Tuesday, September 16, 2014

Thigh Pain (Burning), Meralgia Paresthetica

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

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

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

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

Tuesday, September 9, 2014

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

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

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

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

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

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

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

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

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

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

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

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

Friday, September 5, 2014

Race Stumbling Blocks? You Can Overcome the Unexpected

Do you think, when this athlete was topping off the air in his tires this morning, that he thought, "You know, I'm sure glad I'm the the type of racer who never gets penalized..." I wonder if he was prepared for this.


The Boy Scouts had it right when they chose Be Prepared as their motto


They carried a man off the race course on a stretcher. I heard that he just collapsed on the run.  Maybe it was the heat – a low of 75 degrees last night. And the sun came up well before the first athlete was body marked or the transition area opened to further push the mercury toward inferno status… from a racing point of view anyway. You know, one of those days when the heat simply blasts you when it radiates off the asphalt. It’s a good thing most were wearing hats and could put ice in them at the aid stations. As we watched them load this competitor into the ambulance, we hoped it wasn’t something serious.

 Plan “B.” Everyone needs one. You arrive at the race course and – SURPRISE – no wet suits for the swim (like happened to us recently.) Or – SURPRISE – the expected temperature is 15 - 20 degrees higher than where you live and train. This happened to us at the Boston Marathon a few years ago where runners were just finishing a winter of snow and bitter cold. An unexpected New England heat wave brought temps in to the mid 80’s. 1 degree below the record for that day we we told. The entrants, some of whom had waited their whole running careers to toe the line in Hopkinton on Patriot's Day, were dropping like flies. There were so many people with heat related problems that the enormous armory-like building they use at the finish line with cots as far as you can see, was simply overflowing with “bodies.”

 All too often, racers just plow ahead “business as usual,” and if they’re lucky, only have a poor performance. They wonder why, despite ample beverage intake at the post-race party and more on the way home, they still don’t pee for hours. There’s a take home lesson here.

 There can be course changes, weather curve balls, rightly or wrongly you get penalized  (been there, done that!), alterations to the order of events, unintentionally getting kicked in the stomach, or face –hard- on the swim just to name a few things that cause us to re-evaluate our original race plan. How about a flat tire? But, if we’re to survive and do our best on that particular day, flexible we must be. Despite one’s physical suffering, always try to remind yourself that everyone has the same course to ride and run on, the same swim course and rough sea. Since you've already worked out your plan "b" ahead of time, and don't lose your cool even though at times it can be incredibly frustrating, perhaps you can do it just a little better than they do. In the immortal words of that famous rock group of the 60’s, Pacific Gas and Electric, “Are You Ready?” (http://bit.ly/1xmq2R3)

 So fellow triathletes, 

Be flexible, keep calm when others may not be

Know when you’ve reached your limit and it’s time for Plan “B

And if you encounter something completely new, break it up into it's parts and solve them one at a time.

Oh, the Boy Scouts have a Scout Slogan too.  It's "Do a good turn daily."

Tuesday, September 2, 2014

When it's Time to Quit Triathlon; You'll Know. I hope

Old triathletes don't just fade away, they head to the big T3 at the senior center!

We're back.  This is Mt. Whitney, the highest peak in the lower 48 states.  Variously measured between 14,495, 14,496,.....14,505, you get the point.  If you were piloting a plane, you'd need supplemental oxygen. One can get there from the east by hiking 11 miles from Whitney Portal, or like the route my sons chose, from the west, by backpacking 60.5 miles to a place called Trail Crest....and then the final 2 miles to the summit.  My thanks to Ben Post and Chris Post for 5 wonderful nights on trail.

But , we got to 13,600, and did not summit.  The weather was closing in, people ahead of us were forced to turn around secondary to poor visibility.  Just like in a triathlon when all of a sudden things are not at all like you've planned or experienced in the past.  You use the information you have at hand and make the best decision you can.  Especially one you won't regret.  So we pressed on, hiked out of Sequoia and Inyo National forests and met a great couple from Salt Lake City, Jay and Mary, who bought the first pitcher when we reached civilization.

Two days later, we found out one backpacker, hiking up to Trail Crest on Tuesday just like we were, with the same information we had, made a different decision.  It cost him his life.  (It took a couple days to find his remains apparently as it wasn't reported to the authorities until after he didn't make it back to his starting point.) Decisions in a triathlon are seldom life and death but they are important none the less.

