Thursday, February 28, 2013

Deep Vein Thrombosis, The Athlete's Risk

“Don’t let the past remind us of what we are not now.”



                                     Suite Judy Blue Eyes; Crosby, Stills, Nash and Young


 




Hawaii 2011-STPT 203



  It’s so easy to be hard on yourself when you under perform.  But is that fair?  Is it even accurate?  This can be a pretty rough sport, particularly when you are your own harshest critic, and you’re out for results, results, results!  I learned a long time ago that from one year to the next, any given race course can change dramatically.  Although the transition area and the bike and run courses are the same, there are many variables that you can neither control nor account for in a measureable fashion.  Sure, you know that the wind can significantly alter the face of the bike course but how about the way it changes the swim?  White caps, current, shifting of the buoys on their tethers, just to name a few of the variables which could slow your performance in a number ways. And that’s just one variable.


 So in May, at the post race party of your inaugural race of 2013, try to be aware of the host of variables that are really out of your control, but need to be taken into account to judge 2013 to any previous year. And as CSNY sing "Fear is the lock, and laughter the key to your heart."  See you at the post race party.


 


 Deep Vein Thrombosis (DVT), Why This is Important to You


 It’s almost Spring, Summer’s coming, airline travel, extended car rides to races, and for those at risk the potential for formation of a blood clot, usually in one of the deep veins of the leg.  Sometimes these clots will dislodge, traveling through the venous system back to end up in one of the lungs in what’s known as a pulmonary embolus (PE). A PE can be a life ending event!


 One of the major risk factors is extended immobility, sitting in one position for a long time – like flying coast to coast – or some athletes with certain medical conditions, some medications, or those with recent trauma like a bike crash may be at increased risk.  Anytime blood flow is compromised or the vessel damaged, the risk is higher.  The list below, while certainly not all inclusive, gives you some idea as to the breadth conditions to consider when considering the potential for DVT:


 


                        Smoking                                  Oral contraceptives


                         Pregnancy                                Cancer


                         Previous DVT                          Recent Surgery or trauma


                      Obesity                                     Advancing age


                      Heart Disease


 


 So What Do We Do to limit Our “Exposure?”


 In short, the answer is by not staying immobile.  By moving your legs at regular intervals, walking the aisle of the plane, stopping the car at the occasional rest stop or restaurant. Even simply exercising in your seat be it calf raises, knee to chest, toe ups, etc.all help.   Avoid crossing your legs or ankles for extended intervals, avoid caffeine and alcohol to excess, and do your best to stay hydrated.


 While some DVT’s are silent, others yield swelling in one leg, sometimes both, even redness on occasion. Symptoms of a PE are not so subtle, heralded by chest pain, acute onset shortness of breath, even a pink frothy sputum in some cases.


 But, if we follow these simple tips we reduce our chances of DVT.  That said, if you think you or one of your fellow travelers has a clot, seek medical help immediately.  It could easily be the difference between life and death.



Sunday, February 24, 2013

Top of Foot Pain From Running Shoes

"I was looking for the latest book on triathlon injuries but I couldn't find it.  Maybe I was looking in the..."


 



 



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"Keep your eyes on the stars, and your feet on the ground."


                                                              Theodore Roosevelt



Roger is the fastest runner in our group.  And it's usually not close.  Tall, lanky, experienced, he sets the pace for the rest of us.  Well, until he's in pain that is.  Yesterday, a couple miles into our Saturday run, he pulled up next to me and began describing a numb feeling in his foot that occasionally went out to his toes.  Sometimes it even went up his leg.  No trauma, no recent shoe change, that sort of thing, and he's had it before.  Some runners will complain more of pain than numbness in this site.


 


 






 




This is a pretty common complaint and the fix can be fairly straight forward.  It's often only needed temporarily.  Two majors things need to be considered initially. First, when you look at the laces of your running shoe, you'll note that when you don the shoe and snug it up, the laces toward the toe don't slide much if at all and most of the tightening is done at the top of the shoe.  This puts much of the pressure on the foot in a relatively small area.  Then, if you look at the anatomy of the top of the foot seen above, you see a number superficial nerves (in yellow) and it's pretty easy to compress them against the bone.  The other group of athletes with pain here seem to have compression over the metatarsal itself.




