Running Marathons and Staying Injury Free - Mayo Clinic Video

Mayo Clinic Florida sports medicine physician Daniel Montero, M.D., provides tips on avoiding injuries while running in a marathon. He also addresses tips on:

- safely keeping up when running in large crowds
- staying hydrated
- dressing for weather conditions
- running the way you were trained to do

Analysis of Rafael Nadal's Knee Injury - Computer Animation from NYTimes

Rafael Nadal missed seven months last year with a knee injury. Nadal, an 11-time Grand Slam champion, returned to the tour at a small clay-court event in Vina del Mar, Chile, in February after recovering from a partially torn patella tendon and inflammation in his left knee. That knee will face its toughest test when he plays in the French Open, his first Grand Slam event since his return.



The 26-year-old Spaniard is favored to win and become the only player with eight French Open titles, even though he said his knee is still “not 100 percent.” Although he can practice less than an hour a day, he’s made the final in each of the eight tournaments he’s played since he returned to the men’s tennis circuit in February.

References:

Even at Half Speed, Nadal Still the Man to Beat in Paris - Bloomberg http://bloom.bg/111VzBK

FDA: High-dose simvastatin increases risk of muscle injury - caution with lower doses plus Amiodarone, Verapamil, Diltiazem

Based on review of data from a large clinical trial and data from other sources, the U.S. Food and Drug Administration (FDA) is informing the public about an increased risk of muscle injury in patients taking the highest approved dose of the cholesterol-lowering medication, Zocor (simvastatin) 80 mg, compared to patients taking lower doses of simvastatin and possibly other drugs in the "statin" class.

The muscle injury, also called myopathy, is a known side effect with all statin medications. The most serious form of myopathy is called rhabdomyolysis. Patients with myopathy generally have muscle pain, tenderness or weakness, and an elevation of a muscle enzyme in the blood (creatine kinase). The higher the dose of statin used, the greater the risk of developing myopathy. The risk of myopathy is also increased when simvastatin, especially at the higher doses, is used with certain drugs (see Simvastatin Dose Limitations below).

The data come from the SEARCH study, in which myopathy was seen in nearly 1% of patients taking the 80 milligram dose of Zocor but in only 0.02% of patients taking the 20 milligram dose of Zocor.

Update 6/2011: FDA Restricts Use of Simvastatin 80 mg, due to increased risk of muscle damage http://goo.gl/K9O5v

Rhabdomyolysis was rare in the SEARCH study. It happened in only 11 of 6,031 patients (0.02%) in group taking the 80 milligram dose of Zocor, but was not seen in patients taking the 20 milligram dose.

New data also suggest that people of Chinese descent should not take Zocor at the 80 milligram dose -- and should be careful even when taking lower doses -- if they also take niacin-containing products.

Simvastatin Dose Limitations

These limitations apply to ALL patients taking simvastatin.

Do not use simvastatin with these medications:

Itraconazole
Ketoconazole
Erythromycin
Clarithromycin
Telithromycin
HIV protease inhibitors
Nefazodone

Do not use more than 10mg of simvastatin with these medications:

Gemfibrozil
Cyclosporine
Danazol

Do not use more than 20mg of simvastatin with these medications:

Amiodarone
Verapamil

Do not use more than 40mg of simvastatin with this medication:

Diltiazem

References:

FDA Drug Safety Communication: Ongoing safety review of high-dose Zocor (simvastatin) and increased risk of muscle injury. FDA.
FDA Warns of Zocor Risk to Muscles. WebMD.

FDA Restricts Use of Simvastatin 80 mg, due to increased risk of muscle damage http://goo.gl/K9O5v

Image source: Simvastatin. Wikipedia, public domain.

Mild traumatic brain injury (MTBI)

What is Mild traumatic brain injury (MTBI)?

Mild traumatic brain injury (MTBI) is commonly known as concussion. A universally accepted definition is lacking.

Mild traumatic brain injury and concussion are classified by:

- transient loss of consciousness
- amnesia
- altered mental status
- a Glasgow Coma Score of 13 to 15
- focal neurological deficits following an acute closed head injury

"Red flag' symptoms include: progression of physical, cognitive, and behavioral symptoms, seizure, progressive vomiting, and altered mental status.

What is the prognosis of mild traumatic brain injury (MTBI)?

Most patients recover quickly, within 1-2 weeks.

However, persistent symptoms may be noted in 5-20% of persons who have mild traumatic brain injury (MTBI):

- Physical symptoms include headaches, dizziness, and nausea, and changes in coordination, balance, appetite, sleep, vision, and hearing.

- Cognitive and behavioral symptoms include fatigue, anxiety, depression, and irritability, and problems with memory, concentration and decision making.

Who is at greatest risk after a mild traumatic brain injury (MTBI)?

Women, older adults, less educated persons, and those with a previous mental health diagnosis are more likely to have persistent symptoms.

Protecting the brain from concussion: $20-helmet is a good way to protect $100,000 education



Neuropsychologist Kim Gorgens makes the case for better protecting our brains against the risk of concussion -- with a compelling pitch for putting helmets on kids: A $20-helmet is a good way to protect $100,000 education. "Mind your (brain) matter."

References:
Subacute to chronic mild traumatic brain injury. Mott TF, McConnon ML, Rieger BP. Am Fam Physician. 2012 Dec 1;86(11):1045-51.
Image source: Hippocampus, from Wikipedia, public domain.

Participation in clean-up of oil spill associated with airway injury and chromosomal damage

In 2002, the oil tanker Prestige spilled more than 67 000 tons of bunker oil, heavily contaminating the coast of northwestern Spain. The study population included local fishermen who were highly exposed (n = 501) or not exposed (n = 177) to oil. They were evaluated 2 years after the spill.

Elevated markers of airway injury

Persons exposed to oil were at increased risk for lower respiratory tract symptoms (risk difference, 8.0). However, lung function did not significantly differ between the groups. Exposed participants also had higher levels of exhaled vascular endothelial growth factor (risk difference, 44.8) and basic fibroblast growth factor (risk difference, 16.0).

Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public domain.

Chromosomal damage

A higher proportion of exposed participants had structural chromosomal alterations (risk difference, 27.4), predominantly unbalanced alterations.

Participation in clean-up of a major oil spill was associated with persistent respiratory symptoms, elevated markers of airway injury in breath condensate, and chromosomal damage.

References:

Health Changes in Fishermen 2 Years After Clean-up of the Prestige Oil Spill. Ann Intern Med, October 19, 2010, vol. 153 no. 8 489-498.