Most of us are corporeal beings, so our lot in life is to be constrained by time and space. There are only so many seconds in our lives and hence, we need to be constantly minding our fractions. There will be many articles coming through the last few weeks on methods to achieve the balance required to have success in life and triathlon. However, I will propose that something’s ‘gotta give.

How do we determine what we will focus on and what will we let slide? In other words, what factors determine our choices? Maybe I wanted to really know, why do any of us choose the lifestyle of triathlon, when so many other important things clamor for our attention?

Looking at the title, you might think this is about a Vietnam-era special forces dude who’s been wronged, but it’s actually about what can be a life-threatening medical condition. There has been a lot of interest in this condition recently in the mainstream media. Are endurance athletes at risk?

What subject could be more germane to a group of endurance athletes than mental toughness? After all, given the vast evidence supporting the central governor theory of fatigue, it follows that increasing mental toughness will boost performance. I propose further that we are all tough on crime, we dole out tough love and even our cleaning products are tough on stains, so c’mon: let’s all get tough.

Similar to many aspects of common sense, it’s hard to really define what we mean by mental toughness. This is pretty important, since most of us hope to enhance our mental toughness and it’s hard to enhance what you cannot describe.

It’s been an unusual winter in the upper Midwest. Fortunately, it seems winter and now spring has been cancelled due to lack of interest. This has meant a unique opportunity to get outside and hit the roads and trails really early. So let’s turn the volume up and get cracking on the base miles, right?

Maybe, but in a continuation of last month’s quest for understanding bone health, we might wish to stay in the gym a tad bit longer.

His absence was glaring. "He" is a former Division I collegiate swimmer and now a colleague of mine. He is always at the pool. He swims fast… really, really fast. So where was he?

He was in the DEXA scanner that morning -- I learned later -- having been diagnosed with a wrist and vertebral compression fracture the prior weekend.

Think of the issues which many of us consider “limiters.” Poor core strength, inefficient running form, curtailed training time and suboptimal balance in the pool are but a few of the many limiting issues heavily discussed on forums such as these. However, consider the limits offered by the biases inherent in the way we make everyday decisions. Recognizing these human foibles might offer the most powerful opportunities for improved performance.

Alert multisport readers might have noted a flurry of interest in vitamin supplementation a couple of months ago. A study published in the Archives of Internal Medicine suggested vitamin supplements were associated with increased mortality risk.

This trial, which was a subset of an Iowa women’s health study, looked at mortality among a cohort of women aged around 62 who were followed for up to 18 years. The findings were somewhat surprising, in that there was a small statistical increased risk of death among those subjects who recalled taking vitamins.

Whoa!

This week I was reminded of a fascinating study done earlier this year; the radio show I was listening to emphasized the study as nothing short of astonishing. The paper was published in the Proceedings of the National Academy of Science in April 2011. Its authors found apparent potential bias involved of whether the study’s justices granted parole. They cited “extraneous” factors.

The study, done in Israel, evaluated three decision periods of the day: initial, after first meal break and after second meal break. Parole judges gave a favorable ruling to 65% of applicants first thing in the morning and immediately following both of the daily two food breaks. However, the favorable rulings declined to nearly zero prior to their next food break or the end of the work day. This effect remained constant over 50 decision periods, several judges and was controlled for severity of crime, time served and potential for rehabilitation.

Causality (hunger equals ornery) is not established and other confounding variables might have been at play, but it surely seems as though if you were up for parole, you wanted to be on the docket right after lunch!

I once heard we are all here because we were the best swimmers. Ponder on this for a moment and the light will go on.

If you think qualifying for Kona is hard, imagine the odds you overcame as you were being formed. You needed to be the fastest, strongest, best built and most resilient swimmer of a wave of, oh, let’s say 300-million others. So you beat the entire U.S. population to the swim exit! You rock!

With this as an obtuse preamble I will now deftly segue into the topic of the month: Does triathlon impair the ability of the male to reproduce?

Exercise = Good
More Exercise = Better
Excessive Exercise = Bad (?)

This simplistic series of equations has been a hot topic for quite awhile. Increased physical activity has been shown in innumerable trials to decrease cardiovascular risk factors, improve insulin sensitivity, decrease BMI, lower blood pressure, and improve stress/anxiety scoring systems. So, exercise seems to be the great panacea.

What about “excessive" exercise?

It’s probably no surprise to many of you that I am not gifted in math. Nonetheless, I have been pondering the fraction we all try to maximize as athletes. Think of the denominator (the bottom number) as the time you have, and the numerator (the top number) as the way you’d like to fill your time. Most of us have a tough time getting more time, because after all, there are only 24 hrs in a day

Since I’m on call these two weeks and indeed, doing this late at night, I think I’m okay on the title. What are the top 10 things you can do to prevent ever seeing the likes of me in a professional encounter?

It’s finally racing season for many of us and it’s heating up both literally and figuratively. The early season often prompts the most questions about this condition, as we finally “go for it” after months of solid preparation -- my topic this month is the muscle cramp.

Really, to an outsider, most triathletes have already accomplished the title to this piece, especially gauging our training and race attire. However, I will be focusing on a more vexing topic today: injury-induced muscular inhibition.

It has been driven home to me personally after a disastrous long-term fling with an attractive companion, a 61cm Reparto Course Bianchi Cross Concept Cyclocross uber-commuter bike.

