Race Reports: St. George and Boise 70.3 Ironman

By Dr. Michael Cerami

Thanks for being patient with my postings. I feel like there are finally a few minutes to relax and catch up. I had 2 70.3 Ironman races in the last 6 weeks which had very different outcomes.

My St. George race did not go as planned. I had a mechanical issue with a rear tire on my bike that cost me a lot of time. I was finally able to salvage the race because of the generosity of a guy named Ryan who owns Kompetitive Edge http://www.kompetitiveedge.com/ (an online triathlon website) who lend me his brand new wheel to finish my race with.

My time was way off what I expected but I was happy to be able to complete the race considering the other option was to sit around for 6 hours and watch the race pass me by.

BTW: This race should be called “The Map is Not the Territory”. I looked at the race guide many times and thought that the hills didn’t look too bad. As I usually ride the run course a day or two prior to the race, I decided to verify my information. Whoa, was I ever wrong! There were 4 big hills with a max 8% grade. 

The Boise race was a totally different animal. The weather was awesome and quite a bit different than last year’s disastrous conditions (see screenshot). It’s kind of a weird race because they start the race at 12 noon every year to accommodate to the early season temps. Ah well, you get what you get.

I think our age group started in the 4^th wave so we were pretty close to the front. I didn’t set any records but was very happy with my exit time considering we had some decent chop after the 1^st and 2^nd buoy from a headwind.  I have been working on my technique all winter and it resulted cutting 5 minutes off my average swim split in the last two races.  I felt great exiting the water and lost a little time in T1 with getting my bike shoes on but was on my way pretty quickly. My bike computer died the night before in the hotel room which was probably a good thing in that I rode completely by feel which was quite fun J. I held a very consistently pace through the entire ride and was hoping to pick it up a little for the last 10 miles of the ride because it was a gentle downhill ride into T2. The headwind nixed that idea almost immediately. It wasn’t tough but consistent and mentally a bit challenging at that point in the race. I rolled into transition #2 (they moved T2 to the park and now it’s a nice grassy area which I love) at a bike time just a little over 3 hours and feeling pretty good.

The run: My opinion = OK result. I talked to my coach Cari about this and we think I may have focused too much on my heart rate as I was thinking it was running too high and she reminded me that during a race there’s always going to be a certain amount of HR “drift” from the excitement of the competition. I neglected to add in those extra beats during the run and consequently was slowing down to lower my heart rate which I probably didn’t need to do. Another lesson learned. Final race time: 6:00:05; 6^th in my age group.

Overall, the race went well for me although I still need to figure out how to get more speed and endurance out of my legs on the run. I should be easily capable of running a sub 2 hour ½ marathon. I’ll keep working on it.

After the finish I was tired and sore and wondered while I was sitting on the back bumper of a rental U-Haul truck why I keep doing these things to myself. Then I remembered that I NEVER make any decisions about a race until at least 48 hours after the finish. Within a week I was ready to get back at it.

Next up: My return engagement with Boulder 70.3 in early August followed THE BIG ONE; Tahoe Ironman in September.

Thanks again for all of your interest and support.

Dr. Mike  

Dr. Michael Cerami owns Utah Sports and Wellness and has been a competitive triathlete for over 18 years. He is available for a no charge consultation one Saturday per month at The Salt Lake Running Company (700 East store) by appointment. He can be reached at 801-486-1818 or online at www.utahsportsandwellness.com

Race Report: Salt Lake ½ Marathon 2013

By Dr. Michael Cerami 

Well that was a surprise! How about all that rain!!! I have never run in Utah when the rain has been so consistently heavy for so long. Whew, soaked!

OK, on to the report. There were some good things and some dumb moments during this race. So yes, I’m human and “born to make mistakes”. My plan was to keep my heart rate down significantly and see what extra energy I would have at the end of the run. 

I started the run by taking an easy 2 mile run to the start line so I actually ran 15 miles that day. By the time I arrived all the festivities were over and since the timer doesn’t start until I actually cross the timer/chip line, I stopped for a second, looked out over the valley and enjoyed the view. “OK, let’s do this”, I said. Of course at this moment there was just a slight mist in the air. The downhill first 4 miles are always pretty easy and not a good gauge of effort. Things were looking good even though it started raining heavier.  My heart rate was right where I wanted it to be. 

At mile 6 to 7, my heart rate started to rise and by mile 8 I began to cramp in my right thigh. This was strange because I never have that problem. It didn’t hit me until the race finished that I didn’t hydrate at all. Dumb, dumb, dumb! Lesson learned. 

Miles 7-11 were a struggle with the rain and cramping. I did my best and pushed through even though I was hurting. Finally I told myself I had enough left over to push through and ran a really good final 1.5 miles.  

