In Our Corner: Larry Creswell

by Nick Mathers, EC Team Member

This month we sat down with with Larry Creswell, M.D., a cardiac surgeon in Jackson, Mississippi, and another of Endurance Corner's expanded writing team. Larry's going to be traveling to his fourth international ironman this year and he shares his thoughts on racing out of the country, as well as providing insights into healthy living.

Endurance Corner: Tell us a little about your triathlon background.
Larry Creswell: I'm in my fifth year of racing, having started with an olympic-distance race in 2005. My first ironman was in 2007 at Ironman New Zealand. I've done five up until now and this year's race at Ironman Western Australia in December will be my sixth.

EC: Did you have any sporting or athletics background growing up?
LC: I had a brief swimming career during my last couple years in high school -- both on a club and school team. But that was it for a long time.

EC: What made you want to start triathlon?
LC: I woke up on my 40th birthday and decided I wanted to be healthier. At the time I weighed about 260 pounds. I tried to eat better and returned to swimming for fitness. That year I moved here to Jackson and continued that healthier fitness and nutrition pattern. I met a buddy at work who talked me into getting a bicycle and so I did that for a while. Then one day, my friend came into my operating room and said, "Larry, we're going to do a triathlon." It took a little while, but we committed to doing it. And then we set a goal of doing an ironman -- Ironman New Zealand -- two years out. We spent those two years learning and working up to be able to do that. And for both of us, it was building up from pretty close to zero. At this point, I don't really see an end to participating -- it's a lot of fun for me. It's not really about chiseling another three seconds off my best time.

EC: To have raced five IMs in three years you must have done more than one a year.
LC: Yes. I did two in 2007 (New Zealand and Florida), South Africa in 2008 and Brazil and Florida in 2009.

EC:Is there something that appeals to you about the international races? If it's just a matter of "Ironman," there are plenty options in the U.S.
LC: Well, there are a couple reasons. For me, part of what goes into this is thinking about races where the combination of the course and weather can be as gentle as they could be. The distance is always going to be a challenge for almost everyone. I don't need to look for more. For me, Ironman Florida in the U.S. affords good weather and a flat course, which appeals to me. That said, it comes in a time of year that often conflicts with things at work.

When you scout out other opportunities for similar courses to Florida, you'll see that New Zealand, South Africa and Brazil are sort of like that. Western Australia is certainly a similar course with similar conditions.

I think about Ironman Canada or Coeur d'Alene being great venues, but those courses don't necessarily suit what I'm looking for in the sport right now.

I've also chosen races that are either during the North American spring or late fall/early winter because the weather here is so hot in the summertime that it's just really hard to do the training. Here in Jackson it's humid a lot earlier and that heat lasts a lot longer. I can handle the heat for isolated periods of time, but after a while it's just harder and harder to bounce back from. So in looking for races that meet all my criteria for a "good" race, a lot of the North American ones get eliminated.

EC: So no Ironman Louisville then?
LC: Ha... no, we'll never see that.

EC: What's the winter like for you?
LC: Well, it's great. I can ride all winter long. Running is great in the winter too. And that's why it's easy to train for races like New Zealand in March or South Africa in April.

EC: Is there anything specific that you do to get yourself ready for a race halfway around the world?
LC: Well, I was just thinking about that because I just did a local olympic tri this morning. It's always easier to sleep in your own bed, hop in your car the morning of race and only drive a short distance.

I live in an area where we really only have one triathlon that's not at least a long day trip, if not an overnight. I think there's not a whole lot of difference between packing a bag and loading up your gear for an overnight compared to getting everything together to take on a plane. The key is just being organized about remembering to take everything -- particularly if you're traveling overseas. The only real difference is that you want to show up a little earlier -- at least the Tuesday before a Saturday race -- to recover from the travel and get ready for the event.

EC: Do you need to sign up a year in advance for the international races?
LC: Not really, although as those races get more popular, they are starting to sell out. But that's nowhere near as fast as the North American races. However, with work for me, I do need to plan almost a year ahead if I want to be certain that I can be off. I really need to take careful stock of what's happening at work, discuss everything with my partners regarding their plans and then lay out the calendar.

EC: When you travel for these destination races, do you also add a tourist component, or is it all business -- in and out for the event?
LC: I've done it both ways. Each of my trips have been with one of the US-based tri travel companies and are also with at least one other friend who is doing the race. It was an eight day trip when I did Ironman New Zealand, which didn't afford too much bonus tourist time. When I did South Africa, we stayed an extra week to do the safari thing. For Australia this time around, there will be a little of the tourism thing at the front end of the trip.

