Wednesday, September 27, 2017

It's Not A Sin To Walk During a Triathlon / PRP, Platelet Rich Plasma II

PRP, Platelet Rich Plasma, An Update

A couple months ago I did a blog on PRP to try and give the athlete some way to judge for him or herself whether the hype that follows any new product or procedure.  Newer websites will promise you the moon for this not inexpensive injection but the more we perform it in a variety of circumstances, the more we learn that it's mostly ineffective except in certain narrow applications.  For example, the below quote from Wang et al. shows PRP ineffective for patellar tendinitis, ACL repair, rotator cuff repair to name a couple.   But we don't know everything yet so stay tuned as we continue to look for high quality studies that increase our knowledge base and your chances of success if choosing this therapy.

Platelet-rich plasma has shown great promise and potential to stimulate biologic activity in difficult-to-heal musculoskeletal tissue. However, the optimal formulation, method of administration, and dosing for different tissues have yet to be determined.
Within a given platelet-rich plasma preparation technique, there is a high degree of inter-subject and intra-subject variability in the composition of platelet-rich plasma produced. This likely contributes to the inconsistent results reported in the current platelet-rich plasma literature.
Current evidence best supports the use of platelet-rich plasma as a treatment for osteoarthritis of the knee. Evidence on the use of platelet-rich plasma as a treatment or adjunct for rotator cuff repair, lateral epicondylitis, hamstring injuries, anterior cruciate ligament (ACL) reconstruction, patellar tendinopathy, Achilles tendinopathy, and fractures is inconsistent or only available from low-powered studies. To our knowledge, no comparative studies examining platelet-rich plasma treatment for partial ulnar collateral ligament tears in the elbow currently exist.
Current evidence suggests that different platelet-rich plasma formulations are needed for different tissues and pathologies. Ultimately, improved understanding of the underlying structural and compositional deficiencies of the injured tissue will help to identify the biologic needs that can potentially be targeted with platelet-rich plasma.
Wang, Dean MD; Rodeo, Scott A. MD

Walk in a Triathlon? Sure You Can

"Superman where are you now? Phil Collins, Land of Confusion

30 years ago I ran my first Boston with two friends from Miami.  We vowed to do it 25 years later.  And 25 years older!  Second time around, when the gun started the field of 25,000 in Hopkinton at noon, it was 87 degrees.  It was hot!  Especially for marathon running. 

I've written before that when I got to 20 miles, overheating and way behind on fluids, I made one of the worst decisions of my racing career.  I got on the bus, a yellow school bus, and was driven to the finish. In a vehicle! I was transported like a helpless person to the finish. I was a DNF (a DNF for gosh sakes!) in the famed Boston marathon.  What a dip!

At a lecture by noted Triathlon Coach Joe Friel, he once compared the running boom of the 70's and 80's to the growth of triathlon today. (If you'd been told 20 years ago that someone would pay $40,000.00 or more to get a slot at Ironman Hawaii, you'd thought them clearly insane. Yet, we find ourselves clearly there. The annual Ironman Foundation auction, puts up 4 entries to the race to the highest bidder/donator, the profits going to the Ironman Foundation Charities. This branch of IM donates a significant sum each year to a host of deserving Kona organizations like the rescue squad, various help agencies, etc.

Friel's story went something like this. In the 70's, folks would have a friend convince them to go jogging, like it, and progress to running.  And then strange things would happen. It might start out with a local 5K race, they'd get hooked, and after smoking too much Runners World Magazine, they'd be convinced they could begin marathon training.  And some could. Their lives became consumed with running and a myriad of details until they found themselves running the first 10 miles of a 26.2 mile experience. All went well until mile 18, when they found themselves with shot quads, over heated, and out of ideas. (Oh, I see you've have been there.)

Compare the above scenario to triathlon where it seems easy to tackle the local sprint tri, maybe even an Olympic distance race...and then you start to dream...and a friend of a friend is doing IM Lake Placid...and, "With just a little more training, I could be an Ironman." Well, maybe.

