Archive for Medical Monday

The Triathlon Rx | April 30, 2012
4 comments

Medical Monday: Hip Check

A day home sick is a perfect day to do a little updating! I should probably be folding the 3 loads of clean laundry I just dumped on my living room floor instead, but clearly I’ve got priorities here…

As of lately, it seems like people ask me only one of two questions: 1) How is the hip coming along? and 2) When are you going to be running again? It’d be great if I could just hand them all a business card with my blog address and not have to re-explain, again, the whole story. But I understand their curiosity, and hey – I’d like to know the answer to #2 myself! So for you guys, I thought I’d get this in writing.

Independence Day 10K, 2009. Where’s Waldo?

1) HOW IS THE HIP COMING ALONG?

If you’re just stumbling upon The Triathlon Rx and don’t know what I’m talking about, you can either disregard this post entirely, or jump over to my post-surgery story.

According to my iCal, we are approaching 20 weeks out from my December 14th surgery. That’s 4.5 months of physical therapy, and probably more face time with my surgeon than he could ever hope for! As with most things in life, rehabilitation has not been a linear progression, including some “unexplained” weeks worse than usual. You might have read a few weeks ago (which sadly was only two posts ago… my bad!) that my PT said I could “try running.” There should be asterisks smothering those two little quoted words, because that definitely wasn’t a go-ahead to just go lap Lake Calhoun. He meant more like a 1:5 jog easy:walk interval to SEE how it feels.

How did it feel?

Sh!tty. The muscular strength just isn’t there yet (hence why I still walk like a penguin) and it was both painful and awkward. (If you saw a quazimoto attempting to gallop around the lake at 1:30 on April 4th, please bleach that image from your memory. Thank you.) Have I run through worse pain before? Sure, but I think maybe I’ve finally come to understand it’s just not worth it.

2) WHEN DO YOU THINK YOU’LL BE RUNNING AGAIN?

This is one thing (out of the many many things in life) that I simply do not know. My PT doesn’t know. My doctor doesn’t know. They’re not making predictions and neither am I. The three “races” that I’ve signed up for this summer so far are two open water swim races and a half iron relay, and as much as I hate to say this I’m don’t even really feel committed to either of those.

Don’t get me wrong – I do enjoy running/biking/swimming/training, and I do enjoy just being in the community at races. But I race to race. (A concept I’m sure my buddy Susan, dealing with a cracked out back is very familiar with!) They didn’t drill the competitiveness out of me during surgery – if anything, I’d say it’s only gotten stronger because there is no validation coming from what I’m used to doing (running).

The two exceptions to this rule (and it is very critical I get this in writing here dear Mama reading…) are if and only if:

A) My mom would FINALLY agree to do a race with me

and

B) If I have kids someday. I would definitely do races with my kids for fun.

(Christmas 2009 – snowed in and stuck in the cities, so we run!)

So that pretty much sums up the two FAQs. If I were to add a 3rd, it would be “What can you do for training?” I have been biking a fair amount when possible, and swimming (though still not as much as I should be). I also got a new swim toy that has beyond exceeded my expectations, and definitely changed (for the better) my desire to swim. Yes, this means a product review is coming soon!

The last thing I should mention – and no, this site has not been hacked - is that I’ve been doing… yoga. :eek: Especially after my Open Letter to Aladin Pants man!! No worries… I’m not going to start speaking in Sanskrit or doing wheat grass shots. BUT for right now, it gives me some sort of a structured routine, and it’s nice that it’s not a solo activity. I will probably update a bit more on this part later.

Sorry. I couldn’t help it… :D

Reader Qs: 

What is your go-to activity in times of rehab? 

Do any of you have a local twin cities swim coach recommendation for me? Ideally someone to work with two times a week. One of the OWS races I signed up for is, um… Somehow my mind read 5K, but it’s 5 miles. Point to point. So Ironman swim x2 plus some change. But hey, you don’t have to saddle up a bike for five hours afterwards! ;)

Mac just said I’m running on reserve power, which must be a sign it’s time to go! Catch you later chicos.

-E

Category: Medical Monday | Tags: , , , , , ,
The Triathlon Rx | February 20, 2012
12 comments

Medical Monday: Get Swole.

This might be a stretch to pull off as a Medical Monday, but laughter is the world’s best medicine, right? A friend shared it with me last week, so now I’m sharing it with you! Proprietary rights to Rock Rannick over at Muscle & Brawn. (Original post)

___________________________________________________________________

Four Ways To Get Freaking Huge

Time To Get Swole

Man, do I have some magical, mystical, mass building advice for you today. But I know – you’re extremely skeptical. You’re waiting for the bullcrap; to be let down by some cool sounding training system with overly complicated mumbo jumbo, and exercises that suck.

Sorry, no fail for you today.

I don’t hand out fail. I’m not pushing an agenda. You want to get big fast, then do the following.

1 – Stay with a Simple Routine

Listen, you have been searching for the ultimate routine for years. In fact, you spend more time reading about routines then performing routines. And each week you switch routines. I’ve found it, this week I’m making the change to blah, blah, blah and will grow!

Fail!

Enough with this foolishness. I’m about to carpet bomb your fantasies, so you have been warned. Brace yourself. Here goes…it doesn’t matter what routine you use. Yes, you heard me right. Doggcrapp, Max Stim, Dogg Stim, Max Crapp…whatever. Just pick something and stick with it. And make sure the routine isn’t complicated. You don’t need complicated.

