Sunday, October 30, 2011

Raynauds and Winter Training

Perhaps the owner of this bike has something else on his/her mind!



Smith and Wesson?? Do you ride it or shoot it?



Although it’s only October, we in Virginia have had our first snow of the year. I think it’s a good time to start this year’s discussion of cold hands, Raynaud’s Syndrome in some cases.

Raynaud's is pretty common. Many will have it as an isolated phenomenon and in others, it accompanies a more global process. Those affected will have more issues in the cold conditions than warm, their fingers will have decreased sensation and turn white, almost snow white, on occasion. When placed in modestly warm water for 2 or 3 minutes, the digits re-warm and turn every shade of red and purple you can imagine before simply settling on only mildly red. Once warm, starting a car is easy.

If you want to document this, next time it occurs, start taking pictures with your cell phone, and save them for your health care provider. You will asked about a family history of certain kinds of arthritis, bowel disease and the like. You may find that your complaints are the same (or different) but it's a good starting place.

My sister and I both have this to a greater or lesser degree and I think I'm the biggest purchaser of chemical hand warmers at our local backpacking store. But, I ride outdoors all year unless there's snow or ice on the road. Cold water swimming, however, can present a certain challenge!

For those readers who may not know (or who may have it and wonder) Raynauds Syndrome is the discoloration and numbness of the fingers that many adults see in response to cold (or sometimes changes in emotion.) The finger whiteness discussed above, sensory disturbance, and even pain, make them pretty useless when trying to type or any other fine motor activity. In a few minutes, as the fingers begin to warm, they turn blue then a purple-red with a "pins and needles" feeling before they normalize. This whole process can take from just a few minutes to an hour and can be quickened by immersing ones hands in warm water as noted above. Or stick them in your pants.   Women seem to get this more than men, 2nd to 4th decade of life. There are medical answers to this, and especially medicines to avoid, which might increase the frequency of attacks.

That said, I've had it for 30 years, my Mom longer, so it's easy to follow long term. And mostly we just live with it. I use chemical hand and foot warmers biking in the winter, and when it's below freezing I have some Sidi rechargeable warming inserts for my winter biking boots (they're not cheap and don’t work all that well - read don't waste your money). It's all just a matter of preparation. So, welcome to the world of Raynauds Syndrome, it's an inconvenience but not much more.

A number of readers have had excellent posts about how to solve the cold hands problem that can accompany winter riding. Excellent suggestions have come forth about a variety of different types of gloves/mittens/socks, chemical hand warmers, etc. Some athletes have simply chosen to ride indoors until the bloom of Spring and give those Computrainers a work out. If, however, you want to stay outside all winter, depending upon your climate, some alterations may be in order to remain comfortable.



As we've noted here before, a surprising number of athletes suffer from Raynaud's Syndrome, a spasming of the small arteries in the digits, often when cold. About 5% of men and 8% of women have Raynaud's and it can affect ears, toes, and even your nose.

So, to remain comfortable we have to remain warm. All it takes is a little trial and error. Well, maybe a lot of trial and error. I'd suggest you start by putting a thermometer outside your window to get an accurate temperature before you venture out. It's better than the Weather Channel as you may live a real distance from where they get their measurements. Then, get an idea of what gloves, layering of gloves, mittens and layering/lining of mittens you need at 50 - 55 degrees, 40 - 45 degrees, etc. If your mittens are so bulky that you may lose control of the bike, figure out something else. A reader from last year noted that the important thing was not to layer each digit as you might do with shirts and coats, but to provide a “den” for the fingers. Mittens, more than a single layer, with touching digits and some type of warmer seemed best for him. One thing that many over look is a product called Bar Mitts (they also have Mountain Mitts for your mountain bike.) These are sleeve-like neoprene that fit right over your handle bars and block cold, rain and snow...not that you'll be riding outdoors on 23 mm tires in the snow. I hope. You don't even need very thick gloves to stay toasty. I'll admit that they may look a little dorky but the bike group conversation will quickly move on to something else and you keep your hands warm. I'll attach a couple pictures from a local riders bike.







