Monday, July 30, 2012

Achilles Tendon Rupture, What's New?

"Here Men from The Planet Earth First Set Foot upon The Moon
July, 1969 AD We Came in Peace for All Mankind."

                                               By far the best "foot" quote I could find.

A black foot?


Achilles Tendon Ruptures

The Achilles Tendon is one of the largest and strongest tendons in the body.  It does, however, rupture on occasion in the mature triathlete making running, cycling, and even normal walking just about impossible.  Traditionally, when faced with this injury, a surgical path was chosen to re-approximate the torn tendon ends with stout suture.  Subsequently a period of several weeks immobilization followed to allow the construct to heal.  Depending upon the severity of the tear and the surgeon’s confidence in the quality of the repair, which I’ve hear described as “sewing moonbeams to flatus,” the athlete can return to running somewhere between 3-6 months post op.  Sort of ruins your whole season doesn’t it?

Over the past several years, an effort’s been made to determine if the current level of success in returning the runner back to his/her sport can’t just as easily be accomplished without an operation.  This could possibly eliminate the associated complications of post surgical infection, bleeding, nerve damage, etc. and likely lower the cost of treatment.  The beef against non-surgical care has always been that there’s a trade off that by lowering the associated surgical rate of complications you also increase the number of re-ruptures.  


One high quality study with 144 patients, half treated with surgery and the others without, showed an almost identical re-rupture rate leading the reader to surmise that either treatment was satisfactory.  However, in the June 12, 2012 Journal of Bone and Joint Surgery, a piece by Dan Bergkvist, MD compared 487 patients from competing hospitals in Sweden.  The re-rupture rate was nearly comparable (3% in the surgical group, 6.6% in those treated without an operation) but there was slightly superior performance and strength testing in the operative group.  This lead the authors to note that surgery “may beneficial in selected patients.”  In other words, you as an athlete will have a higher demand once “back in the game” and if this unfortunate injury befalls you, surgical repair may still be your best option.  That said, the data would also support your choice of nonsurgical care if you so choose.   
 

Wednesday, July 25, 2012

Cheating In Triathlon


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




                                                                                             John McGuire, former Navy SEAL




 



 














Race start is mere hours away. Will everyone follow the rules?



 


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.  Are you sure?


________________________________________________


 


“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 last week 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?


 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.  And, not just any non-WTC race but the World Championship in Hawaii.  That said, please do not interpret this as critical of WTC or IM Hawaii 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, 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.


 About ten years ago, complicity among athletes was suspected 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 in Hawi with two timing chips, only one of which was his own.  In other words, one competitor went 112 miles, at least one other significantly less.


 In last years event, a gent cut about 5 miles off of the run by neglecting to include the 2 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 winner was disqualified shortly after the event when her blood was 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 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'll finish this piece with the thought that it's been reported that some age groupers, with nothing more to win than a trophy, are thought to have illegally injested steroids, human growth homone, testosterone, etc. in their quest to win.  To again quote John McGuire, "If you'll cheat yourself, who won't you cheat?"


 



Sunday, July 22, 2012

Cheating in Triathlon

"If you cheat yourself, who won't you cheat?"  
                                                                                             John McGuire, former Navy SEAL


Race start is mere hours away. Will everyone follow the rules?

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.  Are you sure?
________________________________________________

“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 last week 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?

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.  And, not just any non-WTC race but the World Championship in Hawaii.  That said, please do not interpret this as critical of WTC or IM Hawaii 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, 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.

About ten years ago, complicity among athletes was suspected 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 in Hawi with two timing chips, only one of which was his own.  In other words, one competitor went 112 miles, at least one other significantly less.

In last years event, a gent cut about 5 miles off of the run by neglecting to include the 2 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 winner was disqualified shortly after the event when her blood was 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 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'll finish this piece with the thought that it's been reported that some age groupers, with nothing more to win than a trophy, are thought to have illegally injested steroids, human growth homone, testosterone, etc. in their quest to win.  To again quote John McGuire, "If you'll cheat yourself, who won't you cheat?"

