Sunday, November 24, 2013

Finger Fractures, A Bigger Deal Than You Think/Glucosamine Helpful?

 


Fractures of the Fingers

 

 

 

frienshipIII

 Friendship 


Glucosamine For Joint Pain?  I get asked fairly regularly about whether there's any merit to using glucosamine, or glucosamine and chondroitin as it's frequently sold as a dietary supplement in this country.  Sadly, even though it's sometimes labeled as shark cartilage, no studies to date have shown it any more helpful in those with joint pain or arthritis than placebo.  (Maybe it's helpful to sharks.)  The standard line you hear from most orthopedists is that it won't harm you when taken in recommended amounts but like so many of the supplements sold to the triathlon population, it will give you expensive urine and little else.


_________________________________________________



If you think a broken (fractured) finger is a minor injury, think again. Without proper treatment a fractured finger can cause major problems. The bones in a normal hand line up precisely. They let you perform many specialized functions, such as grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can cause your whole hand to be out of alignment. Without treatment, your broken finger might stay stiff and painful.Your hand contains 27 bones.


Cause


There are 8 bones-the carpals-in your wrist. The palm of your hand contains 5 bones called the metacarpals. The 14 bones in your fingers are called the phalanges. Fractures to the metacarpal bone that leads to your little finger accounts for about one-third of all hand fractures in adults.


Generally, a fractured finger occurs as the result of an injury to your hand. You can fracture a finger when you slam your fingers in a door or put out your hands to break a fall. You can fracture a finger during a ball game if the ball jams your finger. Carelessness when working with power saws, drills, and other tools can result in a fractured finger.


Symptoms


  • Swelling of the fracture site.

  • Tenderness at the fracture site.

  • Bruising at the fracture site.

  • Inability to move the injured finger in completely.

  • Deformity of the injured finger.


Diagnosis

If you think you fractured your finger, immediately tell your doctor exactly what happened and when it happened. Your doctor must determine not only which bone you fractured, but also how the bone broke. Bones can break in several ways. They can break straight across the bone, in a spiral, into several pieces, or shatter completely.


Your doctor may want to see how your fingers line up when you extend your hand or make a fist. Does any finger overlap its neighbor? Does the injured finger angle in the wrong direction? Does the injured finger look too short? Your doctor may X-ray both of your hands to compare the injured finger on your uninjured finger on your other hand.


Treatment


Nonsurgical Treatment


Your doctor will put your broken bone back into place, usually without surgery. You'll get a splint or cast to hold your finger straight and protect it from further injury while it heals. Sometimes your doctor may splint the fingers next to the fractured one to provide additional support. Your doctor will tell you how long to wear the splint. Usually a splint on a fractured finger is worn for about three weeks. You may need more X-rays as you heal so your doctor can check the progress of your finger as it heals.




Surgical Treatment


Depending on the type and severity of the fracture, you may need surgery to have pins, screws, or wire put in place to hold your fractured bones together.



Rehabilitation

Begin using your hand again as soon as your doctor determines it is okay to move your finger. Doing simple rehabilitation exercises each day will help reduce the finger's stiffness and swelling. You may be required to see a physical therapist to assist you in these exercises.


For more information on fractured fingers, including symptoms and treatment, talk with your orthopaedic surgeon.


DSCN0289


Image 1, Entertainmentmesh.com



Thursday, November 21, 2013

Bat Bites, Cat Bites, Dog Bites, ?Bear Bites? While Training

 



A Marine was deployed to Afghanistan. While he was there he received a letter from his girlfriend. In the letter she explained that she had slept with two guys while he had been gone and she wanted to break up with him. AND, she wanted pictures of herself back. So the Marine did what any squared-away Marine would do.


He went around to his buddies and collected all the unwanted photos of women he could find. He then mailed about 25 pictures of women (with clothes and without) to his girlfriend with the following note: "I don't remember which one you are. Please remove your picture and send the rest back."


_______________________________________________________


Animal Bites

Each year millions of people in the United States are bitten by animals. Most bites occur on the fingers of the dominant hand, but animal bites can also occur about the head and neck area.  On a Winter morning training run a few years ago in the pre-dawn dark, I was about a half mile from my house.  I know the roads so I have no head light and totally started when a bat tried to land on my head!  I turned around immediately and upon removal of my knit cap once home, my wife could see the faint claw marks in my scalp.  You talk about your surprises!


I finished the run.


Cause


 

 Most animal bites are from dogs. Cat bites are the second most common cause of bites. The risk of infection from a cat bite is much higher than a bite from a dog.


