Thursday, July 22, 2010

Training Doldrums, or 14,496.811 feet

Mt. Whitney, California, 14,496 feet, 7/17/2010

"Nothing happens by accident. I learned this the hard way, long before I knew that the hard way was the only path to true, certain knowledge." Pat Conroy, South of Broad

I've been told that many of us train all winter with a subconscious goal, not of the season of races, but primarily with the season opener in mind. How were my transitions last year in race #1, am I prepared to exceed my swim time from last year now that I truly understand the course? That sort of thing. So, that regardless of this years performance (hopefully good), once the race is over some of us lose our way. We have difficulty finding that intensity, that focus, that drive. I don't think that this is uncommon.

This week, my 20 year old son Ben and I hiked 72 miles on the John Muir and High Sierra Trails concluding with a scramble to the summit of Mt. Whitney, the highest peak in the lower 48 states. At 14,496.811 feet Whitney serves silent guard over Sequoia National Park and the giant trees standing over 3,000 years. Our hiking partners were two delightful deaf gents, both half my age and strong hikers. (And they had the GPS!) When you're on the trail with a non-verbal partner there's plenty of time for thought. As I tried to keep up, I was reminded of Daniel Coyle's line in "Lance Armstrong's War" describing the old men observing the cyclists in the Paris - Roubaix road race, watching "with yearning, bleary eyes the young men they used to be." You can bet I know what he means.

In addition to reminders of the many years of use (overuse?) that my legs have had it served to remind me that with more races up ahead, that I simply needed to shift my goal, my way of thinking. I was able to clear my brain of facts from the first race and move on to remembering as much as I could about the successes and failures from last years second event. What time did I awaken, what did I eat, where was body marking, etc.? And, the memory that really did the trick was the collapse of the bike rack during my ride so that upon re-entering the transition area, putting my back from whence it came was, ah, a challenge! (A volunteer took it from me as others worked to replace the rack.)

It worked! Now, as I sit at the Fresno - Yosemite Airport with incredibly sore legs from the hike, my triathlon focus is firmly on the future.

Yours will be too. Just think about it.

Hiking partners Jon and Matt with son Ben Post.

Saturday, July 10, 2010

Clavicle Fractures, Part 2

I am headed to California tomorrow to hike the High Sierra Trail and climb Mount Whitney with our middle son. The blog will be on vacation for two weeks as I won't even have a cell phone. But I wanted you to be as impressed as I was in Sonoma Orthopedics and the development of intramedulary fixation of clavicle fractures.

Frank Schleck crashed on the cobbles in this years Tour de France fracturing his clavicle in 3 places. It took a 3.5 hour surgery to put it back together. But, were he lucky enough to have a different fracture pattern (see page 48 of this years TdF Velo News guide), perhaps his clavicle could have been fixed this way.
See . It's pretty cool actually.

Will report again in two weeks.

Wednesday, July 7, 2010

The Triathlete and Joint Replacement

"Some day I'll wish upon a star, and wake up where the clouds are far behind me. Where troubles melt like lemon drops, away above the chimney tops, that's where you'll find me." From, "Somewhere Over the Rainbow" (Or, it could be the unrealistic attitude of the triathlete with lower extremity arthritis when told that a joint replacement is in his/her future.)

“When I wear these knees out, I’ll just get ‘em replaced and race another ten years.” (Joe Triathlete)

In the words of Johnnie Carson, "Wrong barn breath."

The first triathlete I ever met doing Iron distance racing with an artificial joint in place was a gent about 35 years old who’d taken a bullet to the knee in Vietnam - and he had no choice. Winston Allen, from Florida, had his knee replaced last year and has his eye on Kona this fall racing at 80 or 81. A tall order for anyone of that “vintage” even with two knees which came from the original manufacturer.

A replaced weight bearing joint, be it hip or knee, is a reasonable approximation of the original equipment. But to date, we’ve not figured out how to make them last indefinitely. That said, we’re getting better. Current expectations are a product life expectancy of about 20 years depending on in whom the joint gets installed. Consider the different demand loads placed on the prostheses by your average Medicare eligible 65 year old looking for a bridge foursome versus a 50 year old triathlete with premature arthritis and stated expectation of returning to the sport.

When I have my Orthopedic Surgeon hat on, I try to council patients to make what they have last as long as possible. This may require oral medications, injections of various substances designed to reduce inflammation and pain or increase the viscosity in the joint. It may require the dreaded activity modification (read reduce or stop running.) I say this, not to make one suffer but to consider the patients age, longevity prospects of the prosthesis and the potential for a revision (replacement of the replacement) and it’s possible complications. It's not like we're changing a light bulb here where not only is the second one just as good as the first, the only downside might be dropping it. The second total joint replacement is significantly harder to do than the initial one and the rate of complication rises. Infection, fracture, premature loosening, post op anemia, blood clots, the list goes on.

So, when you hear that you have some degree of arthritis in the knee or hip, see what long term plan you can adopt to put replacement as far into your future as possible. My friend Mike did IM Hawaii in 2004 and shortly after was diagnosed with significant hip joint arthritis. With a little weight loss and attention to detail, he was able to forestall a hip replacement for 6 years having just had the operation in May.

You might consider this a goal to shoot for, barn breath.