The problem can be magnified when, while running.  The tongue of the shoe rotates a little making for uneven pressure on the foot like in the photo below.  See how displaced the tongue of the right shoe is?




 Some shoe companies have a small loop on the tongue itself to try and prevent this.  Here the left shoe shows one example:



 Perhaps the easiest way to redistribute the pressure over one point specific part of the foot is the modify the lacing pattern. This was taught to me by Mark Lorenzoni, 30 year owner our local running shoe store, and a man who knows more about running related problems than most doctors.  You'll see below that one set of lace eyelets are skipped to reduce the pressure in that specific area:



 Lastly, another very efficient, and cheap, way to skin this cat is to simply increase the padding over the top of the foot.  This can be accomplished by cutting the entire tongue from an old running shoe and making a double thickness tongue in your shoe as seen below.


 






 So, if you get pain, numbness, or both over the top of your shoe give these easy fixes a try and good luck.


And good luck to "ladies man" Roger below.



DSCN0939


 Image 2, Google Images




Wednesday, February 20, 2013

Are My Running Shoes the Source of My Pain

"Superman where are you now? Phil Collins, Land of Confusion


 


I'm not certain that running shoe issues were a top priority in Superman's life.  Maybe he was more interested in the whereabouts of Lois Lane.


 














Seen in a restaurant in central Ohio.



 


Even the most junior of triathlete newbies thinks he/she knows the pathophysiology of plantar faciitis.  "Inflammation" of the part that inserts into the heel, right.  Since it's so common, many readers have no doubt suffered PF.  Let's go over what we do know.  First off, the plantar fascia, the band of thick connective tissue on the bottom of your feet originates (begins), not inserts, from the bottom of the calcaneus or heel bone. (But that said, even many in medicine still refer to the heel as the insertional point of the PF.  It's not a big deal.)


 The fascia then proceeds forward up to the toes.  Take off your shoe, bend your toes of your left foot up with your left hand, and then feel the band of tissue in the arch with your right. This is the PF. In most of us, we can follow it almost all the way to the heel.  And, although we use the term faciitis, no real evidence of an inflammatory process, or -itis, has been found.  Instead, at least one group of researchers prefers the term plantar faciopathy to be more consistent with a degenerative condition. (http://www.plantarfasciopathy.org)


 


 





 


Just to be sure your home diagnosis is correct, one of the hallmarks of PF is a stabbing-type pain on the bottom of your heel (not the back) that usually occurs when you first get out of bed and put your foot on the floor.  Those of you "more seasoned" triathletes who occasionally need the facilities at night also get to experience this pain then as well.  In fact, a number of resources suggest that you never put an unshod foot on the floor when you are experiencing these symptoms.  They suggest that slippers, etc. are always present at the bedside.  Once you get going, the pain usually diminishes but will return after a long drive, or extended time seated at your desk.


 In addition to runners/triathletes, this condition is frequently a problem with the obese as well as pregnant women who choose footwear that doesn't provide adequate support.  


 I did a blog on Plantar Faciitis a couple years ago which, if you're a little unsure of the basics, should help with that: http://tinyurl.com/b5fynkg .


 


 














Ardent triathlon fan.


 


 A recent article in the Journal of Skeletal Radiology described a second type of PF.  Although most of the time the diagnosis is made without radiologic studies, recalcitrant cases might start off with plain x-rays and/or an ultrasound.  This article by Leong et al. demonstrated a high proportion of "non-insertional plantar fascia disease," in other words, a different part of the PF as the source of the distress.  These would not have been detected without the imaging study.  Thus, the authors recommend employing ultrasound to assist in diagnosis making when patients have heel pain that fails to respond to traditional treatment.  At that point, the pain can be classified as in the typical location, or an atypical segment of the PF and treatment be based on the accuracy of the study.



