Tuesday, March 31, 2015

How to Find a Great Sports Med Doc


- What are you doing?

- Just wondering who's the best.

                                                     Top Gun
__________________________________

I was flattered when asked by Joe Friel and Jim Vance a couple years ago to write a chapter for their book Triathlon Science.  It's a good reference text if you don'e own a copy. 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 tried to make was to have an "injury resource team" in place before you are injured so that your down time is minimized.  One of the key pieces of that team would be a doc who understands the needs - and differences - of the athlete.
  
Don't be embarrassed to ask around now to see what's available, who's available.  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 in a place that you might ordinarily not look.  As the Boy Scouts say, Be Prepared.
__________________

Bill Vollmar, MD perfect sports doc














"Son can you play me a melody, I'm not really sure how it goes. But it's sad and it's sweet and I knew it complete when I wore a younger man's clothes."           Billy Joel

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

Triathletes are what's known in MBA circles as early adopters.  They'll try things (anything you ask??)  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.  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 here according to the ART web site is almost two hours from my house.

A recent Men's Health magazine 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 two photos above are of Bill Vollmar, MD, seemingly "only" a Family Practitioner from
Lancaster, PA and some might think he'd 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!  

And, 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.

And lord knows I've had more than 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! And 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 a shoulder related swimming issue.

Look for Primary Care physicians, FP's or Physiatrists (a doc who specializes in physical medicine and rehab), etc., men and women in your community who've earned the respect of the running/triathlon world as a care giver and have 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.



Tuesday, March 24, 2015

Donut Swimming: Want to Swim Faster?



"Krispy Kreme Doughnuts, everybody loves them."


But from David Letterman  "I thought this was interesting, on the box, 'Konsult Kardiologist.'

Drooling just looking at them 
______________________________________________________________
My first encounter with Krispy Kreme donuts was at the Pensacola Three Mile Bridge Swim about 15 years ago.  I had my first the night before the event.  And second, and third...you get the drift.  It was a wonder we could swim at all.  It's been a love affair ever since.

We used to have a Krispy Kreme Donut Shop near our house.  On weekends when you were driving with the kids, and the "Hot Donuts Now" sign shown from across the highway, it was impossible not to stop and watch the glazed donuts in the conveyor cooker as they slowly made their way to the end.  To each kids delight, the employee would skewer a hot, fresh one and hand it over.  Yep, not many things taste better than a ten second old donut!  And for just a few moments you're not concerned about how many calories in equals how much working out is required for reversal.  For a few sweet moments, it's just the best!
______________________________________________________________

OK, back to swimming faster.  This was originally published a while back in one of the online swim mags.  It's called the Cone Drill in a piece written by David Marsh, former head coach at Auburn and Olympic Assistant Team Coach which I will publish in it's entirety.

This is especially important pushing off the wall where many of us create so much drag, surface prematurely, losing all the momentum gained from the turn.  It's a quick read.


The Donut Drill
Visualize swimming through a donut (cone) 


More plainly put, you need to diminish the drag you create while swimming.
 "To put it simply, if you want to swim faster,
you need to reduce the drag you’re creating in the
water. There’s an endless number of technical drills
one can practice to improve body position, timing,
and technique to reduce drag.
 But there are also mental or visualization
drills that swimmers should incorporate into their
practices. One of my favorites is the cone drill. In
essence, visualize the recovery of your stroke—any
stroke—as if you’re trying to squeeze your entire
body into a streamline position to swim through a
cone, from the large end to the small end.
For example, if you’re swimming breaststroke,
during your hand recovery, your biceps should be
tight to your ears and your head in a streamline
position as you extend forward, swimming through
the imaginary cone. For freestyle and backstroke,
extend each recovery stroke as far forward as
possible, allowing your body to find a streamline
position and squeeze through the imaginary cone.
 For swimmers who may not be able to rely
as much on pure strength to power through the
water and cover stroke flaws, improving body
streamline when swimming and when pushing off
the wall will reduce drag and lead to more efficient
and faster swimming. Next time you are swimming,
visualize that you’re trying to streamline your way
through a cone, from the large end to the small end."





