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Rock Star Triathlete Articles

BLOOD CLOTS/BLOOD THINNERS by John Post, MD

Blood
Thinners and Blood Clots

Testing an athlete’s serum lactate
levels while pedaling under a controlled load and controlled conditions is one
way to determine the lactate threshold and from that one’s training zones. If
this athlete takes a blood thinner, would testing of this sort put him
or (and possibly as important in these litigious times) the
test director in jeopardy?

Blood is drawn from the athletes left ear
lobe at 3 minute intervals during testing.
_____________________________________________
Blood Clots/Thinners

I fail to be surprised each
time I see/hear about another athlete who’s taking blood thinner medication for
a recent, and some cases not so recent clot. There are frequent reports in a
number of the on line Tri forums and I thought a review would be beneficial.

A pulmonary embolism or clot in the lung (sometimes air or fat, etc.)
can be fatal! A person with an acute PE can complain of chest
pain, often worse with deep breathing, the onset of a cough which may contain
blood tinged sputum and they can breathe more rapidly. They may note both a
shortness of breath and more rapid heart rate. This is obviously an emergency –
go to the hospital – and treatment will be initiated to prevent new clots from
forming, start oxygen, and occasionally clot busting meds will be given. A
frequent source of clot can be the legs, say there’s been a long airline flight
(like to Kona), long car ride, etc. Other risk factors include birth control
pills, positive family history, recent orthopedic surgery, cancer, etc.
Prevention would obviously be the best choice as once diagnosed, there will
likely be a 3 – 6 month period where blood thinners are taken on a daily basis
and the blood is drawn at regular intervals to make sure the medication is
working correctly. It’s called Coumadin and is the active ingredient in rat
poison believe it or not.

To prevent a PE, when you are on a long
drive/flight get up and move around frequently, move your legs. Bed ridden
patients in the hospital can be fit with devices that squeeze the foot or calf
to keep the blood moving and prevent pooling.

Triathletes ask about
racing and training while taking Coumadin understanding that they are at
increased risk for bruising, bleeding -both external and internal – and that any
cut or abrasion on the skin will bleed more. Once the Coumadin dosage has
leveled off and the medical team feel the clot stabilized, then a return to
training can be considered. I don’t think anyone would take issue with swimming
or strength training, and probably not running if the return to the roads is
done slowly and carefully. Biking, where the potential for a crash (read injury)
is higher, gives us the biggest worry. All of us have crashed at one point or
another and in one of my previous blogs I reported being momentarily unconscious
after my helmet contacted the asphalt unexpectedly. I am very glad I wasn’t
Coumadinized when that happened because of the risk of bleeding into my head and
permanent damage. I believe I’d be inclined to ride the stationery bike watching
old TdF videos for quite some time.

Lastly, the question of eating green,
leafy vegetables comes up as they have plenty of vitamin K and vitamin K
reverses the blood thinning action. Most people would agree that if your diet is
constant, eating about the same amount of greens daily, that you should be ok
and it’s those patients who have a big salad one day (the day prior to their
blood test could be a problem) but chili cheese dogs on the the other days. Keep
it even.

In short, prevent those leg clots by moving around on long trips
and, if for any reason you think you might have a PE, get to the hospital
pronto, it’s the best course for you.

www.johnpostmdsblog.blogspot.com

POOL RUNNING CAN BE FUN by John Post, MD

Pool
Running Can Be Fun

“You got to do what you can, and let Mother Nature do the rest.”

Meat Loaf

At some time in our careers, water running, or aqua jogging,
will be recommended as a method of cross training injured athletes. Others find
it an ideal form of non-impact aerobic training. Basically, you
“run” in water that’s deeper than your limb length. This can extend from the
diving well up in to the lanes, with a flotation vest or belt to increase
buoyancy…so you don’t drown. Although most run the length of the available
area, others attach themselves, say to the ladder, and run in place. Running
with a partner provides easy conversation, or, a water proof source of music
may be of benefit. One attempts to mimic one’s form as closely as
possible to that used on land.