Chris and Ben Post at Bearpaw High Sierra Camp, Sequoia National Park 2014

Calling it a day in triathlon

Sometimes, we just need to call it a day.  One of the guys in my tri circle, we'll call him Walter, is a good athlete.  Very good actually.  He's always at the top of the age group, has qualified and raced Kona, and can always be counted on to push you on a long weekend bike ride.  He's been over to my house for Thanksgiving dinner and my kids love his stories.  But he crashes!

A few years ago we were out in the foot hills of the Blue Ridge Mountains.  Beautiful territory meant for bike riding. (That said, I am always amazed that this far back in the woods, people have dumped mattresses, refrigerators, you name it, in this back woods area.  Wouldn't it be easier to trash the landscape in a place where it would be easier for the rest of society clean it up?)  Anyway, on a downhill in the woods, for a variety of reasons Walter crashes and, unusually for an in-shape triathlete, suffered a hip fracture.  He was taken to the University hospital and underwent very successful surgery to repair the fracture.  A "bump in the road" was a post operative blood clot in his leg, a DVT, the subject of an upcoming piece for Ironman.com, and required medication to thin his blood for about 6 months.

Recovery included racing in the US and cross country ski racing in Europe. Walter was back in the thick of things actually talking on occasion of moving to Kona.   His time on the Big Island was that positive an experience.  But less than a year ago, along comes another bump in the road, a second serious bike accident with a number of injuries, the most serious of which was a frontal skull fracture requiring plates to be applied to his skull and his jaw to be wired shut for a month and a half.  Sounds bad.  Was bad.

But hey, he's just like you, and with a lot of encouragement from friends, was back training before he knew it.  Strong guy!   Just like you.  I saw him a few weeks ago looking thin, fit and strong.  And he'd already entered another Ironman race in the very near future.  Would you think this the best course of action?

Who knows?  Each of us makes the best decisions we can with the information at hand.  You've seen, I suppose, that as you age up, the number of competitors in your age group goes down.  And if you're "really old," only a few!  I was once told by a friend that:

"It's easy to win my age group.  They only put old men there for me to race against." 

But part of the reason that the numbers go down is injury, arthritis, wear and tear, you name it.  The body just won't do that any more.

There may be a point when it's time to find an alternative to triathlon/biking.  When you're there you'll know it.  You turn into a race volunteer.  And you can still be as loud and noisy as you want cheering on those in your age group who are still racing.  Hey, my roomie in Kona will be at the start line in Kailua Bay waiting for the cannon like everyone else, and he's 83.

 I wonder if the family of the man who died on Mt. Whitney would think he made the best decision with the information at hand.  In the words of Otto von Bismarck, "Only a fool learns from his own mistakes.  The wise man learns from the mistakes of others."

Be a wise man.

Sunday, August 24, 2014

Joe Friel: My Mentor, My Friend: 40 Days til Kona

This is my 500th blog post.  I'd like to dedicate it to Joe Friel, my mentor, my friend, my patient.  None of what I have achieved in triathlon would be possible without him.  From coaching me for many years and meeting me at the finish line in Kona with an ice cold beer (or two!), to being my roommate and putting up with my endless questions about human performance.  We come at this sport from different angles and often agree to disagree on various topics.  Joe has about the strongest will power of anyone I know, absolute control over what goes into his mouth or the exercise he does and it's quite contagious.  When he's designed a work out for you and the goal is not met, you feel as bad that you let him down as you do in not meeting the preset parameters.

In short, Joe Friel sets the pace the rest of us might aspire to, lives life with honor and hard work, is true to his athletes, true to his family, true his team.

So, to Joe Friel I dedicate this 500th blog.

Super coach Joe Friel (L) encouraging course record holder Bob Scott in Kona

"It's going to be a Hard Day's Night."   The Beatles

We're 40 days till the cannon blast signals the start of the Ironman World Championship. The athletes who are racing this year are beginning to struggle with the upcoming need to think about tapering, opposing that intense internal drive to get every bit of training they can out of every day. It can be as much as 20, 25, even 30 or more hours per week. Age groupers too! For the first timers on the Hawaii course there are so many questions involving bike transportation, accommodations, training on the island, heat acclimation, and learning as absolutely much as possible about the race and it's conditions to ensure they're in the annually expected 93% who finish the event instead of the handful who don't.

I think the biggest mistake that newcomers make is that in spite of spending 7, 8, 10 or more days on the Big Island, they don't get it. They are so focused on the race that although they finish well on Saturday, it's "mission accomplished," so to speak, they've totally missed the Hawaiian feeling of Ohana (family) or the spirit of Aloha. And, for those who've brought family and friends, they've learned little to nothing about this wonderful place as they become consumed with Ironman.

