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 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 →

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 →

“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 →