Sunday, May 30, 2010

More Events Added for 2010

A rolling stone gathers no moss. Or is that, Maas? In any event, I've now loaded up with four more events to an already promising 2010 season. Or should that read ambitious? The following four events have been added to my race calendar, which can always be viewed on the right side navigation area of this blog.

June 6 - Buffalo Sprint Triathlon - 1/4 mi swim, 13 mi bike, 3 mi run

This comes six days prior to the Liberty Triathlon, my first Olympic distance tri in over twenty years. So why do something the week before? Why do birds suddenly appear, every time you are near? A couple of reasons. One, I am going to wear 2XU Calf Guards during the competition.

These 'sleeves' can be worn during competition or used simply as a recovery tool. With similar benefits to compression tights but in a smaller package, calf guards improve circulation and protect against leg fatigue and muscle soreness. I have been wearing compression socks for recovery the last couple of years and am a great believer in them. I wore some compression socks in the Fargo Half-Marathon a few weeks back and am convinced they allowed my sore right calf to finish the race.

So, now I want to try them for a triathlon. And obviously you cannot wear socks into the water, so I'm going to try the sleeves. A good test tri before the oly. And I also want to get another swim in the new wetsuit, which I haven't worn since the Arkansas event in late April. In other words, the Buffalo event will be kicking the tires on some new equipment.

Jul 11 - Cornman Triathlon (USAT), Gladbrook, IA - 500 meter swim, 14 mi bike, 5K run

First, the name is cool! Cornman. Screw Ironman! Can you deal with the Cornman....can you?

Second, this event is the Midwest Special Qualifier which qualifies the top 33% per age group for the USAT Age Group National Championship in Tuscaloosa, AL on September 25, 2010. So, I'm curious how I can stack up in the 45-49 age group. Could I actually qualify for nationals? We'll find out!

July 17 (signed up) - Dubuque Duathlon, Iowa (USAT) - Run 1.2 Miles, Bike 17 Miles, Run 3 Miles

This is simple math. One needs two USAT sanctioned duathlons to qualify for end-of-year national ranking. I've got one in already and needed one more. Finding USAT sanctioned du's in the Tundra is tougher than one would think. Iowa is a neighboring state. The drive will be four hours. My alternative would be a trip to the south late in the year. Been there, done that back in April. This will du, er, do.

August 21 (signed up) - Young Life Triathlon in Detroit Lakes - 1/3-mi swim - 12-mi bike - 3-mi run
Did it last year, placing 5th overall. I think I can do better. Plus, the Boy® gets to spend quality time with the grandparents at the lake while the Well Kept Wife™ and I can find an eating establishment that doesn't have chicken nuggets or cheese pizza on the menu.

Monday, May 24, 2010

Race Result: Fargo Half-Marathon

Event: Fargo Half-Marathon
Date: Saturday, May 22
Location: Fargo, ND
Results: Half-Marathon Results, Full Marathon Results

Personal results
Goal: 1:29.59 (6:51 per mile)
Actual: 1:29.12 (6:49 per mile)
Overall: 76 (6032 total); top 1.26%
Overall Males: 66 (2363 total); top 2.79%
Overall Male Age Group (45-49): 5 (216 total) top 2.31%

The Recap

The alarm woke my up at the ungodly hour of 4AM. But that is what separates athletes from the "oh, just grow up already" adults who want to party all night and are just getting in at the same hour. Like the Marines say, "I'll do more before 6AM than most people do all day."

At 6:15AM I found myself sitting in a parking lot and having a very eerie Déjà vu moment. I then turned to my left and recognized the dormitories of Reed-Johnson Hall. These were the dorms I stayed in for the first two years of achieving my B.S. in pharmacy at North Dakota State from 1979-85. Thirty-one years later, here I was again. So many forgotten (repressed?) memories came flooding back at once that I almost teared up.

There was the old NDSU Fieldhouse. I could recall the indoor state track meet where two people had boxed me in during the 400 meter finals until I elbowed my way through and made my own opening. There was the outdoor track that always seemed to have a gale force wind blowing down the backstretch. There was Sudro Hall that took every waking hour of my five years on campus in order to secure that pharmacy degree. My God, so many memories.

But I was here for the Fargo Half-Marathon. And this would start outside a building that had not existed when I was on campus: the Fargo Dome. We would finish inside of it. Very cool.

The forecasted gusty winds never materialized. The winds were still 12-14MPH but were virtually non-existent and I only found myself looking for a big bodied wind break once early in the race. But it was overcast and by the time I was thinking about lining up for the 7:30AM start it was a steady rain. The shoes were already soaked through. The nice thing about the Nike LunaRacers is they sort of glow when wet. So as the race went along I received many, "Love your shoes!!", comments from the crowd.

It was less than five minutes before the gun and I was looking around for familiar faces and recognized Steve Aesoph from Jamestown, NoDak. Steve is putting on a XTERRA triathlon later in June. If you have the date open...sign-up! I'll be there and looking forward to the mountain bike and trail run along with the swim where you have to exit and return to the water. Very cool. Steve and I had enough time to exchange pleasantries before the race started.

The first three miles were easy. I was just flowing along reminding myself every few hundred yards that no matter how good I felt:
  1. It was a long race and save the gas in the tank as I knew I would need it
  2. I had experienced a bad right calf cramp the Saturday before coming off the bike at the Park Rapids triathlon. It had been sore all week but was in serviceable condition. I was estimating mile six or seven before it would bark....if it was going to
  3. I had not run this distance (13.1) in over twenty years...even in training leading up to this event
It was during this stretch early in the race that Mike Fretland, the Park Rapids triathlon male overall champ, came up to me and we chatted about shoes, compression socks, the weather, goals, and upcoming races. Then I nodded to Mike and shooed him away as he needed to get up with the faster runners as he was using the race as part of his training regimen. I hope to run into Mike again this summer at a couple of tri's.

I hit the 5K at 20:24 which was a tad faster than I wanted but again, it felt pretty smooth. And just before I seemed that all the mile markers were just a tad off. Something that many fellow Garmin users talked about after the race. So my splits, which you can view at Garmin, aren't always on the mile. Sometimes I hit the split per Garmin and others per the actual road course. I was never too sure. And the course felt a tad long....and it was by one tenth of a mile. Here are the splits below:

Miles four through six started to become work. I was trying to keep contact with a group of gents while navigating around huge puddles and slippery corners. A few times my hand would gently find itself on the back of someone. The easy feeling pace of the first three miles was now feeling like work.

Between miles six and seven is where the right lower leg was becoming compromised. This was my make or break moment. I either coast in so as not to cause any long-term damage to the Achilles and calf. Or, relax a bit. Compose. Know that between miles seven and eight the Boy®, the Well Kept Wife™, and Grandpa Maas are waiting with the bottle of fuel (Hammer Perpetuem/Hammer Gel). I waited.

Precisely between miles seven and eight there was the Boy® waving a Minnesota Vikings flag. There was the Well Kept Wife™ already with arm outstretched with the bottle. I grabbed, said something like "right calf" and I was gone. I milked that bottle for the next 1/2 mile and dumped it outside the aid station at mile nine. And I was good to go.

