Wednesday, October 29, 2014

You're Not Old Till You Exit the Pool on the Stairs

"I'll take any risk to tie back the hands of time."

Dr. Frankenstein: You know, I'm a rather brilliant surgeon. Perhaps I can help you with that hump.

Igor: What hump?

I was told over twenty years ago that "you're not old until you start using the stairs to get out of the pool."  It's one of those things that after a while takes hold in our brains till we come to believe it as fact.  True or not, I still leave the water directly from my lane, the old push up technique.  And I'm no longer young.

Another one I learned in premed from Homer Jackson Moore, MD, one of the sharpest guys I've ever met and a major reason I got accepted to med school.  Trying to keep up with, and every once in a while,get ahead of "Jack" Moore was a full time job.  However, it got me the grades  I needed to gain entrance to "the U" Medical School . Jack used to say, "Take the stairs and add a day to your life."  Let's see how that fits into a triathlete's world. 

Does that single comment shape us into the travelers that we are today?  I think so.  Rarely do I step on a moving sidewalk or escalator at the airport.  Famed triathlon coach Joe Friel told me many years ago in this type of discussion to think that "those airport stairs were put there just for you."  A third member of the discussion admitted that if he had a layover, the stairs were "an opportunity to get stronger."  He'd go up and down them repeatedly like mini mountain climbing.  When asked if passers by would think him nuts he repeated the oft quoted line from Michael J. Fox, "What other people think of me is not my concern."  And he did get stronger.  And faster.

I have another friend who, when traveling, rather than sit and stare at mindless talking heads on TV giving you weather information about a place you may never in your life visit, finds an empty gate and does push ups.  Or sit ups, leg levers, planks, hip thrusts, you name it.  Once again, if she gets an odd look she thinks, "They'd be welcome to do some of these with me."

Before 9/11, it wasn't all that hard to park your stuff in a terminal locker, head out for a run and then finish with a sponge bath in the men's or ladies room when you get back.  You wouldn't be the first person with a long layover to make your way to a local health club for a weight workout or couple hours on a stationery bike.  I've read that some enterprising folks have even made their way into the airport hotel fitness center.  And some airports have actual gym facilities.

There are opportunities in your life like this every day from how far away from the door of the supermarket you park to shunning the elevator in office buildings.   I've reported before that during my junior year med school clerk ships, while training for my first Boston Marathon, that the West Wing where our patients were located had 16 floors.  And before getting our assigned patients, my friend Dennis and I agreed we wouldn't use the elevator.  

At all.

You guessed it.  We were assigned to West Wing 15, the fifteenth floor of the hospital.  So several times a day it was fifteen flights of stairs up and fifteen down.  What really got your goat was when you forgot something like your notebook at one end or the other....and it was fifteen flights up....

I had to smile a few weeks ago when flying with our two 20+ year old sons. We were on the way to the connecting flight to go backpacking in Sequoia National Park, the boys about 10 feet ahead of me.  And they took the stairs, not the escalator.

So when you have a little time between flights and consider poking around in search of an empty gate for a little core work, remember Michael J. Fox, a very likable guy and "What other people think of me is not my concern." 

Thursday, October 23, 2014

Yes, You Can Workout Outside in Winter

Overcoming the Cold, Especially Hands and Feet

Depending where you live, it won't be long

A letter I recently received. 

Although it's author, a UK athlete named James from Guernsey, is not a triathlete, we have the same problem he does.  How to continue to train in an uncomfortable environment?

Hi John,

I think you could be the man I need to speak to!

I'm an open water swimmer from Guernsey in The Channel islands (off the coast of France) and I was really hoping I could get your advice after seeing that you once swam the Channel with Raynaud's?

I also have Raynaud's as you can see from the attached pics. The purple foot is the time I made the mistake of getting in a hot shower after a long cold swim.... You know that feeling....! The yellow foot is typical of all swims, and the same goes for my hands, but the hands had come back to life for the photo..

How did you get on with the channel? Was Raynaud's the biggest hurdle? My main fear is permanently damaging feet/hands with no blood circulation for such a long period of time.

Any advice will be greatly appreciated.

Yes, You Can Workout Outside in Winter

This is the time of year when many folks, the non-believers as it were, think we're nuts.  "What, you're going outside to run in this kind of weather, why you must be K-razy!" 

We spent the holidays in Chicago last year, and on Christmas Eve, when our 25 year old son went out for a morning run, at 0 as in Z-E-R-O degrees, Grandma was after him like flies on flypaper. "How about this wool hat?  Those gloves couldn't be thick enough.  Would you like this scarf?  How about wearing Grandpa's long johns?" etc."  She meant well.  But with a little trial and error, you can still run or bike outdoors providing the footing/traction is safe and visibility OK.  In the car vs runner arena, the car still wins most of the time.