Wednesday, July 18, 2012

Baker's Cysts, Lumps in the Knee

"The main thing is the YOU beneath the clothing and skin - the ability to do, the will to conquer, the determination to understand and know this great, wonderful, curious world." 
                                                                 W.E.B. DuBois to his daughter Yolande, 1914
_________________________________________________

Just when you are comfortable with your training plan, or life in general, you round a corner and see something like THIS! We always like to be prepared for that which surprises us.  Well, a little prepared any way.


Yes, these are full sized aluminum canoes just like the ones you used at summer camp.  The artist, Nancy Rubins, calls this Monochrome II, Chicago.  I had the privilege of seeing it on Saturday at Chicago's Navy Pier.
_______________________________________

Baker's Cyst

Got a lump on the back of your knee? Somebody mention Baker's Cyst or popliteal cyst? Although it may be news to you, these are more common than many people suspect. While not normally an isolated finding, there are two bursae (bursas) in the back of the knee joint which can fill with fluid. Even though it feels like a mass, and when we think mass we think cancer and these have nothing to do with cancer. Most commonly these are a secondary process in reaction to something going on in the knee joint itself. They are neither life nor limb threatening but can be quite bothersome. They are not the result of an infection. People who have them will report that some days they're large, some small, and while intermittently painful, the patient can actually be symptom free for much of the time.

The mass or fullness is actually fluid that has filled the cyst, much the consistency of the normal fluid found in a human joint. Often times they will accompany arthritis in the older patient and, although less frequently, a torn knee cartilage (meniscus) in the young.

If one is diagnosed with this problem, a number of options will be discussed and one of them is simply to do nothing. Many patients, once they discover that it's not cancer, will choose this option. Others prefer an aspiration of the cyst and injection of a steroid preparation. If still symptomatic to the point where, if a potentially treatable issue is uncovered, the next step might include plain x-rays and follow up MRI. These might be stepping stones to arthroscopy. In the patient with enough arthritis, and an accompanying Baker's Cyst,to warrant a knee replacement simply replacing the joint (not so simple for either patient or surgeon) will lead to resolution of the cyst.

Lastly, very infrequently, no other causative agent can be located and the patient will request excision of the cyst. This is pretty rare in my experience.

So, if your doc tells you that you have a Baker's Cyst, there's no rush to do anything, analyze your options and after weighing the risks/benefits choose what's best for you. Patience is always helpful.





Baker's Cyst, Lumps in the knee

"The main thing is the YOU beneath the clothing and skin - the ability to do, the will to conquer, the determination to understand and know this great, wonderful, curious world." 


                                                      W.E.B. DuBois to his daughter Yolande, 1914     _________________________________________________


 Just when you are comfortable with your training plan, or life in general, you round a corner and see something like THIS! We always like to be prepared for that which surprises us.  Well, a little prepared any way.


 



 Yes, these are full sized aluminum canoes just like the ones you used at summer camp.  The artist, Nancy Rubins, calls this Monochrome II, Chicago.  I had the privilege of seeing it on Saturday at Chicago's Navy Pier.


_______________________________________


 Baker's Cyst


 Got a lump on the back of your knee? Somebody mention Baker's Cyst or popliteal cyst? Although it may be news to you, these are more common than many people suspect. While not normally an isolated finding, there are two bursae (bursas) in the back of the knee joint which can fill with fluid. Even though it feels like a mass, and when we think mass we think cancer and these have nothing to do with cancer. Most commonly these are a secondary process in reaction to something going on in the knee joint itself. They are neither life nor limb threatening but can be quite bothersome. They are not the result of an infection. People who have them will report that some days they're large, some small, and while intermittently painful, the patient can actually be symptom free for much of the time.


 The mass or fullness is actually fluid that has filled the cyst, much the consistency of the normal fluid found in a human joint. Often times they will accompany arthritis in the older patient and, although less frequently, a torn knee cartilage (meniscus) in the young.


