CPR and First Aid

December 1st, 2010

CPR Practice

Yesterday I took a 4 hour first aid and CPR class at work. I’ve taken the class a few times before but it’s been longer than I’d like to admit since the last time. While it’s important for everyone to know first aid and CPR, it’s even more important for those of that spend time in remote areas.

In medical emergencies, the first few minutes are critical. Our instructor said that for every minute that CPR is delayed, the survival rate drops about 10%.

One recent change to doing CPR is they now teach doing chest compressions first instead of starting with giving breaths. The blood has enough oxygen in it to supply tissue for a few minutes so it’s better to get the blood circulating. The current standard is 30 chest compressions at the rate of 100 per minute followed by 2 breaths for 5 sets and then you can take a 10 second break before starting the next set.

There was some confusion in our class about whether doing the breaths were necessary. Although the standard way still includes doing breaths, they have found that some people haven’t given CPR because they didn’t want to do mouth to mouth on a stranger without some protection. In that case, it’s better to go ahead and do the chest compressions and skip breaths than do nothing at all.

Although it’s good to know more first aid in the backcountry than is taught in the community first aid and CPR classes, those classes are a great start. Both the Red Cross and American Heart Association have classes in many areas that don’t cost too much. Some employers will bring a class to the workplace so there’ll be some first responders on site so you may want to ask your workplace.

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Getting Sleep the Night Before an Event

April 5th, 2010

It is common to not be able to sleep well the night before a race or even a non-competitive event that pushes our limits. When I was younger and racing nearly every weekend, I did get to the point where I’d sleep quite well. Now that I’m only doing a few long events a year, I have more trouble. It doesn’t help that I don’t seem to sleep as well as I used to.

Several nights of poor sleep will likely affect performance but studies have shown though that if it’s just the night before a race, not sleeping well doesn’t affect the ability to perform well. What it can affect is the mental ability to push to the body to the limit. My personal experience has matched what the studies have found. If you want more details on the studies and the science of sleep, this article is a good read.

Events like 24 hour solo mountain bike races or 500+ mile RAAM qualifiers are tough enough mentally without throwing in lack of sleep the night before. Even something of the length of the Leadville 100 mountain bike race can get harder mentally as the day wears on. I’ve tried 3 things to help me sleep well the night before an event.

REM Caps

REM Caps from Hammer Nutrition contain Melatonin, herbs and other nutrients to naturally aid in sleep. I’ve had mixed results with REM caps.

As long as I get to sleep within an hour of taking REM caps and don’t get woken up in the first hour or two after going to bed, they seem to work very well. If for some reason I’m up later than planned or I get woken up soon after going to sleep, I actually seem to sleep worse than if I didn’t take them. Using REM caps in the week leading up to an event works well for me so I’m more rested.

Ambien

Ambien is a prescription sleep aid and comes in 2 versions. There’s the regular and a CR version that is timed release and contains more medication. The regular version only lasts 4-5 hours for me and then I wake up so I take the CR version. My wife on the other hand has trouble waking up after 8 hours even with just the regular version.

I sleep well with Ambien CR although I still may wake up a time or two throughout the night. The downside is that sometimes I feel a bit foggy mentally for a few hours after waking. It’s not bad but I just don’t feel 100% focused. It may be because I take the CR version.

Lunesta

Lunesta is another prescription sleep aid. I sleep really well with it and wake up clear mentally.

It’s downside for me is I get a really nasty, bitter taste in my mouth the entire day after taking it. From searching the web, it seems this is a common side effect. It doesn’t bother me with solid foods much but can be bad with certain drinks. Since I use nearly all liquid nutrition during races, it can be tough to drink enough. I even find it hard to drink plain water because of the taste.

Since the last 2 are prescription medications, you’ll have to get your doctor to write a prescription. If you decide to try something to sleep better before an event whether it’s prescription or not, make sure to try it out several times before the event. You don’t want to have side effects and end up ruining your event.

Do you have some method that works for you to sleep well the night before an event? Please leave it in the comments below.

UltraRob

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Living in the Least Obese State

July 18th, 2008

Colorado has the lowest percentage of obese people according to the Center for Disease Control. Even so nearly 1 in 5 are obese. The CDC has an unbelievable animation of how obesity has increased in the last 22 years.

Obesity is defined as a BMI higher than 30. I currently weigh 201 pounds and am 5’8″. That gives me a BMI of 30.5. Yes, that makes me one of the obese people in Colorado. I gained 30 pounds in the 6 months after RAAM in 2006. It was tough to cut back enough on food when I went from training 20-30 hours a week to riding 2-3 hours.

