A busy semester/work/training season delays a cold season reflection.
While the off-season plays an important role in race season performance, the race season mentality presents a danger to the athlete. When building the aerobic base in the off-season the athlete's thinking can weigh too heavily on heat production from skeletal muscle, leading to inadequate protection of the skin with less heat from skeletal muscle. At least the endurance/snow sport neophyte has such error potential, anyway. In "Frostbite and Dermal Cold Injury" Katie Dolbec, MD defined and described frostbite as freezing injury with ice crystals in tissue and frostnip as a cold injury without freezing within the tissue, with a propensity to develop into frostbite.[1] Cold injuries can be difficult to manage in the middle of a long run. In 1977 the New England Journal of Medicine published a frequently cited case report, from Dr. Melvin Hershkowitz, describing frostbite of his penis.[2] This occurred before the proliferation of synthetic wind-proof underwear, but also before the proliferation on non-windproof synthetics, which are worse than cotton for cold injuries(see below). This individual was missing some of the vascular skin that would offer some protection to the glans, even if providing something else at risk for cold injury. This protection appeared to be the pattern in a different report in the British Medical Journal in 1989. This report described frostbite and frostnip in seven subjects involved in outdoor winter activities in Norway.[3] The circumcision status was listed along with the details of the cold injuries. Only the circumcised subject had any symptoms in the glans following short cold exposure (i.e. a few hours at most). That too was my experience following a 10-mile run on January day, slightly below freezing, in 2008. I went out to run early in a weekend morning on quiet country road on the hills of central NH. I was clad head to toe in synthetic apparel, which I wasn't thoroughly accustomed to. Other than gloves, a hat, and jacket, my apparel was designed for breathability and wicking. By the second split the distal end of my external organ became overwhelmed by the cold and I reached in my pants to warm it up, trying not be conspicuous. Running biomechanics was compromised in so doing. I would intermittently resume normal running for a few strides to gain speed and get back to warm shelter sooner. Well over an hour after commencing my run I ran indoors to tend to my pain. Only frostnip, but extreme pain for 10 minutes or so. I crouched, holding my crotch, and breathed as best I could. Live and learn. The pain confined to the mucosal/epithelial surfaces left exposed after someone specializing in the female reproductive tract (or one of his cronies) stripped away vascular skin. No substitute for windproofing; but, a supplemental option involves skin expansion (Research it if intrigued). In the spirit of Men's Health Month, it's time our bodies have some respect from womb onward.
1. Dolbec MD, K. Frostbite and Dermal Cold Injury. Wilderness Medicine. www.wildernessmed.org/images/Frostbite_and_Cold_Injury.ppt. Accessed 21 June 2013.
2. Hershkowitz, M. Penile Frostbite, an Unforseen Hazard of Jogging. New England Journal of Medicine. 1977 Jan 20;296(3):178.
3. Travis S, Roberts D. Arctic Willy. BMJ, 1989 Dec 23-30;299(6715):1573-4.
Friday, June 28, 2013
Monday, May 27, 2013
Lessons of the Off-Season/Pre-Season
The annual break from the "A" races tends to be nothing short of exhilarating, from my experience, even if that joy comes at a price. The snow-covered trails make for a welcome recess from the pavement Getting reacquainted with the great outdoors without the pressure of the race season reawakens the human spirit, which might have been in a tangle with equipment failures, day before bike check ins, race briefings, etc. The off-season skate ski workouts in the extensive pine forested trails and more varied swim training add to core strength and stability in ways that hours on the bike can't. I could do with some substitution of training specificity well into February, in order to get the best of the great outdoors and some butterfly workouts. Absent are time-sensitive dial-workouts, at least until the pre-season race.
I spent the last off-season (i.e post-August) receiving diagnosis and correction of the prior years' cycling biomechanical problems. I also received good instruction on core strength and stability and in flexibility of key muscles.
The pre-season races serve partly as field tests. Everything from the running mount pointed uphill, such as at Lake San Antonio, to different atmospheric conditions. The Wildflower Long Course, a distance of 70.3 miles, was another dot to connect in the history of challenging races. Last year, I did this distance three times in air that was not the cleanest, in interior Monterrey and San Luis Obispo County, Providence, and Austin. What was different this year around Lake San Antonio was a noticeable effect of the air contents when just standing around or with minor exertion. Perhaps this was smoke and dust due to the drought and wind from the forest fire not too far away. That effect may be one of the prices I'm still paying. Meanwhile the new saddle was an improvement; but, the position is not quite right. The dots that connect leading up to the swim start of the next race will fit an appropriate line to the finish.
Sighting begins long before the swim buoys. One of the conclusions is as always, trust your instincts--Ed's Third Axiom.
I spent the last off-season (i.e post-August) receiving diagnosis and correction of the prior years' cycling biomechanical problems. I also received good instruction on core strength and stability and in flexibility of key muscles.