A simple routine focuses on progression of weight using basic heavy compound lifts including:

  • Squats
  • Deadlifts
  • Bench Press
  • A form of the Overhead Press

E. T. C.

If you find that your routine has you doing giant sets, drop sets, or focusing on the dreaded mind-muscle connection, run like the wind. And worse yet, if it contains too many isolation movements…well…FAIL. You don’t need training techniques or isolation movements, you need to:

2 – Lift Heavy Ass Weights

Lift heavy ass weight. Heavy ass weight makes muscles grow. Heavy ass weight can be in any rep range, because it is heavy ass weight and is kicking your balls seven ways to Sunday.

What rep range should I use? FAIL! It doesn’t matter – Lift heavy ass weights!

What should my rep speed be? FAIL! It doesn’t matter – Lift heavy ass weights!

Should I do cable crossovers before or after flyes, and should incline bench be performed with a 22 degree angle, or a 24 degree angle? FAIL! It doesn’t matter – Lift heavy ass weights!

What split is the most effective for mass? FAIL! FAIL! FAIL!

GO LIFT HEAVY ASS WEIGHTS!

But I don’t want to lift heavy! So and so says that squats are bad for your knees, and my mom is afraid and wants me to take up knitting.

Both so and so, and your mom (no offense to moms) can barely lift a roll of toilet paper to wipe their own asses. If you want to look like your mom, listen to the training advice of your mom. If you want to pack on muscle, lift heavy ass weight!

The end!

3 – Stop Bitching and Get Your Ass to the Gym!

I’m tired.

My toe hurts.

My right nut seems small today, maybe I shouldn’t train.

Want to know how to fail? I mean epic fail? Continue to make excuses, and avoid going to the gym. Want to know how to succeed? Gird up your balls, shut the hell up, and get your ass to the gym, 52 weeks a year. The end.

This isn’t complicated.

Of course your left nut hurts! You’re lifting weights. Lifting heavy ass weights will hurt from time to time. Pain is part of the equation. We aren’t collecting bottle caps here, Charles.

4 – Forget Your Damned Abs and Eat!

I want a six pack!

Bud, if you think you can pack on muscle and carve out a six pack in the same month, you need to lay off the crack pipe.

This just in…if you want muscle, you need to eat big. If you want to be a 220 mass monster, but only weigh 120, you need to start eating like you weigh 220 pounds.

How long should I bulk before I cut? FAIL! Eat until people at the gym start asking you where you get your steroids from. Then, and only then can you start cutting.

Should my bulk be dirty or clean? FAIL! Grab a shovel and get to gettin’.

Whole milk has fat! Almonds have fat! I can’t eat fat! FAIL! Listen, drinking whole milk and lifting heavy ass weights equals muscle mass.

Final Thoughts

  1. Lift heavy ass weight using heavy ass compound lifts.
  2. Eat big.
  3. Never miss a workout.
  4. Stick with a basic routine.

Follow these 4 rules for two years and you will dramatically change your body. The end.

___________________________________________________________________

Pham Woodbridge

I’m feeling about the farthest from “swole” as you could possibly get right now. Apparently surgery + crutches + 9ish weeks off turns skeletal muscle into mushed peas. Who knew?

[OK that was a gross analogy. I'm never going to want pea soup again.]

I suppose I should post a PT update and such soon, but long story short I’m still on one crutch, still gimping, and damn this thing is taking its sweet time! X-rays last week (images to come once I can convince the disc to open on a Mac) showed that the bone healing is “on track” according to my doctor, and I suppose I should take his word over my own impatient timeline.

Reader Qs:

I know the majority of you guys are triathletes/runners, but how many of you push the weights? What is your favorite strength exercise? There were many years when I was too preoccupied with mileage to make time for strength, but after working with a variety of coaches, I’ve developed a little crush. ;)

-E

Category: Medical Monday | Tags: ,
The Triathlon Rx | January 2, 2012
19 comments

Staying fit while on crutches

I am just shy of 3 weeks into this post-surgery rehabilitation period, and have another 3 weeks to go. While six weeks certainly isn’t the longest I’ve been on crutches (try 6 months!!), this is the most restricted I have ever been in terms of weight bearing activity and exercise. Despite my fears of turning into a whale… the scale has not really budged. Despite my fears of turning into a limp noodle… well,  my arms are still strong! ;)

When an injured athlete is faced with a period of non-weight bearing activity and handed the crutches of doom, all sorts of questions and fears may arise. Will I lose all my pre-injury fitness? Will I gain weight? Will I have to start over from square one? Will I be forced to give up coffee since I can’t carry a cup?! (Because really, that’s all that honestly matters.) While each athlete will have unique circumstances, I’m 97% confident I can say the answer to each of these questions is NO. Including giving up coffee!

Steps to staying fit while crutch-bound

(1) First and foremost, get medical clearance from your physician. Check what is OK, what isn’t, and keep your medical team updated as you progress through recovery.

Assuming you’ve been given the green light…

(2) Don’t check yourself out mentally!! Even if you “love” to workout, it’s pretty dang easy to hang up your handicapped parking tag over the couch and stay there for good. And what goes better with a movie than a pint of Ben & Jerry’s…?!

Don’t get me wrong – take your well-deserved time to recover and mentally/physically recharge. But don’t get too comfortable on the couch, because you will eventually be able to get back at it again, and there is no need for you to start over from the very beginning! Instead of getting down because of what you can’t do, focus on what you can. Which means…

(3) Upper body strength: Your arms will get a head start simply from using crutches, but if you’re an athlete who is used to putting in a couple of hours a day, chances are that won’t quite cut it. Free weights can be difficult to maneuver as you need  both hands to crutch, and probably shouldn’t try and grab that 35 pound DB with your pinky. Machines, however, are for the most part very doable. Push ups, yes. Pull ups, yes. (Just remember not to jump down!!) Chest, shoulders, triceps, biceps, back… you can hit em’ all.