I’m much heavier than I should be now and I feel it. I’ll really feel it in 3 weeks at the Leadville 100 mountain bike race.

Even when I’m fit, lean and racing well, I’m still close to 170 pounds. According to the BMI, I shouldn’t be over 164.5 pounds. BMI works well as a general gauge but it only measures height and weight. Newer measurements that also include waist size are more accurate.

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Sinus Infection Prevention

October 7th, 2007

Sinus Rinse

It’s fall and we’re heading into the cold part of the year. At least here in Colorado, sinus infection are common with cyclists during this time of year. I’m not sure exactly why but I think it was to do with the really dry, cold air and breathing hard while training. It’s also when we get more colds and try training too much before we get over them. My non-active co-workers also are more likely to have sinus infections during the winter too but not as bad as cyclists.

For the last several years, I haven’t made it through a winter without being on antibiotics at least once for a sinus infection. Not only do I have bad summer time allergies but I’m also allergic to molds and dust. I have some congestion most of the time which contributes to my sinus problems.

With my extra job stress this year, I’ve been on antibiotics 4 times for sinus infections. The last time was about 2 months ago. The biggest thing that makes it hard for me to train while on antibiotics is that it messes my stomach up. That makes it hard to eat enough on long rides and can cause a bonk. Eating yogurt and taking iFlora or Digest Caps really helps my stomach.

This last time I was on pretty strong antibiotics for 18 days. Within a week of finishing the antibiotics, I was feeling like I had a sinus infection again. I was doing everything that I know to do. I was taking antihistamines, using nasal spray and Mucinex.

When I was in to my asthma and allergy doctor’s office to get my allergy shot, I told them I was having trouble again. They said I really should be using the Sinus Rinse. A couple years ago they had tried getting me to use it too and had given me a free one.

I had never used it. You use it to spray a saline solution up one nostril and let it run out the other side. That just didn’t seem pleasant to me. My dad had been using it for a while and had told me it doesn’t feel that bad and had really helped him.

They gave me another one even though I told them I still had the other one. I figured I’d give it a try to try to avoid taking more antibiotics. It ended up not feeling bad at all and I got a lot of crud out of my nose. The key is to bend over enough so the solution doesn’t run down your throat. I’ve also found when I’m really stuffed up it helps to take a really deep breath and hold it while squirting the solution up my nose.

Even after using it once, my sinuses felt better. After a couple more days of using it, my sinuses felt fine. I used it for a couple weeks and then felt well enough and quit using it. After several days, my sinuses started bothering me again. I guess I need to use it every few days to keep things cleared out.

According to the list on the website of places to buy the Sinus Rinse, it should be easy to find at a drug or grocery store. My free one only came with 5 packets for making the solution but I think the ones in the store come with 50 packets. I bought a box of 100 packets at Walgreens once the ones that came with mine ran out.

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Banjo Brothers’ Big Bad Bulky Biker Bodyfat Challenge

February 9th, 2007



Since the Race Across America last summer, I’ve gained over 25 pounds. I’ve always had trouble with my weight and this winter it’s been worse than normal. For one thing I got used to eating a lot when I was training 20-30 hours a week. After RAAM I realized just how much I had put off while training and so I was hardly riding. At the same time, my doctor decided my medication was too high for my thyroid so he reduced it. It turned out that I really need to be in between the dosage I was on and the next lower strength pill. Being on too little thyroid medication makes me gain weight faster. Then to top it off I got injured just after Christmas. I wasn’t getting much exercise before that but at least I was get a longer more than none.

I need something to get me to be careful what I eat and get my weight back down. That’s where the Banjo Brothers’ Big Bad Bulky Biker Bodyfat Challenge (B7 Challenge) comes in. It’s a challenge that The Fat Cyclist is putting on that ends on August 1st. The final score consists of two things. The first one is the percentage of your weight loss goal that you achieve. The second one is how much faster you get for a 3 mile cycling time trial. If I end up with a better score than The Fat Cyclist, I get a free jersey from him. If I lose I have to give him what I wagered.

Last year I did basically the same challenge except that it only went until June 1st and was called the B5 Challenge because it didn’t have a sponsor. I tracked my food intake and my weight very closely with Diet Power and made my weight goal. It was while I was training for RAAM so I was burning plenty of calories. I wrote a post last April about what was working for me that has a screen shot of my weight loss.

