Wednesday, December 31, 2014

January First, A Triathlon Do Over - Lucky Us

“A person who never made a mistake never tried anything new.”                                                 Albert Einstein (probable tri wannabe for sure, eh?)

Transition area just waiting for your bike.

You're a triathlete, you're serious about this stuff.  

What a great day January First is!  We get a do over. Like in hop scotch when we were 10. Those flubs and missteps from last season?  Pffft, gone just like that.

Use January 1 as a time to fix just one thing.  If you just choose one thing, it's a lot easier to be successful. New Years resolutions are not about the grand or fantastic, they're about picking a goal that is worthwhile, viable and obtainable.  It's important to be realistic.  Maybe you'd like to lose 50 lbs but a realistic goal would be 20 lbs. Or perhaps you'd like to reduce or eliminate alcohol,  finally sign up for masters swim lessons/stroke eval even though you  know it will embarrass the living daylights out of you. Pick something very personal and selfish.  It's all about you for today.  You can work on world peace some other time.

"At the beginning of the year, it's good to know every race you're going to do," says 6 time Ironman World Champion Mark Allen.  And what better day to plan it than today?  I'll bet that many have already accomplished that task.

 We get the opportunity to review what training/racing errors, nutrition challenges and perhaps over zealous goals that were chosen for 2014.  And if Allen's comments are good for races, wouldn't they necessarily be good for key work outs as well?  And, while we're at it, how about your Racing Weight plan per Matt Fitzgerald?  As has been discussed previously, about 8 weeks before your base period is to start (somewhere about now, eh depending on your particular schedule?), if you can gradually reduce your caloric intake by 2-400 calories per day, remembering that crash diets seldom work, your upcoming work load and caloric needs will dovetail nicely.

 Is this finally the year that you're going to practice open water swimming until you like it?  (Like it?  Is that even possible?)  Even if there are fish and turtles in your hometown lake, and you're a tad uncomfortable sharing your Saturday swim with them, it's something that can be overcome.  Think about getting one of your friends who's pretty comfortable in that environment to accompany you, perhaps several Saturdays in a row come Spring.  And, after a few "desensitization" sessions, you'll surprise yourself at how possible this is.

 You are fully in control of your 2015.  Like fine wine, here's hoping you use it wisely.

Promises to self: 1) I will ride my race wheels more than just occasionally so when there's a problem during the race I've already solved it in training.
                            2) I will use my wet suit frequently so that it's just second nature come race day.
                            3) I will say thank you to all the volunteers who are there just to see you do your best.
                            4) If something starts to hurt, unlike my past, I will back off until it resolves or if it doesn't get it checked out.
                            5) I will help people new to the sport just like I was helped way back when.
                            6) And possibly most important for the long run, a quote from my boss at Ironman, "Race day didn’t feel monumental, but like a slightly more complicated Saturday long ride. Sure, I got a tiny bit stressed at gear drop-off (“S*** I forgot my gels … we can access these bags in the morning, right?!”) and battled the usual fitful sleep on race eve. But aside from those few expected blips, it was business as usual. I think this is a significant point to get to as an athlete—when [racing] becomes  comfortable . Not ordinary, exactly, but the sort of thing that makes you shrug and say “this is just what I do.

"This is just what I do!"
Happy New Year, happy training and I wish you a successful, thoughtful and most of all, injury free season.  I will leave you with one quote from Colin Powell that has meant a lot to many:  A dream doesn't become reality through magic; it takes sweat, determination, and hard work.

Here's a toast to all your dreams for 2015 and wishing you plenty of sweat, determination and hard work.

Thanks for reading, 

John H. Post, III, MD.

Monday, December 29, 2014

Where Does Your Knee Hurt?

Heard in a bar in Chicago, "Nobody ever asks how's Waldo?"

It says, "DEAL WITH IT." Maybe harder to do if his knees hurt!

Knee Pain

We see our fair share of knee pain in this sport as in any endurance arena.  How to care for it relies on determining the exact cause such that a specific diagnosis can lead to specific treatment.  Although much of the knee is subcutaneous, located right under the skin, making the correct diagnosis can be more complex than many might think.  Things to take into account include possibility of recent injury, your age, duration and location of pain, exacerbating and remitting factors, etc.

