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DOG BITES BIKER, BOTH SURVIVE by John Post, MD

Dog Bites Man, Both Survive


The sword of time will pierce our skins, it doesn’t hurt when it begins. Johnny Mandel, Suicide is Painless

I’m a slower biker than I used to be. Or maybe the dogs have gotten faster. Either way, a dogs teeth “pierced my skin” last year while I was cycling a few miles north of town. I stopped, went to the owner’s house and reported it. Surprisingly, he offered no apology, no help, no phone call, no nothing. He just said,”I’ll take care of it.” Well, that’s not good enough. I told him I’d notify animal control as soon as I got home. He was not happy and made that very clear.

Actually, I pedalled out of sight of the house…and dog…stopped, cleansed the bite with everything that was in my water bottle. I tried to remove as much of the dog’s saliva as possible. As soon as I was back in cell phone range, I called my wife, gave her the facts and the house
address in case the headlines in the next day’s paper included “Biker shot north of town”(The dogs owner made out like it was the biker’s fault) she’d know where to start the search.

Then it was a short ride to my doctors office where the wound was cleaned and disinfected, tetanus booster administered, and phone call made to animal control. Although you’re concerned about infection, rabies, although unlikely, is more of a concern. I had a bat land on my head once while running – I know – a what? Although I felt the sharp claws as it landed on my skull cap, the skin wasn’t broken and I wasn’t bitten. They are known rabies carriers. The difference here is that with the dog, it can be observed for any signs of illness, it’s inoculation status is known, as is it’s physical location. None are true with the bat.

We’ve been vaccinating dogs in this country for over seventy years and this has reduced the documented cases of rabies to less than 5 annually. Internationally, however, upwards of 50,000 deaths occur each year, probably more. In the U.S. when we think rabies we think skunks, raccoons, foxes, and as mentioned, bats. A bat’s bite can be missed, particularly by children. If one is found in the home,particularly with access to sleeping children, it should caught for later examination.

In short, although dogs chase us repeatedly, and there are some roads we avoid simply due to canine presence. Should you be bitten:

1) Identify the animal and inform local animal control
2) Cleanse the wound as best you can immediately
3) Seek medical care

As mentioned, very few die from this disease. But if you need the post-exposure rabies prophylaxis (series of shots), they are neither painless nor cheap. In other words, forget about those new aero wheels!

John Post, MD
www.johnpostmdsblog.blogspot.com
“Your Medical Help at the Races”

SELF INDUCED INJURY, TIBIA FRACTURE by John Post, MD

Self Induced Injury, Tibia Fracture


I have given a name to my pain, it is Batman.” Jack Nicholson as
The Joker
And speaking of pain, I was recently asked asked about a blog I did on stress fractures a little while back and thought the following important as we set our training plans for the upcoming season. Although our weather forecast here in Virginia calls for 6 – 12″ of snow tonight, athletes everywhere are creating training plans to fit race schedules this Spring and Summer.Even the lawyers at a bicycle accident law firm would be surrounded by questions. Especially from athletes.  So many athlete’s questions involve self-induced injury!  If there are any accidents, lawyer for bike accidents can be hired! Time and again when a triathlete reports a physical issue, and then comes up with an, “I know when I did it” type of answer, I think about prevention. Any list of the most common overuse injuries in runners would include : 1) Patellofemoral pain (21%), 2) ITB friction syndrome (11%), 3) Plantar faciitis (10%), 4) Meniscal injuries (6%), 5) Shin splints (6%), 6) Patellar tendinitis (6%), 7) Achilles tendinitis (6%), 8) Gluteus medius injuries (4%), 9) Tibia stress fractures (4%), 10) Spine injuries (3%) as noted recently. People can get AED Training in case of any first aid injuries.

In one medical study, 6 young men presented with midshaft tibia stress fractures which failed to heal with the usual conservative care of rest, immobilization, etc. and 5 went on to complete fractures!! Think having a rod place down the middle of your tibia might alter your training?

We also think of the metatarsal bones in the foot as commonly seen sites of stress fractures but I was taught that they’ve actually been reported in all 26 bones in the foot and the sesamoids.

