Friday, February 27, 2015

If You Need Your Knee Injected

  Oil can.....Oil can...., my, my, my goodness -- I can
  talk again! Oh -- oil my arms, please -- oil
  my elbows.
                                            TIN MAN, Wizard of Oz, 1939

Knee Injections

Synvisc, Orthovisc, Euflexxa, Quaker State, Penzoil

With accumulated wear and tear, or even after trauma, the bone covering articular cartilage of the knee joint can erode.  You know it as arthritis. In addition to the various types of cortisone which can be injected, a class of agents focused on one of the building blocks of cartilage, hyaluronic acid, is also available for injection.  They are known as hyaluronate preparations and can be effective diminishing both joint pain and swelling.

These agents (Euflexxa, Hyalgan, Synvisc, etc.) can be costly and are usually not considered until the patient is a failure to other conservative measures like limb strengthening exercises, joint injectons of a cortico steroid, Tylenol, possibly a non-steroidal anti-inflammatory drug like ibuprofen (Advil) or naproxen (Aleve.)

An office procedure, after sterilely prepping the skin at the intended point of injection, and aspirating any effusion (excess joint fluid) which may be present, the physician takes great care to ensure exact placement into the joint.  Depending on the product, there can be 1-3 injections one week apart and other than the sting of the needle stick seem to cause very little in the way of pain.  Post injection the patient is asked to refrain  from vigorous exercise (like triathlon!) for 48 hours.

The success rate in lowering pain and swelling while increasing patient activity levels can be impressive. Upwards of 80% patient satisfaction has been reported.  One company advertises “Over 1.8 million knees treated….and still going strong.”  It can be repeated if/when necessary, but not indefinitely.  And, if it’s included in a overall program to maintain/preserve knee health as well as forestall a larger procedure like joint replacement, it’s role is clear.

Should you have a hip or knee replacement, by current recommendations, it's game over for triathlon.

So, if you have osteoarthritis of the knee, and a hyaluronate is being considered by your care giver, it may be “just what the doctor ordered.” 

Tuesday, February 24, 2015

Does It Suck to be Your Triathlon Spouse? Probably.

Endorphins, the exercise high, is there a cost involved? My wife told a friend once that she wasn't too worried about me having an affair,"HE MIGHT MISS A WORKOUT!" "Is it really that bad?" I later asked her. "YES", was her rapid response.

She wonders when hubby's run will end. The "iron deficient" baby chews on the metal pole. 

The Younger Athlete

I saw a survey of Ironman athletes a number of years ago where the total workout hours/week were reported and I was amazed by the age groupers responses. Volumes of 20, 30 and 40 hours/week, a few even more, were stated, (admitted to?) by many. While I'll assume that some folks include planning, workout prep and clean up in these figures, they are impressive none the less. And for those who report the same number of hours not including planning and trips to the bike store for parts, wow!  

Since then I've spoken to many athletes and more than a few spouses to fuel this piece and I've basically determined that most triathletes are blind. They are blind to the impact that their workout schedule has on those around them from family to friends and co-workers. Some even think their training is invisible to others as they:

1)   go to the pool at 5:30 am...while somebody else gets the kids up, dressed and checks for last minute school needs.

2)  run at noon instead of going out to lunch with the gang but by the time they're showered and back to their work station sweating like two pigs somebody else has gotten those needed reports together.

3)  ride with the Saturday bike group, somebody else gets the kids from soccer practice and chores started...and, oh yeah, picks up your dry cleaning.

So the triathletes commitment to the sport takes an equal commitment from family and friends for which the athlete needs to say thank you, frequently, and be cognizant of on a daily basis. Each of us needs to carve out other areas of time, maybe even letting that butterfly collection or special project lie fallow till season's end. His/her disposable time is already spoken for.

The "More Seasoned" Athlete

Remember "The Portrait of Dorian Gray?" 

In the novel by Oscar Wilde a painting of a handsome young man seems to age rather than the young man himself?  I fear some of our relationships bear a remarkable resemblance.  

Some years ago, at the King Kamehameha hotel in Kona, Hawaii, I watched as a gent, at 82 the oldest in the race that year and up until then the oldest to attempt this event I believe, bounce out of his cab from the airport. Wearing a Campagnolo cycling cap, he helped the driver unload the suitcases chatting with everyone in sight. He was clearly delighted to be on Hawaiian soil.  Then he helped his oxygen dependent, wheel chair bound wife out of the cab and into her chair.  She seemed less glad to be in the mecca of long distance triathlon.