A major concern about an animal bite is the possibility of rabies. Because most pets in the United States are vaccinated, most cases of rabies result from the bite of a wild animal, such as a skunk, bat, or raccoon. Only a few people die from rabies in the United States each year, and most deaths are due to bat bites. In other countries, dog bites are the most common source of rabies. Rabies causes an estimated 55,000 deaths worldwide each year.


Even if a bite does not break the skin, it may cause crushing and tearing injury to underlying bone, muscles, tendons, ligaments and nerves. If the skin is broken, there is the additional possibility of infection.


Signs of an infection include:



  • Warmth around the wound

  • Swelling

  • Pain

  • Discharge of pus

  • Redness around a puncture wound


 


Signs of damage to tendons or nerves include:



  • An inability to bend or straighten the finger

  • A loss of feeling over the tip of the fingerA physician should be contacted and told how the bite was received and to ask what treatment is needed. The physician will wash the wound area thoroughly and check for signs of nerve or tendon damage. The arm may be examined to see whether there are signs of a spreading infection.



Immediate First Aid


The bitten area should not be put into the mouth. The mouth contains bacteria, which can cause infection.




Superficial Wounds


For superficial wounds, the area should be washed thoroughly with soap and water or an antiseptic, such as hydrogen peroxide or alcohol. An antibiotic ointment should be applied and the wound should be covered with a nonstick bandage.


The area should be watched carefully for signs of damaged nerves or tendons. Some bruising may develop. The wound should heal within a week to 10 days. If it does not, or if there are signs of infection or damage to nerves and tendons, medical help should be sought.




Presence of Bleeding


Direct pressure should be applied to the area using a clean dry cloth and the area should be elevated. If an area is not actively bleeding, it should not be cleaned.


The wound should be covered with a clean sterile dressing and medical attention should be sought.


If the wound is to the face, head, or neck, medical help should be sought immediately.



Medical assistance


The physician will probably leave the wound open (without stitches), unless there is a facial wound. Xrays and a blood test may be needed. A tetanus shot and a prescription for antibiotics may be prescribed.


If the tendons or nerves have been injured, a specialist may be consulted for additional treatment.


The incident should be reported to the public health department. They may ask for assistance in locating the animal. This is so that the animal can be confined and observed for symptoms of rabies.


*Sent to me by a U.S. Marine, veteran of the war in Afghanistan.   Thanks for serving!



Sunday, November 17, 2013

Cold Hands/Feet While Training, Fix 'Em; and How Drug Companies Screw You

 


"You can have my gun when you pry it from my cold, dead hands."  Men in Black, Edgar (Vincent D'onofrio)


 











Edgar

 


 I cover this topic every year as new readers sign on.


Although it’s not yet December, we in Virginia have had our first snow of the year. I think it’s a good time to start this year’s discussion of cold hands, Raynaud’s Syndrome in some cases.


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


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


 My sister and I both have this to a greater or lesser degree and I think I'm the biggest local purchaser of chemical hand warmers at our local backpacking store. But, I ride outdoors all year unless there's snow or ice on the road. Outdoor swimming in winter, however, can present a certain challenge!  Fortunately most triathletes avoid outdoor swimming and the thought of cold water drives them positively - indoors!


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


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


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


 



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


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



 



 One follower offered  "I've found disposable hand warmers to be essential for winter running -- I start using them when the temperature drops below 50. For running races, I wear thin gloves, then hand warmers, and then socks over both. If I heat up too much in the race, I can toss the socks or even the hand warmers."


__________________________________________


How the drug company Sxxxxx is killing you (and me)


Sxxxxx pulls Cyyyyyyy off the market to clear way for higher-priced Lzzzzzzz


Thought you might be interested in this. Sxxxxxx can make a lot more money using Cyyyyyyyy for the treatment of MS than for cancer. BUT, Sxxxxx would not be able to charge as much for using Cyyyyyy in MS as the other MS drugs (Cyyyyyy has been out a while for the treatment of cancer so the price was already set).


 Solution: Several months before Cyyyyyy gets approval from the FDA for the treatment of MS, they remove it from the market. Then, when it gets approval for MS bring it back under a different name at a much, much, much higher price.


 Got to love those drug companies.


 



Tuesday, November 12, 2013

Compartment Syndrome

  DSCN0286


Compartment Syndrome

Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.


Compartment syndrome can be either acute or chronic.


Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.


Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.


