Monday, July 29, 2013

Athlete's Responsibilities on Race Day

"She danced into the danger zone where the dancer becomes the dance."     Flashdance

  

Some triathletes allow themselves to be comsumed by the sport.  Don't be one of them.

This is taken from USAT, "USA Triathlon Fatality Incidents Study" published October 25, 2012.

You have the responsibility to yourself, your family, fellow competitors and race directors to "Show up for the race healthy, fit and prepared."  If you are not all of these things, then you are expected to drop whether or not there's a refund, you're embarrassed or "already made the trip."  It's just the right thing to do.


Hawaii 2010 043

Learning the ins and outs of the Ironman swim course well before race day.

.

.

Here's USAT's Shared Responsibility List


Unrecognized heart problems are the primary cause of sports-related sudden cardiac death.

 


􀀀 Consult with your
doctor about any warning signs during training such as chest pain/discomfort,
shortness of breath, light-headedness, or blacking out.

􀀀 Your health, fitness level, and
preparation should guide your selection of an appropriate race or event.

􀀀 Your race plan should be
consistent with your health, fitness level, and preparation.

􀀀 Choose an event because it
places an emphasis on athlete safety, and is sanctioned by USA Triathlon.

􀀀 Practice and prepare for open
water swim venues. Race day must not be your first exposure to an open-water swim competition.

􀀀 Thoroughly review the race’s website
and all pre-race communications so you are knowledgable on the timetable for race day arrival and preparations.

􀀀 Utilize all checklists and
information from the event, USA Triathlon and your coach to mentally prepare
for the competition.

􀀀 Make certain your equipment is
safe and working properly. Make certain your wetsuit fits properly.
Get your bike checked before the event.


􀀀 During the event, STOP
at the first sign of a medical problem such aschest pain/discomfort, breathing
difficulties, light-headedness, or unusually high heart rate and seek medical
attention. Your life may
depend on it. This is particularly important during a race swim, in which
rescue poses unique challenges.

􀀀 During the event, tend to a
fellow athlete who has a medical problem.

􀀀 Learn CPR and be prepared to
use those skills when needed. Ask your family and other supporters to do the same.

􀀀 Visit usatriathlon.




Wednesday, July 24, 2013

You're Not a Real Triathlete Unless.........

You've heard it, you're not a real triathlete unless you've _______ ...  competed at a certain distance or run some particular race.  This was sent to me by my runner son today, a piece written by Olympian Andrew Lemoncello, hits this nail on the head.  Read on. 



___________________________


High Country Running: Are you a real runner?





Simply put, if you run, then yes, you are a runner.


It doesn’t matter if you run four-minute miles or 15-minute miles. It doesn’t matter if you walk/jog to get your dose of exercise in. You can confidently call yourself a runner.


I pose this question because I was recently told that I wasn’t a real runner because I listen to music when I go out for some of my runs. In the 18 years that I’ve been running, I’ve never seen or heard of any kind of stipulations that distinguish you from being a real runner and a fake one.


Here was the situation: I was in Phoenix, just setting out for my two-hour long run when I had to stop at a crosswalk. While I waited to cross the road, a fellow runner approached me and gave me a look of disdain as she saw I had my earphones plugged in. Something inside of her lit a spark strong enough to tell me that because I was wearing something that pushed music through my ears, I had no credibility as a runner. I didn’t say anything and continued on with my run once the road was clear.


The comment rung through my head for the entire run and, to be honest, really hacked me off. What annoyed me about the comment was that personal preference dictated to this woman what another runner should be. That’s the antithesis of the running world I have experienced over the years. Runners accept the idiosyncrasies of others. We revel in our differences and find a bond in the shared miles (and the pain that goes with them, no matter how fast you run).


If I didn’t like that she was running four minutes a mile slower than me, does that make her any less of a runner? Of course not. Running is such a simple sport, one that anyone can do and enjoy without high-tech equipment or special venues.


One of the greatest joys of living in Flagstaff for me is that I can run at Buffalo Park every evening and see lots of people out there running and walking to get themselves fit and enhance their lives by becoming healthier.


What did I learn from my Phoenix experience?


Well, judgmental people do exist. Don’t listen to them. Run how you feel and how you like. Enjoy yourself and know that you are improving yourself every time you step outside to run. It doesn’t matter if you’re fast or slow, big or small, wide or tall; we can all be proud, “real” runners.


