Sunday, November 30, 2014

Supplement Makers Think You're Stupid

As First Lady Eleanor Roosevelt once said, as triathletes, sometimes we must "Do what you feel in your heart to be right.  You'll be criticized anyway."

Great shirt!
Sleep - so crucial to athletes for restoration of Hgh among other reasons.  Why is it that some of us still leave our phones nearby all night?  Is it to get that emergency message from our air carrier about the latest unimportant lettuce keeper that could be purchased with frequent flyer miles?  Or the hotel chain great deal on a queen........

The "right" thing to do would be, with the phone on airplane mode or do not disturb, charging in another room so the pale light of the screen doesn't disturb our phase IV sleep, to check it in the morning after our well-earned nights rest.

Supplements - mostly you're better off not spending the money

I was teaching a course in South Carolina last year to a couple hundred Primary Care docs, Nurse Practitioners and PA's.  It's one of my favorite things.  They absolutely thirst for knowledge. What's special about these sessions is that after a 2 hour lecture, we just sit down and talk shop.  You see, they know they'll never see me again so they're free to ask me "stupid questions."  These are generally things they've wondered about for a long time but couldn't ask the doc back home as they might "look stupid."

Many years ago I heard about a woman recounting a story about an old man who used to answer all her "stupid questions."  She explained "If you ask a question, it makes you look stupid for 5 minutes - but if you don't ask - you stay stupid for fifty years, so always ask questions in your life."  Sometimes we talk for a long time.

After the lecture one of the reps that was detailing a new product said to eliminate toe nail fungus, a real problem without easy answers in many patients, approached me.  Since all the attendees had gone, she gave me a few samples of the attractive boxes with serious looking brown bottles inside, and the 60 sec sales pitch on why this would be the next best selling solution.  At that point, I could have just taken her very convincing word on why this would be successful and start encouraging my runner/swimmer friends to use it, or, do my home work and research it first.  I chose the latter.  

I wouldn't let someone give me an injection without knowing what it was, or take some unknown supplement just because the guy at the store in aisle 6 said it would make me recover 20% faster.  Neither could I use or recommend this toe nail fungus medicine for the same reason.  As Cuba Gooding, Jr. in the movie Jerry Maguire, repeatedly said, "Show me the money!"

Like most docs, I've done this before many times and it's a simple matter of going to the product web site, reviewing it, and proceeding from there.  Bad sign #1 - no product web site.  Only with the help of Google, and a good bit of patience, could I find anything about this liquid.  Pay dirt!  But not at all what I expected.  Is this some kind of recently discovered miracle anti-fungal just distilled from plants in Africa?  Nope.  Is this some kind of recently discovered miracle antibiotic just distilled from plants in Asia?  Nope.  This miracle product, that I was supposed to stake my reputation on by recommending it to friends and athletes was.....wait for it.... simply the same antiseptic you clean hot tubs with!

Fake Web Site

Someone with something to gain (think money) has set up a bogus web site ostensibly evaluating a similar product against others on the market.  Really.  I didn't believe it at first either.  Go to . Take 5 seconds to check it out.  Looks like a real eval of several products by some type of expert, right?  Say you want to contact them and hit "contact us," just like in the cowboy movies, it leads into box canyon.  A dead end.

All of us need to remember that the dietary supplement industry is essentially unregulated.  It's not overseen by the FDA as pharmaceutical products are.  In fact, neither you nor I have any idea if any of these products are safe, effective or cause cancer!  We simply don't know since the supplement industry operates under a different set of rules.  Of the 54,000 products currently marketed only 170, that's one hundred seventy, or 0.3% have documented safety tests.

The following is on about this toe nail fungus product Zeta-clear:

 yes it is a scam and I have tried many natural cures
Hi, so it is true. Zeta Clear does weirdly dominate the internet and fakes their own positive reviews. This product does not work and the company unethically deletes negative reviews off the internet.

Apparently this is well known.  To everyone but me that is.

I make this point because salespeople, print or web ads, anyone, can make something like the "extract of Bubinka juice" sound like exactly what you need, free speed.  You need remember the old adage that if it's too good to be true, it probably is.  They sound good at first but with the test of time are disproven.  Over and over and over and..........

