Triathlon and the Ultimate Fight

I was reading Obama´s health care plan and the creation of a databank:

Mr. Obama announced last month that his new budget included $215 million toward the creation of a national databank of medical information, intended to associate specific gene patterns with various diseases and to predict what genetic, lifestyle and environmental factors correlate with successful treatment. Once all those relationships are clarified, the path will open to drugs or other interventions that firm up the good links and interrupt the bad ones.

http://well.blogs.nytimes.com/2015/02/16/genes-tell-only-part-of-story/?emc=eta1

Skeptics point out that genetic medicine, for all its promise, has delivered relatively few clinical benefits. And straightforward analyses of lifestyle and environment effects on health may occasionally lead to clear-cut advice (don’t smoke), but more often sow confusion, as anyone curious about the best way to lose weight or the optimal quantity of dietary salt knows… Barbara has obvious genetic predispositions, like most patients, but not inherited diseases like cystic fibrosis or genetic signatures on tumor cells. Those alcoholism genes are unquestionably going to turn out to be subtle troublemakers, the kind that nudge people in the wrong direction, raising risk but not sealing doom.

The relationship between medical problems like the one of Barbara and triathlon performance are quite similar.  We have seen this phenomenon with the kids that left the team:

Which chapter came first? Was it the genetic predilection for alcohol that created her lifestyle (pure chaos) and environment (streets, shelters, hotels)? Or did the story start at another point in the cycle, with alcohol selected as a comforting longtime companion, then taking over?... Either way, Barbara’s medical problems are predictable spokes on the wheel: bad heart, terrible liver, crumbling hips, gummed up lungs, AIDS from a brief foray into injectable drugs.

Talent identification for triathlon has to do more with lifestyle and environment than genetics, as we have mentioned multiple times in this blog.  But, are the environmental and lifestyle teachable?  We come back to same problem: EDUCATION.  We struggle to teach a healthy lifestyle and the environment we live in sucks.  Obama is fighting the ultimate fight already with a handicap:

Furthermore, the influence of Barbara’s lifestyle and environment on her medical conditions doesn’t require a giant database or a powerful computer to interpret. Mr. Obama’s data crunching and Barbara’s own analysis are bound to concur: “Gotta find a place to live, gotta make new friends, gotta take my meds.”

Triathlon and Winners’ Psychology

Nothing can substitute real life experiences.  I was called in by my sister who told me that my mother was vomiting a “black stuff.”  She is a 94 years old.  I said: “It is an emergency…there is a gastroenterologist next door, call him while I get there.”  She got an endoscopy next day, she had a gastric ulcer but it does not appear that it was the cause of how bad she looked, it was a consequence to me.  IF YOU DO NOT BELIEVE WHAT YOU SEE THE PATIENT IS DEAD.  The same things for winning in triathlon, if you do no clock you progress you are lying to yourself, and the chances of winning are null.  Believing what we see is the first step.

Planning after believing what we see is the following step.  Here, we can have a good plan or a bad plan but either one of them could be useful if we describe and follow step by step how to achieve goals.  I decided to go with the gastroenterologist who told me to contact the doctor in certain hospital where he was going to do the endoscopy.  In Mexico, most of the doctors are useless, not just from the point of view of what they do; they are unable to play in a team.  In our town, we do not have transplants because we are unable to put together, in a team, a bunch of doctor who could do it (renal transplants have been around for decades in the world). When we decided to do a surgery, the gastroenterologist decided to move out of the care and I was left with an internist and a surgeon who said he was busy to do the surgery in the next 24 hrs.  I contacted, in a hurry, a surgeon who could have the privileges in the hospital.  I was not able to take mom someplace else at this time and I was left with supervising what they were doing the best I could.  In a strange move, I was left out of the surgery; I did not make waves because I put the surgeon in and I was desperately trying to make a team work.  I ACCEPTED WHAT THEY TOLD ME.  It was a nightmare.  Planning training in triathlon means to practice cadence vs low cadence while training cycling; reps at high speed vs long pacings that last more than five minutes when running, as well as high cadence vs low cadence jumping while running; decreasing strokes when swimming vs poor technique but speed for the moment to get certain speed to be in the second or third pack.  In triathlon, there is a chance to plan what follows, very different from a medical emergency.

The decision of which road to take depends on the state of knowledge of the individual.  I knew I was just supervising, something I did with residents as a Chief Resident but this was different; my mom was dying.  I played as a Chief Resident overviewing what they were doing.  My mom came back home but three days later she started to deteriorate -they did not put a drainage after surgery assuming they resolved the problem by liberating gut (it was trapped because of the edema).  I changed the game at this time.  I needed a team to be able to do our best this time, only chance.  I called a friend (surgeon) who went to Medical School with me; I presented the case to him.  He said: “I need to see the patient before making a decision.”  He came home (my mother´s) and reviewed the case:  “I need a team all the way to do something.”  Then I knew we were in the game.  He said: “I’ll call a few doctors (it was Sunday), she needs surgery and we will do it in two hour:  We need to do an abdominal surgery again.” 94-years-old, with mild heart failure and problems to keep a good oxygen saturation, adding sepsis to it.  The last chance for Rachel.  I asked to her about it and she said: “Go for it.”  The surgeon and I were left after the surgery, in addition to one nurse; the only medical team committed to Rachel.  Commitment to improve is the requirement in triathlon; athletes need to be students of their sport, experts in physiology, nutrition and administration.  This is the way to avoid falling into a trap.  Little knowledge is dangerous, just like the doctors in Mexico.

The surgeon who performed the last surgery wanted Rachel to improve because he likes winning; the other were just playing medicine.  The decision made changed the outcome of Rachel. It was made on solid basis of how life works, something that every athlete should know. Do we want to win or just “play triathlon?”