I was happy with my mental tenacity and it’s always good to get another challenging race over with and deal with the adversity. In my opinion racing is always about learning who you are and what you’re made of so in that sense it was an awesome day.

Take home points:

·         Hydrate even when it’s pouring rain. I just literally forgot as I had my head down the final 5 miles. I believe this is what caused my cramping and held me back at the end.

·         Be prepared to make a choice in the middle of the race. When my cramping started and my form dropped, I considered abandoning the race. I went through a few thoughts comparing how good it would feel to stop versus how I would feel the next week knowing I hadn’t completed the race. My final decision was based on the fact that I needed a completed distance event to mentally prepare for the 70.3 Ironman in St. George. I couldn’t go into that race without the confidence of having this race finished. Your decisions may differ of course and remember it’s always best to have this conversation prior to the race.   

·         Even though my time was 20 minutes slower than last year, I’m ok with it. But I do admit it was difficult knowing I might have finished top 5 in my age group if I ran it with my usual effort (instead of finishing 62^nd.) 

My next recap will be following the 70.3 St. George race. Have fun and race strong.

Dr. Mike

Dr. Michael Cerami owns Utah Sports and Wellness and has been a competitive triathlete for over 18 years. He is available for a no charge consultation one Saturday per month at The Salt Lake Running Company (700 East store) by appointment. He can be reached at 801-486-1818 or online at www.utahsportsandwellness.com

Change in Plans

By Dr. Michael Cerami

As most of you know, I have a pretty full schedule of races this year and the training is going well. My first big event is St. George 70.3 Ironman on May 4^th and I’ve decided to make a few changes to my run plan after some interesting evaluation and experimenting last month.

As a reference, last year I noticed during most of my longer events that I ran “out of gas” at the 10-11 mile mark. I tried a variety of different tactics from fueling changes to better hydration all with negligible results. 

After listening to an interview with Mark Allen on “The Fit, Fat, Fast” Podcast I tried going for my long run with a little change that made a big difference. I had one of the best runs of my life by slowing down just a bit by limiting my max heart rate. Of course I was running at a slower pace but my energy at the end was dramatically better. Since then I’ve done 3 more long runs with the same result.

My theory is that “saving” more energy in the early part of the run will allow me to push it more during the last 3 miles of the race and finish strong. Overall this year I’m going to try and keep the rate down with the intent of eventually get back to my old pace per mile. If I can achieve these outcomes I feel I can really set myself up for much better long term (5 year) racing plans that will be achievable and more importantly FUN.

My first chance to test this new approach will be in 2 weeks at the Salt Lake ½ Marathon. Instead of going for a PR on time, my goal will be to keep my heart rate down below a specific number and then try and pick the speed up for the last 2 miles. The next test will be the 70.3 race in May where I’m really looking forward to the new plan.

Here’s wishing you a great start to your season.

Dr. Mike

Dr. Michael Cerami is a local Utah sports chiropractor and triathlete who has been treating patients for over 25 years. He writes a weekly patient blog and monthly athlete article for community education on a wide variety of topics including treating sports injuries, nutrition, exercise, motivation and wellness. 

Getting Lost in Internet Research

By Dr. Michael Cerami

I would guess that more than 90% of my patients have spent time looking into their symptoms trying to self-diagnose their problems on the web before making an appointment with me. It’s only natural and mostly helpful for patients to better understand what might be causing their problems. The web is a vast resource of knowledge comprised of everything from articles, online forums, research, opinions and more. I can guarantee that you’ll get a TON of information on almost any topic you choose. Any there lies part of the problem; there are so many opinions that it’s almost impossible to decide which one is right.

If you compare health care choices to financial choices it might create some clarity.

·        What’s the best treatment plan?

·         What’s the best financial strategy?

Is there really a “correct” answer? “Put your money under your mattress! Put your money in the stock market!” The answer depends on more factors than I can list here such as: Your experiences with money, your philosophy of investment, your aversion to risk, etc, etc...

I think part of the issue is that when we start to research a project (our health, how to build a shed or what’s wrong with our broken dishwasher) we assume that we will, with enough clicking and digging, find the answer we are looking for. While this is true for so many what we’ll call “End Point” projects (How to fix my dishwasher), it won’t work for finding the exact right answer for your health issue.

I’ve referenced Dr. Jerome Groopman’s book; “Your Medical Mind.” many times in my articles and this quote says it all. “If medicine were an exact science like mathematics, there would be one correct answer for each problem. Your preference to treatment would be irrelevant to what is “right”. But medicine is an inexact science.”