Hopefully I will be able to get back on track and lose my goal of 25 pounds. The problem is I’ve actually gained a little weight since the start of the B7 Challenge. although I’ve actually gained a little bit. Since I was injured, I didn’t do my time trial the beginning of January so I did my initial one this last Tuesday. It was the first time in a long time that I’ve actually gone all out. There’s good pain and there’s bad pain and for the time trial I was deep into the bad pain zone. My guts so big it felt like it was keeping my lungs from expanding as far as they should. My HR wasn’t quite as high as I can hold when I’m fit. I still felt like I was going to blow a couple times and I didn’t have anything left at the end. I did it in the Air Force Academy. This is a different course than what I used last year during the B5 Challenge so I can’t compare my time to last year. I certainly felt like I was slow. The Air Force Academy was closed after 9/11 and was only reopened last fall.

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Life is Dangerous

September 14th, 2006


Life is full of dangers even if you don’t participate in fun things like cycling. On my first project at HP, the technical lead always made sure my code was checked in before I left on Friday. She always said she didn’t know if I’d come back on Monday. I’ve always maintained that you can get injured or killed even if you’re a coach potato. You might as well enjoy life. At least that way you’ll have great memories and have something to talk about when you’re crippled. Fortunately I’ve always been able to show back up to work on Monday. I’m still aware of the risks while I’m out which is why I always wear my RoadID.

A few weeks ago one of my co-workers, we’ll came him Jack, didn’t show up to work. Nobody heard anything until afternoon when his son called and said he wasn’t able to come in to work but didn’t give any details other than his arm was shattered. After a few days, our manager got the scoop but was sworn not to tell us what happened. Jack didn’t come back to work for a couple weeks. In the meantime we properly padded his cubicle to make sure he didn’t get injured by bumping anything. Once he was back, I found out that he had been filling the bird feeder. He wasn’t thinking and stepped back right off a retaining wall. At least the only thing my co-workers here at Fluke Networks have done to my cube, is put up a banner welcoming me back after RAAM.

The worst I’ve done is crash mountain biking in Moab and limped around the office for a few weeks. I had just gotten a full suspension mountain bike and had never ridden full suspension before. Sure I had tested it a couple times on some local trails I new well but hadn’t done anything long or hard. I was screaming down Porcupine Rim with some other good Expert racers. One by one they had dropped off. We had hit the single track at the bottom a short distance from where you come out to the highway. I finally dropped the last rider that had hung with me. I dropped over a drop off. The rebound was set pretty fast on the rear and I wasn’t used to it.

When I hit a little rock, I got launched through the air. When the first other rider got there, I was face down in the dirt with blood gushing out of my chin and my bike on top of me. I hadn’t moved because my wind had been knocked out plus I was in on awkward position in addition to my bike being on me. He asked if I was alright and I said I didn’t know. Once I got up, he said my chin didn’t look that bad. I was scraped up but able to move.

By the time I had gotten collected, the other fast riders had caught up and we rode on down to the road. I was in pain but nothing I thought was serious. I knew the other guys wanted to hammer so I told them to go on. We had some slower recreational riders that we had last waited for at the top. I figured in worst case if I was in too much pain to ride they’d find me and go get help. As I rode in to Moab, my knee kept swelling. Pain was shooting up my arm from my elbow to the point that I was nearly in tears. Of course we were camped up near the Slick Rock Trail which meant climbing up a big hill to get back to camp.

Julie was back at camp and when the other guys got back, they told her I had crashed but they didn’t think it was anything serious. They suggested she drive down to check on me. She debated whether to because I refuse to bail and get a ride back. My friends finally convinced her and she drove down. By then I had made up most of the climb and didn’t have too far left to ride. She asked me how I was doing and the first thing I said was I thought we should put the bike on the rack and go to the ER. That’s all she needed to hear to know I was in a lot of pain.

The ER visit was less than reassuring. It turned out I had a really deep gash on my chin underneath the big glob of blood and I needed stitches. The doctor numbed it up but didn’t really seem very experience and getting it numbed up was quite painful. The nurse aid seemed to have no idea what she was doing and had to keep asking the doctor what to do when she was cleaning up my chin. Julie could have done much better. At some point we found out that she was a ranger at Sand Flats and worked at the ER part time. By the time she had it cleaned out, it wasn’t numb anymore so I had to go through getting my chin numbed all over again. Before the doctor got it stitched up it wasn’t numb anymore. He said he only had a couple more stitches and just kept going as I clung to the table in pain. The x-rays of my elbow and knee didn’t show anything. They figured I had a bone bruise near my elbow and my knee was just freaked out and swelling.