Anatomy

Compartments are groupings of muscles, nerves, and blood vessels in your arms and legs. Covering these tissues is a tough membrane called a fascia. The role of the fascia is to keep the tissues in place, and, therefore, the fascia does not stretch or expand easily.



The area between the knee and ankle has four major muscle compartments: anterior, lateral, superficial posterior, deep posterior.

Figure A: Reproduced and adapted with permission from Gruel CR: Lower Leg, in Sullivan JA, Anderson SJ (eds): Care of the Young Athlete. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000. Figure B: Reproduced and adapted from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.


 

Description

Compartment syndrome develops when swelling or bleeding occurs within a compartment. Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted. Without a steady supply of oxygen and nutrients, nerve and muscle cells can be damaged.


In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result. This does not usually happen in chronic (exertional) compartment syndrome.


Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.


Cause


Acute Compartment Syndrome


Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. Rarely, it develops after a relatively minor injury.


Conditions that may bring on acute compartment syndrome include:



  • A fracture.

  • A badly bruised muscle. This type of injury can occur when a motorcycle falls on the leg of the rider, or a football player is hit in the leg with another player's helmet.

  • Reestablished blood flow after blocked circulation. This may occur after a surgeon repairs a damaged blood vessel that has been blocked for several hours. A blood vessel can also be blocked during sleep. Lying for too long in a position that blocks a blood vessel, then moving or waking up can cause this condition. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this manner usually occurs in people who are neurologically compromised. This can happen after severe intoxication with alcohol or other drugs.

  • Crush injuries.

  • Anabolic steroid use. Taking steroids is a possible factor in compartment syndrome.

  • Constricting bandages. Casts and tight bandages may lead to compartment syndrome. If symptoms of compartment syndrome develop, remove or loosen any constricting bandages. If you have a cast, contact your doctor immediately.




Chronic (Exertional) Compartment Syndrome


The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes who participate in activities with repetitive motions, such as running, biking, or swimming, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.



Symptoms


Acute Compartment Syndrome


The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched.



  • The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.

  • There may also be tingling or burning sensations (paresthesias) in the skin.

  • The muscle may feel tight or full.

  • Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.




Chronic (Exertional) Compartment Syndrome


Chronic compartment syndrome causes pain or cramping during exercise. This pain subsides when activity stops. It most often occurs in the leg.


Symptoms may also include:



  • Numbness

  • Difficulty moving the foot

  • Visible muscle bulging



Doctor Examination


Acute Compartment Syndrome


Go to an emergency room immediately if there is concern about acute compartment syndrome. This is a medical emergency. Your doctor will measure the compartment pressure to determine whether you have acute compartment syndrome.




Chronic (Exertional) Compartment Syndrome


To diagnose chronic compartment syndrome, your doctor must rule out other conditions that could also cause pain in the lower leg. For example, your doctor may press on your tendons to make sure you do not have tendonitis. He or she may order an X-ray to make sure your shinbone (tibia) does not have a stress fracture.


To confirm chronic compartment syndrome, your doctor will measure the pressures in your compartment before and after exercise. If pressures remain high after exercise, you have chronic compartment syndrome.



Treatment


Acute Compartment Syndrome


Acute compartment syndrome is a surgical emergency. There is no effective nonsurgical treatment.


Your doctor will make an incision and cut open the skin and fascia covering the affected compartment. This procedure is called a fasciotomy.


Sometimes, the swelling can be severe enough that the skin incision cannot be closed immediately. The incision is surgically repaired when swelling subsides. Sometimes a skin graft is used.




Chronic (Exertional) Compartment Syndrome


Nonsurgical treatment. Physical therapy, orthotics (inserts for shoes), and anti-inflammatory medicines are sometimes suggested. They have had questionable results for relieving symptoms.


Your symptoms may subside if you avoid the activity that caused the condition. Cross-training with low-impact activities may be an option. Some athletes have symptoms that are worse on certain surfaces (concrete vs. running track, or artficial turf vs. grass). Symptoms may be relieved by switching surfaces.


Surgical treatment. If conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so that there is more room for the muscles to swell.


Usually, the skin incision for chronic compartment syndrome is shorter than the incision for acute compartment syndrome. Also, this surgery is typically an elective procedure -- not an emergency.




Sunday, November 10, 2013

Updated Caffeine and Aspirin Recommendations for Endurance Athletes, 2014

This article summarizes current philosophy regarding racing fluid replacement, aspirin and caffeine dosing, etc.


