Thursday, October 1, 2015

I'm an Athlete, Do I Need a Bone Density Test? Do I Need Extra Calcium?

I'm pretty low risk, do I need a bone density test?  What would I do with the results?

I would suspect that at least half of you have had a serious bike accident, some even with a broken bone.

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Watch me pull a rabbit out of my.....spokes?

Bone density tests help to determine if a patient has the diagnosis of osteoporosis, a condition that causes thinning of the bone. There are specific criteria that are used to determine when this test is appropriate.

Having an abnormal bone density test may guide treatment, but the treatments often involve medications that can have significant side-effects

Patients who don't need a bone density test, may be best served by waiting until they meet appropriate criteria for the test.

What is Osteoporosis?

Osteoporosis is a condition that weakens the bones of your skeleton. Bones, like other tissues in your body, are living structures that constantly are changing. New bone is made and old bone is taken away. Osteoporosis develops when the pace of new bone formation cannot keep up with the loss of bone. 

Current Recommendations - The U.S. Preventative Services Task Force recommends a bone density test at least once for all women age 65 and older.

Who should have a bone density test?*

  • all postmenopausal women under age 65 who have one or more additional risk factors for osteoporosis (in addition to being postmenopausal and female)
  • all women age 65 and older regardless of additional risk factors
  • postmenopausal women who sustain a fracture
  • women who are considering therapy for osteoporosis if bone density testing would facilitate the decision
  • women who have been on hormone replacement therapy (HRT/ERT) for prolonged periods
Using Osteoporosis Drugs:
Many people think of bone as a structure, like the frame of your house or the chassis of your car. But bone is a living tissue that is constantly changing. New bone is always being made, and old bone taken away. Osteoporosis develops when the rate of bone loss exceeds the rate of bone formation.
Treatment of osteoporosis focuses on trying to increase the rate of bone formation and decrease the rate of bone loss. This can be accomplished by different methods including exercising, stopping smoking, eating right, and taking medications.

Calcium is a mineral found most abundantly in our bones. It's one of the building blocks of normal bone, yet many people do not injest enough to maintain healthy bone stock.  With society living longer, this creates a significant problem if the bone loses it's strength and becomes susceptible to fracture.  All of us should consume calcium every day and a small number of need extra, possibly in the way of some kind of supplementation if one's diet is insufficient.  There are both dairy and non-dairy forms of calcium.  Some have previously recommended larger doses of calcium but this has come under fire recently and may even be harmful.

Vitamin D
Vitamin D works together with calcium to help maintain normal bone health. Vitamin D is necessary for your body to absorb calcium; even if you are ingesting calcium, your body may not be able to absorb it if you don't also have enough vitamin D.
Children who do not get enough vitamin D have a condition called rickets, and adults who don't get enough vitamin D have a condition called osteomalacia.

Bisphosphonates are a type of medication known as antiresporptive medications. These medications prevent bone loss by inhibiting the normal function of cells called osteoclasts. These are the cells responsible for removing old bone. When osteoclasts are working harder than the cells making new bone, the development of osteoporosis can be accelerated.

Calcitonin is a hormone produced in your thyroid gland. Calcitonin is naturally made in your body when blood calcium levels are high. This tells your body to retain calcium within the skeleton, rather than use calcium in the bone to replenish the calcium in the bloodstream. Calcitonin works by limiting function of the osteoclast cells that consume bone to release calcium in the bloodstream.
Calcitonin is usually administered by a nasal spray. Side effects of calcitonin include runny nose, headaches and nose bleeds.

Hormone Therapy/Estrogen:
Estrogen therapy (ET) or hormone therapy (HT) are effective treatments for preventing bone loss and reducing risk of fracture. ET has been shown to cause an increased risk of uterine cancer, and is therefore used alone only in patients who have had a prior hysterectomy. In others, combination estrogen and progesterone treatment (HT) is used.
Concerns about increased risk of breast cancer, stroke, and blood clots have surrounded the use of these medications for osteoporosis. Therefore, the FDA recommends the use of ET/HT only if other medications cannot be used and there is a significant risk of osteoporosis.

