Monday, August 31, 2015

When to Pack Your Last Transition Bag and Call it Quits

"Eckhardt, think about the future!" 
                                                       Jack Nicholson, The Joker, Batman

With a smile like that he must have PR'd the swim!

One of Nicholson's best lines ever was in the film Batman!  

But then, to one degree or another, don't we all think about the future?  Some of us more than others?

 There comes a time when we need to move on.  Triathlon becomes a less significant factor in life, less of a priority, and training becomes more an obligation than a challenge.  That early morning swim is a burden, not an opportunity to work on a race limiter.

 The sword of time will piece our skin,

It doesn't hurt when it begins,

But as it works its way on in,

The pain grows stronger, watch it grin.   

                                                   Suicide is Painless, Johnny Mandel. M*A*S*H, the movie

 I know a number of people who were in triathlon for a short while and out.  On to something else.  It was a fling, an accomplishment, but not a lifestyle.  They didn't own a power meter, never found out the answer to a question on Slowtwitch. They weren't certain of the date of the World Championship in Hawaii. (It is in Honolulu, right?)  In fact, they had more on their plates than triathlon. Work, family, hobbies, other passions, etc. were all part of the game and while important, tri didn't take front and center stage.

 Not so for the woman I met in Kona on Friday,16 hours before race start in Kona last year. This was bike check in, on the pier, for what would be her 40th, that's right, fortieth Ironman distance race.  I'm no Psychiatrist but in discussing the importance of triathlon in her life, the word addiction would have to have entered the conversation somewhere.

 However, eventually the luster grows dull for most of us and we want to, or have to in many cases secondary to chronic or recurrent injury, pass the torch.  And you know what, it's OK when that day comes.  Really, it is.

 "Cal" is one of the best triathletes in our area.  Like a fool, I let him talk me into a workout at the pool a couple years ago, something different he said, just for fun (Cal's kind of fun obviously.) We'd swim 100 yards, jump out on to the pool deck and do ten push ups, and be back in our lane to push off for the next 100.  Can we do it on 2:00? Yes.   Can we do it 1:50? Yes, Cal we can.  I think we needed a funeral home consult after that work out.

 But, Cal's life has gotten more complex lately as his kids have gotten older and entered wrestling, travel wrestling, you name it.  Cal's moved away from tri despite having the ability to run a half IM sub 4:30 in the very competitive 45-49 year old age group.  (I'm certain that some of you read this as discarding a gift that you, or me for that matter, will never have.  I feel your pain!) In short, your day to step back from the sport will come.  When it does, it'll be just fine.  Honestly. I saw that day a while back, and it's just fine.

The race is run, how did you fair?

Thursday, August 27, 2015

Spend Your Money on a Coach (Or Your Boy/Girlfriend) Not Supplements

For too long, too many people have believed that dietary supplements can only help and never hurt. Increasingly, it’s clear that this belief is a false one.
                                                                                                          Paul Offit, MD


I've never been a fan of supplements.  I mentioned in a previous blog a story about my roommate in Kona one year who mixed up a dozen or so pills, liquids, gels and powders in a blender, ground them up into this grey slime reminiscent of Dan Ackroyd's portrayal of the pitch man pushing a Super Bass-o matic 76 - it's pretty funny - .  And down the hatch.  When asked which of these many supplements was responsible for his Kona qualification, he shook his head and said, "Who knows, but they can't hurt me other than making me poor, right?"  Well, probably not right.

Every year the sports world is once again surprised when one substance or another, take deer antler spray for instance, which is quietly sold to a subset of unsuspecting athletes who swallow the promises of those hawking the supplement as that which will surely give them greatness. Shortly thereafter, the product is exposed to either not do as promised.  Or worse, as a result of shoddy manufacturing technique and testing, the athlete tests positive for a banned substance which, sadly was an impurity (at best) in this great "aid" to performance, and the unsuspecting athlete is banned from sport.

The New York Times published an opinion piece in December that I'll reproduce in it's entirety below to give you kind of a middle of the road approach on the logic of why simply accepting anecdotal evidence from generic pro triathlete ABC without evidence based research or knowledge of manufacturing standards might not be your best course of action toward improving your triathlon performance.  

