My adventures

Three Weekends of Outdoor Fun

September 18, 2018 By Larry Creswell, MD Leave a Comment

I had a terrific time these past three weekends and thought I’d share some photos.

First up was a weekend at Crystal Mountain, a ski area near Mt. Rainier in Washington state, for a Ragnar Trail Relay. Interestingly, my family lived in Washington state for several years when I was a kid and we enjoyed family ski trips to Crystal Mountain in the 1970’s. It was fun to return. This was my first Ragnar event and I thought it was awesome–a camping weekend at the mountain base with ~2500 runners. I joined two 8-person relay teams representing Ironheart, a support group for athletes with heart problems. This was also my first-ever trail running event and the series of 8-mile, 5-mile, and 3-mile trail runs up and down the mountain were certainly a challenge. I have a renewed respect for veteran trail runners. For me, the highlight was the fellowship with my teammates.

Next up was a long weekend in the Lake District in northern England for some swimming in Lake Windermere, England’s longest lake. I participated in Epic Events’ One-Way Windermere (WOW) swim, an 11-mile swim from end-to-end, an event that attracted ~175 swimmers! This swim is a British classic and, because of its length and water temperature (~16-17C, 61-63F on race day) that mirrors the English Channel for much of the year, a bit of a proving ground for Channel aspirants. For me, it worked out to be a relaxed, 5 hour 40 minute swim, with a chance to practice feeding every 30 minutes. It was a solid effort and, to my surprise, it was good for 2nd place among the non-wetsuit men, so it even came with a prize at the finish! Big thanks to Epic Events, all the volunteers, and especially my paddler, Chris Cheal, and my sister, Lori, who cheered loudly.

This past weekend I travelled to San Francisco for Water World Swim’s 10k Bridge-to-Bridge Swim. I did this event last year with a wetsuit and I was happy to secure a non-wetsuit spot for this year’s swim. San Francisco Bay is a spectacular venue for any swim. And with this particular swim, you get to take in all the sights as you swim from the Golden Gate Bridge along the entire San Francisco waterfront, passing Alcatraz Island along the way. The water was chilly (~16C, ~61F), but the swim was pretty quick with the help of the current. Swimming downstream is always fun.

I’m taking a couple weeks off from swimming for some well-needed rest. Next up is the Waikiki Looong Swim in late October.

The Ragnar team captains–Dave Watkins, founder of Ironheart, and Greg Bateman. At the finish, and looking proud of their teams’ accomplishments.

At the finish for Team #48. Seven members remain….after a medical emergency took one teammate (and his teammate wife) to the hospital.

The Ironheart teams celebrating after the event.

Lake Windermere is about a 2 hour’s drive northwest of Manchester, England. The scenery’s lush and green and the Lake is nestled amongst the rolling hills.

The start of the Windermere swim, at Fells Foot park. A day of swimming in England wouldn’t be complete without some fog and mist (and rain, to be truthful). Thanks to Epic Events for the photos they agreed to share.

This isn’t me swimming, but I stayed for the weekend at the Beech Hill Hotel in the background.

A warm embrace with my paddler, Chris Cheal, at the finish. I’m not sure who had the more difficult day. I think I’d be crippled if I kayaked for nearly 6 hours.

With my sister at the finish. Looking a bit warmer and happier after a change into some dry clothes.

Checking out the next day’s Bridge-to-Bridge swim during the night Alcatraz tour.

Motoring out to the South tower of the Golden Gate Bridge for the start of the swim. This year we had a clear day. Last year, the road deck of the bridge wasn’t even visible because of the fog. Much easier navigation this year!

Just before the start….and ready to swim toward Alcatraz island, a couple miles in the distance. It’s cold–but it never gets old–swimming in San Francisco Bay.

#GoingLong in the Swim: A Weekend of Swimming in the UK

August 12, 2018 By Larry Creswell, MD 4 Comments

I just got back from a few days in the UK with my coach, Justin Daerr. The trip was a bit of a whirlwind, with stops in London, Henley-on-Thames (with a swim event), and a quick trip down to Dover for some English Channel recon. It was the best of British swimming locales.

Sticking primarily to public transit, I think we set a new record for number of rides: The tally included 4 flights, 2 plane trains in the Atlanta airport, 4 bus rides, 12 rides in the London Underground, 9 train rides, 1 ride on the Thames Clipper boat, 7 rides on the Docklands Light Rail, 2 ferry rides across the Channel, and 1 Uber ride! I think I’m worn out more from the public transit than from the swimming.