Miles nine though eleven went well. I had some renewed energy and confidence. Yes, the right leg seemed on the verge of seizing up at any moment. But I was running through streets and avenues that I had frequented during my NDSU training days. The trees seemed the same. The houses the same. And just as earlier in the day, all those memories came back. Days of running fast miles through these very same streets. The feeling of invincibility that all youth has. I tried to remember those days, those feelings of just loping along. And it worked. I started to reel in people who has left me at mile six.

With two miles left, I knew if I stayed with the pace....I would have my goal of sub 1:30. It was really starting to be a struggle. And to get through that, I buddied up. I came up with another runner who had passed me very early on in the race and was now laboring. As I passed him I mumbled something like, "Lets go. We're so close." And he went with me. We would match strides for the next two miles. Picking off more runners along the way. Silently encouraging each other if the other started to lag.

The big Fargo Dome finally loomed. Man, it was going to be close to go under 1:30. I wanted to walk. I just wanted it to be over. A half mile to go. Legs were screaming to just stop. My form was non-existant and probably looked like a lumbering Neanderthal. People must have been trying to be nice when they were shouting, "Nice form! Nice stride! Looking good!", because it certainly did not feel that way. The watch was ticking ever closer to 1:30 and the Dome seemed so very far away.!

All I recall near the end is the watch read 1:28 and the entrance to the Dome and the finish could be seen. I sprinted with all I had left. I passed three people and the roar of the finish line crowd was something I will remember. I finished and must not have looked too good. I was noticeably wobbly and someone put a hand on me and asked if I was alright. I replied, "Yep, just old." A ton of handshakes from people who had either carried me or I them. I had done it. I went under my goal of one hour and thirty minutes. 1:29.12.

I spied Mike waiting on his wife to finish. Mike looked fresh as a daisy. Steve found me while sitting in a chair. Steve's feet were not pretty. He had gone sans socks. He figures it will be a week before he can run again.

Back at the hotel I iced for three hours straight. Then napped. when I got up I was sore but surprised I could move fairly easily. Success all around. A great road trip. A great event. But honestly, I won't be thinking of any races that exceed a 10K for a little least not in June!

Next event: Liberty Triathlon, Oly distance. Small chance I could do the Buffalo sprint the week before but I'm in no hurry to make that decision.

Thursday, May 20, 2010

Race Preview: Fargo Half-Marathon

Event: 2010 Fargo Marathon Weekend; competing in half-marathon
Date: Saturday, May 22
Location: Fargo, ND
Previous Results: Never competed in this event

I'll be heading out for the second weekend in a row to travel westward. This time we make the journey to Fargo, North Dakota. It is Fargo where I attended North Dakota State University ('79-'84), graduating with a B.S. in Pharmacy.
I have previously laid out a quite heady goal of going sub 1 hour & 30 minutes for this event. And while that is certainly possible, it most likely won't be achieved. I just simply don't have the run mileage necessary to sustain that pace. And I do not intend to lay waste to my entire triathlon season by gutting out such a performance. I'm going to use this event as a building block for the upcoming Liberty Triathlon Olympic Distance event on June 12. And also to gauge my potential for doing a half-iron man (70.3) in the future.
Last years half-marathon on Fargo drew 4382 competitors. There were 170 males making up the coveted 45-49 age group. I'd like to find myself in the top 150 overall and the top 10 in the age group. It all depends on who shows up, how the weather breaks, and how the race draws out.

Right now, the weather looks not to be a good one for running any personal bests. It should be well into the 60's by race time (7:30 AM). But more importantly, there will be a gusty wind from SE at 21 mph. Zoinks! I'll be finding me some big guys to hide behind. Hopefully the winds won't be as bad as predicted. The races course directly into that wind to start. So we would be buffeting a huge wind, then turn around and heat up with the wind behind us. I can taste that dry mouth now.
I hope to have my personal aid station in the form of the Boy® and the Well Kept Wife™ between miles 7-8 where I'll receive my own personal bottle of Hammer Nutrition Perpetuem, the world's finest endurance fuel. I hope this is the ticket to making it through the back half of the race. Hammer Nutrition Perpetuem - 32 Servings (Orange/Vanilla)

I'm going with the Nike LunaRacer flats. I have talked with fellow triathletes who have worn these shoes in halfs and come away very satisfied with the performance and cushioning provided. Nike Men's NIKE LUNARACER+ RUNNING SHOES 9 (NEUTRAL GREY/BLACK/VOLT)

Undecided is whether I sport calf compression hose (I prefer the SLS3 socks) or not. Given the state of my calf muscles post the Lakes to Pines triathlon, it may not be a bad idea. But the restrictive feeling of the hose could end up bothering me late in the race. SLS3 Compression Sleeve White S/M

Goal: 1:30 (6:51 per mile pace)
Realistic Goal: 1:32 (7:01 per mile pace)
Satisfactory Goal: 1:34 (7:10 per mile pace)
I don't think I've done that before. Set a max-mid-min goal, a window of possible success from which I'd be ecstatic, thrilled, or satisfied with my result. In this case, it is necessary as I've not competed at this distance in some twenty one years and then the result was 1 hour and 19 minutes (6:01 pace). I can factually tell you, that won't happen again! I've been dealing with a gippy right calf since last weekends triathlon. In fact, there has been some thought this week that I may not be able to compete at all. But it looks like I'll be able to make the starting line at this point.
I know of at least two people competing this year in the half-marathon. The legendary Steve Aesoph from Jamestown, NoDak who is the race director for the XTERRA Pipestem event I will be competing in come June. And Mike Fretland of Bismarck, NoDak who just won the Lakes to Pines triathlon in course record fashion. I hope to rub shoulders with each before they leave me in the dust.
Good luck to everyone running in all the events in Fargo this weekend.

Wednesday, May 19, 2010

The Age Grouper

Courtesy of Runner Triathlete News, May 2010 issue. RTN is a publication for runners, triathletes, and cyclists throughout the Southwest. I'm happy to subscribe to it.

Campsite of transition - trinkets on display
Shoes yawn open - helmet perched on aerobars
The fifteenth final check

Bare feet walk over gravelly asphalt
Look back at the bike like a pre-schooler looks back at Mom
Clutch goggles and cap and breathe in chemical toilets

Study bobbing red buoys like a charlatan palm reader
Nagged by doubts and a full bladder
3...2...1... - Beep goes the watch

Wade, plunge, swim
Soup of feet and elbows
Face to face with another face twisting for air

Ridiculous crawl three-quarters of a circle around a buoy
Shoulders cry out
Triceps tighten

Discomfort of not knowing what time, how far
Prehistoric language of splashing water gives way to cheering
Hand, then foot touches mud and you emerge

Peel off cap and goggles and blink at the world like a newborn
Stagger ashore on wobbly amphibian legs
Beep goes the watch

Run from water like you did something wrong
Count racks and look for red gym bag
Win noiseless game of Marco polo with the bike

Simon Says theater of helmet first
Mother May I buckle my chinstrap
Run alongside the bike to the chalk line

Ragged breathing, water pours off the face
Gritty feet fight into stiff nylon shoes
Beep goes the watch

Lake water
replaced by sweat
replaced by plastic flavored water

Wind whips past the ears
Hum of thin black rubber on hot pavement
'On yer left!"