 If one is diagnosed with this problem, a number of options will be discussed and one of them is simply to do nothing. Many patients, once they discover that it's not cancer, will choose this option. Others prefer an aspiration of the cyst and injection of a steroid preparation. If still symptomatic to the point where, if a potentially treatable issue is uncovered, the next step might include plain x-rays and follow up MRI. These might be stepping stones to arthroscopy. In the patient with enough arthritis, and an accompanying Baker's Cyst,to warrant a knee replacement simply replacing the joint (not so simple for either patient or surgeon) will lead to resolution of the cyst.


 Lastly, very infrequently, no other causative agent can be located and the patient will request excision of the cyst. This is pretty rare in my experience.


 So, if your doc tells you that you have a Baker's Cyst, there's no rush to do anything, analyze your options and after weighing the risks/benefits choose what's best for you. Patience is always helpful.


 


 


 


 


 



Tuesday, July 17, 2012

The Triathlete's Workout Guilt, Sure You Have It










Underpants run participant, Kona, Hawaii, 2011



"It's not having what you want, it's wanting what you've got"
Sheryl Crow


 


Triathlon training takes a long time. (Duh, many of you say.) This is especially true when preparing for the longer distance events. There's only so much you can do squeezing training in and around your schedule before you have to do the same to their schedule whether "they" is wife, husband, kids, co-workers, etc. Frequently we find ourselves battling that inner demon who tells us that we need 30 more minutes on this run but our soul tells us to go home and relieve the baby sitter.


 I was rereading John L. Parker, Jr.'s "Once a Runner" this week and thought a page spoke directly to this. I'm sure you've all read this wonderful text - if not go to Amazon.com and order a copy right now - but wanted to refresh your thought processes reminding us that endurance athletes have had to vault this hurdle for ages.


 Here are fictional runner Quenton Cassidy's thoughts on the subject while tubing down the Ichetucknee River with his girlfriend Andrea:


 "In order to arrange this day of perfect drifting, an entirely traditional local pastime, he and Mizner - now floating up ahead with his date - had arisen at 7:30 and run seventeen miles. It was the only way they could spend their day in the sweet haze of Boone's Farm apple wine and still appease the great white Calendar God whose slighted or empty squares would surely turn up someday to torment the quilt-ridden runner. They went through such contortions occasionally to prove to themselves that their lives didn't have to be so abnormal, but the process usually just ended up accentuating the fact. There were several ways it could be done. If they were going to the beach, they might put it off and run when they got there, but contrary to popular opinion, beach running is only jolly fun for the first five miles or so. After that, the cute little waves become redundant, the sand reflects the sun up into the eyes blindingly, grains of sand slip annoyingly into the heel of the shoe or flip up on the back of the leg. Fifteen hot miles on a long, flat beach sounds like good sport only to those who haven't actually done it. Also, the ocean is too infinite: the run seems as if it will never end.


 They could always put off training until they got back in the evening, but that just made things worse. No beer! None of the sticky wine! Their friends would slyly tempt them, to see if they really took all that training stuff seriously. It was too much to ask. Better to get it all over with and then be able to enjoy the day like any other citizen."


 Any of this sound familiar in your life. I'm bettin' the answer's yes.


 



 



Monday, July 16, 2012

The Triathlete's Work Out Guilt, Sure You Have It



Underpants run participant, Kona, Hawaii, 2011

"It's not having what you want, it's wanting what you've got" 
                                                                   Sheryl Crow

Triathlon training takes a long time. (Duh, many of you say.) This is especially true when preparing for the longer distance events. There's only so much you can do squeezing training in and around your schedule before you have to do the same to their schedule whether "they" is wife, husband, kids, co-workers, etc. Frequently we find ourselves battling that inner demon who tells us that we need 30 more minutes on this run but our soul tells us to go home and relieve the baby sitter.

I was rereading John L. Parker, Jr.'s "Once a Runner" this week and thought a page spoke directly to this. I'm sure you've all read this wonderful text - if not go to Amazon.com and order a copy right now - but wanted to refresh your thought processes reminding us that endurance athletes have had to vault this hurdle for ages.