The trip was primarily for the purpose of swimming in Henley Swim’s Thames Marathon Swim, but we tacked on the trip to Dover so that I could introduce Justin to the Channel swimming scene. We had a terrific time.

Here are some photos from the trip….

Next up for me….I’ll be returning to the UK in 3 weeks for a 10.5-mile swim at Lake Windermere in the Lake District. I’m looking forward to the trip and my longest nonstop swim yet.

Our home for a couple days in London was the Canary Riverside Plaza Hotel. I’ve stayed here a couple times, in large part because of the awesome swimming pool alongside the Thames with panoramic views of London.

We had a chance on 2 successive mornings to swim at the Serpentine in Hyde Park, the site of the Olympic triathlon and 10-km open water swimming events. On this occasion we also enjoyed viewing–and swimming alongside–a temporary barrel sculpture by the renowned artist, Christo. We joined (for a nominal fee) the Serpentine Swim Club, the oldest swim club in the UK so that we could do some “before hours” swimming and take part in the Club’s weekly Saturday morning race, this time an 880-yard event. I think Justin was the winner, taking the other Serps by surprise, I’m sure.

The local swans also enjoy swimming in the Serpentine. They’re surprisingly unflustered by the swimmers.

Before heading to Henley, we did a little sightseeing in London, including a trip to the viewing gallery at the top of The Shard, London’s tallest building.

The primary purpose of the trip was to swim in Henley Swim’s Thames Marathon Swim, a 14-km route from Henley-on-Thames (shown here from my room) to the town of Marlow. In this section of the river, there are a series of locks and dams to allow for recreational water activities. It also meant that there were 3 short breaks–and aid stations–where we’d get out and walk around the locks. For anybody looking to #GoLong in the swim, this is an awesome event–very well organized and a chance to swim no more than 25 yards from shore.

This was my 2nd time for this swim event. I was also here in 2013. This time, I was excited to snare a non-wetsuit entry. Here, Justin and I are next to the large buoy ready to start the race.

The race photographer did a good job of capturing Justin….

and me about 10 km into the swim.

Next, it was off to Dover for a very quick look around. Here we have Swimmers Beach at Dover Harbor and the White Cliffs of Dover in the background.

It’s great to visit the statue on the waterfront of Matthew Webb, the first swimmer to cross the Channel, in 1875.

Our last activity was a ferry trip across the Channel to the French port city of Calais, to get a measure of the Channel. The weather was terrific, mostly sunny and with calm seas.

We took a drive down the French coast to Cap Gris Nez, the nearest point of land to England. The White Cliffs of England, though 21 miles away, look deceptively close. The day of our visit, 9 pilot boats were escorting swimmers–7 solo swimmers and 2 relay teams–across the Channel. The luckiest finished their swims at the foot of this cliff. Some happy swimmers, no doubt!

Japan and Triathlon Fatalities

February 25, 2016 By Larry Creswell, MD 2 Comments

I’ve recently returned from a trip to Tokyo, Japan, where I was the guest of the Japan Triathlon Union (JTU). The occasion was their organization’s 5th Annual Forum, which this year was devoted to the issue of triathlon race safety.

I appreciate the kind invitation from Mr. Otsuka and Mr. Nakayama, the help of JTU’s Kenta Kodama with the travel arrangements, and the tremendous help with translation from Ms. Tomoko Wada. My hosts were gracious in every way. I must also thank the kind folks at USA Triathlon (USAT)–Terri Waters and Kathy Matejka, for help with gathering some updated information to present in Japan, and USAT President Barry Siff for making the necessary connections with JTU.

As readers here will know, I’ve had an interest in triathlon-related fatalities and the broader issue of sudden cardiac death among endurance athletes. I had the opportunity to lead a recent USAT effort to learn more about triathlon-related fatalities and our work resulted in a 2012 report entitled “Fatality Incidents Study.” As I’ve said before, this report is good reading for athletes and event organizers who are looking for recommendations about how to race safely and conduct events with athlete safety as a first priority.

Sadly, there were 6 triathlon-related fatalities in Japan in 2015, the most ever in a single year there. Dr. Ryoji Kasanami, the Chairman of the JTU’s Medical Committee, had become familiar with our work here in the USA and was interested in learning how our findings might help JTU with better safety planning, on the parts of both athletes and event organizers.