Pain location: For those athletes with pain over the front of the knee, first thoughts are of issues with the knee cap or patella.  Patella tendonitis, the big tendon below the cap, dislocating patella, usually not in question when it occurs but can be a recurrent problem, Osgood Schlatter Disease, seen most commonly in adolescents with an irritated growth plate, or lastly, so-called Chondromalacia Patella.

So many will, when asked to point to the location of pain, point to the knee cap itself. Commonly known as patellofemoral syndrome, it's frequently considered the single most common cause of chronic knee pain.  It's exacerbated with prolonged bent knee sitting like flying economy or sitting in a car all the way to Grandma's house.  Some will demonstrate abnormal alignment or tracking of the knee cap as it fits into the front of the femur.  Initial conservative efforts center around identifying any contributing factors be it the flat footed or knock kneed runner, or one with an abnormally shaped kneecap.  Females have more issues with this than males. 

If you happen to experience medial or inside knee pain, think arthritis, medial meniscus or knee cartilage tear, pes anserine bursitis and much less frequently, tears of the medial collateral ligament or MCL.  Most will have had some type of trauma if a meniscus tear or MCL tear are being considered.

Less frequently diagnosed, lateral or outside knee pain can be a lateral meniscus tear or lateral collateral ligament (LCL) injury, although in the multi-sport population it's more often an overuse injury of the iliotibial band.

Finally, posterior or pain in the back of the knee can come from posterior meniscus tears or a Baker's (popliteal) cyst.  This is a fluid build up much like a ganglion cyst.

Location is just one factor the doc considers when thinking about your pain.  Others include whether or not swelling is present and if it is, might it simply be joint fluid or is it more likely to be blood in the joint from recent trauma?  Blood can accumulate with a meniscus or ligament tear, and in some cases a fracture of one of the bones.

When does the knee hurt?  Up and down stairs load the patellofemoral joint, the back of the knee cap, whereas prolonged sitting followed by pain (including when you first arise in the morning) can point toward an arthritic process. 

Is the knee joint locked or does it lock then unlock?  By locking it's meant that the joint will neither bend nor straighten.  There's something physically preventing motion of the joint, occasionally just pain will do this, but most often there's something loose inside the joint that gets between the bones much like a door stop. 

The last two things I'll mention are clicking/popping and giving way.  Many normal knee joints can make all sorts of popping sounds which, if not painful, are usually nothing to be concerned about.  If painful they can signal an issue within the joint.  Giving way happens in many knees which have strength issues or can just buckle when loaded in an odd fashion in some.   In others the buckling phenomenon occurs because the knee is unstable from a ligament point of view.  The ligament is torn or stretched and doesn't function as it previously did.

So if you have knee concerns, try and use the above to see if it's something that requires medical attention.  The running related overuse problems in our community are often taken care of at the local running shoe shop as they have enormous experience dealing with them over the years.  In some locales like ours they probably have more "patients" than the doctors have.  And since most running shoe shop guys don't know how to do surgery, most of the time you get get the recommendation for a non-surgical solution!  Lucky you.

Wednesday, December 24, 2014

Better a Slow Time Than No Time

I know it's hard to get out the door some mornings.

Pretty, sure, but winter weather can wreak havoc on your training.
Everyone knows how hard it is sometimes to get in the winter workouts that serve as the base for future athletic success later in the spring and summer, and if we're really lucky, in the fall in Kona.  Plus there will be sick days later in the year, those weddings, funerals and graduations at which attendance is mandatory regardless of what key workout you might have had planned for that day.  (Hard to believe I know, that someone would schedule some event that takes priority over your hill repeats.)  This, to me, is why it's so important to complete all the scheduled workouts over which you have control now since there will be a bunch which you don't.
So how do I have the best shot at getting them in now?  Well, like most things in life these days, knowledge and preparedness count a lot.  First, you need to pay attention to the conditions.  Years ago I went to Lowe's and got one of those cheap indoor/outdoor thermometers, the kind with a wire lead that you just feed outside the window giving you the exterior temperature where you live, not wherever the TV station gets their readings which could be many miles away.  You shouldn't be surprised when told that there are often days when it's 6-8 degrees colder at my house than the TV guy says, something you really want to know when selecting which hat, gloves or number of layers will be the minimum to keep you warm. Or, as the Navy SEALs say "There's no bad weather, only bad gear." 