Monday, March 16, 2015

You Don't Mess Around With Jim -Head Ironman Referee

 

You don't tug on Superman's cape
You don't spit into the wind
You don't pull the mask off that old Lone Ranger
And you don't mess around with Jim*
 
*If you happen to be in an Ironman that is!
  ___________________________________________________________________
 
Before the blog, first this about the enormous good done by Jimmy's team. 
 
2014 Race Across America Team Intrepid Fallen Heroes


 
 From Intrepid Fallen Heroes web site: In June 2015, Team Intrepid Fallen Heroes will compete in in Race Across America- a 3000 mile competitive endurance race- this year as a 4-person mixed team. In June 2014, Team Intrepid Fallen Heroes participated in the Race Across America winning the 8-person team division and raising $650,000 to support our wounded military heroes suffering from traumatic brain injury. The team races again this year with a goal of once more achieving victory and raising even more funds for our wounded troops. Please join us in this great challenge.
 
____________________________________________________
 
Refereeing an Ironman

Several years ago, while on a rolling section of the Queen Ka'ahumanu Highway portion of the IMH bike course, one of the motor scooter bound bike refs was just itchin' to get someone. They sat off to my left rear. Lurking. Waiting. Like a mosquito on a hot summer day. There was a sizable group of athletes whose positions relative to the other bikes were totally dictated by the terrain. A spreading out occurred going downhill with the inevitable bunching up come the next short up hill. And that's when the ref struck nabbing a slew of folks allowing them a short "unplanned rest" in the penalty tent. I sent a note to the race office describing what I felt was just
not the standard I'd expect of a referee, unfair really, and the following year I saw no ref behavior of this kind.

Fast forward to 2010 when I meet the Ironman Head Referee, Jimmy Riccitello, the man does indeed set the standard. Multiple times I saw him help out an athlete or aid in race conduct at this years event, never drawing attention to himself. On the Friday afternoon before the race, during bike check in, one woman's race wheels didn't make it to Kona and here's Jimmy, butt on the pier, stretching out some sew ups, which he helped this woman mount. All real casual like this happens every day. (Maybe it does.)

12 hours later, the transition area is a madhouse with 2100 athletes, volunteers providing assistance, and bike repair teams making last minute fixes. And where's Jimmy? Helping an age group woman trying to figure out if her speed suit was legal for the swim. Sure you could say why would someone wait until an hour before arguably the most important race of her life to figure this out. But he didn't. He researched the
question and determined that a short run of this particular suit was not legal, unfortunate for her in that this was one of them, but she was able to follow the letter of the law with a clear conscience.

I have three kids, and, at the heat of action during the race asked Jimmy how many he had. "Two," was the answer. I told him I hope they married my kids if they were anything like their dad. He just smiled. Later, when recounting this interaction to an IM employee, she added, "I feel honored to have gotten to know him and work with him the last several years. I have also been with him and his children outside of our work worlds and can validate that he is a wonderful father…a better parent than many. He’s not just the 'good time dad."

There are other examples but these three illustrate the point. In 2015, where the national pastime is complaining, we are so fortunate to have this gentleman help us both follow the rules and have a successful day doing so. Maybe he thinks of the athletes as his 2100 children. Who knows. Thanks, Jimmy. Thanks, Dad. But if you plan to stretch the rules, watch out, Jimmy's right around the corner behind you.

 
 
Images 1, 4 from Team Intrepid Heroes web site.

Friday, March 13, 2015

A Triathletes Best Friend? Another Triathlete


"I need help," she posted.


Embedded image permalink
                                                              Credit @linda_alread
 ___________________________________________________________                                                  
This is also posted on Slowtwitch in similar form.  I don't think we say thank you often enough.


As you might suspect I get a lot of e-mail traffic with various musculoskeletal and medical questions for which athletes seek an independent opinion. “I broke my collar bone on a recent ride, they’re saying I should have surgery, what do you think?”  Or, “It’s been a couple weeks since my complex knee surgery, when do you think I can run again?”  Like most Sundays, there was one waiting for me recently.  It was from a woman in NC named Georgia, a veteran of many marathons and triathlons, who, very unfortunately, had suffered a small cerebral hemorrhage.  This is a type of stroke that occurs when a tiny artery inside the brain bursts leading to the death of some surrounding brain tissue.  They comprise about 10% of strokes.  In those with significant bleeding, permanent injury or even loss of life can result. 