But what happens when you get to mile 95 on the bike, are beat, rethinking how you might have hve been overly aggressive for the first 56 miles and would like to call it a day.  But you're not even off the bike - and there's some running to do shortly.  As Joe Friel says, "You have to have a plan B; you need alternative alternatives."  And simply get on the bus isn't one of them.

In other words, it's OK to stop at a bike aid station and sit in a real chair while taking on fluids for 5-10-15 even 30 minutes.  No one will penalize you or draw a red slash through your race number. It's OK to ask the medical people for a little help, they're not going to take you out of the race unless you're a danger to yourself or others. It's OK to walk. Well, it's ALWAYS OK TO WALK. Or to sit at a run aid station to collect your wits. Then you can proceed at your pace if that's what it takes.  It matters little down the road what your time was, only that you had a plan B and you finished.

You have a full 17 hours to finish this thing. No harm in using all seventeen of them.  If you've thought these potential problems through ahead of time, then during the press of the event where folks don't always make the best of decisions, you'll not decide something in haste that you'll come to regret.

Just think about it. It's been a decade since I DNF'd and I still feel stupid.

Sunday, September 17, 2017

In the Days of Iron Men and Wooden Ships

What's the Best Diet for Triathletes?

High fat? Low fat?  High carbs?  Low carbs? What's the best diet?  Who knows? 
Dave Scott recently came out supporting a new study in the NY Times on the side of fat over carbs.  Supporting the carb side was noted multisport author Matt Fitzgerald in The Endurance Diet, a carefully crafted and well documented volume.  Maybe it's like so many "facts," you pick the studies that support your beliefs.  Once again, the take home point here is that nothing in triathlon is one size fits all, and we don't make major changes in our work outs, nutrition, anything, based on a single study or single expert. Perhaps, for some of us, both positions are correct.

Stay tuned.

Skid lids ruled the helmet wars not that long ago. Seen yours lately?


In the Days of Iron Men and Wooden Ships

Over 100 years ago, Pulitzer Prize winning author Stephen Vincent Benet, reflecting on the impact of Captains and Clipper Ships, wrote about those men who served in the Naval Service at the end of the 18th and beginning of the 19th centuries.  He observed that of these men, who lived and died at the helm, there was “salt music in their blood.”  Perhaps, without knowing what the future held, he was subtly referring to the Ironman athlete of today.

“There was a time before our time,
It will not come again,
When the best ships were wooden ships,
But the men were iron men.”

The fledgling years of Ironman Triathlon were the late 70’s and early 80’s, when no one knew if this Ironman thing would make it or go the way of chariot racing, jousting or the pentathlon.

Let Me Take You Back to 1981

"Start off slow...and taper back."    Walt Stack

Triathlon has become a highly regulated sport.  There are governing organizations, certifications on many levels, and ever-changing rules and regulations.  We occasionally need to fall back to the pioneers of our sport, those adventurous souls who, when presented with the idea of swim long, bike long, then run a marathon thought, “Peachy, that sounds like fun!”  Mostly they did this on faith alone. 

“Cowman” Ken Shirk, one of these early pace setters, and one who was able to complete the entire original Kona course wearing a cow head complete with horns.  Why would he want to do that you ask?  (I must admit,the answer doesn't come to me immediately either.)  He's completed many more since. A strong individualist, he fit right in to the then prevalent mindset of people at the far end of the endurance sport bell curve.  Ken’s pedigree includes being the second man to finish the Western States 100 mile race. Or, more accurately, the second human to finish the event not horse bound! 

His Ironman swim required a modified breast stroke which Ken labeled the “cow stroke.”  Well, of course.  Wouldn’t you?  'Course you would.  I don’t know how many times he’s finished the event, both as a legal registrant, and I’m told, as a bandit, but it seems the event has gotten too big, gone in another direction, for the Cowmans of life.  Sad.

Many of you were not born in February 1981. The race was still in February back then and this would the first time for the Big Island course having been recently moved from Oahu.  T1 was on the pier, T2 down south in Keauhou.  There was no Energy Lab (NELH) section.  The race had been run in Honolulu from 1978 – 80 but had just gotten too big to be contested in the populous state capitol.