PHILADELPHIA — PARENTS whose children are admitted to our hospital occasionally bring along something extra to help with their care: dietary supplements, like St. John’s wort to ameliorate mild depression or probiotics for better health.

Here’s the problem: The Joint Commission, which is responsible for hospital accreditation in the United States, requires that dietary supplements be treated like drugs. It makes sense: Vitamins, amino acids, herbs, minerals and other botanicals have pharmacological effects. So they are drugs.

But the Food and Drug Administration doesn’t regulate dietary supplements as drugs — they aren’t tested for safety and efficacy before they’re sold. Many aren’t made according to minimal standards of manufacturing (the F.D.A. has even found some of the facilities where supplements are made to be contaminated with rodent feces and urine). And many are mislabeled, accidentally or intentionally. They often aren’t what they say they are. For example:

In 2003, researchers tested “ayurvedic” remedies from health food stores throughout Boston. They found that 20 percent contained potentially harmful levels of lead, mercury or arsenic.

In 2008, two products were pulled off the market because they were found to contain around 200 times more selenium (an element that some believe can help prevent cancer) than their labels said. People who ingested these products developed hair loss, muscle cramps, diarrhea, joint pain, fatigue and blisters.

Last summer, vitamins and minerals made by Purity First Health Products in Farmingdale, N.Y., were found to contain two powerful anabolic steroids. Some of the women who took them developed masculinizing symptoms like lower voices and fewer menstrual periods.

Last month, researchers in Ontario found that popular herbal products like those labeled St. John’s wort and ginkgo biloba often contained completely different herbs or contaminants, some of which could be quite dangerous.

The F.D.A. estimates that approximately 50,000 adverse reactions to dietary supplements occur every year. And yet few consumers know this.

Parents of children admitted to our hospital often request that we continue treating their child with dietary supplements because they believe in them, even if that belief isn’t supported by evidence. More disturbing were the times when children were taking these supplements without our knowledge. Doctors always ask parents if their children are taking any medicines. Unfortunately, because most parents don’t consider dietary supplements to be drugs, we often never knew about their use, let alone whether they might react dangerously with the child’s other treatments.

The F.D.A. has the mandate, but not the manpower, to oversee the labeling and manufacture of these supplements. In the meantime, doctors — and consumers — are on their own.

Our hospital has acted to protect the safety of our patients. No longer will we administer dietary supplements unless the manufacturer provides a third-party written guarantee that the product is made under the F.D.A.’s “good manufacturing practice” (G.M.P.) conditions, as well as a Certificate of Analysis (C.O.A.) assuring that what is written on the label is what’s in the bottle.

The good news is that we’ve been able to find some vitamins, amino acids, minerals and a handful of other supplements that meet this standard. For example, melatonin has been shown to affect sleep cycles and has a record of safety, and we identified a product that met manufacturing and labeling standards.

The bad news is that this was a vanishingly small percentage of the total group. Around 90 percent of the companies we reached out to for verification never responded. They didn’t call us back, or their email or manufacturing addresses changed overnight. Of the remainder, many manufacturers refused to provide us with either a statement of G.M.P. or a C.O.A.; in other words, they refused to guarantee that their products were what they said they were. Others lied; they said they met G.M.P. standards, but a call to the F.D.A. revealed they had been fined for violations multiple times. Perhaps most surprising, some manufacturers willingly furnished information that their product didn’t meet standards — like one company that provided a C.O.A. showing that its product contained 47,000 International Units of beta-carotene, when the label stated 25,000.

Now, when parents in our hospital still want to use products whose quality can’t be assured, we ask them to sign a waiver stating that the supplement may be dangerous, and that most have not been studied for their effectiveness. “Use of an agent for which there are no reliable data on toxicity and drug interactions,” the waiver reads, “makes it impossible to adequately monitor the patient’s acute condition or safely administer medications.”

What can other individuals who are concerned about supplement safety do? They can look for “U.S.P. Verified” on the label — this proves the supplement has been inspected and approved under the United States Pharmacopeial Convention. Unfortunately, fewer than 1 percent of the 55,000 or so supplements on the market bear this label. The real answer is that, until the day comes when medical studies prove that these supplements have legitimate benefits, and until the F.D.A. has the political backing and resources to regulate them like drugs, individuals should simply steer clear.