You're never too old to learn.  For the years prior to the quantification of hyponatremia, low sodium in the blood stream, or EAH (Exercise Associated Hyponatremia) in the ground breaking work of Mitch Rosner, MD at the University of Virginia, I followed the recommendation of the Ironman Official Coach to sip water constantly race morning,  and peeing just before the gun so that I'd be "tanked up."  That methodology has since been disproved, and drinking fluids to excess can even be lethal, so that while popular in 1993, in 2013 it is discouraged.  There's still a good bit of debate between those who say "drink only to thirst" and others who believe that each individual needs his/her own fluid management plan based on personal experience.  While I follow the teaching of Doug Casa at the Korey Stringer Institute and favor the latter, that's an argument for another day.


Moving on, I have preached, and been part of an Australian study during the Ironman in Hawaii, caffeine loading.  I've also written that it remains one of the few legal performance enhancers and how one should calculate a personal dosing schedule during Iron distance racing, make the first dose about 500 mg, etc.  Looks like current research may refute this concept as well depending on one's goals.


I have followed the literature regarding death in triathlon for years and came across the piece below on Twitter. It's reproduced in it's entirety.  My request is that, while this is the author's best guess for 2013, knowing further experience and research will modify these recommendations, that you take just a moment to pass this on to all of your older endurance athlete friends be they runners, swimmers, triathletes, whatever.  If by disseminating this evidence we can prevent a single death, that athlete and his/her family would be eternally grateful.


Please remember when you are evaluating this or any other data, don't just take what an author says for granted.  We triathletes are bombarded by claims from deer antler spray to the latest make you faster supplement.   The data on marathons and cardiac events is based on observational studies. So not the same strength as having a randomized study with matched controls or some huge Framingham database. Though most all the authors seem to come to the same conclusion that there is an increase in cardiac events. However, as pointed out in the New England Journal of Medicine by Kim, the incidence is really small and aspirin may have limited efficacy (page 139, 1/12/2012).  So perhaps not a consensus on taking an aspirin. Though you have to wonder if there is any danger in a single aspirin before a race.


Thanks, John Post, MD 



Running Doc: Research proves that limiting caffeine &  taking a baby aspirin can help prevent sudden death 











dnp;

PETER MORGAN/REUTERS


The Running Doc addresses the issue of sudden death among marathoners and other long-distance athletes, advises limiting caffeine and taking a baby aspirin the day of the event, cites published research.




Dear Running Doc:


I know you have recommended limiting caffeine and taking a baby aspirin race day to prevent sudden death.


Yet with the recent deaths we have seen in the news, like at the Rock 'n' Roll Half Marathon in Virginia Beach, being a 45-year- old runner planning to run the NYC marathon, I went to my doc for a check up. All my tests were normal including a stress test but my doc said there is no scientific evidence to support what you suggest so he did not recommend it! What should I do? Jerry P. New York, NY.


Dear Jerry:


Thank you for your question. With all due respect, your doc is absolutely wrong. The recommendations of the International Marathon Medical Directors Association (IMMDA) are a no-brainer for someone with no medical problems and recent published research backs them up. IMMDA docs are medical directors for endurance events throughout the world and made recommendations based on interviewing successfully resuscitated victims and from autopsies of sudden deaths at our events. The recommendations are presented at the end of the column again with IMMDA’s permission. They can also be found here: http://www.aimsworldrunning.org/articles/IMMDA_Sudden_death_and_how_to_avoid_it_3.20.10.pdf


Dr. Arthur Siegel, from McClean Hospital in Boston, is a leading researcher on sudden death in long distance running and a consultant to IMMDA. He published his results of groundbreaking research in 2013 in the World Journal of Cardiovascular Disease (2013, 3, 17-20). His work gives the scientific evidence to back up the IMMDA recommendation.


He concluded: "The increased risk for cardiac arrest and sudden death during marathon running occurs predominantly in middle-aged males with previously silent coronary heart disease. The use of pre-race low-dose aspirin is evidence- based by validated clinical paradigms to protect such runners from acute cardiac events during races triggered by high, even if transient, atherothrombotic risk."


Similarly, research has been published regarding limiting caffeine to less than 200mg on the morning of a long run. The article: "Caffeine Reduces Myocardial Blood Flow During Exercise" by John P. Higgins, Kavita M. Babu in The American Journal of Medicine (Vol.126, Issue 8) http://www.amjmed.com/article/S0002-9343%2813%2900189-7/abstract?source=aemf also is scientific published evidence supporting our recommendations.


And events are starting to recognize these recommendations and getting the word out. Dr. Paulo Afonso Lourega de Menezes, an IMMDA, has arranged for his Rio marathon to be the first major marathon to fully endorse these recommendations.