The take away lesson here is that none of us is immune. Running programs which ramp up more quickly than the athletes body can take can be hazardous to ones health, and that when weather or life get in the way of training, the better choice might be to just forget a work out or two rather than accept overload at a later date. Each of us is different as we define overload so just because a training partner can work at a certain level does not necessarily mean we can. If we just think before we make choices and listen to what our legs are telling us, we reduce the potential for self induced injury. And, we’re more likely to kick butt in that first tri. Good luck. But, if there are any injuries, personal injury lawyers based in Arkansas need to be hired.

www.johnpostmd’sblog.blogspot.com
Triathlon Swim Starts

TRAINING ADVICE FROM HEAVEN by John Post, MD

 

Training Advice From Heaven

ALII DRIVE, start and finish of the Ironman World Championship. You can bet this snowy picture wasn’t taken in Kona!

 

Dick Tomlin was a friend. A super triathlete, he podiumed twice in Kona and even won Worlds one year. He was killed on his bike in June 2005 when he was the victim of a hit and run by a motor home while training near his Kingman, AZ home.
The last time I talked to him was in February or March of that year when he was trying to help me get faster and I was trying to help him with some pain control issues he was having with arthritis in his lumbar spine.
The following is going to be a little disjointed, just like a phone call, where we talked about whatever came to mind. Even though Dick is no longer with us, you’ll see that he has a number of important training points to make: he credited his age group best bike speed to consistency, lots of winter miles indoors, abundant one-legged drills. He would decrease the resistance and do 100 revs with the right leg and then the left. Repeat this 6 times, “like wiping your feet on the floor mat.” Learn how to cycle with each of your legs.”
For short course tri preparation, he’d ride “really hard sprints.” He’d set up a one mile course near his home where he’d ride faster than race pace and, “Do a dozen with 15-20 seconds rest in between.” He didn’t do much hill work as “The races I do don’t have ’em.” Although he usually rode alone, he had one friend, a CAT 2 cyclist, who he’d been riding with for 12 years allowing, “Those guys know so much, it really pushes me up.” Weights were important as he’d follow Joe Friel’s Training Bible, “Except the max weights,” 3X’s/wk in the winter and once/wk in season. An average training week would include 110-120 miles on the bike, 25-30 miles running and 8-9,000 yds in the pool, he’d “Work up to double this for Ironman.” This would be “22 hours/week in late July and hold it to September.” He wanted 8 consecutive weeks over 250 on the bike and 50 on the run, reserving one weekend day for a 5 hour bike and a 2-2.5 hour run. Or, for variety, it would be a 2hour bike and 3 hour run. Clearly he was motivated.
But, Dick was not without pain as he’d had both knees scoped in 1998 noting, “I’d run in pain for a decade.” He took his share of Glucosamine. Plantar faciitis was a continuing issue. And I already mentioned his back. But he did not shy away from what he perceived as the work required to be tops in the age group.
And he was a nice guy.

Training a bit of a problem on your street, too?

How To Indulge As A Triathlete

This article was focused on Holliday season. All though that time of year has passed this article still has relevance for all triahtletes as athletes can struggle during winter months to stay on track.

As we head into the second half of December, the party season is in full swing. This is a great time of the year but also a minefield for athletes; everywhere we see temptation that would derail all the good work we have done in the past weeks to regain fitness after a good break from the race season.
We should enjoy the festive season as it truly is special and with a little planning we can come out of this month still in great shape and ready to advance into the new year.

There are two big problems we face during this period that I want to talk about in this article and I will also recommend the steps we can take to avoid them, i.e.:

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Donating Blood, It’s Easy – Do It Today by John Post, MD

Should Triathletes Give Blood? Of Course!


“For every complex problem, there is an uncomplicated answer; neat, simple and wrong.” H.L. Menken

HuliSue’s is a terrific barbecue place in Kamuela, HI when you find yourself north of Kona some day. If you ordered a beef sandwich, you’d get plenty of iron to help make red blood cells. Ah, but then what do you do with those red cells? Keep ’em? Donate a few to someone who might really need them?