It's been said that you heat up 10-15 degrees once you get going so that's in your corner. A friend tells me "there are no bad runs, only bad gear," meaning you don't need to be cold if you plan properly.  Many of us have other issues like Raynauds Syndrome.  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 conditions 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. 

But if you still have questions, head back to your local running shoe specialty shop. Probably not your generic sporting goods store.  But you don't buy your running shoes at a sporting goods store anyway.  Most likely the sales team is made up of runners.  Runners who've had their outdoor exercise for the day already  and would be only too happy to discuss cold hands and feet ,wool socks, mittens, and the like.  It's runners talking about running.  Doing the thing they like second best*.

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.

 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.

Note: I didn't mention that men can get frostbite of their private parts if they don't make allowances for it with their gear.  Take it from the voice of experience, the rewarming process "hurts big time!" Avoidance is best.

If you want to document the possibility of Raynauds, 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!

The challenge of year round outdoor swimming in colder climates. Ice skates work better.

 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 that unless they've markedly improved over those 5-6 years ago, 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.

Seen on the pier in Kona 2014
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."

*Best, you ask?  Eating.

Sunday, October 19, 2014

Cross Training - Try SEAL Team PT in the Off Season


Birthday Push Ups

John Post, MD

As I hung up the phone, and my wife saw that dreamy, days of yesterday look in my eyes, she said, “You didn’t say ‘yes’ this time, did you?”  For the last six months, a younger friend, in great shape and finisher of three Ironman Triathlons, had been after me to join a morning workout group called SEAL Team Physical Training.  Once a month they had Bring a Friend Day.  I would later learn they say, only half jokingly, “Bring a friend on Thursday, lose a friend on Friday.”  And then they all laugh.  All except the new people like me that is. 

They won’t talk to you unless you’re in push-up position.  I looked around and saw several guys who could have been football players in college, or high level runners who may have lost a step, but not two, since then.  About half the group did not look like they were the a.m.  exercise type, a look I would very soon find  was deceiving when we went for our warm up run.  STPT was started in Richmond, VA several years back by a former Navy SEAL who had ideas on making those around him stronger and fitter.  And he needed a job.  It worked well enough that there are branches in Charlottesville and in multiple mid Atlantic locations so far.  They meet outdoors every weekday morning at 6:00 a.m., come rain, come shine, come whatever, and heaven forbid someone’s late.  It becomes an “opportunity to get stronger.”  The group pays for individual shortcomings - we get to do push-ups.  Only 10 or 20 if the instructor is in a chipper mood, 30 or more if not.

   There’s also a curious little ritual I would learn about called birthday push ups as today was the birthday of a bouncy young woman named Rachel.  After hearing this, knowingly the members all went back into push up position (anybody getting tired of push ups yet?) as Rachel jogged to the front. “Everybody ready?” she bellowed in her sweet, young voice. “And…down one, down two, down three…” until we got to twenty four.  “And one for good luck.”  A whispered voice from behind let us know that this is how the group celebrates birthdays.  By doing push ups, naturally.  Don’t you?   One for each year of the birthday celebrant.  But by now, with the work out only 5 minutes old, I was push up-ed out.  So to keep up, I went to my knees and did “girl push ups.”  I’d shortly be informed that, no, sir, they’re not girl push ups but members simply going to their knees regardless of sex.  Got it?  As it turned out we were lucky that the birthday girl was young.  It can be a real bear when one of the older members age up.

Then they go for a warm up run.  Often times it’s the old indian file which I hadn’t done since high school.  And that was a long time ago.  The instructor, looking like he could do 1000 push ups, or looking like he’d just done 1000 push ups, had us line up according to running speed.  Everyone made for the middle, except the high level boys as they loped like Usain Bolt to the head of the line.  Although I’ve lived here for 30 years, and been to this particular park many times for kid’s soccer games, I’d never really given much thought to the neighborhood across the street.  It seems now that maybe I should have been more curious.

If you haven’t run it recently, indian file is supposed to group runners of near similar ability running in a line one behind the other.   The tail end runner sprints to the head of the line, tucks in front, then says “Go” to the new tail end guy or gal and they then sprint to the front.  I was familiar with the concept but the pace was just a tad faster than I could tolerate. Oh, and it was slightly up hill. 

