Athlete's Heart Blog

Dr Larry Creswell

Dr. Larry Creswell on athletes and heart health.
About Larry / Contact
  • Facebook
  • RSS
  • Twitter

Writing on…

Copyright © 2023 · Wintersong Pro Theme on Genesis Framework · WordPress · Log in

You are here: Home / Archives for race

Book Review: Heart to Start

March 13, 2015 By Larry Creswell, MD 1 Comment

HearttoStartBook

 

 

 

 

 

 

 

Check out the newly published “Heart to Start:  The Eight Week Exercise Prescription to Live Longer, Beat Heart Disease, and Run Your Best Race,” by cardiologist, James Beckerman, M.D.  The book is available at Amazon and other outlets.

This is a terrific book!

First, let me share a little bit about the author.  Dr. Beckerman is the Medical Director of the Center for Prevention and Wellness at the Providence Heart and Vascular Institute in Portland, Oregon.  He is also the team cardiologist for the Portland Timbers Major League Soccer team and the founder and medical director for Portland’s Play Smart Youth Heart Screenings.  He is passionate about wellness, exercise, and preventive cardiology.  Follow him on Twitter at @jamesbeckerman.

Perhaps you’ve had a heart attack and your doctor has recommended exercise.

Perhaps you’ve discovered that your blood pressure or cholesterol is elevated and your doctor has suggested exercise as a treatment.

Perhaps you’ve just decided to get up off the couch and be more active.

The inevitable question is, “How do I get started?”  This book is for you!  In Dr. Beckerman’s words, “This is a book about exercise and I guarantee that it will move you….”.  More coach than doctor, he will guide you every step of the way as you get going.  Take him up on the offer.

This book starts with a very personal and riveting Foreword by Dave Watkins.  He asks, “What is your legacy?”  He shares his near-death experience with urgent heart surgery for a diseased heart valve and aortic aneurysm on the verge of rupture.  There were certainly ups and downs during Dave’s recovery, but he survived and then some!  Read about Dave’s return to exercise, his successes in triathlon, and the founding of his Ironheart Foundation.  Dave’s story will provide ample motivation.

The book is divided into 3 sections….

Warm Up.  In the first section, Dr. Beckerman helps you to take stock of your health in general and your heart in particular.  He introduces the concept of preventive cardiology and illustrates this with real-world examples where “an ounce of prevention is worth a pound of cure.”  Dr. Beckerman shows you how to use the Sit Rise Test and the 6-minute walk test to size up your fitness level.  This section concludes with a discussion of how traditional cardiac rehab and structured exercise can be so valuable.

Workout.  In the second section, Dr. Beckerman lays out what he calls your “Heart to Start Exercise Prescription.”  You’ll start with an assessment of your VO2max, an index of your aerobic capacity or fitness, and then embark on an 8-week exercise program that is tailored to your fitness level.  There are both HEART (aerobic exercise) and START (strength exercise) components.  The program is structured but simple.

Cool Down.  In the final section, Dr. Beckerman sums things up.  He recognizes that there are always choices and asks you to remember to consider, “What would a healthy person do?”  For those wishing to continue on, he leaves you with a 12-week exercise program that will get you to the start line of a 5K running race.  It’s a program that he uses in Portland with his popular Heart to Start group (see the photo).  You can be sure that the program works.

H2S

 

 

 

 

 

This book is for….

If you’re ready to get going, take a copy of “Heart to Start” to your next doctor’s visit and talk about getting started.  Team up with your doctor to put Dr. Beckerman’s exercise prescription to work for you.

For many readers here at the blog, exercise may already be an important part of your routine.  But I bet you know others, perhaps in your own family, who haven’t yet embraced exercise.  Get them a copy of the book and help them get started.

Perhaps you’re in a position to organize a group exercise program like Dr. Beckerman’s Heart to Start program.  I bet he’d be happy to hear from you and help you get things organized.

 

Related Posts (Other Book Reviews):

1. Cardiac Athletes, by Lars Andrews

2.  The Exercise Cure, by Jordan Metzl, MD

 

Filed Under: Athletes & preventive care, Exercise & the heart Tagged With: athlete, exercise, heart, heart disease, race, rehab

Mixed Emotions About The Medical Tent

September 17, 2014 By Larry Creswell, MD 4 Comments

Tent

 

 

 

I’m fascinated by the medical tent at endurance sporting events.  Maybe that’s not surprising.  After all, I’m a doctor and an athlete.

I have mixed emotions about the medical tent, though.  Maybe you do, too.  Let me explain….

Dr. Laird and the Kona Medical Tent

I got to thinking about the medical tent this past month when I listened to a talk given by Dr. Robert Laird, the long-time (now retired) medical director for the Ironman World Championship race in Kona.  He gave a talk at a sports medicine symposium held in conjunction with this summer’s Challenge Atlantic City events.  He told the ~23-year history of medical support for the Ironman race, beginning with its first year in Kona in 1981.  That year, Dr. Laird stood on the pier watching the swimmers, dressed in running gear, stethoscope around his neck, cap on his head….and he alone was the extent of the medical support.