Here are fictional runner Quenton Cassidy's thoughts on the subject while tubing down the Ichetucknee River with his girlfriend Andrea:

"In order to arrange this day of perfect drifting, an entirely traditional local pastime, he and Mizner - now floating up ahead with his date - had arisen at 7:30 and run seventeen miles. It was the only way they could spend their day in the sweet haze of Boone's Farm apple wine and still appease the great white Calendar God whose slighted or empty squares would surely turn up someday to torment the quilt-ridden runner. They went through such contortions occasionally to prove to themselves that their lives didn't have to be so abnormal, but the process usually just ended up accentuating the fact. There were several ways it could be done. If they were going to the beach, they might put it off and run when they got there, but contrary to popular opinion, beach running is only jolly fun for the first five miles or so. After that, the cute little waves become redundant, the sand reflects the sun up into the eyes blindingly, grains of sand slip annoyingly into the heel of the shoe or flip up on the back of the leg. Fifteen hot miles on a long, flat beach sounds like good sport only to those who haven't actually done it. Also, the ocean is too infinite: the run seems as if it will never end.

They could always put off training until they got back in the evening, but that just made things worse. No beer! None of the sticky wine! Their friends would slyly tempt them, to see if they really took all that training stuff seriously. It was too much to ask. Better to get it all over with and then be able to enjoy the day like any other citizen."

Any of this sound familiar in your life. I'm bettin' the answer's yes.




Wednesday, July 11, 2012

Knee Pain in Female Athletes


"Luck has nothing to do with it, because I have spent many, many hours, countless hours, on the court working for my one moment in time, not knowing when it would come."      Serena Williams
















Surface to air missiles in London Olympics: It's interesting to see what lengths we need to go to as a society to protect athletes.  Recently, it was announced that there would be 6 sites around London where surface to air missiles will be positioned to counter the threat of terrorism.  These missiles are part of an elaborate plan to thwart a potentially hijacked plane.

 


Knee pain in female athletes
Much has  been written regarding exercise based knee pain, particularly in women. Traditionally, when we see female athletes/runners in the office, the most common location of pain is over the anterior knee, the so-called patella femoral pain syndrome or PFPS.  This is best described as pain when running, squatting, up and down stairs and especially after prolonged sitting.  A recent study published in the Journal of Bone and Joint Surgerycompared the rehabilitative efforts of two groups of female runners randomly assigned to either the common knee exercise program of quadriceps strengthening, etc., or one centered on hip strengthening.  Both groups did flexibility exercises before performing the strengthening program.

After 4 weeks of either exercise regimen both groups were re-evaluated.  Interestingly, less knee pain was found in the hip exercise group than the knee exercise group.  The authors concluded that in females with PFPS, performing the hip program was more effective at reducing pain in the first 4 weeks of rehabilitation.

So what does this mean to you?  Well, first off it's that the running stride/pedaling stroke is not done in isolation and that, as has been sung for many years, "The shin bone connected to the knee bone," is in fact correct.  Simply said, knee pain is not necessarily corrected by attention to the knee.  This is one of the reasons that I am such a staunch supporter of your local running shoe store where, when pain arises, a quick eval by the owner, who's seen more feet than the Kentucky Derby, can often point us in the right direction by examining the whole of our running mechanics.  And, as the above study suggests, perhaps a hip strengthening program is just what the doctor ordered.

Lastly, although this is still July, many thousands of young women are either participating in, or soon will be, a series of work outs to get them ready for the cross country season.  If some attention is paid to the athlete as a whole, and not to simply running a distance to fill in a log book, a higher percentage of these young athletes can participate pain free this fall. 



Image 1, Google images
Image 2, Mandy Baskin

Knee Pain in Female Athletes

"Luck has nothing to do with it, because I have spent many, many hours, countless hours, on the court working for my one moment in time, not knowing when it would come."      Serena Williams





















Surface to air missiles in London Olympics: It's interesting to see what lengths we need to go to as a society to protect athletes.  Recently, it was announced that there would be 6 sites around London where surface to air missiles will be positioned to counter the threat of terrorism.  These missiles are part of an elaborate plan to thwart a potentially hijacked plane.