The biggest hang up for me is that I superset all my lifts. The patience is simply not there to sit on a machine and just wait between sets. It drives me nuts!! But for the time being… I will get over it. Logistically it makes life a lot easier to take one machine at a time. If possible, try to hit the gym at a less-busy time of day.

(4) Cardio: It is still possible! Two options (that I know of… if there’s something else out there, please let me know!!): Hand cycle ergometer, and pulling in the swimming pool. Unfortunately not all gyms will have a hand cycle… but if you have access to one, I definitely recommend taking advantage of it! Forewarning: the first few times (just like when pool running) it will feel like you’re not doing anything. And/or it will feel very difficult. Possibly both at the same time. Chances are that it’s mostly mental because it’s simply not an exercise you’re accustomed to. Keep at it, and you will likely notice it starts to feel [mentally] easier, and you will actually start working up a sweat!

In terms of swimming, please make sure that any open wounds/incisions have completely healed before you get in the water!! You may be dying to get back to exercise, but not at the cost of big nasty infection. If your doctor has cleared you to get in the pool (submerged – not the same as showering!!) then hop splash to it! Assuming most readers here are triathletes, this is your golden opportunity to work on that often-dreaded portion of multi-sport. How much you can use your legs will depend on your doctor’s/PT’s orders – you may not be able to kick at all, or you may be able to do a light flutter. Invest in a pull buoy if they’re not available at your pool (usually between $5 and $10), and pull away. This is also a great time to work on stroke drills – fingertip drag, distance per stroke, single arm, catch up, rhythm, etc.

Some lower body injuries may still allow you to pool run. If you’ve been given the go to do this, and are wondering where the heck to start (or looking for pool running workout ideas!), check out two of my previous posts: Pool Running, and Pool Running Part II.

(5) Core stability: Although it will depend on what your injury was, you may very well be able to keep up your core work! Again, check with your medical team. Your regular routine may need to be modified a bit – typically the rapid, jerking movements may be best if skipped. There will also be some trial and error involved… you may find you can do planks just fine using only your “good leg”, or that Russian Twists use too much quad muscle to do comfortable.

(6) Physical therapy: This should probably be #1. If you have been ordered physical therapy, I can’t stress how important it is to keep up your exercises as prescribed!!! It may be tedious. It may be time consuming. But your physical therapists have been through four years of an undergraduate education, a competitive admissions process to their masters or doctoral program, and an additional 2 to 3 years of education. PLUS passing the National Physical Therapy Exam, as well as state certification exams. Read: they know their ****. They can determine proper exercises based on your current status, and help you advance them as you improve in recovery.

(7) Diet: No hate mail for this one please!! Truth be told, if you’re used to putting in Ironman worthy workouts every day and you’re now limited to 40 minutes on the arm ergometer, you may need to adjust your diet a bit. If your maintenance calories had been 3800… well, they’re probably not right now. Calories in = calories out… capisci?

On the flip side, if you’ve been down at that racing weight for maybe a little to long, or are one of those people who struggles to maintain a healthy weight, this could be your easy fix. If calories/eating/weight while injured is causing a great deal of anxiety, it may be worth checking in with a sports dietitian or sports psychologist for good measure.

^^ I can’t wait for the day I can get back to THIS! ^^ It was my first full triathlon (and first tri podium finish!) and I will do what it takes – even if that means being patient – to get back there! :D

In terms of other crutching tips… there are a couple things I would like to add:

  • Backpack. Or those nice little drawstring bags. Keep one with you at all times!
  • Travel coffee mugs. Lovely reader Brynna recommends the Contigo brand because she can throw them in her bag, and they don’t leak a drop! Unfortunately, most of the [ridiculous too] many mugs I have aren’t that leak-proof. I just picked up a Thermos brand “Stainless King Travel Tumbler” at CostCo, and honestly I’m pretty sure it could withstand a bomb. Put it in your above mentioned backpack and you’re good to go!
  • Remove floor rugs and their best attempts to trip you up.
  • Under-arm crutch padding… OR forearm crutches. There are some nasty injury/wound pictures lying within my iPhoto albums, but I’m glad I didn’t take one of my rib cage post-crutches. Rubbed. Raw. :(

Being injured is never fun. Ever. But keep your head in the game, and remind yourself that this just a speed bump in your life, not a road block. Do what you can do safely, and you will be back in action before you know it!

Reader Qs:

What do you do to stay fit/sane while you’re injured? Do you have any crutch-success tips to add?

-E

*This post has been added to Train on Top archives, where you can find other articles on training, cross training, nutrition, and injury prevention.

Category: Medical Monday | Tags: , , , , ,
The Triathlon Rx | December 17, 2011
25 comments

Three Days Post-Surgery: Success!!

Step #1: Make it through surgery

Check!

Several hours after going under, I heard from my parents, who heard from my surgeon that the unscrewing, sawing, drilling, and plating was successful! I have a sweet post-op xray with the new fancy hardware store, but don’t have it on a disc yet so that will have to wait! In the mean time, check out the new hospital space suit/body heaters:

Yeah… talk about instant birth control right there. They’re like hospital gowns with a vacuum hose attached, pumping in hot (or cool) air. Makes you look like the Michelin Man. Also made me feel like I was sitting in a sauna, so had to turn that bad boy down. Of course the hair net is always super attractive. ;)

What I remember before surgery is all the prep, anti-bacterializing my hip, and taking out my contacts. I remember saying goodbye to my parents and the nurses wheeling me into the OR, and I remember them transferring me to the operating table. I don’t remember them at all putting the mask with anesthesia on me, and I definitely don’t remember doing the backwards countdown or anything else until I woke up 3 minutes 6 hours later! Kind of a bummer… that back words countdown and knock-out moment was kind of my favorite part.