Mimicking run duration and intensity is also important. For
example, if you’re scheduled for 45 minutes of steady running, do 45 minutes in
the water. As you’d imagine, heart rates will be lower but many find that they
can come within about 10-15 beats/minute of their land running HR. It’s possible
to run intervals repeating levels of intensity done on land.

Athletes have shown that not only can they maintain their level of
fitness, but with dedication can actually improve. This comes into play
when one begins to return to the road. Initially, shorter workouts can
be supplemented with time in the water keeping the workout time “whole.”

Again, it’s a priority to duplicate your form on land, arm swing, head
position, elbow engagement, etc. If your pool has both vests and belts,
you may find one or the other allows you to more easily maintain this action.
Your hip flexion will likely increase in the pool giving you an artificially
lengthened “stride.”

Like many, I am currently water running at the end of my swim workout. And,
watching the others in my swim group continue to turn out the yards is all
the distraction I need to stay focused. And, I can still joke with the
lifeguards while I’m running!”

STRESS FRACTURE, EH? PART TWO by John Post, MD

Stress
Fracture, Eh? Part Two

This is Ironman Week here in Kona as the sleepy fishing village and
occasional port for cruise ships turns into Triathlon Central. There are
people everywhere, fit people, running and biking up and down Alii Drive.
I hadn’t been here an hour before seeing Norman Stadler and Chrissie
Wellington. Good luck to them both on Saturday! It’s going to be a
fun week.

“Dig Me” Beach, a term I heard
credited to Scott Tinley, is seen here, soon to be clogged with
swimmers trying to get used to the change from simply following the
line on the bottom of the pool to the gentle waves and salt water of
the Pacific in Kailua Bay.

But the athlete with an injury like a stress fracture is
sitting home, an opportunity missed. I covered the basics of stress fractures
here 1/15. That these are in the category of overuse injuries where the
muscular envelope of the lower extremity becomes fatigued and the skeleton
is unable to adapt to the increased load.

The bone fractures as it is unprepared for the intensity of exercise delivered.
This might be advancing one’s training program
too quickly, changing from the relative forgiveness of the running track to
asphalt or concrete, aged or improper equipment or increasing exercise duration
as a tennis player with a substantial increase in court time.

There are 26 bones in the foot and most likely all of them have been subject
to a stress fracture at one time or another. They are frequently seen in the
other bones of the lower extremity when insufficient rest is included between
workouts. People taking Prednisone, Dilantin and other medications are at
increased risk. Women have more than men.

The predisposing symptom is pain, not so much at
rest, but brought on by exercise and it worsens. Although occasionally
visible as a crack in the bone on x-ray, frequently these films will be
negative. If the examiner finds point tenderness over a bone and a stress
fracture is suspected, an advanced study like an MRI, or more likely a bone
scan, will be order. (This is not to be confused with the DXA, the bone scan
used to measure osteoporosis, predominantly in women.)

If diagnosed, the order of the day will be rest.
This can be up to 6-8 weeks, some will be placed on crutches or given a fracture
boot, but if one returns to sport before it heals, chronic difficulties can
follow making healing a challenge. Triathletes might be shifted to pool running
and biking so as not to lose excessive fitness.

So, if you have recurring pain in the same location, and think this may
potentially describe you, get it checked out, you’ll be glad you did.

John Post, MD Kona Resident 10/1-9
www.johnpostmdsblog.blogspot.com

Ironman Hawaii, What Competitors Need to Know

With Ironman Hawaii just around the corner, athletes are now onto their final and specific training block leading into the race. This article is an overview of the training strategy and key workouts we use to coach our athletes taking part in the race.

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FIRE CRACKERS THROWN AT CYCLIST by John Post, MD

Yes, they have Halloween, even in Kona, Hawaii. This home is on Alii Drive. Note palms in the back ground.

Those of you who read my blog know that it’s all about exercise safety in addition to caring for the injured athlete. One of our better local triathletes was beginning a ride near his home last week when a slow moving minivan approached with the sliding side door open. At first the biker heard explosions to his right and then very quickly he felt fire crackers hit his shoulder and neck! As the driver sped away, the athlete took chase. But who can catch a car on their bike?