Smokin flyin crankin
Bare thighs born to turn these pedals
Gears shift and you lunge and climb

Adrenaline, then elation, then dull pain
Invades the engine of heart and lungs
Spreads to drive train of quads, glutes, hams

Loosen straps, swing a leg,
Coast to dismount, more baby steps
Beep goes the watch

Hook brake levers over wobbly steel pipe
Unbuckle the chinstrap as blind toes feel for shoes
Bend, zip, zip, grab, run

Snap the race number and pull on a visor
Beep goes the watch
Tell your legs they're not biking anymore

Strides and breathing smooth out
Check calf numbers and relax or press
Choke down half a paper cup of sticky flavored drink

Do the math when you see the fast guys coming back
Hold it together against fatigue
Who moved the last mile marker?

Lead legs burn
Lungs vacuumed out
Nothing in the tank

Loudspeaker name, music, applause
Merg and the boys
Banner, electronic burgundy mat

Beep goes the watch

written by Mark McGraw, College Station, Texas.

Sunday, May 16, 2010

Race Results: Lakes to Pines Triathlon - Park Rapids, MN

For the third year in a row, I attended the lovely Lakes to Pines triathlon in Park Rapids, MN. As I have done this event since its inception, I have been able to see it grow from relative obscurity to now officially being on the map. Maybe it was the perfect weather this year. Maybe it was the fact a record sixty-three people made the trip. But it is official, this race is now known. For seven (7) males went under the previous course record. Five (5) females went under the previous female course record.

Overall Results

The male class was won by Mike Fretland of Bismarck, ND. I had last seen Mike in September, 2009 at the West River Triathlon in Dickinson, ND. Mike had finished 2nd overall that day, and I had followed in third.

The female class was won by Kailee Fretland, wife of Mike. So they had a great day bringing home a true daily double! It was good to see and chat with both of them again. They are good people. And I'll also be seeing them again next week at the Fargo Half-Marathon.

Note - Special thanks to Kevin O'Connor of Gear West Triathlon. Those unfortunate souls who track my Twitter account might recall this little nugget from earlier in the week:

Mr. Sandman, I did not like the dream you sent me last night where I entered T1 to find my rear tire flat.

OK, this was a little spooky but not quite as bad as the nightmare dream. As I was packing for the trip to Park Rapids, I discovered the Boy's® rear bike tire was flat. No spare around. This meant an emergency run to Gear West as we headed out of town. Kevin had a new tube on in less than 10-minutes. We were saved.

The recap:

Swim - 500 yards
Goal - 8:30
Time - 7:49
Overall Rank - 15th (63 total)
AG (45-49) Rank - 3rd (4 total)

This was an indoor swim in a 25-yard pool. Nothing of note here other than a personal PR for 500-yards. My goal this year is to go under 7:30, and I'm inching closer. I had a nice, smooth swim. If I had lap-by-lap splits I would not be surprised to learn that I had a negative split on the back 250-yards. My confidence had been boosted earlier in the week by the Boy's® swim coach who had said, "your work is paying off as you now look taller in the water."

Goal - 1:10
Time - 0:51

Had a good exit from the pool and hit the transition area well. I had decided to give the ol' shoe's in the pedals with rubber bands method one last try. This would be the last time I do that....ever.

Bike - 14.7 miles
Goal - 40:05 (22 MPH)
Time - 39:06 (22.6 MPH)
Overall Rank - 5th (63 total)
AG (45-49) Rank - 3rd (4 total)

That split should be faster and the average speed hovering right around 23 MPH. Two issues arose, one at the beginning and one at the end. The first occurred as I left T1, hopped on the bike and put my foot down on the shoes to start building speed before slipping into them. One shoe came unclipped from the Speedplay pedals. C'est la merde!

I remained calm, and laid the bike down. Put on the shoe that had come off. Went to the bike and ripped the other shoe off the pedal and put it on. Got on the bike and hammered. I probably lost all of forty seconds. But I was pissed.

The bike course is a double loop. The wind was probably about 7-8 MPH and not bad at all compared to the gales I've been training in all spring. I was humming along at a 23.1 MPH average and feeling good. Then near the 3/4 mark, the left calf gave me that special little shimmy. You know the one. The one that let's you know if you kept up the current pace, the muscle would soon rebel and seize up. I went into a higher cadence and kept the speed up. It seemed fine. In fact, the Well Kept Wife™ couldn't even keep up with me via the camera.

With less than a mile left on the bike, the right calf did decide to freeze up like a stone cold rock. Unlike the left calf it gave me no warning. I was down to one leg. I stretched. I massaged. I tried to keep going but I had to back way off and lost valuable time.

After the race I talked to four other participants who also had calves cramp up. I'm not sure, but I think the beautiful day has a part in it. For the last two weeks we've been experiencing wet and cold weather here in the Tundra. Basically highs in the 40's. By the time we jumped on the bikes in this event, the temperatures were easily approaching 70. That's a thirty degree swing over the course of a few days. I know I had hydrated well. And I may have red-lined it a bit on the bike.

I'm guessing without these two issues (shoes and cramps), my time would have dropped from 39:06 to 38:06 which would have put me at 23.1 MPH....which is where I was riding shortly before the cramps occurred. But that's racing.

Goal - 1:00
Time - 0:51

Second transition was event free. No issues with the calf once I was in my flats.

Run - 5K
Goal - 20:24 (6:35 per mile)
Time - 20:45 (6:42 per mile)
Overall Rank - 9th (63 total)
AG (45-49) Rank - 2nd (4 total)

My legs felt absolutely dead. So I was pleasantly surprised to see my run split despite not hitting my target. I just had nothing in the tank. My run mileage had been down the previous two weeks, but I'm hoping my legs are a lot fresher for the Fargo half marathon next Saturday. Otherwise, I may as well mail that in right now.

Goal - 1:11.09
Time 1:09.22
Overall Rank - 5th (63 total)
AG (45-49) Rank - 2nd (4 total)

My lofty goal for this event had been to come under the previous course record (1:12.24) set in 2008 by Dave Bjorklund. If I achieved that, anything else was gravy. As I stated at the beginning, not only did I better the previous course record by three minutes.....six others did as well! So this event is starting to attract a deep field. Mike Fretland and I agreed that sooner or later someone will do this event in under an hour.

Who knows? Maybe it will eventually be the Boy® who does it? Yes, there was an equally exciting kids event again. I mean, who can argue with this look of determination from him finishing?

And to show you how much time a kid can improve over one year, take a look at these numbers. Last year, the Boy® did the exact same course (50- yard swim, one mile bike, 1/2 mile run) in 10:36. With almost a year of swim team under his belt, a bigger bike, and some recent runs in prepping for his annual track and field event he finished in 6:33.

So, Dad finishes fifth overall and takes 3-minutes off the previous course record. The Boy® finished fifth overall (23 total) and takes over four minutes off his previous best. A good showing for us. We were all chatty afterrwards about tactics and such. Nearby, the female in the house rolled her eyes at us. Secretly, we think she wants to do this event next year.

And best of all, Grandpa Maas was able to see generation number two and number three compete. This was special to me. My father worked long hours while I was growing up and was not able to see me compete until I was a senior in high school. To be able to see him watch his grandson is just fantastic.

I would be remiss if I did not thank the entire staff, volunteers, and personnel who put together this great local event. Where else do you walk into a Friday night spaghetti feed to being immediately greeted, "You're back!! Great to see you again!" Then be joined as you eat by various staff who want to catch-up on your life, give you advice on the newest road hazards to watch for on the bike...and end it all by giving you a high-five as you cross the finish line.

