make take some effort.  In an earlier blog I mentioned talking with one finisher after the Ironman World Championship.  This was at Splasher's Restaurant located at the finish line in Kona who said he'd had several glasses of fluid post-race, more to drink in the condo, and two beers at Splasher's - not one but two beers - before we started chatting. So after what amounts to nearly 100 ounces of fluid replacement, he still had no urge to pee.

If you have some of those knee high compression hose, put them with your post-race clothing so you know to wear them on the jet home. And even though you may prefer that window seat to rest your head against the bulkhead and nap, grab an aisle seat this time so you can get up and move around frequently.  It keeps the muscles in your calves contacting and the blood flowing throughout your legs.





Note right calf appears larger than left calf from behind.


Although the development of a DVT and subsequent PE is fairly rare, I've seen it in my patients enough times to have great respect for the process.  One only needs to check Slowtwitch or other tri forum and the number of athletes who've suffered a DVT is surprising!

Those who are obese, have a blood clotting disorder, take birth control pills, are pregnant or who smoke are at greater risk. If you can remember a few of the symptoms you'll be half way.  As noted above, these can be non-symptomatic but then again you may notice a little calf swelling, perhaps more on one side than the other.  Or, an unexpected leg cramp. Similarly, a pulmonary embolism can be asymptomatic but frequently there's chest pain, shortness of breath, coughing up blood and a feeling of rapid heart beat or sudden sense of doom.  If this description ever fits, it's an emergency and you need get immediate medical attention.

Excellent Resource: http://www.stoptheclot.org/news/article126.htm



Tuesday, April 26, 2016

Juice Cleanses of Little Proven Value, Just Like You Thought


Scrubbing Bubbles like on TV for your innerds?  I don't get it.

A couple years ago, one of my Kona roommates was an earnest young woman from California who, upon leaving the Big Island, was heading home for a juice cleanse WE with a number of  her friends - "for support, sometimes these can be pretty hard." - She was really looking forward to it.  Maybe not so much the cleanse itself but the renewal of old friendships.  As a physician, the idea of "cleaning out toxins" like so much scrubbing bubbles detergent as one would see on TV made little sense.  Like every medical student I suppose, I'd seen the inside of human stomach and intestines in Gross Anatomy class as a first year and I couldn't understand the concept of so many little gastrointestinal soldiers with mops like on a Navy


ship all swabbing the deck inside me.

The New York Times published the following piece yesterday that sheds a similar light on the process.
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Photo

CreditOriana Koren for The New York Times

Misconception: Juice cleansing can remove toxins from your system.

Actually: To say that drinking juice detoxifies the body isn’t quite the same as claiming leeches suck out poisons, but it’s fairly close.
The practice of cleansing has become as ubiquitous as the use of hand sanitizer. Celebrities do it. Spas offer it. Fancy food stores sell pricey bottles of juice to accomplish it, and a $700 juicer will soon facilitate the process for those who are not satisfied with the current D.I.Y. options. But what is it that everybody is trying to remove from their bodies? Is there any science behind it?
“People are interested in this so-called detoxification, but when I ask them what they are trying to get rid of, they aren’t really sure,” said Dr. James H. Grendell, the chief of the division of gastroenterology, hepatology and nutrition at Winthrop-University Hospital in Mineola, N.Y. “I’ve yet to find someone who has specified a toxin they were hoping to be spared.”
Toxins exist. Doctors typically define them as something that enters the body that has a damaging effect on its own — like pesticides, lead or antifreeze — or in large quantities, like alcohol or medications such as acetaminophen, the active ingredient in Tylenol.
But for the most part, the body handles toxins just fine on its own.
“The human body is well designed to eliminate wastes and toxins, and a number of organs play a role,” Dr. Grendell said.
The kidneys and the liver do the main removal work. They draw substances out of the bloodstream and process them for the body to excrete as feces and urine.