Step #2: Make it out of the hospital

Check! 

(Last week at the clinic with pneumonia.) With minor complications. They kept me a day longer than intended due to not quite hitting the pain management marks on schedule. Then, my second night I ended up spiking a fever of 101.5, but was freezing with goosebumps, and was super congested. You might remember that I got pneumonia the week before surgery – brilliant timing, right? – so they were concerned about a reoccurrence of that. After being intubated and staying in the hospital, it’s apparently quite easy to get pneumonia. Let’s not do that!! Several PT sessions in “the gym” (full of stairs, beds, curbs, and all the other foreseeable obstacles one could encounter), a long check-out list with a bag full of drugs, and they sent me on my way! I’m staying at my mom’s house for about a week, or until I can drive again, whichever comes first. ;)

Step #3: Physical Therapy

half check…

I’m trying to channel my inner JuliaGoBigGreen here. This stuff is hard! Knowing me, I of course saved my last big leg workout for the morning-of. (Side: my friend at the gym told me he got hell from his surgeon for running the morning of… told me you bleed a lot more. Dr. Van or anyone else… true? BS?) Anyways, did my last big legs workout and hit my heaviest squat to date. Two days later, my PT is helping me to do a simple [body weight] leg lift. Oh my GOODNESS is that ever frustrating when something so simple feels so unbelievably hard!!

   

The exercises she has me doing are the same ones a patient would do after a total hip replacement… something I’m trying to avoid as long as possible! I am doing (1) quadricep contractions (thigh squeezes), (2) gluteal contractions (butt squeezes), (3) heel slides (photo left, just sliding the heel up towards the butt and back down), (4) straight leg raise (sounds so easy, and this is by far the hardest!), (5) abduction / adduction (photo right, sliding the heel out away from the body and back in), and (6) short arc quads (place a can or rolled up towel under knee, try to raise foot off ground… second hardest).

I have to keep reminding myself that they did cut through all these muscles along the lateral side of my leg, and had to sew them back together. It’s not just the bone that needs to heal, but also a ton of muscles! I do these 2x per day, and trust me… it feels like a “workout.” So funny to think that!

Step #4: Ride power-cart at Target

check!

You bet I did… as a kid I always wanted to ride the power chairs whenever we went to target or Costco or something. You know what? They go like a quarter of a mile an hour and make you feel bad for holding everyone else up. Not all it’s cracked up to be.

What I really want is one of those ride on Power Wheels Fisher Price cars… hahha let’s go with the Dune Racer:

Here’s a “friday confession” for you – I used to babysit triplets that lived across the street from me, and they had this ride on Jeep. I’d always convince the boys that they wanted to ride their scooters or something so I could ride the Jeep. And it did go faster than .25 mph. :)

Step #5: Get off meds and DRIVE!

Next Friday.

Hopefully! I can’t drive until I’m off all narcotics (vicodin, oxycontin, roxicodone), and until I have the follow-up appointment with my doctor on December 23rd. That’s just next Friday! Being independent is something that has always been important to me, and obviously being on crutches there are a lot of things I simply can’t do because I don’t have two hands. Carry soup to the table? Nope. Reach anything out of an upper cabinet? Nope (oh wait, I couldn’t do that anyways…). So it’s going to be quite a while before I can do any of that two-handed stuff, since I’m estimated to be on crutches for the next six weeks. BUT I would sure as $#!& like to be able to drive myself to PT. What else is this handicapped parking tag good for? ;)

So chicos… I made it. It wouldn’t have been without my amazing medical team, and my supreme friend/family support squad! Your prayers, texts, emails and facebook messages of votes of confidence truly mean the world to me. You are all angels, in every sense of the word.

-E

Category: Medical Monday | Tags: , ,
The Triathlon Rx | August 29, 2011
7 comments

Medical Monday // training, racing, medicating

¡Buenos dias chiquitos! Before you leave today, don’t forget to enter the Vital Sox Compression Sleeve / Arm Warmer giveaway! Closes on WEDNESDAY.

Last week, one of my very best friends asked me about taking over the counter medications before a race. She traveled to the land of the Canuks to race Ironman Canada (which was YESTERDAY!!), and was curious if anything she might take would interfere with her race day. With the amount of time one commits to training for an iron distance race, I would definitely agree that you don’t want an OTC medication (or any medication for that matter) to be your downfall. If my race turns into a nightmare, I want it to be because I was undertrained, overtrained, unprepared for the course/weather/competition/whatever. I do NOT want it to be because I took too many Naproxen.

So of course, she innocently asks me a sports science question. And I get excited and respond with a novel. I’ve done some editing of our emails to make sure all bases are covered, and with that I think we’re ready to go!

There are two general categories of meds an athlete would take pre-race: those that cause some sort of anti-inflammatory reaction // and // those that don’t.