Please consider adding the Lakes to Pines event to your 2011 schedule. They do a great job. Showers available right on site (local high school) after the event. Great staff, volunteers, and community. Should you have any questions about the event from where to stay to where to eat, feel free to e-mail me.

Thursday, May 13, 2010

Race Preview: Lakes To Pines Triathlon

Event: 3rd annual Lakes To Pines Triathlon
Date: Saturday, May 15
Location: Park Rapids, MN
Previous Results: 2008 - 3rd overall, 2009 - 3rd overall, 2010 - ???

Main Triathlon
Swim: 500 yard swim held in the Park Rapids H.S. Pool.
Bike: Double Loop 14.7 mile ride on paved roads.
Run: 5K run on a fast, out-and-back course finishing on the H.S.Track.

Kids Triathlon
Swim: 50 yard swim will be held in the Park Rapids H.S.Pool.
Bike: 1 mile ride around High School Parking Lot
Run: 300 yard run finishing on the H.S.Track.

Let's talk weather first. As in 2008 and 2009 this event has been somewhat cursed by wind and cold. Last year was extreme. 33-degrees F but with 24 mph wind it felt like 21-degrees. Yes, there was an actual windchill.

In 2009, there were four waves of swim in the Park Rapids high school indoor pool. I was in the last wave. As I watched the first three waves, I witnessed something that you may only ever see in The Tundra during a triathlon event. People would exit the pool and saunter into the locker rooms to get on their clothing for the bike/swim portion. Think about that for a moment.

It wasn't as stupid as it sounds. Had you actually left your gear outdoors, you would not have located it due to the high winds. I saw people leave helmet, shoes, etc all out in T1 and as I set up my bike, watched as peoples gear blew around the transition area. In the end, I decided to don all my stuff, including helmet, at pool side. I donned two layers of clothes....and still froze. A number of people went with instant warm pads inside shoes and gloves. It was bad.

This year, the weather is looking conducive to actually being friendly. By the time the race kicks off at 9:00 AM with the first swim wave, the temps should be warming towards 50-degrees. I might not need to worry about any layers if it creeps into the low 50's! And the winds may be light for the very first time in the history of the event. Keeping my fingers and toes crossed for that!

This event also has a kids triathlon so the Boy®, fresh off his swim meet last weekend, will be making the trip with his old man to take on the field.

I'm not sharing goals for this event. I have them, but in this case I am keeping to myself. Two reasons. One, they are somewhat lofty. Two, my real job and the weather (wet and cold) this week have played havoc with my workouts severely limiting my planned week. could all blow up on me this coming Saturday. And I hate having egg on my face!

Monday, May 10, 2010

The Boy® Has Good Swim Meet

The Boy® meet three C-Standards at the Twinvite meet held at the University of Minnesota this past weekend. This was a long course (50-meter) he had to meet the boys 9-10 year old long course standards as designated here.

He did well, meeting C-Standard qualifying for three events: 50 Backstroke, 50 Freestyle, and 100 Freestyle. And he is well within striking distance of achieving B-Standards before the long course season is over.

For the 50 Butterfly and 50 Breaststroke, it is all about technique. And he has some work to do in both those areas. It will come.

I was especially impressed with his 100 freestyle swim. I had emphasized the need to balance his 50 splits. Neither going out too fast or too slow. We were shooting for a 56-second split going out and 56-split coming back. He did a 52-53 for a 1:45. I thought that was pretty amazing to hit his splits like that. With a 10-year old, you are never sure if they are actually paying attention to you or not!

The other thing we were looking for was a good start. During warm-ups, he had a start from the blocks in which his legs were spread wide apart as below.

So we discussed keeping those legs together, and for his 50 Breaststroke there was dramatic improvement as below:

So, a weekend of little victories. The confidence is growing with this young Jedi each week.  We just hope we've found a sport he will stick with and carry into adulthood. And he has the right coaching staff with the Plymouth Swim Team to help keep the sport in perspective and not be hating it by the time he is in high school.

Next up: The Lakes to Pines Triathlon in Park Rapids this coming Saturday (May 15). Bot myself and the Boy® are entered. I'm just hoping for start time highs in the 50's and no wind. But I half expect temps in the 40's and gusty winds. Argh!

Friday, May 7, 2010

Introducing Athlinks

Thanks to Super Mario, I now have another avenue to suck up my free time. Athlinks is a free-of-charge social networking website which primarily presents race results for Running, Swimming, Cycling, Mountain Biking, Triathlon, and Adventure Racing. Athlinks claims to have the "most comprehensive database of endurance race results and events anywhere in the world". Users can mark their own race results, and build a thorough list of their race history.

The website also has a "rivals" feature, where a user can compare themselves to athletes with similar results. Like other social network websites, a user maintains a group of "friends". In addition, users may keep a training log, list their gear items, upload photos, and present a schedule of future events.

As of October 2009, the website claims to have results for over 133,000 races.

I have loaded my profile and also begun to look for races which I can claim my own results. It's the results feature that I like the most, hoping that someday they will allow a import of past results into blogging services such as Blogger. I've spent the last free nights also entering information on races for which results could not be found. It takes about 24-hours and ....Voilà!....the race and results are there for you to claim and add to your results page.

The rivals section is also neat in that it compares common race results amongst other athletes in your neck of the woods.

If it is cold and rainy in your part of the Tundra as it is here, you might want to waste some time this weekend and check it out. If you do, feel free to add me as a friend. If you are already a Athlinks member, let me know so I can add/confirm you as a buddy or buddy-ette as well.

As for me, this weekend is chalk full as the Boy® competes in three swim meets at the University of Minnesota Aquacenter. It is long course season, and this will be his first long course meet. We're excited.

Thursday, May 6, 2010

Fostering Patient Adherence in the Management of Tinea Pedis

I know....what in tarnation am I talking about? For those who don't know me personally, I am a registered drug dealer (AKA pharmacist) by trade. I gave up the retail rat race thirteen years ago after suffering in that environment for fourteen years. In my current role within a PBM (pharmacy benefit company), I still am required to keep my pharmacy license up. Which means thirty hours of continuing education every two years.

I thought I'd do something new with the blog. I have created On the Mend entries before, but now wanted to bring to you first hand information on various topics that you might have interest in. Such as tinea pedis, commonly known as athlete’s foot. And if you have been hanging around locker rooms as long as I probably have experienced a bout of this fungus among us.

If you like this concept, let me know. I'll continue to post if something of interest comes along. Or if you have a topic you'd like covered, I will track down the information....keeping your request anonymous. Oh, and by the way, I use Lotrimin for my little foot affliction. Lotrimin AF Antifungal Cream for Athlete's Foot, .85-Ounce Tubes (Pack of 2)

Here we go.......



