Ramblings of an Emergency Physician in Texas
We got about 4 inches of rain a few weeks ago, which must have been perfect timing for the bluebonnets (State Flower of Texas, by the way). They exploded, and they’re beautiful.
Here’s a pic from today (and this is just a convenience photo, there are much more dense collections around, but I was cycling and trying not to croak during the ride):
The red flowers, by the way, are still bluebonnets, but they’re called maroon bluebonnets. There, you learned something today.
Injuries sustained while riding Segway transporters are significant and on the rise, according to a study of emergency department visits published online in Annals of Emergency Medicine.
“The Segway may seem cool, but there’s nothing cool about a head injury,” said Mary Pat McKay, MD, MPH, FACEP, of George Washington University in Washington, D.C. “One-quarter of the patients who came to our emergency department with Segway injuries were admitted to the hospital. Forty percent of the admitted patients were admitted to the ICU because they had traumatic brain injuries.”
via Segway Scooter Injuries On the Rise; ER Docs Recommend Helmets.
Wow, sobering data.
I have enjoyed riding Segways, and if I had any use, any at all, I’d have one. And a helmet, which I’d wear.
Segways are pricey, good helmets aren’t cheap, but the ER visit is going to bill out for about 15-30 really nice helmets, so get one, and wear it.
Patient
It’s a Friday, early afternoon, so the bike trail will be lightly used. Traveling through old Fair Oaks to take the wooden pedestrian bridge across the American River. Crossing the bridge there is a 180° turn on the south down–slope of the bridge that takes you back to the bike trail along the river—another 90° at the end of the bridge approach and you are heading west. Gravel! Gravel?
From following his Twitter feeds he’s recovering, though rib fractures will make you aware that we do breathe. A lot.
Good reading, and he dodged a big bullet here.
Check out Mr. Hassle’s Long Underpants, a newly-converted-to WordPress blog, for her new look!
And, to prove she’s a ‘real’ EM doctor, she’s had this day.
Riding today, I was about 8 miles in, and I was loafing, enjoying the scenery. Then I got passed by a mountain bike. A mountain bike.
So, I did what any modestly competitive skinny-tire cyclist would, I let him get out about 100 yards, then turned it up. As I’d get close he’d look back, see me, and stand up in the pedals to pull out another lead. We were going upwind (slightly), and so I’d just slowly reel him back in, and he’d power away again. (I should mention here that I’m not a terrific cyclist, but the relative advantage of a skinny-tire bike on smooth pavement is big, and I wasn’t having to work nearly as hard as my mountain-bike rabbit).
That lasted for about 3 miles, then reality set in, I drafted for a while, and thanked him for the nice tow as I panted by.
And, it did me a lot of good. I ride solo, and had been stuck at one narrow range of average MPH on this ride; thanks to the challenge, I went more than a full MPH faster for the course, which is a big step (and it tells me I’ve been slacking).
Thanks to you, enthusiastic mountain-biker!
Oh, and Gunner 1 (Link now fixed).
I’m back on my road bike, and am enjoying the exercise as much as anyone who dislikes exercise, but at least the scenery changes enough to keep my interest.
There’s a low-water crossing on my route, and I’ve ridden over it before, just about 4-6″ of running water over concrete. I chose a different path back home through the water, after seeing a mountain-bike follow it. I hadn’t really considered how much more contact are a mountain-bike tire has than my overinflated skinny road-bike tire. I should have.
When the dime-sized contact patch rolled up on the algae, the water running along was enough to wash the bike out from under me, and so now I’m lying in the stream. I was nice, cool water, but a) it was a nasty surprise to fall and b) I was lying atop my new blackberry. So, out of the stream, no harm done to me or the bike (and the Blackberry worked fine after a drying-out period).
I still like the bike riding. Now I have a ziplock baggie for the phone, because with my skills you never know.
SI.com – More Sports – Overall leader Rasmussen pulled from Tour – Wednesday July 25, 2007 11:15PM
GOURETTE, France (AP) — One of its biggest stars is already gone, and now so is the leader of the Tour de France.Michael Rasmussen was removed from the race by his Rabobank team after winning Wednesday’s stage, a day after Alexandre Vinokourov and his team withdrew when the star cyclist tested positive for a banned blood transfusion.
