[Thomas Summer, MD]

Thomas Summer, MD on May 21, 2021 at 7:10 am · in reply to: Random Knee Pain: New Knee Crunching Noise #54190

Hi!

where do you feel the pain/pressure? Is the crunching noise painful?

hard to tell what the problem is exactly.

You should not ignore it. But as long as you don’t feel pain while training (and after) you can continue. What is your main activity?

hope that helps a bit?!

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on May 14, 2021 at 11:38 pm · in reply to: Final fitness advice pre-alpine rescue course #54030

Hi Arthur!

Great that you are doing the DIMM. I did the program in Austria/Germany and really enjoyed it.
Regarding the training, there is one very important rule: If there is only a little bit of doubt, DO LESS!

enjoy the course and take it easy!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on May 14, 2021 at 11:23 pm · in reply to: AeT and AnT, many doubts #54029

Hi!

are you sure that the lactate results are correct?
What is your RPE at these intensities? Nose breathing…

[Thomas Summer, MD]

Thomas Summer, MD on May 4, 2021 at 12:04 am · in reply to: vertical speed records #53669

Hey Scott!

Thank you for the very good explanation. But don’t be a poor sport;-)
I’m pretty sure that all the guys ran on similar terrain with similar inclines. So let’s say we are comparing grapes to raisins (depending on their age).
Reinhold will most likely not join this discussion, but maybe Steve will…

[Thomas Summer, MD]

Thomas Summer, MD on May 3, 2021 at 11:47 pm · in reply to: Swim in “Intro to Ultras Training Plan” #53668

The overview is indeed misleading. It looks like there is more swimming than running.

[Thomas Summer, MD]

Thomas Summer, MD on May 3, 2021 at 11:27 pm · in reply to: Anemia? Low RBC, Normal Ferritin #53667

The big question is: why would someone restrict their diet? I know many athletes who are too rigid with their diet. And for most of them, it causes problems. Even up to severe eating disorders. I think it is important to be aware of this problem…

[Thomas Summer, MD]

Thomas Summer, MD on May 3, 2021 at 6:22 am · in reply to: Relapse #53637

Hi Sam!

difficult to make any suggestions without examining the knee.
But it’s always better to be cautious. Give it some rest. Do nothing that hurts. But get some light, non-weight-bearing movement. Just for blood flow. Biking is perfect.
And don’t forget the blood thinners, if you use the crutches and don’t put all the weight on the leg.

Most important: try to relax and take every moment as it is.

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on May 3, 2021 at 4:53 am · in reply to: Knee Pain … #53635

Hi Alex!

Yes, running is a different beast, especially when you run 16-17 hours/week! I hope you built up to that volume over a long time!?
Do you have a lot of tension in your quads? Does foam rolling and yoga help?

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on May 3, 2021 at 4:44 am · in reply to: Relapse #53634

Hi Sam!

Sorry to read that.
Report back after you saw your doctor if you want.

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on May 3, 2021 at 4:39 am · in reply to: Anemia? Low RBC, Normal Ferritin #53633

Hi Melanie!

A consult with Rebecca is a very good idea.
Have you ever worked with a coach? For us very driven athletes, it is sometimes very helpful to have someone to hold us back (trust me, I know what I’m talking about;-))

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 30, 2021 at 12:42 pm · in reply to: Anemia? Low RBC, Normal Ferritin #53550

Hey Melanie!

A Ferritin of 54ng/ml is pretty sure not the cause of anemia. But it’s possible that it causes symptoms. But as I wrote: there are many other causes for fatigue.
How was your Ferritin in the past? Did you feel better with higher numbers?

Dilution can be a contributing factor. That’s why it is best to take the blood in a fasted state in the morning.

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 30, 2021 at 5:44 am · in reply to: Anemia? Low RBC, Normal Ferritin #53506

Hi Melanie!

Was there ever any additional blood work done? MCV, MCH, Vit B12, Folic acid, CRP…

As hemoglobin is measured in g/dl it is also depending on plasma volume. So the more water the more “dilution” which means relatively less red blood cells per dl. So there are things like hydration status to consider. And especially, that with lots of endurance training you increase your total blood volume. But your body increases the plasma volume more than the red blood cells. So this means that the blood gets relatively more “diluted”. That’s not a bad thing, but actually good. If you are doing a lot of endurance training that could be the case for you, as your hemoglobin is only slightly below normal values.
There are many reasons for “unusual fatigue”. Maybe it’s even not so “unusual” when you are “extremely active”!?

hope that helps?

and better chew some red meat than the iron pills;-)

Thomas

[Thomas Summer, MD]

Thomas Summer, MD on April 23, 2021 at 6:38 am · in reply to: Low Ferritin? #53328

Hi Lindsay!

Good approach and great to hear that you are already feeling better.

take your time and enjoy the mediation:-)

[Thomas Summer, MD]

Thomas Summer, MD on April 15, 2021 at 11:10 am · in reply to: Performance loss through warmth #53157

Hey Dada!

to drop it off could be difficult. and I’m not sure if it’s a good idea for me to write here “sure, let’s meet for a beer tomorrow..”;-)
I think it’s best to meet when things get better and then have a beer together at the lake.
I’ll not forget about it, and I’m looking forward to your next question;-)

zum Wohl!

[Thomas Summer, MD]

Thomas Summer, MD on April 13, 2021 at 12:59 pm · in reply to: Low Ferritin? #53100

Hi Lindsay!

lab sounds good.

working with Scott sounds even better.

Allergy? Do you have any known allergies? Any other (respiratory…) symptoms? Symptom improvement before taking claritin sounds cool. I’ll try that with one of my next patients;-) but seriously: claritin is an antihistaminic, so a side effect is actually tiredness. Are your symptoms still better since taking it? Mention the allergies at your doc. It’s possible to test for that. But don’t stress too much about it, if you don’t have any other symptoms.

Stress because of COVID is really something to consider. Especially if you even work with it. Do you have psychological support at work? This pandemic is creating so much stress for most of us. And on so many different levels. It’s also big stress for me. Especially working at the clinic. I found a very good psychologist. She helps me to deal with all the stress.
As you sad “stress is stress”. Some stress is good. Too much stress is… too much stress!

so: hakuna matata!
Thomas