Most of you have probably heard the term NSAIDS – non-steroidal anti-inflammatory drugs. You don’t really need to remember the whole thing – just that the NSAID stands for anti-inflammatory. NSAIDS work to reduce inflammation in the body, help prevent blood clots (thin the blood), can reduce fevers, and blocks the COX enzymes (refrain from jokes – it stands for cyclooxygenase). The COX enzyme is responsible for prostaglandin synthesis, which in turn contributes to inflammation, pain, and fever. We could go into the science and chemistry, but I don’t think that’s what you’re here for. ;) Common medications in this category include:

  • Aspirin
  • Ibuprofin (Advil, Motrin, Midol, Nuprin)
  • Ketoprofen (Orudis-KT)
  • Naproxen Sodium (Naproxen, Aleve, Anaprox, Naprelan)
  • Celecoxib (generic of Celebrex. Rx only)

Then there is the category that does not cause an anti-inflammatory reaction. Because inflammation is such a big component of sports injuries… athletes are much less likely to take these on a whim. (Unless of course you were unaware that Tylenol and Advil won’t do the same things for you… in which case, keep on readin’.) ;) Again, a common [but incomplete] list would include:

  • Acetaminophen (Tylenol)
  • opiate agonists (Vicodin, morphine, codeine. Lets hope we’re talkin’ Rx only…)
  • local anesthetics

There are a few that get complicated because they’re multi-ingredient pain killers… Tylenol No. 3 (300 mg acetaminophen, 30 mg codeine), Tylox and Percocet (acetaminophen and oxycodone – different strength combinations), Combunox (400 mg ibuprofen, 5 mg oxycodone), Vicoprofen (200 mg ibuprofen, 7.5 mg hydrocodone). Unless you’re taking any of those or extra curious, I wont go into it. However, I will strongly advocate that everyone should discuss everything they’re taking with their doctor – prescription, OTC, vitamins, supplements, the isht you buy at GNC – everything. It might be fine to take one medication on it’s own, but if your doctor doesn’t know you’re also taking ­­­­_____, you could be talkin’ trouble.

In terms of the effect on performance… the two basic terms to know are ergogenic (performance enhancing) and ergolytic (performance inhibiting). While you will certainly find articles and published research touting ergogenic effects of particular medications, the research is not consistent.

[... One little tangent that I need to throw out there: If you’re not racing pro or collegiate, chances are you’ll never be drug tested. But for the love of God, the sport, and your own health, build a better engine. Don’t inject it with rocket fuel. (Unless you’re talking about Roctane, in which case I fully approve. Pineapple orange please.) Dopers suck. ...]

The biggest thing an everyday athlete would want to watch out for is the [unintentional] heavy-handed use of Aspirin or NSAIDS. As with almost everything in life, moderation is key. Without splitting atoms here, they can affect kidney function -> affects hydration and plasma volume -> dilutes electrolytes -> increases risk of hyponatremia. Keep the M[oderation]-word in mind, make sure you’re supplementing your electrolytes in addition to your fuel stores, and really you should be just fine. :)

So much for a short explanation. When I can actually apply the stuff I’ve learned, I get a little carried away. ;)

Reader Qs:

Do you typically pop an advil pre-race? Pre-training? Or are you one of those people that would rather pull a nail out of your foot with eyebrow tweezers than take medication for something? I am… or at least I used to be. After my less than pleasant encounter with poison ivy earlier this month, I think I’ve softened a bit. Prednisone might make you look like a blowfish, but it makes the itching go away. Thank you Gregor Mendel, Louis Pasteur, James Watson, Francis Crick, Alexander Fleming, and the many more who have contributed to modern medicine. :)

CONGRATULATIONS ON AN AMAZING IRONMAN CANADA FINISH C.C.!! CAN’T WAIT TO CATCH UP WITH YOU WHEN YOU GET HOME!

The end.

-E

Category: Medical Monday | Tags: ,
The Triathlon Rx | July 25, 2011
6 comments

Medical Monday // Electromyography

Alternate title… “The Day I Was Electrocuted.”

[Disclaimer - if you don't like needles, there is a needle picture coming! It's teeny tiny though. And no blood.]

(Marking nerve landmarks. Please ignore unfortunate/awkward position of the hand.) Last week I had the pleasure of being on the receiving end of an EMG, or Electromyography. That E_G sequence may look familiar to you, as in ECG (electrocardiogram), EEG (electroencephalogram), EKG (same as ECG). An electrocardiogram is for monitoring your heart, and an electroencephalogram for picking up electrical activity of the brain. (Question for you Dr. Greg or anyone else who can answer… why is an EMG -graphy, and ECG and EEG are -gram?)

So then, what is an EMG?

An EMG, or electromyography, is a diagnostic test used to evaluate the health and functioning of motor neurons and the muscles they stimulate. You can use electrodes placed on the surface of the skin to detect or transmit electrical signals, and/or you can do a needle EMG, in which case a needle is placed directly into the muscle and records electrical activity. I was fortunate enough to do BOTH, because really, who doesn’t want to be shocked and skewered by their doctor?

     

The electrodes were moved around as he shocked different nerves. A made-me-jump shock at my elbow felt like a finger tap on the medial side of my palm. Hmmmm….)

Your doctor may order an EMG if you are experiencing tingling, numbness, loss of motor control, weakness, pain, or cramping. An EMG may be used for preliminary testing for muscular dystrophy, polymyositis, myasthenia gravis, carpal tunnel syndrome, amyotrophic lateral sclerosis or a herniated disk in the spine. Putting my sarcasm aside for a minute – I am very thankful that I have none of these are my diagnosis, and honestly and deeply do appreciate my health.

A neurologist typically reads the graphs/charts created during the EMG, and will go over it with your doctor, who will go over it with YOU. There are really only two outcomes: normal tells you you’re fine, but doesn’t solve the question/issue you were trying to solve by doing an EMG in the first place… and abnormal tells you you have more testing to do.