We have a great community of runners in Flagstaff and fantastic training groups set up by Run Flagstaff. There is something for everyone. I strongly encourage you to try one of these group runs as you may just get the same joy I do when I see groups of people out enjoying their running together.


Andrew Lemoncello is an Olympian, professional runner for Mizuno and an assistant coach for Flagstaff’s own world-renowned coaching resource, McMillanRunning.com.Myles Schrag is coordinating editor for High Country Running. He welcomes submissions (500-word maximum) from runners of all levels about any aspect of the local running scene. You can reach him at myless@hkusa.com.


__________________________________


From the Onion


Nation Down To Last Hundred Grown-Ups


 



'Mature Adults Could Be Gone Within 50 Years,' Experts Say


SUITLAND, MD—According to alarming new figures released Monday by the U.S. Census Bureau, the nation's population of mature adults has been pushed to the brink of extinction, with only 104 grown-ups remaining in the country today.



One of the last remaining grown-ups in the United States.


The endangered demographic, which is projected to die out completely by 2060, is reportedly distinguished from other groups by numerous unique traits, including foresight, rationality, understanding of how to obtain and pay for a mortgage, personal responsibility, and the ability to enter a store without immediately purchasing whatever items they see and desire.


"Our grown-ups are disappearing at a much faster rate than we previously believed," said Census Bureau chief Robert M. Groves, who believes the decline in responsible adults may now be irreversible. "Unfortunately, we've only recently noticed this terrible trend, perhaps because of this group's unusual capacity to endure hardships with quiet dignity instead of whining loudly to draw attention to themselves."


"If nothing is done, these wondrous individuals, with their special ability to consider the long-term consequences of their own behavior and act accordingly, will be wiped-out completely," Groves added.


According to recent data, the grown-up population has plummeted dramatically since 1950, when a Census count found that more than 24 million Americans could both admit when they were wrong and respect a viewpoint other than their own. Today, only one in three million citizens can provide thoughtful advice to a fellow human being instead of immediately shifting the topic to their own personal issues or what they had for lunch.


Experts confirmed the mass extinction of grown-ups has coincided with the rapid expansion of other demographic groups, including people who seek medication for every problem they encounter, 33-year-olds who participate in organized kickball leagues, personal injury litigants, and parents who try to become friends with their own children.


"Grown-ups are as fascinating as they are rare," said anthropologist Arthur Ambler, who has lived among level-headed adult populations and documented their lifestyle. "It may seem odd to the rest of us, but for mature adults, occasionally putting the greater good ahead of their own interests or remaining calm when something doesn't go their way is commonplace."


"Imagine confronting a problem directly instead of pointing a finger, cowering in fear, or pretending it just isn't happening," Ambler added. "This is how these people actually live, if you can believe that."


Many social scientists, including Ambler, have called for a complete record to be made of the declining population's customs, worrying that knowledge of how to dress for a job interview or when to rotate one's tires could soon be lost to civilization forever. Future generations, they soberly note, will likely go their whole lives never knowing a grown-up person.


When contacted for comment, Colorado resident Ray Vogel, a grown-up, told reporters he was resigned to his group's fate.


"We recognize that our time has come and gone, and we're prepared to let nature run its course," said the 54-year-old, who has a well-funded 401(k) and has never taken out a high-interest loan to purchase a Jet Ski. "I'm just grateful my two children didn't turn out patient and considerate like me. They'd never be able to get anywhere in today's world."


According to Vogel, the nation's remaining grown-ups have drafted a letter to be read by the rest of us when they are gone that implores us to make "good decisions" in their absence and explains how to reignite the pilot light on the hot-water heater should it go out. The note is also said to include some money that we are firmly instructed to use only in case of a real emergency.


_________________________________________


Sometimes, taking a break from reading even more about SBR is medicine in itself.  Hats off to The Onion for this little break from life.










 


 




Sunday, July 21, 2013

Runner/Triathlete With Bloody Urine

__________________________


Print Your own cast


A real change from the days when we'd put plaster casts on one roll at a time.  Each of these new casts would be individualized according to the type and location of the fracture.  Pretty cool.


2013


Cortex cast concept


Versus


2010



 


 "Oh yeah, life goes on, long after the thrill of
livin' is gone." 
 John Cougar Mellencamp


______________________________________


Bloody Urine 


After a pleasant work out, you look down and  see blood in the toilet: now what?


 


 Ever looked into the commode after your long run, and instead of
the usual concentrated deep yellow urine, you
see blood?
  Yep, it can be quite a shock.  But, like most things,
if you take the time to do a little research you can narrow the list of
possibilities...and cancel the call to the funeral home.