So Jerry, I feel comfortable telling your doc he/she is wrong and that to decrease the risk follow our most basic recommendations:


1. Participants should not only be sufficiently trained, but equally important, they should have a goal and corresponding race plan that is appropriate for that level of training and fitness. If not, do not attempt the distance.


2. Have a yearly physical examination and be sure to discuss your exercise plans, goals and intensity at that visit.


3. Consume one baby aspirin (81mg) on the morning of a long run/walk of 10k or more if there is no medical contraindication.


4. Consume less than 200mg caffeine before and during a 10K or more.


5. Only drink a sports drink or its equivalent during a workout of 10k or more.


6. Drink for thirst.


7. Do not consume a NSAID during a run or walk of 10k or more.


8. Consume salt (if no medical contraindication) during a 10k or more.


9. During the last mile, maintain your pace or slow down; do not sprint the last part of the race unless you have practiced this in your training. Run/walk as you train.


We wish you and every one running a great, safe and healthy NYC marathon.And PLEASE follow these recommendations.


Lewis G. Maharam, MD




Thursday, November 7, 2013

Testosterone Therapy Found Not Completely Safe

Should you be worrying about low testosterone ?


                              Probably Not.


Is it safe to take it anyway, or because a guy in my bike group does?         No, not in all of us*.


Photo


_________________________________________ 


 This was posted by WTC on Twitter and will be the highlight of your day. "What's Your Fitness Age?"


http://t.co/MnTAt39zRJ


__________________________________________________


One more thing you may have missed : WR holder David Rudisha is taken down by not one but TWO young Irish track stars  http://vimeo.com/77528958


To be fair, it was a smaller track and they might have used their lower centers of gravity to their advantage.


 __________________________________________________


Low T -  In June I wrote a piece on testosterone called, "Testosterone, Should I? http://tinyurl.com/k2nal4g which contained the following two quotes:


 "A man on TV is selling me a miracle cure that will keep me young forever.  It's called Androgel...for treating something called Low T, a pharmaceutical company-recognized condition affecting millions of men with low testosterone, previously known as getting older." 


and


"Much of the medical community finds fault with the seeming epidemic of men with low testosterone levels and the pharm company manufactured 'need for treatment of this condition'."


  There's no need to re-hash the entire piece but, after the NY Times ran the article poo pooing the use of this drug it recieved a number of educated responses, some appear below and bear reading by those who may be considering evaluation and treatment.


This ad campaign has been labeled as "a sophisticated effort to define low testosterone as a disease for which the treatment is [testosterone-replacement therapy.]




  • M.D.

  • Boulder, CO




I am positively exhausted from having to explain to my middle-age male patients that there is not a sudden epidemic of hypogonadism that they have been made aware of (and are suffering the symptoms of) by a benevolent pharmaceutical company ad. I have this conversation at a minimum of three times daily whereas, prior to last year, I had the conversation, maybe, three times a year. At least my anecdotal experience tells me that direct-to-consumer marketing is efficient use of Pharma dollars.





  • martyr

  • Upstate NY




Let's see - Viagra and Low-T supplements are covered by insurance - but the Congress is objecting to birth control being covered by insurance. The Low-T supplements only require a small co-pay (according to the article) but osteoporosis drugs, such as the one I take with proven medical benefit, has a high co-pay. To top it all off, women's health insurance costs more than men's - something is wrong with this picture....





  • ACW

  • New Jersey





As a woman, I have found, as most smart men and women have, that the most important sex organ is the one between the ears. A man who actually does have low testosterone due, say, to advancing age not only can continue to have a satisfying sex life, assuming the availability of partners and mutual affection, he may actually be a preferable lover, for reasons that need not be spelled out here but which will be clear to anyone who thinks about it. 

Those ubiquitous ads for testosterone cream also list so many side effects (including, women should not come in contact with it)! I'm not sure I'd want to be intimate with a guy who was using it. I'd be scared of getting it on me.

Don't fix what ain't broke. Especially don't risk breaking it in the course of trying to soup it up.





  • Julie McNamara

  • San Diego, CA




Really? Does anyone really believe this world needs more testosterone ? Humans need to get way better at managing the amount that's already floating around out there.


______________________________________


*Is it safe?