But hey, they think you're stupid and will buy anything.  Prove them wrong!

Sunday, November 23, 2014

Fast Heart Rate, Why Do I Have It?

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

Near Broad Street, Charleston, SC

I used to moonlight when I was a resident and invariably, late on any given Friday night, Dean L. would make his way into the Emergency Room all beat up, blood coming from his nose, his ears boxed in, all scraped up.  And the story was always the same.  "There I was, walking along, minding my own business, when some dude......"  Dean would recount some wild tale about being outmanned and out numbered, and the result would fall in my lap!

This would also describe one of the more common questions that athletes write me about.  Basically, the "There I was, riding (or running) along, minding my own business, when all of a sudden my heart rate monitor showed me at 240!  Now what?"

The most common cause of unexplained jumps in numerical value is unrecognized electrical interference (high tension power lines, welding, etc.,) poor fitting leads, or some other type of mechanical/user problem.  Not long ago, one of the gents in my Sunday bike group was sure he was having some sort of cardiac rhythm disturbance.  A little while later we had to stop while he pulled his slipped chest strap up from around his gut.  (Maybe the heart rte monitor was monitoring his stomach!  Maybe he was hungry?)

Assuming that's not the issue, the first two heart rhythm issues of substance that come to mind are atrial fibrillation and atrial tachycardia.  Atrial fibrillation, or A fib, is defined on the Mayo Clinic web site as:

"Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body. During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation symptoms include heart palpitations, shortness of breath and weakness."

Tachycardia on the other hand is a regular, rapid heart beat from any number of causes, some of which may require treatment.

These are rhythm abnormalities that can happen both episodically and in bursts making diagnosis difficult.

The first thing in making a diagnosis would be, "Are you symptomatic when you're recording this perceived high heart rate?"  Light headed, dizzy, shortness of breath, chest pain, that sort of the thing.  Secondly, you need to take your pulse, the neck is easiest, and see if the pulse rate matches the numbers that you see.  If you train with a tracing heart rate monitor or power meter, or could borrow a friends, some record your heart rate continuously and might prove helpful in this setting.

Office based electrocardiograms are often normal in this setting.  If there is reason to look further for a diagnosis, you could ask about wearing a Holter Monitor - sort of an all day EKG - and see if it's picked up anything abnormal.  It's also important to record any symptoms you may have, and the time you had them, to see if there's a match with the monitor's readings.  If you still don't have an answer, there's yet another type of monitor with EKG leads that are worn for a month at a time.  Sometimes longer, except when in the pool or shower.  I have one patient who wore it for 3 months.... but he got his answer!  Again, if symptoms occur and it's recording a funny rhythm, they can be matched.  What's convenient about these monthly monitors is that all you have to do is play it into a local telephone for the results to be interpreted.

So, I can't give you an exact or specific answer to your particular issue, but this is a road map that will get you that answer and help you answer questions about your training and racing future.  If you have any question at all, ask.  Let some doc listen to your heart do a quick EKG.  Peace of mind is a wonderful thing.

Tuesday, November 18, 2014

Winter Cycling/Running 2014-15, Keeping Those Toes/Fingers Warm

A basketball team is like the five fingers on your hand. If you can get them all together, you have a fist. That's how I want you to play.
                                                                                                                                Mike Krzyzewski

One of the things on your off season to do list during might be get a neutral bike fit by a pro who doesn't benefit if you buy a new bike or aero bars.  This is John Cobb*, arguably one of the best fitters ever, shown here helping a masters athlete customize his bike fit.  This racer had very specific requests with regard to arm placement and potential positional back pain. This Cobb fit was most definitely worth the money.


The Navy SEALs say "there's no such thing as bad weather, only bad gear." Overcoming Cold Fingers and Toes While Winter Riding

I cover this topic each year as new readers sign on.  Here's what's new in 2014.

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 fingers, cold toes, and Raynaud’s Syndrome in some cases.

 Raynaud's is pretty common. Many athletes write to me and without knowing what they're describing, will have Raynaud's as an isolated phenomenon.  In others, it accompanies a more global process. Those affected will have more issues in cold conditions than warm, their fingers will have decreased sensation and often turn white, almost snow white.  As often as not there will also be a numb sensation also.  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.

