[Thomas Summer, MD]

Thomas Summer, MD on April 13, 2021 at 6:30 am · in reply to: Low Ferritin? #53086

Hey!

Steve, don’t let us talk her into overtraining or even RED-S with this little information;-)
of course overtraining is something to consider, but it’s a diagnosis of exclusion. Fortunatelly PR-ing is no sign of overtraining. Who would want PRs then?!;-) It’s true that peak performance is a fine line, but only if you stay there for too long, with too much sharpening.
Vit D is something to consider. But check your levels first, before you dose too high.
What was checked for thyroid function? also fT4 and fT3 or only TSH. Thyroid is an area of discussion not only in sports med…

your doc knows more about you! Let’s see what she thinks…

all the best!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 13, 2021 at 1:51 am · in reply to: Low Ferritin? #53079

Hi Lindsay!

24ng/ml is a bit low. I would like to see it over 50. But the hemoglobin is very good. I doubt that your symptoms are from an iron deficiency. Did anything happen in early March. Why did you think about overtraining? Let’s see what your doc says about it. But iron substitution is probably something to consider anyway.

Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 12, 2021 at 12:20 pm · in reply to: Low Ferritin? #53052

Hi Lindsay!

How low is your ferritin? Any other abnormalities in the lab? The first step is to find out why your ferritin is low (if it is really too low) and then see what is the best therapy option. But there could also be other reasons for your symptoms. I’m sure your doc will find out what’s wrong and provide the best therapy.

hope that helps!? If you have any other questions just ask (in whatever part of the forum you like;-))

gute Besserung!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 9, 2021 at 9:30 am · in reply to: Cartilage replacement – next 10 years #52952

Hey Sam!

I fully agree with Pete. Don’t focus on any timeline. See what you can do each moment. Your leg will guide you. But if you are in doubt it’s always better to be conservative. 10 months after surgery is very early for a scramble. I wouldn’t recommend that and risking anything. But once more: don’t focus on a timeline! It’s better to wait one more week or month, than risking anything too soon. Whatever will come will come. Work with your physio and try to enjoy the process.

kalipe!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 9, 2021 at 9:17 am · in reply to: Sprained Ankle #52949

Some more thoughts:

how is it progressing? did some professional check the ankle?
Movement is key. But only with a little discomfort, not pain. I would also send you to the pool, but this f…… pandemic… But you can use the water to get blood and lymph flow going. Use alternating hot and cold. I would also recommend compression socks, to reduce the swelling. Taping, also Kinesiotaping, would be something to consider, for a period of time. But you probably need someone who really knows how to apply it. What I also like for sports injuries are enzymes to take orally. That helps with the recovery. Here in Europe, I would recommend “Wobenzym”. I don’t know where you are from, but you will find something similar all over the world.
With endurance training, you can be creative. It’s the best time to try something new and work on weaknesses. I like Steve’s idea with the rowing (the question is if you have access?).
Looks like the triathletes understand each other;-) It wouldn’t come to my mind that sbr stands for swim bike run. That’s probably because I can only run;-)

have a quick recovery, but take your time!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 6, 2021 at 8:26 am · in reply to: Critical Speed (N-Zone Topic) #52814

Hi Steve!

good question. I actually don’t really use this term, but from what I understand it’s somewhat similar to AnT. So where lactate is still at a steady state. But critical speed is not only limited to lactate, but also other factors. So it might be pretty well represented with an AnT test in the field to determine HR at AnT.
Please share your opinion, Steve! I think I have to do some reading about this topic, as the term is something you hear about regularly.

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 6, 2021 at 7:51 am · in reply to: Bimalleolar fracture #52813

Hi May!

any plans on removing the screws and plate?

[Thomas Summer, MD]

Thomas Summer, MD on April 5, 2021 at 2:40 am · in reply to: Endurance Athlete Friendly Podiatrist in Switzerland? #52773

Hi Joshua!

unfortunately, I can’t recommend a podiatrist in Switzerland. But maybe we have some swiss guys on the forum!?

[Thomas Summer, MD]

Thomas Summer, MD on March 30, 2021 at 1:24 pm · in reply to: Temperature Impact on HR (maybe: N-Zone)? #52556

Hey Leon!

I would recommend reading the article I link here:

Performance loss through warmth

Another point to keep in mind is that most of the energy produced by a muscle is “wasted” as heat and not for the actual movement. So there are high demands for cooling the body. Especially if the intensity rises.

You need some warm days to adjust now. And you will need some cold days to adjust when winter is coming. But at first, we should all look forward to spring and summer. And hopefully some time in the Biergarten. Sieht aus als sollten wir eine deutsche UA Runde machen!?;-)

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 30, 2021 at 1:38 am · in reply to: Cartilage replacement – next 10 years #52522

Hi Sam!

A recent study on athletes showed good long-term results for Novocart 3D.

