New Blog on Why Triathletes Need Vitamin D Every Day

I am moving future blogs to www.johnpostmd.com
Have a look!

tinyurl.com/ax2tbxn 

Surprised? Triathletes Do Not Have Fewer Injuries Than Single Sport Athletes

What to wear when your has chores for you.

I've made it a little too large so you can really appreciate it.

I'll bet this athlete was dressed and out the door in a snap.

A recent piece in the NY Times quoted what we've known for years that when single sport athletes switch to triathlon, their overall training hours go up and that rather having a decrease in injuries thinking they're spreading their workouts over three sports requiring "different muscles," the injury rate actually increases.

Joe Friel, author of the Triathletes Training Bible teaches that the true benefit from training comes, not during the workout itself, but during the subsequent rest period. Upon recovery from the added stress, the musculoskeletal system is just a little stronger than it was before.

This is the time of year, with snow on the ground that we're allowed to dream. We examine past racing successes and failures and use them as a springboard to set up our next season. Hopefully this is accomplished with more than just an ounce of common sense. Not only is the absolute load your body sees important but the rate of change of this load is also crucial. As one example, I did a blog on stress fractures a while back and one of the take home messages is that we can all do a significant amount of training as long as the rate at which we increase the volume and intensity of this effort is such that we can handle it. And no, I don't mean "handle it" as simply being able to either fit it into an already packed schedule or that you're tough enough to get it done. This should be interpreted as being able to accept the increase in training load on top of what's currently be done and the total training increase isn't greater than, say 5%, maybe 10%, of the previous weeks efforts.

We all know that there are a few people, maybe the ones you train with, who seemingly don't need to follow the ease into the work out guidelines. A pair of women I swim with are like that. They have no idea of/need for warming up. While the rest of us complete a 1200 yard warm up set, they pop into the pool as the main set is being described, adjust their goggles, and push off the wall full tilt for the first 200. Of course I'm jealous. But my logbook is fed 1200 more yards more than theirs on a regular basis.

So as we dream about that podium spot at the local sprint tri in 2013, construct a sensible training plan that carefully increases the rate at which your knees/Achilles are called upon to run more hills or time trial bike efforts. And, most importantly, when that little twinge becomes full fledged pain, take some time off of that discipline...channel your efforts into a different part of triathlon....you needed to work on your transitions anyway.

If you can carefully mold and execute your training plan, you stand a good chance of staying away from people like me (doctors) and having a terrific season. Good luck!


I'm fond of asking athletes if they think they do a great job slipping their training in between meetings, car pools, before the sun (and family) get up every day.  If they see their training as invisible.  While it's probably not, at least making the attempt to keep other's schedules and feelings in mind make for a happier triathlon family.

Below is the second fun photo, my way of "camouflaging" my indoor trainer.  You can hardly see it behind the planter.  Right?

Note clever camouflage. Plants nearly blocking view of indoor trainer

An Ironman Age Group Winner's Take On Fluids/When to Drink

I received this very thoughtful response from a quality Ironman Athlete, 2011 Louisville Age Group Winner, Dr, Steven Maves, in 9:40, 3:08 marathon!  He is an anesthesiologist by day, used to taking care of the sickest and most complicated patients.  Here are his thoughts on race day fluid management.

Dr. Steve Maves, pre-dawn darkness Kona Pier, 2011



John,

I liked you article about drinking. Mostly. I did want to make several comments that I think get way too neglected in the discussion. First, the most quoted study on the risk of "hyponatremia" seems to be the one at the Boston Marathon a few years ago. It was a poorly designed study at very best. Several reasons: It was not hot, they did not measure baseline values on anyone, they defined hyponatremia as less that 135 (If my memory serves me, iffy at best). As you know, I see a ton of preop sodium numbers on healthy outpatients. Lots are less than 135, and these are even in people who have missed their morning coffee which should further lower Na. At the very least, researchers need to measure sodium pre exercise. Anyone starting out "hyponatremic" would need to be excluded. Personally, I would redefine hyponatremia to less than 128 or 130 mainly because you are not likely to be symptomatic until it is below these levels. Plus, the test itself has a degree of error so that running the test twice on the same sample is just as likely to give you 133 on the first run and 136 on the next. It would also depend on whether the same is analyzed at a real lab verses an iStat machine (did Apple make those?).

I think you hit the nail on the head about the pre hydration crap. Lots of people still follow this folly and I still read people recommending this.

Personally, I think the answer is to know your sweat rate and try to come close. I can never stay hydrated! There are several reasons I think this happens. We know that elite athletes do not suffer from over hydration (mostly anyway). It is primarily a problem with slower, sometimes much slower, athletes that spend way too much time at aid stations seeing how much they can drink. For these types and those close to them, thirst is the way to go. But for the athlete who pushes hard, this simple method won't work. You have to start drinking early and on a schedule. At least I do and I don't think that I'm that unusual. I limit this discussion to hot weather.

