Friday, January 28, 2011

"Kidney Stones, What Are Those?" Tim DeBoom, 2003

"You don't tug on Superman's cape.
You don't spit into the wind.
You don't pull the mask off the old Lone Ranger,
and you don't mess around with Tim.

When I flew to Kona in 2001 it was just 19 days after the 9/11 World Trade Center tragedy in New York.  There were less than 30 passengers in our plane designed to carry 150.  Everyone was nervous.   And, as hard as this may be to believe, there were a number of no shows for the race.  Tim DeBoom gave the American triathlon world a big boost of national pride by wresting the Ironman Triathlon World Championship from Peter Reid.  He repeated in 2002.

DeBoom had had a good 2003 and was the Hawaii pre-race favorite going in.  Living up to his pre-race hype, Tim was 4th out of the water on race day.  He had an even better bike and departed T2 firmly in second place.  With 2:45 IM marathon speed it looked as if championship #3 was just over the horizon...or, just up the Queen "K" Highway as the locals might say.

Tim began to have trouble in the mid third of the run.  By mile 12 he'd consulted with the roving medical van about back pain.  Within two miles he was walking, weaving and dizzy.  As the medical team approached, he passed out and was quickly carried into the medical vehicle.  He passed in and out of consciousness as they made their way back to the pier and race medical facilities.  Later, after a good bit of testing, he was diagnosed as having passed a kidney stone during the run.

A kidney stone is exactly that, a crystalline "rock" in the kidney or ureter (tube connecting kidney and bladder.)  They form when the urine has an excess of certain metabolic by products which can crystallize and become a stone.  These stones come in all sizes from microscopic to as big as a marble.  People liken the pain that they generate to that of childbirth...only worse!  And, unfortunately, if you've ever had a stone you're relatively likely to have another.  Actually, they're pretty common.  The reason that this is especially important to triathletes is that a major precipitating factor is dehydration.

As shown by Tim DeBoom, the presenting symptom is usually pain, and lots of it.  It's often felt in the low back and groin, and in male triathletes, the testicles.  They can color the urine, even give it a bloody appearance on occasion.  In addition to testing the urine, diagnosis can be aided by a good history and physical exam.  Occasionally an abdominal x-ray will reveal the stone, but frequently a more involved study is required.

Treatment is initially pain based from anti-inflammatory drugs and oral narcotics all the way to hospital admission.  We usually strain the urine to try and catch the stone, first for analysis and later for patient counselling and treatment.  Those stones that don't spontaneously pass may require some type of surgical procedure.  As noted above, if you've had one, you're at risk for another.  One of the best things you can do is to stay well hydrated.  Ever heard that before?

Thanks, Tim, you've done a lot for the sport.

Finally this quote: "Desire.  Some people want it to happen, some people wish it would happen, and the successful make it happen."

Friday, January 21, 2011

2011, Your Year Without An Overuse Injury

The sun sets over the pier in Kailua-Kona with race start 14 hours away.

"He Au Hou i 'Eheu o ka Noio"
A New Era on the Wings of a Noio

"...(this is) a year of change and new beginnings. It is a time to reflect on the past and respect what it has taught us,but it is also a time to move forward - Imua. We enter this year on the "Wings of a Noio," embracing change and welcoming new beginnings."

These words were the theme of last years Ford Ironman World Triathlon Championship.

For many of us, the passing of this race marks the end of the year and an opportunity to reflect on both successes as well as lost opportunities in 2010. And, as noted above, it's also "a time to move forward."

Achilles Tendon Injuries
          Using your "head"

"We run, not because we think it is doing us good, but because we enjoy it and cannot help ourselves." Sir Roger Bannister

OK, repeat after me.  I will not have an overuse running injury this year.  Really.  I'm going to use my head. Really, I am.

I was  recently reading an article in the Orthopedic literature about a trend toward fewer operations in achilles tendon ruptures (Journal of Bone and Joint Surgery if you're interested. ) and felt that the problems most of us might encounter will fall short of an actual rupture.

Anybody in your running group out with achilles tendon problems? If not now, statistics would point toward the probability in the future as 8-10% of running related issues are achilles in nature. It's the strongest tendon in the body connecting the heel bone (calcaneus) to the calf musculature but it's not damage proof.

Achilles tendon pain may occur in any athlete, particularly those who may be deconditioned for the chosen activity, runners who do excessive hill work or the old "too much too soon."  It starts gradually, 4-6 cm above the heel, as pain only with exercise subsiding with rest. Jumping sports like volleyball can accelerate the process, or when making a significant change to one's training plan. You do have a training plan, right? Even normal running can cause tiny tears in the tendon which heal spontaneously unless the runner over stresses the area with insufficient rest. When symptomatic, rest is KEY! Ultimately, this can lead to a chronic tendinitis picture with nodules in the tendon and in very rare cases, rupture of the tendon. I'll bet that would change one's training.