Bone Forming Medications:
A new medication is being used to help the body make more bone. The medication called teriparatide (Forteo), is a synthetic version of parathyroid hormone. Parathyroid hormone is your body's internal signal to make more bone. Given by injection, teriparatide stimulates the body to increase the amount of bone formation

The take away here is to be aware that the problem exists, may exist in you, and at least be aware of the diagnosis and that there are treatment options.  Happy Training.

Photo credit:
Much of this info is taken from, and a variety of other sites

Wednesday, September 23, 2015

Should You Change Your Bike’s Tire Pressure? Flying? At Races?

Should You Change Your Bike’s Tire Pressure?  Flying?  At Races?

               Let's have a look at the conundrum surrounding suggestions of tire pressure alteration in the low pressure environment of modern jet travel or at bike check in locales where the “afternoon sun will get the tires so hot they’ll burst.”

“Sir, you’d better take some air out those tires if you rack your bike early,” is heard frequently at venues like Kona, Hawaii for fear that one’s expensive tires may spontaneously explode.  Or, more worrisome, that they may blow up and damage one’s even more expensive race wheels.  Also heard at bike shops across the country, the time honored advice that reducing the air in one’s tires will reduce the potential of having them detonate in the reduced atmospheric pressure of that jet en route the your race site.

I was first confronted with this issue at Ironman Hawaii.  My local bike shop had taught me their philosophy years before and in my experience I had no reason to doubt them.  Inflate tires at purchase and “leave ‘em”, except to perhaps add air from time to time to correct for leakage.  These guys raced a lot, all over the country, and in a tradition that works well in triathlon, if it works for them it will work for me.  But here I am 6,000 miles from home, in what is likely the most important athletic event of my life, being advised to change my behavior or suffer dire consequences.  Yep, dire consequences.  By a volunteer no less.  And it seems to make sense.   Sort of.  What, if anything, should I do?

Well does it make sense?  No, not really.  If you think back to high school chemistry class you might, if you were paying attention (no, I guess not), or might not remember that there are relationships between the temperature and pressure of a gas explained by Boyle’s and Charles’s laws.  Basically they’re proportional.  In other words, as temperature rises so does pressure but it’s the amount of change that concerns us.  How much does the temperature have to go up before the tire goes kaplooey?  We know that bike tires like many other aspects of our lives are regulated and have to meet a standard.  That standard is blow off pressure, the force required to blow a tire off it’s rim. If the tire is Japanese made it’s governed by the J.I.S., the Japanese Industrial Standard.  If it’s from Germany, the D.I.N., etc.   This standard is typically double the recommended maximum inflation pressure.  It tells you that the manufacturer will test an adequate number tires, correctly mounted on recommended rims, inflated to double the maximum printed on the tire itself, and the test tires won’t explode.  If we can figure out the temperature needed to raise the tire on your bike to that pressure and stay below it, we’re golden.

Here’s where it gets complicated and some of you might want to skim to the next paragraph.  Beginning with the equation of the ideal gas law, pV=nRT, where p is the pressure of the gas, V is the volume occupied by the gas, n is the absolute quantity of gas present, R is the universal gas constant, and T is the temperature of the gas, if we constrain the system of interest to have a constant n and V, the ideal law can be redefined and we are able to compare the impact of a change in temperature on pressure. I’ll be happy to share the calculations but suffice it to say that if we assume a 70 degree day when we rack the bike, and tires set at 110 psi, we calculate the temperature needed to bring the tire to 220 psi, the blow off rating.  Still awake?

The answer is…..536.993 degrees Fahrenheit*, an unreachable result. That value is, of course, above the auto-ignition points of both gasoline and paper, and there are greater issues at hand if it is reached!  Or, as the Chemistry Phd. I pestered for the math help here pointed out, “based on these values, it is unlikely the required temperature will be reached under the conditions of ambient sunlight.”  An understatement if there ever were one.