Preparing to cross the road at the park gate, and enter the opposite neighborhood, very fortunately for me we stopped momentarily at the red light.  Long enough for me to catch my breath, sort of, and focus on our intended route.  It was up hill as far as I could see.  “Dear God, we’re not going indian file up there are we?” I thought as the light turned green.  Yes was the answer.

But the Olympics were coming, and I had this image of Roger Bannister rounding the Iffley Road Track at Oxford, head held back, flying over the cinders, as he headed for destiny with Chataway and Brashers falling back out of camera focus, spent, their pacing duties complete.  I put my head down, realized the group had pity on the new guy, and the pace eased just a little as we continued the run.

As it would later turn out, this would be the only time I would nearly drop out of an exercise.  We approached the half way point on the hill as the climb steadily and quickly increased.  Audible breathing spread group wide as my 5 file-mates worked under the strain of the ever increasing effort.  And they were used to this while I was aching for a full breath.  Think iron lung short of breath.  Or as Gilda Radner on SNL playing Roseanne Rosenannadanna frequently uttered, “I thought I was gonna die!”  Ah, I see you’ve been there.

I was literally this close to my last step, forming the words, “I have to stop,” prior to actually speaking them, when the person behind me said, “I have to stop, you all go ahead.”  But we didn’t go ahead.  In what I would soon learn is a signature move at STPT, we all stopped and walked. A guy named Steve said, “We’re not leaving anyone behind,” as if it were a daily occurrence.  Indeed it is a daily, or at least weekly, occurrence.  They never leave anyone behind, even new guys like me.  If the exhausted teammate had waited one-half second longer before confessing his exhaustion, he’d have been encouraging me instead of the other way around.

Later, after enough  bear crawls to have you wondering if that Icy Hot pad was still in the drawer at home, sit ups, more push ups,  crab soccer tag, sprints, and, oh yeah, some more push ups,  the hour workout mercifully came to a close.  Your suffering is complete for today.  You have the mental image of your hot tub at home and a glass of cold iced tea.  That is if you can walk erect long enough to make it to your car.  The group of 50 or so has had a great work out, smiles all around, and my friend asks, “So, did you have fun?  Are you coming back?”  It’s one of those instant decisions that change the path of your life.  “Uh, sure, why not?”

Fellowship among adults is not often easy.  Easier when you’re part of a big company I suppose, or perhaps a member of a Navy helo squadron with lots of other pilots your age.  There’s always a softball game or touch football on Sunday afternoons.  But on the outside, friendship is not guaranteed.  In fact, it can be quite a surprise to those used to, for example, the camaraderie of the hospital doctors lounge or the frat house.  I remember quite clearly the comments of a friend who was quite comfortable with his senior medical position at the hospital carrying over to his community life, easy recognition and great service at the establishments in town.  But when he retired and moved to a new community, he was most dismayed to report that at the barber shop, “I was just the next retiree in line.”

But Seal Team mitigates that.  There are faster and slower runners, faster and slower paddlers on boat days.   I forgot.  They have those rubber zodiac boats you see in the war movies as John Wayne lands at Anzio in search of the enemy, his shirt still starched nicely thank you.  We race.  Most of the time it looks like Wrong Way Peach Fuzz from Rocky and Bullwinkle fame is steering the boat or that the helmsman is way over the legal limit of .08 as we careen across the lake counting stokes as a group.   “One, two, three, one two, three.”  With just a little practice, however, we learn quickly how to work as a group.  The races can be very close, competitive and exceptionally exciting.  They’re usually best two out of three, for the Championship of the Free World level importance, as you might expect.  Both the victors and the vanquished take enormous pleasure from the effort.  But, as the real Navy SEALs say, “It pays to be a winner.”

Everybody’s friendly.   As a physician, I see people from all walks of life in my office, many who’ve discarded any sense of commitment to exercise.   Here at Seal Team, for an hour a day anyway, is a group of folks, 16 – 65 years old, white, black, you name it, who vote with their feet, and paddles, and show up at this always outdoor exercise class regardless of the weather.   Quarterly, we do the Navy Physical Strength Test to get some idea of where we stand.  It’s pull ups, push ups, sit ups, and a mile and a half run for time.  What’s really encouraging in this self-paced work out is that there are all sizes and shapes of “former athletes” some of whom can still run a sub 7 minute/mile pace and others, who, when they start the class, are unable to do even a single sit up.  On the days we do the PST, virtually everyone can see personal improvement.  A sincere effort is made to recognize this improvement in each individual, identifying them by name and accomplishment.  And boy do they improve!  And boy do they smile!

