Sunday, July 26, 2015

DIY Energy Drinks and Gels

Caution: This blog post discusses the use of pure caffeine, a substance that can be hazardous if misused.  Please do not take anything I say as proven fact, or rely on the few links I have provided: Do your own research, and verify everything before proceeding on your own.

Why is it that adding caffeine to something cause its price to multiply?

A case of 12-oz sodas costs about $0.25/can, yet a case of 16-oz energy drinks costs $1.25/can.  If we allow for the fact that the energy drink is a third larger, a 16-oz soda would cost about $0.33 each.

So the extra cost for adding about 100mg of caffeine is $0.92.  Really?

Caffeine powder is available from reputable online vendors for about $3.00 for 50g (50,000mg), meaning the cost for 100mg is $0.006.  That's six tenths of a cent.

Clearly, energy drink makers don't see soda as their competition, but other caffeinated beverages, such as coffee, which is a buck at McDonald's (who has surprisingly good drip coffee).  So energy drinks are priced not by the cost of adding caffeine, but relative to the competition.

Lately I've been trying to better manage my budget, and had largely replaced energy drinks with coffee and tea (especially green tea).  But this doesn't work so well during a summer day, and my teeth aren't as white as they used to be (my whitening toothpaste isn't keeping up).

Another consideration is that energy drinks don't provide what I'm looking for in a sports beverage.  I'd like to have caffeinated versions of the electrolyte and calorie beverages I use for training and racing.

So I decided to look into making my own caffeinated drinks and gels.  Which means using raw caffeine.

First, caffeine can be nasty stuff.  It is rapidly absorbed by the body.  It can stop the heart if taken in massive doses.  It should be treated as the drug that it is, and not as "just another supplement".  I would treat raw caffeine the same as I would treat a gun or hazardous chemicals: To be locked up at all times except when actually in use.  And to be kept far, far away from children.

Assuming you are able to keep your caffeine safe from misuse, there are other things to consider before purchasing caffeine.

First, what kinds of caffeine are available?  Three kinds are most common: Anyhdrous Caffeine, Dicaffeine Malate, and Caffeine Citrate.

Anhydrous Caffeine consists of only caffeine molecules.  It the "rawest" form of caffeine, and is the type most commonly used as an additive.  But anhydrous caffeine can also be the harshest on your digestive system, especially the stomach: This form of caffeine is one of the most sour substances known. I'd call it "violently" sour.

Dicaffeine Malate binds two caffeine molecules to a malate molecule, where the malate buffers the the caffeine.  Buffering blocks absorption by the stomach, meaning it will be absorbed by the small intestine, which is a slower process.  However,  dicaffeine malate does break down a bit in the stomach, meaning its effects are felt less suddenly than anhydrous caffeine, but more quickly than caffeine citrate.

Caffeine Citrate is the most buffered form of caffeine, and may work best for folks who get mild stomach upset from other forms of caffeine.  It is important to note that due to the large size of the citrate molecule (about the same size as the caffeine molecule itself), this form of caffeine has half the caffeine per gram compared to the other two forms, though it tends to cost about the same.

For my initial tests I followed the Goldilocks Selection Method ("pick the middle one") and chose to purchase dicaffeine malate from Powder City.  I chose Powder City for several reasons: 1) They have lots of useful information on their site.  2) They provide a tiny 50 mg scoop (1/4" in diameter) with every package purchased.  3) They have a great reputation in the market, and appear to be in this for the long term.  4) They were the only reputable vendor offering all three forms of caffeine.  Other vendors tend to offer only anhydrous caffeine, though that is slowly changing.

I ordered five 50g pouches, far more than I'll ever need, because their shipping rates, while reasonable, were combined with a free shipping limit that, for a given cost, meant they essentially gave me free product in exchange for free shipping.  So I have lots extra, if anyone local is interested in a pouch of their own.

My first test was to see how dicaffeine malate affected me, and how it changed the taste of what it is added to.  So I poured two 8oz glasses of orange juice, and added half a scoop (about 25 mg) to one of them.  After stirring thoroughly, I tasted a sip of each.  The difference in sweetness was very noticeable, but not objectionable.  The caffeinated OJ still tasted plenty sweet.

I finished the caffeinated OJ over the next couple of minutes.  I felt no caffeine "rush" like I do after gulping a cup of coffee:  Over the following minutes I gradually felt more energized.  About like I would after drinking half an energy drink.  I added a half scoop to the other class of OJ and drank that as well.  As expected, I wound up feeling about the same as if I had just finished a Monster or other energy drink.

