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. 

Monday, June 20, 2016

Why Would You Wear a Camelback in a Race?

At the 20 mile mark of this weekend's local marathon

I don't get it. Why, with aid stations every two miles, would you wear a supplemental drinking device that adds weight?

I went to the local marathon Saturday. I really felt for the athletes.  Watching the start (at 67 degrees unfortunately) and people clad in any number of different attires.  Many had some form of long sleeve garment, even a sweatshirt or two, based on the weather prediction of 60 at the start and a high of 74.  "Good thing they're calling for 74 today 'cause it'll be 85 tomorrow."

Ah, but the weatherman was wrong, and tomorrow came a day early.  It heated up quickly such that the race course looked like one big Good Will shop, just spread out a bit.  There were hundreds, maybe thousands of discarded clothing items on the side of the road starting bout mile 3, and among them, many supplemental drinking systems.  I imagine the racer remembered where he/she left it and planned to return and get it after the event. 

But there's an unneeded step in an already very long day for many.  My point here is that although many racers were first timers, and correctly they did what worked for them in training, this was one of those instances when simply asking a veteran who'd run this type of event before what they recommended, and would have saved them this step.  A marathon is hard enough already.  Now sunburned, exhausted, and maybe even coming from the opposite side of town, these racers have to go back out and retrieve something valuable.

This brings me to the larger issue of homework.  Race homework.  So many events have huge expos these days that the newer to the sport can find someone, maybe even one of the sales people in the expo with years of running under his/her belt.  Preferably, lessons like this have been learned in that local 5k or sprint tri.  Go to any book store for reading advice.  Joe Friel's Training Bible series or his very popular Your First Triathlon can ready even the most recalcitrant of us.  In short, do your best to have race questions answered before you leave home on race day.

Monday, June 6, 2016

1 in 2 of You Will Crash Some Day; Over 40% Kona Racers Needed Med Attn/Surgery At Some Point in Their Career

George Patton and I share the same birthday.

 "A man must know his destiny. if he does not recognize it, then he is lost. By this I mean, once, twice, or at the very most, three times, fate will reach out and tap a man on the shoulder. If he has the imagination, he will turn around and fate will point out to him what fork in the road he should take.  If he has the guts, he will take it."   George Patton

 Maybe something to think about right before the gun in your next race.  Put it on a scrap of paper. Make it a quick read at the start line, then get out there and, like Patton, KICK BUTT!
Before summer open water training in a local lake, river or ocean, make sure you line up a swim buddy first.

Road Rash

"Ain't no doubt about it we were doubly blessed, 'cause we were barely 17 and barely dressed." Meat Loaf, Bat out of Hell

 Possibly without intending, Meat Loaf was describing the amount of protection one gets from cycling clothing when you hit the asphalt. Barely dressed. But, you look good doing it. Right?


This image was sent to me by a follower.  Glad it's not my elbow.  Bet you are too!  This is several days old, dry, quiet looking, but that hole on the right side could still be, as they say on TV, "A heap of trouble!"

This injury is the result of a bike crash on to asphalt and I'll bet it hurt.   This repair was not done at the local Urgent Care but the local hospital operating room.  If, for no other reason, than to get the debris vigorously washed out of the wound.  The potential for infection is significant.

Following your bike crash, you visit your friendly local emergency room where cultures are taken from the wound (put in a cotton tip, send it to the lab to see what unexpected bacteria can be found in what should be a sterile environment). Then you're introduced to the orthopedic surgeon on call, told that your next stop is the operating room...NO, you cannot go home to let the cat out or turn off the sprinkler because you're being prepped for immediate I&D, irrigation and debridement. You meet the holding area team, the anesthesiologist, the circulating nurse for the OR as she seats you in the center of the operating table, etc. You're surprised how cold the operating table is against your naked behind! Just the first of many unfamiliar sensations.

This is all a true story. This triathlete suffered a fairly involved injury, without broken bones, to her arm above the elbow and the above sequence occurred. This picture is her arm about a week out.  She's also under the care of an Infectious Disease specialist to help manage the antibiotics as appropriate to the organisms cultured at surgery. So what are the lessons that we take away from this? Well, it's hard for many of us to get through a full season without dumping our bikes at least once - or more.  I surveyed 1600 KONA ATHLETES in 2015 and one of the questions was "Have you had a bike crash serious enough to require medical attention?  Surgery?" Almost half of the men (48%) and nearly as many women (42%) said yes.  