I’ve been with these people, people who have now become friends, for over a year now and even my fitness has improved.  But my birthday’s just over the horizon.  Celebrating it Seal Team PT style would prove to be a tall order for certain given the fact that I was already practicing surgery before a good percentage of the others were even born.  Inside, I was pretty sure that I just couldn’t do it.  I hadn’t in many years.  I couldn’t equal my age in push ups and that it would prove a bit of an embarrassment.  The old man can’t keep up, can’t “chew the leather” as Al Pacino would so famously point out in his Academy Award winning performance in Scent of a Woman.

But I practiced, worked on it, until B-Day arrived, the anniversary of my birth, and they knew it was coming even though I didn’t mention it.  Blame Facebook I guess.   I was called to the front of the group.  More than one smile along the way.   “Everybody ready?”  OK, here goes nothing, I thought.  “And….down one, down two, down...”   We easily passed through twenty, and thirty but by 40 I was beginning to tire.  “Let’s pause and shake it out,” got us, well me actually, a ten second break.  As we got to 50, a voice from the back yelled out in not a little pain, “So how old are you anyway?”

That voice did 15 more push ups, and one for good luck.  And so did I.

These days, when my wife does the laundry, washing the work out clothes, she says, “I put a little vinegar in to get out the stench. And you better hurry up.  I’ve got a big salad and fresh fish on the stove.  Gotta get you ready, you’ll be having another birthday before you know it.”

Wednesday, October 15, 2014

Thoughts on Tires, Ironman and Mama’s Fish House

The Setting Sun Highlights the Kailua Pier and Transition on the Eve of Ironman World Championship

Ready for this?  On Saturday at the Ironman World Championship I watched an athlete in the pre dawn hours of race morning pump up his tires.  He had deflated them the previous day following the antiquated custom of “letting some air out of them so they don’t pop” in the afternoon Hawaiian sun.  He was using his own pump from home not one of the ones supplied by WTC.  But the pump was broken.  Had been broken for awhile.  The needle on the gauge was broken off so he chose to pump the tires up until they felt right.  When I discussed this technique with one of the panic mechanics on the pier, a gent who works in a bike store and does this every day, he mentioned, “Once the pressure gets to 90 or 95 psi I can’t tell if it’s 195.  I doubt he can either.”
The basic importance here is the hopeful elimination of race flats.  But if on race day, with the adrenalin flowing, tires get over (or under) inflated, the athlete is risking not only malfunction and lost time, but an accident should the tire deflate when descending a steep hill at 40 mph .
A second and somewhat sad observation the mech offered was how “ill prepared and ill equipped” some of the athletes were.  In Kona, not only are you expected to be able to handle routine bike maintenance issues, the eager race volunteers are instructed not to mess with your bike or wheels.  They can hold the bike or pump and the rest is up to the racer.  You’d best be ready. 
So many are not.  When it comes to their own equipment be it tires, tire pressure, valves clogged with sealant just to name a few, experience is lacking.  According to my new friend the mechanic, “These people would have a lot less stress if they’d just take the time to understand how their race wheels work.”   (Think Normann Stadler melt down as defending Kona champion after his second flat in so many hours which lead to heaving his not inexpensive bike off the side of the road into the lava fields melt down.*)  This experience comes from using race wheels in training such that when an issue arises, they’ve dealt with it before.
We’re entering the offseason.  Why not see if your local bike store offers a 3-4 lesson course on basic bike maintenance.  If not, ask for a private one.  This is what these folks love to do.  When you show interest in their trade they’re usually most enthusiastic about sharing what they know.
Give yourself the gift of knowledge.  You’ll thank yourself one day.

Restaurant Intentionally blocks cell signal

Mama’s Fish House – the day after the Ironman I flew to Maui to teach a course on office orthopedics to a large group of primary care docs.  On the way back to the Kahului Airport for the flight home to Virginia, first of three flights actually, I had a meal at Mama’s and the food was exceptional.  I’m sure I’ll go back one day if I ever get to Maui again. When I made an off handed comment to the waitress that we were “7 miles from a major airport yet I had no cell service,” I was told, “Yep, we like it that way.”  In fact, it’s intentional.  The restaurant owners want guests to have an exceptional dining experience, not one constant interrupted by non urgent electronic communication, so the building was constructed in such a manner that it's without cellular service. It might also explain why they have free valet parking for all guests.  At first blush it sounds odd, and some of us who are welded to our devices might think mean even, but I enjoyed both the meal and the casual conversation.  Looks like maybe not being connected for an hour two is OK and that the owners were correct.  Nary a cell phone ringing was heard.  Have the Wasabi Fried Calamari if you go.