One concept of staying warm in the winter comes from NOLS, the National Outdoor Leadership School as they do a great deal outdoors in the winter and have developed a layering system that can be adapted to your climate be it Austin or Anchorage.  Check out their video on layering:

The other biggie is to do as much the night before from setting the coffee pot to checking the weather forecast.  If, when the alarm goes off, there's as little thinking to do as possible, only reacting, you have a better chance of not getting to the bedroom door and having that invisible bungee cord snap you back into bed. On one level you how much better you'll feel once your work out is in progress, but when you're sleepy it's hard to remember that.  So before bed, every piece of possibly needed gear is on the bathroom floor and the morning's work out planned in it's entirety. If like me you're a coffee person, the coffee is made and the timer set for a couple minutes before your alarm.  I've found many times that the aroma of freshly made coffee gets me over that out of the sack hurdle and into my day.  You can stagger into the bathroom with one eye open, close the door so you don't awaken your spouse, dress by the shower light, and head to the kitchen for that coffee.  The whole process takes but a couple minutes before you find yourself out the front door thinking about your previously planned route.  If you're biking, generous front and back lighting is always a bonus.  If running, a waist mounted strobe keeps Detroit steel away.

Later, even though you didn't set the world on fire during this morning's efforts, as you enter the data from your workout into Training Peaks, you agree with this piece 100%, a slow time is better than no time.

And then next summer:


Thursday, December 11, 2014

I Don't Stop When I'm Tired, I Stop When I'm Done

Not everyone can be an Ironman. Not everyone wants to be an Ironman. And, some that want to be an Ironman are told they do not have what it takes. But once you are an Ironman, you are an Ironman for eternity. It was an Ironman who came up with, "Swim 2.4 miles, bike 112 miles, run 26.2 miles, and brag for the rest of your life." 

If the above is the only thing you remember when you walk out the door on a lousy weather day, when you'd rather stay in bed, rather do almost anything else, let it be this! 

Everyone encounters days where it's easier not to get out of bed, not to think about working out, not see what your thermometer reads.  And some days you do go back to sleep.  Not often, but it does happen.  It's OK, not something to beat yourself up about or get too worked up over.  But keep it an only once in a while experience.  On those other days, when you know it's cold, or windy, or both, just think about the transition area of your future "A" race.  

Let's see, body marking was pretty smooth, oh, and look at the water, smooth as glass today.  I'll park my bike get the message.  Think about a carrot of some kind, the calorie expenditure of your five mile run and how close you are to your racing weight.  Just  a couple more miles and you'll have 40 for the week.  Play the mind game, get dressed from the complete pile of clothes of laid out last night and before long, when the first drop of sweat beads up on your forehead you'll think, "Whew and to think I almost slept in today.  I'm not going fast, but I'm going."  In the words multiple national age group swim record holder Shirley Loftus-Charley, "A slow time is better than no time."

You know she's right.

Monday, December 8, 2014

We Need to say Thanks For Jordan Rapp

There are a lot of egos in triathlon, many teacher wannabes like me and no shortage of those who pass on information of questionable value.  Some years ago, the investment firm E.F. Huffon had a very clever TV commercial, "When E. F. Hutton talks, people listen" as the image of a young professional remarking at a cocktail party that he invested through E. F. Hutton, which caused the loud conversations to all come to a stop and listen to him.

In our sport, that E.F. Hutton is Professional Triathlete Jordan Rapp, or rappstar.  Simultaneously he is a humble athlete, a leader, a teacher.  A guy who just makes you want to do your best.  His words at Ironman Arizona, a race that he has won, are a perfect example of blending humility with motivation.  Every triathlete should read them before their race.  Folks in AZ were fortunate enough to hear it live and in person.  You can read them below.

Thanks, Jordan.


Here is your opportunity to read Jordan Rapp's closing remarks from 2014 Ironman Arizona's opening ceremony. Maybe his best since, "When the Shite Gets Brown."

What do you say to a group of remarkable people who are about to undertake something remarkable? I think you all need nothing more than a reminder that you are remarkable.

Ralph Waldo Emerson wrote,

"A man should learn to detect and watch that gleam of light which flashes across his mind from within, more than the lustre of the firmament of bards and sages. Yet he dismisses without notice his thought, because it is his. In every work of genius we recognize our own rejected thoughts: they come back to us with a certain alienated majesty."