MORE FROM OUR WEEK OF MISCONCEPTIONS


When asked what about this process would be helped by juice, Dr. Grendell seemed at a loss.
“It’s hard to understand because there is no good scientific evidence that a juice cleanse, or any other food for that matter, is particularly relevant to removing toxins,” he said.
This isn’t to say that drinking vitamin-rich, antioxidant-filled vegetable juice can’t be beneficial for one’s health, he added, or function as an effective tool for weight loss or resetting one’s habits. It’s the vague talk of toxins that reminds doctors of leeches.
Dr. Antoinette Saddler, a gastroenterologist at the George Washington University School of Medicine & Health Sciences, agreed to read throughone of many blog posts available online about cleansing. She said she was perplexed from the beginning.
A juice diet rests the stomach, it claimed.
“Why does the stomach need resting?” she asked
She read further. Juices require less of the stomach’s digestive processing, it said.
“Who said that was beneficial?” she said.
And then she got to the inevitable detox claim: Juicing “allows the body to have more of the resources it needs to support the phases of detoxification, and even to begin to help remove the cumulative toxins stored in the body.”
“What does that even mean?” she said. Exasperated, she stopped reading.
The blog post was actually written by a doctor, Dr. Woodson Merrell, the author of the book, “The Detox Prescription.” Reached by phone in his Manhattan office, Dr. Merrell, who practices a mix of Western medicine and indigenous traditions, such as Chinese medicine, seemed resigned to dismissive attitudes from gastroenterologists.
Dr. Merrell said what it comes down to for him is that Americans need to eat more vegetables, period. If juicing is the path to that, great.

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“The whole thing about juice is it makes that easier to get. And it’s easily digestible and absorbable,” he said.
As for resting the stomach, he believes well-chewed food is as good as juice, but most people don’t chew well.
“I’m a fanatic about chewing,” he said.
For Dr. Merrell, juice — like any healthful food — provides nutrients that help the liver process toxins, much like grease on a gearshaft. He warned that juice should be thick and contain all parts of the fruit or vegetable, including fiber.
“I’m not talking about some thin watery juice,” he said.
But he also acknowledged that cleansing “has been so overly hyped. Lots of people making wild claims of things.”
_______________________________
The 3 Juice Colon Cleanse: How apple, ginger and lemon can FLUSH pounds of toxins from
 your body http://fb.me/3Pc4M6M35
                  _____________________________________


Similar confusion enters the realm of the colon cleanse, another planet in the detox galaxy. But colon cleanses, which can come as herbal remedies in the form of pills or teas or blended drinks, and sometimes as enemas, don’t push out toxins any more than juice.
“I understand the intuitive appeal of using these colon cleanses — ‘Get the toxins out, make your abdomen feel better,’” Dr. Saddler said.
But that intuition leads one down the wrong road, scientifically.
Stool is actually beneficial to the lining of the colon. Increasingly, doctors are even tapping into its benefits, she said, for example transplanting stool from healthy people into the guts of sick people.
“The idea that stool is somehow poisonous and toxic is very misguided thinking,” she said.
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http://www.nytimes.com/2016/04/21/health/juice-cleanse-toxin-misconception.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=1

Monday, April 25, 2016

Triathletes "Sight Plan" Part 2, Racing


You have to have clear vision for the entire race.


Successful open water swimmers work out the kinks in the pool well before race day
You

In our second blog last week, we went over how to swim straight in open water by sighting, looking straight ahead ever so briefly, during your stroke then making tiny course corrections when needed.  You stay as close to on course as possible and save time by not swimming wide right or left. We also talked about "blind swimming," getting a slight push off the pool wall right down the center of the lane, closing your eyes and swimming a few strokes to see if you veer slightly to the right or the left.  This can all be exceptionally helpful come your first outdoor event.

When you wear a brightly colored swim cap provided by race management, remember that there's a different amount of friction between goggle straps and caps, when compared to sliding them over your cap-less hair.  And, there's a different amount of friction between goggle straps hardly sliding at all over brand new caps compared with older/well broken in ones.

In mass start races, it's recommended that you swim with goggle straps tucked under your cap so that should another racer accidentally run their hand down the back of your head during a stroke, they won't pull your goggles down.  For non-mass starts, either inside or outside seems to work.  But here's the thing.  You're going to practice in the pool, right? Frequently, depending on the goggle brand, sometimes when you push off the wall, the force of the water peels the straps down the back if your head when a cap is on it.  Perhaps adjusting the strap tension can assist but remember the teaching of American swimming great Penny Lee Dean who says you don't want to look like a raccoon when the goggles come off.

The short of all this is if you practice now, in April, TOMORROW at the pool, you'll have one difference between the pool and the lake/ocean mastered and can spend your mental energies on a different aspect of your race.


.  

Wednesday, April 20, 2016

Every Triathlete Needs a "Sight Plan"


You need to be able to swim the shortest route to swim the fastest.


