Tuesday, May 11, 2010

Wear Insoles (Marin IJ)

My Sunday hoops game is a testament to the limitations of the human body – athletic tape is more plentiful than cartilage in this crowd. But it’s also a testament to perseverance – why else would these blacktop veterans continue to play a game that takes such a toll on the body? Some of my fellow weekend warriors have asked for advice on how to prevent and recover from sports injuries. Well fellas, in the spirit of graduation season, here goes...The following commencement address on recreation-related trauma is shamelessly modeled after an old Chicago Tribune column popularly known as “Wear Sunscreen.” My aim is to provide some flecks of wisdom for readers who, like me, are graduates of their competitive prime and fully cognizant of their performance decline.
Fellow aging athletes, if I could offer you only one tip for your athletic future, a pair of shoe insoles would be it. The benefits of insoles are self-evident; well, at the very least the benefit of having feet is self-evident. And if you are going to have feet and use them for activities that make them hurt, you should try insoles. They just might help.
Now, like insoles, the rest of my advice to weekend warriors and middle-aged rec league contestants has an inconsistent basis in medical science, and is to a large degree a product of my own experience…
Enjoy the pain and hardship of your sport. Actually, that’s bull – you cannot possibly appreciate how much the pain and hardship of your sport pounds your joints into submission. But trust me, twenty years from now you will look back with an ache of nostalgia at the way you used to move.
Warm up before the game. Hopefully your P.E. teacher taught you that. And realize that stretching alone doesn’t count; calisthenics in the sauna most definitely do.
Stop and collect your gear. Sometimes you need the knee brace. Sometimes you need the ankle wrap. The risk of re-injury is always there, so in the end you might as well wear both.
Cross-train or cross-fit. Even if you prefer not to. The best way to limit the repetitive strain of the tennis court is to balance it with time on the yoga mat. And if you succeed in doing this, please tell me how.
Swim – it is good for you – so long as the lapping of monotony against your head doesn’t drive you crazy.
Try running barefoot. But not all the time, and definitely not on gravel. If you need convincing, pick up a copy of Born To Run.
Don’t be reckless with recovery time. Middle-aged athletes are like leftovers from the Olive Garden – not so good on the third consecutive day.
Don’t worry about taking supplements – most of them won’t help, unless they are steroids, epo or HGH, and I’m not going there. Do worry about taking over-the-counter pain-killers – they do help, at least temporarily. But realize that taking too much ibuprofen is about as good for your stomach as pounding a pint of bleach. The real troubles, though, will come from the nagging pains that you ignore, like the twinge in your calf that warns that your Achilles tendon is about to snap.
Try acetaminophen first, but please don’t exceed recommended doses – a liver is a good thing to keep. Teeth are also nice to have, so if you play a contact sport, wear a mouthguard. If you knew how much a dental implant costs (I speak from experience) you wouldn’t ignore this accessory – it is clinically proven to decrease visits to the oral surgeon.
Pay attention to your diet. Especially before and after strength work-outs. Lowfat chocolate milk is probably just as good as a protein shake, and tastes better too.
Understand that many therapies – massage therapy, hydrotherapy, even aromatherapy – may be pleasant and relieve pain but do not improve performance. If you find one that does, hold on to it, for it is precious.
Take it slow with new sports – they will make your muscles ache. Similar to facing your property tax bill, the best way to limit shock to the system is by giving yourself time to adapt.
Most lower back pain will eventually get better and, for pain alone, surgery probably won’t help. Weight loss, core muscle strength and physical therapy probably will. I like to prescribe myself daily back-rubs from my honey.
Don’t feel guilty about not wanting to move on. So what if you are playing hoops against men half your age? Some of the greatest days on the court are those when you unexpectedly feel young.
Know when to ice it (right away), know when to heat it (a couple days later), and know when to walk away (if you need to, consult Brett Favre on this one).
Maybe you run the quadruple Dipsea for kicks, maybe you power walk a few laps on the weekends. Maybe you ride Camp Tamarancho on a unicycle, or perhaps you stick to the straight and flat. Maybe you can surf Ocean Beach in tsunami, or perhaps you wait for a two-foot swell at Bolinas; whatever your passion and your skill, take care of your body and get plenty of sleep too.
Accept certain inalienable truths: All athletes will get injured and the older you are the longer the recovery. You too, will one day retire. And when you do, you may fantasize that you were as springy as Lebron or as shifty as Pele. I know I will.
Be careful with the advice you heed. But be patient with those who supply it. And realize that some physicians may be better at giving advice than following their own.

But trust me on the insoles. Occasionally, I’ll even wear them myself.