Enter San Francisco's Walt Stack ,a part of Ironman before everyone and his brother was labeled hero, a real larger than life guy. He’d done countless races before coming to the Big Island and had established himself as a legendary figure in our young sport.  Not fast, but steady, he could always be counted on to be one of those still standing at any race’s end. (Seven years later he would do a very cute Nike commercial.)

From a piece about Walt in Sports Illustrated: "Stack was out running the hills near his home. It should be called climbing. He was with a group of young women from his running club, the Dolphin South End Runners, when suddenly, one of them recalls, "I heard a sharp crack. I looked back, and Walt was stretched out on the sidewalk, bleeding from a cut on the head. 'Walt, what happened?' I yelled. " 'That's what comes from being a dirty old man,' he said. 'I dropped back to look at your legs, and I ran into an overhanging branch.' "

Walt's first, and only, Ironman was in 1981 when there was only one Ironman race anywhere, no WTC and no separation of pro’s and age groupers.  Everybody was an age grouper!  You need to remember that these were the early developing days of the sport and we didn’t know a great deal about aerodynamics on the bike, refueling or nutrition, and if you mentioned compression it was assumed you were speaking about the compression ratio of your car’s engine.  Ironman had no swim or bike time cut offs, and only a rudimentary course.  Like the Outback, “No rules, just right.”

The swim had no buoys, no course, and according current Swim Director Jan War, “You just swam out to a canoe and back.”  When asked about turn-around help for any competitor not from Kailua-Kona, or perhaps the directionally challenged in ocean swimming navigation, to aid even finding the turn-around boat, he laughs loudly as one who knows the punch line of a joke before you do.  According to Jan, his predecessor, the crusty Mo Matthews, was fond of reporting, “If they can’t find the turn-around boat, they shouldn’t be doing the race.”  Uh, OK Mo. (I have since talked many times with Mo before he passed away and found him a delightful grandfather type.)

 Stack was ready for the event and at 73, the oldest competitor ever to attempt the distances.  After a 4:11 swim and leisurely bike, history has it that he was pretty tired on the run.  Really? So, he just eased off the course, lay down in someone’s yard, and took a nap.  Once refreshed, he set off on the remainder of his 26 mile jaunt, and near its conclusion got hungry.  So what do you do when your stomach starts talking, head for the restaurant naturally.  In this case, the Kona Ranch House (Joe Friel's Favorite) which used to be on Palani Road but is no more.  The way I heard it, he was eating his waffle breakfast, reading the morning paper, with the results of “yesterday’s” Ironman race in it. The race in which he was still competing!

 Once breakfast was finished, he got back out on the course, finished the event in a speedy 26 hours and 20 minutes, and still holds the record for longest race time in Kona*.

 On one hand, it’s a shame that the sterility of present day doesn’t seem to have a place for Cowman, the Amazing Walt Stack and countless other characters who put this event into the national spot light.  But they are the rocks on which this sport is built.  If you happen to be walking around Kona one day and spy a guy with cow horns on, don’t simply assume him an asylum escapee but walk over, shake his hand and say “thanks, Ken.”  Maybe, if you’re really lucky, he'll share some of the finer points on the cow stroke with you!

*Surprisingly, in researching this piece, I found that 20 hour race times were not all that unusual in the early years.

Monday, September 11, 2017

One Month Till Kona: What You Should See & Do

Joe Friel: My Mentor, My Friend, One month Till Kona

This is my 663rd blog post.  I'd like to dedicate it to Joe Friel, my mentor, my friend, my patient.  None of what I have achieved in triathlon would be possible without him.  From coaching me for many years and meeting me at the finish line in Kona with an ice cold beer (or two!), to being my roommate and putting up with my endless questions about human performance.  We come at this sport from different angles and often agree to disagree on various topics.  Joe has about the strongest will power of anyone I know, absolute control over what goes into his mouth or the exercise he does and it's quite contagious.  When he's designed a work out for you and the goal is not met, you feel as bad that you let him down as you do in not meeting the preset parameters.