Now, when I said "scoop" above, that's a level scoop of the powder, not packed down.  A half scoop is about half of that.  A heaping scoop would be closer to 100 mg.

Some folks use a calibrated scale and careful techniques to precisely measure their caffeine.  But the cheapest "good" scale I found that was accurate to at least a milligram cost over $50, and I didn't really trust it.  Getting a feel for the "buzz per scoop" has worked well enough for me.

There are two fundamental ways of taking anything into your body: A bunch all at once, or gradually over time.  It is important to take this into account when making quantities of caffeinated beverages in advance, for future use.

I know from my own experience that it takes about 100 mg of caffeine to get me started in the morning.  On cooler mornings this is taken all at once, typically as coffee gulped to minimize the time I spend in a morning fog.  Most mornings, I typically add a heaping scoop to a large glass of OJ.

During long continuous moderate exercise (riding the bike or jogging for an hour or longer) I feel best when taking no more than 100 mg of caffeine per hour (generally less).

When I make APX per the manufacturer's recipe (one APX scoop in 20 oz water) I add one level scoop of caffeine.  This is my standard "between workouts" beverage, when I'm recovering from one workout and getting ready for another one.

But for prolonged activity, I make my APX more concentrated (2 scoops in 24 oz) and add a heaping scoop of caffeine (100 mg), and I also carry water with me.  When I feel good, I drink more water. When I'm feeling spent, I drink more APX.  For these longer activities, I generally try to stay in the zone of "slightly uncomfortable".

I next tried making caffeinated honey. I started out by putting 50 mg (a level scoop) into about 2 fluid ounces of JJ's honey (about as much as a large gel).  The honey was too thick to mix evenly, so I added a bit of water (10-15 drops).  The result was better than I expected:  I couldn't taste the caffeine at all.

There is one important thing to keep in mind when making your own caffeinated products: Labeling!  I put a rubber band around the neck of any bottle containing caffeine.  My caffeinated honey goes in either my SoftFlask or Gel-Bot. (both from Hydrapac, and bought from TCSD Sponsors).

While it may sound like making your own caffeinated beverages is easy, I want to reiterate that there are hazards that require close attention.  There are several general principles that apply to using hazardous things in general, and specifically to hazardous food additives:
  1. Work from recipes.  This encourages you to plan in advance, it permits you to double-check what you are doing, and it greatly reduces the risk of silly mistakes.  A recipe helps ensure you get consistent and repeatable results every time.
  2. Take notes!  I have written down everything I've tried, and recorded what went right and wrong.
  3. Consistently do all work in a single place.  I use one end of my kitchen counter, the same place every time. Build good habits when using caffeine.
  4. Clean the work area before and after using powdered caffeine.
  5. Wash your hands both before and after using powdered caffeine.  It takes only a moment, and will make a huge difference if you happen to wipe your eye.  This stuff can be harsh!
  6. Avoid using caffeine directly from the pouch it is shipped in.  It is too easy to spill, and the pouch can puff caffeine into the air when opened and closed.  Transfer some of the caffeine to a smaller wide-mouthed screw-lid container that is easier to open and close.  Powder City sells containers that are ideal for this, but I find a small baby food jar works very well.
  7. Close nearby windows and turn off fans before opening the caffeine container.  You really do not want this stuff to get around.
  8. Store caffeine away from where anyone (adult, child or pet) could reach it accidentally.
I know the above rules may seem overly cautious, but they are really just common sense.  I do pretty much the same for my Sriracha sauce.

UPDATE:  I've simplified my work area by using a red roll-up silicone baking sheet for my work area.  All cleanup is done at the sink, and any spilled caffeine powder shows up well on the red surface.  Much easier in all respects.  My counter is white, and I was very concerned about spills I couldn't see.  No longer an issue.

Now that I've been making my own caffeinated drinks and gels for a couple months, I must say the results are "nothing special".  That is, my homemade products have replaced the manufactured ones with no unpleasant surprises.  But the pleasant surprises of reduced cost, plus getting caffeinated versions of what I want, are well worth the minor amount of hassle.

Again, these are my own personal experiences.  You may have different reactions to caffeine, so be sure to start out slow, and take your time.

I'm not trying to change the world.  Just trying to save a buck and gain greater control over my workout and race nutrition.

