[Thomas Summer, MD]

Thomas Summer, MD on May 19, 2020 at 1:48 pm · in reply to: Total fast versus carb fast? #41894

Hi Dave!

I would also recommend salt tablets. Or something salty before. And drinking enough.
In regards to fat-adaptation, I wouldn’t eat too much protein, because that could also be gluconeogenic. I really like essential amino acids (EAA), while my long fasted runs. They are not insulinogenic and can even delay mental fatigue.
Are you using any caffeine?
For me, it helps, when I only use a little bit of sugar – like sucking on a gummy bear – when I start to feel sluggish, into my long runs. You get the carbs through your mucous membrane in the mouth and probably without any effect on fat burning.

Mahlzeit!

[Thomas Summer, MD]

Thomas Summer, MD on May 15, 2020 at 5:04 am · in reply to: Covid Recovery and the Lungs #41731

Hi Al B!

For severe cases, there is probably a higher risk for long term consequences. If that’s also true for mild cases is very speculative. And if that is even permanent no one can tell at the moment. For light cases, at the moment, it seems that there is not much risk for long term consequences. But unfortunately, there are some small case reports or CT- studies, that show dramatic changes to the lung tissue. That can lead to too many worries in the public. At the moment it’s too early to make a reliable statement on this topic. There is so much new science and new studies published every day. It’s difficult to stay up to date, but I’ll post here, if there are any new informations on this topic.

What were your symptoms? How long? Fever?! Positive (and then negative) test? When did it start? What do you mean by “…my lung function still feels off…”?

I’m happy if I can help a bit. In the case of covid-19 I would really like to have more informations, but unfortunately there is a lot we don’t know.

Thomas

[Thomas Summer, MD]

Thomas Summer, MD on May 5, 2020 at 9:00 am · in reply to: Is allergy treatment preventing endurance adaption? #41172

Servus Daniel!

I wouldn’t reduce the adaptation to endurance training only to IL13. But for sure endurance training causes inflammation and stress on the body. Many different mediators are involved and lead to adaptation after recovery. There are some studies that suggest that this adaptation is impaired when you block the inflammatory response with medications or even ice baths and other things. As with most things, balance is key.
One of the key mechanisms in asthma is an inflammation of the bronchia (IL13 plays a key role). So one therapeutic option is to inhibit this inflammation. This can be done by corticosteroids (inhaled or even systemic) or by LTRA (Leukotriene-Receptor-Antagonists).
ICS are inhaled corticosteroids, so they act mostly on the lung. Only if you go beyond 1mg/d systemic effects are possible. This way (and also by oral administration) they would also suppress inflammation in the whole body (not only the lung). LTRA are taken orally, but they are far less anti-inflammatory.

Overall I don’t really see an adverse effect of the medications on endurance adaptations. It’s far more important that you control your asthma with the right medications so that you are able to train normally. From what I know there is no evidence that people who are on asthma medications have less adaptation to endurance training.

What’s your experience? What medications do you take?

I hope that helps!?

uphill regards!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 30, 2020 at 8:30 am · in reply to: Meniscus tear surgery #41056

Now that you got an acute trauma to the knee I would tend towards surgery. If only partial resection is done, you will be able to exercise quite quickly. At first bike and in the water, then running. Let’s see what the MRI shows. Thursday is quite soon. When could the surgery be? How old are you?
Now is a good time to look for a good physiotherapist. Where are you from? How severe are the restrictions?
Continue with elevating the knee. Ice only if you have pain and/or swelling. And it’s always a good time for core training;-) but only without stressing the knee.

cheers!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 29, 2020 at 1:01 pm · in reply to: Ankle injury #41037

sounds like you are making good progress!? Keep up the good work, but listen to your ankle. In the case of doubt, better do less than more.

cheers!

[Thomas Summer, MD]

Thomas Summer, MD on April 29, 2020 at 12:54 pm · in reply to: Meniscus tear surgery #41036

Hi Josh,

How is the knee now? pain? swelling? mobility? stability? What have you done for the last 2 days?
Have you done any physiotherapy or other therapy in the last 5 months?
When do you get the MRI?
Recovery and rehab depend on the kind of injury and kind of possible surgery that would be done.