Here is my logic. Because of the physiologic effects of cold water and weightlessness on the swim, most (I believe) pee prior to leaving the water. I always have to pee immediately after swim workouts. This never occurs after a one hour ride or run (I do not hydrate during my swim workouts). Warm water swims being worse for causing dehydration I'm told. So, we get on the bike a little down. The harder I push the longer it takes for thirst to be a factor that I think about. Honestly, if I don't start hydrating until I'm thirsty, I'm in trouble.

 I've checked fluid loss during 2-5hr bike rides of all kinds from tempo to just plain endurance. Even when I drink 24oz per hour (that's my goal and about the max I can tolerate) and the temp is 85-100 (think Kona or Louisville), I will still come off the bike down 4-6 pounds. That's a lot of fluid. Trying to run hard with those deficits is challenging and dangerous. Not to mention, this is where most of my nutrition comes from. I plan,of course, to change that to a less fluid source.  If you intend on a lazy ride stopping every 8-10 miles to put down 24oz you are going to have problems. Or if it is just down right cold like the year I did Coeur d' alene IM. Then it is off on the run. Again, if you are not putting down fluids you are in trouble. I don't tend to walk water stops (unless forced to by dehydration - think Kona) or fatigue (think Kona). I think it is impossible to get more that 3-4 oz in you at these water stops. I know my running sweat rate is 8oz per mile. You simply can't keep up. I have athletes that I coach weigh in and out of run workouts to get a handle on sweat rates at various temps and efforts. Most are in the range of 6-8 oz per mile (regardless of pace). If you come off the bike down, you are in big trouble. Again, if you plan to walk the run or it is cold, things have to change.

Two final thoughts

1. I hope the people I compete against wait until they are thirsty to drink. They will be pushing hard and those of us who stayed hydrated will be eating them for lunch while they suffer their folly.

2. Bottom line is you must know your individual fluid requirements, make adjustments for effort, temp and sun.

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My thanks to Dr. Steve Maves for permission to print this.

The Athlete With Bloody Urine Can be OK

As race results are posted on the back of the van.....Darn, you beat me....again!

Hematuria, blood in the urine

"Oh yeah, life goes on, long after the thrill of livin' is gone."  John Cougar Mellencamp


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.

In medical jargon bloody urine is known as hematuria.  Heme meaning blood and uria from urine. It can range from very slightly blood tinged all the way to frankly bloody.  It's not a diagnosis, it's a symptom.  But a symptom of what?  Let's follow a local Charlottesville runner, aged 22, runs 60 - 100 miles per week, is professionally coached and works in the local running shoe store.  He obviously has a handle on correct foot wear.  He started with a very slight pinkish tinge to his urine after his longest runs but over time has developed frank hematuria.

So, although even if you watch too much television, and are certain this is cancer, and you have mere days to live, medically speaking the first place we look is to a phenomenon called "Runner's Bladder" as it's both the most common as well as the most benign.  It's described  as bladder wall trauma, bruising, which leads to a small amount of blood in the urine.  When the runner decreases running volume or takes a couple of days off, it goes away.  For a while that is, until long runs resume.  It's said that running with a partially full bladder can eliminate this problem but it's a level of discomfort many can't stand.  Every heel strike reminds one of the urine's presence.

A visit to the Urologist by our runner reveals that although the mostly likely diagnosis is Runner's Bladder, the list of possibilities including kidney stones, tumor, infection, various kidney problems, etc., is pretty long.  So, to solidify the diagnosis, the Urologist plans to perform a cystoscopy - an in office procedure in which he will insert a small fiber optic scope through this runners penis up into the bladder. ("You're going to put a what into my where?"the runner was heard to exclaim!)  In the past, predominantly because of the larger size of the scope and the pain it would cause, this type of procedure was done in the Operating Room under anesthesia.

Good news.  During cystoscopy, our athlete's bladder wall revealed generous bruising and no other obvious source of bleeding.  So for now, he'll continue his running career, and his hematuria knowing that he's not causing irreversible long term damage.  Maybe he'll try again to learn to run with his bladder half full.  But he's 22 with a head full of steam.

Maybe.

Teaching Triathlon Coaches; Athlete Success Factors

Professor Friel

2013 TrainingBible Coaching Annual meeting.

This weekend, the annual get together of TrainingBible Coaching took place in the Chicago suburbs with great attendance and a real give and take from all. I was invited to join the faculty including Joe Friel and Olympian Ryan Bolton. I do a fair amount of teaching each year, mostly to other doctors, but the one WE where I'm privileged to talk to triathlon coaches has become one of my favorites. I think that this group really pays attention and they make you glad you went to the time and effort to put a talk together just for them.