Reader Darkwave added these very useful comments: I've found disposable hand warmers to be essential for winter running -- I start using them when the temperature drops below 50. For running races, I wear thin gloves, then hand warmers, and then socks over both. If I heat up too much in the race, I can toss the socks or even the hand warmers.

As always, please share your experience and comments.

Thursday, October 27, 2011

Concussions Off the Bike

Substitute Swimmer for your Triathlon Relay?


Kimo the dog.  I wear glasses, but my eyesight's not all that bad.  While treading water at the Coffees of Hawaii barge (every year during IM race week in Kona, the good folks at Coffees of Hawaii set up a large sailing craft about 700 m off shore, where anyone who swims up
Coffees of Hawaii barge
to it is offered a small paper cup of Kona's finest.  It's pretty darn cool and I'd suspect they serve over 1000 "customers" each morning.  And the coffee's hot, too!)

So, while sipping my excellent brew, goggled, without glasses, I noted a group of three swimmers approaching, one with a very odd mask on, but hey, it's Hawaii, home of the underpants run.  And I'm in the middle of the ocean at a coffee barge for gosh sakes.  I thought the mask had ears on it.  But, once they were closer, I could see that the third swimmer was a German Shepard...with a life vest on.  Now there's something you don't see every day back home.  When they had their fill of coffee, all it took was a simple, "Come Kimo," and off they went, continuing their swim.

ACL Reconstruction Follow Up
In August, I did some reporting on ACL (Anterior Cruciate Ligament of the knee) tears.  Reuters reported this week, in a study of Australians followed for over three years following their reconstructions, that "half of people who played sports competitively or just for fun don't perform as well as they used to."  When narrowed down to those who played competitively pre-injury, only 91 of 196 returned to their competitive sport.

While this is a single study, and review of many give a more representative picture, suffice it to say that tearing an ACL can be a serious injury.

Concussions Off the Bike
Who among us hasn't been on a group bike ride where there hasn't been a crash of some sort?  If you were lucky, it was just a little road rash.  If not, a portion of the injury could be a head injury.  And this is true for helmeted cyclists as well.  Not infrequently a concussion will occur and this has the potential for being a more serious injury than we may have previously thought.  The October 10, 2011 Sports Illustrated  has an article on the NHL which discusses the head injury to it's "most important star" Sidney Crosby.  They are rededicating themselves to player protection, and we should too.

But haven't we always had the culture of endurance over safety?  Haven't we seen the films of the last 400m of IM Hawaii where Paula Newby-Fraser, the Queen of Kona is weaving down Hualalai Street like some kind of drunk when Karen Smyers sprints by?  Or Chris Legh, or Wendy Ingraham and Sian Welch, as they weave uncontrollably toward the finish line?  Maybe they've crossed a line of a different sort!  In the mid 2000's, I had the slowest bike time of all 1700 competitors in Hawaii  when I stopped to help a biker on the down hill from Hawi whose front wheel had hit one of the plastic highway road reflectors at just the wrong angle.  POW! Instantaneous crash, broken helmet, closed head injury, you can guess the rest as we waited for rescue help together.  In short, once a concussion is recognized, that athlete's day is done - they should not be allowed to resume their sport, triathlon included.

Research is showing that healing of injured brain tissue requires sufficient nutrients and rest. If this isn't allowed to occur, then the potential for increased injury increases.  Previously, injury severity scales left a great deal of interpretation to the examiner when deciding how serious the concussion really was.  Now, especially in NCAA sports, if a player suffers a concussion of any magnitude, he or she is out of the game.  No questions asked.