To be fair, it's this goal oriented behavior that got them here, but with actual pre-race training at a minimum now, there are frequent opportunities to learn and entertain while in Kona. Having been there 20 times, here are ten suggestions to ensure both the best race and the best experience for racer and family alike.  Some for you, some for the family...and some for the family to give them something to do other than watch you obsess over the race.

1.  On Sunday, a week before the race, are the light hearted PATH 5K and 10K runs.  They benefit the Peoples Advocacy For Trails Hawaii.  It's a non-profit in West Hawaii that teaches elementary kids safe cycling.  Could there be a better use of you tax deductible entry?  And it gets the family in the Big Island mood.

2. Eat at some place different every day. Splashers, Kona Inn, Fish Hopper, Jackie Rey's, Lulu's, Lava Java, they all have something good to offer.  If you really like raw fish, Da Poke Shack on Alii Drive gets rave reviews.

3.  Most peoples training plans are in full taper mode with which I agree.  But I'd suggest you start most days with a short swim on the race course.  And I'd do it at 6:50 am if I were an age group male, 7 am if I were an age group female since that's when you'll start on Saturday given the time changes for 2014 and 2015.  You can judge the position of the sun, estimate the surf, pick distant objects upon which to sight off, etc.  You don't have to swim a lot but it's fun, it's social, and where else can you swim out to a floating coffee bar Tuesday through Friday?

4. Everyone, and I mean everyone, runs the Underpants Run on Thursday, 8am, King Kamehameha's Kona Beach Hotel. http://www.underpantsrun.org/  Register on line or at the Ironman Expo...and bring a camera. It's less than 2K at about a 10min/mile pace...when you can stop laughing. Bring a special hat or mask. One guy was Elvis a couple years ago and it worked. 

5. When thinking about gifts for those back home, particularly kids, both Longs Drugs and the ABC stores have a wide variety of items for not a lot of money. You will spend more money in the Ironman store than you think. ("Well, I'll never be back here again and I do need 10 more triathlon oriented shirts in the dresser.")  Consider mailing things from Kona so you won't be overweight when your luggage is weighed at the airport.  It can get expensive.

6. Say hello to some one you don't know every day. And, if they're having a little trouble since English isn't their first language, take a breath and see if you can work it out. It just takes a little patience to be a good ambassador. And besides, it's fun.

7. Get with someone who has a rent-a-car and view every inch of the race course.  You might have to omit the two mile out and back in the energy lab, NELH (Or if you're really compulsive you could take the tour and see parts of it.)  I think you want no surprises on Saturday.  And you can have lunch in Hawi.  It's really nice.

8. Be patient and kind to the people of Kona - this is their home we're invading.

9. On Saturday, say THANK YOU to every race volunteer you encounter. And every policeman.

10.  And finally, when you get to the post-race area, don't be in a hurry to leave.  Lots to see and do from finisher's medals, food of many types, pictures, etc.  Since many of you will leave Hawaii in the next 24 hours or so, and because of the stress your legs have endured and overall dehydration, understand that you are at risk for developing blood clots in your legs.  The best thing is prevention where your efforts at hydration begin now and continue until you reach your destination by air.  When on the plane, don't just sit or sleep please. Get up every couple hours, walk around, use those leg muscles - especially the calves - till you arrive home.  It'll pay off.

Tuesday, August 12, 2014

Don't Let Your Doc Do This!

It's Good to be the King!

American Tim O'Donnell
In Your Doctor's Office

 The pressures physicians feel these days have never been more intense. The gradual switch to electronic medical records, decreased reimbursements, major alterations to resident education, etc. have many docs changing the style of practice they manage. The use of physician extenders like nurse practitioners, PA's, and Athletic Trainers has never been higher. In many instances this can be a good thing. These bright, motivated medical care givers often have a great deal of knowledge and experience, plus the time to answer questions possibly omitted by the physician or surgeon. They frequently choose this line of work because they enjoy teaching, and your thirsty triathlon loving brain is just what they like.

Let me begin with two stories.  First is about a woman with shoulder pain I saw a while back.  She complained to her care giver of this problem and it was felt a shoulder MRI was in order.  Normal.  Once back in the care giver's office, there was consideration that this was potentially of neck origin so an MRI of the neck was ordered.  Normal.  In short, perhaps choosing a course where an exam by someone who knew a little more about shoulder pain, maybe even some plain x-rays, might have been a more cost saving approach. 