I hope I'm invited back next year.
__________________________________________________________________

Today's blog will not be a long one.  I simply wanted to present a few of the most interesting and applicable thoughts that emerged from Chicago.

A fascinating lecture was offered by Joe Lotus, a name well known in Chicago tri circles, IM veteran and guy who seems to think problems through carefully.  He talked about the factors that contribute to an athlete's success by presenting data from a study of the 2008 Canadian Olympic Team where medal-winning athletes were questioned about which factors contributed most to their successful performance.  Below were the 5 most common responses:

   1) Strong athlete/coach relationship
   2) High level of athlete awareness
   3) Strong support system - Family, coach, priest, etc.
   4) Effective training environment
   5) Management of competition environment

The study pointed out that responses 1 and 2 were overwhelming favorites.  When you think about this, I suppose it's not hard to agree with this information.  While most of us will never be Olympic caliber athletes we can still apply the above in our own lives.  If you're are a coached athlete, ensure you and your coach are on the same page and that your relationship reflects the above.  If you coach yourself, be willing ask, to change, to learn during your training cycle.  I think if you can avoid the "need" to make up work outs if you've been sick, out of town on business, victim of absolutely awful weather, etc. then you'll be less likely to suffer a training related injury.  It was 11 degrees running in Chicago this morning, -7 if you look for the wind chill.  It's easy to see that a steady diet of this might put a damper on outside training some times.

One other point made this WE involved children in sports. In my mind it's also applicable to us adults.  There must be enjoyment being involved in sport.  Up to 75% of kids drop out sports by age 13....mostly because they're not having fun anymore.  Since triathlon can be an individual sport, and occasionally the work outs more drudgery than entertainment, it's up to you to keep it enjoyable over the long haul.  Mix things up, train with others, the Saturday bike group, that Tuesday evening Masters swim class, etc.  Do that and you'll be a triathlete for a long time. And a darned successful one too.

Thanks to Joe Lotus

The Ultimate, All You Need To Know, Hydration Plan

The Power of Water!

Alii Drive, Kona, Hawaii, after the tsunami from the Fukushima, Japan earthquake

Hydration and Dehydration, All You Need to Know 


First, my bias:
      I believe the "drink all you can drink" hydration method to be both incorrect and dangerous.
      I believe the "drink to your thirst" plan misses out on an opportunity for you to excel, and at it's limits could also be dangerous.  Here's why.

Your first day in medical school, with only a little tongue in cheek, they tell you that the answer to a question you may ask today is somebody's educated guess given knowledge available today.  If you'd asked that question 20 years ago, same question, you'd likely get a different answer.  The same may be true if you were pose this question 20 years from now.  In other words, as science moves on and we continue to learn, the following is what I believe the exercise science literature says today about your hydration and leave it up to you to ask again in two decades.

First, let's review the above two extremes.

I still have the CD on which a famous tri coach, at one point the official coach of Ironman so he should know something, gives the instructions to really tank up at supper the night before your race, and carry a water bottle with you around the transition area as you're prepping on race morning to start, well, saturated!  The only other really good part of that plan was to pee, probably in the body of water in which you are about to race, at the end of your warm up swim moments before race start.  You begin with an empty bladder. (Because, if you follow that strategy, it won't be empty long!)  Then, each of us has seen directives where, particularly on the run, we should never pass an aid station with out drinking at least something.  I'd agree with stopping if, at many of the stations you bypassed fluid and got a banana piece, pretzel, apple slice, gummy bear, etc.

Option "B" would have us consume fluids normally up until race start, and then only drink when we felt thirsty, whenever that might be. As I see it, this can be problematic.  First, as we age, our ability to conserve water in our bodies diminishes and our own ability to sense thirst decreases (Mayo Clinic.)  Another getting older problem is that we respond more poorly to changes in ambient temperature.  And, although I've heard it said by some that dehydration doesn't typically effect performance, and that the winner of the race may well be "the most dehydrated one out there," that would be counterintuitive to what we know about dehydration.  In fact, a piece by noted Sports Nutritionist Asker Jeukendrup recently stated that, "Exercise performance is impaired when an individual is dehydrated by as little as 2% of body weight.  Losses in excess of 5% of body weight can decrease the capacity for work by 30% (Human Kinetics, 1/14/2013.)

Thus it would seem that we would be best off if we constructed a hydration plan, just like we've constructed a training plan and a race plan, to keep us from over hydrating, risking Exercise Associated Hyponatremia (See my 12/17/2012 blog), and under hydrating risking a performance decrease.  Right?

Dr. Doug Casa, head of the Korey Stringer Institute at the University of Connecticut, and author of one of the definitive books on Preventing Sudden Death in sports says that ideally we would each use a "personalized hydration plan based on our own individual sweat rate."  You can do this if you wish by referring to Track Coach 2004;167: 5321 - 5328.  It's not a  bad idea.