Between 10% and 20% of the world population is infected with a dermatophyte, a fungus that affects the skin and skin derivatives. Within their lifetime, up to 70% of adults will have tinea pedis, commonly known as athlete’s foot; it is the most common of all dermatophytic infections. Dermatophytes can infect many other skin surfaces and are usually classified by the affected body area; tinea means fungal infection of the skin. For example, tinea capitis means fungal infection of the scalp. Other possible sites of infection include the following: tinea unguium (onychomycosis, fungal nail infection), tinea cruris (ringworm of the groin), and tinea corporis (ringworm of the body and face). Between 1995 and 2004, there were over 750,000 outpatient medical visits with tinea pedis as the diagnosis code. It was the third most common dermatophyte diagnosis reported and comprised 18.8% of all diagnoses. However, this report does not include the patients who self‐treated their tinea pedis. Most of the patients were male (64.4%) and were 1.62 times more likely to be between 25 and 44 years of age.


Dermatophytes are fungi that can invade and infect the upper layer of the skin, hair, or nails. They are not like pathogenic yeasts; they do not disseminate and they are not lethal. In the United States (U.S.), tinea pedis is most commonly caused by either Trichophyton rubrum or Trichophyton interdigitale. The organism Epidermophyton floccosum is another possible cause, but this occurs less frequently. All of these fungi are spread between humans and have been found on surfaces or items that commonly come in contact with bare feet (e.g., showers or baths, pool decks, locker rooms, shoes, bath towels, and socks).

Patients who wear occlusive shoes are more likely to develop tinea pedis. Occlusive footwear may increase perspiration and decrease aeration; this moist environment promotes fungal growth. There is little information in the literature describing why men are more commonly diagnosed with tinea pedis. One explanation is that women wear sandals and open‐toe shoes more frequently than men. Studies have shown that up to 70% of athletes are affected by tinea pedis. Athletes are at increased risk of exposure to foot trauma, communal showers, pool decks, and they wear closed footwear more frequently, which promotes sweating. Perspiration removes the protective antifungal surface lipids, softens the top layer of the dermis, and increases softening of the skin. Foot injury can compromise the skin’s barrier and increase infection risks, and communal showers and pool decks are commonly infected with dermatophytes. Swimming and running, compared with other sports, are associated with an increased incidence of tinea pedis.


Tinea pedis can be subclinical and unnoticed by patients until it is diagnosed during a routine medical examination. The classic symptoms of tinea pedis are pruritus, peeling, and flaky skin. Symptomatic tinea pedis is divided into 3 categories: interdigital, moccasin‐distributed, and acute vesicular tinea pedis.

Interdigital tinea pedis, between the toes, is the most common location for a dermatophytic infection of the foot. Trichophyton rubrum, Trichophyton interdigitale, and Epidermophyton floccosum are frequently the pathogens. The space between the fourth and fifth (smallest) toes is the most common area, but it can also affect areas between any of the other toes.(Figure 1) The skin within the toe web may appear macerated and soggy or scaly with dry fissures. Patients may complain of mild‐to‐severe itching in the infected area(s). Deep fissures can be painful. It is common for the infection to spread to other parts of the foot. Bacterial superinfections of the organisms can develop, causing inflammation and foul odor.

Figure 1. Interdigital Tinea Pedis

Hyperkeratotic moccasin‐distributed tinea pedis occurs when a tinea affects the part of the foot covered by a moccasin‐style shoe (i.e., soles, heals, and sides). (Figure 2) The skin typically appears hyperkeratotic (darker), scaly, flaky, reddened, somewhat thickened, and the usual organism involved is Trichophyton rubrum. Patients usually complain of intense pruritus. Unfortunately, this type of tinea pedis responds to treatment slower than other forms of the condition.

Figure 2. Hyperkeratotic Moccasin‐Distributed Tinea Pedis

Acute vesicular tinea pedis, the least common type, typically erupts secondary to a more chronic web infection.(Figure 3) Vesicles rapidly develop on the sole of the foot, and they may rise to the surface, fuse into larger blisters, or remain under the surface of the sole. If vesicles rupture, they can be sites for secondary bacterial infection. Acute vesicular tinea pedis is seen more often in patients who wear occlusive shoes and is most often caused by Trichophyton interdigitale. The inflammation is usually severely pruritic.

Figure 3. Acute Vesicular Tinea Pedis

The clinical history and physical exam are critical for the diagnosis of tinea pedis. The diagnosis is confirmed by either microscopic examination or culture results. A scraping from the edge of the infected area is soaked and softened in 10% to 20% potassium hydroxide then examined under a microscope. Scrapings can also be sent for culture; however, test results take at least 2 weeks.

Related Conditions and Complications

Tinea unguium (onychomycosis, fungal nail infection) is often detected and recorded in codiagnosis with tinea pedis; in fact, onychomycosis may be the reason for recurrent tinea pedis. The risk factors for onychomycosis are as follows: increasing age, positive family history, history of nail trauma, diabetes, immunosuppression, smoking, and poor circulation. The most common cause of onychomycosis is Trichophyton rubrum, but Trichophyton interdigitale, Epidermaphyton floccosum, and Candida species have also been observed. Presentation differs depending upon the infecting agent. Typically the nail thickens and a white, yellow, or brown discoloration occurs. Occasionally, pitting and small fissures are present. Topical and oral antifungal ointments and creams may be used, but treatment is complicated by a long duration and a high recurrence rate. Debridement of the infected nail removes most of the invading fungi and will hasten clinical resolution. Patients should be informed that long‐term therapy is necessary and that, even with effective treatment, the nail may not be restored to its original appearance.

Patients with a tinea may occasionally develop an autoeczematization reaction (also known as an id reaction or a dermatophytid). The id reaction is an immunologic dermatologic response to various infectious and inflammatory cutaneous conditions. Although it is not only associated with a tinea, an autoeczematization reaction is more commonly associated with the acute vesicular type of tinea pedis than with the interdigitale or the moccasin‐type tinea pedis. The rash is typically generalized, diffuse, pruritic, and sterile. The exact prevalence of a dermatophytid is unknown; treatment of the underlying infection is critical and symptomatic therapy with systemic or topical steroids and/or antihistamines may also be indicated—the application of wet compresses may also be helpful. Another complication of tinea pedis is the transfer of this fungal infection to another body part. A common clinical scenario is 2 foot–1 hand syndrome. This occurs when patients scratch their tinea pedis and then the infection spreads to the hand. Trichophyton rubrum is the most common isolate identified in this syndrome. Untreated prolonged tinea pedis can create an environment for secondary bacterial infections. In one prospective case‐control study, the odds of tinea interdigitale were 3.72 times higher in patients with cellulitis than it was in case controls.


Avoiding the conditions that promote fungal growth is the most important nonpharmacologic treatment; and keeping feet dry, as often as possible, is vital to achieving a cure. After activities during which the foot perspires, the patient must change their shoes and socks and wash their feet as soon as possible. Feet should be dried thoroughly, especially between the toes. Until the treatment course is over, patients should use a different towel to dry their feet to avoid spreading the infection to another body part; towels should not be shared with others. Additionally, shoes should be aired out and the insides should be dusted with antifungal powder or sprayed with antifungal agents. A study showed that wiping the insides with a wet towel and/or pouring cold or boiling water into sandals or sneakers reduced dermatophyte passage. In addition, wiping the insides of boots with a wet towel or rinsing with boiling water proved effective in reducing the transfer of fungus. Socks should be washed in hot water prior to being worn again. When using communal showers or bathrooms, patients should wear shower shoes to avoid direct contact with surfaces that may be infected with fungi. Nonocculsive footwear should be worn as often as possible; runners and other athletes should exercise in ventilated shoes. The majority of placebo‐controlled trials showed that placebo treatment has a failure rate of more than 65%. Given this information, it is obvious that antifungal drug therapy must accompany lifestyle modification.