So, a youngish-looking 50ish-year-old guy walks into his new doctor’s office, he feels weak and listless. He reports he has been requiring phlebotomy every two weeks (a procedure where blood is withdrawn and discarded) due to development of very high hemoglobin (red blood cell count). This condition has been diagnosed (with an expensive genetic test) as a bone marrow abnormality due to overproduction of red cells known as polycythemia vera. Additionally, he has been treated with an alkalating agent (chemo).

Hold the presses! In other news, he had been given testosterone patches by an expert in anti-aging medicine, which he started approximately two months priorto the above blood count “issues.” Stop me if you heard this one…

Sure, I could roll my eyes and dismiss yet another get-fast-quick product, applying my usual skeptical demeanor and tendency towards therapeutic nihilism. But, as the poster in Mulder’s office attests, “I want to believe.”

As you all are well-aware, there are innumerable products on the market touting different mixtures of performance enhancing aids. Many companies have products for nearly every conceivable peri-event time frame. However, I wanted to focus on one particular product: the pre-race formula by a prominent sports nutrition company.

The risk for upper respiratory infection is modest for sedentary folks, decreasing among regular exercisers (defined as three to four times per week). But there is an increased risk of infections among those who exercise daily at a “strenuous” level; even having rates exceeding the sedentary folks.

Hmmm. What does that mean for you and me?

The topic for this month's column is deep venous thrombosis (DVT), an extremely dangerous condition where a clot forms in the largest of the venous vessels of the upper and/or lower extremities. This condition results in sudden swelling of the affected limb, often with associated warmth, redness of the skin and a deep aching pain. DVTs can masquerade as muscular or myofascial trauma and skin infection, also known as cellulitis when extreme.

While no definitive studies on incidence or prevalence of DVT or pulmonary embolus exist specifically for long-course triathletes, many scholarly works report the relatively high risk endurance athletes may face with respect to the general population.

Ah yes, the “off season,” time for reflection, assessment, shedding fatigue, mending nagging injuries, pursuing different athletic activities and minor surgery…say what?

I bet I’m not alone in this male audience of men of a certain age whose spouses might wish a certain freedom from responsibility for anti-procreation. I speak definitively that this has been an issue in our household for some time.

So here's how it went down for me.

Hematuria, also known as the “OH MY GOD I’M PEEING BLOOD!” syndrome is likely to afflict many of us all at some time or another, and most definitely gets your attention.

Arguably, as devoted long course triathletes, we may even be at higher risk for this condition than the average citizenry. I will go through the usual causes for blood in the urine, in order to give you a bit of background should you ever experience this (and I hope you don’t).

by Bob Albright, D.O.

“Enhanced lactate clearance, increased VO2 max, maximization of ATP formation and free radical clearance.”

Wow, sign me up!

I’m a generally optimistic guy -- really -- but a substance which does these things would seem too good to be true. Guess what, it seems it is.

by Bob Albright, D.O.

I realize it’s certainly just due to the increased volume of cycling that we have all been putting in lately, but it sure struck me as remarkable that several members of the Endurance Corner team recently met with disaster in the form of bike crashes. Having spent a morning in the ER myself a few weeks ago, it got me thinking about what exactly happens to folks with respect to bike crashes from a medical perspective.

by Bob Albright, D.O.

Accepted dogma states one’s performance will decline if you lose greater than 4-6% of body weight during a session. This makes sense, as you would lose vascular volume -- leading to higher heart rates for the same exertion, decrease availability of serum and cellular volume to sweat (and hence cool -- thus setting up a vicious cycle) and increase the relative density of the bloodstream -- perhaps leading to circulatory “sludging” (or at least increased rheology --from more cells per volume of blood). Hence, current guidelines suggest avoiding more than a 2% loss of body weight during the session.

As usual, what the actual studies show us is a need to question these assumptions.

by Bob Albright, D.O.

Not to worry, elections are still two years away… I still plan to give you all my usual upbeat, perhaps overly glib effort.

Today’s subject is one most all of us have encountered, chronic tendon injuries and whether eccentric exercises are a major part of the solution. I hope to also discuss their effectiveness and perhaps how they may work.

Loosely defined, a tendon injury which goes on for months (or years -- anyone?) with associated tenderness, limitation to range of motion and overall function may be determined to be a tendinosis. Tendinosis implies the tendon is no longer actively inflamed, but instead its tissue has entered a static phase characterized by fibrous tissue replacing healthy tendon. The situation may even be made worse by anti-inflammatory medications.

by Bob Albright, D.O.

Let me do my best to explain a central physiologic concept near and dear to all our hearts (and brains, muscles and other non-beating organs): osmolality and how it relates to the need to drink, prevention of dehydration and maintenance of general health (thus avoiding the Ancient Mariner’s fate).

by Bob Albright, D.O.

No, this will not be a baseball article or a non-paleo diet breakfast product endorsement. I will try to put potassium’s (K’s) role in muscular function and general health into perspective, and help us with relating its role in our health and athletic performance. Most of us have heard of potassium, equating it with bananas and orange juice and-- for murder mystery buffs -- the perfect crime.

by Bob Albright, D.O.

Okay, so you left it on the course... all of it... in fact, you left so so much of it that you now need to get some of “it” back. You end up in the med tent. Quoting one of my favorite band’s lyrics, “You may ask yourself, well, how did I get here?”