The pre-season races serve partly as field tests. Everything from the running mount pointed uphill, such as at Lake San Antonio, to different atmospheric conditions. The Wildflower Long Course, a distance of 70.3 miles, was another dot to connect in the history of challenging races. Last year, I did this distance three times in air that was not the cleanest, in interior Monterrey and San Luis Obispo County, Providence, and Austin. What was different this year around Lake San Antonio was a noticeable effect of the air contents when just standing around or with minor exertion. Perhaps this was smoke and dust due to the drought and wind from the forest fire not too far away. That effect may be one of the prices I'm still paying. Meanwhile the new saddle was an improvement; but, the position is not quite right. The dots that connect leading up to the swim start of the next race will fit an appropriate line to the finish.
Sighting begins long before the swim buoys. One of the conclusions is as always, trust your instincts--Ed's Third Axiom.
Monday, September 26, 2011
ITU Short Course World Championships: Expect the Unexpected... and the Expected
Having gone to China on alert for anything arthropod, water, or food born, I thought I had covered all the bases. I arrived armed with sunscreen, antacids, antibiotic and N95 masks. I was not accustomed to potent allergens; and, I still don't know what caused me to lose half my body weight through my eyes and nose during the ride home from the opening ceremony. I felt like every ion in Christiansted Harbor was hosed into both eyes over the course of 15 minutes. Based on the cessation of burning when I stepped off the bus I assumed the ventilation system was involved. After some trial and error I again suspected the food played a role in some capacity. The American restaurant version does not have the same effect. I thank the individual who donated the antihistamines. Sorry I didn't get your name. One more item for my travel supply list.
While I was well-armed with outlet adapters and a voltage converter, I discovered something else. The electrical outlets accepted multiple configurations. My trimmer was the only appliance I had that couldn't handle more than 120 volts. The bathrooms had outlets with three holes labeled on the left side as 115V and the right as 240V, suggesting the left and middle would supply 115 volts. I would do without my converter I thought. My trimmer's AC adapter hasn't worked since.
This exceptionally challenging Olympic distance left many of us a bit flustered. A new personal worst for me? Based on my data, anecdotes, and the finishing times of others this was a counterfeit Olympic distance. While the traction for the Saturday races were compromised by the wet blue mats, I welcomed being able to run fast in transition without my feet being cut to shreds.
In the massage tent ballistic stretching was used, which I have not encountered in North America, and rightfully so. The amount of time spent in massage was good, however.
The continued dominance of certain countries in the elite race is an interesting pattern. I have my doubts about USA Triathlon's approach to starting people earlier and earlier in life. I suspect a different set of variables will shape the podiums for generations to come.
Well done Team USA. It was an honor to compete among so many talented medalists.
While I was well-armed with outlet adapters and a voltage converter, I discovered something else. The electrical outlets accepted multiple configurations. My trimmer was the only appliance I had that couldn't handle more than 120 volts. The bathrooms had outlets with three holes labeled on the left side as 115V and the right as 240V, suggesting the left and middle would supply 115 volts. I would do without my converter I thought. My trimmer's AC adapter hasn't worked since.
This exceptionally challenging Olympic distance left many of us a bit flustered. A new personal worst for me? Based on my data, anecdotes, and the finishing times of others this was a counterfeit Olympic distance. While the traction for the Saturday races were compromised by the wet blue mats, I welcomed being able to run fast in transition without my feet being cut to shreds.
In the massage tent ballistic stretching was used, which I have not encountered in North America, and rightfully so. The amount of time spent in massage was good, however.
The continued dominance of certain countries in the elite race is an interesting pattern. I have my doubts about USA Triathlon's approach to starting people earlier and earlier in life. I suspect a different set of variables will shape the podiums for generations to come.
Well done Team USA. It was an honor to compete among so many talented medalists.
Sunday, May 1, 2011
Traveling with American Airlines
A beautiful day in New England. A Wildflower and 70.3 St. Croix day. I could attend neither due to vacation competition at work. American Airlines has remained the major passenger carrier to St. Croix. Last year my Crate Works bike box arrived in St. Croix missing the six-prong strap. I complained both to the on-site baggage service and online. The response I received is at the bottom. Meanwhile their baggage damage policy appears here: http://www.aa.com/i18n/travelInformation/baggage/liabilityLimitations.jsp
Their disclaimer is "American assumes no responsibility for damage to or loss of protruding baggage parts such as wheels, straps, pockets, pull handles, hanger hooks or other items attached to the baggage."
For a long time I have put up with my luggage looking like it fell out of a plane at cruising altitude every time I fly. If somebody just didn't put something back on or just took it off I am going to say something. At least TSA cooperated with the investigation for their part. I haven't used that voucher nor have I done business with AA since. I'll let you decide whether AA exercises due care and good personnel management.