At the moment I would follow the advice of the surgeon and do more cycling for endurance training. Walking is also fine, but be careful with downhill walking, because it places higher demands on knee stability. If there is more swelling or pain, then it was too much.
A stair session is a good idea if you can go only up. And if you have a stable leg axis and your knee doesn’t collapse inwards (especially if you get fatigued). I would recommend training that with your physio. Focus on stability and proprioception, then shift to strength.
I would also recommend training the other leg. There you can go really hard;-) There are interesting studies that when you train one leg, it also transfers to the other leg. Whole-body strength training is also recommended. This way you get a release in growth hormone, which also helps the recovery of the knee. Furthermore, core strength is also important for knee stability.
Give the knee a year after the surgery. Then see where you’re at. Scrambling and alpine descents are a pretty high impact on the knee. But I think that should be possible if you have good strength and proprioception.

I would also recommend eating enough protein (2,5g per kg body weight) and supplement with collagen. You can take the collagen before the rehab training, with Vitamin C and creatine. You can also supplement with Vitamin D and K2 and Omega 3 fatty acids.

Maybe Pete has some more recommendations!?

Focus on what you can do at the moment. You will learn a lot along the way. And the mountains will wait for you!

kalipe!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 29, 2021 at 8:45 am · in reply to: Cartilage replacement – next 10 years #52495

Hi Sam!

I like your last sentence Keep working, it will come.

Your progression and end result depends on the procedure of the surgery and the size and location of the cartilage damage. And also the meniscus repair is something to consider.
Can you share more information?
My advice is to get a good physio, who can guide you through rehab. And also listen to the advice of your surgeon.
Most important is to get the strength back into the muscles of the leg, so that you have good joint stability and proprioception.

take your time, but have a quick recovery!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 29, 2021 at 8:29 am · in reply to: Performance loss through warmth #52494

The renal insufficiency may be a contributing factor. But it’s interesting that you get the deterioration within 10min.
Why are your kidneys insufficient?
You could do a sweat test if you suspect that there is a connection to your increased sweating!?

We can decide where you drop the bear in your next question;-) at the moment I’m not sure if I’ll be in Vorarlberg or in Bavaria in mid April.

cu
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 28, 2021 at 8:14 am · in reply to: Performance loss through warmth #52470

Hi Dada!

I’m sorry, but there is no special bonus for the guy with the most problems;-)

Sounds like you already did a lot of investigation. Good that your docs didn’t find any underlying issue.

What comes to my mind is:
– fluid- and electrolyte balance. Are you drinking enough? Or too much? Do you get enough minerals? How much do you sweat?
– if you are a big guy that could be a problem. Especially if comparing to smaller persons
– heat is something the body can adapt to:
https://www.irunfar.com/2018/06/handle-the-heat-heat-acclimation-for-endurance-running.html

You can adapt to the heat, that’s for sure. But it’s hard for me to guess any specific reason for your problem. Especially, if you already saw an endocrinologist.

Maybe my suggestions can lead in a direction, or you find something useful in the article?!

But the most important thing against the heat is a cold Tegernseer;-)

Prost!

[Thomas Summer, MD]

Thomas Summer, MD on March 24, 2021 at 6:51 am · in reply to: Recovery – How to know when to jump back in? #52326

You don’t get overtrained by just one big effort. But you have the risk of going in this direction if you start too early with the training. Unfortunately that’s a common response to an unsatisfying race.
Your response to the effort is normal. It’s even a bit a surprise that you could run 10km “feeling ok” two days after. I remember a lot of races and big efforts, where I had to take the stairs backwards for some days afterwards;-)
Take your time!

[Thomas Summer, MD]

Thomas Summer, MD on March 24, 2021 at 3:05 am · in reply to: Recovery – How to know when to jump back in? #52323

Hi Leon!

Looks like you were running an ultra, not a marathon?! I’m sorry, that you didn’t finish.

As I read this I remember how I felt after my first marathon;-) I gave myself 4 weeks to get back into normal training. I took the first week completely of from running. Only walking and aquajogging and easy (short) cycling. Then only short running sessions every other day to find my rhythm. Always listening to my body. That is also my experience with other athletes.
I ran track and field and then road marathons. Was your race on the trails and a hilly course? I find it’s easier to recover muscle-wise from a trail race. But the overall fatigue stays for longer. That your resting HR is still elevated is a sign that your body is still under stress and busy with recovering. So allow the recovery to happen and don’t stress the body with additional training. I would recommend only short recovery sessions every other day. At least until resting HR is back to normal. Then extend the sessions and see how it feels. I would wait with higher intensity at least for 3-4 weeks after the race. The better you recover now, the easier it will be to progress with training. Do some core. Sleep as much as possible. Eat healthy. Get some sun…
The good thing is, that with more experience you will bounce back much quicker. After some years of marathon running, I felt ready for training after only 1-2 weeks of recovery. …until you joke with your friends: “the older I get, the faster I was”

hope that helps?!

next time you’ll finish! And the better you recover now, the better you will finish;-)