TRIATHLON AND COMPETITIVENESS

We discussed with Nicolas Romanov (years back) about the characteristics of the triathletes; he said that “fighters” were born and he did not want to deal with athletes who weren´t “fighters.”  He spoke about being hungry in order to fight (he feels that is the reason why he fought).  Looking into being hungry and fighting for something is not easy; I remembered triathletes who used to eat “a torta” (a sandwich) a day for a year because lack of money or stubbornness to say “I am sorry;” but until now they have not fought for at least two tortas.  On the contrary, triathletes who get used to a torta a day just try enough for such a torta using means that are not triathlon oriented (lying to people to obtain benefits).  Richard Bach used another metaphor to say the same in his book Jonathan Seagull. 

Dionicio Cerón (three times in a row London Marathon winner) has spoken about it:

How to overcome such impasse has been our problem for the last five years.  To make people believe beyond a torta, which it means: “to create dreams in people’s head,” has been our task for the last five years.  We have failed.  We have not passed the stage of PLAYING TRIATHLON.  That is what our triathletes have achieved.  It is difficult to achieve the level of being a professional.  We have achieved the level of vacancier playing triathlon.  Unfortunately, this is what I see in our triathletes: “The vacanciers looking for the next vacance.” We have written about in previous posts:

28 sept. 2012

TRIATHLON EDUCATION IV, ‘VACATIONING’

I have seen high performance institutes that have all what is needed to support athletes, except education.  The infrastructure is there including the human resources to support athletes at the highest level and sometimes they achieved “Gold.” This happens when the personnel is well trained and devoted to athletes.  Unfortunately, it is like taking a vacation trip for many athletes; a vacation trip that could last for years.  I discuss this with my patients also.  Some of my patients look “beautiful” when living with family, boyfriend, wife, husband, etc., but when they leave the relationship what we see is something “horrible.”   

Retirement brings a lot of what we are after leaving the environment that helps us to develop “our talent.”  Tiger Woods is an example, even though he is not retired from golf but from his former family.  I know what my wife gives and what belongs to her and I would not be the same in her absence.  LIFE IS SO SIMPLE.  The champion depends on his/her environment.  I owe most of what I achieved to my family.  Education should help us to recognize what belongs to us or to somebody else.  When retired (in the sense of Tiger Woods), we come back to what we are and we can look horrible.  One of my patients used to tell me, the zip code comes back to me.  I have seen athletes in Cuba who gain tons of weight after retirement because they were just supported by the system but nothing belongs to them.  Educationally, nothing was gained by the athlete.

We have an athlete who wants to go to the Paralympics at the age of 56.  He won silver in Sydney running the 800 meters (one leg amputee).  He wants to compete in Triathlon and has been working to be able to make the team.  He says: “If I go, I will be looking for the medals.”  He sure is beyond being comfortable with “a torta a day.”

Triathlon and Obesity

It is important for me to get more information about subjects (topics) and not to speak just from my experience, even though I could be an expert on the subject.  When Carl Whittaker and David Keith did family therapy, they considered an obese family member as the iceberg of the family problems (that was in the 70’s and 80’s. David Keith was my supervisor, and we even had a Grand Rounds Presentation, “Medicine in the Postmodern Era, SUNY, Syracuse).  In 2013, Obesity was introduced as an illness, although technically is not an illness but in order to be reimbursed and studied, it needs this category so the money can flow.  The same thing for alcoholism and other out of control “maneuvers” used to balance ourselves emotionally.  The British started to tackle this problem differently.  The same way I would approach it; the relationship between low educational-social status and obesity.  A year ago the Telegraph published an article where a politician was brave enough to mention the relationship between poverty and obesity:

But what we eat also has a social dimension. You can lead a man to a doughnut, but you can’t make him eat. What is the connection between poverty (relative, not absolute), and the obesity that is unprecedented in history?

When a government minister says something that is not only true but also profoundly discomfiting we are surprised and even shocked, so cynical have we become about the intellectual probity of our political class. Anna Soubry, a junior health minister, is therefore to be congratulated for her truthful but disquieting remarks this week about obesity and its statistical association, in modern Britain, with poverty…

Grossly obese people, who have always existed, were once regarded almost as curiosities, but were well-off rather than poor. Now, in the poorer parts of Britain, where unemployment is an hereditary condition and the state is almost of Soviet predominance in the economy, the obese are often confined by the age of 40 to wheelchairs by their size and immobility.

http://www.telegraph.co.uk/health/9821278/Its-not-poverty-thats-fattening-its-the-bad-eating-habits.html

Dr Claire Griffiths, who led the study of 13,333 schoolchildren over three years, said: "Although the prevalence of obesity is higher than desirable across the whole city, it appears that children living in the most deprived and most affluent areas of the city are at the lowest risk, with boys and girls following different patterns.

http://www.telegraph.co.uk/health/healthnews/9864364/Middle-class-children-more-likely-to-be-obese.html

What is the relationship between obesity and triathlon?  The majority of our triathletes in Mexico are obese or overweight.  I do not have numbers, but I have seen competitions in the Mexican Triathlon Circuit.  Let´s play with an analogy:

THE White House has confirmed that US intelligence agencies have been collecting data held by Facebook, Google, Apple and other web giants for nearly six years in a bid to ward off threats to national security.