 In medical jargon bloody urine is known as hematuria.  It can
range from very slightly blood tinged all the way to frankly bloody.  It's
not a diagnosis, it's a symptom.  But a symptom of what?  Let's
follow a local Virginia runner I’m familiar with, aged 24, runs 60 - 100
miles per week, is professionally coached and works in the local running shoe
store.  He obviously has a handle on correct foot wear and running related issues.  One day, out of the blue, with no particular trauma or warning, he
started with a very slight pinkish tinge to his urine after his longest runs
but over time developed frank hematuria.


 So, the first place we look is to a phenomenon called
"Runner's Bladder" as it's both the most common as well as the most
benign.  It's described as bladder wall trauma, a type of bruising, which leads to a
small amount of blood in the urine.  When the runner
decreases running volume or takes a couple of days off, it goes
away.  For a while that is, until long runs resume.  It's said that
running with a partially full bladder can eliminate this problem but it's a
level of running discomfort many can't stand.  Every heel strike reminds one of
the urine's presence.


 A visit to the urologist by our runner reveals that although
the mostly likely diagnosis is Runner's Bladder, the list of
possibilities including kidney stones, tumor, infection, various kidney
problems, etc., is pretty long.  So, to solidify the diagnosis, for
reasons specific to this individual, the urologist plans to perform a
cystoscopy - an in office procedure in which he will insert a small fiber optic
scope through this runners penis up into the bladder. ("You're going to
put a what into my where?"
the runner was heard to exclaim!)  In
the past, predominantly because of the larger size of the scope and the pain it
would cause, this type of procedure was done in the Operating Room under
anesthesia.


 Good news.  During cystoscopy, our athlete's
bladder wall revealed generous bruising and no other obvious source of
bleeding.  So for now, he'll continue his running career, and his
hematuria knowing that he's not causing irreversible long term damage. 
Maybe he'll try again to learn to run with his bladder half full.  But at 24, with a head full of steam, he's his own man.  And,
like many other things we see happen to this athletic group from runner’s trots
to plantar faciitis, in my experience, I’ll see a lot of people with these
things once, and then never again.  Or, an  equally common scenario is that it resolves for the most part but every once in a while, again after long runs only, the urine is said to be "a little rusty."  This puts runner and family at ease, however, understanding that it's not cancer or something more serious.  As they say in Minnesota, "Good deal!"


How your own 2013 cast would be made 



Wednesday, July 17, 2013

If You're Early You're on Time, If You're on Time You're Late!

 


On Lance Armstrong

“ I think it is just terrible and disgusting how everyone has treated Lance Armstrong, especially after what he achieved, winning seven Tour de France races while on drugs. When I was on drugs, I couldn't even find my bike.”


                                                                                Willie Nelson





DSCN1271


 Am I late for the show?


 


Time - the slowest (combined) transitions in Hawaii at the Ironman World Championship last year (2012) was 44:52.  Forty Four friggin minutes to change some clothes!! What are you  thinking?  People would kill to get into this race and you're in the changing tent shootin' the breeze with the volunteers!  WTF?  The quickest, Pro Tim O'Donnell, was a gossamer 3:38.  And it's a hike getting all the way around the pier!  But he's a Naval Academy man.  What do you expect?


The age group start in Kona is not a fixed time.   Although published at 7:00 am, 30 minutes after the male pros and 15 following the ladies, the order can be given to fire the cannon anywhere between 6:55 and 7:05 when the starter feels that the swarming mass of athletes treading water is in the best, and safest, position to commence.  They blow off the ceremonial cannon which, for some reason also shoots out an ever expanding smoke ring, 2 feet, 3 feet, 5 feet, as Kailua Bay turns into a Class VI river below of bodies, swimming over and under others, kicking, pushing, more like pro wrestlers Ric Flair  or  Mike "Mad Dog" Bell  than Michael Phelps 


In 2011, working transition in Hawaii, at at 6:54 a.m., a guy walks by me on the pier, goggles in his mouth, pump in one hand, pre-swim bag in the other, and asks me if I know where he's supposed to deposit these.  In what is arguably the most important athletic event of this man's life, one where thousands would do anything to be standing where he is, he shows no more interest in being prepared than for the weekly card game back home.


I put up a piece on transitions a few months ago which may be of benefit.  http://www.johnpostmd.com/john_post_md/2013/05/transition-speed-tips-from-an-age-group-winner.html


Happy Racing.  Now get out there and practice!