So, as an athlete, how do you determine if your bike mate's had a concussion after that crash?  Well, you're probably not a neurologist, but starting with an "index of suspicion," at least considering that it's possible helps.  Was there a loss of consciousness, confusion, head or neck ache, blurred vision or anxiety?  In an athletic contest, the athlete would be asked, "Who Scored last?" or "Where are we playing today?"  Finally if the suspicion continues, the player would be checked for balance and coordination.  Now, I'm not saying that every time somebody in your bike group goes down that you start this cascade.  But what I am saying is, as a friend of somebody who's had an accident and my not realize that they've suffered a head injury and are not making the best of decisions, you need to take charge.  Nice the injured rider into calling a day, just because, and give them a ride home.  Likely, a trip to the local ER just to be on the safe side would also work  Then, maybe after all that, it gets to be Miller Time.

Image 1, Google Images

Sunday, October 23, 2011

Stem Cell Transplants

The View From T1 in Kona


"I have no reason to be over optimistic, but sometimes when you smile I can brave bad weather."    Tommy, The Who

How can you help but not smile when you share the frivolity of 23 year old age grouper Brian Yannutz who puts a shark fin on his bike helmet? (I think it was ultimately removed by race officials prior to race start - safety.)

One of the advantages, and disadvantages, of working on the pier during IMH is that you not only see the race unfold, you're close enough to touch the athletes.  Or, in some cases, be "touched" by the athletes as they smash into you having exited the swim and slightly misjudge the turn into the men's changing tent where you're directing traffic.  But, you quickly guide them inside with a friendly comment so they can don bike gear and head to the Queen Ka'ahumanu Highway and the heat and winds that await them on their 112 mile journey.  As the race progresses, you see not only their splits, recorded for eternity, but you see the expressions on their effort filled faces, maintained for only an instant.  Are they springy and smiling as they exit T1 - most are, or do they seem tired but gritty with determination as they hand off their two wheeled steed to the volunteer bike catcher at rides end?  Are their black shorts covered with salt?  Do they wave to the adoring crowd or merely take the next laborious step as they head out on the the run? Body language, it's everything isn't it?
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Life Giving Stem Cell Transplant

You've seen the newspaper articles concerning the "miracle" of stem cell transplants.  And, in many cases, it truly is nothing short of that. Stem cells are juvenile cells which possess the ability to grow into red and white blood cells, platelets, etc., and one day possibly nerve cells and more for the treatment of brain and spinal cord injury and so forth.  Currently, the main source of these cells is from human bone marrow as they're used in the treatment of leukemia (body makes too many young white blood cells) or anemia (blood cell production slows or ceases) and various other types of blood related disease processes.  14,000 or more bone marrow transplants are done in this country annually. But, one of the major hurdles for these patients is finding a donor, an exact match.  This is especially true of those of southern European of African ancestry where the match rate can be as low as 15%.

Along comes umbilical cord blood which significantly improves the potential of finding a match!  The source of nearly half a million possible donors annually comes from the National Marrow Donor Program and Eurocord, organizations which arrange for the placental and umbilical cord blood of new borns to become part of the universal blood bank pool.  In the past, these were discarded but now, with the mothers permission, they can be harvested to help others.  Thousands have benefited from this new source.  In other words, it's prevented thousands of deaths of those who otherwise wouldn't find a match!

What Triathletes Can Do  Become a possible donor.  It's easy. Since upwards of three quarters of those who can not find a living related donor turn to the Donor Program, you can be there to help.  Simply go to www.marrow.org where you'll find:
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Join Now small

Join Now

Thousands of patients hope for a bone marrow donor who can make their life-saving transplant possible. They depend on people like you. You have the power to save a life. Take the first step today.
Button Join Now Dark
Do it today!
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I'll leave you with this:  Charles Shackelford, former North Carolina State basketball player noted, "I can go to my left or my right, I am amphibious."

Sunday, October 16, 2011

Pain and Pain Medications

A "Thank God I'm Not Racing!" Party in Kona?  Say it ain't so.