When rewarmed by being placed in modestly warm water for 2 or 3 minutes, the digits turn every shade of red and purple you can imagine before simply settling on only mildly red. In a few minutes, as the fingers begin to warm, they can also 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 or shirt on your warm belly.   Women seem to get this more than men, often in the 2nd to 4th decade of life. There are medical answers to this, and medicines to avoid, which might increase the frequency of attacks. Once warm, daily tasks like starting a car or typing become 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 diagnosis 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 Fall or Spring, however, can present a certain challenge!  Fortunately most triathletes avoid outdoor swimming unless at gun point and the thought of cold water drives them positively - well, indoors!

 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. As mentioned, 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. There may be improved rechargeable warming shoe inserts of which I am not aware.  Let me know.)  Neoprene bike shoe covers, either just the toes to block the wind, or full booties can be useful.  Ultimately, it's all just a matter of preparation.  So, welcome to the world of winter riding/running and possibly 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.

 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.

Or on your Tri 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."

So don't let the cold alter your training plan, it doesn't stop the SEALs.


Friday, November 14, 2014

Essential Quickie Fall/Winter Hotel Bike Workout

"I looked out this morning and the sun was gone."  

                                                                                                             More than a Feeling  Boston

Open water swimming does Not look inviting today!

The essential 45 Minute Hotel Bike Workout that anyone can do when on the road.

Even though, when asked about Chris Carmichael's role in training Lance Armstrong, Floyd Landis labeled him "a beard," not everything that came out of CTS was bad.  To the contrary.  Now that Carmichael has retired, and we seem to have left LA behind us (and if you haven't read Cycle of Lies: The Fall of Lance Armstrong by Juliet Macur, you're really missing something.  It would make an excellent Christmas gift to your favorite triathlete or cyclist) CTS lists 43 coaches on their web site and a good number of athletes. 

I don't know where the following was published but it's one of those simple things that can really make a business or family trip less painful.  We get to serve that commitment to train for sure.  Although this is not get out and smell the flowers as you ride by in a foreign city, it is very effective in whipping your butt satisfactorily such that your log book, coach, or that little person that lives inside you who feels guilty when you deviate from your ATP by more than 1% remains happy.

This is a modification of the original and how to take advantage of the resources you have, not feel bad about what you don't have.

If you can choose a hotel that has highly adjustable spin bikes, throw your bike shorts in your luggage. Some hotels will even let you bring your pedals and bike shoes. (It only takes a pre trip phone call to find out.)  But whichever route you follow, be sure to respect the hotels equipment.  That way you'll make it easy for others and be assured you can do it again on your next stay.

Leaving your Power Tap and HR monitor at home, just follow this guide and a good workout will unfold.  It's posted two ways.  The list you see, and then a layout that will stay on an exercise bike and is easy to follow. Print off the second one.  Couple copies.

Warmup:  8 minutes

Fast Pedal: 1 minute
Recovery: 30 seconds
Fast Pedal: 1 minute
Recovery: 30 seconds
Hard Effort: (7 0n a scale of 10) 2 minutes
Harder Effort: (9 effort) 1 minute
Hard Effort: 2 minutes
Harder: 1 minute
Hard Effort: 2 minutes
Harder: 1 minute
Easy Spin: 6 minutes
Hard Effort: 2 minutes
Harder: 1 minute
Hard Effort: 2 minutes
Harder: 1 minute
Hard Effort: 2 minutes
Harder: 1 minute
Cooldown : 10 minutes
____________________________Simply hit your chrono at zero when you begin and follow the times

Time 0
Warmup:  8 minutes

Fast Pedal: 1 minute
Recovery: 30 seconds
Fast Pedal: 1 minute
Recovery: 30 seconds

Time so far: 11:00
Hard Effort: (7 0n a scale of 10) 2 minutes
Harder Effort: (9 effort) 1 minute
Hard Effort: 2 minutes

Time so far: 16;00
Harder: 1 minute
Hard Effort: 2 minutes
Harder: 1 minute
Easy Spin: 6 minutes

Time so far: 26:00
Hard Effort: 2 minutes
Harder: 1 minute
Hard Effort: 2 minutes
Harder: 1 minute

Time so far: 32:00
Hard Effort: 2 minutes
Harder: 1 minute
Cooldown : 10 minutes

Good luck and pass this on to your travelling friends.