In short, Joe Friel sets the pace the rest of us might aspire to, lives life with honor and hard work, is true to his athletes, true to his family, true his team.

So, to Joe Friel I dedicate this 663rd blog.

Super coach Joe Friel (L) encouraging course record holder Bob Scott in Kona

"It's going to be a Hard Day's Night."   The Beatles

We're one month till the cannon blast signals the start of the Ironman World Championship. The athletes who are racing this year are beginning to struggle with the upcoming need to think about tapering, opposing that intense internal drive to get every bit of training they can out of every day. It can be as much as 20, 25, even 30 or more hours per week. Age groupers too! For the first timers on the Hawaii course there are so many questions involving bike transportation, accommodations, training on the island, heat acclimation, and learning as absolutely much as possible about the race and it's conditions.  This event, where the best of the best race, still has enough DNFs that athletes want to ensure they're in the annually expected 93% who finish the event instead of the handful who don't.

I think the biggest mistake that newcomers make is that in spite of spending 7, 8, 10 or more days on the Big Island, they don't get it. They are so focused on the race that although they finish well on Saturday, and it's "mission accomplished," so to speak, they've totally missed the Hawaiian feeling of Ohana (family) or the spirit of Aloha. And, for those who've brought family and friends, they've learned little to nothing about this wonderful place as they become consumed with Ironman.

To be fair, it's this goal oriented behavior that got them here, but with actual pre-race training at a minimum now, there are frequent opportunities to learn and entertain while in Kona. Having been there 20 times, here are ten suggestions to ensure both the best race and the best experience for racer and family alike.  Some for you, some for the family...and some for the family to give them something to do other than watch you obsess over the race.

1.  On Sunday, a week before the race, are the light hearted PATH 5K and 10K runs.  They benefit the Peoples Advocacy For Trails Hawaii.  It's a non-profit in West Hawaii that teaches elementary kids safe cycling.  Could there be a better use of you tax deductible entry?  And it gets the family in the Big Island mood.

2. Eat at some place different every day. Splashers, Kona Inn, Fish Hopper, Jackie Rey's, Lulu's, Lava Java, they all have something good to offer.  If you really like raw fish, Da Poke Shack on Alii Drive gets rave reviews.

3.  Most peoples training plans are in full taper mode with which I agree.  But I'd suggest you start most days with a short swim on the race course.  And I'd do it at 6:55 a.m. if I were an age group male, 7:10 am if I were an age group female since that's when you'll start on Saturday given the time changes for 2016.  You can judge the position of the sun, estimate the surf, pick distant objects upon which to sight off, etc.  You don't have to swim a lot but it's fun, it's social, and where else can you swim out to a floating coffee bar Tuesday through Friday?  The family can swim out there too.  Got a water proof camera for that Christmas card photo?

4. Everyone, and I mean everyone, runs the Underpants Run on Thursday, 7:30 am, King Kamehameha's Kona Beach Hotel.  Register on line through 10/9 or at the Ironman Expo Tuesday or Wednesday...and bring a camera. It's about 2K at about a 10-12 min/mile pace...when you can stop laughing. Bring a special hat or mask. One guy was Elvis a couple years ago and it worked. 

5. When thinking about gifts for those back home, particularly kids, both Longs Drugs and the ABC stores have a wide variety of items for not a lot of money. You will spend more money in the Ironman store than you think. ("Well, I'll never be back here again and I do need 10 more triathlon oriented shirts in the dresser.")  Consider mailing things from Kona so you won't be overweight when your luggage is weighed at the airport.  It can get expensive.  Maybe even bring a mailing tube to mail IM posters for the gang at the pool.

6. Say hello to some one you don't know every day. And, if they're having a little trouble since English isn't their first language, take a breath and see if you can work it out. It onlytakes a little patience to be a good ambassador. And besides, it's fun.

7. Get with someone who has a rent-a-car and view every inch of the race course.  You might have to omit the two mile out and back in the energy lab, NELH (Or if you're really compulsive you could take the tour and see parts of it.)  I think you want no surprises on Saturday.  You can have lunch in Hawi.  It's really nice.