May 10, 2010
Dear Mr. Rose:
Thank you for contacting American Airlines Customer Relations. I am pleased to respond to your inquiry.
I'm sorry that your baggage was damaged when you traveled with us. Some items to be checked as baggage for a flight are not able to withstand normal handling and are vulnerable to damage. Included in this category are such things as strollers and car seats, sports items not packed in hard-sided cases, electronic equipment, previously damaged baggage, unsuitably packed or overpacked baggage, boxes, and certain expandable and vinyl type bags.
Our baggage liability policy, which is posted at all check-in locations, automatically releases American Airlines from responsibility for fragile items. In addition to certain baggage contents, fragile items include, but are not limited to, bag components such as wheels, locks, pullstraps, outside pockets, retractable handles, hangers and stability features located at the foot of the bag.
Since the article you presented is excluded from our liability, our baggage agent was correct in denying your claim. It is not appropriate for us to overrule such decisions since we have not had the benefit of seeing the item in question. Moreover, the ultimate responsibility for handling problems involving damaged baggage rests entirely with our local stations, and their decision is firm and final.
Nevertheless, as a gesture of goodwill and to encourage your continued business, we've made arrangements for an eVoucher (see details below) for you to use toward the purchase of a ticket to travel with us. I hope you will accept our gesture in the spirit of compromise.
Mr. Rose, please travel with us again soon. We will do our best not to disappoint you again.
Sincerely,
Carol A. Alexander
Customer Relations
American Airlines
Their disclaimer is "American assumes no responsibility for damage to or loss of protruding baggage parts such as wheels, straps, pockets, pull handles, hanger hooks or other items attached to the baggage."
For a long time I have put up with my luggage looking like it fell out of a plane at cruising altitude every time I fly. If somebody just didn't put something back on or just took it off I am going to say something. At least TSA cooperated with the investigation for their part. I haven't used that voucher nor have I done business with AA since. I'll let you decide whether AA exercises due care and good personnel management.
May 10, 2010
Dear Mr. Rose:
Thank you for contacting American Airlines Customer Relations. I am pleased to respond to your inquiry.
I'm sorry that your baggage was damaged when you traveled with us. Some items to be checked as baggage for a flight are not able to withstand normal handling and are vulnerable to damage. Included in this category are such things as strollers and car seats, sports items not packed in hard-sided cases, electronic equipment, previously damaged baggage, unsuitably packed or overpacked baggage, boxes, and certain expandable and vinyl type bags.
Our baggage liability policy, which is posted at all check-in locations, automatically releases American Airlines from responsibility for fragile items. In addition to certain baggage contents, fragile items include, but are not limited to, bag components such as wheels, locks, pullstraps, outside pockets, retractable handles, hangers and stability features located at the foot of the bag.
Since the article you presented is excluded from our liability, our baggage agent was correct in denying your claim. It is not appropriate for us to overrule such decisions since we have not had the benefit of seeing the item in question. Moreover, the ultimate responsibility for handling problems involving damaged baggage rests entirely with our local stations, and their decision is firm and final.
Nevertheless, as a gesture of goodwill and to encourage your continued business, we've made arrangements for an eVoucher (see details below) for you to use toward the purchase of a ticket to travel with us. I hope you will accept our gesture in the spirit of compromise.
Mr. Rose, please travel with us again soon. We will do our best not to disappoint you again.
Sincerely,
Carol A. Alexander
Customer Relations
American Airlines
Friday, March 25, 2011
What is fairness in sport?
USADA states that its mission is "To be the guardian of the values and lessons learned through true sport." However, their pursuit of fairness implicitly assumes that the lack thereof is orchestrated by the athlete and/or coach against his/her competitors. Today's youth share are being exposed to messages that solutions, to intangible "health" problems (i.e. mental health), are pharmaceutical. The "problem" may be to other individuals, with the patient not even being consulted. One need not look any further than the National Institute of Mental Health website to see what kind of "epidemics" are growing.
Use of the DSM, as a platform for medical decisions, glosses over genuine health issues, such as nutritional deficiencies, which could have neurological manifestations. The correlation between socioeconomic status (which affects state-sanctioned mental diagnosis) and nutritional status warrants examination, considering today's obesity statistics. To bypass medical evaluation and go directly to psychiatry may miss simple solutions conducive to the wellbeing of the individual, the effectiveness of our educational systems, and the growth of our economy. The DSM is culturally based. The DSM-IV, for instance, details Asperger's Syndrome as including "failure to develop peer relationships appropriate to developmental level" and "the disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning."[1] Unquestionably a good example of failed biological homeostatis, especially if the "patients" are content. Where was an anti-left-handed drug when we needed it decades ago? I don't know how the arbitrary pharmaceutical impetus for mental can fall under the same auspices of algorithms used to diagnose and treat congestive heart failure and diabetic ketoacidosis.
