Author Archives: John Post

About John Post

Othopedic Surgeon 6 Kona finishes Married, 3 children Marine Veteran Helicopter Pilot

Being Aware of Osteoporosis by John Post, MD









I was asked to comment on a piece recently published in the L A Times which noted that cycling, and swimming to some degree, are sports which keep you in shape but are low impact, put little mechanical stress on the skeleton, possible contributing to decreased bone mass. Osteoporosis.

So what is osteoporosis? Essentially it means porous bone, a condition that diminishes bone mass and density. Your bones are not static. They are constantly remodelling related to the stress they undergo. Although we’re used to seeing the sequelae of osteoporosis in the elderly manifesting itself as hip, wrist and spine fractures…why grandma keeps getting shorter…but, in truth, as we age bone formation often doesn’t keep pace with bone loss. In women, this bone loss accelerates after menopause. It’s been noted that in the decade following menopause that women can lose one fifth of their bone density! Definition-wise, osteopenia is diminished bone density, osteoporosis the actual disease state. In osteoporosis, fragility fractures fractures can occur from the simplest of causes, a minor fall, even just sneezing. In fact, I’ve had patients over the years with broken hips certain that the hip “just broke” before they fell. I believe them! Continue reading

It’s World Championship Time in Hawaii by John Post, MD



“It’s going to be a hard day’s night. The Beatles



We’re 40 days till the cannon blast signals the start of the 2012 Ford Ironman Triathlon World Championship. The athletes who are racing this year are beginning to struggle with the need to taper 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 hours per week. Age groupers too! For the first timers 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 conditions to ensure they’re in the annually expected 93% who finish the event instead of those who don’t. Continue reading

Hematuria, Blood in Your Urine by John Post, MD

Hematuria, blood in the urine


“Oh yeah, life goes on, long after the thrill of livin’ is gone.”  John Cougar Mellencamp


But Lew Hollander, yellow cap, would say you’re way wrong.  At age 81, he finished his 22nd  Ironman in Kona this year.  He says it’s how he “tests” himself.  Hard to have higher personal standards than Lew, a role model to us all.  He also makes many older triathletes jealous as he’s basically able to do this with only a modicum of injuries, often the rate limiting step to continued performance, particularly as we age.

Ever stood astride 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. Continue reading

Frozen Shoulder by John Post, MD

Frozen Shoulder

“Outside of a dog, a book is man’s best friend. Inside a dog, it’s too dark to read.”Groucho Marx
While donning my running shoes by my Jeeps interior lighting one recent morning I realized we only have 12 hours of daylight this time of year and it’s decreasing steadily. Since work takes up 8 of them, some of our training must be done in the dark. I have a friend who used start his training
day at 0230! Yes, he’s a mite intense. He’d get a majority of his training done in the dark.

You need to go the extra mile to absolutely ensure your safety-especially from motor vehicles. While running, attention to a possibly slippery road surface, choice of routes, bright clothing, reflector vests, even a red strobe light on your butt while always paying attention to your surroundings.

When cycling, riding single file is even more important than in summer daylight. Although we’ve all seen riders with hardly a reflector, I ride with 3 red lights behind: 2 solid on my belt and a strobe under my saddle. My friend has a suit with lights up and down the arms resembling Landing Signal Officer on an aircraft carrier. But, by gosh he’s visible. Careful, it’s a jungle out there.

Frozen Shoulder
In the office this is known as Adhesive Capsulitis. The patient is usually not aware of trauma (although a percentage of this group has has recent trauma or surgery to this shoulder) but notices an ever increasing loss of motion, a “capsulitis” or shrinking/tightening of the capsule around the shoulder joint. For some reason, it’s much more common in women than men, non-dominant shoulder, aged 35-55. Diabetes seems to increase the risk of developing FS. This is not arthritis or infection although its true cause is not known. Continue reading

Should Triathletes Donate Blood? Sure. by John Post, MD


“Back off man, I’m a scientist.” Peter Venkman, Ghostbusters

I think triathletes should donate blood. All of us. Doesn’t matter if it’s the Red Cross or your local blood service, just do it. Did you know that only 3% of the population gives blood so that 100% may ultimately benefit?