It's been said that we can alter the "natural" aging process by being physically active.  That more sedentary behavior contributes much to aging and illness. The athlete, however, through personal choice, lives a lifestyle that has the potential to keep him/her looking and feeling youthful, alert and active.  But what if both in the relationship don't make that choice. How about if the spouse is more active in the work place, volunteers at the hospital, or just plain doesn't think that the above 5:30 am work outs are of any interest what-so-ever?  (Yes, hard as it is to believe, such people exist.)  The result is a couple which early on shared much but as time passes share less.  The spouse may seem to age a tad more quickly or has a harder time keeping the weight off.  He/she too may have a little more difficulty when unexpected physical chores pop up like shoveling sudden snow or restacking the wood pile when fresh supplies arrive.  It can make for some issues that are not easy to resolve.  While the pat answer, the obvious "Well, just do the things together that you enjoy together," works at one level, there evolves a deep seated fundamental difference in the relationship not present a decade before.  I don't pretend to have an easy answer here but maybe just knowing that this may occur is enough to keep the similarity bonds tighter in those just starting out. For those a little further on, patience and understanding that not everyone makes the choices you make go a long way.  It's about give and take.  Well, mostly it's about give - you need to give.

Thanks to T.J. Murphy, I've become fascinated with CrossFit.  One of their slogans works well here as we may try our best to compartmentalize the athletic part of of our lives, to not let it spill over into "spouse time" or "spouse conversation."  We just need to stop spending time reporting what Fred in the bike group is up to or the cute comment from Amanda at the pool today.  CrossFitters already know this and would point you to the sign that says, "Most people don't realize this but you can go to the gym without telling everyone on Facebook about it." Or telling your spouse either.

Friday, February 20, 2015

Concussions Off the Bike: You Need to Take Charge!

             Substitute Swimmer for your Triathlon Relay?

Kimo the dog. I wear glasses, but my eyesight's not all that bad.  While treading water at the Coffees of Hawaii barge (every year during IM race week in Kona, the good folks at Coffees of Hawaii set up a large sailing craft about 700 m off shore, where anyone who swims up to it is offered a small paper cup of Kona's finest.  It's pretty darn cool and I'd suspect they serve over 1000 "customers" each morning.  And the coffee's hot, too!)

So, while sipping my excellent brew one fine morning, goggled, without glasses, I noted a group of three swimmers approaching, one with a very odd mask on, but hey, it's Hawaii, home of the underpants run.  And I'm in the middle of the Pacific ocean at a coffee barge for gosh sakes.  I thought the mask had ears on it. Like maybe a Batman mask.  But, once they were closer, I could see that the third swimmer was a German Shepherd...with a life vest on.!  Now there's something you don't see every day back home.  When the dog's owners had their fill of coffee, all it took was a simple, "Come Kimo," and off they went, continuing their swim.

ACL Reconstruction Follow Up
In a previous blog, I did some reporting on ACL (Anterior Cruciate Ligament of the knee) tears. Reuters reported recently, in a study of Australians followed for over three years subsequent to their reconstructions, that "half of people who played sports competitively or just for fun don't perform as well as they used to." When narrowed down to those who played competitively pre-injury, only 91 of 196 returned to their competitive sport.

While this is a single study, and review of many give a more representative picture, suffice it to say that tearing an ACL can be a serious injury.

Concussions Off the Bike

Who among us hasn't been on a group bike ride where there hasn't been a crash of some sort?  If you were lucky, it was just a little road rash. If not, a portion of the injury could be a head injury. this is true for helmeted cyclists as well a the non-helmeted.  Not infrequently a concussion will occur which has the potential for being a more serious injury than previously thought.  If you've paid any attention to the news in the past year, the NHL and NFL have reversed course for the most part and are giving very serious attention to this issue.

Of note was Wes Welker, a reciever on the Denver Broncos, who suffered 3 concussions in 10 months last season.  Kevin Van Valkenburg wrote recently:

"Wes Welker says he's going to be fine.
Sometimes he forgets stuff -- Where did I put my keys? What's the name of that restaurant? -- but who doesn't?
"My wife will be like 'How can you not remember that? Is it the concussions?'" he says. "I'm like 'No, babe, I just forgot!'"
There are days when it's hard to convince his wife, Anna, that those little lapses aren't a harbinger of something more. Two months ago, they went out to dinner with another couple, and the friends asked Welker how old he was. "I'm 33," he said, and Anna shot him a horrified glance. "Wes, what are you talking about?"
"She was adamant," Welker says. "I'm sitting here looking at her like she's crazy. Then I start to think: 'Jeez, did I forget how old I am?'"
He added up the years. He was born on May 1, 1981. He was right, and she was wrong. Thirty-three years old. "We laughed," he says. "But I'm like "Babe, I'm the one with the concussions here!"