Knee pain in female athletes

Much has  been written regarding exercise based knee pain, particularly in women. Traditionally, when we see female athletes/runners in the office, the most common location of pain is over the anterior knee, the so-called patella femoral pain syndrome or PFPS.  This is best described as pain when running, squatting, up and down stairs and especially after prolonged sitting.  A recent study published in the Journal of Bone and Joint Surgery compared the rehabilitative efforts of two groups of female runners randomly assigned to either the common knee exercise program of quadriceps strengthening, etc., or one centered on hip strengthening.  Both groups did flexibility exercises before performing the strengthening program.

After 4 weeks of either exercise regimen both groups were re-evaluated.  Interestingly, less knee pain was found in the hip exercise group than the knee exercise group.  The authors concluded that in females with PFPS, performing the hip program was more effective at reducing pain in the first 4 weeks of rehabilitation.

So what does this mean to you?  Well, first off it's that the running stride/pedaling stroke is not done in isolation and that, as has been sung for many years, "The shin bone connected to the knee bone," is in fact correct.  Simply said, knee pain is not necessarily corrected by attention to the knee.  This is one of the reasons that I am such a staunch supporter of your local running shoe store where, when pain arises, a quick eval by the owner, who's seen more feet than the Kentucky Derby, can often point us in the right direction by examining the whole of our running mechanics.  And, as the above study suggests, perhaps a hip strengthening program is just what the doctor ordered.

Lastly, although this is still July, many thousands of young women are either participating in, or soon will be, a series of work outs to get them ready for the cross country season.  If some attention is paid to the athlete as a whole, and not to simply running a distance to fill in a log book, a higher percentage of these young athletes can participate pain free this fall.







Image 1, Google images

Image 2, Mandy Baskin


Sunday, July 8, 2012

Alcohol and Triathlon


Time to Change Swimming Holes!Whoa.  Time to change swimming holes.

"Where's the booze? It's flowing like mud around here."   Al Pacino, Scent of a Woman
___________________________________________________
So how does alcohol affect endurance athletes anyway?

Beer. It's not just for breakfast anymore.

When you're at a wine tasting with a bunch of doctors it can be kind of boring. One thing for certain is going to come up - a study done a number of years ago showing a cardio-protective effect of alcohol consumption, but only with one or two servings per day. More than once you'll hear someone state, over their third or fourth glass of wine, "I'm really working on that protective effect." It's like they want you to think they'll live to be 140 years old!

This observation is true but, again, it's optimal effect is with a single glass, possibly two, daily. The other side of this equation is a college student, one of my kid's roommate for example, a gent we'll call Joe.  Joe didn't return to the dorm one Saturday night his freshman year, and when he stumbled in mid day on Sunday - with a big plaster splint on his hand from an injury of unknown origin (which would eventually require surgery) - and, oh yeah, the papers releasing him from jailwhere he'd spent the night having been arrested for being drunk and disorderly, he just sighed. But, at some schools, isn't boorish behavior the norm on a college Saturday night.  How much worse does your behavior need to be to raise the ire of the gendarmes?

I make this example to provide a range of minimal to near maximal consumption and the potential effects on athletic performance. Many of us, particularly the more youthful, may underestimate the ability of alcohol to reverse the effects of those hours, even weeks of training.  It can reduce your endurance as well as your decision making capacity as illustrated above. It effects your pattern of sleep in both duration and cycle, particularly REM sleep, essential to memory and hormonal development. This has been shown to have a deleterious relationship with post workout muscle repair, the key to the training effect. (See Triathlete's Training Bible by Joe Friel) The hormone HGH, human growth hormone, is one that's gotten a good deal of press recently. Part of it's function involves muscle repair and growth, and alcohol has been shown to decrease HGH secretion by 50% or more! This is an important sentence that should be read twice.