 That said, I know of two docs in my community who take advantage of this situation. The physician extender not only does the initial work up, orders and interprets tests like MRI's or CT-myelograms, they make the decision for surgery and do the work up, all before the patient has ever even met the surgeon. In fact, it's so bad, rumor has it that one our docs meets the patient for the first time in the OR! 4 years of med school, 5 or more years of surgical training, and the first time they ever lay eyes on the patient is in the OR!  Maybe not the best way to practice the profession.

 Short of listing some kind of patient bill of rights, in my opinion, this just really short changes the patient, YOU.  When you give your history to the doc, your story of the problem, he/she may glean something completely different from your story than the extender.  Sometimes, what may seem to you like the smallest detail, can completely change the way the data is interpreted. This then may significantly alter the tests that are ordered and your ultimate treatment.  And, in some settings, whether you've seen the physician or not, your charges reflect that you have. Remember to check.

 So, think about this next time you need medical care, ask initially what the standard is for this particular medical team or office.  Don't be afraid to state your expectations.  If things don't seem right, they probably aren't, for you as an individual anyway.  And, you can always vote with your feet.

Thursday, July 24, 2014

How to Break Your Age Group Record

Please note: my two sons and I are heading to California's Sequoia National Park for a week of backpacking and climbing Mt. Whitney.  I'll have no internet access, or electricity for that matter, for about ten days.  See you in early August.

Call me a relic call me what you will
Say I'm old fashioned, say I'm over the hill.
Today's music ain't got the same soul
I like that old time rock and roll.
                                                                                                  Bob Seger

Maybe not everything benefits from getting older

On October 11th, the age group record for the Hawaii Ironman Course in the 65-69 year old age group was 11:19:07 set in 2011.  The next day, an athlete named William Wren decided to put in a spectacular performance and dropped it to 10:44:31.  That's a 30 minute drop in one year folks!  And against the hardest competition in the world.  He managed a 1:04 swim, 5:29 bike, and 4:01 run against 35 others in his age group on race day.

What's Wren's secret?  Well one of them is, shhh don't tell anyone, he aged up!  Yep, into a new age bracket where everyone else was his age or older.  None of those 64 year old whipper snappers to race against for example.

I've written about age group record holders before and where some of them plan for a year, maybe even two years, for a day like William Wrens.  We can learn from him.  If you have a specific race or individual goal, like toeing the line on famed Alii Drive on the Big Island as part of the World Championship field, then perhaps you can pick a qualification race one year, maybe even two years, in advance to give it your best shot at qualifying.  It would be the year you turn 45, or 65 like Wren for example.  (Just to be on the safe side, you wouldn't put all your eggs in one basket, like having only a single shot at the Olympics.  There might be a conflict such as a wedding or other family issue which effectively eliminates your prime choice so you'd simply move to race "B".)

Your second step would be to drastically increase your knowledge base about the available events, comparable difficulties, etc. including checking out author Ray Britt of runtri.com.  He has two very easy to read books called Racing Ironman and Qualifying for Kona: The Road to Ironman Triathlon World championship.  Your goal may not be to qualify for Kona but Britt has a great deal of usable stats and advice so I own a copy of both.

Lastly, if you're going to put your all into this adventure, is there something else that you've perhaps dreamed about that will put you over the top?  Do you have a race limiter that you could devote a little more time or energy to?  Perhaps it could be professional swim lessons or a treadmill eval of your running stride that can keep you injury free while fine tuning your body for this effort.  Would having a coach help?  Well, if you turn to Ironman.com and their FAQ section, the answer you get is "You can take two routes: either work with a coach or do the research yourself. You’ll find plenty of books and online materials about triathlons, but we find that working with a personal coach is important for about 75 percent of IRONMAN athletes." 

I was in charge of bike inspection in Hawaii this year and I watched folks from Training Peaks ask every athlete who checked in and racked his/her bike the afternoon before the race, "Would you mind taking a one question survey?"  The athlete didn't even have to slow down to answer.  The question was, "Do you have a coach?" Over half of them said yes.

I would be remiss if I left out your support crew, your family, because if you're really going to do this it becomes a family effort like it or not.  Perhaps you offer a significant vacation - no not to Kona where you'll be as distracted as can be - but to some place of family significance where swim, bike and run are not on the agenda.  Well, they might be if you and the family were doing them together.  At their pace.

We may not all be William Wren's, whom I've been told is a really nice guy, but if we're smart enough and patient enough, we might just be able to reach that triathlon goal a year or two from now when we age up.  If Wren can, you can.

Care to be the first to rack your bike at your goal event?