Before every Ironman - but especially before our very first, for those of you undertaking this distance for the first time on Sunday, I think doubt is normal. Even after the successes I've had, I question myself. Those disappointing races are the ones that stick with me. I know the guy who has come up short. I recognize him. I feel like he's the guy I see in the mirror everyday. That guy who crossed the finish line in first? Who even crossed the finish at all? He seems like someone else. A bard or a sage. Of a sort anyway. Not me. But a stranger.
I think that we all can understand other people having good races, great races even. The person who trains so much. He doesn't have kids. Doesn't have a wife - or a husband. She doesn't have a job that takes it out of her physically and mentally. Or who does but seems to be able to juggle it all anyway. A superhuman while the rest of us are mere mortals. There are all those reasons in the world why someone else should have a great race.

But what about us? What about all of us who are here? Not the person sitting next to you. Not some other person. But you. What about you?

How many of you have crossed that finish line after 140.6 miles before? …

Remember that was you. I think it's normal to reflect on those moments with, as Emerson said,

"a certain alienated majesty."

I think we can all feel like we were someone else on that day. Maybe you were someone else, in a sense. The man without that new job. The woman who was not yet a mother. The woman without that new job. The man who was not yet a father. But in spite of what may have changed - or what may not have - that you still didn't get to swim/bike/run enough in training, that you still haven't figured out how to open up a Perform bottle without spilling it all over yourself, that you still haven't found a gel flavor that you really like - does such a thing even exist? What matters is you are here now. You are here not only to be a part of something special, but to do something special yourself.
And what about those of you for whom this is the first time? Do not dismiss yourself either. Do not dismiss those thoughts you had that compelled you to believe, "I can do this." You can do this. You too are here. And that is something remarkable. The courage that you showed in even just signing up. The fortitude to believe in yourself enough to undertake this challenge. That belies the strength that you have inside of you. The strength that will carry you from that small dock on the southern shore of the lake through that finish chute on Mill Avenue. Anyone brave enough to sign up for an Ironman has what it takes to finish one.

All of you, recognize that gleam of light in your own thoughts, the thoughts that - at least for a moment - that you didn't reject. The thoughts that let you to believe - truly believe, "Anything is Possible." Those were not the thoughts of someone else. The genius in this case is you - even if swimming, and biking, and running 140.6 miles seems ludicrous right now.

Believe in the training that you have done. The hard work that you did when no one was looking. Those moments when you wondered, "can I do this?" and then you discovered you could. I think most of you probably had those moments in training. I know I did. Reflect on the work that you did in anticipation of Sunday. That was you. Not someone else. But you.
And for those of you who may not have had those moments, or who may have faltered or even failed in training, or at races, don't believe in yourself any less. But if - and when - you need to, draw on the strength of those around you. And if - and when - you are able, share your own strength with those around you. The best part of this race is that you are never alone. This race exemplifies the idea of community. Of camaraderie. In those dark moments, there will be someone ahead of you to chase, someone behind you to spur you on, and - most often - someone next to you to share the journey with.

Ironman is something we do ourselves, but we do not do it alone. And we especially do not do it alone at this race.

I will close with another quote of Emerson's, one that speaks to the character of every single man and woman that is here tonight.

"What lies behind you and what lies in front of you, pales in comparison to what lies inside of you."

Thank you and have a great race out there.
Image: Google Images, Larryross/

Friday, December 5, 2014

The Only Easy Day Was Yesterday/ Colonoscopy, You're Next

Race day didn’t feel monumental, but like a slightly more complicated Saturday long ride. Sure, I got a tiny bit stressed at gear drop-off (“S*** I forgot my gels … we can access these bags in the morning, right?!”) and battled the usual fitful sleep on race eve. But aside from those few expected blips, it was business as usual. I think this is a significant point to get to as an athlete—when Ironman becomes  comfortable . Not ordinary, exactly, but the sort of thing that makes you shrug and say “this is just what I do.
                                                              Jennifer Ward Barber

The Only Easy Day Was Yesterday

A very well-known aphorism of the U S Navy SEALs, it reminds us that each day, each training session, presents us with both challenges and opportunities to improve.  As triathletes there is the ever-present press to excel as we meet these challenges with gusto.