Sunday, July 14, 2013

Work Out Guilt, the Curse of the Triathlete

 
Hawaii 2010 129


 Waiting, waiting patiently for their triathlete to return from a work out.


 


"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.


So what do you do?  How do you do all of this, plus sleep so that you secrete the much needed human growth hormone vital to tissue repair, and then toe the line in Sunday's tri confident that you'll do your best? A long treatise is beyond the level of a blog but I can help you by pointing to Kona Champion Karen Smyers as she writes in the foreword of Time-Saving Training for Multisport Athletes by Rick Niles, "I train as a means to an objective, and that objective is to race faster than I did the time before."  She goes on to point out that she averaged 12 hours per week of training for her first five years in the sport and noted steady improvement.  This book, and others like it, give you a plan and a means of executing this plan emphasizing training quality over training quantity. 


Another well written piece by Courtney Baird in the May-June 2012 issue of Inside Triathlon explains the training philosophy of serial entrepreneur Sami Inkinen who was able to go sub 9 hours on the tough Hawaii course with 12 hours, or less, of weekly training.  It's a little long, but that becomes the piece's strength as you get to peer inside the head of both the athlete and the knowledgeable author.  Each of these is pretty easy to pick up and may be just the thing that both improves your racing as well as your quality of life.  Since Inkinen doesn't go the gym, but follows Coach Matt Dixon's teachings on functional strength, his gluteal and hamstring muscle training come from steep hill running and low cadence/high gear bike work outs.  It works for him.  It could work for you too.



Thursday, July 11, 2013

Hit by Lightning: Are You At Risk?

Lightning: Are you safe on that bike?  Probably not.  A very quick Google search yielded at least 6 cyclists who were killed by lightning while riding.  The often asked question, "Well, I'm on rubber tires, aren't I insulated?"  Lightening and all electricity for that matter takes the path of least resistance as it flows. In a car, the path of least resistance is through the walls of the car, through the tires, and into the ground. Unfortunately, if you get struck on a bike, the path of least resistance is through your body. It goes without saying that this is not good.


A 23 mm bicycle tire does not offer you any protection whatsoever.   As you've been taught in the past, avoidance is your best friend.   When confronted with a thunderstorm, head inside, stop at a store, get a snack, or even hop into an automobile...but not a convertible.  If far away from either of these the best advice seems to be:


1)  Don't look for cover under a single tall tree as it may act as a lightning rod


2)  Seek a location away from large masses of metal, construction equipment, motorcycles, fences, railroad tracks and anything metallic which could transmit an electric charge from a distance to you


3)  When in the woods, protect yourself by finding a low area preferably under heavy growth of small to mid size trees


4)  If  you find yourself absolutely out in the open, and you feel your hair standing on end, lightning is nearby. Don't simply lay flat on the ground but kneel and bend forward, hands on knees, till the danger passes


 


Below are two folks who've been hit.  They display the characteristic Lichtenberg Figures, tattoos really, of the path taken by the electricity.


 




How do you know if you might have been struck?  Are there symptoms?


Below is a reprint from the Department of Emergency, Univ of Illinois


Lightning is primarily an injury to the nervous system, often with brain injury and nerve injury. Serious burns seldom occur. People who do not suffer cardiac arrest at the time of the incident may experience lesser symptoms, which often clear over a few days:



  • Muscle soreness

  • Headache, nausea, stomach upset and other post-concussion types of symptoms

  • Mild confusion, memory slowness or mental clouding

  • Dizziness, balance problems


Longer term problems


Most survivors experience only some of the symptoms below:



  • Problems coding new information and accessing old information

  • Problems multitasking

  • Slower reaction time

  • Distractibility

  • Irritability and personality change

  • Inattentiveness or forgetfulness

  • Headaches which do not resolve with usual OTC meds

  • Chronic pain from nerve injury

  • Ringing in the ears and dizziness or balance problems

  • Difficulty sleeping, sometimes sleeping excessively at first and later only two or three hours at a time


Delayed Symptoms



  • Personality changes/self-isolation

  • Irritability and embarrassment because they can't remember people, job responsibilities and key information

  • Difficulty carrying on a conversation

  • Depression

  • Chronic pain and headaches


Friends, family and co-workers who see the same external person may not understand why the survivor is so different. Friends may stop coming by or asking them to participate in activities or survivors may self-isolate out of embarrassment or irritability. As with other disabilities, families who are not committed to each other are more likely to break up.


