Tuesday, April 28, 2015

Too Many Supplements/Vitamins May Increase Your Cancer Risk

"One pill makes you larger and one pill makes you small. And the ones that mother gives you don't do anything at all."
                                                                                                         Jefferson Airplane

Image result for pills

Dr. Oz is Way Off Base*
"More than half of Dr. Oz's recommendations are contradicted or not supported by medical research, a new study says.
Dr. Mehmet Oz is an extremely popular talk show host who dispenses health advice to millions of viewers, but he's been widely criticized for recommending unproven treatments."
                                                                                      WebMD News from HealthDay
Triathlete Cancer Risk?

They say that one third, or more, of triathletes, feel that they need one type of supplement or another to (attempt to) improve their athletic performance.  But, while according to Paul Offit, MD, head of infectious diseases at Philadelphia Children's Hospital in Do You Believe in Magic? who makes the point that there's precious little scientific evidence that most of them do anything, some researchers are beginning to discover that some might do the exact opposite.  In fact, Tim Byers of the cancer center at the University of Colorado, notes that more and more research is pointing toward the fact that people who consumed, "more dietary supplements than needed tend to have a higher risk of developing cancer."

Previous small studies that may have shown a benefit from vitamins or OTC supplements have been reversed when the study group expanded to "thousands of patients for 10 years." Just as pointed out in Offit's text, Byers research team learned that the "supplements didn't benefit patients health when compared to placebo, and that some people actually got more cancer while on the vitamins." 

"In one example, a trial on beta-keratin supplements found that people taking more than the recommended dosage ended up with a 20 percent higher risk of developing lung cancer, as well as heart disease. Another trial on folic acid found that people who took it ultimately wound up with more polyps growing in their colons — these small clumps of cells lining the colon can sometimes become cancerous."

In other words, if you can't back up the claims on the bottle with science, not just some anecdotal stories..."After taking this pill, I could run faster than Roger Bannister.  For real!" don't put them in your body.

*Half of Dr. Oz's Advice Unproven or Wrong: Study

WebMD News from HealthDay
Dec. 19, 2014 -- More than half of Dr. Oz's recommendations are contradicted or not supported by medical research, a new study says.
Dr. Mehmet Oz is an extremely popular talk show host who dispenses health advice to millions of viewers, but he's been widely criticized for recommending unproven treatments.
For example, during an appearance before Congress in June, Sen. Claire McCaskill (D-Mo.) told Oz he gave people false hope and said his shows were a "recipe for disaster." And a study that Oz said showed the effectiveness of coffee bean weight-loss pills was retracted last month, the Washington Post reported.
"Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits," said the new study in the British Medical Journal.
The authors added that the "public should be skeptical about recommendations made on medical talk shows," the Post reported.

Tuesday, April 21, 2015

Runner Pees Red- Now What?

Runner Sees Blood in Urine: now what?

Kona Lua: "Get A Head"

"Oh yeah, life goes on, long after the thrill of livin' is gone."  John Cougar Mellencamp

Ever looked into the commode after your long run, and instead of the usual concentrated deep yellow urine, you see blood?  Yep, it can be quite a shock.  But, like most things, if you take the time to do a little research you can narrow the list of possibilities...and cancel the call to the funeral home.

In medical jargon bloody urine is known as hematuria.  It can range from very slightly blood tinged all the way to frankly bloody.  It's not a diagnosis, it's a symptom.  But a symptom of what?  Let's follow a local Virginia runner I’m familiar with, aged 22, runs 60 - 100 miles per week, is professionally coached and works in the local running shoe store.  He obviously has a handle on correct foot wear.  He started with a very slight pinkish tinge to his urine after his longest runs but over time has developed frank hematuria.

So, the first place we look is to a phenomenon called "Runner's Bladder" as it's both the most common as well as the most benign.  It's described as bladder wall trauma, bruising, which leads to a small amount of blood in the urine.  When the runner decreases running volume or takes a couple of days off, it goes away.  For a while that is, until long runs resume.  It's said that running with a partially full bladder can eliminate this problem but it's a level of discomfort many can't stand.  Every heel strike reminds one of the urine's presence.