I gave a talk at the Forum where I outlined the USAT experience with fatalities since 2003. In large part, the information is summarized in my previous blog post, Triathlon Fatalities: 2013 in review. I was able to include some updates through the 2015 season, but the central themes were the same now as then:

There is variation in the fatality rate from year to year, with an overall fatality rate of ~1 per 70,000 participants
Most fatalities occur during the swim portion of events
Most victims are male
Fatalities are most common among middle-aged athletes
There have been no fatalities among elite (professional) athletes
Among victims, there is a wide range in athlete experience and ability
There is a small number of trauma-related fatalities, arising from bicycle crashes
Among non-traumatic fatalities, the vast majority suffered cardiac arrest at the race venue
Available autopsy information for non-traumatic fatalities has shown heart abnormalities in the majority

Dr. Kevin Harris, from the Minneapolis Heart Institute, and I will be presenting an abstract at the upcoming American College of Cardiology meeting in April in Chicago on this topic. We’ll be sharing consolidated information about 106 fatalities, including the autopsy findings from 41 of the non-traumatic fatalities. I’ll report back here at the blog with an update in April.

Dr. Kasanami shared information about the Japanese experience with 37 fatalities over the past 3 decades. There were many similarities to the experience in the USA:

Some years were “safer” than others
Most fatalities occurred during the swim portion of events
Most victims were male
Fatalities were most common among middle-aged athletes
There have been no fatalities among elite athletes
There were no fatalities in young athletes

There were also some notable differences:

There were no fatalities during the bike portion
Autopsy was seldom performed in the victims

Interestingly, the bike course is always closed to vehicular traffic during triathlons in Japan, and this might obviously have an impact on the number of crashes and trauma-related fatalities. One interesting anecdote shared by a pathologist attendee related to the finding of inner ear bleeding (hemorrhage) in 2 victims. I’m not sure about the significance of this observation.

I’m intrigued by the many similarities of the Japanese experience with race-related fatalities. I also know from preliminary discussions with officials at Triathlon Australia that the experience in Australia is similar as well. I suspect that the causes of cardiac arrest in participating athletes are common broadly, and are more dependent on simply the human condition rather than race-related factors that might be specific to one region or another (eg, race safety or technical rules, approach to medical care on site, warm-up, etc.).

I’ll mention here that the Medical Committee of the International Triathlon Union (ITU) is very interested in this issue, particularly as it relates to elite athletes. I understand that efforts are being made to implement the requirement for mandatory periodic health evaluations, including EKG screening, for youth, U23, and elite athletes who participate in ITU races, perhaps beginning in the 2017 season. This follows on the heels of the international rowing federation adopting a similar policy, gradually, during the 2014 and 2015 seasons.

I worry a little about the ITU focus on elite athletes, since the problem of race-related fatalities seems to be largely one of age-group athletes, but I hope that age-group athletes will be paying attention to any recommendations that are implemented.

Lastly, I’ll close with some photographs from the trip. Since this was my first-ever visit to Tokyo and Japan, my hosts graciously afforded me about 8 hours of free time one day for the purpose of sightseeing and I took advantage. I hope to return to Japan soon to see even more.

USAT Medical Multisport Conference

May 21, 2015 By Larry Creswell, MD 2 Comments

I had the chance to be a speaker at the November, 2014 USA Triathlon (USAT) Medical Multisport Conference that was held at the Olympic Training Center in Colorado Springs. The weekend brought 2 days of talks that focused on aspects of sports medicine that were particularly relevant to triathlon and multisport.

Travis Tygart, CEO of the United States Anti-Doping Agency (USADA) was the keynote speaker. We heard about event and safety planning from a very experienced group of USAT-affiliated physicians, including W. Douglas Hiller, MD, Andrew Hunt, MD, and John M. Martinez, MD. I gave talks on some of my favorite topics: “Triathlon Fatalities,” “Endurance Sport: Is it Heart Healthy?,” and “Cardiovascular Considerations in the Aging Athlete.” We had lunch with Kathy Matejka, the USAT Event Services Director and dinner with Rob Urbach, CEO of USAT.

I met some terrific folks and I learned a lot.

It was great to visit the Olympic Training Center. I particularly enjoyed the museum area and a workout at the pool. The snow and cold weather got the best of a planned group run, though.