Saturday, May 9, 2015

APX Review

Many of you have heard me go on and on about the products, services and companies that have made real differences in my triathlon life, especially those provided by TCSD Sponsors.  For most products and services, the benefit was obvious to me rather quickly, sometimes in minutes, but more often in a few weeks or a month.

My search for nutritional products has taken quite a bit longer.  First I had to find the right base diet, to fit both my metabolism and my activity.  I made some major (but simple) changes 18 months ago that got me almost everything I was looking for.  Only then did it make sense for me to settle on the nutritional products I'd want to use with training and races.

TCSD members get to sample just about every sports nutritional product on the market, sometimes even before they go on sale to the public.  I have a box of samples at home that must contain 40 different products.  But for me, samples only tell me what doesn't work or feel right at first taste, not what will work long-term combined with hard training.

My most difficult situation concerns liquid products.  My primary need is for a water-based product that not only provides rehydration, but also restores electrolytes and provides some easily-absorbed calories.  I want to meet as many of my needs as possible with a light liquid before I resort to heavier products, such as gels, chews or bars.

Many liquid products pass the first-taste test, but fail for me when consumed during exertion.  For example, I love Gatorade just about anytime, but it causes me major problems ("gastric distress") if I drink it during or just after a race or hard workout.  I repeated this process with several other products, only to be disappointed each time.

Until, that is, I tried APX.  Having been upset by so many prior products, I kept testing APX, waiting for it to fail.  For one year.  Then for another.  Only recently did I finally decide I had finally found the right product, one I could trust under all circumstances.

TCSD's own Jay Weber was our APX rep, and each time I told him APX was still working for me, he'd ask "When are you going to write a review?"  Jay has since moved on to Xterra Wetsuits (yes, it's been that long).

Well Jay, here's that review!

First, some basic facts about APX:
- APX is a local San Diego company that's been around for about a decade.
- APX is a proud TCSD Sponsor.

Next, the ingredient list:  Dextrose, Fructose, Natural Fruit Flavor, Citric Acid, Salt, Potassium Citrate, Magnesium Citrate, and Ascorbic Acid

8 ingredients.  That's all.  That's a much shorter and simpler list than just about anything else out there.

A note about powders versus pre-made liquids:  Pre-made liquids tend to contain emulsifiers and stabilizers to keep the contents mixed and stable between the time the product is bottled and the time it is consumed, which can be many months, and involve storage and transport in a wide range of temperatures.  Powders will not contain such things because the ingredients are naturally more stable as powders, and are generally consumed within a day of being mixed.  For me, this is a case where "less is more".

Getting back to the ingredients:  There is one odd thing here, where I am concerned:  All prior products I had tried that contained only simple sugars had caused me problems.  Only those that also included more complex carbohydrates seemed to stay down.  APX is the first drink containing only simple sugars that has caused me no problems whatsoever.  I'm not sure why, but I suspect it must have something to do with either the electrolyte balance or the flavor.

APX comes in three flavors: Pomegranate, Tangerine, and Ruby Red Grapefruit.  I've tasted them all, and they each have a light taste, just enough to cover the taste of the other ingredients.

I've been using only the Grapefruit flavor with my workouts, mainly because it's the one I've done all my testing with.  I'm almost afraid to try the other flavors "for real", as if I'll make the Grapefruit flavor mad at me or something.  And who said athletes aren't superstitious?

As for my testing, my most recent tests were on the bike and run.  I had taken APX with me on a 3-hour bike ride with a fair amount of time hammering in aero, but no hills.  It was my only liquid on the bike, and I felt great at the end of the ride.  For those of you who know me, I usually bonk toward the end of the 2-hour TCSD Saturday ride, so this was a real improvement.

My other recent test was a 2 hour run without hydration, where a bottle of APX was my first recovery drink.  For me, this is a worst-case test, since my stomach is most sensitive when I'm exhausted and dehydrated.  For this bottle, since I knew I would be following it with more water, I had gone well above the recommended mixing ratio of one scoop per 20 ounces: I had put 3 scoops in 24 ounces of water.  So it was "worse" than my worst case: If anything was going to trigger my stomach, this was it.

Nothing happened, other than I had one of my fastest recoveries ever: I was ready for a strength training workout after 20 minutes and another bottle of water.  And that workout also went well, showing that the APX was quickly absorbed.

Now, I don't recommend doing a 2-hour run without hydration or nutrition!  This run was designed to test my joints and metabolism (as well as APX), and was run along the Mission Bay path, where there are about 2 water fountains every mile.