Site of the 2010 TGINR party
I briefly mentioned the "Thank God I'm Not Racing Party" in Kona hosted by Competitor Magazine in my 10/4/2011 blog but as best I can tell it wasn't repeated this year.  Too bad as I think it's a terrific idea along the lines of the Underpants Run.  These are things that just seem to fit in the Hawaiian ambience but might be hard to duplicate at other race sites.  Jessi Stensland wrote on Active.com that "There's always a reason to celebrate in Kona and last year's first (hopefully annual) TGINR "Thank-God-I'm-Not-Racing" party, hosted by Competitor Magazine on the eve of the race is a perfect example. The inaugural event, held at Huggo's On The Rocks, was packed with pros, supporters and other industry folks. An open bar, buffet and baseball caps with TGINR were free for all."

Maybe if we're lucky, the TGINR party will reemerge in 2012.
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Might be you one day!

Ankle fracture weeks before "A" race Ironman
"Sickness will surely take the mind, where minds don't usually go.  Come on the amazing journey, and learn all you should know."
                                                             Tommy, The Who
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"At some point in your triathlon life, you may have some type of injury such that you're in enough pain that some sort of  pain medication is offered/requested.  So many of us are resistant to the "there's a pill for that" mentality but we're addressing situations which are out of the ordinary and by using the suggested medication, perhaps other parts of life will benefit like amount of sleep, ability to exercise, spousal relations, etc. There are many options, and if you have a general idea of what might work best for you ahead of time, then you'll be neither over nor under medicated.  Let's look at some of your choices.

Aspirin

Anacin, Ascriptin, acetylsalicylic acid and other forms of this work horse medication have been around for decades and have found wide acceptance as an analgesic in the treatment of minor pain.  Either alone or in combination with or substances such as narcotics, it's proven most effective.  It also finds use as an antipyretic (lowers temperature,) an anti-inflammatory agent and most recently as an anti platelet drug in the prevention of myocardial infarction's, strokes and blood clots in low doses. The author takes a daily baby aspirin (81 mg) for just such an indication.  It's primary negative is the occasional formation of GI ulcers or stomach bleeding.  It's one of the most commonly used medications world wide.

Acetaminophen

Tylenol, like aspirin, is an analgesic (diminishes pain) that's available without a prescription and is useful in treating minor pain and flu like symptoms.  It also finds it's way into combination drugs like narcotics for more severe pain such as post operative, obstetric, or in those with cancer pain. It is not an anti inflammatory and does not share the same side effects as aspirin. But, if inflammation is part of the presenting symptoms, then acetaminophen may not be the best choice. In chronic use or larger doses, it can be potentially fatal to liver function, and is a common cause of death in those who've taken a drug overdose.  It is quite safe when used appropriately.

Non-Steroidal Anti Inflammatory Medications

The NSAIDs, Motrin (ibuprofen), Naprosyn (naproxen),Clinoril (sulindac),Celebrex (celecoxib), etc. as they are called, can be quite useful in treating chronic or arthritic type pain as well as acute pain.  Like aspirin, NSAIDs also have the ability to lower temperature.  Their primary role in in the treatment of inflammatory conditions, the -itis's, as in tendinitis, bursitis, etc.  Once again, occasional GI distress is the major potential side effect and is reported to be less the family of drugs like Celebrex, a COX-2 inhibitor.  As with any medication, you should take it when needed but stop when you don't.

Corticosteroids

In select circumstances, these anti inflammatory agents like prednisone, Medrol Dose Packs, etc. can be quite effective over short durations.  They are not to be confused with anabolic steroids like the weight lifters have reportedly used.  You might be given these orally or as an injection into a joint or a tendon sheath.  Side effects can be elevated blood sugar in diabetics, weight gain, and adrenal suppression. Careful here.