There might be compelling reasons not to mess with your tires at the race, however.  The relationship between a wheel, tube and tire is a complex one.  I’ve been in T1 more than 30 times for Iron distance races and the biggest thing people fool with is their tires.  Some folks know a lot less about their equipment than others and when there’s a misstep in this process they’re lost.  We’ve all seen more than one racer come unglued in this situation. If the competitor has relatively new tires, has broken them in at home and is satisfied with their performance, does deflating/inflating them change their relationship with the wheel?  Does this action allow even the smallest portion of the tube to get stuck between the tire bead and wheel leading to a predictable outcome once re-pressurized?  According to Scott Paisley, owner of Blue Wheel Bike and Virginia Masters State Champion, regardless of flying or environmental temps, the only reason to ever reduce tire pressure is when packing the bike for shipment, “And it won’t fit into the box.”

So, when you say “Well I got my information from the Internet, it must be right” or you see the viral Jeff Gordon video on line ( and wonder if it’s real – it’s not by the way – and it tells you that you need to be conscious of the late day sun cooking your tires into an explosion, it doesn’t hold air.

Thursday, September 17, 2015

Open Water Swimming and Jelly Fish

"Believe half of what you see and none of what you hear."

                                                       Grapevine, Marvin Gaye

"Dig Me Beach" Kailua-Kona, Hawaii

"There I was, half way thru the run in the (fill in the blank) Ironman when all of a sudden I took off like a jet!  And that's why I'm standing here on this pier a qualified athlete."  

                                                             Overheard on the Kailua pier in 2014

Triathletes are nice enough folks.  They pay their taxes, work hard, help old ladies across the street (if it doesn't get in the way of today's track workout that is.)  But when it comes to taper time before a big race like Ironman, things can get pretty deep.  I guess it's like this in any sport.  Some gal, your chief rival the year before, starts with, "you know my back is still sore despite the chiropractic care...and my shoulder, from that crash a couple months ago, still slows me in the water.  Why there are some days I trouble just getting dressed it hurts so much."  And then once the gun sounds, all you see is her tail lights.

You're not the only one (only thing?) in the water 

 I can't tell you how many times I've been "nipped" by jellyfish during an open water ocean swim.  More than 20 times I'd bet.  Kona, Boston, Chesapeake Bay, Florida, SC, come to mind quickly.  Many of us have run into a jellyfish or two either training or racing in ocean water. More of an inconvenience than anything for most of us, some poor souls have a more significant reaction. I received a note from an athlete a while back who stated a jellyfish sting allergy and she wondered about the legality of wetsuits in an important ocean swim she has in her future, I suppose thinking the wetsuit a shield of sorts.  Triathletes understand the significant differences between events held in a pool or lake and those in sea water.  Currents, waves, sighting,  etc., all are a little different and the triathlete who shows up event morning for their first effort trying to race in an ocean environment is not only stupid but risks both success and physical harm.  It's one of those times where the old adage of practice makes perfect has never been more true.

Well, our allergy athlete in question's race is the Ironman World Championship in Hawaii where wetsuits are not permitted. I've been stung in Kailua Bay a number of times, but it's always more like little needles that hurt/itch a little that day and then, like most of us anyway, it's gone. I've never even seen the ones that got me. If you're lucky, and looking ahead while you swim, which I know most of us don't do, and there's a big Portuguese man-o-war ahead, you can try and swim around it. Remember, it's tentacles can be 5-8 feet in length and have 100's of stinging cells on each. It's not uncommon after a stinging that some swimmers experience nausea, headache, muscle pain, etc., and after the initial welts subside a few are left with permanent scars.

In some locations, primarily around Australia, some jellyfish stings are so powerful that those who encounter them may need hospitalization with intravenous anti venom without which they suffer respiratory failure and and die.

So, if this fall you are stung by one, first (with gloves) peel off any left over tentacles and apply vinegar, straight from the kitchen. More involved stings may require medical attention and support from a cardiopulmonary perspective. And, always be aware of the signs of an allergic reaction - difficulty swallowing/breathing/swelling of hands, face or tongue, etc.