Of course, today it’s much different.  On race day, there is a 50- to 60-bed field hospital set up in a tented area across from the Kailua Pier.  It’s arranged in pods of 6 patient beds and staffed with many physicians, nurses, physical therapists, and non-medical volunteers as well.  On race day, it’s the 3rd largest “hospital” on the Big Island of Hawaii.  And on race day, up to several hundred athletes among the nearly 2,000 participants in the race receive medical care there.

The medical support team also has a fleet of makeshift “ambulances”–rented white vans with a temporary red cross affixed to the side.  Without these vehicles, the need to respond to athletes on the 112-mile bike course or 26.2-mile run course would overwhelm the resources of the local EMS system.

If you’re an athlete with medical needs on race day, the setup is awesome.  In truth, the Ironman event as we know it today would be impossible to stage without this elaborate medical support.

My Own Medical Tent Memories

Thankfully, I’ve avoided the medical tent as a patient.  I did take a break at a medical aid station along the run course at the 2012 Ironman New Zealand race when I was feeling poorly.  But after a cool refreshment, some much needed shade, and a short break, I was able to continue along my way.

I’ve waited near the doors of the medical tent on a couple occasions, though, while my athlete friends were receiving treatment.  I remember my buddy, George, losing 12 pounds during the Ironman New Zealand race in 2007 and needing rehydration.  I also recall my friend, John Pendergrast, an ophthalmologist, needing treatment for a couple hours after finishing the Ironman South Africa race.  Our small group of traveling partners waited anxiously to be sure that John was okay.

I volunteered once in a major medical tent–for the Ironman Florida race.  I worked the 6 pm to midnight shift.  My lasting memory will be of the athletes who arrived at the finish line and then collapsed.  On a day with high temperatures in the gentle 70’s I was surprised at how many athletes arrived at the medical tent at the finish line severely hypothermic and dehydrated.  It seemed that the athletes who were worst off were those who arrived after finishing the race in 10-11 hours or so.  Perhaps the later arrivals had gone too slowly to get “messed up.”  We treated a bunch of athletes that night.

I’ve enjoyed reading the accounts of others who’ve worked in the triathlon medical tent.  Check out the report by professional triathlete and physician, Tamsin Lewis.

Marathon Medical Tents

Of course, the medical tent today isn’t confined to triathlon.  There is elaborate medical safety planning for the major running races, too.  There is often a medical tent at the finish line of the big city marathons and these are often staffed, at least in part, by volunteers.

I recently attended a lunchtime lecture given by one of my cardiology colleagues who had volunteered at the medical tent for the Boston Marathon.  There’s a sports medicine symposium before the race and the attendees are offered the opportunity to volunteer in the medical tent.  This gives physicians a chance to put into practice what they’ve just learned.  Listening to his tale, I get the impression that virtually any medical problem can manifest during the marathon, but that dehydration and heat-related illnesses are the common medical ailments.  He shared (and I’ve heard from others as well) that ice baths for rapid cooling of victims with severe heat-related illness probably make the difference for survival–that the EMS system and local hospital emergency rooms might not have the available resources to get athlete patients cooled so quickly.  That’s an eye-opener.

Malpractice Insurance Issues

I’ve often wondered–and even worried–about the issue of malpractice insurance coverage for physician volunteers at medical tents.  It’s one thing if you’re an emergency physician or sports medicine physician.  But it’s another situation entirely if you’re volunteering in a capacity outside your specialty–and perhaps outside the state where you’re licensed.  The issue would seem to be relevant not only to physicians but also to nurses and other licensed healthcare professionals as well.

It would be interesting to know if there are instances of malpractice lawsuits brought by athlete-patients against medical tent volunteers.  I’m told by the folks at USA Triathlon (USAT) that they’re not (yet) aware of any instances.

In order to encourage volunteer participation by medical professionals at triathlon medical tents, USAT has organized a malpractice insurance coverage opportunity.  This opportunity hasn’t received much publicity.  For a very modest premium, any licensed medical professional can obtain insurance coverage in situations where their own policies wouldn’t be applicable.  I bet this would help put some potential volunteers’ minds at ease and encourage their involvement.

The Mixed Emotions

So, back to the mixed emotions.  No doubt, the medical tents at triathlon and major running events provide a useful and needed service.  In some cases, it would be impossible to hold events without an organized medical safety net that includes an on-site medical tent.  And no doubt, countless athletes have benefitted from care they’ve received by volunteers at these medical tents.  So, in the sense of providing a safety net for participants, the medical tent is great.

But on the other hand, I have to wonder if the very existence of the medical tent and ready availability of volunteer medical care doesn’t encourage unsafe behavior on the part of athletes or event organizers.  I also wonder how outsiders view this whole enterprise.  Surely, if intravenous hydration is required by large numbers of participants just to complete an event, there must be something wrong–either in the venue, the weather conditions, or the preparation of the athletes.  Yet I hear many athletes talk casually about how they’ll “just get an IV” after the race.