Read more: http://www.theweek.co.uk/us/prism-leak/53475/white-house-admits-it-has-access-facebook-google#ixzz2qqeP1GO6

Facebook says:

I want to respond personally to the outrageous press reports about PRISM:

Facebook is not and has never been part of any program to give the US or any other government direct access to our servers. We have never received a blanket request or court order from any government agency asking for information or metadata in bulk, like the one Verizon reportedly received. And if we did, we would fight it aggressively. We hadn't even heard of PRISM before yesterday.

When governments ask Facebook for data, we review each request carefully to make sure they always follow the correct processes and all applicable laws, and then only provide the information if is required by law. We will continue fighting aggressively to keep your information safe and secure.

We strongly encourage all governments to be much more transparent about all programs aimed at keeping the public safe. It's the only way to protect everyone's civil liberties and create the safe and free society we all want over the long term.

The problem is not if Facebook gives information or the US government takes it.  The problem is created by people that believe that the internet is for everybody and is possible to write private messages.  Zuckerman knows it and will never write information that could compromise him in any way.  I believe that he does not use a cell phone as the majority of the users.  The lack of experience with this kind of matters and ignorance makes us fall into traps (this is what I would call poverty).  We do not believe that “emotional intelligence” makes people win battles, including the battle against obesity and addictions.  The use of the internet was diverted as well as the use of food.

We have known athletes who had 2% of fat in the body to find out that he was using testosterone to keep it that way.  But we can have a 4% fat without drugs from experience by choosing our food.  Touretsky told me that Popov was winning when the fat folds decreased and that was the way he monitored Popov. 

Triathlon and the Art of Coaching II

We start with the same introduction of the previous post (I):

7 oct. 2013

TRIATHLON AND THE ART OF COACHING

I heard a friend saying: “I do not know a coach who has crafted champions from scratch more than once.”  We went over several coaches, but we had difficulties finding coaches not just in triathlon but in any sport.  They do exist!  There are not as many as we would like to believe.  I thought about Javier Gómez’ coach and believed that he is a good advisor which Gómez needs at this time of his career.  Gómez was born in Switzerland and his family learned something there that helped at this point of his life.  I thought about the Brownlees. His father is a doctor and ran competitively when in College; his mother is a former competitive swimmer.  The Brownlees have several coaches depending on the different triathlon segments.  Bob Bowman grew old with Michael Phelps; he even had a house next to Michael’s.  Crafting a champion needs a coach, a family and a culture since they are born in order to be successful.  It is necessary to be at the right place at the right time when all those three ingredients are ready. Bowman worked pretty hard raising Michael from scratch, as he puts it: “Coaching Debbie (Michael’s mother) was even more difficult than coaching Michael.”  He has had a few others swimmers but none of them was really crafted by him.  The three ingredients mentioned above need the same level of education; meaning the same guidelines to follow in our thought process.

What is what we need to teach?  What makes this environment unique?  There is a good book that has a provocative name: “The Art of Thinking Clearly,” written by a Swiss, Rolf Dobelli. The book gives guidelines to learn in order to think clearly, guidelines needed if we want to be successful.  Several similar books have been written dealing with the issue of what to teach.

I found interviews with the author in the internet and it is obvious; the coach should know that a family and a competitive culture is needed to create champions.  We started by creating an environment, which has been always evolving, to then “think” about creating champions. 

http://www.youtube.com/watch?v=GY3gdc5XlOk

The environment became cohesive after four of five years, having multiple crises since the creation.  After having the environment, we considered in working training athletes.  In a sense, this is part of “thinking clearly.” I acquired the concept of the "good" environment working with patients in group psychotherapy, following the format of Irving Yalom:

I tell my patients: "At least you have to be like Bart Simpson; 'I am a expert in excusing myself.'"  Rethink what you said and believe it; then, you will have the chance of being a better human being.  Our champions in triathlon are good human beings and do not lie to themselves; they think clearly: Gomez, Brownlees, etc.

Triathlon and Medicine

We did a test on our triathlete who has been with us for the last 13 years the last month.  There were things to mention that have been recorded before for other sports:

1)   The ECG findings were:

a)   Huge R waves and T waves on V2,V3,V4,V5,V6 compared to controls and meeting criteria for LVH (left Ventricular Hypertrophy); without left atrial enlargement, left axis deviation, ST segment depression, T wave inversion or pathological Q waves.

b)   IRBBB (incomplete right bundle branch block) was seen in aVR and V1.

c)   No ventricular arrhythmia was seen.

2)   His lactate threshold was located at 178 beats per minute at a speed of 16.7 kilometers per hour.