The first thing, as an athlete, you want to know how long it takes to return to the predonation levels. Back to where you’re not actually reverse blood doping. Well the plasma level is back up in 24 hours and the oxygen carrying red cells normalize in about 4-6 weeks. That’s why you can donate again in 8 weeks. Think about how frequently you read on Slowtwitch about someone being injured, car hits bike and the like, and then think what if that becomes you? Will there be blood available? The red cells only have a shelf life of 5 or 6 weeks, some of the components even less. Continue reading

Knee Collateral Ligament Injury by John Post, MD

“…fate comes at you cat-footed, unavoidable, and bloodthirsty.” Pat Conroy, South of Broad

We hear a lot about knee ligament injuries, especially when they happen to someone else who is dear to you who got injured and need an attorney’s help. But when it’s our knee that’s out of commission from falling off the bike while still clipped in, or twisted water skiing at the lake, it’s a different matter. The ACL or anterior cruciate ligament gets a lot of press. Bode Miller, Tom Brady, Tiger Woods. But the collateral ligaments (Tom Brady again) seem to take a back seat here. One reason could be that they usually heal without a lot of fuss so maybe less notoriety as well. Continue reading

Elbow Pain of Swimming/Biking Origin by John Post, MD


I took a walk around the world to ease my troubled mind. I left my body lying somewhere in the sands of time.”

Kryptonite, 3 Doors Down

Your thoughts when injured?

We frequently think of overuse injuries as running related but swimming can also take it’s toll. Swim training/racing can put us at risk for a multitude of upper extremity difficulties. We frequently see problems with the rotator cuff stealing the headlines, particularly in overhead throwing sports, while less commonly the elbow is involved. Many of us have either heard about or experienced Tennis Elbow (pain over the outside of the elbow or Lateral Epicondylitis, less often from playing tennis than from an alternate source despite its moniker.) Triathletes are more prone to Medial Epicondylitis – pain over the inside of the elbow. This is known in the literature as Golfer’s Elbow. You might be able to guess why. Continue reading

Baker’s Cyst (Knee Cyst) by John Post, MD

Got a lump on the back of your knee? Somebody mention Baker’s Cyst or popliteal cyst? Although it may be news to you, these are more common than many people suspect. While not normally an isolated finding, there are two bursae (bursas) in the back of the knee joint which can fill with fluid. Even though it feels like a mass, and when we think mass we think cancer and these have nothing to do with cancer. Most commonly these are a secondary process in reaction to something going on in the knee joint itself. They are neither life nor limb threatening but can be quite bothersome. They are not the result of an infection. People who have them will report that some days they’re large, some small, and while intermittently painful, the patient can actually be symptom free for much of the time. Continue reading

Arthroscopy for Arthritis, When is it Appropriate? by John Post,MD


“I’ll take any risk to tie back the hands of time.” Styx

Triathlon covers all walks of life and all age groups. It’s addictive, and it’s cumulative training, plus getting older, can have deleterious effects on the body. Why do we see fewer and fewer folks in the older age groups? It’s not ’cause they’re busy playing Mahjong at the Senior Center. As we begin to “wear out” arthritis can become part of the picture and we reach for the cure so we can continue training and racing.

When the knees start to go (and we’re not talking about the patient with some type of inflammatory arthritis here), many remedies can be recommended and be helpful including rest, or decreased training load anyway. Some variety of braces or sleeves are often of benefit. Therapy of one form or another with oral meds and injections have been known to be helpful in specific cases. And what about surgery? Continue reading

Work Out Guilt, of Course You Have It by John Post, MD

“It’s not having what you want, it’s wanting what you’ve got” Sheryl Crow

Triathlon training takes a long time. (“Duh”, many of you say.) This is especially true when preparing for the longer distance events. There’s only so much you can do squeezing training in and around your schedule before you have to do the same to their schedule whether “they” is wife, husband, kids, co-workers, etc. Frequently we find ourselves battling that inner demon who tells us that we need 30 more minutes on this run but our soul tells us to go home and relieve the baby sitter.

I was rereading John L. Parker, Jr.’s “Once a Runner” this week and thought a page spoke directly to this. I’m sure you’ve all read this wonderful text – if not go to and order a copy right now – but wanted to refresh your thought processes reminding us that endurance athletes have had to vault this hurdle for ages. Continue reading