Saturday, October 4, 2014

Will Arthritis Slow You Down? Maybe Not.

Male and Female Brain Development Report from National Institutes of Health

     All babies start out with the same number of cells, which over nine months, develop into a complete female baby. The problem occurs when cells are instructed by the little chromosomes to make a male baby instead. Because there are only so many cells to go around, the cells needed to develop a male's reproductive organs have to come from cells already assigned elsewhere in the female.

     Recent tests have shown that these cells are removed from the communications center of the brain, migrate lower in the body and develop into male sexual organs. Now the brain is sort of similar to a full deck of cards, so this means that males are born a few cards short, so to speak, and some of their cards are in their shorts.

     This difference between the male and female brain manifests itself in various ways. Little girls will tend to play things like house or learn to read. Little boys, however, will tend to do things like placing a bucket over their heads and running into walls.

     This basic cognitive difference continues to develop until puberty, when the hormones kick into action and the trouble really begins. After puberty, not only the size of the male and female brains differ, but the center of thought also differs. Women think with their heads. Male thoughts often originate lower in their bodies where their ex-brain cells reside.

A question that comes up all too often is the athlete who wants to compete but due to a medical condition beyond his or her control they find themselves to be "former triathletes."  I've always found this to be a troubling definition as the person is, in one sense, allowing themselves to be defined by a sport when they have so much else to offer.  I suppose we're all former somethings. But like Julie Andrews says in Sound of Music, "When the Lord closes a door, he opens a window somewhere."  I firmly believe that when confronted with a situation like this, opportunity is knocking somewhere else in your life and that before too long, you'll open the door where this knocking occurs.

The following is a letter I received recently that may reflect this approach to life:

Dear Dr. Post,
I'm a 51 yo former triathlete who can no longer run due to an arthritic knee that is "bone on bone." I had my last of 3 surgeries in May 2011 and have not been able to run more than 3 miles without increase in pain. This is after a series of 5 sinvisc (sp) shots. They lasted 3 months , but after that back to the pain. I currently swim 15k a week and ride 6 hours w/o too much discomfort save for a hilly , hard ride, then it starts to hurt. The next step is partial or full knee replacement. Can you tell me if there is a chance of running after such a surgery and is there a criteria/series of questions to help a patient decide to have knee replacement? Thank you for your blog, Chris

This is a slight modification of my response.

Chris - this is a big problem that faces many triathletes. As you scan the number of entrants in each age group at your local triathlon, as we age the number of folks in each older group is less than the one preceding. And you know that there are a bunch of former triathletes (like you) who'd like nothing better than to be at the starting line but can't because of arthritis such is present in your knee or some other medical issue.

I'm sitting at the airport having just taught an Orthopedic course to a couple hundred primary care docs this morning and this is what we discussed. Arthritis of the knee comes in many flavors. Some have worn through the cartilage over a wide area while others have a smaller lesion surrounded by normal tissue. It sounds like you're in the former category and replacement, if it's just killing you, may be a surgical option. But, at 51, if you can modify your activities such that you can put off any kind of surgery as long as possible, that might be the best path. If you have such pain that the above is not an option, the partial replacement, Unicondylar Knee Arthroplasty (UKA), is a good option if your disease is predominantly over only half of the knee. It's a smaller operation than a replacement, no ligaments are cut and motion down the road tends to be better. I like it.  Some of us are candidates for an operation called an osteotomy where the knee is slightly realigned redistributing the pressure.  In the right person, these can lead to a pain free joint without putting any hardware into the joint.

As far as running after artificial joint implantation, I don't think you'd find a manufacturer that would support it. But that isn't to say that some haven't done so quite successfully.  I am writing this in the San Francisco airport on the way to Kona.  While you look up when you walk down the street in Hawaii, I look knees, looking for scars and "new friends" to make when they tell me all about their knee surgery and activity level since.

In the global picture, you want whatever is done to last the rest of your life, if possible, and if you have a lot of life left, you'd want this to survive as long as possible before you undergo surgery again. Golf, doubles tennis, light aerobics, hiking, etc. are all on the recommended list.  Running is usually not.  In short, if my brother had a UKA, I would encourage him to be a biker-swimmer-hiker, etc. but to wear his running shoes when he cuts the grass. I suspect that your best advice will come from your surgeon who knows your knee better than any of us. And, while you may on one hand be a former triathlete, I'll bet you're a present something else that will ultimately be even better.  It's only a sport and you're so much more than a sport.  We're pulling for you.  Good luck!

From Michael J. Fox - "It may seem hard to believe, but it's catastrophe that offers the most promise for an even richer life."