So, you think you might be having an achilles issue and want to know what to do. Well, before you call the doc, you'd try twice daily cold therapy-watch out for frostbite. Have a friend inspect your legs looking for redness or maybe a cracking feeling coming from the narrowest point of the tendon. It can be pretty dramatic. A small heel lift from your local running shoe store can be beneficial, both right and left sides, particularly if you've had limb length inequality issues in the past. While there, ask them to look at your shoes and your gait. I have great respect for the local running shoe store owners and they can be an invaluable resource.

In summary: 1)back off your running volume/intensity
2)twice a day icing
3)careful stretching
4)short term heel lift (work shoes too)
5)see your local "running shoe guy" then Sports Med Specialist if not getting better quickly. 

Good Luck!

Saturday, January 15, 2011

How Many Bikers Does It Take To Change a Tire?

"I don't know what I've been livin' on,
but it's not enough to fill me up.
I need more than just words can say,
I need everything this life can give me."  Van Halen

Saturday morning, and you're supposed to go for a long ride, and this is the view outdoors. As Johnny Carson used to say, "Not so fast barn breath!

Most of the better triathletes I know are pretty rigid when it comes to sticking to a training schedule.  You can see it on Saturdays at the kids soccer games.  The ones who were able to get their work out in before the game are more relaxed.   They can check that box off for the day.  I'm sure you know what I mean. The others just sit there and itch.  That said, if one has a ready alternative plan when peering out the window to the above realizing the weatherman grossly underestimated the snowfall, it would be beneficial.   A shorter indoor ride watching that Netfix movie would be just perfect.  Or maybe some time at the gym.   Basketball.  Just have a plan.

Flat Tire Embarrassment

When was the last time you inventoried the items in your saddle bag?  Sure, you think you know what's in there.  Last Sunday was a good example of why this is important. With ice on the roads we were mountain biking out in the woods, always a pleasant break from the routine. Coming down a hill, my friend flatted, and from there on it was like a scene from a Jim Carrey movie.

How many times have we heard that tire changing is just one of those things you have to know?  Not enough I guess.  Picture this group of highly educated professionals including a Psychiatrist, Law School faculty member, large animal Vet, 2 IMH finishers, etc. and as you observe the owner of the flat select a "new" tube from his saddle bag, it has that grey, dusty appearance of old rubber that you've seen before.  Silently, you wonder if it came from Eddy Merckx saddle bag, but you don't want to challenge a friend.  So you ask, "You sure that'll still work?"

Step 1)  Install Eddy's tube but fail to realize CO2 cylinder isn't fully screwed in...and when activated, CO2 goes up friends sleeve
Step 2) Borrow another CO2 cylinder. Screw 2nd CO2 cylinder in tightly (thank you) but realize tube is no good when it won't hold inflation
Step  3) Borrow a third CO2 cylinder.   Borrow another tube. Watch two friends make the repair as bike owner takes barb after barb from other riders.
Step 4) Finish ride.

My point is that while we think we're ready for such problems, in fact we may not be.  Take 5 minutes tonight and see what's in your bag.  What do you think should be in there at a minimum? Are you prepared for a dog bite, road rash, allergic reaction, etc.? If you ride when it's dark, do you have a small light, for example? 

I've worked as a "panic mechanic" in Kona on the pier on race morning.  You'd think that 2 hours before what is arguably the most important athletic event of these peoples lives, that they'd be ready for anything...and you'd be wrong.  The most common repair?  Changing tires.

Thanks Andy.

Sunday, January 9, 2011

You've Had Your Knee Scoped, Now What?

"I used to be schizophrenic, but we're OK now!

 Yep, these legs did the race in Kona this year. You?
 It's true!

This photo was taken on the pier in Kona the morning before the event...and the owner was wearing  an Ironman wrist ID band.  Most impressive.

 After Knee Arthroscopy
This may be the culmination of a potentially sad chain of events in your triathlon life.  It may have included an injury or just a gradual onset of pain, swelling or some type of mechanical problem.  But for most of us it's neither the end of the world nor one's athletic career.  It's just a speed bump. 
"The first thing they all want to know is not, "Am I going to die during surgery," or "Is my leg going to fall off," or "Are you going to make me 6" shorter with this operation?" They want to know, "When can I start training again?" says a doc I know.  And you know he's right.

In my way of thinking, assuming no complications with anesthesia or the surgery itself, you ask:

"What was found?"
      What's my diagnosis?
      Exactly what structures are abnormal and what was done to them?
      What does this mean to me both short and long term?
      Understanding the inside joint issues puts you back in control of things.
      This is definitely an advantage over proceeding blindly.
      Who knows the future vagaries of injury?

"What do I do now?"
      What are my post-op instructions?
      Do I have any activity limitations? Weight bearing?
      When can I start training again? Limitations?
      Do I need Physical Therapy?

"Should I keep my records?
       I give all my patients their intra-operative photographs.  Some surgeons give DVD's of the procedure. Should you need further treatment in the future, taking these photos can be quite helpful. They also enhance your understanding of your surgery.

You have a lot invested here both personally and functionally, and you don't want to contribute to less than the most successful outcome by being overly aggressive, or sometimes worse, not active enough.  Know that you'll keep your end of the surgical contract. You'd like to have that same Kona pier asphalt under your feet (careful. Wear sandals, it can get pretty hot in the middle of the day.)