Sunday, August 27, 2017

The Clasp of Kona - A Sport Where the People Win



Note in physician's log, men's changing tent 2016 Ironman Kona - "Athlete reports earplug stuck in ear.  Forceps extraction." 

Just like that, the racer is on his way with hardly any time lost at all. Thanks for being there Dr. Charles Johnson!
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Kona start/finish line on Alii Drive. 

The Clasp of Kona


    At Kona, more than any other race throughout the vast Ironman collection, the emotional lives of the racers, in good seasons and most especially in bad, are on display.  Unlike many other sports, the professional athletes are still part of the crowd, visible in the daily landscape, and for the most part quite approachable.  There’s Julie Moss and “the Spectacle” in 1982, which for many athletes who walk the streets of Kailua-Kona today, put Ironman in their cross hairs of possibilities.  And Paula Newby-Fraser, the “Queen of Kona” whose 1995 meltdown so close to the finish showed the triathlon world, no matter your pedigree or number of previous wins (7) in your satchel, each of us can eventually run out of gas and be unable to take one more step.

But, as they say in the Sound of Music, “When the Lord closes a door, he opens a window somewhere,” the brilliance of the smile of the 1995 winner Karen Smyers still illuminates the final 400 meter stretch down Alii Drive to the Ironman World Championship finish line.  The pros we’ve come to know, and respect, wear their hearts on their sleeves while racing, much as we fans also do cheering.

Kona is simply the best.  There was talk not that long ago of rotating the location of the World Championship.  Kona one year, then Germany, Australia, maybe Canada, but the backlash was loud and clear.  It’s Kona!  Got it?  Despite small course changes over the years, addition of buoys to the swim, bringing T2 from Keauhou to the pier, adding NELH – the energy lab – the course is alive, leads are always in doubt.   Should you be so fortunate as to win here, treasures are yours that cannot be bought.  Your name is in the same sentence with Dave, and Mark, and Rinny, for life.  You’re on Bob Babbitt and Mike Reilly’s speed dial for gosh sakes.  You reap a lifetime of spoils.



Multivitamins, beneficial to the triathlete?

"Most people take multivitamins because they are concerned they aren't getting what they need in their diets.  The multivitamin serves as an insurance policy.  In November 2013, a review of 26 studies found that otherwise healthy men and women didn't have a lesser risk of cancer or heart diseases after taking a daily multivitamin.  They wrongly assume that vitamins taken in concentrated pill form are processed and presented to the body in the same way that they would be if you got them in fruits and vegetables.  Probably the smartest (and least expensive) way to get what we need is just by paying a little more attention to our diet."

                                                     Paul Offit, MD Do You Believe in Magic?, 2013

Sunday, August 20, 2017

Why Training With Other Triathletes Makes You Better


"I need help," she posted.


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                                                              Credit @linda_alread
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As you might suspect, I get a lot of e-mail traffic with various musculoskeletal and medical questions for which athletes seek an independent opinion. “I broke my collar bone on a recent ride, they’re saying I should have surgery, what do you think?”  Or, “It’s been a couple weeks since my complex knee surgery, when do you think I can run again?”  Like most Sundays, there was one waiting for me recently.  It was from a woman in NC named Georgia, a veteran of many marathons and triathlons, who, very unfortunately, had suffered a small cerebral hemorrhage.  This is a type of stroke that occurs when a tiny artery inside the brain bursts leading to the death of some surrounding brain tissue.  They comprise about 10% of strokes.  In those with significant bleeding, permanent injury or even loss of life can result. 




Fortunately for Georgia, she had a complete recovery.  That’s the good news.  The bad news is that an underlying reason for the hemorrhage was never determined and her doctor “refuses to clear me for competitions.” 