And that, my friends, is more than I’m sure you ever wanted to know about electromyography. :)

(Needle EMG! It was honestly the size of an acupuncture needle… teeny!) If you’re wondering why I was getting an EMG in the first place, it’s a long story that I’m about to make really short. A couple Sundays ago, I was in the middle of a pull set (in the pool) when I realized water was flooding through my left hand. No matter how hard I focused on it, I couldn’t keep the fingers on my left hand together. I was only about 1,000m into the workout, and it was a pretty easy swim to begin with, so I was reasonably frustrated and confused. (Imagine trying to kayak with a paddle full of holes!!) No pain, just weakness and lack of motor control. If you have ever come in from a winter run and you can’t coax your fingers to turn a door key or untie a shoelace, that’s exactly how my fingers felt (/feel). Fortunately, I already had an appointment scheduled with my sports med doc anyways for later that week, so I was able to get in and get her (doctor’s) opinion relatively quickly.

However, the issue is still not resolved, as I haven’t been able to successfully swim more than 1000m before losing strength in my left hand. (I know – cry me a river. But even if you don’t love swimming, you’d probably miss it too if you’re used to swimming on a regular schedule!) It’s mostly affecting the extensors and the pinky and ring finger, which to me sounds like an impinged ulnar nerve. The person reading the EMG had the same consensus, and now, I think, it’s just a waiting game.

Reader Qs:

Have you ever had an EMG, ECG, or EEG? If so, why was it ordered, and what did it show?

See … Mondays aren’t really so bad. You get to learn something new, and you don’t even need to sit through a whole semester of PHAR 5201! Make the start of the week a good one!

-E

Category: Medical Monday | Tags: , , , ,
The Triathlon Rx | June 13, 2011
11 comments

Medical Monday // Too sick to train?

Several weeks ago, my friend Frayed Laces talked about being in a “health limbo.” She pretty much summed up the way I feel bout getting sick, and in very eloquently stated:

If I’m gonna be sick, I want to be so sick that it completely knocks me on my butt. Not just “kind of” sick so I miss my workouts but can still function.  Hanging out in health limbo is really irritating to me.  Consider me irritated.

From Thursday through Sunday (yesterday), I was essentially hanging out in that health limbo. It started out feeling just like a cold – the whole mucus, coughing, runny/stuffy nose, etc. thing. Very attractive I’m sure. I still put in a solid workout on Thursday morning, but by that evening, started to feel a bit off. Friday morning the alarm went off at 5 as usual and I seemed to be feeling OK so I headed off to the gym to put in the scheduled workout. I try not to give myself a chance to stop and think or be conscious at 5am though…  I just get up and go. So it wasn’t until about 3/4 of the way through the workout that I realized I should probably take it down a notch. Down a notch I went, and I cut out about a quarter of what was scheduled. On Saturday I felt absolutely miserable – couldn’t swallow anything (no TWSS jokes please), head was pounding, stomach was churning (?), and I topped it off with a low fever. So I did absolutely nothing other than lay on the couch, nap, eat popsicles, and watch HGTV. Waking up on Sunday felt much better, and I think the accumulated 24+ hours of sleep I got over the course of Friday and Saturday really helped. I got the Sunday’s workout in, but took the intensity way down. So the question I’m finally getting to here is…

When are you too sick to train?

My personal answer to that question has varied over the years, depending on how seriously I’m training and the importance of the impending race. There was definitely a period of time (high school) when I was so stupid stubborn that I wouldn’t let anything get in my way of the scheduled training session. Now days, I’d like to think I’ve grown to be a bit wiser, and am pretty confident that there’s a middle ground.

The Neck Rule…

Probably the most common “theory”, and one I’m sure many of you have heard before: if your symptoms are above your neck (scratchy throat, congested nose, headache) then you’re OK to workout. If your symptoms are below your neck (chest congestion, fever, throwing up, diarrhea) then you should bail on the planned training session. Good rule of thumb, but not 100% fool proof.

The [current] DR.TR Rule…

Try to use a little common sense: If you are already feeling miserable, and just the thought of jostling up and down while running makes your head pound even harder, then take a day off. If you feel like a short workout to get blood flowing will help you feel better, than do a quick half an hour. Maybe keep it close to home in case you need to bail.

( <- staphylococcus aureus. If you want to actually be grossed out, stick that into google images and check out some of the infections. Don’t say I didn’t warn you!)

If common sense fails you, try to look at it physiologically: If you have a fever, exercising will only cause your core temperature to further increase (Stay home). If you got the flu, your immune system is compromised. Gym equipment is notoriously germy (staphylococcus, streptococci, fungi causing athletes foot and jock itch, etc.), so reduce your risk of picking up anything else. And for our sake, please reduce the risk of contaminating the rest of us. ;) (Stay home.) If you haven’t been able to eat anything or have been losing a lot of body fluids (vomiting/diarrhea) you are going to be dehydrated. Which leads to a higher heart rate, higher perceived rate of exertion, and a higher core temperature during exercise. Double whammy if you have a fever. (Stay home.) If you are just short on sleep, a short workout might be just what you need to boost your energy. (Go for it.) If you have the common cold, no one is going to judge you for taking it easy, but a short workout shouldn’t make you worse. (Go for it.) If you’re in that female half of the population and blessed enough to get a period (insert sarcasm here) a short workout can also boost your mood, reduce cramps, and reduce crabbiness. (Go for it.)