Most of us are already aware of the diuretic nature of alcohol which contributes to dehydration. And, in a sport where we spend so much time and effort figuring out our proper diet, race nutrition and race hydration, alcohol only compounds the problem.

There are a number of other issues with alcohol including inhibition of nutrient absorption like zinc, vitamin B12 and thiamine just to name a few. Remember when we used to drown in Tour de France information when Lance was pushing for number 6 or 7. Heck, they'd even show footage of the team dinners after he won a stage, no alcohol in sight of course. I recall seeing Jan Ullrich with a wine glass in his hand at a Team Telecom meal. Retrospectively, maybe Lance knew something Jan didn't. Maybe he knew a lot of things Jan didn't!

So, for your best athletic performance, keep the alcohol to a minimum, Doctors orders.


Image 1, Scott Mueller

Alcohol and the Triathlete

Time to Change Swimming Holes! Whoa.  Time to change swimming holes.


 


"Where's the booze? It's flowing like mud around here."   Al Pacino, Scent of a Woman


___________________________________________________


So how does alcohol affect endurance athletes anyway?


 


Beer. It's not just for breakfast anymore.


 


When you're at a wine tasting with a bunch of doctors it can be kind of boring. One thing for certain is going to come up - a study done a number of years ago showing a cardio-protective effect of alcohol consumption, but only with one or two servings per day. More than once you'll hear someone state, over their third or fourth glass of wine, "I'm really working on that protective effect." It's like they want you to think they'll live to be 140 years old!


 


This observation is true but, again, it's optimal effect is with a single glass, possibly two, daily. The other side of this equation is a college student, one of my kid's roommate for example, a gent we'll call Joe.  Joe didn't return to the dorm one Saturday night his freshman year, and when he stumbled in mid day on Sunday - with a big plaster splint on his hand from an injury of unknown origin (which would eventually require surgery) - and, oh yeah, the papers releasing him from jail where he'd spent the night having been arrested for being drunk and disorderly, he just sighed. But, at some schools, isn't boorish behavior the norm on a college Saturday night.  How much worse does your behavior need to be to raise the ire of the gendarmes?


 


I make this example to provide a range of minimal to near maximal consumption and the potential effects on athletic performance. Many of us, particularly the more youthful, may underestimate the ability of alcohol to reverse the effects of those hours, even weeks of training.  It can reduce your endurance as well as your decision making capacity as illustrated above. It effects your pattern of sleep in both duration and cycle, particularly REM sleep, essential to memory and hormonal development. This has been shown to have a deleterious relationship with post workout muscle repair, the key to the training effect. (See Triathlete's Training Bible by Joe Friel) The hormone HGH, human growth hormone, is one that's gotten a good deal of press recently. Part of it's function involves muscle repair and growth, and alcohol has been shown to decrease HGH secretion by 50% or more! This is an important sentence that should be read twice.


 


Most of us are already aware of the diuretic nature of alcohol which contributes to dehydration. And, in a sport where we spend so much time and effort figuring out our proper diet, race nutrition and race hydration, alcohol only compounds the problem.


 


There are a number of other issues with alcohol including inhibition of nutrient absorption like zinc, vitamin B12 and thiamine just to name a few. Remember when we used to drown in Tour de France information when Lance was pushing for number 6 or 7. Heck, they'd even show footage of the team dinners after he won a stage, no alcohol in sight of course. I recall seeing Jan Ullrich with a wine glass in his hand at a Team Telecom meal. Retrospectively, maybe Lance knew something Jan didn't. Maybe he knew a lot of things Jan didn't!


 


So, for your best athletic performance, keep the alcohol to a minimum, Doctors orders.