OK, now how do we apply the above?

Pre-race.  We've seen above that you don't start the night before, and maybe just a little on race morning.  You already have a mental check list including body marking, transition set-up, a visit to the port-a-pottie for that last minute poop and bladder emptying. Drink some, without going over board, so that you don't toe the start line thirsty.

If your race is only an hour (even 1.5 hours in some of us) it's actually been shown that performance wise, you really get no benefit by drinking.  None.  You just lose the time you slowed at the aid station. But, if most of the water is poured on your face and head on a hot day, or you grab some ice that's put into your hat, I say go for it.

In a longer race, be conscious of your thirst and drink accordingly.  Remember that although you may be "trained" to drink frequently whether or not you need it, don't.  If you are the 175 lb. athlete in Dr. Jeukendrup's model, to be 2% of your body weight down, you have to be 3.5 lbs down!  Not impossible at all but something to be aware of.

If you carry a belt with fluids or a hand held device in training, don't race with it.  These may be beneficial in practice but most definitely not in a race.  Look around, everybody ahead of you doesn't have one.

Lastly, remember the old adage of never doing anything new on race day?  This might include finding out the official beverage of your upcoming race.  You'll want to determine if they provide a commonly used product or possibly one that your GI track doesn't like all that much.  Or, one you don't know at all.  A simple e-mail to your race director will get you that information and from my experience, race directors are great people, interested in your success and happy to help. Now that you know, get some of this beverage, give it a go during training, and make an unknown a known.  If you don't tolerate this specific product, you can always simply rely on the old standby, water, and a gel product you've consumed in the past.

OK?  These are the basics from which you can and should build your own hydration plan, one that fits YOU.  So, like Baby Bear in the story of Goldilocks, when she says, "Ahhh, this porridge is just right," you'll arrive at the race finish line, "Just right!"





Images 1,2 Google Images

Faster in 2013, Plan it Today

It's January for Pete's sake!  You can be better, you can be faster, you WILL be faster in 2013!  You have months to get there. 

I'm just sure of it.

Dinner with God
  (This is not new, but given the time of year, I thought it appropriate.)

God is eating dinner alone.
Aaron Rodgers approaches the table and God asks "What do you believe?"
Rodgers says, "I believe in hard work, and in staying true to family and friends."
God can't help but see the goodness of Rodgers and offers him a seat to his left.

Tim Tebow walks up and God says what do you believe?
Tebow says, "I believe in your total goodness, generosity, and that you have given all to mankind."
God is greatly moved by Tebow's eloquence and offers him a seat to his right.

Finally, Tom Brady comes to the table, God asks, "And Tom, what do you believe?
Brady replies, "I believe you're in my seat."
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I had someone tell me once that they'd think twice before hiring some one deeply involved in this sport.  Sure, the old adage about giving  something you want done to the busiest person you know is part of this, the positive part, but does the prospective hire think, plan, drown in triathlon during their work day to the point that it diminishes their effectiveness....?  I don't know, but knowing more than a few people who fit this description, what do you think?
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"Lack of planning on your part does not constitute an emergency on mine."

What did you forget? And don't say nothing. At one point we've all omitted one thing or another. In a previous blog, I somewhat sheepishly admitted leaving my bike shoes home for one of my "A" races, an event in which I'd won the age group the year before. Needless to say I did not repeat!

This is the time of year that the conscientious triathlete not only begins to dream of the potential for the upcoming racing season but starts to develop a series of goals and a road map to get there. This could be something as complete as a computer generated Annual Training Plan where the entire schedule, division of swims, bikes, runs, rest days, the works, are populated. Or, it could be sitting down with the local swimming guru if this is your weakest sport, your limiter so to speak, and getting his/her hands on expertise at incorporating the best combination of workouts, drills, indoor and outdoor swims to put you at the greatest advantage come race day. It also wouldn't be out of the question to plan that single sport block that we've discussed before.  It's a unit of time early in the season, where an inordinate amount of training - but not so much that it leads to injury - is devoted to one of the three sports. Swimming seems to get the most attention.

Since this blog is about minimizing injury, this time of year would also be ideal to plan ones training stress, training volume - the amount of work you plan. This is the slope of the effort line from now till the first race that not only gets you prepared, it does so in a very gradually increasing fashion, to minimize the potential for Achilles tendinitis, IT band problems, stress fractures, etc.



I firmly believe that much of the misery, lost training time, races missed, etc. could be avoided if each athlete took the time to plot out the whole year, just as Mark Allen preaches, with this in mind. It would sure make my work load easier, and life happier for many.

It's January for Pete's sake. If you haven't finished your Annual Training plan, do it today.