Unfortunately for this driver, he passed the athletes wife in her car at the next stop sign where a quick cell phone call from our boy allowed her to follow the van getting the license # and a description of the driver. He was apprehended that evening and a confession quickly followed. Charges have been pressed against the 11th grader from a nearby high school, and since he’s under 18 and this is his first offense, he’ll avoid court and go straight to the probation officer. As the athlete noted, “I make my living as a pilot and can’t afford to lose my hearing or eyesight.”

Our athlete was uninjured, although I suspect many of us – me included – would have crashed or run into a phone pole if the firecrackers were thrown at us. I believe I might think some one was trying to kill me. So what do we learn from this? Always carry your cell phone. Get in the habit of looking at license plates, even jot them down, which is easy to do if you keep pen and paper in your fanny pack with your emergency first aid kit. Don’t confront rude drivers alone.

It’s easy to think about retribution, about getting even, about finding those who run us off the road and putting a potato in their exhaust at night or flattening the tires on their car…or worse! But our goal is to live to ride another day and some of those folks on the road where I live might be just crazy enough to run me into the weeds if they thought I’d done something to them. Or worse, they’d run you into the weeds for something I did. And then we’d all lose.

Be careful………….. it’s a jungle out there.

The Keys to Improving Your Consistency and Discipline – Part 1 of 2

A common question I get at TriathleteMind.com relates to “being more consistent and disciplined”.

Not a surprise given the length and volume of training put in over a season. It’s hard to be ‘great’ day in and day out.

Here’s a specific comment I recently received from a 50 year old female age grouper in New Jersey:

“I want to improve my diet and eat healthier all the time. I know and have felt how intertwined everything is…better diet=better sleep=better weight=better energy level=better performance. I’m just SO inconsistent and undisciplined.”

This is a big challenge for most triathletes (…and people in general). For the most part we know what food is best for us, yet that knowledge doesn’t always translate into consistent action.

I could elaborate on many facets of why this is, but getting down to the core, we need to understand that Continue reading →

THE MENISCUS; TORN YOURS? by John Post, MD

The
Meniscus – Torn Yours?

”
I don’t need a whole lots of
money, I don’t need a big, fine car. I got everything that a man could want, I
got more than I could ask for.”
Grand Funk

In other
words, my knees work just fine, thank you.

The meniscus is an
important structure in your knee. Menisci, actually as we have two in each knee,
an inside (medial) one and an outside (lateral) one. They are “C” shaped bits of
fibrocartilage also known as semi-lunar cartilages which serve many functions.
This is important as it wasn’t that many years ago that surgeons felt the
meniscus to have no purpose and excised them at will, especially in the
pre-arthroscopy days. Some of you no doubt can remember that HS athletic injury
by looking at the sizable scar on your knee from your open menisectomy
(excision).

It’s currently felt that the meniscus aids in the lubrication
of the joint, stress transfer from femur to tibia, and that it contributes to
the stability of the knee. Unless injured, the meniscus will provide a lifetime
of service to it’s owner with out complaint. That said, through injury,
arthritis or just plain bad luck, any among us may suffer a “torn knee
cartilage.” As was true for both Tom Brady and Tiger Woods, the tear can
accompany injury to one or more major ligaments. Usually bad news.

Frequently, the injured triathlete will have a physical exam, x-rays
and/or an MRI with subsequent arthroscopy to remove or repair the damaged
meniscus. (In highly selected cases, a meniscus transplant may be considered
when more traditional methods have failed.) The arthroscopy is done in the
sterile environment of the operating room under a variety of types of anesthesia
– most of my patients watched theirs on the TV at bedside! The scope is
introduced through two 1/4″ punctures which rarely even need stitches at the
end. Oftentimes the procedure is completed in under an hour, there are no
crutches, and rehab exercises begin in the recovery room.

The surgeon
who’s seen the inside of your knee is likely in the best position to determine
your return to sport, possible limitations, etc.

Take good care of your
menisci, they should last a while!