By the time we got back to camp if I tried moving my leg in any way, my quads would seriously cramp. The guys took down our tent so we could drive to my uncle and aunt’s house in Grand Junction. It was Sunday night and they were gone to church so we couldn’t get a hold of them. We know how to get in their house so they came home to find me all bandaged up and in a sling and Julie was in a removable cast because she had sprained her ankle a couple weeks before.

A couple days later, I ended up going to my doctor which sent me to an orthopedic doctor. It turned out my knee had been bleeding internally. The blood was in a bursa instead of the joint so there was nothing that could be done to drain it. The doctor said it would take about 6 weeks for my body to re-absorb it and the less I moved my knee the less chance I’d end up with chronic bursitis. It took 4 weeks before I could bend my knee enough to walk very well and another couple weeks before I could bend it enough to start riding again.

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Allergies and Asthma

July 26th, 2006

As I posted a couple days ago, I have hypothyroidism. Unfortunately that isn’t the only medical issue I have. I also have bad allergies and asthma. My asthma is mainly triggered by allergens but I also have a bit of exercise induced-asthma.

Of the 32 pollens in the standard prick test, there’s only 4 that I’m not allergic to. I’m off the scale for grass and sage brush. That’s why I put in my profile for Race Across America that I was worried that some farmer cutting his hay in Kansas would trigger an asthma attack. Last year while doing the RMCC 400k brevet, I went by a hay field where they were cutting hay and could feel my lungs shutting down. I struggled through the last 80 miles of the ride and ended up going to the ER after I finished. My peak flow, which is a measure of how well you can exhale, was only 30% of predicted at the ER. Even when I feel I’m breathing well, I’m only 80% of what is predicted for non-athletes. Athletes are typically 120-130% of predicted.

I take a lot of medication to keep me breathing reasonably well. I take Zyrtec, an anti-histamine, every night. I also take Singulair at night. Morning and evening, I take the inhalers Pulmicort and Serevent and the nasal spray Nasonex. Before exercise I use another 3 inhalers. They are albuterol, Atrovent, and Intal. I also get allergy shots once a week and a Xolair shot once a month. A couple of these require a therapeutic use exemption for use as an athlete. I don’t really expect to be tested with what I do but I’d rather have my form on file with USADA than risk it. I also had to provide RAAM with documentation before racing.

Every race I’ve done that has been at least 24 hours long, I’ve had trouble with asthma except for the Adirondack 540 last year. I think that was partly because it rained a lot the first day and night of the race and also because I changed how I took my medication. In long races my asthma doctor also has me periodically take the 3 inhalers I normally take just before exercise in addition to the medication I take once or twice a day. In the past I had tried taking as much of it at one time so I wouldn’t have to deal with taking medications too often. At the Adirondack 540, I decided to try spreading out my inhalers as much as possible. For example I normally take 3 puffs of Pulmicort twice a day but during the race I took 1 puff every 4 hours. Instead of taking the albuterol, Atrovent, and Intal at the same time, I spread them out. My thought was that at times I was low on protection from the medication and by spreading it out I’d be more evenly protected. I really do think it made a difference.

Based on those results, I came up with a medication plan for RAAM. In addition to all the medication I normally take, I got a pneumonia vaccine since people have dropped out of RAAM in the past because of it. It ended up taking Jure Robic out this year and it was thought that Kenny Souza was suffering from it when he stopped for over 7 hours in Durango. The only time I really had much trouble with breathing was on the climb into Prescott. I think what triggered it there was that because of the dryness of the desert I had blood draining out of my sinuses into my throat and it was irritating my air passages. I took albuterol, Atrovent and Intal and stopped for about 20 minutes and then improved enough to get back on the bike.

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Hypothyroidism and Ultra-Endurance Activities

July 24th, 2006

When people find out that I have hypothyroidism, they ask how that affects my ability to do ultra-endurance activities. The biggest effect is that I have trouble with my weight. Even while I was training for the Race Across America, I logged my food everyday to get my weight to where I wanted it. Now that I’m not riding as much and not logging my food, my weight is creeping back up. Although the weight is a problem for my performance, the fact that my metabolism is slow may actually help me since I don’t need as many calories. I also think my asthma hasn’t been as bad since my thyroid medication has been regulated to the point I feel better. It’s possible that it is at least partially responsible for some of my asthma problems.

I had hypothyroidism symptoms for a while before I was diagnosed with it. The main test for hypothyroidism is a blood test for TSH which stands for thyroid-stimulating hormone. It is produced by the pituitary gland to tell the thyroid to produce more hormone. The problem is in the past labs have said that a normal value was 0.5 to 5.5. In early 2003 the range was changed to 0.3 to 3.0. I think the first couple times I was tested I was near the upper end of the range but didn’t know enough to know what it meant. Free T4 and Free T3 are the other things tested for.