There are numerous alternative medications and home remedies that patients may use to treat their athlete’s foot infection. Soaking in a solution of vinegar, baking soda, boric acid, or bleach are recommendations found on many layperson Web sites. Formulations with any of these substances would result in a pH that may be toxic to the organisms commonly causing tinea pedis. However, there are no published clinical studies of these products; therefore, there are no data documenting their safety and efficacy. In addition, the requirements indicating frequency of use or duration of therapy are also unknown. Tea tree oil and Solanum chrysotrichum are 2 herbal remedies that are frequently recommended for the treatment of tinea pedis. There is some evidence that a 50% topical solution of tea tree oil reduced symptoms in substantially more patients (64% versus 31%) and had a higher cure rate (72% versus 39%) than placebo.16 However, a meta‐analysis of all randomized trials involving tea tree oil suggests that it is ineffective for the treatment of dermatophyte infections. Topical Solanum chrysotrichum is a Mexican herbal medication that has been shown to have comparable efficacy to topical ketoconazole in a controlled, randomized, double‐blind study (N = 101). However, the safety, potency, and purity of available preparations cannot be guaranteed because these are not U.S. Food and Drug Administration (FDA)‐regulated products.



Topical and systemic treatment for tinea pedis is common. Most clinicians will try a topical therapy initially, especially if the infection doesn’t appear to have invaded deep into the keratinous tissue. Deep‐seated infections will likely require a systemic therapy. Topical agents are generally effective, well‐tolerated, and relatively inexpensive.

Topical Azole Antifungals

These agents are fungistatic and are only fungicidal when used at very high concentrations. Azoles selectively interfere with the natural synthesis of ergosterol, a critical fungal sterol of the cell wall, and serve to prevent the growth and duplication of fungi. None of the topical azoles is significantly absorbed through the skin. All azoles are active against Trichophyton, Epidermophyton, and Microsporum species. Clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sertaconazole, and sulconazole are the azole antifungals that are currently approved by the FDA for the treatment of tinea pedis. Over‐the‐counter (OTC)‐brand extension is common with many of the antifungal agents. For example, Lotrimin® brand products can contain clotrimazole, butenafine, or miconazole. Therefore, it is important to recommend treatment according to the active ingredients rather than just the brand name.

Randomized, controlled trials have shown that all of the azole antifungal agents are superior to placebo for treating tinea pedis.9,19 One trial initiating the twice‐daily application of clotrimazole 1% cream, or solution, for 4 to 6 weeks reported cure rates between 56% and 86%.9 In another study, the once‐daily topical application of 1% econazole cream resulted in a culture and microscopic cure for approximately 73% of participants. In addition, ketoconazole 2% cream applied once‐or twice‐daily for 4 weeks demonstrated a cure rate between 77% and 87%. Similarly, 4 weeks of the twice‐daily application of miconazole 2% cured tinea pedis in 60% to 95% of subjects. Oxiconazole 1% applied once‐ or twice‐daily has been shown to cure tinea pedis in up to 76% of patients. Applying sertaconazole 2% cream twice‐daily for 4 weeks yielded cure rates between 46% and 66% in one study. In another study, 57% of patients treated with twice‐daily applications of sulconazole 1% cream were cured of tinea pedis. The results of a meta‐analysis suggested that there is little difference in efficacy rates among the various topical azoles; however, duration of therapy does improve outcomes. One week of treatment with a topical azole is inferior to 4 weeks of therapy. This may be because azoles are only fungistatic against dermatophytes and a longer duration of treatment is needed to completely eradicate the organism from layers of skin.

Allylamines and Benzylamine

Terbinafine and naftifine are allylamines, and butenafine is a benzylamine. The 2 classes have a similar mechanism of action and antifungal spectrum of activity. These drugs inhibit ergosterol synthesis and stop fungal growth and division. They are fungicidal to dermatophytes but only fungistatic to Candida. All 3 agents are active against the common organisms that cause tinea pedis. Terbinafine and butenafine topical formulations are available without a prescription, but topical naftifine requires a prescription; terbinafine is also available orally with a prescription. Systemic absorption of these agents after topical application is minimal. Data from 2 studies indicated that treatment with twice‐daily naftifine 1% gel resulted in fungal cure rates of 63% and 66% after 4 weeks. In another study, terbinafine 1% cured tinea pedis in 91% of participants after 7 days of treatment. When patients were treated with 1% butenafine cream, 91% of them experienced a cure from their tinea after 4 weeks of therapy.

A meta‐analysis of randomized, controlled trials found that there was no difference in the failure rates between the allylamines (terbinafine and naftifine) and butenafine. However, the same review found naftifine and terbinafine were generally more effective than azoles in direct comparison trials. In a double‐blind, randomized trial involving 193 participants, investigators compared the efficacy of terbinafine with that of clotrimazole, after both 1 and 4 weeks of treatment: 1 week of treatment with terbinafine cured 81% of patients, while 1 week of clotrimazole yielded a 30% cure rate; after 4 weeks of treatment, 85% of those using terbinafine were cured as compared with 68% of the participants randomized to treatment with clotrimazole. At the 18‐month follow‐up, participants from the terbinafine group had a lower rate of tinea pedis recurrence when compared with those from the clotrimazole group. Terbinafine’s higher efficacy after shorter courses of treatment may be a result of its fungicidal activity and its ability to accumulate in the upper layers of epidermis. Therapeutic concentrations of terbinafine have been observed in the stratum corneum for several weeks after application has been discontinued. Treatment with once‐daily or twice‐daily naftifine 1% cream was compared with treatment using twice‐daily clotrimazole 1% cream in a randomized trial: After 6 weeks of therapy, 81% of those treated with naftifine and 58% of participants using clotrimazole achieved a cure. There was no difference in effectiveness observed between once‐daily and twice‐daily naftifine therapy. In fact, therapy with naftifine 1% for 1 week was compared with treatment using a clotrimazole‐betamethasone formulation and resulted in a cure for tinea pedis at a rate of 33% and 24%, respectively. After 4 weeks of therapy for tinea pedis, the cure rate increased to 68% for naftifine and 50% for those using the clotrimazole‐betamethasone formulation. These data indicate that 4 weeks of naftifine therapy is an effective treatment for tinea pedis. Another study indicated that 1 week of treatment with butenafine 1% cream, applied twice‐daily, resolved tinea pedis in 43% of subjects, but 4 weeks of therapy cured 78% to 94% of participants.


Nystatin is not effective against dermatophytes and should not be used to treat tinea pedis.

Other Agents

Ciclopirox does not interfere with ergosterol synthesis; instead, it creates a large polyvalent complex by binding cations like Fe3+ and Al3+. These complexes inhibit important enzymes, like cytochromes, and interfere with mitochondrial electron transport and energy production. Ciclopirox also impairs the integrity of fungal cell membranes. Ciclopirox has broad‐spectrum activity against dermatophytes, Candida species, and various other fungi, including Cryptococcus neoformans, Blastomyces dermatitidis, Histoplasma capsulatum, and Aspergillus. It also has some activity against gram‐positive and gram‐negative bacteria, which may make it a good alternative for treating tinea pedis when a secondary bacterial infection is present. It is only used topically and is only available with a prescription. In a clinical trial, ciclopirox 0.77% cream cured a fungal infection in 85% of patients after 4 weeks of twice‐daily therapy.