What Medical Tests Are Available?


There are two kinds of medical tests:



  • Anatomic tests take an x-ray, CT scan and MRIs or blood count measurement. These tests will often come back "normal" for lightning survivors because, similar to concussions, the injury is in how the brain works, not in what it looks like on a ‘picture’ kind of test.

  • Functional tests show how something is working so that it may be more useful to have neuropsychological testing for brain injuries. Neuropsychological testing is expensive but may be useful for those who need to document learning or processing disabilities for school or work.


Where Can Survivors Get Help?


The Lightning Strike and Electric Shock Survivors, International (LSESSI), is a support group formed in 1989 by a lightning survivor. LSESSI has helped hundreds of survivors, families, physicians and other professionals by:



  • Providing print and related materials

  • Supporting family and friends of survivors

  • Connecting survivors with others in their area

  • Organizing an annual meeting where survivors and their families can come together for support and information.


Phone: 910-346-4708, 
Email: info@lightning-strike.org
Adddress: P.O. Box 1156, Jacksonville, NC 28541-1156.


What are the Four Steps to Recovery?


The four most important factors in overcoming disability from lightning injury, or from any illness or major injury for that matter, are:



  1. Having a supportive family/friends network.

  2. Becoming your own advocate and learning as much as you can about this disability or having a family member do this for the survivor.

  3. Finding a physician willing to listen, read, learn and work with the survivor and their family. There is no ‘specific’ treatment for lightning injuries. Care of the brain injury and chronic pain problems is similar to that for concussion and nerve injury from other causes.

  4. Having a sense of humor because not all of this will go away. Laughter is a great stress reliever for everyone.


Learn more at the MedScape victims lightning page 

This factsheet courtesy Dr. Mary Ann Cooper, Professor Emeritus, Departments of Emergency Medicine and Bioengineering University of Illinois at Chicago


 So. bike tires do not offer you any insulation, and, don't even ask about your running shoes!


funny-sign-ice-cream-dinosaurs-avenge


Image 1, 2 Google images


Image 3 TheMetaPicture



Tuesday, July 9, 2013

Revised: Athletes Over 40 and Are They at Risk?

Triathlon and Men Over 40 (Bloomberg)



Lawrence Creswell is a terrific swimmer and physician. As a thoracic and cardiothoracic surgeon, he may be especially qualified to comment on the article first published in Bloomberg.  Like me, he is interested in keeping the sport safe for all regardless of age or experience level.  Below is a reprint of one of his recent posts but first a few words.

I first became interested in death in triathlon once it was sensationalized by the media.  As a swimmer, seeing that the deaths were listed as drowning, I took particular interest in the swim portion of the race and why we as a group of smart people didn't have a better handle on causes and cures of this issue. 


What's  really happening here?  Well, some would have us believe it a 50-50 proposition that we make it to the finish line alive.  But, sadly, there are those who, in fact, do not make it, participating in a sport they love.  They usually do not make it through the swim.

 When observing any mass swim start like than of an IM, people starting, people stopping, swimming over, and getting swum over by fellow entrants, who can say that triathlon isn't a contact sport?  But that's not what we want.   Even in wave start events like the 2011 NY tri, a 64 year old gent was pulled from the water, cause of death listed as heart attack.  Also in that race, a 40 year old mother of three, and stated to be, "in great shape, swam the course the day before," succumbed, her autopsy inconclusive.


 Unlike marathons where those who die seem to do so in the final mile, in our sport it's the swim.  Some lake, some ocean, some olympic, some half, some IM.  Many of these athletes are both experienced and adequately trained...just like you!  A cardiologist would tell you that the stress of the swim is more like likely to produce a rhythm disturbance of the heart, or fluid collecting in the lungs.  Pulmonary edema.  Add to that the anxiety the swim produces, and it's more than a little, the difficulty of being spotted in the water if in trouble, lack of ability to rest, and so many coming from a swim-bike background, and at least a possible partial explanation comes forth.

There's a lot more to this discussion but suffice it to say that a lot of people are looking at it, and although I didn't think so for the longest time, you and I should be one of them.   So to summarize, at present, deaths are rare but they do occur.  When they happen, it's in the swim, cause(s) unclear.  Arrhythmia and pulmonary edema are being studied the most, heart disease in the older athletes.  The USAT Report can be read in it's entirety athttp://athletesheart.blogspot.com/2013/06/triathlon-and-men-over-40.html . A quick summary to enhance your understanding.