I would again highly suggest this book especially important is Chapter 3 titled “But Is It Best for Me?” where a patient gets lost in trying to decide whether and what type of prostate surgery he should have. There are studies and research to support all the various methods and what is recommended in the United States is different that what’s recommended in Europe. There is no right answer. The patient gets so overwhelmed with information it paralyzes his decision process. That’s how we arrive with the feeling of being caught in the MC Escher painting above.

My recommendation on internet health research:

1.       Do your homework, but limit your overall time to a predetermined amount (x hours).

2.       Get a better understand of how your body works and its anatomy.

3.       Grade your pain accurately using the F.I.D method (more on this next month).

a.       Frequency

b.      Intensity

c.       Duration

4.       Research some of the most common options for treating your problem. (Rest, taping, etc)

a.       Try these options before spending money on a doctor’s visit.

b.      Be honest with yourself about your improvement (or lack of) with your self-treatment.

5.       Go to your doctor’s visit informed.

a.       Ask for a visual interpretation from your doctor if you need one.

b.      Ask questions: all physicians have a time limit but they should not be dismissive of any questions you have about a recommended treatment plan. 

c.       Make sure your doctor will amend the treatment plan if you heal faster or slower than expected.

6.       Be honest about your goals and the time needed to repair.

a.       If you really want to run that Spring marathon, you NEED to get treatment plan ASAP

Use the web resources to your advantage, not to confuse you. Building a relationship (when the time is right) with your doctor though one on one personal contact will create a lifetime resource for helping you out through the maze of life. Good luck

Dr. Michael Cerami is a local Utah sports chiropractor and triathlete who has been treating patients for over 25 years. He writes a weekly patient blog and monthly athlete article for community education on a wide variety of topics including treating sports injuries, nutrition, exercise, motivation and wellness. 

Save Money by being Healthy

By Dr. Michael Cerami 

Last week I read you the riot act on how health care costs are killing us (oh the irony!). Today I’ll give you some action steps to help avoid getting sick.

#1 Tip: Supplementation and Vitamins

Yes you need them. There is so much good published research coming out about food quality. It’s important to make the right food choices and to add to those choices with supplementation. Remember it’s supplementing your diet, not allowing you to eat junk and try and fix it with vitamins!

I can’t count how many seminars and conferences I’ve been to that show how the benefits of things like fish oil, Vitamin D, Magnesium, a greens supplement and more. I know it can be a little overwhelming so try and start with a few basic principles:

Supplementation: 5 keys to make it work

·         It has to be affordable

·         It has to be convenient

·         There has to be a reason to take it

·         Build slowly

·         Create a system to that helps you remember to be consistent

Don’t go crazy to start with. Not many people have the discipline or money to take 22 pills per day and/or spend $250.00 per month on them. Start with the basics: A triglyceride based fish oil, Angstrom Magnesium, Vitamin D. After a few months of being regular, add a few more products.

Remember the reason you are “supplementing” your diet: you are designing your future by getting healthier today. It’s like a forced savings plan.

Take your vitamins in the morning or at lunch. Put them where you can see them to remind you. I put everything in a weekly container on Sunday and then each morning transfer the daily pills to my smaller bottle and put it in with my lunch so I see it when I get my lunch ready. Easy breezy.

#2 Tip: Lab Work

You can save big bucks by ordering your own lab work. Go here: https://www.directlabs.com and review the testing available. Plug in your info and then get your blood drawn down across from St. Marks at their local lab facility. You will get your results back in less than 2 days usually. You may need your physician or health care provider to review your personal needs and testing results, but it should be a lot cheaper than going through normal channels. They also run a special every month.

Dr. Michael Cerami is a local Utah sports chiropractor and triathlete who has been treating patients for over 25 years. He writes a weekly patient blog and monthly athlete article for community education on a wide variety of topics including treating sports injuries, nutrition, exercise, motivation and wellness. 

It’s Time to Take Control of Your Health

By Dr. Michael Cerami

If this article doesn’t scare the pants off you, it should.  http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/ The unpredictable and exorbitant cost of medical treatment continues to rise astronomically. Our insurance companies will continue to limit our choices and reduce payments until there is a consumer revolution in health care.

Yes, strong words and somewhat apocalyptic I admit. I MEANT to get your attention. Look at some of these fees:

·         $15,000.00 for lab tests

·         $995.00 for an ambulance ride

·         $8000.00 for a stress test

·         $9400.00 for an ER visit

·         $1791.00 per day room charge

·         $13,225.00 per day ICU charge

·         $6538.00 for 3 CT scans

Let’s keep talking numbers. I had a patient last month that asked me a very interesting question. He was referring to his mom who has struggled with her health her entire life and is really hurting now. He said, “Dr. Cerami, I wonder how my mom would be feeling today if she was under chiropractic care her entire life? I mean, I feel so good it’s a shame she didn’t start getting adjusted when she was young.”  I thought about it for minute as an investment. If she invested in her health maintenance for just 20 years of care at our office, her out of pocket costs would be about $10,000.00. At first glance it seems like a lot. But wait… now compare it to those fees quoted in the magazine article.