Some "therapeutic" drugs such as SSRIs are prescribed for a variety of mental imperfections, sometimes off-label with impunity. SSRIs attenuate pituitary activity, which is needed for growth and development [2,3,4]. Effectively thyroid hormones, androgen, and estrogen levels are at risk. Theoretical analytes, such as serotonin and its metabolites, are generally not measured at all. Leading reference laboratories have not established reference ranges for psychopathology, only for more concrete disciplines such as oncology. Psychiatrists make a subjective diagnosis purportedly based on direct questioning and questionnaires, or rather just commit forgery to expedite the diagnostic process, as a recent New York Times article illustrates.[5] Next, they will see if any extraordinary sequelae develop. What nature has in store for a developing brain/body is not revealed by a shrink who tampers with the hypothalamus/pituitary axis. Correlations with antipsychotic use have included obesity and type II diabetes, neither of which are conducive to optimal performance.[6] I can see that a system for mental diagnostics is apt to be window dressing, while the drug agenda is preexisting. Some young victims may not even receive an evaluation.[7] Revelation of the individual's extraordinary potential may otherwise be forthcoming and unprecedented. Do athletes benefit from thyroid and steroid hormone activity? Are they getting bonus points for attenuating these functions? Why are professionals and lay people trying to convince people that the solution to life's minor problems are pharmaceutical? A preexisting agenda of drugging young people is not conducive to the health and development of their bodies.
Public campaigns of the past few decades have aimed to dissuade people from use of exogenous chemicals due to risk of acute toxicity or other problems. The nutrition campaigns of the same era underscore the importance of long-range optimal performance. What is absent from the knee-jerk repertoire of drug-centric gurus is exercise, meditation and other measures of internal control, and time, which brings wisdom and developmental milestones. Inasmuch the education model of staring at the front of a room for most of the day is ingenious, the victims of the decrepit school systems need a fair chance to show what they are capable of. Drugs appear to be cheaper than infrastructure. If the school systems become more decrepit and the general population becomes more unscholarly and paranoid one can only wonder where pharmaceutical practices will go. If you want to raise something that stares silently for long periods you raise a python; but, it won't act like it has a four-chambered heart.
World Anti-Doping Agency (WADA) has created a biological passport system; more or less a delta check system on an individual athlete's biochemistry. In the case of minors, chemical levels are especially subject to change. Psychiatry makes no effort towards a biological passport, nor its impact on biological development. Other than the International Normalization Ratio (INR) for oral anticoagulant monitoring, clinical laboratories are not operating support at the biological passport level. In the event that something profound measures analysis in a clinical laboratory, test results will be matched against population-based intervals rather than the patient's own normal values. From a clinical standpoint, if a drug made sub-4:00 Alan Webb run a mile in 5:30, he is asymptomatic (unless he complains maybe). Clinical laboratory science does not necessarily detect loss to an individual, especially when methodology is subject to change. To reach their potential young people need to learn to keep an open mind and be allowed to discover nature's blessings, not that they need to be drugged for everything and effectively be stunted. It seems counterintuitive that someone would be happier because they did not receive nature's blessings. In order to cultivate milestones for humankind third party distress should be handled separately.
The priorities should be not just cleanness of competition but cleanness of health. For those who already have predilections towards health they need to be free from siege and brainwashing towards pill-popping solutions to immaterial problems. Cleanness of competition also necessitates that people be allowed to be human and discover and reach their potential.
True fairness involves being neither doped nor duped against performance. Fairness in sport stands a chance when professionals quit acting as mercenaries waging chemical warfare masked as medicine.
1. Atwood, T. The Complete Guide to Asperger's Syndrome. London: Jessica Kingsley Publishers; 2007.
2. Gen Hosp Psychiatry. 2010 Sep-Oct;32(5):559.e5-7. Epub 2010 Apr 27.
3. Pediatr Res. 2009 Feb;65(2):236-41.
4. Demers, PhD, DABCC, LM. Pituitary Function. In: Burtis CA, Ashwood ER, editors. Tietz Fundamentals of Clinical Chemistry. 2nd ed. Philadelphia: W.B. Saunders Company, 2001.
5. Wilson D. Child's ordeal reveals risks of psychiatric drugs in young. The New York Times. 2010 September 2; Health.
6. NIMH. Significant weight gain, metabolic changes associated with antipsychotic use in children. 2009 October 27. Science Update.