 Lastly, I posed the question of being injured by one's running shoes.  It was intended to question the reliability or uniformity in the manufacture of your shoes, not necessarily shoes that are the wrong size, etc.  Levis for men, as one example, are marked with a waist and inseam measurement.  But, you can get a stack of ten similarly marked brand new Levis, head to changing room, and find that while some fit, some do not. I believe while some variability exists between running shoes of the same brand, and something could be glued/sowed incorrectly, the probability is pretty low.  But not zero.  This was definitely not the case a number of years ago when defects and errors in manufacture were found regularly.  When I talked with the folks at the local running shoe store, they were generally pleased with the shoes being what they advertised and only very infrequently would an incorrectly manufactured shoe be the source of a runners problems.  Never-the-less, the smart athlete keeps this in the back of his/her mind.  Good luck.


 Image #2, Google images


 



Sunday, February 17, 2013

Getting A Kona Slot, A Few Thoughts From One Who Has

"By perseverance, study, and eternal desire, any man (or woman) can become great."


                                                             General George S. Patton


 


                To me, Patton's three most important words are perseverancedesire and any!


 


A few observations from the cheap seats on your best chance to cross the finish line on Alii Drive.  Commander John Collins is reportedly the author of, "Swim 2.4 miles, ride 112 miles, run 26.2 miles, and brag for the rest of your life."  A personalized plate might follow.  I'm luckier than most having started in this sport before there was a need to qualify for Kona.  There was only one Ironman, located on the Big Island having recently moved from Oahu, and if you wanted in you simply filled out the application and sent in the check.  In fact, I think I may still have that application around here somewhere.  Entry was $100.


 




 Triathlete Magazine was kind enough to put this chart in their October 2012 issue to give us the big picture or a close approximation of how the slots in this event are distributed.  I'd bet that most of you still have the issue at home or can borrow a copy.  It's worth doing.  It reflects the old thought process of defining the exact nature of the problem giving you the highest likelihood of getting the best solution.



 



 One of the first patterns you see is that the older you are, ability within the age group stays with the younger ones in the 5 year span.  For an example, generally speaking, your best shot at qualification is the year you age up and the following year. I looked at a couple of age groups over the last few years, one in particular had 64% of the qualified athletes in those first two years, 16% in the last two years.  The spread is less dramatic in the younger age groups.


 From talking to athletes on the pier in Kona during bike check in, two large groups emerge: those who've raced in Hawaii before, some many times, and those who've been trying for a good while.  Luckily for you, there are a lot of first timers.* One woman pointed out that while she didn't think she got a lot fitter the year she qualified, she'd learned so much about the little things in triathlon, and about herself, that she just "experienced in.  I know so much more about my bike and biking in general, pacing strategies, how to get through a bad patch and not lose too much time, when to pee, etc." 


 So it would seem that if you're pushing 40 or older, this may be a multi year plan laid out step by step, year by year. An Australian man told me that he had a 3 year map.  Year one, race, learn, race, learn, repeat. Year two maximize equipment, bike and shoes, bike fit/running stride analysis, anything to minimize injury, "And spend a lot of time with my family." Then, in year three, he had worked it out with the family that IM qualification came first (well, almost, he'd still bend training around his kids soccer games and the like, but he was free, and guilt free, to do whatever it took.)  And it worked!  He had actually worked out a perfect, for him, family support system plan such that everyone got a little of what they wanted.  Contrast that to your tiptoeing into the house on Sunday when your long bike went too long and your feeling of guilt....yep, we've all been there.


 So, if  1)  You're a reasonably good athlete in your age group,


          2)  You have the perseverance and desire like George Patton,


          3)  You have a support group, work situation, and social situation to support this,


          4)  Understand that this can be an expensive proposition and the "support group" is OK with that,


 


I'd say "go for it!"


 


Pick a year to try, get clearance from the above "higher authority"


Get a coach who really knows what he/she's doing.


Talk to as many people as you can, learn the little things.


 


And then, on Friday, find me and let me escort you on to the pier.  It would be my privilege.


 * One of my favorite days of the year, every year, is the Friday afternoon before race start in Kailua Bay.  As athletes have passed bike check, they come on to the pier, the transition area.  Matched with a volunteer Athlete Escort, they rack their bike, hang their run and bike bags, and generally get the lay of the land with regard to traffic flow, changing tents, etc.  Having already completed much of my work, I mix in with the Athlete Escorts and try to get as many first timers as I can teaching them about swim entry/exit, bike hand off, etc. so that by the time they leave the transition area, they have changed unknowns into knowns, and their confidence is sky high! 