A visit to the urologist by our runner reveals that although the mostly likely diagnosis is Runner's Bladder, the list of possibilities including kidney stones, tumor, infection, various kidney problems, etc., is pretty long.  So, to solidify the diagnosis, for reasons specific to this individual, the urologist plans to perform a cystoscopy - an in office procedure in which he will insert a small fiber optic scope through this runners penis up into the bladder. ("You're going to put a what into my where?" the runner was heard to exclaim!)  In the past, predominantly because of the larger size of the scope and the pain it would cause, this type of procedure was done in the Operating Room under anesthesia.

Good news.  During cystoscopy, our athlete's bladder wall revealed generous bruising and no other obvious source of bleeding.  So for now, he'll continue his running career, and his hematuria knowing that he's not causing irreversible long term damage.  Maybe he'll try again to learn to run with his bladder half full.  But he's 22 with a head full of steam.  And, like many other things we see happen to our athletic group from runner’s trots to plantar faciitis, in my experience, I’ll see a lot of people with these things once, and then never again.

We both hope.

Thursday, April 16, 2015

Balance in Triathlon; Do You Respect Your Injuries?

"I always wanted to be somebody. Now I realize I should have been more specific!"  Lily Tomlin

Respect your injury.

Most triathletes are psychologically stronger than they are physically.

Many athletes focus on training related injures involves solely whether or not they’ll be affected in an upcoming race.  Little thought is given to making injury resolution priority #1.  They've sought help from a friend, an internet forum, or local medical professional. But in the end, many realize they've invested so much time and energy as part of this sport, there's a good chance they know more about themselves athletically than any physician.  Although this is likely not true medically, this gives them an insight into helping their care giver help them. It's a pretty unique patient-doctor relationship that as a physician I don't see all that often but one I enjoy.

Brett Sutton, famed tri coach, views it this way: "injuries are nothing more than a test of character.  You see quickly how they deal with adversity.  Injuries go but the scars remain in the minds of most." (Sutton's comments leave me wondering if those are positive or negative scars.)

The take home message here is that we will all be injured at one point or another, some of us frequently, some of us annually, some less.  You know that all of us get a great deal more out of of triathlon than finish line times.  Although you've heard this before, you can't hear it often enough.  Listen to your body.  Most triathletes us are stronger psychologically than physically!  Really.  And I think you know it.  (For those of you old enough, does the name Gordon Liddy, organizer of the Watergate burglaries during the Nixon administration, mean anything?)  If we have the potential to do things to ourselves in the name of fitness, we have the potential to undo them as well.

Monday is the "most commonly injured" day.  It's not actually. It's just the day that people complain of pain the most. "I don't understand it. I just ran my usual 5 miles this morning."  What they don't see is that it may have taken a couple days for the effects from Saturday's big brick workout to become apparent.  I see it all the time.

  Take local athlete Mark Foley.  He is a master at achieving a sense of balance between offspring, job, triathlon and just plain enjoying living that many strive for but few of us achieve. You know how when you're talking with one of your tri friends, (or perhaps someone talking to you? Am I getting warm here?) and it becomes obvious that your idle chatter is cutting into their work out time? And they start to fidget? And then fidget a little more? And if you talk to them too much- "well, my T1 split at his race was 2:33 but at the next one it was..." they go into a full grand mal seizure? Yeah, I thought you did. It reminds me of one of those Whack-A-Mole games.........

Mark doesn't do that, ever. He has this sense of calmness, of control, that everything's going to be OK.  I think this is because he sees triathlon as a part of life, but not life itself.  Like many successful athletes, he's learned to utilize the darkness.  He plans work outs around work and life instead of the opposite, even if this means getting that morning work out done before heading to the lab, it gets done. Achieving this morning competence can be quite valuable since when you're the first one up, you can get in a run and wave to the deer and the newspaper guy.  Or, some time on the trainer with Phil Liggett and Paul Sherwin distracting you with previous TdF dvds.  My swim group meets at 5:30.  In short, you can get in some quality training and be done when others are just stirring.