Available at:
http://www.nimh.nih.gov/science-news/2009/significant-weight-gain-metabolic-changes-associated-with-antipsychotic-use-in-children.shtml
7. Agency for Healthcare Research and Quality. Antipsychotic use doubles for very young children, while mental health visits are few. 2011 March. Child Adolescent Health. Available at:
http://www.ahrq.gov/research/mar11/0311RA16.htm
Use of the DSM, as a platform for medical decisions, glosses over genuine health issues, such as nutritional deficiencies, which could have neurological manifestations. The correlation between socioeconomic status (which affects state-sanctioned mental diagnosis) and nutritional status warrants examination, considering today's obesity statistics. To bypass medical evaluation and go directly to psychiatry may miss simple solutions conducive to the wellbeing of the individual, the effectiveness of our educational systems, and the growth of our economy. The DSM is culturally based. The DSM-IV, for instance, details Asperger's Syndrome as including "failure to develop peer relationships appropriate to developmental level" and "the disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning."[1] Unquestionably a good example of failed biological homeostatis, especially if the "patients" are content. Where was an anti-left-handed drug when we needed it decades ago? I don't know how the arbitrary pharmaceutical impetus for mental can fall under the same auspices of algorithms used to diagnose and treat congestive heart failure and diabetic ketoacidosis.
Some "therapeutic" drugs such as SSRIs are prescribed for a variety of mental imperfections, sometimes off-label with impunity. SSRIs attenuate pituitary activity, which is needed for growth and development [2,3,4]. Effectively thyroid hormones, androgen, and estrogen levels are at risk. Theoretical analytes, such as serotonin and its metabolites, are generally not measured at all. Leading reference laboratories have not established reference ranges for psychopathology, only for more concrete disciplines such as oncology. Psychiatrists make a subjective diagnosis purportedly based on direct questioning and questionnaires, or rather just commit forgery to expedite the diagnostic process, as a recent New York Times article illustrates.[5] Next, they will see if any extraordinary sequelae develop. What nature has in store for a developing brain/body is not revealed by a shrink who tampers with the hypothalamus/pituitary axis. Correlations with antipsychotic use have included obesity and type II diabetes, neither of which are conducive to optimal performance.[6] I can see that a system for mental diagnostics is apt to be window dressing, while the drug agenda is preexisting. Some young victims may not even receive an evaluation.[7] Revelation of the individual's extraordinary potential may otherwise be forthcoming and unprecedented. Do athletes benefit from thyroid and steroid hormone activity? Are they getting bonus points for attenuating these functions? Why are professionals and lay people trying to convince people that the solution to life's minor problems are pharmaceutical? A preexisting agenda of drugging young people is not conducive to the health and development of their bodies.
Public campaigns of the past few decades have aimed to dissuade people from use of exogenous chemicals due to risk of acute toxicity or other problems. The nutrition campaigns of the same era underscore the importance of long-range optimal performance. What is absent from the knee-jerk repertoire of drug-centric gurus is exercise, meditation and other measures of internal control, and time, which brings wisdom and developmental milestones. Inasmuch the education model of staring at the front of a room for most of the day is ingenious, the victims of the decrepit school systems need a fair chance to show what they are capable of. Drugs appear to be cheaper than infrastructure. If the school systems become more decrepit and the general population becomes more unscholarly and paranoid one can only wonder where pharmaceutical practices will go. If you want to raise something that stares silently for long periods you raise a python; but, it won't act like it has a four-chambered heart.
World Anti-Doping Agency (WADA) has created a biological passport system; more or less a delta check system on an individual athlete's biochemistry. In the case of minors, chemical levels are especially subject to change. Psychiatry makes no effort towards a biological passport, nor its impact on biological development. Other than the International Normalization Ratio (INR) for oral anticoagulant monitoring, clinical laboratories are not operating support at the biological passport level. In the event that something profound measures analysis in a clinical laboratory, test results will be matched against population-based intervals rather than the patient's own normal values. From a clinical standpoint, if a drug made sub-4:00 Alan Webb run a mile in 5:30, he is asymptomatic (unless he complains maybe). Clinical laboratory science does not necessarily detect loss to an individual, especially when methodology is subject to change. To reach their potential young people need to learn to keep an open mind and be allowed to discover nature's blessings, not that they need to be drugged for everything and effectively be stunted. It seems counterintuitive that someone would be happier because they did not receive nature's blessings. In order to cultivate milestones for humankind third party distress should be handled separately.
The priorities should be not just cleanness of competition but cleanness of health. For those who already have predilections towards health they need to be free from siege and brainwashing towards pill-popping solutions to immaterial problems. Cleanness of competition also necessitates that people be allowed to be human and discover and reach their potential.
True fairness involves being neither doped nor duped against performance. Fairness in sport stands a chance when professionals quit acting as mercenaries waging chemical warfare masked as medicine.
1. Atwood, T. The Complete Guide to Asperger's Syndrome. London: Jessica Kingsley Publishers; 2007.
2. Gen Hosp Psychiatry. 2010 Sep-Oct;32(5):559.e5-7. Epub 2010 Apr 27.
3. Pediatr Res. 2009 Feb;65(2):236-41.
4. Demers, PhD, DABCC, LM. Pituitary Function. In: Burtis CA, Ashwood ER, editors. Tietz Fundamentals of Clinical Chemistry. 2nd ed. Philadelphia: W.B. Saunders Company, 2001.