After well over a year with APX as my only calorie + electrolyte drink, I can only give it my highest recommendation.  It has made a real difference in how I train and recover.  More importantly, I no longer fear pushing to the point where taking nutrition used to become my worst problem.

APX is available just about everywhere locally, including at the following TCSD Sponsors (where your TCSD Member Discount applies): Moment Bicycles, Hi-Tech Bikes, Pulse Endurance Sports, and The Triathlete Store.

APX is available in single-serving packets and in 26-serving resealable bags (scoop included).  After the TCSD discount, APX costs about $0.77 per scoop (130 calories), making it a good value compared to the alternatives.

And one last detail:  All APX profits go to charity.  The company was created as part of a sponsorship effort (much like Rudy), and has never stopped.

For more information. please visit the APX site:

Thursday, April 30, 2015

Achieving a record.

My plan is to do my first half-marathon this year, and to do so in record time.

Of course, by definition, whatever time I achieve will be a PR.  But that's not what I mean.  I'm taking an actual record time.  One that's in the books.  Just for a different race.

The world record FULL-marathon time, that is.  The American record, to be specific.  For women, to be precise.  A time of 2:19:36.  Which I'll round up to 2:20.  That's an average pace of 10:40 per mile, which is about the fastest I think I'll be able to sustain non-stop.  It is entirely possible my first half will take an additional 20 minutes.  But my target, at least for now, is 2:20.

My goal is simply to do this non-stop, without walking, as a step toward doing a full marathon using a run-walk technique.  My ultimate goals are to become able to do 1-2 half IM races per year, and to do at least one full IM at some point in my life.

The thing is, I've never run for longer than about 80 minutes.  Not once.  My regular run training includes one 10K run every week, which takes about an hour, depending on what else I add into the run.  Back in the '80's I briefly flirted with the idea of training for the half-marathon distance, and once ran 10 miles, after which my legs fell off.

So, the first step is to see if I can simply stay on my legs for 2:20, jogging, just to see if I can do a run-like gait for the required time.  Three days ago, on last Monday, I jogged non-stop around Mission Bay for 2:10 (I mistimed timed my turnaround) and covered 10.5 miles, for an average pace of 12:23 per mile, a gentle jogging pace.

But now it's the following Thursday, and my legs are still stiff and weak.  But no joint or foot pain whatsoever, which means it's mainly endurance conditioning I need.  Which should not be a problem.

So, as the first real test on my half-marathon journey, I call this a great success!

But there's more to consider: I did this without nutrition or hydration.  Which is a failure as a race technique, but OK as a training assessment.

After I stopped, I drank 24 oz of APX (3 scoops) and another 34 oz of water (for 58 oz total).  Then I did an hour long strength training workout during which I drank another 34 ounces of water.  When I got home I had another 24 oz of water.

That's 116 oz of fluids, nearly a gallon total.  I didn't pee until another half hour after that, a bit over 2 hours after the run had ended.

My next run will include carrying fluids: I have a Fuel Belt that holds a total of 24 oz.

So my next training goal is to see if I can drink and run at the same time.

Friday, March 27, 2015

Car bike racks: What to do?

Bike rack selection is an important issue, especially if you drive a high-efficiency vehicle (high MPG or EV). The most important thing is for the rack and bike(s) to be out of the airflow, and roof-mounted racks typically have the worst effect on efficiency.  Hitch racks generally do well.

Security is another issue.  Bikes on a rack are more noticeable than bikes inside a vehicle.  When I went shopping for my last vehicle, I wanted something that would meet the following requirements:
  1. Fit 1 bike (tri and/or road) inside the vehicle with the front wheel on.
  2. Fit 2 bikes (tri and road) inside the vehicle with the front wheels off.
  3. Have a hitch available as an option, to mount a 2+ bike hitch rack (so other stuff can be inside the vehicle).
  4. Get at least 40 MPG highway.
After I had pared the list of possible vehicles down to something manageable, I took my bike with me and shoved it into each of them, often to the amusement of the sales staff.

The car I wound up with, a 2012 Mazda 3 hatchback with the high-efficiency SkyActive drivetrain, not only met the above requirements, but was also the most fun to drive at a very reasonable cost.

Soon after getting it, I joined a Mazda 3 forum to learn more about the car and its idiosyncrasies.  We talked about the mileage we were getting for our various commutes, and how we achieved it.  Someone on the forum found a spreadsheet that helped test and compare performance over commutes, and converted it to a Google Docs spreadsheet we could share.  For repeatability purposes, the test required us to be on cruise control as much as possible.  We plotted our commutes on Google Maps and plugged the elevation profiles into the spreadsheet, to see how elevation changes affected our commute mileage.