Friday, May 7, 2010

On Labeling (Marin IJ)

On a recent trip to Safeway, I decided to pay attention to what was in my shopping cart. Standing in the checkout line, I scanned the nutritional labels on the items I’d selected. What I found was shocking; an eight-ounce package of sliced ham is infused with over two grams of sodium (nearly a full day’s supply). A small glass of Cran-Raspberry juice drink is loaded with 28 grams of carbs. A mouthful (one ounce) of Colby-Jack cheese contains six grams of saturated fat – 30% of your fat budget for the day. And, a single serving (one cup) of the frozen potpie I’d picked out for lunch has a whopping 501 calories and 26 milligrams of cholesterol. Well, I had to put that pie into the send-back pot. While making adjustments to my cart, I decided that although nutritional labels can seem scary, they are actually quite useful.

Once home, I did some research and discovered that food labels are indeed effective. They’ve been shown to benefit public health by encouraging suppliers to offer healthier choices and by encouraging consumers to choose them. What then should we think of other health-focused labels? Labeling lead levels in children’s toys – most of us can agree that this is a good idea. Nutritional content of chain restaurant food – I know that this information might change my choices at the drive-thru. Parts per million of hemp in my t-shirt – that, is probably over-kill. And how about labeling the radiation emissions of cellular phones? Well, that depends. One of my colleagues recently told me that she wasn’t too concerned about cellphones causing brain tumors because they seemed so innocuous. I agree, cellphones seem harmless (unless they are tempting you to text and drive) and they sure are convenient, but the fact is that we don’t know what the long-term risks of heavy use really are.

As I discussed in a column last year, there is some evidence that long-standing use of cellphones increases the risk of certain types of brain cancer. Most concerning is that the impact of cellphone use on the brains of children and teenagers has not been adequately studied. Could it be that cellphone use, much like drinking anti-freeze, seems innocuous at first but turns deadly later? I, for one, am not at all sure, but have advised others to limit direct held-to-the ear cellphone use as much as possible.

Given how little we know about the long-term danger (or safety) of cellphones, it seems reasonable for consumers to ask for easy access to information about the radiation (defined as the specific absorption rate or SAR) of individual phones. This is what State Senator Mark Leno’s new bill, SB 1212, would require at the point of sale (via labeling on exterior packaging). This bill, which is similar to one endorsed by Mayor Newsom in San Francisco, is set for debate in the Environmental Quality committee on April 19th. From a discussion with Senator Leno, I learned that the rationale for labeling is twofold. First, the labeling would address the fact that there is a significant and not necessarily intuitive disparity (over four-fold) between the SARs of different cellphone brands. The Environmental Working Group (EWG) has published a list of radiation levels for over 1,000 phones on their website (www.ewg.org) and if you check it out you will notice that there is a considerable difference between the lowest SAR phone (Sanyo Katani II: 0.22-0.55 watts/kg) and the highest ones (Blackberry 8820 and others: greater than 1.5 watts/kg). Second, the labeling would help to raise consumer awareness of the potential risks of what is a very common and yet modifiable exposure. Says Renée Sharp, Director of the California Office of the EWG; “We see this as a very nominal, basic step so that people can make informed choices. If people are more aware of the radiation coming out of their phone, they may be more likely to buy a low radiation phone or buy a headset or use speakerphone.” The headset, explains Lloyd Morgan of the Central Brain Tumor Registry of the United States, is the preferred risk-mitigation strategy; “Because the radiation decreases as the square of the distance from the cellphone increases (100 squared is 10,000), the difference between the lowest SAR phone and the highest SAR phone is inconsequential compared to keeping the cellphone away from your head or body.”

So, let’s think this through; is it reasonable to conjecture that a consumer who buys a high SAR phone may also buy a headset? Yes. Is it realistic to assume that some informed consumers might choose a lower SAR phone over an equivalent higher SAR phone? Seems to be. Are these actions likely to have a measurable effect on brain cancer rates? Who knows, but the answer could be yes, and if it is, requiring cellphone makers to make SAR values clearly evident seems an innocuous step with significant public health benefits. Realize also, that the Federal Communications Commission (FCC) already requires that manufacturers calculate the SARs, but that most bury the information deep in the phone’s manual. Putting the information front-and-center would give consumers the choice to pay attention, or not – and to change their behavior, or not. And much like me at the supermarket, some folks might be surprised how information can affect simple choices.