Tuesday, November 11, 2014

Race Wheels: Why You Need Them For Training

Be Prepared - the Boy Scouts Motto

Perhaps it should also be the triathlete's motto

Making sure it's right one more time.

Not too long ago, at an early season local sprint triathlon, I was watching a woman struggle mightily getting her tires/wheels where she wanted them.  Since I practice what I preach, that promptness pays big dividends on race day, my bike and transition area had been set up for quite some time and it was "chill time" for me.  I was leaning back against the fence just glad to be a part of the sport.  I asked this athlete if I might be of any assistance and was told "yes, I don't usually do too much on my bike."

The rest of the tale involves an athlete, any athlete probably, like so many in the transition area that morning, who liked to race but when anything out of the ordinary cropped up the racer is SOL.

You'd think that at a certain performance level, this would no longer occur.  And you'd be dead wrong.  Talk to one of the panic mechanics at the World Championships and you'd find that the most common thing they do is help folks adjust the tire pressure of their race wheels.  The most obvious reason being that they only use them a couple times per year, like the big carving knife your parents have for the Thanksgiving or Christmas dinner, kept in a box in a drawer until the holidays.  But the carving knife doesn't have a presta valve.

This issue takes on a greater importance if you stray from the straight and narrow by using latex tubes, sealant, etc.  All the more reason to understand your gear and be able to, without a lot of fuss or muss on race day, address simple problems quickly and correctly.

One way would be to use the race wheels during routine training.  They're not going to break.  Because you care for your stuff, they won't get scratched.  And should a flat occur (if you're lucky) you get on the job training at repair.  Should you plan to purchase new wheels for the upcoming season, why not get them early, put several rides on them, learn what makes them tick and you'll be both more prepared and less worried on race day.

I know the guys at my LBS and am quite certain that I could ask them when they might have a quiet moment in their week, one that would allow me to return and mount my tires (or tubes and tires) on my new wheels.  And we'd all have fun doing it.  I'd bring hot Starbucks or bagels and cream cheese just for being the nice guys that they are.

I've written before that frequently local bike shops will have bike maintenance classes over a few week day or weekend days that teach you everything you need for basic care.  They can be quite enjoyable.  Winter's almost here, or maybe it's already come where you live, and what better time is there to start preparing for the 2015 season? 

My tire pressure is just fine, Jack.

Friday, November 7, 2014

When You Dress, Make It a Transition

Up in the sky, look: It's a bird. It's a plane. It's an Ironman

The Adventures of an Ironman

"Faster than a speeding bullet! More powerful than a locomotive! Able to leap tall buildings at a single bound!"
"Look! Up in the sky!"
"It's a bird!"
"It's a plane!"
"It's an Ironman!"

"Yes, it's Ironman - strange visitor from another planet who came to Earth with powers and abilities far beyond those of mortal men. Ironman - defender of law and order. Champion of equal rights, valiant, courageous fighter against the forces of hate and prejudice, who disguised as Clark Kent, mild-mannered reporter for a great metropolitan newspaper, fights a never-ending battle for truth, justice and the American Way."*

5 minute post Ironman registration smile

You know those guys, the ones who are in the shower for 20 minutes after the workout..and it takes them forever to carefully complete each step in their personal grooming?  (Let's see now, comb hair just so, make sure shirt is creased just so, check hair again, etc. Like John Travolta in Saturday Night Fever?  Isn't there one in every group?  What the heck are these people doing in there?  They for sure ain't triathletes!

Do you frequently, when getting dressed after a swim workout at the gym, with no one around to talk to, make it a transition practice?  One local athlete I know does it all the time.  "It makes me think through every step of a race transition."  He silently says "go" and then it's clothes out of locker, not haphazardly but in a controlled everything in it's place manner, gear back in, don street clothing, replace locker contents and done.   Although he says he doesn't actually time himself, I don't really believe him.  I must admit though that knowing he's a good athlete (I've seen his splits,) and a great transitioner, he regularly beats folks who can bike and run faster since he can cut off a couple minutes in a sprint triathlon transition.  Maybe we should follow his routine on occasion.