Fortunately for Georgia, she had a complete recovery.  That’s the good news.  The bad is that an underlying reason for the hemorrhage was never determined and her doctor “refuses to clear me for competitions.” What she was seeking in her e-mail to me was a doc familiar with endurance athletics who could approach her as an athlete, not just the next stroke victim waiting in line.  “But the trouble I am running into is that most non-endurance athletes believe that triathlon and certainly Ironman are grueling competitions where all athletes crawl across the finish line on death’s door.”  (Uh, isn’t it?  Maybe that’s just me.)  “As an athlete yourself, I am sure you can appreciate that I did not enjoy hearing that.”  I’ll bet many reading this now understand her emotion 100%.

What she needed was someone who understood both Neurology and triathlon so she contacted me.  While I’m not that person, I know how to find that right person.  The  triathlon web site.  Sensing her urgency and bewilderment, I made it my priority for the day.  I put up a “Neurologist needed” thread on the forum, and it didn’t take 2 hours to get a response.  Wow!  We’d found a doc in WI.  And then shortly thereafter one in CT who were ready to take her on.  I e-mailed the good news and she was excited.  

But wait, there’s more.  In another two hours, a doc from her part of NC chimed in ready to offer assistance.  Georgia was ecstatic.  “Dr. Post, you are a champion. Thank you thank you thank you!!!” Here in the space of 4 hours, she’d gone from adrift in triathlon, not sure if she’d ever race again, to having someone in her own neighborhood offering to be of assistance.

I thought we were done….until…in another two hours the cherry arrived. The cherry on top of the ice cream Sunday that is.  The following note arrived, “Hey John, I am a neurosurgeon in Long Island, NY.  This stuff is my “bread and butter” so to speak.”  Does life get any better?  Nope, not if you’re Georgia.

When I passed this last morsel on, it went something like this.  “Are you sitting down?  It gets better,” she answered immediately.  “Woo hoo!!!!! I am from Long Island!!! We have a winner!”  It turns out that this gent even knew the NC coaches she trains within NC and plans to speak to them.

What a day; my what a day.



So what are triathletes for?  To help other triathletes of course.  That’s what Georgia would say if you asked her.  Why not do that when she’s setting up her transition area next to you at an upcoming event.  She’ll be easy to recognize, the one with the permanent grin on her face. 

Sunday, March 8, 2015

Obituary for 1982 Ironman Finisher; Ensure You're Not Next





I982 Ironman Finisher Killed in Cycling Accident on Island of Hawaii


63 year old Jeffrey Surnow of West Bloomfield, MI was killed near Waikoloa in the NW corner of the Big Island on Sunday.  Sadly, he was struck by a police officer on a shoulderless road in the early hours of the day.  “The rising sun” may have played a part according to Acting Battalion Chief Capt. John Whitman. “It’s a pretty dangerous area.”

Surnow, very active in the local cycling community, was the founder and director of Michigan’s Birmingham Bike festival described on the web site as, “Although the name of the event is Birmingham Bike Festival, it’s not all about bikes. It’s bringing the community together for a variety of fun and healthy life style events. It encourages families to participate in sport related activities together.”

1982 was only the second year the quite new Bud Light Ironman Triathlon World Championship was held on the Big Island.  Surnow, racer #869, was one of less than a thousand to give this event a try.  A true Ironman pioneer, long before triathlon had reached it’s current level of popularity, he “swam 2.4 miles, rode 112 miles, ran 26.2 miles” and in the words of race founders John and Judy Collins, was able to “brag for the rest of your life.”  The triathlon community offers it’s condolences to Jeffrey’s family and friends.
_________________________________________

A Few Notes on Bike Safety; Please Take 2 Minutes to Read

I live in a university town.  The closer you are to campus the more bike riders you see. Or, as you read on, don't see. Unfortunately, what you see most of is unsafe bike riders.  Many ride helmet-less.  Even more are virtually impossible to see.  Dark clothing, no lights at dusk or later, that kind of thing.  Things you wouldn't do.
Below are some thoughts of one of our peers in response to the loss of Jeffrey Surnow.  I think they can benefit us all.

