Author Archives: John Post

About John Post

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

Knee Collateral Ligament Injuries 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. 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 →

Climbing Mountains Part Two, Being Afraid by John Post, MD

“Do the conditions you encounter exceed your abilities?

Although we as triathletes push pretty hard sometimes, we’re rarely outside our comfort zone in other than a physical sense. In last week’s blog, I briefly described hiking the John Muir Trail with my son Ben a couple years ago. This was a six day journey through wooded areas, over many creeks and streams, as well as some fairly steep mountain trails culminating in standing atop Mount Whitney, the highest peak in the lower 48, with it’s seeming 100 mile view. On the third day, our longest, after traversing some pretty difficult to navigate terrain (since we were so early in the season and didn’t have the benefit of hikers before us marking the correct trail), we crossed one particular river and unbeknownst to us, were off the trail. Way off the trail. We tried to back track to a known point, but we were lost. Lost in billions of acres of land…with no GPS…no cell service…no plan “B”, no nothing. The only way out of this was to think our way out. And, yes, we were at least a little afraid (although maybe the bears and mountain lions were a little afraid of us too. Maybe.)

It’s times like this that occasionally you don’t think terribly rationally. Like during the run in an iron distance race. In the former, although you have a tent and food for a week, you don’t know where you are. And, the in latter, you’ve trained for this for an awfully long time but are rapidly running out of energy and ideas at the same time. You may have to…oh, don’t even think it…walk! And walk a lot. Continue reading →

Training Doldrums, or 14,496.811 feet by John Post, MD

Training Doldrums, or 14,496.811 feet

Mt. Whitney, California, 14,496 feet, 7/17/2010

“Nothing happens by accident. I learned this the hard way, long before I knew that the hard way was the only path to true, certain knowledge.” Pat Conroy, South of Broad

I’ve been told that many of us train all winter with a subconscious goal, not of the season of races, but primarily with the season opener in mind. How were my transitions last year in race #1, am I prepared to exceed my swim time from last year now that I truly understand the course? That sort of thing. So, that regardless of this years performance (hopefully good), once the race is over some of us lose our way. We have difficulty finding that intensity, that focus, that drive. I don’t think that this is uncommon. Continue reading →

The Triathlete and Joint Replacement by John Post, MD

The Triathlete and Joint Replacement

“Some day I’ll wish upon a star, and wake up where the clouds are far behind me. Where troubles melt like lemon drops, away above the chimney tops, that’s where you’ll find me.” From, “Somewhere Over the Rainbow” (Or, it could be the unrealistic attitude of the triathlete with lower extremity arthritis when told that a joint replacement is in his/her future.)

_____________________________________________________________

“When I wear these knees out, I’ll just get ‘em replaced and race another ten years.” (Joe Triathlete)

In the words of Johnnie Carson, “Wrong barn breath.”

Looks like, between me and Dr. Dan Kirschner, you’re getting your fill of medical information. Maybe better too much than too little. The first triathlete I ever met doing Iron distance racing with an artificial joint in place was a gent about 35 years old who’d taken a bullet to the knee in Vietnam – and he had no choice. Winston Allen, from Florida, had his knee replaced a couple years ago and has his eye on Kona this fall racing at 81 or 82. A tall order for anyone of that “vintage” even with two knees which came from the original manufacturer. (Too old you’re thinking? Not so. Of the four men in the 80 – 84 year old age group in Kona this year, 3 of 4 finished! Impresses me!)

A replaced weight bearing joint, be it hip or knee, is a reasonable approximation of the original equipment. But to date, we’ve not figured out how to make them last indefinitely. That said, we’re getting better. Current expectations are a product life expectancy of about 20 years depending on in whom the joint gets installed. Consider the different demand loads placed on the prostheses by your average Medicare eligible 65 year old looking for a bridge foursome versus a 50 year old triathlete with premature arthritis and stated expectation of returning to the sport. Continue reading →

Are You Ready For The Unexpected by John Post, MD

Are You Ready For The Unexpected

Do you think, when this athlete was topping off the air in his tires his morning, that he thought, “You know, I’m sure glad I’m the the type of racer who never gets penalized…” I wonder if he was prepared for this.

Sunday They carried a man off the race course on a stretcher. I heard that he just collapsed on the run; maybe it was the heat – a low of 80 degrees last night. And the sun came up well before the first athlete was body marked or the transition area opened to further push the mercury toward inferno status… from a racing point of view anyway. You know, one of those days when the heat simply blasts you when it radiates off the asphalt. It’s a good thing most of were wearing hats and could put ice in them at the aid stations. As we watched them load him into the ambulance, we hoped it wasn’t something serious.

Continue reading →

Road Rash- Limits of Home Care by John Post, MD

Road Rash – Limits of Home Care

“The road is long, with many a winding turn.” The Hollies, 1969

“You want to know what it’s like to crash on one of these bikes? Get in your car, strip down to your underwear, and jump out at 40 miles per hour!” Jonathan Vaughters

There are two groups of riders: those who have crashed and those who will crash. You look at what used to be your skin, red, raw, and painful. Frequently, if you were really lucky, this is just a scrape, a superficial abrasion – a strawberry – like you had falling on the basketball court.