8. Be patient and kind to the people of Kona - this is their home we're invading.

9. On Saturday, say THANK YOU to every race volunteer you encounter. And every policeman.

10.  And finally, when you get to the post-race area, don't be in a hurry to leave.  Lots to see and do from finisher's medals, food of many types, pictures, etc.  Since many of you will leave Hawaii in the next 24 hours or so, and because of the stress your legs have endured and overall dehydration, understand that you are at risk for developing blood clots in your legs.  The best thing is prevention where your efforts at hydration begin now and continue until you reach your destination by air.  When on the plane, don't just sit or sleep please. Get up every couple hours, walk around, use those leg muscles - especially the calves - till you arrive home.  It'll pay off.

Friday, September 8, 2017

Can Both a Father and Son Qualify for 70.3 Worlds in TN? Yep!

Do You Feel Guilty If You (think) You Train Too Much?

As a triathlete and parent, you always wonder if you let the sport get in the way of your family.  "Do I short change the kids when I'm out on that long bike?"  Over the course of 11 years, with 3 kids growing up, I did enough training to run Kona 5 times.  As any of you know, that's a lot of swim-bike-run.  I don't know how it came up in conversation, but I was talking with my now 27 year old son about it a couple weeks ago.  I asked him point blank if he thought I was always gone, always somewhere else training?  He answered very quickly, "No, you always had time for us growing up!"

Great to hear that coming from your offspring.  So I guess the key is worrying about it, paying attention to it.  Add in a modicum of guilt and even though as a surgeon I had a full time job, it seemed to all work out.  From the kids perspective anyway, and the perspective that counts.  I suspect that you are exactly the same.

Snorkel boating with the family in Cancun
Hey Dad, Wanna Do the Chattanooga 70.3 Worlds Together?

June 18th, 2018 will be Father’s Day.  So what do say we call the old man up, see if we can tear him away from the Orioles game on the big screen, or maybe get him before he heads out to the lake to see if the catfish are biting.  Then we’d say “How about a brick workout today Pops?  50 bike and 10 mile run?” 

I don’t know about your dad but mine would tilt his head up from the Sunday paper, look at me over top of his glasses, shake his head a couple times, and just say “Uh huh.”  He would then disappear back into the news.

But not all families would find this folly.  Take Boulder’s 23 year old Rudy von Berg, part-time grad student, part-time pro triathlete and full time fierce competitor.  Rudy is one of those quick studies in the classroom as well as the sport, now a two-time USAT Collegiate National Champion.  He has two professional 70.3 runner-up finishes including Miami ’16 by only two minutes to Terenzo Bozzone and Buenos Aires ’17 to Lionel Sanders.

Let’s say that if Rudy showed up at his Dad’s house on Father’s Day, there’s a good chance he’d find Dad, Rudy senior actually, not cleaning out the cat box or dusting the hall fan, but just as likely he’d find senior out on the road doing a 50 bike and 10 mile run.  Surprised?  Well, Dad, believe it or not, is the reigning 70.3 Ironman Age Group World Champion.  Not impressed?  Ten months ago in Kailua-Kona, Hawaii Dad took the Ironman World Championship age group crown there as well!  He won by an other-worldly thirty plus minutes over the best age groupers in the world.

Hard to say which of these two fast movers is the better athlete, right?  Well come September 10th in Chattanooga, TN and the 11th running of the 70.3 World Championship, senior will don racer #333 and Rudy Jr. will wear bib #10 as they go up against the best athletes world-wide at the distance.  Toeing the line for family fastest perhaps?

 I can tell you that I’m not much of a gambler. I didn’t have a Powerball ticket for the recent 758 million dollar lottery won by a Massachusetts woman .  But if betting were legal for this race it would be pretty hard to bet against either of these Rapid Roys.  I’m supremely glad that I don’t have to race against either one of them.

I can imagine being a flower on the wall when the following conversation occurs in the von Berg household - ”OK Dad, flip you for who buys the post-race beer.” Then without missing a beat, senior fires back “fugetaboutit!  He who has the hottest race is the recipient of that beer.”