And how do we advise our lady with jellyfish allergy? Well, first, I told her to contact the race director and race medical team well before the event. I'm assuming that her condition has already been thoroughly worked up by a board certified Allergy Specialist.  The race medical guys need to know of the possibilities here. Second, there's a high likelihood that she can be "premedicated" before the race such that should a stinging event occur that she's covered. Sadly, in this day and age, I wouldn't be surprised if a special legal document isn't drawn up for her signature noting the risks she faces and accepts. Hey, it's 2015.

But, the take home here is that most of us, when hit by that odd jelly or two in our morning swim, simply complain about it at breakfast - maybe lunch, a little - and then it's chalked up to triathlon experience.  They might even brag about it one day. 

"Dig Me Beach," a different perspective

Photo credit: Photo 1. This was an aerial shot from race morning a couple years ago but I don't know the photographer to credit 

Friday, September 11, 2015

What Do You Break in a Bike Crash?

"I felt so good, like anything was possible."  Tom Petty

Or, 4 weeks till Kona.

Hawaii 2011-STPT 308

 We hear and read a good deal about broken collar bones be it from the Tour de France announcers Phil Liggett and Paul Sherwen describing a crash in the peleton to perhaps one of our kids Saturday soccer games.

The clavicle is the first bone in the body to ossify (turn to bone) and among the most commonly fractured, particularly in children. It can be fractured via several mechanisms including the classical fall on an outstretched arm as well as striking the point of the shoulder. It's not uncommon to also suffer rib, scapula and/or simultaneous cervical spine fractures and is seen repeatedly in cyclists.

Frequently a patient will tell me they actually heard the bone crack when the fracture occurred. This injury can be confused with an AC separation, a rupture of the ligaments at the end of the clavicle. They're treated differently as you'd suspect.. 

Displaced fractures are pretty easy to diagnose as the whole shoulder seems to fall forward and the patient describes a crunchy sound/feel. Xrays will define the specifics of the break and help guide treatment options. One also checks carefully for any accompanying nerve or vascular damage.  

For non-displaced fractures, immobilization without surgery has been the norm and usually gives good results in a short period of time. The athlete can ride the stationery bike indoors as pain permits (but not outdoors - there's no value in copying Tyler Hamilton - TdF 2003) and you should be back astride the bike by 5-6 weeks post injury. When the fracture is displaced, consideration of surgery to achieve the best long term outcome is undertaken.

In the not too distant past, collar bone surgery was considered both unnecessary as well as unwise. The old adage was "if both ends of the fracture are in the same room it will heal." Well, while a little silly, for the most part it's true.  But definitely not always.  In many displaced fractures of the midshaft of the clavicle, the separation is so great that a non-union (lack of healing) may develop or the fractures heals with a noticeable deformity (malunion.)  While frequently this is not a functional issue, anytime a male athlete is shirtless or female athlete clothed in a shoulder exposing garment like spaghetti straps, the appearance can be strikingly asymmetric.

According to a study in the 2012 Journal of Bone and Joint Surgery where a systematic search of the literature was performed on operative vs nonoperative care of displaced clavicle fractures, there can be a role for surgery in a higher percentage of patients than previously thought.  Their conclusions were, "Operative treatment provided a significantly lower rate of nonunion...and an earlier functional return when compared with nonoperative treatment.  However, there is little evidence at present to show that the long term functional outcome of operative intervention is significantly superior to nonoperative care."

So what does this mean to you?  Well, that there's still a significant role for not having an operation when you break your clavicle for one.  In fact, three quarters of the time, a completely displaced clavicle fracture treated with out surgery will heal with few, if any, long term consequences . However, "It is clear that there is a specific subset of individuals with a completely displaced midshaft clavicle fracture who will benefit from fixation."  This is especially true in the early period after the injury.  They will likely see  more rapid return to function, a decreased complication rate (particularly with regard to the serious negative out come of nonunion.)