What she was seeking in her e-mail to me was a doc familiar with endurance athletics who could approach her as an athlete, not just the next stroke victim waiting in line.  “But the trouble I am running into is that most non-endurance athletes believe that triathlon and certainly Ironman are grueling competitions where all athletes crawl across the finish line on death’s door.  As an athlete yourself, I am sure you can appreciate that I did not enjoy hearing that.”  I’ll bet many of you reading this now understand her emotion 100%.

What she needed was someone who understood both Neurology and triathlon so she contacted me.  While I’m not that person, I know how to find that right person.  The  triathlon web site.  Sensing her urgency and bewilderment, I made it my priority for the day.  I put up a “Neurologist needed” thread on the forum, and it didn’t take 2 hours to get a response.  Wow!  We’d found a doc in WI.  And then shortly thereafter one in CT who were ready to take her on.  I e-mailed the good news and she was excited.  

But wait, there’s more.  In another two hours, a doc from her part of NC chimed in ready to offer assistance.  Georgia was ecstatic.  “Dr. Post, you are a champion. Thank you thank you thank you!!!” Here in the space of 4 hours, she’d gone from adrift in triathlon, not sure if she’d ever race again, to having someone in her own neighborhood offering to be of assistance.

I thought we were done….until…in another two hours the cherry arrived. The cherry on top of the ice cream Sunday that is.  The following note arrived, “Hey John, I am a neurosurgeon in Long Island, NY.  This stuff is my “bread and butter” so to speak.”  Does life get any better?  Nope, not if you’re Georgia.

When I passed this last morsel on, it went something like this.  “Are you sitting down?  It gets better,” she answered immediately.  “Woo hoo!!!!! I am from Long Island!!! We have a winner!”  It turns out that this gent even knew the NC coaches she trains within NC and plans to speak to them.

What a day; my what a day.


Even the support team needs help sometimes.



So what are triathletes for?  To help other triathletes of course.  That’s what Georgia would say if you asked her.  Why not do that when she’s setting up her transition area next to you at an upcoming event.  She’ll be easy to recognize, the one with the permanent grin on her face. 

Thursday, August 17, 2017

The Triathlete in Pain, Opioid Avoidance/ Thank God I'm Not Racing Party


     A "Thank God I'm Not Racing!" Party in Kona?  

Site of one TGINR party
Although I'm lucky enough to go to Kona every October to work the event, I've missed the past couple TGINR parties as I'm usually still on the pier getting those last minute details finished so that come the starting cannon in the morning, those competing have the best shot at success.  Plus, I'm sunburned, been sweating all day, and everybody else is clean and smells nice. Bob Babbitt is not only a great guy, but a great host at this open bar buffet. We've both been part of the event for 30+ years, and although he doesn't really know me, he couldn't have been more gracious.  Thanks Bob.

So if you find yourself on the Big Island the night before this year's World Championship, see if you can't wrangle an invite to this fun event.  And don't forget to thank Bob!


Oh, and get one of the hats.  They're terrific.  Check out Facebook TGINR 2016 for a couple pics from last year.
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Might be you one day!

Ankle fracture weeks before "A" race Ironman
"Sickness will surely take the mind, where minds don't usually go.  Come on the amazing journey, and learn all you should know."
                                                             Tommy, The Who
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"At some point in your triathlon life, you may have some type of injury such that you're in enough pain that some sort of pain medication is offered/requested.  So many of us are resistant to the "there's a pill for that" mentality but we're addressing situations which are out of the ordinary and by using the suggested medication, perhaps other parts of life will benefit like amount of sleep, ability to exercise, spousal relations, etc. There are many options, and if you have a general idea of what might work best for you ahead of time, then you'll be neither over nor under medicated.  Let's look at some of your choices.

Aspirin

Anacin, Ascriptin, acetylsalicylic acid and other forms of this work horse medication have been around for decades and have found wide acceptance as an analgesic in the treatment of minor pain.  Either alone or in combination with or substances such as narcotics, it's proven most effective.  It also finds use as an antipyretic (lowers temperature,) an anti-inflammatory agent and most recently as an anti platelet drug in the prevention of myocardial infarction's, strokes and blood clots in low doses. The author takes a daily baby aspirin (81 mg) for just such an indication.  It's primary negative is the occasional formation of GI ulcers or stomach bleeding.  It's one of the most commonly used medications world wide.