Long story short…

Exercise does the body good – that’s for sure. But there is a definite line between feeling sick and being able to push through it, and actually making your condition worse. IMHO, being outside with fresh air flowing through your lungs will always be better than indoors with recirculated gym air and germy gym equipment. Numerous studies have shown that those who exercise take fewer sick leave days from work and report fewer work related accidents, so we already have the upper hand there. On the few days of the year that you do actually get sick, your body might be ready for a rest day anyways. If your risking infecting a bunch of other people (teammates, colleagues, innocent gym members who may pick up your free weights), do them a favor and stay home. And bust out that Clorox! If you’re just feeling “slightly under the weather”, make sure you hydrate properly, cover your cough, and you’ll likely be fine. :)

Reader Qs:

When are you too sick to train? What is your cutoff point when you say it’s not worth it?

Given the topic, I hope all of you are healthy, and sick-free!! I’m pretty sure I’m done with this little bug (knock on wood) and happy to be able to sweat it out again! Doctor’s appointment on Wednesday, so will be back with a medical update and possibly some footage of a gait analysis. Until next time mis amigos…

-E

Category: Medical Monday | Tags:
The Triathlon Rx | June 6, 2011
15 comments

Medical Monday // Stress Reactions

What does this look like to you?

I’ll tell you what it looks like to me – a healthy, happy, solid right tibia. Which sounds about right… I had a pain-free, speedy 5K on Tuesday the 24th (May), and any tibial pain I was feeling a while ago seems to be gone. (**NOTE** That’s not my leg. The CD from my radiologist doesn’t work on a MAC?! Grrr….)

So then at my doctors appointment last Thursday the 26th, why did my doctor order no running or elliptical for three weeks?

STRESS REACTION.

While I wouldn’t wish a stress fracture on anyone, I’m sure there are quite a few of you out there reading and shaking your head with sadness because you too are familiar with this diagnosis. Stress fractures are in the top 5 most common injuries reported by runners, and have been said to account for up to half of the skeletal injuries reported by military recruits. Contributing factors to stress fractures commonly cited include: age, sex, lean body mass, low bone mineral density, low body weight, late onset of menarche, history of stress fractures, disordered eating, and low dietary calcium intake. However, conclusive evidence regarding the pathophisiology and epidemiology of stress fractures is “lacking” considering many studies are short term and use a small population sample. Nonetheless, the one common thread seems to be participation in repetitive, weight-bearing activity. (1) Oh, hey running! ;)

(Nov. 2008 – femoral neck fracture) So what exactly is a stress fracture? A tiny crack in the bone, resulting from repetitive stress or loading. Often caused by doing “too much, too soon” (coughcough 10% rule!), weakened bones (osteoporosis, osteopenia), sex (women, especially with a history of amenorrhea or oligomenorrhea), and faulty biomechanics (leg length discrepancies, heavy heal strikes, etc.). Presents with pain, swelling, tenderness in a specific spot (the “hot spot”), increases in these symptoms with activity and decreases with rest, and earlier onset of these symptoms with each successive exercise bout or workout. Typical treatment is every athlete’s most dreaded prescription – rest. And possibly crutches or the boot of doom. (2)

A stress reaction then, in short, is the precursor to all of this. You are toeing the dangerous line of developing a stress fracture, but haven’t gotten there quite yet. Which apparently, is the case with my left tibia.

Three weeks of no running was [IMO] certainly a conservative measure, but truthfully my running had become so sporadic at that point that I didn’t really care. Some days it was great, some days it hurt. The mandate of “no elliptical” was an attempt to remove any unnecessary loading on the bone and speed up the process of recovery, and the prescription to bike and swim my butt off was to any ounce of sanity left, not to mention not be disowned from my family (or fired from work) for grouchiness!

Following this three-week-reset I’m going in for a running analysis (Wednesday the 15th) and hopefully will develop a plan with my sports-med team to come back to running (and racing!) safely, and solidly. I’ve been doing all of my treatment for quite a while now at the Institute of Athletic Medicine, and I can say with 100% honesty (and zero persuasion) that I LOVE them. They are honest, direct, proactive, and do what needs to be done!

With a little insight from a couple close freinds/family, I’ve realized lately that ever since my hip surgery in December of 2008 I haven’t been quite the same person.  Aside from the cascade of injuries since that date, my “psychology has been off”. My highs aren’t as high, and my lows… well, they’re definitely more apparent. Everything I think of in my history is separated into a “then” (pre-surgery) and ”now” (post). So I finally asked my doctor lastlast Thursday,

Do you think I’ll ever go back to being a “real” runner again? Like the girl who just wakes up and runs out the door, and doesn’t think anything of it? Do you think I’ll ever be able to run another marathon?

And her response?

Yes. Absolutely. But will you be able to exclusively be a runner, and not do anything else? No.

Seeing as how I’m slightly invested in this triathlon thing, I guess I can roll with that. I’m not sure if her “yes” included being able to run marathons again or not, but for now I’ll just take things one step at a time.

(Manitou Tri – June 2010)  Regarding racing: my three-week hiatus unfortunately extends past June 12th, which is the date of the Manitou Triathlon. This is hands down one of my top three favorite Minnesota races, and “bummed” doesn’t exactly exemplify how I feel about missing it. My plan until my legs are race ready is to volunteer (and relay!!) my butt off. I’m definitely not ready to leave the Minnesota Tri community yet.

READER Qs:

Have you ever had a stress fracture, or a stress reaction? Any local readers racing Manitou?Anybody interested in a TRI RELAY!? :) What is your next race coming up? What is your favorite form of cross training when “on the mend”?