Pete Jacobs, Lance Armstrong and Frank Schleck are three good examples of success with surgery in this setting.  But simply because a professional triathlete or bike racer makes a certain choice when given a set of facts, you don't necessarily have to do the same. Although a very successful ad campaign in the early 90's would have you "Be like Mike" referring to Michael Jordan, you have the wisdom to make up your own mind in this setting. Hey, you're a triathlete! 

So, should you find yourself with a displaced mid shaft clavicle fracture, sitting on a gurney in your Emergency Room waiting to talk with the Orthopedic surgeon on call, this may help you make the decision to go for a simple sling or the potential for repair. 

Monday, August 31, 2015

When to Pack Your Last Transition Bag and Call it Quits

"Eckhardt, think about the future!" 
                                                       Jack Nicholson, The Joker, Batman

With a smile like that he must have PR'd the swim!

One of Nicholson's best lines ever was in the film Batman!  

But then, to one degree or another, don't we all think about the future?  Some of us more than others?

 There comes a time when we need to move on.  Triathlon becomes a less significant factor in life, less of a priority, and training becomes more an obligation than a challenge.  That early morning swim is a burden, not an opportunity to work on a race limiter.

 The sword of time will piece our skin,

It doesn't hurt when it begins,

But as it works its way on in,

The pain grows stronger, watch it grin.   

                                                   Suicide is Painless, Johnny Mandel. M*A*S*H, the movie

 I know a number of people who were in triathlon for a short while and out.  On to something else.  It was a fling, an accomplishment, but not a lifestyle.  They didn't own a power meter, never found out the answer to a question on Slowtwitch. They weren't certain of the date of the World Championship in Hawaii. (It is in Honolulu, right?)  In fact, they had more on their plates than triathlon. Work, family, hobbies, other passions, etc. were all part of the game and while important, tri didn't take front and center stage.

 Not so for the woman I met in Kona on Friday,16 hours before race start in Kona last year. This was bike check in, on the pier, for what would be her 40th, that's right, fortieth Ironman distance race.  I'm no Psychiatrist but in discussing the importance of triathlon in her life, the word addiction would have to have entered the conversation somewhere.

 However, eventually the luster grows dull for most of us and we want to, or have to in many cases secondary to chronic or recurrent injury, pass the torch.  And you know what, it's OK when that day comes.  Really, it is.

 "Cal" is one of the best triathletes in our area.  Like a fool, I let him talk me into a workout at the pool a couple years ago, something different he said, just for fun (Cal's kind of fun obviously.) We'd swim 100 yards, jump out on to the pool deck and do ten push ups, and be back in our lane to push off for the next 100.  Can we do it on 2:00? Yes.   Can we do it 1:50? Yes, Cal we can.  I think we needed a funeral home consult after that work out.

 But, Cal's life has gotten more complex lately as his kids have gotten older and entered wrestling, travel wrestling, you name it.  Cal's moved away from tri despite having the ability to run a half IM sub 4:30 in the very competitive 45-49 year old age group.  (I'm certain that some of you read this as discarding a gift that you, or me for that matter, will never have.  I feel your pain!) In short, your day to step back from the sport will come.  When it does, it'll be just fine.  Honestly. I saw that day a while back, and it's just fine.

The race is run, how did you fair?

Thursday, August 27, 2015

Spend Your Money on a Coach (Or Your Boy/Girlfriend) Not Supplements

For too long, too many people have believed that dietary supplements can only help and never hurt. Increasingly, it’s clear that this belief is a false one.
                                                                                                          Paul Offit, MD


I've never been a fan of supplements.  I mentioned in a previous blog a story about my roommate in Kona one year who mixed up a dozen or so pills, liquids, gels and powders in a blender, ground them up into this grey slime reminiscent of Dan Ackroyd's portrayal of the pitch man pushing a Super Bass-o matic 76 - it's pretty funny - .  And down the hatch.  When asked which of these many supplements was responsible for his Kona qualification, he shook his head and said, "Who knows, but they can't hurt me other than making me poor, right?"  Well, probably not right.

