"Truth hurts. Maybe not as much as jumping on a bicycle with a seat missing, But it hurts." Leslie Nielsen, Naked Gun 2 1/2
Image 2, Mountain Flyer, 11/19/2010
Image 3, Google images
|Craig Alexander, pre-dawn hours of the transition area in Kona|
In other words, don't believe everything you read. Here, or anywhere. (Although I do strive for accuracy in these writings.
I belong to the Arthroscopy Association of North America, ANNA, and in this month's Journal is an editorial by Gary Poehling, MD et al, which speaks to this phenomenon that I'll partially repeat. We have so many "experts", web sites, mags, blogs and tweets which purport to tell what we should do to improve/get faster/lead better lives, that we need to remain vigilant as to the source, veracity, and reliability of the information we take in. In triathlon, bogus information may simply alter performance. In medicine, or your work, faulty or inaccurate communication could have a much more significant consequence.
"Mark Twain once said, “Facts are stubborn, but statistics are more pliable.”1
In an ever more technologically driven society, we strive for endless precision. The written word often carries unwarranted credence simply because it is written, or precise. Surely the phrase, “I read it on the Internet, so it must be true,” sounds familiar. (It should … a Google search of that quote alone yielded 864 million hits in 0.17 seconds.) Likewise, data with clever statistical tweaks can be guilty of the same problem. What researchers and clinicians should strive to discover, on the other hand, is its accuracy—how true it is.
Little has changed in the scientific method since the time of Aristotle, but much has changed in the ability to detect differences. We now have computing power nearly the size of a Cray computer in the palms of our hands. Recall the size of a hard drive in the early 1990s with 2 Megabytes being almost the size of a toaster. Now a typical thumb drive can carry over 8 Gigabytes, or 8,000 Megabytes, of data.
Technology provides us with the ability to calculate data points to the nth decimal. The clinical significance of that datum may be several decimal points to the left, or perhaps, even a whole integer.
Fortunately, we recognize that tremendous progress has been made from the days when “might made right.” We have shied away from expert opinion and veered dramatically toward higher levels of evidence. Terms like prospective, randomized, controlled, blinding, a priori power analysis, narrow confidence interval, outcome measure, and systemic review, appear regularly in most study reports. Most importantly, you, the reader, possess an uncanny ability to separate the wheat from the chaff.
In the future, newer tools will evolve to help us. Perhaps outcome measures, for example, can be standardized and updatable. In the meantime, we must keep our eye on the ball as we will be challenged to produce clinically accurate conclusions with the exponential increase in technology. As Gertrude Stein said, “Everybody gets so much information all day long that they lose their common sense.” Precisely … ."
Craig Alexander, pre-dawn hours of the transition area in Kona
As you can see by the above photo, it's still night when the transition area opens in Kona on race morning. While the location of the pros bikes may be well lit, this is not the case for all of the age groupers. There are a number of flashlights manned by the race volunteers but the thinking triathlete simply remembers to pack a camping/trail running style head lamp for this function. After use, it's left in the pre-swim bag and retrieved at race's end.
Many athletes see this visit to the Big Island as a time to buy gifts for family and friends, a sort of pay back if you will. It is incredibly easy to disregard this increase in ones baggage until packing for home and the weight of your bag far exceeds the airline limit. I, personally have had the privilege of compensating the airline $125 for this grievous act. Why not plan on bringing pre-addressed 9"X12" manila envelopes, add a copy of the race program and a flat box of chocolate covered macadamia nuts, and drop them in the mail? The post office is 3 blocks from the start/finish line of the race.
Image 1 Google Images
"He headed west 'cause he felt that a change would do him good."
Heading west? Like to Hawaii? The Ironman World Championship is in just 54 days! For those of you heading to the Big Island this year, a portion of each of the upcoming blogs will be devoted to making your stay there a little easier. So here goes:
1. Ain't no one happy 'less Mama's happy. If you're racing, and a might distracted, make sure the family is a part of the picture. Volunteering for the race is a must. Work an aid station outside your condo, be an athlete escort on Friday on the pier. They'll thank you for it.
So many of us including big names like Jordan Rapp, Frank Schleck, and Lance Armstrong to name a few have suffered a fracture, a broken bone, during training. These possess a significant potential to really slow us down. Many triathletes take the attitude that that says, "I'll just keep going regardless," possibly putting ultimate healing in jeopardy. But, if you follow these few recommendations you'll be more likely to have a good result.
1. Talk with your doctor, understand what your options are, surgical and non-surgical, what his/her experience is with both methods of treating your exact fracture. For example, with collarbone fractures, the adage used to be "if both ends of the fracture are in the same room it will heal." But, with time have come various plating options that may far out pace non surgical care in 2012.
2. Consume a normal balanced diet maintaining adequate nutrition levels to ensure the body has the appropriate vitamins and minerals to provide a positive healing environment.
3. Calcium, enough but not too much. We used to think the more calcium the better, but no longer. When excess calcium is consumed, in susceptible individuals kidney stones may form. Also, there are a number of studies that are beginning to show a relationship between too much calcium and increasing plaque forming in one's coronary arteries increasing the risk of a heart attack. So, as above, a well balanced diet which includes adequate sources of calcium to at least meet the minimum daily requirement of 1200 mg/day is recommended.
4. Smoking cessation - if you smoke, stop. There's clear evidence that those who smoke have prolonged fracture healing times.