Athletes Responsibility: Show up for the race healthy, fit and prepared.


Visit your doctor for a physical
examination with an emphasis on
heart health before participating.
Unrecognized heart problems are
the primary cause of sports-related
sudden cardiac death.
􀀀 Consult with your doctor about any
warning signs during training such
as chest pain/discomfort, shortness
of breath, light-headedness, or
blacking out.
􀀀 Your health, fitness level, and
preparation should guide your
selection of an appropriate race or
event.
􀀀 Your race plan should be
consistent with your health, fitness
level, and preparation.
􀀀 Choose an event because it places
an emphasis on athlete safety, and
is sanctioned by USA Triathlon.
􀀀 Practice and prepare for open
water swim venues. Race day must
not be your first exposure to an
open-water swim competition.
􀀀 Thoroughly review the race’s
website and all pre-race
communications so you are
knowledgable on the timetable for
race day arrival and preparations.
􀀀 Utilize all checklists and information
from the event, USA Triathlon and
your coach to mentally prepare for
the competition.
􀀀 Make certain your equipment is
safe and working properly. Make
certain your wetsuit fits properly.
Get your bike checked before the
event.



􀀀 During the event, STOP at the first
sign of a medical problem such as
chest pain/discomfort, breathing
difficulties, light-headedness, or
unusually high heart rate and seek
medical attention. Your life may
depend on it. This is particularly
important during a race swim, in
which rescue poses unique
challenges.
􀀀 During the event, tend to a fellow
athlete who has a medical problem.
􀀀 Learn CPR and be prepared to use
those skills when needed. Ask
your family and other supporters to
do the same.
􀀀 Visit usatriathlon.


  Read Dr. Creswell below and do your best to be prepared.

________

From Dr. Larry Creswell

@athletesheart

Cardiothoracic Surgeon, Jackson, MS

Last week, Bloomberg published an on line article by Natasha Khan and Shannon Pettypiece, entitled "Men Over 40 Should Think Twice Before Running Triathlons," that opened with the line, "For men competing in triathlons past the age of 40, the grueling slog to the finish line could be their last."

I can tell from inquiries I've received and from on line and Twitter chatter that this article received a lot of attention.  Of course, there are a lot of male triathletes older than 40!

I don't ordinarily think of Bloomberg or BusinessWeek as a source for information about personal health.  That Bloomberg would publish this article speaks to the current general interest in the intersection of health and endurance sport.  And men older than 40 must certainly be an important demographic for Bloomberg.

At the outset, let's agree that the headine and lead sentence--probably furnished by an editor for the sole purpose of garnering attention--are sensational.  The rest of the article is more balanced, though, and there's a fair amount of factual material that should interest male athletes.  Let's take a look:

1. A personal account.  As a jumping off point, the article shares the sad story of 55-year-old business executive and triathlete, Michael McClintock, who died of cardiac arrest after a training session.  When athletes die at high-profile events like marathons or triathlons, the incidents capture the public's interest.  When athletes die on the treadmill, the high school track, or the local swimming pool, they receive little attention.  A handful of athletes die at running races or triathlons in the U.S. each year; several thousand athletes die each year in non-race settings.  The story of Mr. McClintock is typical.  One of my heart surgery partners died on a hotel treadmill a while back.

2. Sports-related sudden cardiac arrest (SCA) is truly much more common in adult male than adult female athletes.  Like the article suggests, men older than 40 should think twice about exercise.  Men in this age category should due diligence, with their physicians, to their heart health and any potential risk of participating in an exercise program or training for and competing in events like triathlon.  That's only common sense.  Sports-related SCA can happen with any sport, regardless of how strenuous it might appear.  But other forms of heart disease are common in athletes and non-athletes, alike.  Prevention is worthwhile. Finally, it's important to remember than women and younger men are not immune from the problems of SCA or heart disease in general.

3. Triathlon swim.  In triathlon, the greatest risk for SCA does indeed occur during the swim, for reasons that are not entirely clear.  The article mentions one potential theory related to the body's neurohormonal systems that has been proposed by British physiologists.  I've written about this possibility here at the blog.  This is just one theory.  The truth is that we don't yet know enough about SCA during the triathlon swim.  USA Triathlon prepared a checklist that may help athletes reduce their risk.