“Michael Rasmussen has been sent home for violating (the team’s) internal rules,” Rabobank spokesman Jacob Bergsma told The Associated Press by phone.
The good news is, cycling is really trying to fix their doping problem. The bad news is, this expulsion might not be due to doping:
“Of course I’m clean,” Rasmussen said, after a doping test following Wednesday’s stage win. “Like I said, I’ve been tested 17 times now in less than two weeks. Both the peloton and the public, they’re just taking their frustration out on me now. I mean, all I can say is that by now I had my test number 17 on this Tour, and all of those have come back negative. I don’t feel I can do anymore than that.”
Innocent until proven guilty. If the team wants to can him for lying to them, that’s their business, but there seems to be more than a little implication that he’s dirty but not caught. And that’s bad.
Although Rasmussen has not tested positive, some fellow cyclists had openly voiced their skepticism about him.
Fans booed Rasmussen at the start of Wednesday’s stage, and mostly French teams staged a protest to express disgust at the doping scandals that have left cycling’s credibility in tatters. As the starter’s flag came down, dozens of protesting riders stood still as Rasmussen, ace sprinter Tom Boonen and several others began riding away.
Well, if Frenchmen are protesting you, you’re on the right track. The repercussions continue:
All this talk of doping prompted Jean-Francois Lamour, vice president of the World Anti-Doping Agency, to suggest the sport should be yanked from the Olympics. German public broadcasters have stopped airing the race, and one of Switzerland’s biggest newspapers stopped writing about it. The daily Tages Anzeiger said on its Web site Wednesday it will limit its coverage to results and doping stories.
I know next to nothing about sport and drug testing, but this has passed through to surreal…
I like the Tour de France, generally like bike riding, but this was unexpected:
www.cyclingnews.com presents the 94th Tour de France
Cycling News Flash for July 25, 2007Edited by Laura Weislo
Vinokourov positive for transfusion, Astana quits TourThe Tour de France was rocked by news that Astana’s battered team leader, Alexandre Vinokourov, tested positive for a homologous blood transfusion after Saturday’s time trial in Albi. L’Equipe reported on Tuesday afternoon that the Kazakh’s blood had shown evidence of a transfusion from another person with a compatible blood type in an analysis done in the Châtenay-Malabry laboratory. The positive test was later confirmed by the Astana team.
Upon receiving the news, the Astana team suspended Vinokourov and quit the Tour de France, according to a statement which read, “According to the ethical code of the Astana Cycling Team, Alexandre Vinokourov has been suspended of the team with immediate effect. The rider asked nevertheless [for] a B-analysis.”
So, how do you catch a same-type transfusion? New antibodies?
This headline made me read the article. How in the world could wearing a helmet be ‘more dangerous’?
The answer was a little surprising: 
Cyclists who wear protective helmets are more likely to be knocked down by passing vehicles, new research from Bath University suggests.
The study found drivers tend to pass closer when overtaking cyclists wearing helmets than those who are bare-headed.
Aah, so it’s a risk from drivers that increases.
Dr Walker, a traffic psychologist from the University’s Department of Psychology, said: “This study shows that when drivers overtake a cyclist, the margin for error they leave is affected by the cyclist’s appearance.
“By leaving the cyclist less room, drivers reduce the safety margin that cyclists need to deal with obstacles in the road, such as drain covers and potholes, as well as the margin for error in their own judgements.
Read the article to see how they gathered their data, it’s interesting.
And, as both a driver and a cyclist I think the underlying premise is correct: less space is given to bike riders wearing helmets. As a driver I think of a helmet cyclist as a predictable actor, there to ride, usually quickly and in as straight a line as possible. I (now) realize I give a wider berth to the more casual rider.
And I can attest cars don’t mind getting close to me while riding, though I never ride without a helmet, so can’t say about whether I get more or less space with / without.