Every year the sports world is once again surprised when one substance or another, take deer antler spray for instance, which is quietly sold to a subset of unsuspecting athletes who swallow the promises of those hawking the supplement as that which will surely give them greatness. Shortly thereafter, the product is exposed to either not do as promised.  Or worse, as a result of shoddy manufacturing technique and testing, the athlete tests positive for a banned substance which, sadly was an impurity (at best) in this great "aid" to performance, and the unsuspecting athlete is banned from sport.

The New York Times published an opinion piece in December that I'll reproduce in it's entirety below to give you kind of a middle of the road approach on the logic of why simply accepting anecdotal evidence from generic pro triathlete ABC without evidence based research or knowledge of manufacturing standards might not be your best course of action toward improving your triathlon performance.  

PHILADELPHIA — PARENTS whose children are admitted to our hospital occasionally bring along something extra to help with their care: dietary supplements, like St. John’s wort to ameliorate mild depression or probiotics for better health.

Here’s the problem: The Joint Commission, which is responsible for hospital accreditation in the United States, requires that dietary supplements be treated like drugs. It makes sense: Vitamins, amino acids, herbs, minerals and other botanicals have pharmacological effects. So they are drugs.

But the Food and Drug Administration doesn’t regulate dietary supplements as drugs — they aren’t tested for safety and efficacy before they’re sold. Many aren’t made according to minimal standards of manufacturing (the F.D.A. has even found some of the facilities where supplements are made to be contaminated with rodent feces and urine). And many are mislabeled, accidentally or intentionally. They often aren’t what they say they are. For example:

In 2003, researchers tested “ayurvedic” remedies from health food stores throughout Boston. They found that 20 percent contained potentially harmful levels of lead, mercury or arsenic.

In 2008, two products were pulled off the market because they were found to contain around 200 times more selenium (an element that some believe can help prevent cancer) than their labels said. People who ingested these products developed hair loss, muscle cramps, diarrhea, joint pain, fatigue and blisters.

Last summer, vitamins and minerals made by Purity First Health Products in Farmingdale, N.Y., were found to contain two powerful anabolic steroids. Some of the women who took them developed masculinizing symptoms like lower voices and fewer menstrual periods.

Last month, researchers in Ontario found that popular herbal products like those labeled St. John’s wort and ginkgo biloba often contained completely different herbs or contaminants, some of which could be quite dangerous.

The F.D.A. estimates that approximately 50,000 adverse reactions to dietary supplements occur every year. And yet few consumers know this.

Parents of children admitted to our hospital often request that we continue treating their child with dietary supplements because they believe in them, even if that belief isn’t supported by evidence. More disturbing were the times when children were taking these supplements without our knowledge. Doctors always ask parents if their children are taking any medicines. Unfortunately, because most parents don’t consider dietary supplements to be drugs, we often never knew about their use, let alone whether they might react dangerously with the child’s other treatments.

The F.D.A. has the mandate, but not the manpower, to oversee the labeling and manufacture of these supplements. In the meantime, doctors — and consumers — are on their own.

Our hospital has acted to protect the safety of our patients. No longer will we administer dietary supplements unless the manufacturer provides a third-party written guarantee that the product is made under the F.D.A.’s “good manufacturing practice” (G.M.P.) conditions, as well as a Certificate of Analysis (C.O.A.) assuring that what is written on the label is what’s in the bottle.

The good news is that we’ve been able to find some vitamins, amino acids, minerals and a handful of other supplements that meet this standard. For example, melatonin has been shown to affect sleep cycles and has a record of safety, and we identified a product that met manufacturing and labeling standards.

The bad news is that this was a vanishingly small percentage of the total group. Around 90 percent of the companies we reached out to for verification never responded. They didn’t call us back, or their email or manufacturing addresses changed overnight. Of the remainder, many manufacturers refused to provide us with either a statement of G.M.P. or a C.O.A.; in other words, they refused to guarantee that their products were what they said they were. Others lied; they said they met G.M.P. standards, but a call to the F.D.A. revealed they had been fined for violations multiple times. Perhaps most surprising, some manufacturers willingly furnished information that their product didn’t meet standards — like one company that provided a C.O.A. showing that its product contained 47,000 International Units of beta-carotene, when the label stated 25,000.