For too long, too many people have believed that dietary supplements can only help and never hurt. Increasingly, it’s clear that this belief is a false one.
Skip the supplements -

Paul A. Offit is chief of the division of infectious diseases at the Children’s Hospital of Philadelphia, where Sarah Erush is the clinical manager in the pharmacy department

Thursday, August 20, 2015

10 Signs You're a Masters Triathlete

Pretty soon, the tri world will be following the goings-on in Kona. The race date is picked so as not to interfere with the inter-island cruise ship schedule.  This is more important than you may think as when each ship pulls into Kailua harbor, it unloads 100s of tourists ready to see the island by bus or helicopter, dine at any one of Kona's fine establishments while mulling over that Mikimoto pearl purchase or Na Hoku necklace for someone special back home. Each ship makes a difference and IM respects and honors that.  

While the big boats are absent race weekend, they still frequent the area while racers entered in the World Championship bike, run, and most importantly swim in preparation for Saturday's festivities. For the most part, the passengers are from the US mainland and when brought by tender in groups of 75 or more, they dock right next to the athletes in training on the pier.  Well, maybe not athletes in training is not the best description.  Perhaps athletes talking about training would be a better choice of words.  Since the race is almost upon them, their swims are pretty short.  But they have to do something.  So they hang around the pier till mid morning. Many of the pros do the same and are most accessible. 

So after the tenders discharge the hula shirt wearing tourists, these visitors snake thru the large group of barely clad athletes, families and friends there for IM and it makes for a wonderful interaction.  Both groups smile at the other.  Both groups think the other group nuts!  Both groups are right. 

Always a good idea to have any lingering questions about your swim course answered before race day

So, how do you know you're a Masters triathlete?  Well, that line can be drawn many ways as it depends a great deal on your perspective.  If you're 23 the cut off might be at one age or if you're 43 another.  Here are a couple ways, without revealing your age, you might have a sense that you've passed into masters territory.

Adult beverages - relaxing with a glass of wine, or two, the night before a race was never an option before.  Now it occurs more often than not.

Aging up - being the youngest in your age group used to be a good thing, but the older age groups are often more fierce - and in some cases faster.  Really!

Masters prerogative (MP) - at swim team, you may at times employ MP in changing the work out or negotiating sets with the coach and teammates, something you could never do as a youngster.

Fine Line - you no longer have 14 workouts/week.  Hell, you're lucky if you get 7, 8 or 9!  So when it's time to race, you're not sure if tapering will get you out of shape or the warm up gets you in shape.  It's a fine line.

Bodies - Many have taken their ailing shoulders, backs and knees to that place where the cutting is done.  In other words, butterfly is no longer an option.  At least your Ortho doc says so.

Every day something hurts.  And every day it's something different.

Ice is a close friend.  You've learned the difference between Tylenol, Advil and Aleve.  Personally.

Laughing out loud - everybody shows up at bike group, not because their parents or coach are making them.  You don't remember smiling or laughing this much during training as a younger age grouper. 

And just maybe, some thoughts about can't see, can't hear, can't pee.   Remembering when morning stiffness was a good thing.  Having to think twice, maybe three times while swimming a complex set as you try to compute the interval (I know, you screw this up all the time.)

Tuesday, August 18, 2015

Should I Do a Second Ironman?

I have a garage full of cicadas.  The summer must be coming to a close and the racing season slowing for many.

Understanding the intricacies of your race swim course is most important

The number of "first timers" seems to vary from race to race.  When I wanted do a piece in that vein recently, more than one athlete pointed me toward Ironman Texas as having the highest percentage of firsties.  While this stat may or may not be true, it's certainly not because the course is a cake walk.  If you ask Ray Britt, keeper of all that is statistical at, you'll find that only Kona, St. George, Maylasia and Louisville are considered more difficult!  In fact, Britt would tell you that IM /Florida might be he be the best US course for either first timers or those looking to PR on this continent.  When compared to some of the European races, IM Texas average times can be almost an hour slower. Never-the-less first timers still flourish.  Maybe because Texas is a well run, fun race.  And heck, they're Texans for crying out loud!