The ability to sight, to see while swimming, is a skill anyone in open water needs
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I was cutting a rug down at a place called the Jug with a girl named Linda Lou....you know the rest for sure.  Summer's coming, get ready to dance.


Our first outdoor swim of the season every year is in a man-made lake.  It's a good venue, the water's clean and organization good.  They also have good food!  If you choose the mile swim, it's a single "lap" of this narrow but long body of water.  The two mile, twice around.  On the outbound leg, it's your first 800 or so meters racing of the year, everybody's feeling good, checking out the houses that circle the lake and their owners sitting in aluminum folding chairs on the docks.  These folks are so close that they'll actually talk to you as you swim by.  All's going well until you make the turn to head home. Then bam! The orientation of the lake is such that on a clear morning, the blinding sun is directly in  your eyes!  For those athletes who didn't consider this fact in their pre-swim planning, and are wearing clear goggles, the difficulty factor just hit the roof.  But it's not all that easy for the rest of us either.  However, it you're well-practiced in sighting your route, you don't have to look all that often to stay right on course for a fast swim.  Not so for our unpracticed, untinted goggle wearing brethren. 


First off, nobody swims exactly straight all the time.  You need to know your pattern before you figure the rest of this out.  Next time you pool swim, when you have a lane to yourself, do what they call blind swimming.  Push off easily from the wall, ensure you're in the center of the lane, then close your eyes.  Take a few strokes, then see where you are in relation to the center of the lane.  Drifted a little to the right?  Left?  Do this a couple times, then wait a couple days and do it again.  See if you're consistently off to the same side.  Most of us are.  I drift to the right.  So when I'm blinded by the sun, every couple of strokes - without looking up - I just put a tiny bit of left correction in knowing I have a pretty good chance of being right.  Then. after a couple more stokes I do look up, evaluate my position, and correct if needed.
Crowds on the sea wall waiting for the first swimmers to return.
I work the pier in Kona every year and on Friday afternoon help run athlete check-in with a lovely woman from the Big Island.  A real hard worker.  After the racer has racked his/her bike, we take them on a quick tour of the starting area/transition zone so it's not foreign to them in the morning.  I always tell my "students" that the start will be so much of a washing machine, 4000 arms and 4000 legs all trying to swim to the same place, that they will not be able to see the first few buoys marking the swim course.  But if they sight on a red roofed hotel I point out to them just beyond the turn around, they won't need to, they'll swim straight and fast.  In your sighting, pick an object far enough in the distance that it is both easy to see when you only have your head out of the water for a split sec, and bright.  Different from it's surroundings.

How frequently you need to look up varies.  There are times in open water when you're in a group, some faster, some slower, and times when you're virtually alone.  In the former you may get jostled or sucked off your line by a nearby swimmer so sighting frequently, as often as every left arm stroke may be needed.  But the times when there's little outside influence on your direction, it would be much less often.  Remember though, when your head is raised, your hips go down killing off some of your forward momentum.

Let's say you never learned to bilateral breathe.  It's time.  Here's where that skill comes in really handy.  Say the wind and waves are lapping up from the right.  No biggie, just breathe mostly to the left.  In a race, it's really hard (for me anyway) to go more than three strokes without taking a breath.  Each time you go to the pool, from now on, take part of your warm up and breathe to the "other" side.  It'll be really awkward at first but you'll pick it up quickly and make yourself just that much more comfortable and competent in the water.

Now, how do you sight?  Let's use the example that you want to do it with the right arm pull. Think fast and low, your googles just barely are above the waterline in front of you. As you begin the right arm pull, instead of rotating your head to the right to breathe, you extend your neck forward, just for a fraction of a second now, as the pressure of your right hand against the water is sufficient to hold the head up.  Practice, practice, practice in the pool. Once you have it down, get your swim buddy and swim side by side sighting, say every 3rd or 4th stroke, to the other end.  Once mastered, add a 3rd swimmer (that's right, three in one lane simulating a part of your swim where you have a good bit of company) so that you get used to sighting in close quarters.  If you wait till the end of a workout, when people are a little tired and giddy, it  can be great fun.

Once again, practice, practice so it's just second nature on race day.  And the finish line will be a sight for sore eyes.  Good luck!!

Sunday, April 17, 2016

Fear Of The Water? Try These Drills?




Apprehended! The red line through the "23" indicates the athlete
was nabbed for a rules violation by "law enforcement" on the bike course!