Take luck mis amigos (+1,000 if you know the reference!!!!),

-E

(1) Kelsey, J. L., Bachrach, L. K., Procter-Gray, E., Nieves, J., Greendale, G. A., Sowers, M., & … Cobb, K. L. (2007). Risk Factors for Stress Fracture among Young Female Cross-Country Runners. Medicine & Science in Sports & Exercise, 39(9), 1457-1463. doi: 10.1249/mss.0b013e318074e54b

(2) Mayo Clinic. (2010, December 7). Stress fractures. Retrieved from http://www.mayoclinic.com/health/stress-fractures/DS00556

Category: Medical Monday | Tags: , , , ,
The Triathlon Rx | January 31, 2011
45 comments

Medical Monday: Epinepherine + GIVEAWAY!

Today’s Medical Monday is brought to you by a special (non-published) edition of FML Friday, the profits made from the EpiPen® Auto-Injector, and viewers like you.

Epinephrine is a natural hormone produced in the adrenal medulla, along with it’s sister hormone, norepinephrine. Both of these hormones fall under the category of catecholamines. Catecholamines are synthesized starting with tyrosine, taken up by the chromaffin cells in the medulla, and then converted into epi & norepi. It looks like this:

Epinephrine (think “adrenaline”) brings about many of the same responses as stimulation of the sympathetic nervous system, however with typically longer lasting effects. You may have felt these effects at various time throughout your life: when proposing to your soon to be wife, when hearing from your wife that you’ve successfully planted a belly bean, when you’re toeing the start line at that A race, when your crossing the finish line at said A race and thinking how the hell did I do that?!

Epinephrine is also a powerful drug used in the treatment of severe allergic reactions. The hormone causes vasoconstriction, bronchial dilation, an increase in blood pressure, and a reduction in tissue swelling. The most common allergies treated with epinephrine are insect stings, foods, and medications.

Tips for avoiding the self-inflicted stabbing of EpiPen® Auto-Injector or any unnecessary trips to the ER:

  1. Always. Always. Always. Have an EpiPen with you.
  2. If you are allergic to a food, know what it is in every possible shape and form, and everything that may contain that ingredient.
  3. I always say assume best intentions, but that doesn’t equate to assume intelligence. If you tell your waiter that you’re allergic to, oh… lets say sesame seeds for example. Don’t assume that although you stated you were allergic to sesame seeds and cannot have any sesame products, that they will understand sesame dressing is a sesame product. After all, a seed is a seed. Dressing… that’s like liqud, right?

The end.

Of Medical Monday that is. :) So that tells you a little bit about the story of my last week. The rest as filled with 250 notecards of spanish medical terminology, wasting too much time checking Bonktown for a deal that I missed anyways, healing a hip flexor, and hours upon hours of exercise physiology. Speaking of exercise physiology… I also spent probably too much time ranting about the Iowa football rhabdomyASS case plastering ESPN and saying poor football players were pushed too hard. Tell the whole story. Please.

But alas mis amigos (how do you say “alas” in spanish…. anyone?), I’m still here, and I’m still alive. But because I’ve been so neglectful lately, I definitely feel the guilt eating away, and feel the need to make it up to whoever else is still out there for sticking around. Hence the 2nd part of today’s title… GIVEAWAY time!

Thanks to the gracious folks over at CSN, you have the opportunity to get whatever the heck you want.* My only forewarning is that if you’ve never been on CSN’s site, I’d start planning. Now. It took me like 5 days to finally decide on that pull-up bar (review here) because their inventory is so. flipping. big!

*Please note that CSN will only be funding $35 worth whatever the heck you want. The rest you are responsible for. :)

WAYS TO ENTER THE GIVEAWAY

As always, make sure you leave a separate comment for each entry. If you leave me a beautiful comment saying:

1. I want the 12lb medicine ball in purple.
2. I would like more posts with different swim workouts.
3. I found you through the RW forums.
4. I tweeted.
5. ESPN is blind. Those boys are on roids.

well, yes, I appreciate your effort and tanacity. But those 5 entries are all one comment and when I plug in these names into excel, it’s going to be one entry. Capish?

EASY PEASY 5 WAYS TO WIN!

  1. Go to CSN’s site, find something you’d want (Steve… still tryna work on those pull-ups? ;) ). Tell me what it is/why you want it!
  2. Tell me an idea/specific topic you’d like to see here on Dr.TriRunner. It can fall under any day in the schedule: (Medical Mondays, Tried It Tuesdays, Work Out Wednesdays, etc.) or just be whatever the heck you want. (This one doesn’t have a $35 limit. ;) )
  3. Tell me how you first found your way over to Dr.TriRunner, or if you’ve been here a real long time, how you got to RunRoamRecycle. If it was by searching “doctors notes for free” or one of my other ridiculous search terms. Um… you’re disqualified.
  4. Tweet about the giveaway! And this should be a no question entry (if you have a twitter account) because there is now a SHARE THIS and TWEET THIS link at the bottom of each post! Just make sure you include the tag @SperlyTriRunner.. the link is already in there!
  5. The Iowa football deal – what do you think based off what you’ve heard? What do you think based off your gut instinct? Really, any commentary on that. I’d love to hear it.

There you go! The contest will be open for ONE full week – until Monday Feb. 7th – and then I will draw the winner the following day. I’m back off to my new favorite study spot in my ‘hood… free coffee refils all day, free wi-fi, comfy seating (and plenty of it!), and decent food. :D

Happy Monday!

Category: Medical Monday | Tags: ,