5. Wilson D. Child's ordeal reveals risks of psychiatric drugs in young. The New York Times. 2010 September 2; Health.
6. NIMH. Significant weight gain, metabolic changes associated with antipsychotic use in children. 2009 October 27. Science Update.
Available at:
http://www.nimh.nih.gov/science-news/2009/significant-weight-gain-metabolic-changes-associated-with-antipsychotic-use-in-children.shtml
7. Agency for Healthcare Research and Quality. Antipsychotic use doubles for very young children, while mental health visits are few. 2011 March. Child Adolescent Health. Available at:
http://www.ahrq.gov/research/mar11/0311RA16.htm
Saturday, January 8, 2011
WADA vs. CAP
Another championship season is upon us. Is USADA ready? If they know what kind of chemistry is associated with winter triathlon performance they are one step ahead of the athletes, coaches, and the scientific community. For the foreseeable future winter triathlons will remain an art not a science, unlike the disciplines that host elite divisions.
Nonetheless, perhaps the US Anti-Doping Agency (USADA) and the World Anti-Doping Agency (WADA) can clarify standards. The blood collection protocol calls for supine for 10 minutes, which is all well and good. Tourniquet application time is vaguely defined by WADA. For College of American Pathologist (CAP)-certified laboratories, the limit is one minute to prevent concentration of cells, large molecules, etc. Evidence I've noted does not show significant concentration within two minutes of tourniquet application; but, significant changes have been noted by five minutes. For endurance athletes I speculate no tourniquet necessary is the rule not the exception. However, a real standardization could involve dermal puncture and Microtainers for complete blood counts. The athlete would do well to receive a carbon copy of any complaints expressed during the collection process.
Hematocrit (i.e. percentage of blood consisting of red cells) has long been an analyte for detecting doping. It is noteworthy that normal hematocrit ranges vary across different ethnicities, with some African and Asian male populations showing lower hematocrits than white Caucasians. Typical clinical laboratory range for a white, Caucasian male population is 42 - 52 percent. Endurance athletes are know to have a narrower range due to the balance of increased plasma and erythrocyte (i.e. red blood cell) volume. While 52 percent may be a normal hematocrit for a white male, it is unheard of among seasoned, undoped endurance athletes. I have yet to find, in publication, how cells and plasma equilibrate in non-Caucasian endurance athletes. As isolated populations enter the competitive field, just imagine. This conundrum has been best addressed by WADA's Athlete Biological Passport Operating Guidelines, adopted in 2009. The expectation that the athletes hematology and chemistry will be monitored throughout their careers, perhaps equivalent to an International Normalization Ratio for oral anticoagulants. While this passport depends on doping beginning after entry to the testing pool, it alleviates the fallacy of population-based reference intervals used in clinical laboratories. For example, if a drug made Alan Webb run a mile in 5:30, from a clinical standpoint he would be asymptomatic (see upcoming blog post).
The approach of science to fairness in sport will likely be an asymptote rather than an intersection. You can expect that the integrity and assertiveness of the athlete will remain indispensable to fairness and sport.
Nonetheless, perhaps the US Anti-Doping Agency (USADA) and the World Anti-Doping Agency (WADA) can clarify standards. The blood collection protocol calls for supine for 10 minutes, which is all well and good. Tourniquet application time is vaguely defined by WADA. For College of American Pathologist (CAP)-certified laboratories, the limit is one minute to prevent concentration of cells, large molecules, etc. Evidence I've noted does not show significant concentration within two minutes of tourniquet application; but, significant changes have been noted by five minutes. For endurance athletes I speculate no tourniquet necessary is the rule not the exception. However, a real standardization could involve dermal puncture and Microtainers for complete blood counts. The athlete would do well to receive a carbon copy of any complaints expressed during the collection process.
Hematocrit (i.e. percentage of blood consisting of red cells) has long been an analyte for detecting doping. It is noteworthy that normal hematocrit ranges vary across different ethnicities, with some African and Asian male populations showing lower hematocrits than white Caucasians. Typical clinical laboratory range for a white, Caucasian male population is 42 - 52 percent. Endurance athletes are know to have a narrower range due to the balance of increased plasma and erythrocyte (i.e. red blood cell) volume. While 52 percent may be a normal hematocrit for a white male, it is unheard of among seasoned, undoped endurance athletes. I have yet to find, in publication, how cells and plasma equilibrate in non-Caucasian endurance athletes. As isolated populations enter the competitive field, just imagine. This conundrum has been best addressed by WADA's Athlete Biological Passport Operating Guidelines, adopted in 2009. The expectation that the athletes hematology and chemistry will be monitored throughout their careers, perhaps equivalent to an International Normalization Ratio for oral anticoagulants. While this passport depends on doping beginning after entry to the testing pool, it alleviates the fallacy of population-based reference intervals used in clinical laboratories. For example, if a drug made Alan Webb run a mile in 5:30, from a clinical standpoint he would be asymptomatic (see upcoming blog post).