Ever feel like you just can't get our of bed and to the pool to train or compete? It happens to us all from time to time, but don't blame it on getting older. Ole Larson certainly doesn't. In January, the 92-year-old swimmer from Boone, N.C., participated in the 40th annual Sunbelt meet at Mecklenburg County Aquatic Center in Charlotte, N.C. The six-time national record holder swam six events at the meet, making it look easy and proving that age really is just a number. The desire to compete and stay active, relevant, and healthy is a mindset many Masters swimmers embrace, and we love that about this sport and community. We salute you, Ole, for your long-term dedication to swimming and look forward to watching you compete at the next meet! 
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Comfort Drills

New or nervous swimmers, try these drills to increase your comfort level

Water is not our natural environment. Some swimmers are better at adapting to the aquatic world than others. When you don’t feel comfortable, your body will never be able to realize its full potential in any environment, much less in the pool.
I’ve had the privilege of working with some of the best coaches in the sport of swimming: Milt Nelms and the late Richard Quick. Both were incredible teachers and they specifically were experts in helping swimmers become comfortable in the water, and therefore more efficient in their swimming.

Here are some of the best drills they used and that I recommend you try to gain more efficiency and security in your swimming.


Alligator Breathing

While holding on to the side of the pool with both hands and having either your feet on the bottom or securely on the wall, bring your face close to the surface. Open your mouth as big as possible and have the lower part underwater and the upper part of your mouth still above the surface. Calmly continue breathing with half of your mouth in the water and the other half above the surface. You may choke or swallow a few gulps, but that’s why you should be holding onto the side or standing on your feet. After a few tries, you will figure out how to breathe with water in your mouth.
Most swimmers’ biggest technical problems revolve around breathing. If you can gain confidence breathing with water in your mouth, then you will become a more proficient breather because water almost always finds its way into your mouth when trying to breath. Use this drill to teach your brain that you will survive if you get water in your mouth.

Dead Man’s Float

This drill is also sometimes referred to as your “aquatic signature.” The name pretty much sums up the drill, you float as if your limbs and body were lifeless. Your back should have a nice round curve. Let your legs and arms just dangle. When you need to breathe, simply lift your head quickly and sip some air as low to the water’s surface as possible. When you do this, make sure that only your head moves and that nothing else—no arms or legs—assist in your breathing movement.
This drill helps your body understand that you don’t need to kick or pull in order to get air. Going back to the breathing problems many swimmers have, if you can teach your mind to rely on only your head and neck for air, more of your kicking and pulling power will go into making you faster. That effort can be put toward moving your farther down the pool rather than pushing up for air.

Starfish

Be sure that you have a clear lane to use when performing this drill. Swim any stroke. Somewhere in the middle of the lap, try to stop yourself as quickly as possible and come to a flat, floating position on the surface with your arms and legs spread out like a starfish.
It’s harder than it sounds, but learning how to go from swimming speed to a sudden stop, in the shortest distance possible, is a great skill to learn. Once you have the hang of stopping, try starting from the starfish position as quickly as possible. See how long it takes to get back up to speed. Just like athletes on land benefit from learning to accelerate and decelerate their bodies quickly, the same is true for swimmers in the water.

Underwater Twist Kick

Push off underwater. While staying in a streamline position begin to either dolphin or flutter kick while twisting and rotating all the way around. As you move, continue to kick down the length of the pool while staying underwater. If you can do the whole lap without breathing, that’s great! If you can’t, that’s OK, too, just take a breath as quickly as possible and go back to the underwater twist kicking.
This drill builds new body awareness that can help you hone in on having a balanced kick. It also helps you navigate your ever-changing orientation to the surface, all while traveling down the pool. Alternate twisting clockwise and counter-clockwise. You may find that your kick is imbalanced, causing you to go off course when twisting in one direction or another. Is there a big difference in your effectiveness or speed when you turn one way or the other? This is a great drill for self-experimentation that can teach you how to change your kick to make it straighter and faster.
There are just a few drills that you can use to add variety to your training while teaching your body to be more comfortable and confident in the water. And as that increases, your performance will also improve.
* Always ensure that you have proper supervision when swimming, especially when doing drills underwater.
The above comes from Coach Chris Ritter
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Wednesday, April 13, 2016

Triathletes Give Pain the Cold Shoulder



"Too many heartbreak hills have been conquered by too many dentists - the marathon isn't the ultimate challenge anymore.  Even before fitness became a way of life for millions of Americans, in fact, restless runners were probing beyond the 26.2 mile limit, experimenting with more ego-boosting endeavors.  A swim around Manhattan Island, say, or a bicycle ride up Pike's Peak.  Now we have a whole new class of athletes: men and women who swim 2.4 miles, cycle 112 more and then run a marathon, pausing only to change clothes and scarf a banana. Call them triathletes, endurance buffs or just plain foolish, their crudely cobbled-up specialty -- the triathlon --may well be the fastest-growing participatory sport in America."
                                                                            Newsweek November 7, 1983


Check this athletes foot wear, or lack there of.  Strong gentleman!

