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Editor’s note: This article is a general overview of pulmonary emboli and does not constitute medical advice. Always consult your physician if you think you are suffering from this or any other medical condition.
On November 17, 2006, Mike Friedman (Optum-Kelly Benefit Strategies), 24, felt an excruciating pain rip through his torso. “I’ve never been so short of breath,” he said. “It was like a dull knife ripping apart my chest.” In the middle of watching the movie “Cars,” he turned to his date and said, “We need to get to a hospital. I think I’m having a heart attack.”
Forty minutes later, Friedman was under evaluation at the University of Pittsburgh Medical Center, not for a heart attack, but for a pulmonary embolism, a potentially lethal blood clot in his lung.
Pulmonary emboli (PE) are silent killers. Often with little prior warning, nearly 300,000 people are killed every year by blood clots which lodge in their lungs (Kahanov and Daly, 2009). There is no greater cause of sudden death in the healthy population than a pulmonary embolism (Goldhaber, 2004).
First, a clot called a deep vein thrombosis (DVT) forms, often in the calf. The DVT travels from the veins to the right side of the heart which pumps the clot to the lungs. Untreated, this blocks blood flow to the lungs and can ultimately cause cardiac arrest. In total, over 900,000 people are stricken with pulmonary emboli every year. Many of those hit are otherwise healthy athletic people. (Andersen et al, 1991).
PEs are not unheard of in the peloton. Rwandan cycling pro Adrien Nyonshuti (MTN-Qhubeka), the focal point of Tim Lewis’s book, “Land of Second Chances,” lost his 2013 season because of his PE. Vuelta a España champion Chris Horner suffered one in 2011. Top professional Frank Vandenbroucke wasn’t so lucky. His embolism was fatal.
It was the coalescence of four crucial factors that caused Friedman to totter down the UPMC emergency department hall that night.
In late October of 2006, the rider affectionately known as “Meatball” had surgery to remove a recurrent saddle sore. What he didn’t know at the time was that he carries a genetic mutation called Factor V Leiden — one of the approximately 16 known genetic variants that can cause clotting disorders. The surgery, coupled with Friedman’s genome, kicked his clotting mechanism into high gear.
On November 6, he drove 1,600 miles non-stop from his home at the Olympic Training Center in Colorado Springs to his family in Pittsburgh. Fueled by little more than truck stop coffee, dehydration became Friedman’s buddy during the drive. Worse, periods of immobility, such as lengthy drives and airplane rides, often trigger DVT formation. Friedman’s calf cramped badly during the drive. Once the clot took root in his leg, the cramping was constant, an early warning sign that a DVT had formed in his leg.
When Friedman arrived in Pittsburgh, he began to train again. Unable to sit comfortably, he went out for runs. He also did 75-mile rides — without a saddle, but with a DVT in his calf.
Surgery, genetic predisposition, a lengthy drive, plus dehydration — fortunately for Friedman on his date night, he avoided the urge to tough it out, and got to the ER.
What are the warning signs that should alert you to seek immediate evaluation?
1) Shortness of breath — typically appears suddenly and always gets worse with exertion.
2) Chest pain — Not only “heart attack pain,” but pain when you draw deep breaths, cough, or bend at the waist. It does not go away.
3) Cough — especially bloody sputum.
4) Leg pain and/or swelling — usually in the calf. This is a tough one for cyclists. Our calves always ache. One-sided swelling is a tipoff. Friedman’s was only in his right calf below the knee.
5) Clammy and/or discolored skin — Friedman’s leg took on a reddish hue.
6) Irregular heartbeat.
7) Anxiety, lightheadedness, and/or dizziness.
If you’ve got two or more of these symptoms, it’s time to get evaluated immediately. Untreated, 30 percent of acute PEs result in death (Horlander K.T., et al). Once at the hospital, several tests are commonly used to diagnose a DVT/PE episode.
Typically, a chest x-ray is taken to rule out other disorders which mimic a PE. An ultrasound exam of your legs can confirm the presence of a DVT. Standard blood work often includes a D-dimer test, which can tell if your body’s clotting mechanism has been engaged.
A CT pulmonary angiogram is considered the gold standard for PE diagnosis. A small amount of contrast medium which contains iodine is injected into a vein in the hand or arm. The exam is quick — images are taken shortly after injection and take just moments to gather. Any emboli are seen as dark against the white background of the dye within your pulmonary circulation.