Acetaminophen

Tylenol, like aspirin, is an analgesic (diminishes pain) that's available without a prescription and is useful in treating minor pain and flu like symptoms.  It also finds it's way into combination drugs like narcotics for more severe pain such as post operative, obstetric, or in those with cancer pain. It is not an anti inflammatory and does not share the same side effects as aspirin. But, if inflammation is part of the presenting symptoms, then acetaminophen may not be the best choice. In chronic use or larger doses, it can be potentially detrimental to liver function, and is a common cause of death in those who've taken a drug overdose.  It is quite safe when used appropriately.

Non-Steroidal Anti Inflammatory Medications

The NSAIDs, Motrin (ibuprofen), Naprosyn (naproxen),Clinoril (sulindac),Celebrex (celecoxib), etc. as they are called, can be quite useful in treating chronic or arthritic type pain as well as acute pain.  Like aspirin, NSAIDs also have the ability to lower temperature.  Their primary role is in the treatment of inflammatory conditions, the -itis's, as in tendinitis, bursitis, etc.  Once again, occasional GI distress is the major potential side effect. It is reported to be less with the family of drugs like Celebrex, a COX-2 inhibitor.  As with any medication, you should take it when needed but stop when you don't.

Corticosteroids (Do not confuse with anabolic steroids)

In select circumstances, these anti inflammatory agents like prednisone, Medrol Dose Packs, etc. can be quite effective over short durations.  They are not to be confused with anabolic steroids like the weight lifters/body builders have reportedly used.  You might be given these orally or as an injection into a joint or a tendon sheath.  Side effects can be elevated blood sugar in diabetics, weight gain, and adrenal suppression. Careful here. Often used short term for allergic reactions, poison ivy and the like.

Narcotics

Widely prescribed by the medical system, drugs like morphine, codeine, hydrocodone,etc. find a role in controlling more severe pain.  They require special licensing from the Drug Enforcement Agency to prescribe but help patients through surgery, migraines, deliveries, trauma, etc.  They should only be taken when the above options prove ineffective.  On the downside one finds the possibility of tolerance if taken for a long time, addiction, abuse, etc. The country in the middle of an opiod epidemic as you know, and hopefully, should you need pain relief with this class of drugs, specific uses and risks are discussed with you before you fill the prescription.

Alternatives

 In many instances, simply starting with ice and/or heat can make a big difference.  This list of medication categories is not meant to be exhaustive.  Electric stimulation, acupuncture, massage, physical therapy, etc. all may play a role in your care and return to health.

So, depending on your situation, if in pain, and asked to consider one or more of the above options, work with your health delivery team to determine which of the above agents might be best for you, remembering that a lot of pain is probably not OK, a little pain could be.

Sunday, August 6, 2017

Variety, It's the Spice of Triathlon Training


Variety, it's the Spice of Training


Obstacle course racing.  It's great!  If you've read this blog in the past, you know I'm a champion of variety in training and racing.  Keep it fresh.  Keep the interest level high.  In my circle of training buddies, many have done a Tough Mudder (or TM half,) Rugged Maniac, Spartan or other event where getting dirty is just part of a day's work.  Er, day's fun.  That's more like it.  Most are around 2 hours or less, present a fair workout worthy of log book entry, and when done with friends are the tales that make up winter laughter.




Respect your injury.
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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 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 gang, like Darcy, stay committed to your goals!

Tuesday, August 1, 2017

Thinking About an Ironman Tattoo? This May Help


Did you know that the marathon part of the Hawaii Ironman is a Boston Marathon qualifier? I think it became so about 11 years ago.  Pretty hard way to qualify for the famed Boston race.

Here are some photos I took (as you can likely tell) of how others have expressed their IM-ness through body art.