Shoulder Pain

While most frequently the source of shoulder pain lies within the shoulder itself, we must keep an open mind for other sources of distress, some relatively rare.  Below is a brief list of some of the more common reason shoulders may give you some pain.   If you're suffering more than just an occasional ache, this list may give you a starting point at self-diagnosis.  Perhaps it's time to have your technique, your swim stroke reviewed by a knowledgeable source in your community. 

Bursitis    Very common among endurance athletes.  Bursitis can be elbow, heel, shoulder, hip, etc. Any place where there is force between two soft tissue structures and the force applied exceeds the bursa's ability to transmit this pressure. Occasionally treated with an injection.

Arthritis   Age related. Wear and tear degenerative change.  The articular cartilage at the bone ends begins to wear.  This can be an irreversible condition, and in some, put a real damper on their triathlon career.  Some would casually say, "well have it replaced."  I'd expect a shoulder replacement to be the death knell in one's tri career.

Dislocation   The head of the humerus (ball part of the ball and socket joint ) "pops out" as I've been told many times, of the joint.  Dislocations happen to a number joints including shoulders, hips, fingers, toes, etc.  The dislocation must be "reduced," or put back in place, sometimes requiring anesthesia.  Recurrent dislocation frequently leads to surgical repair.

Frozen Shoulder  Stiff shoulder, adhesive capsulitis, just some of the many names of this benign condition found more commonly in women than men. There's usually no trauma, the joint gradually loses motion, and the patient realizes she can not longer fasten her bra in back, reach over head, etc.  It commonly takes a good while for this to resolve, even with cortisone injections into the bursa and the joint.  A small number will end up in the operating room for what;s known as a manipulation under anesthesia or even an operation.

Separated Shoulder  Trauma, falling off a bike or from a height leads to a disruption of the ligaments at the outside end of the collar bone.  There are several grades of injury, the more severe of which describe the collarbone sticking up an inch or more giving the joint a very asymmetric appearance. That said most of these do not require surgical repair except under relatively infrequent conditions.

Bicep Tendon Rupture  The bicep tendon, as the name implies, has two heads, and occasionally the long head of this muscle will rupture.  This can be associated with rotator cuff failure but when an isolated problem, the tendon tears from inside the joint giving the arm a "Popeye" appearance.  This can be accompanied by what appears to be significant bleeding but a little blood goes a long way under the right conditions.  Although you'd think a ruptured tendon would almost demand repair, that's not the case here as these very rarely get repaired.  And the Popeye muscle appearance?  It diminishes significantly over time.

Torn Cartilage, SLAP Tear  Much like the meniscus or knee cartilage of the knee, there exists a circular fibrocartilage ring in the shoulder which works much the same way and is subject to some of the same injury patterns.  But, unlike the knee, the shoulder is not a weight bearing joint and similar appearing structures may function in different ways. One example is the origin of the bicep tendon inside the shoulder joint.  When it tears it's what's known as a SLAP lesion and may require arthroscopy to repair or remove it.

Rotator Cuff disease and impingement  This would probably be the most common source of swimming related pain, particularly during the recovery phase of the stroke.  The cuff is made up 4 muscles of the shoulder and functions basically to keep the joint in correct orientation while the stronger muscles like deltoid do the "heavy lifting."  Physical therapy and other conservative measures can be most successful in restoring pain free shoulder function, but they don't do so over night thus cooperation and patience are helpful.

While not an exhaustive list, these are some of the more common shoulder issues and may give you a start on self-diagnosis if your shoulder begins to ache.  An accurate diagnosis is a must if the athlete is to get back to the sport in an expeditious manner.

Monday, April 11, 2016

Triathletes: Forget About Multivitamins/ Finding a Sports Med Doc


A rock star’s death is at once shocking, because rock stars aren’t supposed to die, and no surprise, because many of them should have been dead a long time ago. The cadaverous Keith Richards, at the age of 72, is a living testament to how much self-abuse — heroin, tobacco, alcohol and sleep deprivation — one man can endure. After the apocalypse, goes the old joke, only Richards and cockroaches will remain.  