Narcotics

Widely prescribed by the medical system, drugs like morphine, codeine, hydrocodone,etc. find a role in controlling more severe pain.  They require special licensing from the Drug Enforcement Agency to prescribe but help patients through surgery, migraines, deliveries, trauma, etc.  They should only be taken when the above options prove ineffective.  On the downside one finds the possibility of tolerance if taken for a long time, addiction, abuse, etc.

Alternatives

 In many instances, simply starting with ice and/or heat can make a big difference.  And, this list of categories is not meant to be exhaustive.  Electric stimulation, acupuncture, massage, physical therapy, etc. may play a role in your care.

In conclusion, depending on your situation, if in pain, and asked to consider one or more of the above options, work with your health delivery team to determine which of the above agents might be best for you.

Thursday, October 13, 2011

E.S.I.'s/Back Injections


Incredible Octogenarians in Kona



I really enjoyed the awards banquet in Kona on Sunday.  Many smiling, happy age groupers and pros who'd done well enough in the previous days Ironman Championship (they've dropped the word triathlon in most places) to earn a spot on the stage and a special podium prize. Our seats were close
enough to the competitors and "voice of Ironman" Mike Reilly (Who was inducted into the Ironman Hall of Fame Sunday,) that it made for a terrific night. The final athletes to stand astride the podium were the 80 and over age group.  That's right, 80 and over.  2010 saw the first man over 80 to finish the difficult Hawaiian course known for it's heat, wind and barren lava fields.  Lew Hollander, a gent who could pass for 65 any day of the year, who's competed in and finished 20 IMH's, crushed it with a 15:48 finishing ahead of 39 other racers.  (Interestingly, the last athlete across the line finished in 16:59:13, a mere 47 seconds ahead of the 17 hour - midnight - cutoff!)

Lew took the age group again this year ahead of two other 80+ year old finishers, and it would have been 4 of 4 if Bob Scott, reigning 75-79 year old course record holder, hadn't had bike rear tire alignment issues.  Can you name any age group where they all finished?  You realize that it wasn't that many years ago that 60 was considered old, over the hill (way over), in Ironman terms yet I watched 75 year old Harriet Anderson, also a finisher this year, beaming with pride after being handed her award from Heather Fuhr, 1997 World Championship winner. Formerly grand old men Bill Bell and Norton Davey gave Kona a good shot, both Ironman finishers at other locations, but the infamous conditions proved overwhelming.  Our hats are off to these fine folks who refused to give up despite the odds against them.  We should be so lucky!
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Epidural steroid injections and back pain.  Sound familiar for some reason?



  • Back pain is present everywhere.
  • There are 15,000,000 visits to the doctor annually.
  • 95% of us will have at least one episode in our life time.
  • Back pain is seen in 50-80% of the population at any one time.  20-30% of athletes.
  • The annual cost of management is 50 Billion dollars.
For those in pain:

80% of the cost is in those with chronic back pain which makes up 10% of patients.  So who's at risk? Well, complaints begin to increase at about age 35 increasing till about age 50 in males and 60 in females.  While there is thought to be some type of genetic component, other risk factors include general fitness, core strength, which certainly plays a role as does type of work place or sports, depression, and cigarette smoking to name a few.

Perhaps you've been diagnosed with sciatica defined by WebMD as:  "Pain resulting from irritation of the sciatic nerve, typically felt from the low back to behind the thigh and radiating down below the knee. While sciatica can result from a herniated disc directly pressing on the nerve, any cause of irritation or inflammation of this nerve can reproduce the painful symptoms of sciatica. Diagnosis is by observation of symptoms, physical and nerve testing, and sometimes by X-ray or MRI if a herniated disk is suspected."