4. The experts are triathletes.  It's nice to see the article quoting expert cardiologists who also happen to be triathletes.  Dr. James O'Keefe is a very capable triathlete and Dr. Andre La Gerch is an exceptional runner (think 1:10 half marathon) and triathlete (think ~4:10 half Ironman).  Perhaps some extra credibility on these issues!  Their advice is sound.  In particular, Dr. La Gerche reminds us to pay attention to warning signs of potential heart disease:  chest pain/discomfort, difficulties breathing, palpitations, unusual fatigue.

5. The long-term.  Dr. O'Keefe introduces the concept of some sort of "sweet spot" for exercise and the idea that "more is not necessarily better."  We know very little at present, but there may well be important heart risks associated with prolonged involvement in endurance sport.  We should pay careful attention as new information becomes available.

6. Competition changes. The article mentions the recent initiative by World Triathlon Corporation (WTC), called SwimSmart.  I've written here at the blog about this initiative and a corresponding initiative by REV3 Triathlon designed to improve race safety.  It's encouraging to see major event producers work to promote better race safety.  WTC just introduced a terrific short video about swim safety narrated by acclaimed triathlete, Paula Newby-Fraser.  It's worth watching.


Triathlon and Men (Women) Over 40, The Safety Issues- Please Read

 Triathlon and Men Over 40 (Bloomberg)




Lawrence Creswell is a terrific swimmer and physician. As a thoracic and cardiothoracic surgeon, he may be especially qualified to comment on the article first published in Bloomberg.  Like me, he is interested in keeping the sport safe for all regardless of age or experience level.  Below is a reprint of one of his recent posts but first a few words.

I first became interested in death in triathlon once it was sensationalized by the media.  As a swimmer, seeing that the deaths were listed as drowning, I took particular interest in the swim portion of the race and why we as a group of smart people didn't have a better handle on causes and cures of this issue. 

 

What's  really happening here?  Well, some would have us believe it a 50-50 proposition that we make it to the finish line alive.  But, sadly, there are those who, in fact, do not make it, participating in a sport they love.  They usually do not make it through the swim.

 When observing any mass swim start like than of an IM, people starting, people stopping, swimming over, and getting swum over by fellow entrants, who can say that triathlon isn't a contact sport?  But that's not what we want.   Even in wave start events like the 2011 NY tri, a 64 year old gent was pulled from the water, cause of death listed as heart attack.  Also in that race, a 40 year old mother of three, and stated to be, "in great shape, swam the course the day before," succumbed, her autopsy inconclusive.

 

 Unlike marathons where those who die seem to do so in the final mile, in our sport it's the swim.  Some lake, some ocean, some olympic, some half, some IM.  Many of these athletes are both experienced and adequately trained...just like you!  A cardiologist would tell you that the stress of the swim is more like likely to produce a rhythm disturbance of the heart, or fluid collecting in the lungs.  Pulmonary edema.  Add to that the anxiety the swim produces, and it's more than a little, the difficulty of being spotted in the water if in trouble, lack of ability to rest, and so many coming from a swim-bike background, and at least a possible partial explanation comes forth.

There's a lot more to this discussion but suffice it to say that a lot of people are looking at it, and although I didn't think so for the longest time, you and I should be one of them.   So to summarize, at present, deaths are rare but they do occur.  When they happen, it's in the swim, cause(s) unclear.  Arrhythmia and pulmonary edema are being studied the most, heart disease in the older athletes.  The USAT Report can be read in it's entirety at http://athletesheart.blogspot.com/2013/06/triathlon-and-men-over-40.html . A quick summary to enhance your understanding.

Athletes Responsibility: Show up for the race healthy, fit and prepared.


Visit your doctor for a physical
examination with an emphasis on
heart health before participating.
Unrecognized heart problems are
the primary cause of sports-related
sudden cardiac death.
􀀀 Consult with your doctor about any
warning signs during training such
as chest pain/discomfort, shortness
of breath, light-headedness, or
blacking out.
􀀀 Your health, fitness level, and
preparation should guide your
selection of an appropriate race or
event.
􀀀 Your race plan should be
consistent with your health, fitness
level, and preparation.
􀀀 Choose an event because it places
an emphasis on athlete safety, and
is sanctioned by USA Triathlon.
􀀀 Practice and prepare for open
water swim venues. Race day must
not be your first exposure to an
open-water swim competition.
􀀀 Thoroughly review the race’s
website and all pre-race
communications so you are
knowledgable on the timetable for
race day arrival and preparations.
􀀀 Utilize all checklists and information
from the event, USA Triathlon and
your coach to mentally prepare for
the competition.
􀀀 Make certain your equipment is
safe and working properly. Make
certain your wetsuit fits properly.
Get your bike checked before the
event.