I hope you get well soon!
let’s see about July… there is also another thing that could make the race difficult;-)

Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 29, 2020 at 4:54 am · in reply to: Do plant based female endurance athletes supplement? #41005

Hi Diana!

Why did you test for iron deficiency? Symptoms? Any other tests or deficiencies? How much iron are you taking at the moment?
As a vegan, it’s very difficult to get enough of certain nutrients. Not only iron. And especially if you are an athlete that can lead to many deficiencies and problems.
I would recommend getting a professional consultation.

Mahlzeit!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 29, 2020 at 3:36 am · in reply to: Could Corona cause Myocarditis? #41004

Servus Dada!

That’s a good question.
There are a lot of reports that covid-19 also affects the heart. But it’s not totally clear, if the virus (sars-cov-2) directly infects the heart. Or if the exaggerated inflammatory response causes the myocardial injury. The receptor, how sars-cov-2 enters the cells of the lungs (ACE2), is also highly expressed in the heart. So a direct infection could be possible.
Asymptomatic means that there are no symptoms. If you have an asymptomatic course of the disease, you will not know that you have it (only if you get tested). Hard training, through a viral infection, puts you at greater risk for developing myocarditis. But even myocarditis is often asymptomatic. So it’s possible that you have covid-19 and myocarditis and you never know it, or have any symptoms. (too complicated?;-))
What could/should be the conclusion!?
Play it save with training if you are at risk and not sure if you could be infected.
Also be aware of the untypical symptoms of covid-19 – gastrointestinal (diarrhea, stomach pain…), loss of smell/taste, conjunctivitis…
If you get the disease, be very careful with training and do not start too early.
But if you are healthy, don’t worry too much and stay active!

stay healthy!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 28, 2020 at 7:17 am · in reply to: Osteitis pubis #40977

That sounds not too bad. Good to react early.
Give the structures some rest, in this acute phase. Try to relieve the tension of your adductors, hip flexors, and abdominal muscles. Self-massage! But everything without pain. You can start with easy core work, but also without pain. Stop running for some days and then report back how you feel in daily life.
I would recommend taking the Ibuprofen only for some days. And then stop it, if you can tolerate the pain.
Also, look for the reasons why this problem could have started. Think about your training. 2x sprinting per week can be a lot!? Too much too soon? Core stability/training? running ground, shoes… other factors…?

[Thomas Summer, MD]

Thomas Summer, MD on April 28, 2020 at 3:16 am · in reply to: where to log #40971

Hey rhysmacallister!

I would recommend to post this question in the “general training discussion”, because as a MD I have no idea what you are talking about;-)

cheers!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 28, 2020 at 3:04 am · in reply to: Ankle injury #40970

Hey Andy!

1h of step climbing sounds good. Any pain afterward? If that doesn’t cause any problems I would continue with it. As long as you don’t get too much dorsiflexion!?
If you have access, pool work (swimming/aquajogging) would be great.
Maybe you find the possibility to ride a bike!?
I would also recommend compression socks.
And of course whisky – locally and per os;-)

cheers!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 28, 2020 at 2:50 am · in reply to: Osteitis pubis #40969

Hi Zirbelkiefer,

give us some more infos, please.
What’s your main sport? What are your symptoms? Since when? How was the osteitis diagnosed? What can you do without pain? Core exercises? …

alles Gute!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 23, 2020 at 8:37 am · in reply to: FAI and Hip Labral Tear #40817

Hi Spencer!

your symptoms are quite typical for FAI, also that the injection removed the pain.

how is cycling?
and as Pete wrote: core, core, core!;-)

Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 23, 2020 at 6:22 am · in reply to: Ankle injury #40812

Hey Andy!
How does your ankle feel after the run? Be careful with running. Any option for x-training?

I drank laphroaig from 1999 yesterday;-)

[Thomas Summer, MD]

Thomas Summer, MD on April 23, 2020 at 2:50 am · in reply to: Part-time Glute Pain, Piriformis? #40810

Hi Kyle!

What did the chiropractor do? Any mobilization of the SI-joint?
Are you taking any medications for pain and inflammation?
overall stress is also something to consider…
As Pete wrote, take it easy with running.

Thomas