                                        Richard Egan, NY Times
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Should Triathletes take Multivitamins?

“On October 10, 2011, researchers from the University of Minnesota found that women who took supplemental multivitamins died at rates higher than those who didn’t. Two days later, researchers from the Cleveland Clinic found that men who took vitamin E had an increased risk of prostate cancer. “It’s been a tough week for vitamins,” said Carrie Gann of ABC News. These findings weren’t new. Seven previous studies had already shown that vitamins increased the risk of cancer and heart disease and shortened lives. Still, in 2012, more than half of all Americans took some form of vitamin supplements.”

Paul A. Offit, MD   

Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine



"I'd like to say I'm a recovering triathlete...but I'm not.  And it's pretty obvious."  Sound like anyone in your life?  This is how bad it is. The World Championship is over 6 months away, and I made my flight reservations 5 months ago.  Frequent flyer miles are perfect since airline travel can be right costly, particularly if you wait. 
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Injury, the triathlete and the medical community












OK.   You didn't have an injury problem until you signed on to this crazy triathlon thing.  Now you might need to seek medical help?


I was asked to write the Medical Care chapter of Joe Friel's new text Triathlon Science.  The publisher describes it as "Leave ’em in your wake, leave ’em in your trail, leave ’em in your dust. Get your brain as fit as your body and achieve your triathlon potential."  One of the points I try to make there is to be ahead of the game.  If you know who you'll choose, should you have an injury, prior to having that unfortunate circumstance, it will definitely help out.

Triathletes are what's known in MBA circles as early adopters.  They'll try things (most anything actually) such as compression clothing, Biestmilch or kinesio tape, often with minimal proof/history that the new product/technique is actually beneficial..... but it might be. Maybe.  

An example might be the following: you're on one of the tri forums, and a poster complains of some variety of musculoskeletal problem.   Invariably one of the "expert" responders - regardless of stated problem or knowledge base - notes the "obvious" indication for ART (Active Release).  Well, ART may be helpful in the right setting but the nearest practitioner to my house according to the ART website is an hour and a half away!  Maybe there's a better answer. 


The March 2013 issue of Men's Health has a piece entitled, "Doubting Dr. Google."  The magazine's cover directs you to The World's Worst Doctor, (turn to page 100 and cough, making the point that "A little medical knowledge can a dangerous thing, which makes the Web a virtual minefield."

The photo above is of Bill Vollmar, MD, seemingly "only" a Family Practitioner from
Lancaster, PA and some would say he might have trouble spelling triathlon.
But he is whip-saw smart, takes care of almost exclusively athletes, and since
unlike me he's not a surgeon, would likely have a non-surgical solution to
almost any injury if it's feasible. Only as a last resort would he consider
involving someone who might want to cut on you!  

In my humble opinion, he is so good that he could take care of me and my entire family. Including my 100 mile/week runner son who is running Boston next Monday.


Lord knows I've had my share of musculoskeletal problems - compartment syndrome, plantar faciitis, achilles tendonitis, rotator cuff tear, I could on. The take home point is that, at least for many of us, we don't have to drive or fly hours to the Pro from Dover with the
treadmill and infra red sensing system for a good portion of our medical needs, we just need to know what's available locally.  In fact, like many locations, the go to guy here for most
running related issues is the owner of the running shoe store. With over 30 years of
seeing runners problems, he could take care of the Olympic team!  Plus I'll bet
there are examples of this in your community, possibly the kids swim coach who's been
working on swim strokes for decades for your shoulder related swimming issue.


Look for Primary Care physicians, Physiatrists (a doc who specializes in physical medicine), etc., men and women in your area who've earned the respect of the running/triathlon community as a care giver with a major practice emphasis on sports related problems. They don't necessarily need to be a member of the ACSM, the American College of Sports Medicine, but it's a nice touch.  It's been shown that a respectably high percentage of us are injured annually so simply doing your homework with the other folks at the pool or on the WE long bike ride may give you just the answer you seek.

So, as pointed out in Triathlon Science don't be embarrassed to ask around to see what's available, who's available, for your specific problem.  It very much might not be the local football team doc or orthopedic surgeon, but someone who's just off your radar screen for now.  Help could be right around the corner...and his name might be Bill Vollmar.