EC: When did you first get hooked up with Justin Daerr as your coach?
LC: After Ironman South Africa I really started thinking that I was done with the sport. But a few weeks later I was out in San Diego for a business trip and got reinvigorated. And as I thought about it, I realized that there are very few things I would invest so much time in and not have any help doing it. I'm not a huge triathlon training group groupie. I have a few local friends in the sport, but not too many. I knew I needed some guidance, so I decided to seek out a coach. After some e-mail back and forth with Gordo, he directed me to JD, and it's been a really good fit.

EC: Let's talk about your medical background and experience, which Endurance Corner taps for its expert writing team. Did you know you wanted to become a heart specialist when you were in school?
LC: I attended the University of Pennsylvania for my undergrad and Johns Hopkins for med school. At one point, I thought I might wind up being an engineer, but ultimately didn't go down that path. And the thing about medical school is that you want to do whatever it is that you learned that day. So you go through cycles of that. I'd always been interested in things related to the heart. For a while I thought I'd become a pediatric cardiologist. But it was when I was in my the third year of medical school during the surgery rotation and I just thought surgery was incredible. I was captivated by the fact that I could do some "handy craft" and just make some things better working directly with my hands.

EC: You write a regular blog -- The Athlete's Heart -- can you tell me a little about your objective behind it and what got you started?
LC: When it comes to my occupation, I'm generally pretty low-key with my athlete friends. There are probably many people that I swim, bike, or run with who have no idea what I do for a living. But from those who know that I'm a doctor who specializes in heart disease, I would always get questions related to medical problems in general and heart-related problems in particular. Even though these questions often had nothing to do with heart surgery -- my medical specialty -- I'd do my best to offer some sound advice.

About a year ago, Gordo asked some heart-related questions on Twitter -- asking the EC doctors to offer some opinions. I can't recall the exact questions, but he stimulated my interest in learning more about athletes and heart disease. I found that, although there is a fair amount of material in the medical literature, there is very little quality information for non-medical folks -- either in book form or on the internet. This is where I got the idea of doing a blog related to heart disease and athletes.

I thought I'd spend some time learning better about the various heart-related issues facing athletes and share my thoughts and findings at the blog. I've had a fair amount of experience with medical writing -- articles, book chapters, books - -and, in fact, I'm the managing editor at "Current Problems in Surgery," one of our specialty's medical journals. I had absolutely no experience in writing about medical topics for a non-medical audience, though -- and I'm finding that it's pretty hard to do.

At any rate, that's how the blog got started last fall. I've done several different kind of pieces at the blog, including articles with general information about a particular topic and "In the News" articles in which I shared my thoughts about new studies in the medical literature. I can tell that there's a need for quality information about these issues from the growing readership at my blog.

EC: What are the basic recommendations you have for athletes when it comes to taking care of themselves?
LC: I have just two important recommendations:

All athletes should have a doctor. Visit the doctor annually to review your medical history and have a complete physical examination that focuses on cardiovascular problems.
Pay close attention to warning signs such as: chest pain, unusual shortness of breath, palpitations (the sensation associated with abnormal heartbeats), unusual swelling anywhere in the body, and blacking out (syncope).

Athletes -- and particularly, male athletes -- are notorious for not doing these things. This is a real opportunity.

EC: Do you see any recurring health problems (not overuse injuries) in athletes, especially because a common perception is, "I'm fit, how could anything be wrong?"
LC: That is certainly the common perception. It stems from the fact that, in most cases, it's true. People in our sport (or any endurance sport) are apt to be healthy people. But it's easy for athletes to overlook or ignore potential problems.

In the U.S., there is a robust system for pre-participation physical exams for student athletes. The system is designed to identify student athletes who have (or may develop) medical problems, particularly heart-related, that may place them at risk during exercise or competition. Unfortunately, there is no such system for the millions of adult athletes out there.

Each year, we read about athletes who die suddenly during competition, often from a heart-related problem. This is a small number of athletes, but the reports are certainly dramatic. In young athletes the deaths are often due to unsuspected congenital heart disease and in older athletes the deaths are often due to coronary artery disease. We ought to do a better job to screen for these problems.

Over the long term, there are a whole host of heart-related problems that athletes face. These would include arrhythmias (abnormal heartbeats), blacking out (that we call syncope), and the athlete's heart syndrome (a set of changes in the heart that accompanies long-term participation in endurance sports), among others. In the months ahead, we'll talk about these issues in my column here at Endurance Corner.