But hasn't triathlon had the culture of endurance over safety?  Haven't we seen the films of the last 400 meters of 1995 IM Hawaii where Paula Newby-Fraser, the Queen of Kona is weaving down Hualalai Street like some kind of drunk when Karen Smyers sprints by to take the win?  Or Chris Legh, or Wendy Ingraham and Sian Welch, as they careen uncontrollably, staggering toward the Kona finish line?  Maybe they've crossed a line of a different sort!  

In the mid 2000's, I had the slowest bike time of all 1700 competitors in Hawaii when I stopped to help a biker on the down hill from Hawi whose front wheel had hit one of the plastic highway road reflectors at just the wrong angle.  POW!  Instantaneous crash, broken helmet, closed head injury, you can guess the rest as we waited for rescue help together. In short, once a concussion is recognized, that athlete's day is done - they should not be allowed to resume their sport, triathlon included.

Research is showing that healing of injured brain tissue requires sufficient nutrients and rest.  If this isn't allowed to occur, then the potential for recurrent injury increases. Previously, injury severity scales left a great deal of interpretation to the examiner when deciding how serious the concussion really was. Now, especially in NCAA sports, if a player suffers a concussion of any magnitude, he or she is out of the game. No questions asked.

So, as an athlete, how do you determine if your bike mate's had a concussion after that crash? Well, you're probably not a neurologist, but starting with an "index of suspicion," at least considering that it's possible helps. Was there a loss of consciousness, confusion, head or neck ache, blurred vision or anxiety? In an athletic contest like football, the athlete would be asked, "Who scored last?" or "Where are we playing today?" Finally if the suspicion continues, the player would be checked for balance and coordination. Now, I'm not saying that every time somebody in your bike group goes down that you start this cascade.  But what I am saying is, that as a friend of somebody who's had an accident and may not realize that they've suffered a head injury - a rider who not making the best of decisions - you need to take charge. Nice the injured rider into calling it a day, just because.  Give them a ride home. Likely, a trip to the local ER just to be on the safe side would also work. Then, maybe after all that, it gets to be Miller Time.

There can be long term issues if you don't protect your riding mates.  Do it.

Tuesday, February 17, 2015

Triathlete Approved Way to Pig Out on Girl Scout Cookies & Minimal Calories

Voluntarily Poisoned by Cute Little Girls Selling Cookies

Girl Scout Thin Mints Can be Poison, But Sooo Good!

    You've been there, seen the cute young ladies near the supermarket on Saturday selling Girl Scout Cookies, and because you're who you are, several boxes made their way into your car along with the groceries, Thin Mints among them.  Maybe several boxes of Thin Mints, eh? My wife has the highest award in Girl Scouting, the Gold Award.  My daughter has the highest award in Girl Scouting, the Gold Award.  To say that we're acquainted with selling Girl Scout cookies around here is an understatement.

Like most of us who routinely watch what goes into our mouths (to power the "tuned like a Switch watch which we call our bodies") you feel a little guilt coming on.  Now it's Saturday, half-time of the Kentucky- Auburn basketball game, and you're nosing around the kitchen for a snack.  You think about a salad, maybe cooking up some more kale (more kale? Nope, I just can't stand any more kale) when you stumble upon the the chocolate gold.  "I'd forgotten about these," you think as the box of little beauties nearly opens itself, the silver sleeve of thin mints virtually "falling" into your hands as you sit back down with the remote for the second half.  It takes a little doing, "These suckers are really sealed in there," but quickly the sleeve is opened and the first thin mint exposed.  And you can smell it.  And it smells terrific.  Way better than kale you think.  Yessir, way better than kale!

You savor the first one.  It goes down easily and quickly, "I'd forgotten how good these were," you say even though there's no one home but you.   Then five are gone.  Wildcats score, you frown.  And when you look down, 640 calories later, the sleeve is empty.  16 Thin Mints gone.  Initially, thinking you might be able to fool yourself, you ask, "Might I have dropped some on the floor?" knowing the answer to be no.  Oh well, an extra couple miles tomorrow maybe.

So how do you eat three Thin Mints and only three?  It's not hard.  It just takes a plan. Here's mine. Grab three, get in the car, don't eat the first one till a mile from home.  When the third one is sliding down your esophagus, even though your satiety center says "I'll have a dozen more please," you're miles from home and it won't happen.
              Why seniors get confused.