We got some great data, with surprisingly consistent results for most of us.  But a few folks had much worse results (10-20% lower).  The most common factor was a roof-mounted rack (bike, ski, kayak, whatever).  Some of them removed their racks, repeated the test for a month, and had results compatible with the rest of us.

The moral of the story, at least for high-efficiency vehicles, is to use a rack as little as possible, and remove it when not in use, especially if it is a roof rack.

I still haven't purchased my hitch or rack.  Probably means I don't travel enough.

Monday, July 21, 2014

Bike Comparison and Sizing

On 07/17/2014 03:56 PM, David Bloxom [tcsd] wrote:
Hi all,

I'm looking at a few used Tri bikes. I ride a 56cm Scott carbon frame road bike, which I have fitted with aero bars, and have been fitted for that set up. I've been told the sizing is right for me.

My question is, in general, should I be looking at 56cm Tri bikes or smaller / larger. I realize the "right answer" is to fit the bike to me and not the other way around. But when looking to but used, that doesn't appear to be the best option.

Hi Dave,

The number "56" is a completely bogus way to compare bikes, even different models from the same manufacturer, much less from different manufacturers.  This number fails to take any of the rest of the bike geometry into account.

The only way I'm aware of to compare any two bike frames is by "stack & reach", so you first need to find the stack and reach for each bike you want to compare.  Here's the Slowtwitch stack&reach database:  Some bike shops and manufacturer websites have additional information, so be sure to check.

But that's only part of the story: There's more to comparing bikes than just the stack and reach: You also need to take cockpit differences into account (unless the same stem, spacers and bars are on both bikes), as well as the relative position of the saddle.

Finally, (well, actually **FIRST**), is to have numeric data for your bike fit, so you can see if any given bike is compatible with your "fit numbers".  After my fit at Moment I was given a printout with not only my fit numbers, but also a drawing showing their geometric relationship to the bike.

I keep my fit numbers in my phone.  When I was demoing bikes, I brought along a small a tape measure, and would adjust each bike to my fit in a few minutes, which permitted me to demo different bikes with the SAME FIT!  Apples to apples.  It would also be immediately clear if a bike couldn't be adjusted to match my fit.  Sometimes, a quick stem and spacer change could turn an "almost but not quite" bike into one that could match my fit.

There are some additional details to take into account before making a final choice, but the above should make it easy (well, straightforward) to eliminate the "no way" bikes.


Monday, April 21, 2014

Hiccup Hell

Keeping with the theme of hellish medical posts (which explains the lack of posts here - I haven't had other medical issues that start with 'H'), here's another.

Almost two weeks ago I started having hiccups.  Not a problem, right?

They lased overnight, ruining any hope of a full night's sleep.  Well, that's unusual, but I can get by missing one night's sleep, right?

Not really.  Hiccups at night can't be stifled, so they tear into your throat when you do manage to get a moment's sleep.  After a night of this, you wake with a shredded throat and no voice.

I started missing work after that first ruined night. By the second night I had delirious moments from the lack of continuous sleep.

Non-stop hiccups are tiring, fatiguing, and exhausting.  For the first day or two, that can be partially fought with sugar and caffeine.

I searched online for every hiccup home remedy.  The highest rated ones fall into two categories:
  1. Distract the autonomic nervous system.
  2. Stimulate the Vagus nerve.
The first group generally involves increasing the blood CO2 levels by any of a variety of means: Holding your breath, breathing into a paper bag, drinking water slowly, and so on.  The plan here is to make the body worry about getting rid of CO2, and thus weaken the hiccup feedback loop.

The Vagus nerve, among other things, carries sensation from the stomach to the brain.  So the second group involves eating food with strong "stomach reactions", the two most common of which are sweet (sugar, honey) and hot spices.

For me, the first group did absolutely nothing. The second group could give a few minutes of relief, but the hiccups always returned.

There was a third group I found on my own: Activity.  Climbing a flight of stairs could yield 20 minutes hiccup-free.  But I was too unsteady to risk running or riding a bike, and walking didn't quite do the job. 

And I was getting more tired with each passing day.  By the third day, it became sheer torture.  My diaphragm was so tired that it was increasingly difficult to stifle each hiccup.

On the morning of the fourth day (after the third sleepless night), I decided to go to Urgent Care.  The moment they opened.