 Image 2, Triathlete Magazine



Tuesday, February 12, 2013

Deer Antler Spray, A Triathlete's Edge?

 "There's a sucker born every minute." Author Unknown


Ninety years ago, Victor Lustig, a master of persuasion, was able to sell the Eiffel Tower. Really.  He posed as a French official noting that the Tower was specifically built for the Paris Exposition of 1899, and never intended to be permanent.  His story was that even though popular, maintenance of the structure was proving overwhelming to the French government and that, secretly, arrangements had been made to sell it for scrap knowing there would be public outrage once these plans were unveiled.  He assembled several potential company representatives, many with serious doubts as to the veracity of this project.  Once Lustig made it clear that the "winning" company bid would accompany a substantial bribe to him, the representatives became convinced and the deal was sealed.  The Eiffel Tower was sold.


Fast forward to 2013 and to Deer Antler Spray, referred to by Sports Illustrated in a recent issue.  The article is entitled "Snake Oil For Sale" and it delves extensively into athletes, perhaps like all athletes, seeking that competitive edge.  Some, including


 



National Champion Alabama football players, turn to these alternative products, including stickers with holograms of pyramids to be placed at acupuncture points and one "over the heart. It's going to help your heart have so much more energy," he said. "come fourth quarter you guys will not be gassed at all."  Also supplied were gallons of "negatively charged water which were claimed to provide superior hydration because "It adheres like a magnet to the body's cells.'"


Many athletes on all levels have, at one point or another, accepted these claims at face value and paid regal sums to obtain this edge over the competition.  Fijian golfer Vijay Singh, while not a house hold name to some, leading PGA Tour money winner in 2003, 2004 and 2008, has been using deer antler spray, reportedly paying $9,000 for a supply in November.  A quick trip to any of the internet sales sites shows some for eleven bucks.  Maybe the deer used in Singh's bottles were better looking.


Of interest is the potential for "legally" enhancing performance.  Backers claim that Hgh is converted in the liver to IGF-1, insulin like growth factor and that IGF-1 is "a natural, anabolic hormone that stimulates growth." They go on to state that deer are harvested in New Zealand and their antlers are the "fastest growing substance on planet earth...because of the high concentration of IGF-1." A spray meant for sub lingual (under the tongue) use has been developed.  And if these claims are insufficient to arouse the listener, they add "This stuff has been around for 1,000 years, this stuff is from the Chinese." Ever heard of Ray Lewis, a recent notable user ?


Unfortunately, as with many claims in the supplement industry, there's little if any scientific data to back this up.  In fact, some in the scientific community note that even though the spray does contain small amounts of IGF-1, they question whether or not it even works in humans....much like the claims for negatively charged water which chemists volunteer doesn't exist.


And even worse, one professional football player who used the product later failed an off season drug test when methyltestosterone was found in a lab tested deer antler spray bottle.  He subsequently sued, and won a judgement in excess of 5 million dollars.  Apparently quality control may also be an issue.


In short, as Mom taught you when you were little, if it seems too good to be true, it probably is.  Your time would be well spent reading the complete piece at SI.com (http://sportsillustrated.cnn.com/nfl/news/20130129/the-strange-lab-that-lured-numerous-athletes/index.html) as it is both entertaining as well as informative.  And next time you find yourself in Paris with a man claiming to represent the French government trying to interest you in an upcoming "scrap metal project," offer to trade some swamp land in NJ for the opportunity.  Or better yet, ask if he'd like to get an athletic edge in the upcoming club racquetball tournament?  You know just the stuff.


 


             


 The thinking triathlete's next purchase? Not a chance.


Image 1, 2 Google Images


Multiple Quotes from Sports Illustrated, Time  and Life Building, Rockefeller Center, NY, NY 10020



Saturday, February 9, 2013

First We Get Better Grades Than the Boys...Then We Take Their Jobs

 



First we get better grades


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


This has been in the center of my refrigerator for years. While only tongue in cheek, it was a subtle suggestion from my wife to our daughter that anything is possible.  As you'd expect, our sons saw it too and took from it a challenge, not with the girls, but with themselves.


Anything is possible?  This is the same advice touted by Ben Fertic, former CEO of World Triathlon Corporation as he encouraged athletes with "Along your journey, you have accomplished goals and overcome obstacles, proving time and time again that "Anything is Possible."