Now that your doctors have diagnosed you with a PE, you are likely to be treated with a variety of anticoagulant therapies. How long you’ll remain on anti-coagulant therapy, and when you can get back on your bike are critical questions for any cyclist.
Straightaway, you’ll need patience as the damage caused by the blood clots in your lungs and legs takes time to heal. Swelling of the legs is often worse after a DVT, so your physician may order you to wear compression stockings to keep it at bay. You might find that the mere act of walking up stairs leaves you breathless for several weeks post-PE. Base miles will be the order of the day for awhile.
PEs are complex medical management issues for physicians. It may take several weeks of tweaks until your personal physiology and the medications begin to act in harmony. While the outlook for a fit athlete’s return to active riding is far brighter than for the population at large, you might find yourself on anticoagulants for some time.
Most likely, you’ll be back on the bike, but perhaps not as strongly as Friedman. In May of 2007, six months after suffering a PE, Friedman raced the Four Days of Dunkerque. In December of 2007, Friedman won the pre-Olympics scratch race on the Beijing velodrome which cemented his spot on the US Olympic long team. And in April of 2008, he raced the cobbles of Paris-Roubaix, as he rode in support of fourth-place finisher and Garmin teammate Martijn Maaskant. Nice comeback.
Special thanks to Dr. Chris Roseberry, MD, FACS — the finest cyclocrossing surgeon in Exeter, NH.
The post Pulmonary embolism, a silent killer: What cyclists should know appeared first on VeloNews.com.
4iiii’s $399 Precision ANT and Bluetooth power meter built into this little unit comes with a glue kit for the user to attach it to the left crankarm. The installation kit includes a jig that plugs into the pedal hole to ensure it’s placed in the correct location. After gluing it on with epoxy and leaving it for six hours, the user hangs a 10+ pound weight from three different points on an included load cell spindle. This is done just once for an aluminum crank, but it should be done annually with a carbon crank, since 4iiii says its flex characteristics can change over time.
As a rider’s pressure on the pedal moves relative to the crankarm due to ankle twisting or variations in spindle length, the 4iiii corrects for it based on this calibration data, and the company claims that other crankarm-based power meters without this feature lose up to 9 percent accuracy due to this variation in pressure distance from the crank. The rider also calibrates the 4iiii for temperature at the head unit; 4iiii claims that its active learning temperature compensation system brings the accuracy of the power meter to within one percent. Photo: Lennard Zinn | VeloNews.com
The Stages power meter is not glued on by the consumer; Stages sells pre-calibrated left crankarms for various cranksets with its power unit attached. It has a temperature slope built into its software, since the deflection of the arm under a given force changes with temperature. As soon as Stages wakes up to the movement of the crank, it is constantly checking its temperature and correcting for it. Photo: Lennard Zinn | VeloNews.com
Stages created a sustainable stage for itself at Interbike with its booth made out of an old international shipping container. The container can go by truck, train, or boat to the next bike show, and it can be simply plunked down and opened. The wood text plaques are recycled from scrap generated by a guitar maker. Photo: Lennard Zinn | VeloNews.com
Those familiar with the vast swaths of dead lodgepole pine trees in the Rockies will recognize this blue-stained beetle-kill wood that Stages used for the flooring, tables, and counters of its reusable trade show booth. A fungus carried by the mountain pine beetle colors the wood blue. Photo: Lennard Zinn | VeloNews.com
The $499 WatTeam PowerBeat power meter has a glue-on sensor and a computer unit attached to a metal flange that goes around the pedal spindle. A wire connects the sensor and comp unit, and it communicates with a bike computer via ANT+ or with a smartphone via Bluetooth. The kit includes this ruler that indexes off the pedal spindle to accurately determine the gluing location of the sensor. Photo: Lennard Zinn | VeloNews.com
The user glues a sensor onto the edge of each crankarm. The kit comes with a 2kg mass for the user to calibrate the unit. Photo: Lennard Zinn | VeloNews.com
WatTeam claims accuracy within 1.5 percent from its unit, which measures from both the left and right crankarms. As the rider pushes down on the pedal, the sensor is on the top edge of the crankarm, and the comp unit is on the bottom edge. Photo: Lennard Zinn | VeloNews.com