􀀀 During the event, STOP at the first
sign of a medical problem such as
chest pain/discomfort, breathing
difficulties, light-headedness, or
unusually high heart rate and seek
medical attention. Your life may
depend on it. This is particularly
important during a race swim, in
which rescue poses unique
challenges.
􀀀 During the event, tend to a fellow
athlete who has a medical problem.
􀀀 Learn CPR and be prepared to use
those skills when needed. Ask
your family and other supporters to
do the same.
􀀀 Visit usatriathlon.


  Read Dr. Creswell below and do your best to be prepared.

________

From Dr. Larry Creswell

@athletesheart

Cardiothoracic Surgeon, Jackson, MS

Last week, Bloomberg published an on line article by Natasha Khan and Shannon Pettypiece, entitled "Men Over 40 Should Think Twice Before Running Triathlons," that opened with the line, "For men competing in triathlons past the age of 40, the grueling slog to the finish line could be their last."

I can tell from inquiries I've received and from on line and Twitter chatter that this article received a lot of attention.  Of course, there are a lot of male triathletes older than 40!

I don't ordinarily think of Bloomberg or BusinessWeek as a source for information about personal health.  That Bloomberg would publish this article speaks to the current general interest in the intersection of health and endurance sport.  And men older than 40 must certainly be an important demographic for Bloomberg.

At the outset, let's agree that the headine and lead sentence--probably furnished by an editor for the sole purpose of garnering attention--are sensational.  The rest of the article is more balanced, though, and there's a fair amount of factual material that should interest male athletes.  Let's take a look:

1. A personal account.  As a jumping off point, the article shares the sad story of 55-year-old business executive and triathlete, Michael McClintock, who died of cardiac arrest after a training session.  When athletes die at high-profile events like marathons or triathlons, the incidents capture the public's interest.  When athletes die on the treadmill, the high school track, or the local swimming pool, they receive little attention.  A handful of athletes die at running races or triathlons in the U.S. each year; several thousand athletes die each year in non-race settings.  The story of Mr. McClintock is typical.  One of my heart surgery partners died on a hotel treadmill a while back.

2. Sports-related sudden cardiac arrest (SCA) is truly much more common in adult male than adult female athletes.  Like the article suggests, men older than 40 should think twice about exercise.  Men in this age category should due diligence, with their physicians, to their heart health and any potential risk of participating in an exercise program or training for and competing in events like triathlon.  That's only common sense.  Sports-related SCA can happen with any sport, regardless of how strenuous it might appear.  But other forms of heart disease are common in athletes and non-athletes, alike.  Prevention is worthwhile. Finally, it's important to remember than women and younger men are not immune from the problems of SCA or heart disease in general.

3. Triathlon swim.  In triathlon, the greatest risk for SCA does indeed occur during the swim, for reasons that are not entirely clear.  The article mentions one potential theory related to the body's neurohormonal systems that has been proposed by British physiologists.  I've written about this possibility here at the blog.  This is just one theory.  The truth is that we don't yet know enough about SCA during the triathlon swim.  USA Triathlon prepared a checklist that may help athletes reduce their risk.

4. The experts are triathletes.  It's nice to see the article quoting expert cardiologists who also happen to be triathletes.  Dr. James O'Keefe is a very capable triathlete and Dr. Andre La Gerch is an exceptional runner (think 1:10 half marathon) and triathlete (think ~4:10 half Ironman).  Perhaps some extra credibility on these issues!  Their advice is sound.  In particular, Dr. La Gerche reminds us to pay attention to warning signs of potential heart disease:  chest pain/discomfort, difficulties breathing, palpitations, unusual fatigue.

5. The long-term.  Dr. O'Keefe introduces the concept of some sort of "sweet spot" for exercise and the idea that "more is not necessarily better."  We know very little at present, but there may well be important heart risks associated with prolonged involvement in endurance sport.  We should pay careful attention as new information becomes available.

6. Competition changes. The article mentions the recent initiative by World Triathlon Corporation (WTC), called SwimSmart.  I've written here at the blog about this initiative and a corresponding initiative by REV3 Triathlon designed to improve race safety.  It's encouraging to see major event producers work to promote better race safety.  WTC just introduced a terrific short video about swim safety narrated by acclaimed triathlete, Paula Newby-Fraser.  It's worth watching.