The approach of science to fairness in sport will likely be an asymptote rather than an intersection. You can expect that the integrity and assertiveness of the athlete will remain indispensable to fairness and sport.
Thursday, December 16, 2010
Unpublished Letter to Triathlete Magazine
The advice in the July issue of Triathlete assumes that all fluid lost needs replacement. The article ignores the fact that water is a byproduct of glycolysis, as has been pointed out by Tim Noakes, MD.[1] Effectively two molecules of H2O for every molecule of glucose in glycolysis and an additional two molecules via the citric acid cycle.[2] In the small samples cited in the magazine article one wouldn’t expect much statistical significance, but they were correct that individuals must determine their own needs. Polymorphisms of genes such as GH1 have been shown to be associated with different sweat rates.[3]
While dipsogenic genes modulate hydration status including fluid intake, the practical conclusion from prospective and retrospective evidence is to consume fluids and electrolytes ad libitum.[1,4]
1. Noakes MD, Tim. Lore of Running. Champaign, IL: Human Kinetics, 2003.
2. Nelson, David L. and Cox, Michael M. Principles of Biochemisty. Worth Publishers, 2003.
3. Walpole B, Noakes, TD, Collins M. Growth Hormone 1 (GH1) gene and performance and post-race rectal temperature during the South African Ironman triathlon. Br J Sports Med 2006;40:145-150.
4. Saunders CJ, di Milander L, Hew Butler T, Xenophontos SL, Carioulou MA, Anastassiades LC, et al. Dipsogenic genes associated with weight changes during Ironman Triathlons. Human Mol Genet. 2006 Oct 15;15(20):2980-7. Epub 2006 Sep 1.
In hindsight the above could have been more refined; but, the bottom line is chemical equations need to be balanced. One can expect fluid lost in sweat is partly a byproduct of glycolysis. Enough with the dangerous medical advice.
While dipsogenic genes modulate hydration status including fluid intake, the practical conclusion from prospective and retrospective evidence is to consume fluids and electrolytes ad libitum.[1,4]
1. Noakes MD, Tim. Lore of Running. Champaign, IL: Human Kinetics, 2003.
2. Nelson, David L. and Cox, Michael M. Principles of Biochemisty. Worth Publishers, 2003.
3. Walpole B, Noakes, TD, Collins M. Growth Hormone 1 (GH1) gene and performance and post-race rectal temperature during the South African Ironman triathlon. Br J Sports Med 2006;40:145-150.
4. Saunders CJ, di Milander L, Hew Butler T, Xenophontos SL, Carioulou MA, Anastassiades LC, et al. Dipsogenic genes associated with weight changes during Ironman Triathlons. Human Mol Genet. 2006 Oct 15;15(20):2980-7. Epub 2006 Sep 1.
In hindsight the above could have been more refined; but, the bottom line is chemical equations need to be balanced. One can expect fluid lost in sweat is partly a byproduct of glycolysis. Enough with the dangerous medical advice.
Thursday, September 30, 2010
Prostate Cancer Awareness Month
We might have to take a step back for some general anatomy and physiology awareness. You know people will profit from your ignorance.
Over the past couple years molecular analysis has brought about some important discoveries, or otherwise promising diagnostic advances on the horizon. Clinical laboratory science may move beyond PSA and free PSA to subsets of bound PSA. Prostate basal cells, with their stem cell like properties, are now thought to be a primary origin of malignancy. Morphology is finally becoming outdated as it is with blood malignancies. The American Cancer Society has given due consideration to quality of life, and rightfully so. With individuals more likely to die with it than from it, caution has been urged in screening with PSA. To begin with prostate-specific antigen is a misnomer; it's found in other body fluids. It is the product of one of 15 kallkreins (i.e. serine proteases; enzymes) in a cluster on Chromosome 19. To me it doesn't seem likely that the gene for a kallikrein would be completely methylated in all other tissue. Sure it may have some post-translational modification that may have it more or less organ-specific; but, the enzyme is found elsewhere. Furthermore when is a single enzyme value ever specific for a disease? One large epidemiology study analyzed the meteorologic correlations with prostate cancer [St-Hilair, Mannel, Mandal, and Derryberry 2010]. The latitude factor appeared to be most directly linked to pesticide use in agriculture combined with snowfall. The study noted known endocrine disruptors used in agriculture.