It's also been shown that in some cases, a failure of consolidation of the fracture known as a nonunion is more likely in the smoking population.
5. Do what you're told. Just the way we started this piece. If you're asked not to run, or to pool run only, there must be a good reason behind it. If you want to know why, ask. How long? Ask. It will be easier to comply if you understand why.
Lastly, the healing time from bone to bone varies wildly from say 3-4 weeks for a non displaced rib fracture to months for certain foot bones. Do your best to avoid injury, but if you end up with a broken bone, do your part and you'll have the highest likelihood of success and return to the sport you love.
Images 2 and 4, Google Images
"For every complex problem, there is an uncomplicated answer; neat, simple and wrong." H.L. Menken
HuliSue's is a terrific barbecue place in Kamuela, HI when you find yourself north of Kona some day. If you ordered a beef sandwich, you'd get plenty of iron to help make red blood cells. Ah, but then what do you do with those red cells? Keep 'em? Donate a few to someone who might really need them?
Well, I'm prejudiced. I recently donated my 106th unit of blood to Virginia Blood Services, our local purveyor of blood products recently. If you realize that when a "pint" of blood comes out of your veins, only about a third of it is blood cells, the other two thirds being plasma. Plasma, the fluid portion will be replaced in a couple hours but it will take your bone marrow 3 or more weeks to restore the RBC's. Each person's reaction is different, and changes from donation to donation. One may have to reduce the intensity of work outs for a short time, and probably would cease donations a month to 6 weeks before an important race, or the racing season in general. That said, platelet need is always in season, requires no loss of red cells (or oxygen carrying capacity), and can be done virtually any time in the year.
There are lots of reasons not to give blood...a needle stick, a few days of non-maximal training, rumors from the uninformed, etc. But, there's never an over abundance of blood, it's needed for patients getting dialysis, heart surgery, cancer and trauma victims, etc. Heck, even Lance might have needed a transfusion following his orchiectomy and subsequent chemo.
Lastly, who among you hasn't had a bike crash? One day, the need might be yours.
So, summer can be a rough time for blood banks since their regular donors are often on vacation or keeping irregular schedules. If you want a good feeling of doing something to benefit others, drop by your local blood bank today. You'll be glad you did.
|Clever Hydration System|
"Water, water everywhere, nor any drop to drink."
Rime of the Ancient Mariner
As an Injured Triathlete, Will the New Health Care Law Affect you? Yes.
The new Health care law, so called Obama Care, is so voluminous that few among us understand it completely. This would likely include those in Congress who voted for or against it. On a more personal level, I for one cannot predict how it might change our lives specifically. But, for comparison, the Massachusetts Health Care Reform Act of 2006 is frequently used as a starting point. As you’d expect, the Democrats will focus on the similarities between the two laws and Republicans the differences. I can give you a few specifics as triathletes that you would want to be aware of, both in my specialty Orthopedic Surgery, as well as Primary Care.
According to the American Academy of Orthopedic Surgeons, the Massachusetts law extended health care coverage to an additional 400,000 state residents bringing the state up to 98.1% insured, the highest in the nation. One negative to this is that physicians reported that an average wait time for consultation with the orthopedist/sports doc rose from 17 days to 26 days. Patients who were previously uninsured often have a longer list of problems and comorbidities that need to be addressed, increasing the strain on already limited resources in both private practices and hospital settings. Additionally, health care reform has caused a shortage of Primary Care physicians making it more difficult for orthopedic patients to receive follow-up treatment at local primary care facilities. Nearly one in five non-elderly adults in Massachusetts is unable to find a Primary Care physician. Add to this the fact that although over 50% of current medical students are female, less than 10% of practicing Orthopedic Surgeons are female. As they say in Apollo 13, “Houston, we have a problem.”
Stay tuned as we as a nation continue to try to come to grips with this formidable problem.
Fluid and Electrolytes in Triathletes
Want to rile up a group of triathletes? Tell them you have the definitive answer regarding the management of what goes in their mouths during training and racing for optimum performance. We vary widely from the camp that preaches “drink according to thirst” to those with some variety of prescribed volume and make up of their replacement beverage. Everyone has a say. And, given the size of the triathlon market, the stakes can be pretty high. I certainly don’t claim to know more than the next guy, but Bob Seebohar*, one of the first USAT Level III Elite Coaches, and RD, has an opinion. “No matter whom you believe or what theory you subscribe to, for better performance, triathletes need to consume electrolytes.”**
Bob points out, for example, that the human body is very good as sodium regulation. Understanding that while we may have a diet low in sodium, or one where the salt shaker is never far away the body can maintain a sodium balance or homeostasis. Basically, it’s sodium in equals sodium out through sweat and bodily functions. He goes on to point out that "scientific research suggests acute sodium loading the night before and/or the morning of a competition can be beneficial in improving better fluid balance and acclimating to warm environments.”**
He mentions that this should not be attempted more than two days before one’s event secondary to the potential for gaining weight and bloating. And, if the athlete has experienced difficulties staying hydrated, “combining acute sodium loading prior to competition with a low sodium diet may help.”** As with any change, trying it a few times before quality training sessions makes sense. If you have questions, Bob can be reached at firstname.lastname@example.org or visit www.fuel4mance.com.
* Bob Seebohar was also my USAT Instructor at a USAT Coaching Certification Course
** USA Triathlon Magazine, Summer 2012