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

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.