If this is the case, your physician may suggest an ESI or epidural steroid injection.  These injections are typically done under fluoroscopic guidance by physicians who specialize in spine care including Physiatrists, Pain Management centers, Anesthesiologists, etc.  It takes a good bit of practice to get the very tip of the needle in the exact location desired to deliver an amount of corticosteroid (not anabolic steroid like it's been suggested that body builders use...or is it abuse?)  Currently, one can recieve up to three of these injections in one years time if needed.  This video may be helpful. http://www.spine-health.com/video/epidural-steroid-injections-back-pain-and-leg-pain-video

While relief of pain is seldom permanent, it can, in many cases, be quite long lasting easing leg pain, back pain, or both.  They've been used successfully in the neck, upper and lower back for over 60 years.  If an ESI is in your future, I would discuss the experience of the person doing it along with potential complications to help take part in my own health care.

Tuesday, October 4, 2011

Calf Strains

3 Days till Blast Off in Kona!

The triathlon press watch bike inspection carefully recording equipment details.


The streets here are alive with runners and bikers, tall ones, short ones, old ones, young ones.  It's quite the site!  I ran into Bob Scott from Naperville, IL  this morning after his early swim. Bob is the course record holder in the 75-79 year age group (having previously held 65-69 and 70-74).  He's racing 81 this year...we should all be so lucky.  You may not know that Coffees of Hawaii sets up a barge about 700m off shore here, and as part of your morning aquatic adventure, they include a few ounces of hot Kona coffee to anyone who happens to swim by.  It's really a treat.  All part of the Kona experience.  Also, Competitor Magazine puts on a Thank God I'm Not Racing party on Friday night that's exceptionally popular for all the reasons you might imagine.  That said, come Saturday morning when their studly friends toe the start line, maybe there's a little different sentiment.
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Calf Strains
We recently covered hamstring tears and strains and I thought it a good time to review calf strains.  When you look at the person in front of you's calf, the two main muscles are the Soleus and the larger Gastrocnemius. They function in ankle flexion, pointing the toes down.  The gastroc originates in the back of the knee off the femur while the soleus originates off the back of the tibia and fibula.

I've had patients tell me that when they suffered a calf strain that there was no doubt in their mind that there was something wrong.  "It was like somebody hit me in the calf with a golf ball going 500 miles an hour!" Depending on the level of involvement, symptoms can include swelling, bruising, pain, an inability to contract the muscle, limp, etc.

The Big Hooyah 2011
Pat McCann, a multiple time IM finisher, is see above participating in a local race called "The Big Hooyah" put on by SEAL Team Physical Training. It's one of those events run through the woods, fields, rivers, over and under obstacles.  They've just finished pushing the hay bales seen in the back ground.  Pat's had a number of both hamstring and calf issues over the years and finds, like many that carefully listening to his legs being careful not to overdo is key to his training.  He also recommends keeping the calves warm when the temperature drops.

The current calf strain grading system, like hamstrings, has 3 levels or grades depending upon the perceived severity of the injury.  Historically, the structure thought to be torn was a small muscle known as the Plantaris found deep in the calf.  The advent of MRI changed that and accurately identified the medial (inner) head of the gastroc as the culprit. Grade 1 is the mildest form of this injury which even present in a chronic form.  It's characterized by mild to moderate pain, little to no bruising with many athletes taking minimal time off, resolving in a couple of weeks.

The triathlete with a grade 2 injury is much more likely to display bruising and swelling, moderate to significant pain, and distress with attempted toe off.  One of the Ironman favorites in the 50 - 54 year old age group on Saturday, Steve Maves, who runs a 3:08 marathon after a 5:12 bike, describes his calf tears as not occurring in the expected "runs too fast early without proper warm up" variety but more likely to occur in the middle of a work out when all is quite well warmed up.  In fact, he once had one during warm down!

The most severe injury is the grade 3 tear.  This involves a significant disruption of the muscle fibers, bleeding, etc.  One is frequently unable to walk, did feel like they got shot in the calf, and can have enough torn muscle that it is visible cutaneously in the upper calf!


Treatment
 Ice for the first 48 hours is most important thing, but being careful not to be too aggressive and avoiding frostbite. Many find elevation and rest helps them shorten the period of disability as well. Allowing the damaged muscles to heal before stressing them again pays off in the long run. Gentle stretching, but not to the point of pain, can be beneficial. The literature would support brief use of an NSAID like Ibuprofen.