Well, I’m prejudiced. I recently donated my 100th unit of blood to Virginia Blood Services. If you realize that when a “pint” comes out of your veins, only about a third of it is blood cells, the other two thirds being plasma. The fluid portion will be replaced in your body in a couple hours but it will take the bone marrow about 3 weeks to restore the RBC’s. Each person’s reaction is different, and changes from donation to donation. One may have to reduce the intensity of work outs for a short time, and probably would cease donations a month to 6 weeks before an important race, or the racing season in general. That said, platelet need is always in season, requires no loss of red cells (or oxygen carrying capacity), and can be done virtually any time in the year.

There are lots of reasons not to give blood…a needle stick, a few days of non-maximal training, rumors from the uninformed, etc. But, there’s never an over abundance of blood, it’s needed for patients getting dialysis, heart surgery, cancer and trauma victims, etc. Heck, Lance might have even needed a transfusion following his orchiectomy and subsequent chemo.
Lastly, who among you hasn’t had a bike crash? One day, the need might be yours.

So find your local blood bank on Google, see if you need an appointment or can just drop on by – my choice; I can be out in 30 to 45 minutes – and make that mental note to give this week.  You’ll really be glad you did.

John Post, MD

Rotator Cuff Tears this week

Barefoot Shoe Running Review (Minimal Shoes)

The introduction of the barefoot-style running shoe was something eagerly awaited by runners, triathletes and duathletes around the world. In the past, most athletes wanted a light-weight racing shoe to compete in but, if truth be told, a large percentage of them were looking at this for all the wrong reasons. Either the running shoe could simply not handle their body weight or their running style just did not suit the minimalist nature of the shoe, or sometimes both. What this inevitably lead to were injuries in untold proportions (and certain people rubbing their hands in glee with $ signs in their eyes.)

Word soon got out and so athletes started to return to conventional running shoes. That was until the introduction of a report in 2009 by Dr Craig Richards from the University of Newcastle in Australia. His report concluded that shoes with elevated heel pads and elaborate anti-pronation systems can’t prevent injuries in runners. This was backed up in an excerpt from Born to Run, a book by journalist Christopher McDougall. The story referenced Dr Daniel Lieberman, professor of biological anthropology at Harvard University, who offered the conclusion that “a lot of foot and knee injuries currently plaguing us are caused by people running with shoes that actually make our feet weak, cause us to overpronate (ankle rotation) and give us knee problems.” Continue reading

GET A PROFESSIONAL BIKE FIT, AVOID INJURY by John Post, MD

 

What is the Value of an Experienced Bike Fit? It’s Invaluable!


John Cobb counsels a novice triathlete at Glen Ellyn, IL bike fit.
As a surgeon, I think I learned as much from doing my 1,000th, or 10,000th knee arthroscopy as I did from my 100th. When you do something over and over and over again your learning never stops. Bike fitting is no different.
I would speculate that many of you have had a professional bike fit…or two…or three…or…? Personally, I had a noted east coast coach fit me ten years ago. About 4 years later flew with my bike to the west coast to be evaluated with the IR cameras by “the pros.” These two fits were quite different from each other. Lots of computers, measurements, images, etc. during the second fit. But, I was never really comfortable, faster maybe, more aerodynamic maybe, but not more comfortable, particularly the seat. (I even had xrays taken of my pelvis.)
That is, until I met John Cobb…who just talked to me. And then we talked some more, before coming anywhere near the bike. It was very similar to the doctor patient interaction where, if the doctor actually listens to the patient, something I must admit that I don’t always do as well as I should, the patient will tell you the diagnosis.

We then spent the better part of an hour, first taking the rear end apart and putting it back together. Then the same with the bars and front end, changing bit by bit, until I was simply pedalling for 15-20 minutes talking about the old days of triathlon with John…and I realized it didn’t hurt. Hallelujah! My time was worth the 750 mile drive.

I know that we haven’t reached the end point yet but it’s nice to have a road map for the future. The take home point here is that our sport is many things to many people but foremost it should be enjoyable. We don’t all need to do the Ironman or Race Across America, but if we enjoy the time we do spend training and racing, we’ll benefit from it in ways we have yet to imagine.