I had someone tell me once that they'd think twice before hiring some one deeply involved in this sport.  Sure, the old adage about giving something you want done to the busiest person you know is part of this but do they think, plan, drown in triathlon during their work day to the point that it diminishes their effectiveness....

I, as anticipated, disagreed strongly knowing that a triathlete is a master of the clock.  To quote my fellow Ironman.com writer Lisa Dolbear when asked about time management:

"I could do a tri, I just don't have the time."
News flash: We don't have the time either, but we've found a way to carve it out of our busy lives because that's what you do when you commit to something important to you. Thirty-five year old mother of two, part-time MBA student, community volunteer, fitness instructor and full-time marketing professional Darcy DiBiase is no stranger to busy schedules. She’s also no stranger to triathlon. "I learned how to own my world at 5:30 a.m., and use the time before everyone else’s day started to do things for myself," the three-time Iron Girl finisher says. "And time is only one of the resources I needed to be successful—I’ve also found the right people along the way to keep me motivated and committed to my goals."

That's right, stay committed to your goals!

Sunday, April 12, 2015

One Shallow Dive Can Wreck Your Neck!

Diving Safety

I remember my first time.  The first time in my residency I was called to the Emergency Room of the University Medical Center to see a young man who'd broken his neck and become instantly paralyzed.  For life.  His name was Carl and in happened in shallow water about an hour away from the hospital.  I'd never put a patient in cervical traction, a halo, before and it wasn't easy.  You feel so bad for this young person who's life was filled with such promise when he got out of bed this morning.  The halo is a ring of steel which looks a little like a wedding ring, only 8-10" in diameter.  It's attached to the patients skull just above the eye brows with threaded screws which pierce the outer table of the skull.  Yep, it's screwed directly into their head.  Life as they know it is over. 

“Each summer, orthopedic surgeons see emergency room patients who dive head first into shallow water, break their necks, and are paralyzed,” said Richard S. Siegel, MD. That’s one reason the AAOS/ASIA public service ad warns, “One shallow dive can wreck a neck. Permanently.”  This is especially important to triathletes who, as the weather warms, find themselves hot and sweaty, often in unfamiliar places.
In one ad preaching diving safety, a glowing sunset spotlights a young swimmer as he dives, head-first, into a mountain lake. But instead of blue waters, the lakebed is filled with jagged rocks. The copy reads: “Each year, hundreds of young people are paralyzed from neck and spine injuries caused by diving head first into shallow lakes and pools. Don’t let kids dive in—unless you know what’s below. Check our website for more diving safety tips.” A link toOrthoInfo.org/DivingSafety and the CSRS/ASIA/AAOS logos are also shown.
Nearly 26,000 individuals are treated in emergency departments, doctors’ offices, and clinics for diving-related injuries in the U.S. each year, according to the U.S. Consumer Product Safety Commission. Approximately 800 of those injured—primarily teens and young adult males—are paralyzed due to diving in water that is too shallow.
“Their friends pull them from the water because they are unable to move their arms and legs and can’t breathe. Knowing when and how to dive safely prevents these catastrophic injuries,” said Dr. Siegel. He advises going feet-first if swimmers are uncertain of the water’s depth or if diving into water that is less than twice the swimmer’s height.

So if you're hot and sweaty in an unfamiliar place, and that pond you've just passed looks most inviting, please suppress the urge to dive in and cool off.  You never know what's below the surface.

Words to live by.

Sunday, April 5, 2015

Losing is Good For You

"When the guy kissed her, Cassidy felt a stab of pain that was close to physical, and therefore within the penumbra of hurts he told himself he could bear."

                                    Once a Runner, John L. Parker, Jr.*

In the shadow of a champion

Although the following is written from a somewhat different perspective, it's applicable to all athletes in this sport.  What is the role of the finisher's medal in adult sport?