But if you've gotten one 140.6 day in the bag simply completing the distance is no longer just a dream.  You've done it, you're a finisher, and your finisher's medal adorns the picture behind your dresser.  The time, the effort. the sacrifices away from your job, mates and family while costly have made crossing that line a prize worth all of it.  I know few who would disagree. But should you do the same event the next year or another one a little farther from home?  Let's see.

Local attorney Jim, always wondered if he could do it.  So he picked an event and a year, made a pact with his wife and kids, got the gear, put in the training and achieved his goal. Forever he can say "I'm an Ironman." Yes he's quite happy about it but he has other priorities in life and hasn't done a tri in 8 years.  Another local stud, Pat, has done three IM's including ones as distant as Canada and Germany.  But Father Time (and his Orthopedic Surgeon) talk him down every time he thinks about long distance racing these days.  He'd probably break something!  But the above too examples don't apply to Emily.  She probably wears her finisher's medal while cooking.  And she has an itch.  She looks at her schedule, other race venues, costs, etc. and still has those embers down deep inside quietly heating up while she wonders one thing.  "Could I do better?"

Many find they've learned so much the first go round that the time out of their day/week/month dedicated to tri can drop significantly since they've learned the hard way (I would argue the best way) what works them as an individual and what does not.  They already have a good bike and wetsuit, have perfected the speed shower technique and know of an alternate pool when their favorite is closed.  They've made a science of getting many things done in a short period of time  What's that old adage about wanting something done and giving it to the busiest person you know?  So maybe a 2nd 140.6 is in the cards for some.  That exercise high, those endorphins, can be mighty stimulating.  Besides, athlete Emily has one of those centerline Finis snorkel that looks like fun, and "I just got some neat bike shoes."  Think you can predict her future?

Tuesday, August 11, 2015

The Doctor is Out; You May be in Luck

Have lodging in Kona to share 10/3-12 if you need

The Meniscus

You have two in each knee.  Well, unless some orthopedic surgeon has been messing around in there.  And they're pretty important.  An article in the current Journal of Bone and Joint Surgery notes, "The important roles of the meniscus are well understood and include load bearing and shock absorption important for the integrity of the {joint lining} articular cartilage."*

Unlike in previous generations, there is a real emphasis at meniscal preservation.  When torn, if they can't be repaired, in some select settings they can be replaced by transplant much like a kidney or heart.  A cryopreserved transplanted meniscus has a 63% chance of lasting 10 years without subsequent major surgery.  In other words, we as an orthopedic community are making significant progress in restoration of normal knee anatomy but we're not there yet.

The Doctor Won't See You Now**

Professional meetings for cardiologists may have an added benefit: In some cases, heart patients survive longer when their doctors are away at conferences.

In a retrospective analysis, researchers studied 30,000 patients admitted to teaching hospitals for heart attack, heart failure and cardiac arrest during national professional meetings and compared them with 79,000 admitted during the three weeks before and after meetings.  The study is in JAMA Internal Medicine.

During nonmeeting days, 24.8 percent of heart failure and 69.4 percent of cardiac arrest patients died within 30 days. But while cardiologists were at meetings, only 17.5 percent of heart failure and 59.1 percent of cardiac arrest patients died within a month. There was no significant difference among heart attack patients, although in high-risk heart attack patients there were fewer insertions of a stent to open blocked coronary arteries during nonmeeting days.

The lead author, Dr. Anupam B. Jena, an assistant professor of health care policy at Harvard, said that the difference in death rates may be attributed in part to overly aggressive treatments, such as when a stent is inserted unnecessarily.

“In medical care we often assume that all decisions are black and white,” he said. “But many are in the gray area. And we should not assume that in those cases more is better, and that the benefit of a procedure outweighs the harms. That may not be the case.”

A Sharpie date written on all running shoes notes accurate time of ownership

*Noyes JBJS 8/5/2015
**From JAMA Internal Medicine 2/15

Thursday, August 6, 2015

As an Athlete, Can You Reduce Your Alzheimer Risk?