Now, when parents in our hospital still want to use products whose quality can’t be assured, we ask them to sign a waiver stating that the supplement may be dangerous, and that most have not been studied for their effectiveness. “Use of an agent for which there are no reliable data on toxicity and drug interactions,” the waiver reads, “makes it impossible to adequately monitor the patient’s acute condition or safely administer medications.”

What can other individuals who are concerned about supplement safety do? They can look for “U.S.P. Verified” on the label — this proves the supplement has been inspected and approved under the United States Pharmacopeial Convention. Unfortunately, fewer than 1 percent of the 55,000 or so supplements on the market bear this label. The real answer is that, until the day comes when medical studies prove that these supplements have legitimate benefits, and until the F.D.A. has the political backing and resources to regulate them like drugs, individuals should simply steer clear.

For too long, too many people have believed that dietary supplements can only help and never hurt. Increasingly, it’s clear that this belief is a false one.
Skip the supplements -

Paul A. Offit is chief of the division of infectious diseases at the Children’s Hospital of Philadelphia, where Sarah Erush is the clinical manager in the pharmacy department

Thursday, August 20, 2015

10 Signs You're a Masters Triathlete

Pretty soon, the tri world will be following the goings-on in Kona. The race date is picked so as not to interfere with the inter-island cruise ship schedule.  This is more important than you may think as when each ship pulls into Kailua harbor, it unloads 100s of tourists ready to see the island by bus or helicopter, dine at any one of Kona's fine establishments while mulling over that Mikimoto pearl purchase or Na Hoku necklace for someone special back home. Each ship makes a difference and IM respects and honors that.  

While the big boats are absent race weekend, they still frequent the area while racers entered in the World Championship bike, run, and most importantly swim in preparation for Saturday's festivities. For the most part, the passengers are from the US mainland and when brought by tender in groups of 75 or more, they dock right next to the athletes in training on the pier.  Well, maybe not athletes in training but athletes talking would be a better choice of words.  Since the race is almost upon them, their swims are pretty short.  But they have to do something.  So they hang around the pier till mid morning. Many of the pros do the same and are most accessible. 

So after the tenders discharge the hula shirt wearing tourists, these visitors snake thru the large group of barely clad athletes, families and friends there for IM and it makes for a wonderful interaction.  Both groups smile at the other.  Both groups think the other group nuts!  Both groups are right. 

Always a good idea to have any lingering questions about your swim course answered before race day

So, how do you know you're a Masters triathlete?  Well, that line can be drawn many ways as it depends a great deal on your perspective.  If you're 23 the cut off might be at one age or if you're 43 another.  Here are a couple ways, without revealing your age, you might have a sense that you've passed into masters territory.

Adult beverages - relaxing with a glass of wine, or two, the night before a race was never an option before.  Now it occurs more often than not.

Aging up - being the youngest in your age group used to be a good thing, but the older age groups are often more fierce - and in some cases faster.  Really!

Masters prerogative (MP) - at swim team, you may at times employ MP in changing the work out or negotiating sets with the coach and teammates, something you could never do as a youngster.

Fine Line - you no longer have 14 workouts/week.  Hell, you're lucky if you get 7, 8 or 9!  So when it's time to race, you're not sure if tapering will get you out of shape or the warm up gets you in shape.  It's a fine line.

Bodies - Many have taken their ailing shoulders, backs and knees to that place where the cutting is done.  In other words, butterfly is no longer an option.  At least your Ortho doc says so.

Every day something hurts.  And every day it's something different.

Ice is a close friend.  You've learned the difference between Tylenol, Advil and Aleve.  Personally.

Laughing out loud - everybody shows up at bike group, not because their parents or coach are making them.  You don't remember smiling or laughing this much during training as a younger age grouper. 

And just maybe, some thoughts about can't see, can't hear, can't pee.   Remembering when morning stiffness was a good thing.  Having to think twice, maybe three times while swimming a complex set as you try to compute the interval (I know, you screw this up all the time.)