Tolnaftate has been used to treat athlete’s foot for decades. Its exact mechanism of action is unknown; it is also believed to disrupt ergosterol synthesis, but by a different means than azole antifungals. Tolnaftate is effective against Trichophyton rubrum, Trichophyton interdigitale, and Epidermophyton floccosum, but it is ineffective against Candida. In one clinical trial, using tolnaftate 1% cream twice daily for 4 weeks cured 85% of patients treated. Undecylenic acid is another antifungal used to treat tinea pedis, and has been on the market longer than many other treatment options. It is available in various formulations and strengths ranging from 10% to 25%. The mechanism of action for undecylenic acid has not been detected and it has been shown to be more effective than placebo, but it demonstrates a relatively low cure rate.


Typically, athlete’s foot can be effectively treated with topical therapy; however, there are times when topical therapy may not be effective and treatment with an oral antifungal agent may be necessary. Many times hyperkeratotic tinea pedis will require oral therapy for a complete cure. Itraconazole, terbinafine, and fluconazole are not FDA‐approved for the treatment of athlete’s foot, but they are used for treatment of chronic tinea pedis typically after topical therapy has failed. Oral terbinafine, 125 mg administered every day for 4 weeks, cured 95% of participants with tinea pedis, according to one study. In another trial, patients were treated with terbinafine 250 mg/day for 1 week; in an 8‐week follow‐up they were evaluated for a full and clinical cure of their fungal infection. If their infection was not resolved, a second course of therapy was prescribed. The final cure rate was 89.3% and the percentages of patients requiring a second round of therapy differed according to the type of tinea, as follows: 20.9% of the patients with interdigital and 54.5% those with moccasin‐ distributed tinea required a second treatment. Treatment with traconazole, 400 mg administered once daily or 200 mg given twice daily for 1 week, resulted in clearance rates of 63% and 75%, as reported by 2 different studies. Treatment with itraconazole, 100 mg administered once daily for 4 weeks, cured tinea pedis in 75% of patients. Fluconazole, prescribed at 150 mg/week or 50 mg/day and until a cure is achieved or for up to 6 weeks, was administered to patients with tinea pedis. Investigators observed a 79% overall positive clinical response for patients administered fluconazole once weekly, and the success rate was 93% for those receiving treatment once daily. Griseofulvin is a traditional antifungal agent that has been used since the 1960s. Its exact mechanism of action is unknown, but it is thought to inhibit fungal cell mitosis and nucleic acid synthesis. This agent has fungistatic activity against Trichophyton species, Epidermophyton species, and Microsporum species. Griseofulvin is not as effective for the treatment of tinea pedis as the other oral antifungals.



Since many patients will have to make lifestyle modifications to prevent reinfection or relapse, it is important to understand the etiology and risk factors associated with tinea pedis. Take a moment to explain to each patient how the organism infects the foot and to describe the environments known to harbour dermatophytes (e.g., communal showers and baths, pool decks). Patients should be informed that the type of fungus causing this infection is not the same type of fungus that causes diaper rashes or vaginal yeast infections and, therefore, the treatment may not be the same. Keeping the foot dry is a critical preventive measure that should be strongly emphasized. Individuals, like those working in construction, who wear occlusive footwear and work in environments where perspiring is likely, should change socks frequently throughout the day. When at home, these individuals should wear open shoes. Athletes should adhere to these same recommendations, as well as consider the following: After playing sports, they should change their shoes as soon as possible; spray the inside of their footwear with antifungal agents; or sprinkle antifungal powder on the inside of footwear to reduce fungal transfer and to prevent reinfections. Shoes should be ventilated and fit properly; shoes that are too small may increase perspiration. Swimmers should make sure they wear shower shoes on deck and in bathrooms. Tinea pedis has also been known to infect other family members, especially if showers and baths are not disinfected between users; it is important to disinfect surface areas in shared rooms to avoid spreading the infection. If recurrence is a problem for 1 family member, the other household members should be examined for signs of an infection that may be presenting subclinically.

Feet infected with a dermatophyte should be washed at least once a day. Patients should dry the foot thoroughly, especially between the toes. For this process, it is a good idea to use a separate, clean towel for drying the feet to avoid spreading the infection to other parts of the body. In addition, it is important to tell teenage athletes not to share towels with others or to use a towel that is not their own, clean towel. Any towels or clothing that is in contact with infected areas should be washed in hot water and bed sheets should be washed in hot water every 2 to 3 days until the infection is cleared.

Since tinea pedis is often self‐diagnosed and self‐treated, many patients will use nonprescription products. Fortunately, there are many effective and safe topical agents available without a prescription. Patients should clean and thoroughly dry the infected area and then apply and massage the agent of choice into the infection, which includes the skin 1 to 2 inches beyond the border of the infected area. They should wash their hands after application. It is better to use a gel or powder formulation between toes because of the drying effects of these preparations. Terbinafine‐containing topical products should be applied for 1 week; all other topical products require at least 4 weeks of treatment. Not completing the course of therapy significantly reduces the efficacy and increases the occurrence of a relapse. Therefore, it’s essential to stress the need for adherence to the entire duration of therapy.

When recommending an agent for the treatment of athlete’s foot, efficacy, safety, and patient adherence are the most important factors to be considered. Topical terbinafine has been shown to be more effective than azole antifungals. The topical agents have minimal adverse effects, but patients should be instructed to report any worsening of rash or itching after application. Patient adherence is critical to the success of any antimicrobial therapy; nonadherence is the most common cause of treatment failure. Frequency of administration and duration of therapy are inversely correlated with adherence rates. Therefore, to increase the chances of treatment success, products with the fewest applications, the lowest frequency, and the shortest duration should be recommended.


Topical agents are generally well‐tolerated and they have minimal adverse effects. Local irritation, pruritus, and a rash may occur at the application site and contact dermatitis is possible. Patients should be instructed to seek additional medical care if the initial tinea pedis rash worsens or another type of rash develops.

Although oral antifungal agents are also generally safe, they are only available with a prescription, and they have contraindications that must be considered. Terbinafine has been reported to cause gastrointestinal upset, abnormal liver function tests, rashes, and taste disturbances. Typically, these events were mild and transient. Rare cases of liver failure have been reported after treatment with terbinafine, in patients with and those without liver disease prior to therapy initiation, and many of these patients reported severe comorbidities at baseline. Therefore, testing liver function is routinely recommended during therapy longer than 6 weeks. Terbinafine should not be used in patients with pre‐existing liver disease. Patients should be instructed to report any signs of liver disease (e.g., jaundice, upper‐right quadrant abdominal pain, dark urine).

Although rare, the most common adverse events resulting from itraconazole therapy are nausea, diarrhea, dyspepsia, and abdominal pain. Itraconazole has rarely been associated with liver failure, and will only require the monitoring of liver enzymes after therapy lasting longer than 1 month. It cannot be used for long‐term treatment in patients with heart failure. Additionally, it is a potent inhibitor of cytochrome P450 (CYP) and, be cautioned, coadministration is contraindicated with many agents (e.g., alprazolam, simvastatin, lovastatin, nisoldipine, cyclosporine). Fluconazole’s most common adverse events are nausea and vomiting. About 1% of patients studied experienced an unwanted increase, of more than 8 times the upper limits of normal, on their liver function tests. Patients should be instructed to report signs and symptoms of liver dysfunction.