Her bike passes inspection for the local sprint tri
There are so many ways during your normal day that you can think of to become a stronger faster triathlete. Some examples were seen in a recent blog I wrote about kissing off elevators and moving sidewalks.   I'm fairly sure that you can make up ones of your own, practice them, and then see the results on race day.

Triathlon, perhaps more than some sports, is a way of life to many.  I'm sure there are times during the work day when we are supposed to be studying or planning a project at work, when our mouse accidentally finds it's way to last weeks olympic distance event and the age group results.  "No," you protest.  "No one would actually do that," you meekly assert, the words cheap and hollow, the guilt of having done the same dripping from your mouth.  "Me, too," I echo.

*Adapted from Superman

Tuesday, November 4, 2014

Medical Thoughts at Ironman; the Mumuku Winds Take Their Toll

Do your best to stay out of here if you can

Ironman medical tent waiting for its first customer

Kona is one of the venues where all athletes are weighed at registration.  An unlucky few repeat that when they hit the medical tent.

No athlete plans their race by thinking “OK, body marking, check tires, pre-race pee, good swim and then crash my bike so I end up with medical.”  Right?  Neither do the folks who actually end up partaking of the services offered by the medical team.

Racing triathlon is not an exact science.  There’s a good deal you can do, however, to lessen your chances of an unplanned visit to the tent just as you can plan your transitions thoroughly to require the least amount of time.  Like Crocodile Dundee says to Sue Charlton when describing how the Pitjantjatjara aborigines can walk at night through the forest without hitting anything, “They think their way through.” If, well before the gun goes off signaling the start of the race, like the Pitjantjatjara you “think your way through,” the event you’ll have a safer, more enjoyable day.  I’ve heard it said that your race planning should be broken up into at least three major areas of consideration including conditions, mechanical issues, and your current overall level of race readiness.

On Sunday morning after the 2014 Hawaii Ironman last month I talked with one of the med tent docs about how things went from his perspective in the big tent next door to the King Kamehameha Hotel, Ironman Race Headquarters.  His initial impression was that the harshness of the conditions led to both an increased number of “customers” and a setback in their arrival.  In other words as the day progressed and the famed ho'o Mumuku* winds picked.  The ferocity of the famed Hawaiian winds bearing that name, which roughly translated means ‘the winds that blow both ways.”  One of life’s little pleasures on the Kona coastline.  It’s how you can have a head wind both ways on an out and back course.

  This was especially evident in the northern part of the island not far from the Hawi bike turn around and described by uber-coach Joe Friel “as bad as I‘ve ever seen it.” And he’s seen a lot.  It slowed the second half of the bike for many putting athletes far behind their race plans. In fact, those who’d had a slow start to the day after encountering swells in Kailua Bay were the most affected.  But they were the racers who could afford it the least, the older triathletes who generally spend more time on the course and can ill afford an event more difficult than it already is.

There were (almost unbelievably) 46 athletes over 70 with 4 men and 1 woman in the 80-84 year old age group, none of whom made the bike cut off. Compare that to 2013 where four of four did in the almost eerily calm conditions.

When recalling the goings on in the med tent, the doc felt “ there was nothing we couldn’t handle” describing the expected dehydration, exhaustion, minor bike crashes, etc. One biker was injured in the Waimea area up north and taken to closer medical facilities near there, further details unknown.  It was also a testament to the (syn harshness) that there were, somewhat usually, 14 athletes receiving care instead of the more common 2 or three.

So do your best to stay hydrated, race within your own personal limitations, don’t allow the monotony of 112 miles on the bike get your guard down, and you’ll never know the sensations  of lying on a cot watching the volunteer nurse trying to decide which vein to start the IV.  With perfect pre race preparation, the next tent you see will be Ringling Brothers Big Top with camels in it, not doctors.

*Mumuku - Hawaiian dictionary definition is "Strong wind that blows at Kawaihae"

It's said that ancient Hawaiian warriors, the Alapa, would train in the Kawaihae and Waikoloa region of the Big Island due to the harsh conditions and intense winds.  The first Ironmen of Hawaii perhaps?