This year’s Conference is planned for November 5-7, 2015, again at the Olympic Training Center in Colorado Springs. This year’s keynote speaker will be Robert Laird, MD, the original and long-time medical director for the Ironman World Championship race in Kona, Hawaii. This would be a worthwhile meeting for anybody who’s involved with medical care of multisport athletes, including nurses, physicians, and allied health professionals. Information about the meeting schedule, speakers, and registration can be found at the USAT website.

I hope that you’re able to join us in November!

A Weekend in Atlantic City

July 14, 2014 By Larry Creswell, MD 2 Comments

A couple weeks ago, I had the chance to spend the weekend in Atlantic City, New Jersey for the Challenge Atlantic City triathlon. You may know that this was the inaugural edition of the race and the first iron distance triathlon by Challenge in the United States. It was a terrific event and I had a great time.

I hadn’t visited Atlantic City for about 25 years. Of course, there are new casinos now, both on and off the Boardwalk, but in many ways Atlantic City was very much like I remembered. It’s a very unique combination of nostalgic Boardwalk beach town Americana and the business of towering casino hotel developments. There’s new and old. Shiny and dull. Have and have not. The differences are very striking.

It’s an unusual setting for a long-distance triathlon. No doubt, it’s difficult to produce a 140.6-mile event in any urban setting, yet alone in the middle of the summer tourist season at a beach resort town! I give the organizers a lot of credit for getting things together.

Thanks to a kind invitation from Brad Bernadini, MD, and the race director, Robert Vigorito, I had a chance to be involved with a 2-day Sports Medicine Symposium in the days before the race. I gave talks on “Athlete’s Heart: Good and Bad” and on “Triathlon Fatalities.” The program included a variety of topics. My favorite speaker was Robert Laird, MD, the long-time medical director of the Ironman World Championship. He shared the fascinating tale of medical coverage at the event over the past 30 years. My favorite slide was of Dr. Laird, stethoscope around his neck, standing on the Kona pier watching the first Kona edition of the race, in 1981. That year, he was it. Today, the event stages a 50- to 60-bed medical tent to take care of the athletes on race day. I’ll devote my next blog post to some thoughts about medical tents at large endurance sports events. I have mixed feelings.

As for the race, I chose to do the aquabike event. This was a first. I suppose there have been instances where I haven’t finished a triathlon, stopping on the run. But this was the first time I’ve ever intentionally stopped the race at T2. And I must say that race day has a very different feel when you don’t have to run a marathon after the long swim and bike! Aquabike may be calling my name.

The swim portion of the race was deceptively challenging. Held in the “back bay,” the venue was subject to a brisk incoming tide that produced a very strong current. That, combined with a very unusual serpentine single-lap course made for a difficult swim. As an interesting surprise on race morning, the water temperature was 80 degrees, so no wetsuits were allowed. Most triathletes don’t have much opportunity to do 2.4-mile swims without a wetsuit. It was a beautiful, sunny day, though, and the temperatures were mild.

The bike leg of the race took us away from the beach, up the Atlantic City Expressway (ACE), to the town of Hammonton. There, we had two ~22-mile laps through the countryside which is apparently the U.S. capitol of blueberry farming. There was a rewarding stretch through main street Hammonton on each lap where there were hundreds of cheering spectators, balloons, inflatable archway, and an announcer. The race even provided shuttle buses for spectators who wanted to make the trip to Hammonton to watch the athletes. This was a nice touch. The ride back down the ACE to the beach was tough, into a ~15 mph headwind. For me, at any rate, the ride didn’t seem “flat and fast,” as advertised!

I hope that Challenge is successful in getting this race established. I understand there is a 5-year commitment at this point. I appreciate the alternative to the series of World Triathlon Corporation (WTC) Ironman-branded events and I appreciate the choice of a venue in Atlantic City. If you’re a triathlete, check out this race. If you’re a medical or allied health professional, check out the pre-race sports medicine symposium. And if you’re both….you can have a busy weekend next June!

Like I said, I was glad that my day was finished after the 112-mile bike ride. After a shower–and a casino buffet meal–back at the hotel, I made my way to the finish line on the Boardwalk in front of historic Boardwalk Hall. Most of the 26.2-mile run took place on the Boardwalk amongst the thousands of visitors. It was really a sight. And, as always, it was a thrill to see the athletes finishing late in the evening. In Challenge style, children or family members were allowed to join athletes in the finishing chute. The children seemed to draw the biggest cheers from the crowd.