Now what? First, this is why I carry a water bottle – sometimes to drink from but mostly for hygenic reasons…washing off a dog bite or road rash to try to diminsh the chance of infection or leaving a permanent mark on the skin. Once you’re back home, a mild soap and water cleansing goes a long way, cover with a light dressing and bacitracin to keep the skin from drying out, and figure out when your last tetanus shot was (normally given every ten years but if there’s been a “dirty” injury, and it’s been greater than 5 years, get a booster shot). Continue reading →

Rehydration by John Post, MD

Rehydration

“Water, water everywhere, and all the boards did shrink. Water, water everywhere, nor any drop to drink.” Rime of the Ancient Mariner

It’s summer. By now your racing fluid plan should be well established. Gone are the days, as pointed out in recent blog, where you’ve ignored your fluid intake as, “It wasn’t that long a workout,” or “It was only a sprint triathlon,” (but it was 86 degrees!)
Although there are a lot of opinions on rehydration efforts out there, the only one that really matters is yours. You’ve calculated your sweat rate (weigh your self right before and right after a few lengthy runs to determine the % lost), read up on hyponatremia (dilution of the blood stream from excessive drinking for the current conditions) and have a general idea of your own needs. So why is it that so many athletes find themselves like camels at the oasis or that they don’t pee for 6 or more hours – despite continued fluid intake – after an event?

Continue reading →

Clavicle Fractures by John Post, MD

Clavicle Fractures

“Oh, somewhere in this favored land the sun is shining bright,
The band is playing somewhere, and somewhere hearts are light,
And somewhere men are laughing, and little children shout;
But there is no joy in Mudville — mighty Casey has struck out.” Casey at the Bat

The clavicle is the first bone in the body to ossify and among the most commonly fractured, particularly in children. It can be fractured via several mechanisms including the classical fall on an outstretched as well as striking the point of the shoulder. It’s not uncommon to also suffer rib, scapula and/or cervical spine fractures and is seen repeatedly in cyclists. Frequently a patient will tell me they actually heard the bone crack when the fracture occurred. This injury can be confused with an AC separation, a rupture of the ligaments at the end of the clavicle. They’re treated differently.
Continue reading →

Chronic Plantar Faciitis/Mumuku, the Wind That Blows Both Ways by John Post, MD

Puako is situated on the northwest coast of the Big Island of Hawaii. It is the home of one of the largest petroglyph (carvings in the lava) fields in the Hawaiian Islands. Found there are figures that are unmistakably those of the ancient Hawaiian warrior – the Alapa. Legend has it that, because of the intense heat and winds, this was an ideal training ground to harden these warriors making them Hawaii’s toughest and finest. Generally, the trade winds in the morning blow from the north, and as the volcanic soil heats up, the wind shifts around to the south.

This is especially important to would-be Ironman competitors as, after a crisp 2.4 mile swim in the Pacific with 1800 other racers with arms and legs flailing every which way in a scene more reminiscent of a washing machine than a swimming race, they mount their bikes and head north 55 miles to the coastal town of Hawi – you guessed it, into the wind. Unfortunately, by the time they reach this northern turnaround point, the land has heated sufficiently to reverse the winds, thus the bikers experience a headwind both ways – Mumuku! The locals think it’s cute.

Continue reading →

Pressure to Exceed Your Tri Capabilities by John Post, MD

Pre-race bike inspection. Everyone is still smiling.

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

Mark Foley is a local Veterinarian and a strong biker. His wife PR’d at the Boston Marathon a couple years ago. Their kids are into all kinds of sports. They work up gradually to the endurance sports they choose and are usually successful.

At a lecture in January, noted Triathlon Coach Joe Friel began to compare the running boom of the 80’s to the growth of triathlon today. (If you’d been told ten years ago that someone would pay $50,000.00 to get a slot at Ironman Hawaii, you’d thought them clearly insane. Yet, we find ourselves in the middle of the annual Ironman auction which puts up 4 entries to the race to the highest bidder/donator as the money goes to the Ironman Foundation. 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. Check out www.ironman.com to follow the progress of the last two slots.)

Joe’s story went something like this. In the 80’s, folks would have a friend convince them to go jogging, like it, and progress to running, and 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’re convinced they can begin marathon training. And some can. Their life becomes consumed with running and a myriad of details until they find themselves running the first 10 miles of a 26.2 mile experience. All goes well until mile 18, when they find themselves with shot quads, over heated, and out of ideas.

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.” Maybe.

But what happens when our hero gets to mile 95 on the bike, is beat, rethinking how aggressive she might have been over the first 56 miles, would like to call it a day but she’s not even off the bike – and there’s some running to do…? As Mark Foley says, “You have to have a plan B; alternatives.”

In other words, it’s OK to stop at a bike aid station and sit in a real chair while taking on fluids for 15-30 minutes. 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. Or even every 5th run aid station if that’s what it takes.

You have a full 17 hours to finish this thing. 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.

Injections for Triathletes, What You Need to Know