Alzheimers!  I don't know about you but the very word sends chills up my spine!  I misplace my car keys.  I can't think of a synonym for derailleur.  I'm sure I have it.  Or maybe cancer, or thyroid disease or syphilis or toxic shock syndrome.  But I don't.  And neither do you. There's a certain amount of forgetfulness that's normal.  This normal amount goes up when you're physically tired, stressed or for a number of other reasons and is transient.  So let's talk this out.  Can you Dodge Alzheimer’s disease?

Cliff Rigsbee, bilateral amputee, completes IM Hawaii - the guy's a stud
But first

H. G. Wells asserted that "every time I see an adult on a bicycle, I no longer despair for the future of the human race."

Psychologists might say it's to do with attachment.  The great majority of us learn to ride as a child, the bicycle a type of 'transitional object', taking us away to really explore the bigger world for the first time out of the sight of our parents, our first taste of independence and freedom.  It's the symbolic moment when horizons broaden, possibilities open up; you re moving under your own power, controlling where you want to go.  It wouldn't be too much of a stretch to imagine that as adults we would always cherish a thing that had given us such a formative experience.                      Mike Carter, One Man and His Bike 


What is Alzheimer's anyway?

When we think of Alzheimer's, we think about a gradually progressive process damaging the nerve cells in the brain including loss of memory, abnormal thinking, significant communication difficulties, and eventual personality changes, even premature death.  Yes, often times there's a diminution of one's life expectancy.  The final years of the patients with Alzheimer's are ones that can exact a staggering economic, physical, and emotional toll on the immediate family.

So who ends up with this disease and is there anything you can do to lower your chances of being one of them?  Although you are not able to influence factors like your family history, you can certainly lower your risk by maintaining a healthy life style.  Choices like keeping your weight in check, exercise and certain dietary selections all seem to diminish your risk.

Triathletes make choices using what the data shows.  What does science say?  In this case there are 4 directions you can channel your efforts.

1) Keep an eye on that waistline.  You won't always be an athlete being able to have a pretty flexible diet and still stay near "racing weight."  When you eventually transition out of this sport, most likely you'll still maintain some type of athletic lifestyle be it simply running, tennis, obstacle course races, etc.  All of which will be beneficial.

2) Make the same diet choices you do now.  Mostly fruits and vegetables, whole grains, lean fish, beef or poultry, etc.  As athletes we try to keep our consumption of refined grains like white rice or white bread fairly low minimizing unhealthy fats.  Portion control may be less important now since it's racing season but come the off season and your physical output is reduced, so too should your portion size.  Not easy or course, I'm right there with you.

3) Exercise.  It's a conscious choice now for many of us involving 10, 15, maybe 20 or more hours per week since it's a sport and it's competitive.  But in addition to your waist line, the athletic culture also helps keep that blood pressure closer to the normal range while enhancing more normal blood sugar and cholesterol levels.

4) Lower your need for medicines.  While we try to keep the values in the above near or in the normal range, sometimes our genetics throw us a curve.  My mother had hypertension, so do my brother and I kind of thing.  But if you're staying pretty close to ball park with your diet and activity, perhaps you can forestall the onset of the day you'll need some variety of blood pressure lowering agent or daily pill/injection to lower your blood sugar level.

Keep heart healthy/head healthy. The Alzheimer's Assn web site says two things: 

Head trauma: There may be a strong link between serious head injury and future risk of Alzheimer’s, especially when trauma occurs repeatedly or involves loss of consciousness. Protect your brain by buckling your seat belt, wearing your helmet when participating in sports, and “fall-proofing” your home.

Heart-head connection: Growing evidence links brain health to heart health. Your brain is nourished by one of your body’s richest networks of blood vessels. Every heartbeat pumps about 20 to 25 percent of your blood to your head, where brain cells use at least 20 percent of the food and oxygen your blood carries.

This is a short video that may prove enlightening. Understand Alzheimer's in 3 MInutes

Also, a lecture by a California researcher who directs the UCLA Longevity Center and emphasizes successful aging is here for those who might want do jump in a little deeper.

One more way.