Spring Fever Can Hurt (Marin IJ)

Each spring, something stirs. Spring fever it’s called; sunshine, birds singing, an itch for exploration, and a sense of romance in the air. But in your local emergency room, spring’s stirring mean something quite different. In the ER, spring fever is hay fever and instead of bird songs we hear sniffling and wheezing. The itch is poison oak and that “sense” is an embedded tick being pulled from your skin.
With the brilliance of spring comes a myriad of outdoor opportunities, but also some hazards. If you spend a lot of time outdoors, you’re aware of these annoyances, but nonetheless the season calls for a review. So here are ways to avoid the three Ps of springtime – poison, parasites and pollen.

Thanks to El Niño’s rain, poison oak is growing like crazy and causing agony for careless outdoorsmen. With poison oak, prevention is key. So, please heed these four tips. 1) Know what poison oak looks like (shiny with leaves of three) and do not treat it like a decorative shrub – as a family friend did when she transplanted a bush from her backyard to the planter box. 2) Remember that poison oak’s oil (urushiol) is what causes the rash and that the oil stubbornly sticks to clothing – so do not follow the example of one ER patient who thanked her husband for clearing poison oak by greeting him with a naked embrace. 3) Be careful about slipping into the woods to relieve yourself in the bushes – several days later this convenience may cause prickly discomfort in the danger zone. 4) Finally, do not fall for the myth that drinking poison oak tea makes you immune – it doesn’t, in fact quite the opposite – a poison oak tea party leaves guests with painful swelling of the mouth and throat.
If, despite your best efforts, you fall victim to poison oak exposure, act quickly and you still may be okay. Wash off, as thoroughly and as soon as possible. Scrub with Technu or Fels-Naptha soap and get all your clothes into the laundry. If a rash occurs, (usually two to three days after exposure due to a delayed immune reaction) focus on alleviation. Don’t worry, you can’t “spread” the rash by touching it at this point, although you should definitely avoid scratching at it. Aveeno and oatmeal baths may help calm the symptoms, but severe cases will need steroids (such as prednisone) – sometimes for a two week course of treatment.

Ticks are disgusting creatures. These pests are both parasitic and sneaky; they slowly crawl under clothing and discover tucked-away folds of flesh. To top it off, ticks can transmit infectious disease (such as Rocky Mountain spotted fever and Lyme disease) and in some instances inject a toxin that produces full-body paralysis. Luckily, these complications are rare, and although Lyme disease does occur on the West coast (transmitted by the nymph form of the deer tick, the Ixodes pacificus) it is much less common than on the East coast. It’s thought that we have our backyard friend and tick host, the blue-belly lizard, to thank for this –the lizard’s cold blood kills the bacterium that causes Lyme. Most of the time, ticks are merely esthetic hazards – and stubborn ones at that. There are a lot of myths about how to remove a tick: flame its bottom, smother it with Vaseline, or douse it with gasoline. These tactics might have worked for someone at some time but, really, the safest and most effective way to remove a tick is to patiently exert brute force. Using forceps or tweezers, grab the tick’s head as close to the skin as possible and gently pull until the tick releases. Once successful, do a celebration dance and flush the littler sucker down the toilet. Don’t be concerned if there is redness around the area of assaulted skin – this is a normal inflammatory reaction. If there’s a bull’s-eye appearance to the rash, however, that is more sinister and it’s time to think about Lyme disease treatment and prevention. The Centers for Disease Control and Prevention (CDC) recommend preventive treatment for Lyme disease if, and only if, all of the following criteria are met: the tick is likely to be of the Ixodes (deer tick) species, has been attached to the skin for at least 36 hours and treatment can be started within three days of removal. The treatment itself is simple: 200 milligrams of Doxycyline (this shouldn’t be given to children under the age of 8), but somewhat controversial in this area of the country (given the low rates of Lyme disease). The best way to avoid unnecessary medication is to give you and your family a thorough post-hike preening for ticks – and don’t’ forget to look in the tucked-away places – pulling an attached tick out of your belly button is not a pleasant proposition.

Has your spring been a sniffly, wheezy, watery-eyed one? If so, you’re not alone – so far it’s been a banner year for seasonal allergies. Fortunately, you can manage the discomfort of seasonal allergies by monitoring pollen counts in your neighborhood (check out http://www.pollen.com/allergy-weather-forecast.asp) and talking to your doctor about seasonal treatments (which include inhalers and over-the-counter drugs such as loratadine). Truly miserable sufferers may need immunotherapy (allergy shots). Allergy sufferers, be advised that now is not a good time to stop and smell the flowers.
“Spring,” former Marin resident Robin Williams once remarked “is nature's way of saying, ‘Let's party!’” Particularly in this county, spring is a party not to be missed. And with a watchful eye and prudent prevention, you won’t be left with a three P hangover.