Unusually for me, I’ll let the BBC have the last word:
However, a spokesman for the Royal Society for the Prevention of Accidents insisted: “We wouldn’t recommend that people stop wearing helmets because of this research. Helmets have been shown to reduce the likelihood of head and brain injuries in a crash.
“[The research] highlights a gain in vulnerability of cyclists on our roads and drivers of all types need to take more care when around them.”
Today on my ride I was the only cyclist. That’s a first, no matter wind/ heat /water, and after a while I was wondering if I’d missed an announcement.
I remembered while saying to myself “It’s hotter than hell out here”, and the light came on.
They were here. Hope they had fun!
So, what about that second sample? SI.com – More Sports – Landis ‘B’ sample confirms ‘adverse’ finding – Saturday August 5, 2006 11:51AM
PARIS (AP) — Floyd Landis was fired by his team and the Tour de France no longer considered him its champion Saturday after his second doping sample tested positive for higher-than-allowable levels of testosterone.
The samples contained synthetic testosterone, indicating that it came from an outside source.
“I have received a text message from Chatenay-Malabry lab that indicates the ‘B’ sample of Floyd Landis’ urine confirms testosterone was taken in an exogenous way,” Pierre Bordry, who heads the French anti-doping council, told The Associated Press shortly after the “B” sample results were released.
Lab head Jacques De Ceaurriz said the isotope testing procedure was “foolproof.”
“No error is possible in isotopic readings,” he told the AP.
“Pulling a Landis” is going to be added to the sports lexicon, and not in a good way.
And then, the inevitable Frenchness:
Tour de France director Christian Prudhomme said Landis no longer was considered champion, but the decision to strip him of his title rests with the International Cycling Union.
…
“We can’t imagine a different outcome,” Prudhomme said.
Weird that they don’t control their own determination of winners. They can run the race but not certify and decertify the winners?
Oh, and the trivia answer:
Prudhomme said runner-up Oscar Pereiro would likely be the new winner.
The Floyd Landis announcement today, and the sports radio coverage of it sent me to the internet. One of the radio reports says the discrepancy was in the ratio of epitestosterone (E) to testosterone (T) in the urine, about which I was ignorant.
So, off to MD Consult, where Primary Care: Clinics in Office Practice, Volume 32 • Number 1 • March 2005 says the difficulty catching athletes abusing T for performance enhancement was cracked by:
…measuring the ratio of testosterone to epitestosterone, with a result of greater than 6:1 considered suggestive of exogenous testosterone administration [34].
[34] was a reference to Issues in detecting abuse of xenobiotic anabolic steroids and testosterone by analysis of athletes’ urine. Catlin DH – Clin Chem – 01-JUL-1997; 43(7): 1280-8 which says:
…The process of determining if an athlete has used testosterone (T) begins with finding a T to epitestosterone (E) ratio > 6 and continues with a review of the T/E-time profile. For the user who discontinues taking T, the T/E reverts to baseline (typically approximately 1.0). For the extremely rare athlete with a naturally increased T/E ratio, the T/E remains chronically increased. Short-acting formulations of T transiently increase T/E, and E administration lowers it. ….
So, what’s to be done? It’s not only a retesting of the ‘backup sample’ but a comparison of ratios from previous samples. Landis has been racing long enough there’s probably 200 gallons of his pee in little bottles available for comparison.
I should note this is from a 15 minute session looking at the first literature hits; also, I don’t have anything to do with drug testing in sports. I’m waiting with you to see what happens.
LONDON (AP) — Tour de France champion Floyd Landis tested positive for high levels of testosterone during the race, his Phonak team said Thursday on its Web site, raising questions about his victory.
The team suspended Landis, pending results of the backup “B” sample of his drug test, just four days after Landis stood on the victory podium on the Champs-Elysees, succeeding seven-time winner Lance Armstrong as an American winner in Paris.
The Swiss-based Phonak team said it was notified by the UCI on Wednesday that Landis’ sample showed “an unusual level of testosterone/epitestosterone” when he was tested after stage 17 of the race last Thursday.
…
Bye-bye Tour de France win.
The good news? Now he’s got plenty of time to get that hip fixed…