I believe that Ben was right and hope that you agree.


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Not Everything is What it Seems - Confidence in Triathlon Swimming



How many times  have you seen someone with what looks like an Asian alphabet character tattoo on their arm and are told, "It means strength in Chinese," or some equally powerful statement from which they draw energy.  I've heard that in a larger percentage of tats than you might imagine, the owner is incorrect.


 


I've observed many new to this sport incorrectly assume that since they come from a running or cycling background that they will not do well in the swim portion of triathlon or that they can't improve.  This is just not true!


This week, as we prepare for the 2013 racing season , I’ll bypass the injury pipeline and pass on a little experience. After making many mistakes over the years, I can reveal the secrets to not only your fastest safe swim but how to be equipped for those unexpected problems that can throw a wrench into your whole day.


 In other words, this is why I keep a spare pair of goggles in my suit just above my butt crack in non-wetsuit races. You must think of things that can go wrong, and have a solution in mind, well in advance of the race. Let’s divide these into:


Equipment issues – cap, goggles, suit


Personal issues – need to warm up. need to pee, sunscreen, body prepped for wetsuit removal


Nerves – fear of the immediate future, possible panic attacks


Event issues – being hit or kicked, choking on the water, swimming off course


 We’ll assume for this piece an athlete in a sprint tri, wet suit legal, with at least one race experience. I’m pretty sure that almost everybody practices transitions now. If not, 30 minutes on Youtube choosing what seems to work best for you, is invaluable. You’ve planned an early arrival at the race for body marking, transition set up, and generally getting the lay of the land. You’ve thought about swim conditions, goggle selection (newer rather than older but not new ones) and have brought 2-3 pair – including one that’s shaded for a bright sunny day. Although many recommend goggle straps under cap, that’s never worked for me. I just make sure that as I’m donning my wetsuit…after the bathroom break of course…that I’ve lubed my ankles with Pam or Body Glide, neck and shoulders too, wiping off my hands thoroughly before I touch my goggles. As noted above, I often keep a second set in my suit and a tiny bottle of anti-fog in my hand which I discard just before the gun. I don’t zip up my suit until 2 minutes before my warm up swim asking whomever is standing next to me for assistance. Once in the water warming up easily, and a couple of 20 yard sprints for good measure, I know I’ll need to pee. I just let it fly knowing that it will be rinsed out shortly.  (Right, that's why they call it a wet suit.) I'm guaranteed of not having to stop during the event for this bodily function.


 At this point, right before the gun, if I had to credit one thing for being relaxed, it’s pre-race preparation. Viewing the swim course the day before and maybe even going for a short swim, accompanied of course, can pay innumerable dividends on race morning. Practice is a real confidence builder. That, and not being in any hurry at all on race morning, make for one relaxed triathlete!


 Once my wave starts, I try to stay a little off to the side of the main group to get my own little piece of the water even if it means I add a few yards to avoid being hit or kicked…or both. Sometimes I'll just count to five after the wave has started letting the others go first and compete for the same piece of the lake or ocean.  


If I inadvertently inhale some water and start to choke, I stop, tread water, and don't proceed until it clears. There’s no harm, or penalty, for grabbing a surfboard or boat till you’re stable if you need it.  That’s what they’re for. It’s safety first, remember? And then, it’s back to sighting the swim course. The old philosophy of just following who’s in front of me doesn’t always work all that well for some in open water swimming. I highly recommend that you practice sighting the other end of your lane at the pool daily, even if it’s just one 25 yard lap of your warm up. You’ll be surprised at how skilled you become.


 Lastly, I’m surprised how easy it is to get “pissed off” at a fellow triathlete who happens to interfere with your swim somehow. My advice is to just shrug it off, stay loose, and think about the finish line. That gives you the advantage and keeps the race fun. Ready for a swim PR?







Wednesday, February 6, 2013

Triathletes Should Take Daily Vitamin D


DSCN0316


Triathletes spend a great deal of time and money seeking performance excellence.  Training is often quite regimented, workouts planned days and weeks, if not months, in advance.  When foul weather, illness or injury get in the way, this plan can be delayed, even scuttled completely.  If something simple like daily vitamins, yep, just like Mom recommended, can improve the probability for success, for me anyway it's a slam dunk.  My physician wife and I take Vitamin D daily, have for years, as do many of our physician friends.  My doctor takes Vitamin D.