This concept keeps me motivated, because it puts things into perspective. If you wake up knowing that every day will pose new challenges, and that you are ready to meet them, you will be well equipped to achieve any goal you set.  Oh, and always put all your morning work clothing/equipment out the night before.  It makes getting out the door so much easier on these cold dark days.

Colonoscopy, it will be your turn one day


A man went in for a colonoscopy.  The gastroenterologist examined him, and then turned him on his side to begin the procedure.  The doc immediately noticed a large piece of lettuce protruding from the gentleman's posterior.  "Sir", she said, "did you know that you have lettuce hanging out of your bottom?"

"Yes," replied the man, "but that's just the tip of the iceberg."

Jill Triathlete, a prominent local real estate attorney, was at her Primary Care Physicians office recently for a cold which just refused to go away. Jill thought she might have pneumonia from that Saturday long run in the cold and rain. Fortunately, after the evaluation, it was a relief to find out she didn’t have anything serious. The doctor was idly thumbing through her chart and when she settled on the Health Maintenance page she noted, “Jill Triathlete, you’re 50 and you haven’t had your screening colonoscopy.” Jill’s mind went ablaze with thoughts. “Colonoscopy? Put something where the sun don’t shine? Take a ride on the black stallion? The snake? OMG…if I can just get to the Tesla quickly enough to get to the interstate…..” yet she replies a cool, “Oh, really?”

The American Cancer Society and the American College of
Gastroenterologists "recommend routine testing for people age 50 and older who have a normal risk for colorectal cancer."

Your doctor may recommend earlier testing if you are at a higher risk for cancer.  This could include your family history, blood in your stool or rectal bleeding, dark or black stool, chronic diarrhea, iron deficiency anemia, unexplained weight loss, etc.

Colonoscopy really isn’t such a big deal these days. Most are done under sedation although there are those who, potentially not so wisely, think, “If I can finish an Ironman without sedation, I can sure as heck fire do one these little tests without it. “ But they’re not always correct….as they find out in short order.

It’s the prep that gets folks. And it’s not that it hurts or anything, it’s just inconvenient and their body does things that under ordinary circumstances would be considered very abnormal. The day before the procedure goes something like this:

Hearty Breakfast – 2 cups of tea, no milk or cream,
Lumberjack’s lunch – as much beef bouillon as you wish
PM Snack – either tea or bouillon, take your choice
Supper – Dulcolax pills and this delightful beverage called Miralax, as in laxative. It’s the same plastic jug that you buy a gallon of milk in, but looks, and tastes, like Secretariat’s urine. Only worse. The good news is that there’s a whole lot of it.

Leaving the house is not an option. Leaving the sight of the commode may not be an option either for awhile.. Things pass very quickly through you. But (butt?) think of it this way, you’re getting your innards spic and span so that if there’s anything of interest, your gastroenterologist can see it quickly.


The Colon Cancer Foundation describes the procedure as follows:

Colonoscopy (koh-luh-NAH-skuh-pee) lets the physician look inside your entire large intestine, from the lowest part, the rectum, all the way up through the colon to the lower end of the small intestine. The procedure is used to look for early signs of cancer in the colon and rectum. It is also used to diagnose the causes of unexplained changes in bowel habits. Colonoscopy enables the physician to see inflamed tissue, abnormal growths, ulcers, and bleeding.

After your IV's been started and sedation given, the doctor will ask you to lay on your left side and he/she will insert the scope, a flexible tube with a light at then end and video capabilities projecting the image on a screen that you and the doctor can watch simultaneously.  As the scope gets further into the colon, air can be passed through it to inflate the colon making both vision and scope passage easier.  The whole procedure lasts about half an hour, sometimes a little longer when something out of the ordinary is discovered by the examiner.

You will recover there, and in an hour or two, and when most of sedation has worn off you can leave.  Most do not find it an unpleasant experience and occasionally they give you the photos from "down inside." I wouldn't suggest putting them in your Christmas cards, however.

In short, a great deal of information can be obtained in a short period of time.  Processes, once considered fatal, can be located and treated early, often without surgery.  Make sure you say thanks to the doc.  With a little luck, you won't have to do this again for 10 years.

Picture: credit Patricia Raymond, MD, Colon Cancer Foundation