After 48 hours, heat is applied and a physical therapist may be be employed to assist with tissue mobilization, ultrasound and an exercise regimen to re-strengthen the extremity.  Commonly the grade 1 injury is resolved in a week to 10 days and grade 2 - the most common - in about 6 weeks.  The grade 3 injury, in my mind, should be cared for by a physician, and can require 3 months, perhaps even 6 months to resolve.  I know a couple folks who've had 2, even 3 calf strains in the same calf but fortunately they're frequently only grade 1 tears.  Good luck

Sunday, October 2, 2011

Heat Acclimatization

Kona - One Week!!


       The desolate beauty afforded the biker on the NW coast of the Big Island of Hawaii.

Although when one thinks of the Hawaiian Islands, lush tropical forests come to mind.  They may not be familiar with the Ironman course along the Kona Coast.  As you can see, the harshness, almost moonscape appearance, gives one the feeling of being completely alone.
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For many of us, triathlon training is a similar emotion, but also one that pervades all aspects of our lives. Who among you hasn't been in a social situation, out to dinner with a client or halftime at an offspring's soccer game, and when the conversation slows, your brain drifts to how to improve your T1 time in your next sprint tri? Or, maybe you should go ahead and buy that swimming video your lane mate mentioned.

As one who's spent Ironman race week on the Big Island of Hawaii for each of the last 20 years, you get an interesting perspective of the "top of the pyramid" in our sport and what it takes to get there. I volunteer on the pier every year helping out in Transitions. I get to be part of a talented, dedicated team lead by capable David Huerta. While some of the athletes seem almost consumed by the sport, many see it as just one slice of the pie of life. Just a pretty big piece! Many have the ability, especially when their race season is complete, to put the lifestyle inclusive of 10, 15, 20 or more hours/week of training behind them, spend time with family, cross train by leaving the bike behind and go hiking with the kids, etc. Sounds like a healthy approach to me.
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One note. I learned just how far WTC goes to ensure a fair race and compliance with the rules. When the pros exit the swim and race to the transition tent, they are "helped" out of their speed suits by volunteers who then label each suit with a number. Later, when most of the athletes are well out on their bikes, each suit is inspected to make sure that it followed race guidelines - one was not! (And the entrant later disqualified.)  They're pretty serious in Hawaii.

Very interesting to observe.  Make sure you follow the rules.
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Heat Acclimatization

It's been shown time and again that heat acclimatization is crucial to an athlete looking for his/her best performance.  Even if one spends only ten days acclimating prior to an intense effort in a warm environment, there is benefit to be reaped.  According to TBC coach David Warden, "The cruel irony is that the age groupers are more likely to race in heat.  They are more likely to be unable to train in a warm environment, they're slower and often get a start later in the day, all of which combines for a very long day.  In short, Warden points out that "Since training should simulate racing conditions as much as possible, heat acclimation should be considered a part of the annual training plan."  An interesting perspective for sure.

There's a certain concentration of electrolytes in sweat.  Thus, if the non-acclimatized athlete sweats more in the warm environment, they lose more electrolytes.  Over a ten day cycle, it's been shown that the body can adapt to warmer temps by diluting the sweat concentration, preserving electrolytes.

It's also been demonstrated that there's a higher use of glycogen in the heat as well as increased concentration of lactate, and both of these can be brunted to a degree by allowing the body to accommodate to the changed warmer environment.

Lastly, since the athlete with little to no acclimatization measures has to cool his/her blood through the skin, there's a diminished amount of blood left for propulsion.  This actually increases the stroke rate, the heart rate, and can alter one's training zones by a significant amount.

So, the take home message here is to do what you can to get your body prepared for the environment in which you'll be racing.  The pay off will be the view seen above earlier in the day, a win-win for you.