Taking care of that knee pain today with bio-mechanical correction and FSM might save you (or at least put off) a knee replacement surgery. Getting your child adjusted at 10 years old might reduce the dependence of NSAID medication in the future at prevent liver or stomach problems. Attending to that bicycle crash immediately could get you an additional 20 years of riding in your senior years.

The bottom line is this. YOU need to take control of your health today. There’s no sugar daddy waiting to “help you” when you get sick. The grim reality is that if and when you injure yourself or get sick there’s going to be more than just physical pain. It’s going to cost you more and more very year that goes by and my guess is that your insurance premiums are going to double in less than 5 years.  And for what? Extortion money you pay the insurance company to “cover” you because you think your health outcomes are out of your control?

I believe you can change the outcome if you are willing to do the work.

Please read the entire article to get a clear idea of what’s happening behind closed doors. Then make a real commitment to taking an active participation in managing and controlling your health. You can begin by:

·         Reducing your stress

·         Cleaning up your diet

·         Getting a maintenance adjustment monthly

·         Starting and continuing an exercise program

·         Reading more on how to take better care of yourself

·         Educate yourself on how to make medical decisions:  http://www.amazon.com/Your-Medical-Mind-Decide-Right/dp/014312224X

·         Make your health a priority not a second class citizen that only gets attention when it’s complaining

Remember: all theses action steps will save you BIG DOLLARS (and less pain) in the long run. Start today!

Dr. Michael Cerami is a local Utah sports chiropractor and triathlete who has been treating patients for over 25 years. He writes a weekly patient blog and monthly athlete article for community education on a wide variety of topics including treating sports injuries, nutrition, exercise, motivation and wellness. 

Hip Rotation and Muscle Imbalance

By Dr. Michael Cerami

Hip Rotation is very common in almost all of my new patients. I usually see an imbalance of anywhere from ½” to 1 ½” of discrepancy between the left and right leg. In most cases it takes less than 6 visits but sometimes the correction process takes quite a while (6 months) when it’s a complicated case and post surgical as I’ll discuss later.

  

During an initial examination, I check pelvic alignment front/back and side to side as well as foot position and knee alignment. I also will muscle test the upper or lower extremities to make determine whether there is appropriate neural integration to the all of the muscles in the area.  These tests along with other functional movement screenings will paint a picture of where the source of the problem is located and that’s where we’ll go to work; unwinding the “focal loading” points of the body to create sustainable change.

The reason I mention this process is to describe how we assess and correct hip rotation. To the untrained eye/person/therapist/physician,  it would It would seem much easier to just put a lift or shim in the shoe and call it fixed except for the fact the problem was not really corrected. In my 27 years of practice I have prescribed a heel lift less than 10 times when I couldn’t correct the imbalance using chiropractic adjustments and muscle work. 

The patient I’m referring to above is a bike rider that had labrum (hip) surgery which caused a severe imbalance in his hip alignment and leg length. When this patient went for his bike fit, the only way the fitter could make him balanced was to provide an extreme amount of shimming (photo). This helped but caused other problems and the patient could not ride comfortably for any extended distance.

When I started making corrections on this patient with the Impulse IQ Adjusting Instrument we would get a ¼ to ½” change each visit and a lot of the imbalance would return before the next session which was scheduled weekly. The progress was slow but measurable so we stayed with it and eventually got 90% of the rotation removed by summer’s end and the patient celebrated by riding his fastest ever Snowbird Hillclimb race and finished in the top 10 of his classification.

I think there are a few important take home points here for athletes and patients:

·         Hip rotation and resulting muscle imbalances cause bio-mechanical distortions that affect the hip knee and feet.

·         It you have lift in your shoe or a lot of shims in your bike shoe consider finding out if the “upstream’ cause is your hips.

·         Once the problem is resolved, exercises can help maintain the correction.

·         It’s difficult if not impossible to tell if you have rotation on your own. See here on how to check:  http://saltlakerunningco.com/home/2010/09/symmetry-muscle-imbalance-and-hip-rotation/

·         Get your hip rotation fixed BEFORE you get fit for that expensive or new bicycle.

 Dr. Michael Cerami is a local Utah sports chiropractor and triathlete who has been treating patients for over 25 years. He writes a weekly patient blog and monthly athlete article for community education on a wide variety of topics including treating sports injuries, nutrition, exercise, motivation and wellness.