What Is A Good Swim Time For My Age?


What is a good time for my age? is one of the most common questions we are asked at Swim Smooth and, to be honest, it’s a question we find uncomfortable to answer. That’s because it’s a bit of a loaded question.

L-R: Suzi, Barry, Brian, John, Emmie
One of the most important duties of a coach (of any type) is to help remove barriers from someone’s progress and absolutely never introduce new barriers that were not there to begin with. Normally a swimmer asking this question is looking for an easily achievable target, perhaps one slightly quicker than their current speed, that they can achieve and be happy with. On the face of it this may seem virtuous but such an answer creates a very self limiting mental state that can stay with the swimmer forever: I can’t be any better because of my age.

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Triathlon Lingo 101 – Learn How to Talk Like A Triathlete

As a triathlete, you don’t want to be embarrassed by using the wrong triathlon-related words or terms when talking about your sport (including the ever-popular pronunciation of triathlon as “triath-a-lon”).

Instead, you should be able to impress your friends with your deep knowledge of triathlon lingo. So consider this post your go-to guide for learning all the important triathlon terms.

I’ve split them up into five basic categories: swimming, cycling, running, races and transitions. Without further ado, let’s dive in!

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HOW DO YOU MEASURE SUCCESS? by John Post, MD

How Do You Measure Success for 2012?


Some triathletes overcome greater obstacles than many.”

I’ve seen a number of criticisms directed at the print media of our sport lately. Probably pretty easy to do from the outside. The two most common seem to center around glitz, an abundance of adds loosely connected by a few articles, and second, an inability/unwillingness to be critical of say WTC or USAT in defense of the little guy. (A $650 – or more! – entry fee for a triathlon as one example.) There were even efforts afoot by H3 Publications to present a different Tri publication, seemingly more difficult than perhaps first thought. Whatever your position, as the consumer you have the right to evaluate information and apply it as seems appropriate to your sporting life.

There was a piece by Mitch Thrower in Triathlete a while back which made good reading. He made a number of excellent points regarding the well worn phrase, “We are what we eat,” and the role our current understanding of genetics plays. This relates not only to our bodies ability to process what we take in, but what we become and our control over this outcome. He goes on to show that lifestyle choices can make a significant contribution to the overall end game when combining genetic predisposition along with dietary and exercise choices. Although to some degree your athletic potential is pre-programmed, you are still Captain of the ship! (Sound like something you’ve heard from Ben more than once!)

Mitch puts you in control to some degree. I had a patient some time back that I used as an example while teaching a course in St. Louis to a group of very bright triathlon coaches. This particular young man was being prepared for a knee reconstruction and on his intake form he noted his weight at 380 lbs. When I saw him a couple weeks later for his preop physical, he mentioned erring on his weight which was really 420.  An accurate weight is essential in the operating room as, for example, medication quantity is in direct proportion to patient size…and I doubt one would like to wake up unexpectedly having been given too little of a certain drug!

Since the Day Surgery scale, like many of those at home, isn’t reliable over 330 lbs, I asked the nurses to send him down to the laundry for an accurate weight where the scale goes to 1000 lbs. And he needed it. His ultimate weight was measured at 550 lbs!  That’s right, 550!  In other words, his initially reported value of 380 was 170 lbs. less than actual, something he and I discussed at length after surgery. He admitted that he’d basically lost control of both diet and exercise and anything over 330 was simply a guess. Not a good guess but a guess none the less.

He did well post op, had a stable knee, and the last time I saw him was headed below 500. This is not easy in the rehab period but he’d defined the problem and begun to take back control of his life. I hope he’s had continued success. As triathletes, we already have the exercise part of the equation down. We now understand there’s a significant genetic component in play here, but we are also being given some bit of control knowing that our own destiny is more than putting bike miles in a training log. Can success as you define it be far off?

Happy 2012 and Best of Success in an injury free year of training and racing.
John Post, MD
Knee Pain, A, B, C’s 1/1/2012