At any rate, this is all food for thought.  I’m intrigued by the medical tent.  I hope it’s there when I need it, staffed by capable healthcare professionals.  I’ll probably volunteer again, too.  But I’ll also have some nagging worries.

Filed Under: Race safety Tagged With: athlete, event, medical care, race, race safety

A Weekend in Atlantic City

July 14, 2014 By Larry Creswell, MD 2 Comments

ACSwim2

AquabikeFinish

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.

 

 

Filed Under: My adventures Tagged With: aquabike, Atlantic City, Challenge, race, sports medicine, triathlon

Medical Toll at Obstacle Race

July 6, 2014 By Larry Creswell, MD 1 Comment

Obstacle

 

 

A couple weeks ago I wrote about the medical toll at long-distance running events.  There was also a recent report on the medical toll at an obstacle course race that caught my eye.  On the face of it, the findings were surprising!

At the outset, let me issue a disclaimer.  I haven’t participated–or even spectated–at one of these obstacle course races, so I may not have the best perspective.  I’m talking, though, about races like the Tough Mudder, Warrior Dash, and Spartan Race, among others.  They’ve become very, very popular very, very quickly.  We’re talking 100’s of thousands of participants per year in the U.S.  One day, I’ll give it a try.  I’ll need to be brave!

 

The Study

A group of investigators headed by Marna Greenberg, DO, MPH, in the Department of Emergency Medicine at Lehigh Valley Hospital reported on a collection of patients who required hospital care stemming from their participation in an obstacle course race.  The event was the Tough Mudder Philadelphia race, held over the weekend of June 1, 2013.  As you may know, the Tough Mudder races are characterized by a 10- to 12-mile course with a series of 20-25 obstacles spread over the course.  By report, approximately 22,000 individuals participated in this particular race.

The investigators were the emergency room physicians at the hospital that was designated to care for participants who required hospital care for medical conditions or injuries that developed during the race.  In a report in the Annals of Emergency Medicine entitled “Unique Obstacle Race Injuries at an Extreme Sports Event:  A Case Series”, they share their first-hand experience which they characterized as surprising.

 

The Results

The report provides fair detail about 5 patients with “significant” injuries or diagnoses and compiles a list with pertinent findings in 43 total athletes who received care at the hospital. The 5 athletes with “significant” problems included:

  • 18 year old with myocarditis (inflammation of the heart muscle) caused by electrical shock during the event.  Required admission for 2 days.  Self-limited.
  • 28 year old with depressed level of consciousness and diagnoses of accelerated hypertension (high blood pressure) and pericarditis (inflammation of the sac that holds the heart).  Required admission for 2 days.  Self-limited.
  • 31 year old right-sided weakness who was found to have a stroke, seizure, and dehydration.  Required admission to the intensive care unit (ICU).  Was discharged to a rehab facility and at the time of writing, had persistent weakness due to the stroke.
  • 41 year old who experienced syncope (blacked out) after being shocked at an obstacle.  He fell, causing lacerations to the face.  He was discharged from the emergency room against medical advice to be hospitalized.
  • 25 year old woman with near syncope (nearly blacking out) because of electrical shock.  Required hospitalization for evaluation and was treated for dehydration and rhabdomyolosis (breakdown of muscle).

The 38 others had diagnoses that included:  heat injury, sunburn, ear barotrauma (pressure injury), shoulder dislocation, patella dislocation, heat exhaustion, vomiting, renal failure, various contusion injuries, rib fracture, dehydration, asthma, seizure, leg fracture, ankle sprain, and elbow sprain, among others.

 

The Takehome Messages

You never read about the medical toll at running races that are shorter than half marathon distance.  That’s not to say that athletes don’t have injuries or other medical problems manifest during those races.  It’s just that athletes are usually responsible for their own medical care or receive their care from the emergency medical system (EMS), rather than by race-supplied medical volunteers.  So nobody is keeping track of the “toll.”

This report is great peak into the issues with the obstacle races.  Kudos to the authors for sharing their experience.  Obviously, 43 victims among 22,000 participants is a small fraction.  We might reasonably expect, though, that additional athletes with minor injuries or medical conditions did not visit the hospital for care.

Some thoughts….

  • At an obstacle course race, the obstacles present a challenge and risk that is different from just running.  These events are certainly not risk-free.
  • There are typical medical issues like minor injuries, dehydration, and heat injury.  Some injuries and medical problems may be due very specifically to the obstacles themselves.
  • There will also be injuries that may not be expected–either by the athletes or by the nearby healthcare workers.  At this particular event, the myocarditis, pericarditis, stroke/seizure, and syncope diagnoses were examples.  Electrical shock was an unexpected causative factor.
  • Athletes should keep the potential risks in mind when they decide to participate and exercise great care while participating.

Like I said at the top, I’ll probably be a participant at some point.  But I’ll need to be brave!

Filed Under: Race safety Tagged With: athlete, complication, medical complication, obstacle run, race, safety

 

Loading Comments...