The new Nikola pedal body moves inward and outward 25mm (one inch) along the pedal spindle as the crank goes around; this is when the spindle is at maximum extension. Its inventor, Nick Nikola, is a skater who felt that riders could go faster if they could incorporate their big skating muscles, so he built this pedal that at the top of the stroke is as close to the crank as a standard pedal, but at the bottom of the stroke becomes an inch wider. Trying it on a trainer, it looks weird when watching the feet go back and forth, but the feeling is actually very subtle. There is a spiral cut into the spindle running over a pin inside so that the pedal moves back and forth as the spindle turns within it. Photo: Lennard Zinn | VeloNews.com
Nick Nikola, the founder of Nikola pedals, claims the “natural motion of the foot is to kick outward,” which is why he made his pedal do so; this photo shows when the spindle is at minimum extension. He claims a 2-percent efficiency increase, resulting in an average decrease in 40km time trial times of two minutes. The user can adjust the clocking of the pedal to be fully inboard at a spot other than at the standard 12 o’clock position and hence fully outboard somewhere other than at 6 o’clock as well. Nikola said the University of Pittsburgh is doing clinical trials with his pedal, adding that it appears to relieve the hip pain of riders with Femoroacetabular Impingement (FAI). 4iiii claims that, due to its load-cell calibration and the learning capability of its 4iiii Precision power unit glued to the crankarm, it would measure power output accurately from a rider using a Nikola pedal as it moved inward and outward, and that other crankarm-based power meters would not have that accuracy. Photo: Lennard Zinn | VeloNews.com
The $5,500 multilingual PowerControl 8 is the more accurate, eighth generation computer from the originator of bicycle power measurement, SRM. The PC8 has a magnetic charger plug, GPS, WiFi, Bluetooth, and wireless download. The anodized aluminum housing continues SRM’s asymmetrical mount, is only 8mm wider than the PC7, and fits its existing handlebar clip. The larger, sharp monochrome 2.7” LCD, customizable display has 400x240 pixels, a high-quality contrast, and an auto backlight. Photo: Lennard Zinn | VeloNews.com
The SRM IndoorTrainer Electronic, held in the photo by SRM founder Ullrich Schoberer, has an improved, electronically-controllable flywheel, developed in cooperation with the Italian company Gobat. The magnetic brake, like in SRM’s previous IndoorTrainer flywheel, simulates road feel, but this one can also be controlled electronically via USB cable or Bluetooth LE 4.0 with a personal computer, or via an app installed on a smartphone or tablet. Additionally, the two-button handlebar remote Schoberer is pushing can manually increase or decrease resistance in 10-watt increments or change magnetic brake position, and a PC8 is included on the handlebar. Photo: Lennard Zinn | VeloNews.com
The SRM IndoorTrainer Electronic’s magnetic brake ramps up with flywheel speed by means of eddy currents induced in the spinning steel flywheel by the stationary magnet and, together with the wide range of the NuVinci N360 continuously-variable-gear hub, it provides enormous brake power. Both professionals and newbies can benefit, since bigger chainrings and reducing spacing between the magnet and the flywheel increases brake power, and vice versa; minimum brake power is 80 watts at 80 RPM. With a cadence of 40 RPM and a 53T chainring, a maximum brake power of about 400 watts is possible, while with a cadence of 120 RPM and a 53T chainring, the maximum brake power is the 1,400 watts Andre Greipel uses for indoor sprint training. Photo: Lennard Zinn | VeloNews.com
Based in Milan, Italy, Zehus makes this shiny chrome, 250-watt pedal-assist electric-motor rear hub. The Zehus Bike+ hub has no handlebar controller and mounts on any bike. It switches on and off automatically as the rider pedals and coasts, and it recharges from the bike’s motion when it isn’t driving. It has sensors monitoring pedaling torque and road slope, and the mode can be controlled via Bluetooth with a smartphone. If used regularly on the standard setting, it never needs to be recharged, but a charger plugs into the end of the axle if need be. Photo: Lennard Zinn | VeloNews.com
The Zehus electric rear hub can run on “endless charge” without mileage limit on the “Bike+” setting, or it will go 30km on battery power, or it can be shut off so it’s a singlespeed with a 3kg rear hub running on human power. Photo: Lennard Zinn | VeloNews.com
Cyclists generally measure power output in watts, rather than in horsepower. These Canadian cowpokes are not actually beating this dead horse in the Ryders Eyewear booth at Interbike; they’re doing CPR and ventilating with a cowboy hat in hopes of getting it to put out more than the zero horsepower it’s currently doing. Its horsepower never went up, however. Photo: Lennard Zinn | VeloNews.com
- For same is a pair of Sworks mtb shoes size 41.5. Bought new this summer. They are in great shape but my foot is way too fat for these. $200.00 missing one of those lugs on bottom for more traction when walking in mud, which should never happen! Thanks and my number is 314-440-6184
- looking for both an X2 and an X4. both in 110mm length and 10 degree. have 120mm to trade.