I've been doing a lot of morning runs this year. Usually up at 6 and it's dark and/or blowing snow. I use a Black Diamond running headlamp/taillamp and it's great; you get enough light that you can see and definitely be seen, both coming and going. Various bits of my clothing are reflective as well, which helps when I do encounter the occasional driver on the country roads where I'm running. 

However, there's this other guy, lives in the next subdivision over, and he has been running every day for years. I see him on TWP Rd. 262 (NW of Calgary, it's a popular cycling route as well) whenever I commute at about 7 AM. Thing is, he doesn't wear a light, and his clothing has relatively little in the way of reflective stuff on it. So every time I go to work or to drive my kid to school early, I know I'm going to encounter this guy on an undulating, unlit two lane road, in the dark, and it might be blowing snow or whatever, the guy will be there as little more than a shadow, on either side of the road (depends on whether I'm earlier or later than his turnaround). I worry about that... it's not that I don't pay attention, and not that I don't give the guy all the room I can, but if there should ever be a combination of mistakes between the half-dozen commuters the guy is likely to encounter every morning, that guy has zero protection, and him running with no lights makes it more likely that he's going to surprise someone at some point. 


Not saying in any way that this bears on the case in Hawaii - but as a runner or cyclist we owe it to ourselves and the rest of the traffic to make ourselves as visible as possible. Save the ninja stuff for other venues*. 


If reading this made the same impression on you it did on me, please forward it to anyone you know who might benefit.  Thanks.

*Reprinted with permission


Image, Google Images







Tuesday, March 3, 2015

Sure They Cheat in Triathlon, Don't You?




"If you cheat yourself, who won't you cheat?"  

                                                                              John McGuire, former Navy SEAL

One poster for each race in Hawaii.






If you think there's no cheating in our sport you're just not paying attention.  You're naive.  Oh sure, the pros used to take all kinds of things to win just like the Tour de France, you say.  That's the NFL, man.  Are you sure?

________________________________________________

 Different cheating quote

“The truly scary thing about undiscovered lies is that they have a greater capacity to diminish us than exposed ones. They erode our strength, our self-esteem, our very foundation.” ― Cheryl Hughes

________________________________________________

 Didn't they just kick Frank Schleck, FRANK SCHLECK, mister clean, out of the Tour de France in 2012 for a failed drug test? (And would this necessarily point the finger at his brother, 2010 TdF winner Andy Schleck? And didn't Andy get the victory when Alberto Contado finished ahead of him but was ultimately disqualified for a failed drug test?  Clenbuterol, tainted Spanish beef.  That was the ruse wasn't?

Oprah...Lance...Cycle of Lies. (excellent book by Juliet Macur if you haven't read it.)


 As a preamble, consider the following. I ran my first Boston Marathon in the late 70's and am most familiar with the bogus female winner of the 1980 race, Rosie Ruiz.   Reportedly having qualified for the BAA race in the NY Marathon, it was later proven false when it was discovered she'd taken a subway to the finish.  That's right. SHE TOOK  A SUBWAY to get to the marathon finish line.  The first woman to complete the 26.2 miles from Hopkinton to Boston that year, unusually, she was neither sweating profusely not did she have the body habitus of the typical endurance athlete. When queried why she didn't look fatigued after this punishing event, she replied, "I got up with a lot of energy this morning."  She didn't appear in any of the race photos.  No one could remember seeing her on the course.  She was later disqualified.

 In Triathlon, one might think it much easier to bend the rules, or ignore them completely, in a small home town event.  However, for this piece I'll keep my comments limited to iron distance racing.  That said, please do not interpret this as critical of WTC or Ironman in any way.  They've just been around a long time and have had a good while to experience the "creativity" of man kind.

 In the early 80's, not long after the event moved from Oahu to the Big Island, and there was only a single Ironman race, there was less monitoring of the swim than today.  Also, rather than being a rectangular swim as it is today, the racers swam more of an out and back around a big sail boat.  Add to this, the fact that for many triathletes, the swim is most definitely not their favorite part. Thus, the temptation to swim "as far as I felt like" and just turn around proved too tempting for several.  They were never caught.