It took about 3 frustrating years to get my medication to the point of feeling good. By the time I was diagnosed with hypothyroidism, I’d have a deep fatigue feeling during the last hour of 2 or 3 hour mountain bike races and I would struggle just to keep moving. Even once my blood tests were within the normal range, I still didn’t recover well and would gain 5 pounds if I got sick with a cold. Now I’ve found that I don’t feel good unless my TSH is down near 0.5. I think the important thing is to use blood tests as a guide but make sure your doctor treats you based on how you feel and not be whether you fall within some range.

My TSH has been around 0.5 the last few years but when I was at the Emergency Room after dropping out of RAAM, my free T4 was low. Today I went in to get a blood test to see if that was because of the effort of RAAM or if I’m still that way. The ER doctor said my TSH was normal but of course without knowing the value of it, I don’t know where it was in the range or what range was being used. When we were at the ER, it was 2 in the morning and the first time in over eight days that I’d slept more than 3 hours at a time so I didn’t ask many questions. I need to get the full lab results sent to my doctor so I know what the TSH value was.

I also found that I didn’t feel good when I was on Synthroid and the other T4 only drugs. I had done some research and had read that some people do better with also supplementing T3. There’s a good article on About.com that talks about it and also has links to other good articles about hypothyroidism. Another good article discusses the a New England Journal of medicine report on T4 versus T4 and T3 treatment. I remember reading something that said athlete’s were more likely to need to take T3 but I can’t find it now. I started taking Armour Thyroid and in only a few days I could tell a big difference. My doctor actually planned to put me on Thyrolar but it’s expensive and the pharmacy I use doesn’t even stock it. The pharmacy said to get me regulated on the Armour Thyroid and then use a formula to determine how much Thyrolar to take. I’ve felt well enough on Armour Thyroid to not want to go through trying something else.

I’ve seen things about diet changes that are supposed to help if you have hypothyroidism. One thing that I’ve read is that cabbage somehow keeps you from absorbing the medication well. Eating healthy and avoiding sugar helps me feel better and recover faster from hard training rides but I think that would be true whether or not I had hypothyroidism. Honestly I can’t say that what I eat makes a difference because of my thyroid other than keeping my weight under control.

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Leg Treatment

July 5th, 2006

Today I went in to Dr. Wood to get my leg troubles worked on. He adjusted my pelvis, back and neck. In addition to doing chiropractive adjustments he also uses Active Release Technique to work on soft tissue. As he felt along my IT band he had a “this isn’t good”. He worked out a big knot in the IT band and also said I had a problem with my Sartorius muscle. He also worked some on the tightness in the quads but said it was from the other issues.

A big thanks to Dr. Leahy who developed the Active Release Technique. I am lucky that Dr. Leahy is right here in Colorado Springs. Dr. Wood and Dr. Matthews are also in the office here. They are one of my sponsors and were a big help during my training for RAAM and now they are helping me recover. They have trained providers all over the country. You can search for ART providers in your area.

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Surgery

April 26th, 2006

On Monday I had surgery to remove a lipoma on my forearm. It was just done in the doctor’s office with a local anesthetic. I had debated about having it done for a couple weeks because there’s always the chance of infection and with RAAM less than 7 weeks away I don’t want anything to go wrong. I probably wouldn’t have done it except that I had a much larger one removed last year that was a bit complicated to get out and it wasn’t sore more than a couple days.

It was very small compared to several others that I have but it’s right at the edge of the armrest of my aero bars and has been red and sore after long rides. I figured that I’d get a couple days into RAAM and it would be too sore to use my aero bars. I’ve been going to Strode Family Practice for over 10 years. I used to see Dr. Strode and really liked him but it started getting hard to get appointments with him. When I needed to get in once they said they could get me in right away with Dr. Carter who was a new doctor with the practice. He’s about my age and has been very active outdoors and although he still thinks I’m a bit crazy he understands what I do. He always tries treating me so that I can continue training. When he stitched up my arm, he did it so that it could take some abuse so I wouldn’t have to worry about it while riding.

Monday night I woke up a couple times because I was putting pressure on it. Yesterday I rode on the bike path and barely felt it. Today I went mountain biking and could hardly feel it. Yesterday I got a pneumonia vaccine and I felt it a lot more when I was riding than I did where the lipoma was removed.

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