A very interesting statement from the American Academy of Orthopedic Surgeons as it pertains to our sport notes, "Vitamin D is important for good muscle health. People with very low Vitamin D blood levels may be more likely to experience muscle cramps, bone, or joint pain. Studies suggest that older people who take Vitamin D seem to fall less often, probably due to better muscle function."


Vitamin D is obtained from the diet but precious few foods contain it.  It's also produced by human skin when exposed to sunlight. It functions to aid in calcium absorption in the GI tract, is required for bone growth and bone repair, and helps protect more "senior" triathletes from osteoporosis.


A recent article in the American Journal of Sports Medicine estimated that "a billion people world wide are Vitamin D deficient."  they point out that,


"This problem is particularly important to athletes of all ages, as Vitamin D plays a significant role in bone health, immune function, and physical performance. In the deficient state, the athlete may be at an increased risk for potential problems such as stress fractures, respiratory infections, and muscle injuries."


OK, so we've established it's importance.  In the American diet, Vitamin D comes from fish (salmon and tuna especially), milk, since much of the U.S. milk supply is fortified by law, some brands of OJ, cereal, yogurt, etc.  While some of us partially meet our daily requirements through sun exposure, especially in the Spring, Summer and Fall, cloud cover can cut Vitamin D production in half as can living in the far northern latitudes.  In theory any sunscreen with an SPF over 8 will also block production but reportedly very few of us are sufficiently effective at sunscreen application to stop production entirely.  Your vitamin D level can be easily measured with a blood test at your local hospital if needed (I've never had mine checked by the way.  Although there are various forms, the assay done at our hospital is the total 25-hydroxyvitamin D (VD25).)


Over the past 20 years, mean serum Vitamin D concentrations in the United States have slightly declined among males but not females. This decline is likely due to simultaneous increases in body weight, reduced milk intake, and greater use of sun protection when outside


How much do we need?




The amount needed as an active athlete is of course relative to your dietary intake.  And, one simply wouldn't, in the words of Beldar Conehead from SNL, "consume mass quantities" as it is possible to take too much.  Vitamin A is the same.


As science learns more about this substance, the amount recommended daily has increased.  For example in children and adolescents, the American Association of Pediatrics recommendation as the minimum daily requirement is 400 IU (International Units)/day...and this is just to prevent diseases like Rickets in healthy bones!  They'll likely be raising this to 600IU shortly.


 The American Academy of Orthopedic Surgeons notes, "Recent research supports that the body needs at least 1000 IU per day for good health — depending on age, weight, and growth. Indeed, many people need much more than 1000 IU to keep Vitamin D levels in a good range." 


If you were to understand that my bias is generally not all that supportive of the supplement industry (sorry), and that in my ex-coaches words, "They give you expensive urine."  But based on the above information, recommendations of 500-1000IU/day of supplemental Vitamin D in summer and 1000-1500IU/day in the winter (less sunlight, remember) wouldn't be too far from the mark.  You'll find both gel caps and solid pills at your store and I don't know that there's a difference. Think about it and if this seems to fit give it a try.  I would, however, recommend that you stay abreast of the literature as  you currently do since ongoing research may change this data.



 



Monday, February 4, 2013

Don't Touch My Dog - Clint Eastwood/Medical Mistakes


 






 


 "Don't touch my dog." Clint Eastwood as Walter Kowalski, Gran Torino


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 After a tweet I posted this week concerning errors in the surgical theater, I was asked to expand these thoughts since triathlon has a sizable audience. Given the injury rate among these athletes, a number you will face surgery of one kind or another in the not to distant future.


_________________________________________________________________


"They operated on the wrong leg!"



Believe it or not, According to the American Medical News, "In operating rooms, 'Never events' occur 80 times/week in this country." In other words, wrong site surgery, wrong operation, instruments and surgical sponges left inside patients, wrong patient, etc. If you or a loved one are the patient there are things you can do to help lead to a successful outcome.