 About ten years ago, complicity among athletes was suspected in one race but due to the difficulty of absolute certainty, it may not have been pursued.  I think the issue involved one athlete riding to the limit of the bike route, the turn around, with two timing chips, only one of which was his own.  In other words, one competitor went 112 miles and at least one other significantly less.  Maybe he hung around the course having a Popsicle reserving his energy.

I have a friend whose son babysits for folks who are very competitive IM age groupers.  The son was poking around the fridge looking for a Coke.  Well he never found a Coke...but he did find a cart of EPO just waiting to be injected. 

 In a recent running of the World Championship in Kona, a gent cut about 3 miles off of the run by neglecting to include the 1.5 plus mile out and back portion known as the energy lab (NELH, National Energy Lab of Hawaii.)  He also claimed to have "lost" his timing chip on the run.  It was noticed immediately by several of this gent's competitors and their families that something was awry.  Shortly after the race,  he issued a heart felt confession and apology on Slowtwitch.com and to WTC as well as the competitors in his age group who's races he'd upset.

 You probably remember that the 2004 women's Kona winner was disqualified shortly after the event when her post race samples were found to contain EPO.  She admitted wrong doing even before the "B" sample was analyzed.  In one of the very good things about triathlon, when second place finisher Natasha Badmann was elevated to victor, she was quoted as saying, of all the things that happen to the winner, she "missed the flowers" the most.  A few months later, Ironman veteran (and good guy) Bob Babbitt of Competitor Publishing, at an annual dinner where Badmann was in attendance, surprised her with a re-creation of the finish line for her to cross complete with "flowers, lots of flowers."  Nice guy!

I could go on.  But the point of this is not to say that everyone cheats. They don't.  In fact most everybody follows the rules to a "T".  But every once in a while.........

 I'll finish this piece with the thought that it's been reported that some age groupers, with nothing more to win than a trophy, if that, are thought to have illegally ingested steroids, human growth hormone, testosterone, etc. in their quest to win.  To again quote John McGuire, "If you'll cheat yourself, who won't you cheat?"

Friday, February 27, 2015

If You Need Your Knee Injected


  
  Oil can.....Oil can....

...m...m...my, my, my, my goodness -- I can
  talk again! Oh -- oil my arms, please -- oil
  my elbows.
                                            TIN MAN, Wizard of Oz, 1939



Knee Injections

Synvisc, Orthovisc, Euflexxa, Quaker State, Penzoil



With accumulated wear and tear, or even after trauma, the bone covering articular cartilage of the knee joint can erode.  You know it as arthritis. In addition to the various types of cortisone which can be injected, a class of agents focused on one of the building blocks of cartilage, hyaluronic acid, is also available for injection.  They are known as hyaluronate preparations and can be effective diminishing both joint pain and swelling.

These agents (Euflexxa, Hyalgan, Synvisc, etc.) can be costly and are usually not considered until the patient is a failure to other conservative measures like limb strengthening exercises, joint injectons of a cortico steroid, Tylenol, possibly a non-steroidal anti-inflammatory drug like ibuprofen (Advil) or naproxen (Aleve.)

An office procedure, after sterilely prepping the skin at the intended point of injection, and aspirating any effusion (excess joint fluid) which may be present, the physician takes great care to ensure exact placement into the joint.  Depending on the product, there can be 1-3 injections one week apart and other than the sting of the needle stick seem to cause very little in the way of pain.  Post injection the patient is asked to refrain  from vigorous exercise (like triathlon!) for 48 hours.

The success rate in lowering pain and swelling while increasing patient activity levels can be impressive. Upwards of 80% patient satisfaction has been reported.  One company advertises “Over 1.8 million knees treated….and still going strong.”  It can be repeated if/when necessary, but not indefinitely.  And, if it’s included in a overall program to maintain/preserve knee health as well as forestall a larger procedure like joint replacement, it’s role is clear.

Should you have a hip or knee replacement, by current recommendations, it's game over for triathlon.



So, if you have osteoarthritis of the knee, and a hyaluronate is being considered by your care giver, it may be “just what the doctor ordered.”