Image 1, Scott Mueller



Wednesday, July 4, 2012

Contact

Dr. Post's blog is written for the endurance athlete with up-to-date information pertaining to common, and not so common, multisport medical and injury issues with specific attention to exercise safety. If you don't break it you don't have to fix it.



john.post@mjh.org
No phone # thanks
John Post, MD
Box 4306
Barracks Road Station
Charlottesville, VA 22905



Tuesday, July 3, 2012

Why You Can't Race After Joint Replacement



"Three and Out is Three and out."  Casey Stengel, Manager, N.Y. Yankees, 1949 - 1960





"Yeah I have some arthritis but I'll just push it until it wears out, get an artificial joint, and keep racing."  This theme, or something like it has been the subject of several blogs here over the past several years.  The usual  take home is that life doesn't work that way.  Regardless how good a joint replacement is, it does not equal the "original equipment from the manufacturer.  



When I lecture to other physicians, I often use Floyd Landis as an example. Whether or not you agree with his tactics to wear the yellow jersey in Paris, for the purposes of this discussion he makes and excellent example. Briefly, while a member of USPS pro cycling and a domestique for Lance Armstrong, Floyd had a cycling accident, suffered a hip fracture and underwent surgical pinning of the hip. It worked relatively well for a while but following the 2006 Tour de France, where Lloyd brought home the Maillot Jaune signifying the winner of the great stage race, he had an operation on the hip akin to replacement called resurfacing. The socket of the joint is replaced with a metal cup and the head with a metal ball. It's an operation frequently performed on the young, active population with end stage arthritis of the joint. Floyd is out there riding with the best of them, but is it wise. History would tell us no.


In a recent edition of the Journal of Bone and Joint Surgery, Harlan Amstutz, M.D. reported on an investigation at the Joint Replacement Institute at Saint Vincent Medical Center, Los Angeles, California where they studied 485 patients, mean age of 48.7 years, 74% male, averaging about ten years from joint replacement. Sadly, 23 patients underwent revision (repeat hip replacement.)

The authors concluded that, "High levels of sporting activity can be detrimental to the long term success of hip resurfacing devices, independently from other risk factors. Patients seeking hip resurfacing are usually young and should limit their involvement in sports that the implant construct will be able to tolerate."

In other words, if you have the joint resurfaced/ replaced, your racing days will likely come to a close. That said, being a race volunteer is fun and rewarding. Many of us have already found that out.

Image, Google Images.

Why You Can't Race After Joint Replacement

"Three and Out is Three and out."  Casey Stengel, Manager, N.Y. Yankees, 1949 - 1960"Yeah I have some arthritis but I'll just push it until it wears out, get an artificial joint, and keep racing."  This theme, or something like it has been the subject of several blogs here over the past several years.  The usual  take home is that life doesn't work that way.  Regardless how good a joint replacement is, it does not equal the "original equipment from the manufacturer. 

When I lecture to other physicians, I often use Floyd Landis as an example.  Whether or not you agree with his tactics to wear the yellow jersey in Paris, for the purposes of this discussion he makes and excellent example.  Briefly, while a member of USPS pro cycling and a domestique for Lance Armstrong, Floyd had a cycling accident, suffered a hip fracture and underwent surgical pinning of the hip. 

It worked relatively well for a while but following the 2006 Tour de France, where Lloyd brought home the Maillot Jaune signifying the winner of the great stage race, he had an operation on the hip akin to replacement called resurfacing.  The socket of the joint is replaced with a metal cup and the head with a metal ball.  It's an operation frequently performed on the young, active population with end stage arthritis of the joint.  Floyd is out there riding with the best of them, but is it wise.  History would tell us no.

   In a recent edition of the Journal of Bone and Joint Surgery, Harlan Amstutz, M.D. reported on an investigation at the Joint Replacement Institute at Saint Vincent Medical Center, Los Angeles, California where they studied 485 patients, mean age of 48.7 years, 74% male, averaging about ten years from joint replacement.  Sadly, 23 patients underwent revision (repeat hip replacement.)

The authors concluded that, "High levels of sporting activity can be detrimental to the long term success of hip resurfacing devices, independently from other risk factors.  Patients seeking hip resurfacing are usually young and should limit their involvement in sports that the implant construct will be able to tolerate."

In other words, if you have the joint resurfaced/ replaced, your racing days will likely come to a close.  That said, being a race volunteer is fun and rewarding.  Many of us have already found that out.