  In the current issue of the Journal of the American Medical Association there's a research article about "Testosterone Therapy and Mortality, MI and Stroke".  In a study performed in veterans, testosterone was "associated with increased risk of mortality, MI, or ischemic stroke."  They also suggest further randomized trials to characterize the potential risks of testosterone therapy and I agree.  Whether these findings are applicable to every man who uses testosterone isn't known but it's a great big red flag that testosterone may be anything but risk free.



Monday, November 4, 2013

Three Racers Disqualified in Kona

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


                                                                                        Former Navy SEAL John McGuire


 
Photo


 


This is the World Championship.  Everybody here has raced this distance before.  Or at least a 70.3.  And except for the pros who get money, at least some of them anyway, in Hawaii you get:


1)   A medal


2)   A post race massage.


3)  Mike Reilly calling you an Ironman on Alii Drive - way cool!


4)  Sore feet.


5)  "To swim 2.4 miles, ride 112 miles, run 26.s and brag for the rest of you life," Commander John Collins.


And that's it.  Are these rewards enough to lead some athletes into breaking the rules?  It would seem so.  In the recent past, there was an age grouper who "lost" his timing chip and sort of lost his way on the run never making it into the energy lab.   He ran about 22 miles while the others in his age group  26.2.  This was uncovered almost immediately by fellow competitors, fellow competitors families, and those curious folks on Slowtwitch.


After conversations with WTC brass one year, it was felt that one athlete, or a pair of athletes actually, cheated by having the first of the pair bike to Hawi carrying both of their timing chips. I wonder what the other did for 5 hours.


I know how important it is to Ironman to offer a fair and legal race to all competitors.  Swim Director Jan War and Transition Director David Huerta, among others, are dead serious about getting their portion of the event 100% correct.  It was raining cats and dogs in the early pre-race hours several years ago (I know what you're thinking, "Kona?  Raining cats and dogs?"  Yep, it was, and much of the early race day activity was moved indoors). Serious consideration was given to shortening/changing the bike course to eliminate the steep down hill and left hand turn from Palani Road onto Kuakini Highway to avoid the inevitable crashes that over eager athletes would surely have.  But then WTC President Lew Friedland was adamant that the athletes don't come to ride 108, or 109 miles, they come for a complete course.


Friedland had some local boys on bikes ride up and down the hill at various speeds, including all out, and nobody crashed.  112 miles it is fellas! 


One of my jobs annually is to collect the pro swim attire in the men's changing tent and tag them for later inspection by race officials.  A humorous side note here was when I was told by one of the referees that it would be unlikely that we'd find any illegal suits.  He put his head back ans laughed when he noted, "They'll squeal on each other in a heart beat, you won't find any cheaters."  And he was right.


According to Ironman.com, one athlete was DQ'd last year, none in 2010 or 2011, and three this year.  Having been on the pier for most of the day, I think the three infractions involved illegal swim attire in one athlete, an illegal bike set up, which is probably my fault missing it since I shared responsibility for bike checks.   I believe the third was an athlete who was assessed a penalty but neglected to serve same in the penalty tent.  Since Ironman has chosen not to examine blood, hair, urine etc. on age groupers one can only speculate as to what else they might find.  As said above, they take this responsibility very seriously.  The athlete following the rules should know that there are a lot of people behind the scenes trying to ensure that he/she has these folks in their corner.


Lastly, there's one more issue that really irks me.  The men's and women's changing tents have been given a lot of thought and with the experience of many years behind them, everything is positioned to help the athlete with as brief a stay as possible.  Brief maybe, but at immediate access is water, vaseline, sunscreen, tape, spare shoe laces, bathroom needs, ice, you name it.  In a previous blog, I mentioned a racer who discovered he had no sunglasses for the bike.  But not until he dumped his bike bag on the floor of the men's tent!  The volunteer assisting him offered, "Here, take mine." to which the athlete said thank you but no thank you.  Again, and much more forcefully this time, the volunteer removed his sunglasses and thrust them at the gent, who, very gratefully, accepted.  Just one of the million reasons we say "Thank you" to every volunteer.


What gets my goat is the athletes who urinate on the floor, or just let it fly in their chair while changing, with absolutely no regard for ALL of the other athletes and ALL of the volunteers who have to spend the whole day in the tent.  And they do this with a urinal/port-a-potty not 10 feet away!  I'm quite certain that there was at least one male and one female this year but in the zoo that is transition, their identities escaped us.  But you watch next year folks.  I will make it my business to find these people, identify them, and have them disqualified!  As Demi Moore says in the movie G.I. Jane, "You wanna see pissed off, I'll show you pissed off!"  I'm pissed off.



Hawaii 2011-STPT 308


 


Image #1 Google images