John Post, MD

www.johnpostmdsblog.blogspot.com

Image 1 from Google images

Cool Advanced Bike Trick: How To Install Custom Wiring on Your DI2 Electronic Shifting Group Set

This advanced bike trick is brought to you by Australian triathlon coach Graeme Turner, of Fit2Tri

Disclaimer

These modifications could void the warranty on all components in the DI2 Group Set. These modifications involve fine soldering – do not attempt unless you are confident in completing these steps.

Battery

The Shimano DI2 is rated at 7.4 volts / 500mAh. This voltage is a common voltage for items such as radio control cars and video cameras. Amperage higher than 500mAh can be safely used – it will in fact give much longer battery life between recharges than the standard battery.

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CARRYING ID ON YOUR BIKE by John Post, MD

Plea For Carrying ID When You Ride

I’ve written before about the need to have some form of rapid ID on you when

you’re biking. Sadly, this article makes that point.

________Bicyclist Killed By Car ID’d

Father Of James Madison University Frosh Was On Way To Surprise Son

By Pete DeLea and Jeremy Hunt

HARRISONBURG –
Joseph V. Mirenda left Wintergreen on his bicycle Tuesday morning bound for
Harrisonburg. He was going to stop by and surprise his son, a freshman at
James Madison University, but Mirenda didn’t make it to the end of the 50-mile
trek. On Wednesday, police identified Mirenda, 49, of Virginia Beach, as
the victim in Tuesday’s fatal crash in Rockingham County.

Around 10:30 a.m. Tuesday, emergency personnel were dispatched to Port Republic Road,
about a mile east of Cross Keys Road, where they found the cyclist lying in the
ditch. Mirenda was riding west on Port Republic Road when he was struck
by a westbound 2000 Ford Taurus driven by Jessica Chandler, according to the
Virginia State Police.

No charges were filed as of press time Wednesday,
but investigators obtained a search warrant for the driver’s cell phone
records. First Sgt. Bryan Hutcheson with the state police said
investigators will be looking into whether Chandler, 22, of Port Republic, was
talking on her cell phone or texting in the moments before the crash
occurred.

“We don’t want to leave any stones unturned,” Hutcheson said.

Although the Daily-News Record has confirmed a search warrant was
issued in the case, the document remains sealed by court order at the Rockingham
County Circuit Court. Meanwhile, investigators are still trying to piece
together exactly how the crash happened.

They had spent Tuesday and most
of Wednesday trying to determine the name of the cyclist, who had no
identification on him.

State police caught a break in the investigation Wednesday afternoon when they
received a call from the Wintergreen Police Department.

A Virginia Beach woman contacted the department and said she
couldn’t reach her husband, who was staying at the family’s home in Wintergreen,
Hutcheson explained.

The wife mentioned he may have gone on a bicycle ride.

Wintergreen officers recalled seeing a man riding a bicycle there
Tuesday morning, and he matched the description of the then-unidentified cyclist
killed in Tuesday’s crash.

The state police and Wintergreen officers then
confirmed the man’s identity based on an inscription on a wedding band he was
wearing.

It said “Frauke & Joe” with the date 9-24-88 on
it.

Contact Pete DeLea at 574-6278 or
[email protected]
______________________________________________________

When
I put this up on one of the Tri web site forums, I received a number of cleaver
answers where some people carry there drivers license, a business card, their
cell phone, etc. One athlete has all his vitals written inside his helmet. But
is seems that many simply have identifying data on a card in a plastic bag in a
fanny pack, bike saddle tool kit, etc. Please make the effort. Do it today!

John Post, MD
www.johnpostmdsblog.blogspot.com

How Pro Balazs Csoke Won IM Korea

ironguides own Balazs Csoke recently won Ironman Korea, earning not only his first victory at this distance but also a spot for the 2012 Ironman World Championships. His coach Alun “Woody” Woodward talks about the training program that has brought steady progress for this pro athlete.

Balazs has made steady progress over the last 2 years with a very consistent training program, always working on developing his weakness while building on his strengths. His goal when he came to ironguides for coaching was to qualify for Hawaii, which has come about now with his breakthrough win in the Korea Ironman. Through the last 2 years Balazs has come to realize he has the potential to be a world class athlete and win some big races—goal posts are always moving!

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