- Great Midwest weather means great Midwest events this week.
- Check out this link for all the details Saturday. After Gateway Cross Cup concludes Saturday evening join MOBRA in celebrating a great year of racing and honor those that won the BAR Points Championships as well as our newly crowned Collegiate, National and World Champions.
MILAN (VN) — The Amaury Sport Organisation (ASO) will present its 2015 Tour de France route Wednesday in Paris, but already, enough is known or rumored to suggest that Italy’s Vincenzo Nibali (Astana) will have a chance to defend his 2014 title. [Watch a live broadcast of the presentation on VeloNews, starting at 5:30 a.m. Eastern on October 22 -Ed.]
The race will start in Utrecht, Netherlands on July 4 and finish in Paris on July 26. It is due to run counter-clockwise around the country, skirting the north coast before running through the high Pyrenean and Alpine mountains.
Lack of time trials
29-year-old Siclian improved, but is still not at the level of Alberto Contador (Tinkoff-Saxo) and Chris Froome (Sky) when it comes to time trials. The 2014 Tour had one 54-kilometer time trial stage, where Nibali placed fourth, but next year is due to only have one individual stage, the 13.7-kilometer opener in Utrecht.
Any time lost in the short time trial on day one, “The Shark” could gain back when the Tour rolls through the nervous and technical North. The 2015 edition should have two stages in the Netherlands — one following North Sea’s coastline to Neeltje Jans — two in Belgium, and about three along the coasts of Normandy and Brittany.
In 2014′s cobbled stage five to Arenberg, Froome crashed early while the technically adept Nibali rode away from all of his rivals on the wet stones. He gained 2:35 on Contador and 3:27 on eventual Tour runner up, Jean-Christophe Peraud (Ag2r La Mondiale).
Nibali, along with Contador, will have the upper hand over Froome and Nairo Quintana (Movistar) in 2015′s short and sharp climbs that resemble those of the Ardennes classics. In fact, stage 3 should finish up the same 1.3-kilometer ‘wall’ in Huy, Belgium — the Mur de Huy — that hosts the Flèche Wallonne classic every April.
Along with the Mur de Huy (averaging 9.3 percent), ASO is rumored to be planning a finish on the 2.21-kilometer Mûr-de-Bretagne in stage 8 (6.5 percent) and the three-kilometer Côte de la Croix-Neuve (10.1 percent) in stage 14.
Nibali rode away with the Tour title in 2014 after Froome and Contador abandoned early. He won four stages, three in the mountains, but may not be so lucky in 2015.
The Tour is due to include summit finishes at Pierre Saint-Martin and Plateau de Beille, Pra-Loup, Toussuire, and Alpe d’Huez — it is good news for Nibali, but better news for his rivals, especially lightweight Colombian climber and 2014 Giro d’Italia winner Nairo Quintana. Quintana scheduled the 2015 Tour as his main event after skipping it this year and placing second to Froome in 2013. It remains to be seen how Nibali will respond when challenged by the GC heavies in the high mountains.
Astana should field eight strong riders to support Nibali, especially since he is now a proven Tour winner. With the defense in mind, it signed climbers Davide Malacarne (Europcar), Dario Cataldo (Sky), and Rein Taaramäe (Cofidis). It also added Dutch hard-man, and former world cyclocross champion Lars Boom (Belkin). Boom won the Arenberg stage of this year’s Tour, so he could become the perfect chauffeur for Nibali when the Tour departs from Utrecht.
Astana can also count on this year’s helpers: Lieuwe Westra, Alessandro Vanotti, and Jakob Fuglsang. With the right selection, the turquoise team could compete well in the rumored 25-kilometer team time trial planned for stage 9 in Plumelec.
One of the few question marks resides beyond Nibali’s control: Astana’s standing with the UCI. After three doping positives in 2014, the UCI is expected to review the Kazakh team’s WorldTour license ahead of 2014.
- You won't want to miss the party. If you hold a valid USAC license bring it with you! This gets you in the door. Click on this link to get all the details of the party for Saturday.
- by Robert Grunau A few days of the rains that Seattle is known for relented and gave way to near summer conditions for Sunday’s Magnuson ... The post Fisher, Gaertner Brush Off the Heat at MFG Magnuson Park Cyclocross appeared first on Cyclocross Magazine - Cyclocross News, Races, Bikes,...
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