Losing Is Good for You
                                                                By ASHLEY MERRYMAN

LOS ANGELES — As children return to school this fall and sign up for a new year’s worth of extracurricular activities, parents should keep one question in mind. Whether your kid loves Little League or gymnastics, ask the program organizers this: “Which kids get awards?” If the answer is, “Everybody gets a trophy,” find another program.

Trophies were once rare things — sterling silver loving cups bought from jewelry stores for truly special occasions. But in the 1960s, they began to be mass-produced, marketed in catalogs to teachers and coaches, and sold in sporting-goods stores.

Today, participation trophies and prizes are almost a given, as children are constantly assured that they are winners. One Maryland summer program gives awards every day — and the “day” is one hour long. In Southern California, a regional branch of the American Youth Soccer Organization hands out roughly 3,500 awards each season — each player gets one, while around a third get two. Nationally, A.Y.S.O. local branches typically spend as much as 12 percent of their yearly budgets on trophies.

It adds up: trophy and award sales are now an estimated $3 billion-a-year industry in the United States and Canada.

Po Bronson and I have spent years reporting on the effects of praise and rewards on kids. The science is clear. Awards can be powerful motivators, but nonstop recognition does not inspire children to succeed. Instead, it can cause them to underachieve.

Carol Dweck, a psychology professor at Stanford University, found that kids respond positively to praise; they enjoy hearing that they’re talented, smart and so on. But after such praise of their innate abilities, they collapse at the first experience of difficulty. Demoralized by their failure, they say they’d rather cheat than risk failing again.

In recent eye-tracking experiments by the researchers Bradley Morris and Shannon Zentall, kids were asked to draw pictures. Those who heard praise suggesting they had an innate talent were then twice as fixated on mistakes they’d made in their pictures.

By age 4 or 5, children aren’t fooled by all the trophies. They are surprisingly accurate in identifying who excels and who struggles. Those who are outperformed know it and give up, while those who do well feel cheated when they aren’t recognized for their accomplishments. They, too, may give up.

It turns out that, once kids have some proficiency in a task, the excitement and uncertainty of real competition may become the activity’s very appeal.

If children know they will automatically get an award, what is the impetus for improvement? Why bother learning problem-solving skills, when there are never obstacles to begin with?

If I were a baseball coach, I would announce at the first meeting that there would be only three awards: Best Overall, Most Improved and Best Sportsmanship. Then I’d hand the kids a list of things they’d have to do to earn one of those trophies. They would know from the get-go that excellence, improvement, character and persistence were valued.

It’s accepted that, before punishing children, we must consider their individual levels of cognitive and emotional development. Then we monitor them, changing our approach if there’s a negative outcome. However, when it comes to rewards, people argue that kids must be treated identically: everyone must always win. That is misguided. And there are negative outcomes. Not just for specific children, but for society as a whole.

In June, an Oklahoma Little League canceled participation trophies because of a budget shortfall. A furious parent complained to a local reporter, “My children look forward to their trophy as much as playing the game.” That’s exactly the problem, says Jean Twenge, author of “Generation Me.”

Having studied recent increases in narcissism and entitlement among college students, she warns that when living rooms are filled with participation trophies, it’s part of a larger cultural message: to succeed, you just have to show up. In college, those who’ve grown up receiving endless awards do the requisite work, but don’t see the need to do it well. In the office, they still believe that attendance is all it takes to get a promotion.

In life, “you’re going to lose more often than you win, even if you’re good at something,” Ms. Twenge told me. “You’ve got to get used to that to keep going.”

When children make mistakes, our job should not be to spin those losses into decorated victories. Instead, our job is to help kids overcome setbacks, to help them see that progress over time is more important than a particular win or loss, and to help them graciously congratulate the child who succeeded when they failed. To do that, we need to refuse all the meaningless plastic and tin destined for landfills. We have to stop letting the Trophy-Industrial Complex run our children’s lives.

This school year, let’s fight for a kid’s right to lose.

Ashley Merryman is the author, with Po Bronson, of “NurtureShock: New Thinking About Children” and “Top Dog: The Science of Winning and Losing

* If you haven't read it, it's a must.  The pure essence of training.