If we're lucky it's just a skinned knee or lateral ankle that, with a minimum of local care, heals uneventfully assuming an intact immune system. What about that dog bite? Or that more significant skin embarrassment with depth and significant bleeding?

On the road, as soon as possible following your crash (or animal bite), I'd suggest beginning by lavage (thorough wash out) of the area as best you can with the contents of your water bottle(s). I know a number of athletes who drink very little from their water bottles, particularly in cooler weather, and carry them for just such an emergency. You're prepared for a flat, loose spoke, broken chain, etc., why not be prepared for this is their motto. While you probably wouldn't use water from the creek, tap water from the nearest source, gas station, etc. to irrigate out any debris while still fresh helps a great deal. If there's any doubt, seek medical care. If the wound is over a joint or sizable, if it's at all deep, if you see a tendon, bone or joint, these are all reasons to proceed to the local medical facility right away. The longer you wait, the more time any foreign matter has to set up shop. You can also update your tetanus at that time. In fact, I know one athlete who called his docs office within minutes of an unprovoked dog bite, was told to "come now", which he did...still on his bike of course, and had the wound cleaned, tetanus administered, etc., all done in about an hour allowing him to finish his ride. Can't leave that calendar space white, even for a trip to the doctor, now can we? (See "Once a Runner,"  John L. Parker, Jr.)

For home care of road rash, shower, and although it may not be pleasant, use of a mild soap and wash cloth to get all dirt and debris out of the skin or it will be a permanent tattoo.  Try to avoid any type of strong antiseptic as they frequently do more harm than good.  After you get the wound as dry as possible, apply a very light coating of antibiotic ointment and a sterile dry gauze type dressing.  If you use the non-stick type you will be rewarded for it later.  Keep the area clean and dry until it starts to show good signs of healing and change the dressing every couple of days.  If you have doubts anywhere in the process, get medical attention. Otherwise, happy riding.

Tuesday, May 31, 2016

Racing Plan B for Triathletes- Penalties, Sizzling Heat, You Name It

Prepared For The Unexpected? At Least Thought It Out?*

Woman's unplanned visit to the "sin bin."
If you have, you'll handle the problem, as Ironman supercoach Lance Watson Preaches, "Quick, calm and organized."
Do you think, when this athlete was topping off the air in her tires this morning, that she thought, "You know, I'm sure glad I'm the the type of racer who never gets penalized..." I wonder if her race plan included preparation for this.  Does yours?

Asker Jeukendrup, Noted Sports Nutritionist, Asks, "Is gluten-free Faster?"

A study where two groups of participants, those with and those without gluten in their diets were compared.  The results showed:

There was no difference in performance between the two diets. There were also no differences in gastro-intestinal discomfort, or how the participants were feeling.  In addition, none of the markers of inflammation showed a difference between the diets.

Therefore the authors concluded that a gluten-free diet has no benefits over a gluten-containing diet in non-celiac athletes. It also had no negative effects. The authors advised that athletes seek evidence-based advice before adopting a gluten-free diet for non-clinical reasons to ensure that nutrition intake supports individualized and optimal fueling for sport performance. 

Sunday, local triathlon

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 mid 70's last night. Plus, the sun came up well before the first athlete was body marked or the transition area opened. As the sun climbed higher in the sky pushing the mercury toward inferno status… from a racing point of view anyway, you wonder about where all these athletes were last week.  San Antonio?  Sheboygan?  Anchorage?  Cool climate or warm climate? And how much of their well planned out race plan included weather like this?  It turned out to be one of those days where the heat simply blasts you when it radiates off the asphalt. It’s a good thing most of were wearing hats and could put ice in them at the aid stations. As we watched them load the collapsed racer 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 on Sunday in the opening outdoor 1 and 2 mile swims of the season. Or – SURPRISE – the expected temperature at race start is 15 -20 degrees higher than where you live and train. This happened at the Boston Marathon a few years ago where runners were just finishing a winter of snow running, and an unexpected heat wave brought temps in to the mid 80’s and more. Athletes 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 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, 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, broken chain or spoke, special needs bag going MIA?  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 in your event has the same course to ride and run on and just maybe 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?”