Tinea pedis is a common dermatophytic infection of the foot that causes itchy, scaly, and peeling skin. Trichophyton rubrum, Trichophyton interdigitale, and Epidermophyton floccosum are the organisms that typically cause athlete’s foot. The most frequent site of infection is between the toes (interdigitale tinea pedis) but the soles and the sides of the foot can also be infected (moccasin‐distributed tinea pedis). Moccasin‐distributed tinea pedis is the most difficult type of tinea to treat and, often, requires oral therapy. Pruritic vesicles on the soles of the foot characterize the least common type of tinea pedis (acute vesicular). Topical therapy with nonprescription products containing azole antifungals, terbinafine, or butenafine is effective. Topical terbinafine has been shown to be more effective than topical azole antifungals and has the advantage of only requiring 1 week of therapy, while still exhibiting a comparable cure rate. Patient education is crucial to the success of therapy and lifestyle modifications are necessary because keeping the feet clean and dry will promote healing and prevent reinfection. Maintaining adherence to therapy is critical and completing the course of therapy is essential for a complete eradication of the organism, symptom resolution, and relapse prevention.

Gina J. Ryan PharmD, BCPS, CDE
Mercer University College of Pharmacy and Health Sciences
Atlanta, Georgia

Michael Cantrell, DPM
Instructor of Medicine
Emory University School of Medicine

Tuesday, May 4, 2010

Spaghetti Squash with Jalapeño Cream

It has been a bit on the chilly side this week in the Tundra. Time to add some spice and zest to some carbo loading dishes. This week, I've tossed spaghetti squash with a spicy cream sauce and baked it, mac-'n'-cheese-style, for a warming, hearty side dish that doubles easily and reheats beautifully. Keep this one in mind for later in the fall when the weather starts to get nippy again.

Time: 1 1/4 hours
Yield: Serves 8


1 spaghetti squash (about 3 lbs.)
2 cups milk
2 to 3 jalapeños, stemmed, seeded, and chopped
2 tablespoons butter, plus more for pans
3 tablespoons flour
1 teaspoon salt
1 cup shredded jack cheese


1. Preheat oven to 375°. Cut squash in half lengthwise and use a spoon or melon baller to remove seeds and surrounding fiber. Put squash, cut side down, on a lightly buttered baking sheet and bake until tender when flesh is pierced with a fork, 30 to 40 minutes. Or poke several holes in skin of squash with a fork and microwave it on high 10 minutes. Squash should be tender when pierced with a fork; if it isn't, microwave on high in 1-minute intervals until tender. Let sit until cool.
2. Meanwhile, in a medium saucepan over medium heat, warm milk and jalapeños until bubbles form along the edge of the pan. Remove mixture from heat and let sit 15 minutes. Strain and discard jalapeños.
3. When squash is cool enough to handle, use a large spoon to scrape the strands out of the skin and into a large bowl.
4. In a medium saucepan over medium-high heat, melt 2 tbsp. butter. Whisk in flour and salt and cook, whisking, until flour smells cooked (like piecrust), about 3 minutes. Slowly pour in jalapeño-infused milk while whisking. Reduce heat to medium and continue whisking until mixture thickens slightly, about 3 minutes. Pour mixture over squash and stir to combine. Transfer mixture to a buttered 2-qt. baking dish. Sprinkle with jack cheese and bake until bubbling and brown on top, about 30 minutes.

Nutritional Information - (Note: Nutritional analysis is per serving)

Calories: 168 (53% from fat)
Protein: 6.7g
Fat: 9.9g (sat 5.7)
Carbohydrate: 14g
Fiber: 2g
Sodium: 447mg
Cholesterol: 31mg

Monday, May 3, 2010

Old School - Cycling Eyewear

Lance was crowing about going with a very dated pair of cycling glasses this past Sunday via his Twitter account.
Alright. Bustin' out the ol' school @oakley Factory Pilots today. Channeling my inner Phil Anderson.

Lance ol' buddy. I've got you beat. Back in the late 80's, I had the most in-demand cycling glasses money could buy. Bollé Performance Eyewear was all the rage. And they looked like this:

The glasses even had a high-tech foam "sweat band" running across your forehead. Dead sexy. I do not think sideburns were included. You had to grow your own.

What pair of cycling glasses would you never be seen in again? Share your story!

Sunday, May 2, 2010

Totals: Month Ending April 2010

April was a good month for mileage. I didn't hit the totals I wanted to. This was due to travel, weather, and illness. But I'm happy just the same. I do not expect to have these many miles in the month of May, so best to get 'er done while the schedule was conducive to it. Certainly, a strong April for base building and getting in some speed segments.

Highlight was the big trip to Arkansas for the Iron Mountain triathlon/duathlon stage race in which I came away with the overall Masters title. Race recap here.

Numbers for April, 2010. All per Garmin expect where noted.

April 2010 Total Numbers

Total Workout Hours: 39:44.09
Swim Miles - 10.23
Bike Miles - 376.20
Run Miles - 103.27 (7:47 per mile avg)

Last Month

March 2010 Total Numbers
Total Workout Hours: 31:11.09
Swim Miles - 9.12
Bike Miles - 194.96
Run Miles - 106.43 (8:04 per mile avg)

compare to last year

April 2009 Total Numbers

Swim Miles - 7.22
Bike Miles - 306.65
Run Miles - 57.88 (Nike Plus)

Upcoming in May
May 15 - 3rd Annual Lakes to Pines Triathlon - Park Rapids, MN
May 22 - Fargo Half-Marathon - Fargo, ND

Note - A few weeks ago I spoke highly of a sports cream called IB-Relief. It does now appear there was a name change with the product (my guess is the FDA didn't like the reference to ibuprofen). It is now known as Bio-Relief Homeopathic Topical Cream and is available at Amazon. I have provided a product link below so you can easily order.

This cream is a new and safe daily pain relieving topical cream. It allows for immediate absorption to the site of the pain. This topical cream form offers important advantages over oral pain relievers like Advil. Smaller amounts of the active ingredients may be used as they do not have to be absorbed and passed through the G.I. Tract. It works extremely well on inflammation of tendons, ligaments and joints [sports injuries, sprains, strains and bruises]. Best of all, it is non-greasy, will not stain skin, dries in seconds and is absorbed immediately. And is odorless. I no longer need to smell like a walking infomercial for all things menthol based.

To become effective, it may take 48 to 72 hours as its anti-inflammatory actions are curative. One may apply the cream 3 to 4 times a day unless your physician or health care professional advises otherwise. Active Ingredients: Ibuprofen 1x, Arnica Montana 6x. Other Natural Ingredients: Black Currant (Ribes Nigrum) Seed Oil, Borage (Borago officinals) Seed Oil, Virgin Olive Oil, & Lavender Oil.

It is pricey. $19.99 for 2oz tube. I've been using it on my hammies when I feel that certain 'twinge' after a hard workout. My recovery time is greatly improved. And I don't have to worry about burning a hole in my gut by taking oral ibuprofen. I do recommend this product and will purchase it again.