Men advocating for their collective interest seems to be almost nil. I think nothing on a par with the breast cancer marches. In the 21st Century along comes Athletes for a Cure. Perhaps this angle will more effectively utilize the competitive nature. From my subjective observation fundraising and "awareness" campaigns are more prevalent among the long course athletes (e.g. Ironman/70.3). At 70.3 Cancun in 2008 I noted a couple traveling the world doing 70.3 races with the stated purpose of raising awareness of brain injuries and testicular cancer. Maybe merely doing extraordinary distances already attracts a fair amount of attention. Hopefully the active community can keep due attention to quality of life as both proposed prevention and treatment modes threaten health and vigor.
Until their is Athletes for a Reliable Diagnosis, I will leave it in the hands of the PCF. But, maybe the diagnosis is the problem.
http://athletes.kintera.org/faf/donorReg/donorPledge.asp?ievent=186390&lis=0&kntae186390=758C247C4E2C473E915B4F0DB2FB42BC
At this time "cure" seems to mean absence of malignant cells, even though functional organs are lost. I expect that genuine elimination of only malignant cells will remain a pipe dream for the foreseeable future. First getting priorities straight will be the first step towards success. Prevention will be everything for quality of life. Public health needs reform. Enough with the politicized "cost/utility" war on diseases and in with the humanity. With need molecular data more than family history spurious correlations. There are mutants among us.
Hopefully genuine awareness will prevent profiteering.
Over the past couple years molecular analysis has brought about some important discoveries, or otherwise promising diagnostic advances on the horizon. Clinical laboratory science may move beyond PSA and free PSA to subsets of bound PSA. Prostate basal cells, with their stem cell like properties, are now thought to be a primary origin of malignancy. Morphology is finally becoming outdated as it is with blood malignancies. The American Cancer Society has given due consideration to quality of life, and rightfully so. With individuals more likely to die with it than from it, caution has been urged in screening with PSA. To begin with prostate-specific antigen is a misnomer; it's found in other body fluids. It is the product of one of 15 kallkreins (i.e. serine proteases; enzymes) in a cluster on Chromosome 19. To me it doesn't seem likely that the gene for a kallikrein would be completely methylated in all other tissue. Sure it may have some post-translational modification that may have it more or less organ-specific; but, the enzyme is found elsewhere. Furthermore when is a single enzyme value ever specific for a disease? One large epidemiology study analyzed the meteorologic correlations with prostate cancer [St-Hilair, Mannel, Mandal, and Derryberry 2010]. The latitude factor appeared to be most directly linked to pesticide use in agriculture combined with snowfall. The study noted known endocrine disruptors used in agriculture.
Men advocating for their collective interest seems to be almost nil. I think nothing on a par with the breast cancer marches. In the 21st Century along comes Athletes for a Cure. Perhaps this angle will more effectively utilize the competitive nature. From my subjective observation fundraising and "awareness" campaigns are more prevalent among the long course athletes (e.g. Ironman/70.3). At 70.3 Cancun in 2008 I noted a couple traveling the world doing 70.3 races with the stated purpose of raising awareness of brain injuries and testicular cancer. Maybe merely doing extraordinary distances already attracts a fair amount of attention. Hopefully the active community can keep due attention to quality of life as both proposed prevention and treatment modes threaten health and vigor.
Until their is Athletes for a Reliable Diagnosis, I will leave it in the hands of the PCF. But, maybe the diagnosis is the problem.
http://athletes.kintera.org/faf/donorReg/donorPledge.asp?ievent=186390&lis=0&kntae186390=758C247C4E2C473E915B4F0DB2FB42BC
At this time "cure" seems to mean absence of malignant cells, even though functional organs are lost. I expect that genuine elimination of only malignant cells will remain a pipe dream for the foreseeable future. First getting priorities straight will be the first step towards success. Prevention will be everything for quality of life. Public health needs reform. Enough with the politicized "cost/utility" war on diseases and in with the humanity. With need molecular data more than family history spurious correlations. There are mutants among us.
Hopefully genuine awareness will prevent profiteering.
Tuesday, September 28, 2010
Age Group Nationals
Tuscaloosa was a great host city with good places to ride and run. The park was a good venue, aside from the cold start in the Black Warrior River that it may have necessitated. I could have used more time to warm up; heart rate can get out of whack with a race start in an overcrowded river. Water temperature was well into the 80's. That big gap (1/2 hour) in the waves did a good job giving the 30 and 40-somethings a hot run.
As the pundits say, it's not how hard you train but how hard you recover. In the end it's the little things. Forgetting the address and contact information of VeloCity Pro Cycle had me going in circles late on Thursday and having to wait until late morning Friday to get my bike and losing sleep in the process. Either those antacids were a little too far past expiration or I should have started the cycle earlier. 22nd out of 85 at Nationals... I can live with that; but, I'm having some regrets that I did not rent race wheels after missing official Team USA qualification by four places.
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