3)   His lab work is below.  It took us several years to accomplish the hematocrit and hemoglobin levels working on nutrition and recovery.  The changes suffered several genetic inductions which most likely are irreversible.  Please see our post:

5 août 2012

Triathlon and Genetics

Inducing Genes versus Maximizing Gene Expression

There is a good article written regarding the athletes changes by ECG, meaning athletes training more than 4 hours a day of training for decades. 

http://www.cardiology.org/projects_athletic_14_1670731921.pdf

There are very few things like the one I mentioned above observing and testing athletes; they are well done by Medicine.  On the contrary, we have made many mistakes in Medicine that takes a long time to recuperate from.  We have had the Framingham Study for a long time but we continue to believe in consensus instead of looking at the data very closely.  We are afraid of talking clearly because we want to be politically correct:

 http://en.wikipedia.org/wiki/Framingham_Heart_Study

The Framingham Heart Study is a long-term, ongoing cardiovascular study on residents of the town of Framingham, Massachusetts. The study began in 1948 with 5,209 adult subjects from Framingham, and is now on its third generation of participants.^[1] Prior to it almost nothing was known about the "epidemiology of hypertensive or arteriosclerotic cardiovascular disease".^[2] Much of the now-common knowledge concerning heart disease, such as the effects of diet, exercise, and common medications such as aspirin, is based on this longitudinal study. It is a project of the National Heart, Lung, and Blood Institute, in collaboration with (since 1971) Boston University.^[3] Various health professionals from the hospitals and universities of Greater Boston staff the project.

The page, www.medscape.com gives information about what we, as physicians, have to work on:

The Biggest Medical News of the Year

1)   Overtesting and Overtreating

A total of 17 medical societies released a list of almost 90 common but often unnecessary tests and procedures, many of them ordered for asymptomatic patients.[1] Twelve of the guidelines issued as part of the "Choosing Wisely" campaign caution physicians that asymptomatic patients probably do not need a given treatment. Two examples are stress echocardiograms, which are not recommended for asymptomatic patients who meet "low-risk" scoring criteria for coronary disease, and computed tomography, which should not be used to evaluate children's minor head injuries.

Separately, a national summit involving a wide range of medical groups, as well as hospital organizations, and government agencies, issued a policy paper detailing strategies for dealing with 5 overused treatments that can harm patient safety and quality: antibiotics for the common cold, blood transfusions, ear tubes for children, early-scheduled births, and cardiac stents.[2]

2)   DSM-5 Released

After more than a decade of development and more than 2 years of frequently searing controversy, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was finally released.[3] Some say that a key change is that expanded diagnostic criteria are based more on consensus rather than on objective laboratory measures. Some are concerned that the "DSM-5 will result in the mislabeling of potentially millions of people who are basically normal. This would turn our current diagnostic inflation into hyperinflation and exacerbate the excessive use of medication in the 'worried well,' " said Allen Frances, MD, chair of the DSM-IV Task Force and one of the new manual's staunchest critics. He advises physicians to use the DSM-5 "cautiously, if at all."[4]

3)   JNC 8 at Last: Updated Hypertension Guidelines

At long last, the Eighth Joint National Committee (JNC 8) in December released its new guidelines on the management of adult hypertension, which contain 2 key departures from JNC 7 that the authors say will simplify care.[6] These include relaxing blood pressure targets and backing away from the recommendation that thiazide-type diuretics should be initial therapy in most patients. The next day, the American Society of Hypertension and the International Society of Hypertension released their own clinical practice guidelines,[7] hinting at the discord among experts that has delayed new recommendations for over a decade.

4)   Obesity Declared a Disease

After much impassioned debate, physicians at the American Medical Association 2013 Annual Meeting in June voted overwhelmingly to label obesity a disease that requires a range of interventions to advance treatment and prevention.[8] The decision could have implications for provider reimbursement, public policy, patient stigma, and International Classification of Diseases coding. Physicians disagree on whether the ruling will change everyday practices and whether obesity fits the typical disease parameters, but all agree the decision has spotlighted the need for resources for a public health crisis that affects a third of the United States and costs the healthcare system $190 billion annually.[9]

5)   HIV Research: Closer to a Cure?

Two exciting studies this year showed promise for a cure in HIV-infected patients. In October, an infant infected with HIV-1 and treated with combination antiretroviral therapy (ART) beginning at 30 hours of age remained healthy and had no detectable signs of HIV RNA at age 30 months, despite having discontinued ART 12 months earlier.[32] And in November, researchers reported for the first time that radioimmunotherapy in conjunction with triple ART can effectively kill HIV-infected cells from patients.[33] In addition, an in vitro model showed that the radiolabeled antibody crosses the blood-brain barrier without disturbing the tight junctions of the cells, which might allow such therapy to reach HIV reservoirs in the brain.

I consider that information given to physicians in the Medscape page should be public; reason why I am posting it.  As you can see, nothing has changed since Framingham Study.  We should continue using medicine “wisely.”