 1) Avoid wrong site surgery. (left leg instead of right leg for example)  Make a point telling members of the surgicenter pre op team, nurse, anesthesiologist, etc. what operation you're having and on which side.


 2) Mark your site.  Surgeons these days are require to mark and initial the intended area of surgery be it knee arthroscopy or a hernia repair.  This is done while the patient is awake, often times in the pre op holding area with family present and the patient awake.  It's your opportunity to shine.


 3) Don't joke around.  Sure you have a great sense of humor, and you're a tad nervous as expected.  But this is a time to be serious, pay attention, and make sure that those around you do as well.


 4) Understand your surgical consent form.  We all "agree" with Yahoo, Google or Adobe almost weekly.        When asked to download version 9.0, we casually check the box without reading the voluminous information  provided.  They're counting on you doing that. Not so in a surgical setting.  Your Consent for Medical Procedure is a standard form that points out what the risks and benefits of your intended procedure may be, what each party's responsibilities are, etc.  You have all the the time in the world.  Don't sign it until you've read it.


 5) Don't "help" by clipping or shaving body hair in the area.  This had be shown to be best done right before surgery, if needed at all.


 6) Postoperatively, understand the who and when on changing your dressing.  Also, be aware of the signs of infection, and if there's a question, call.  The doctor would much rather receive phone calls than see something late.


 In short, the days of Marcus Welby patting you on the shoulder are gone.  You are your best advocate and surgery success is a team approach.  You are the most important part of that team!



Friday, February 1, 2013

Surprised? Triathletes Do Not Have Fewer Injuries Than Single Sport Athletes


What to wear when your has chores for you.












image.jpg



I've made it a little too large so you can really appreciate it.



 


 I'll bet this athlete was dressed and out the door in a snap.



 


A recent piece in the NY Times quoted what we've known for years that when single sport athletes switch to triathlon, their overall training hours go up and that rather having a decrease in injuries thinking they're spreading their workouts over three sports requiring "different muscles," the injury rate actually increases.


 Joe Friel, author of the Triathletes Training Bible teaches that the true benefit from training comes, not during the workout itself, but during the subsequent rest period. Upon recovery from the added stress, the musculoskeletal system is just a little stronger than it was before.


 This is the time of year, with snow on the ground that we're allowed to dream. We examine past racing successes and failures and use them as a springboard to set up our next season. Hopefully this is accomplished with more than just an ounce of common sense. Not only is the absolute load your body sees important but the rate of change of this load is also crucial. As one example, I did a blog on stress fractures a while back and one of the take home messages is that we can all do a significant amount of training as long as the rate at which we increase the volume and intensity of this effort is such that we can handle it. And no, I don't mean "handle it" as simply being able to either fit it into an already packed schedule or that you're tough enough to get it done. This should be interpreted as being able to accept the increase in training load on top of what's currently be done and the total training increase isn't greater than, say 5%, maybe 10%, of the previous weeks efforts.


 We all know that there are a few people, maybe the ones you train with, who seemingly don't need to follow the ease into the work out guidelines. A pair of women I swim with are like that. They have no idea of/need for warming up. While the rest of us complete a 1200 yard warm up set, they pop into the pool as the main set is being described, adjust their goggles, and push off the wall full tilt for the first 200. Of course I'm jealous. But my logbook is fed 1200 more yards more than theirs on a regular basis.


 So as we dream about that podium spot at the local sprint tri in 2013, construct a sensible training plan that carefully increases the rate at which your knees/Achilles are called upon to run more hills or time trial bike efforts. And, most importantly, when that little twinge becomes full fledged pain, take some time off of that discipline...channel your efforts into a different part of triathlon....you needed to work on your transitions anyway.


 If you can carefully mold and execute your training plan, you stand a good chance of staying away from people like me (doctors) and having a terrific season. Good luck!


 I'm fond of asking athletes if they think they do a great job slipping their training in between meetings, car pools, before the sun (and family) get up every day.  If they see their training as invisible.  While it's probably not, at least making the attempt to keep other's schedules and feelings in mind make for a happier triathlon family.


 Below is the second fun photo, my way of "camouflaging" my indoor trainer.  You can hardly see it behind the planter.  Right?


 















Note clever camouflage. Plants nearly blocking view of indoor trainer