I learned there is only ONE drug that is FDA-approved for treating chronic hiccups: Thorazine.  Yup, the drug that 20 years ago was THE front-line anti-psychotic.  Turns out that. while it is seldom if ever used today as an anti-psychotic, it enjoys continued use for a surprising variety of other uses.  Go figure.

What hasn't changed is Thorazine's side-effects, though I was mercifully on the lighter end of the scale, primarily having to deal with sleepiness and dizziness, but not much else.   And it does NOT mix with alcohol or other depressants such as sleep-aids, though I wasn't in the mood for alcohol and had no need for sleep aids (they can't stop hiccups).

Like many drugs that affect the nervous system, it takes time for Thorazine to attain its beneficial effects, which for me started happening last Thursday, 4 days after starting.  Friday saw a 50% decrease in hiccups, though I still had terrible sleep Friday night, and still woke with a shredded throat.  Saturday night was far better, and I felt I was back to normal Sunday night. 

I took my last dose this morning, and this evening I can tell it is rapidly leaving my system.

The cause of the chronic hiccups was till a mystery to me, until I talked with my Mom.  She told me that my cousin had a prolonged bout of hiccups a few days after his prostate surgery. 

I had had a scheduled colonoscopy on April 2nd which included light anesthesia, and the hiccups started on the 8th.   A bit longer delay of my onset, but could it be the key factor? 

My earlier searches failed to turn this up as a possible cause, but with a better search, there are tons of links.  That's my best guess so far.

Tomorrow I start (gradually) resuming my training load!  Yay!

Friday, March 29, 2013

Hemorrhoid Hell!

It wasn't easy deciding if, or even what, I should share about my history with hemorrhoids, but given that they aren't exactly rare, especially among athletes, and most especially among older athletes, I decided to tell my tale.

To minimize the grossness, I'll give links rather than write disturbingly detailed descriptions here.   So you should be able to read this even if you are a bit squeamish.  Follow the links at your own risk: Each is informative, but some are quite graphic.

First, some anatomy: Hemorrhoids occur in the anal canal, the lower part of the rectum.  Next, a basic definition, courtesy of Wikipedia, and a great overview of causes, courtesy of WebMD.  What is not hemorrhoids is the soreness due to too-frequent wiping, or using coarse toilet paper: That's just normal skin irritation.  However, prolonged irritation can and will make any hemorrhoids worse.

The most important take-away is that there are two basic forms of hemorrhoids: Internal and external.  Each presents different symptoms and responds to different treatments, though there is some overlap.  Some internal hemorrhoids can exist for many years without ever being an issue, so it is important to note that, while hemorrhoids are never desirable, not all hemorrhoids present problems or symptoms.

My hemorrhoids started to appear about six years ago, shortly after I turned 50.  One interesting fact is that as my reward for surviving to 50, I got "scoped" all the way to my cecum, and the doctor's report mentioned the presence of only "small and inconsequential" hemorrhoids.  Nothing to worry about.

The conditions that led to my hemorrhoids started well over a decade ago: I blame mine on cubicle farms and weight training.  (There can also be hereditary factors, but I have no family history of chronic hemorrhoids.)

Thanks to cube farms and their incessant noise, I started spending more time on the commode, as that became the only quiet place at work where I could think ("throne thinking").  Never had a problem in the gold old days, back when I had an office.  If only headphones and music worked for me, instead of adding to the distraction.  Things got worse when I added a smartphone into the mix.

The very first new word you learn in weight training is "valsalva".  Do it right, and you get a safe increase in lifting power.  Do it wrong and you still lift more, but you also radically increase pressure "down there".  The key difference is exhaling: Too often, I would hold my breath during my largest lifts, which is Not the Right Way.

Combine the two for years on end, and I was on a railroad to hemorrhoids.

My first hemorrhoids would "pop out" during heavy lifts, and were easily "put back" via subtle hand pressure.  (Look around in a gym for that "subtle hand pressure": After you see it once, you'll see it near every weight station.  Try not to laugh out loud.)  Once in a while one would refuse to go back in, after which it would dry out and get irritated: A few days of Preparation H worked wonders.  (Sniff in a gym and you'll smell it: Again, please try not to laugh.)

Then the fateful day came when I found blood in the toilet bowl with my stool, as well as on the toilet paper.  It is important to note that this was blood separate from the stool, not part of the stool itself (which is an indicator for an entirely different set of serious medical issues).  In this case, it indicated the "leaking" or rupture of an internal hemorrhoid.  Another indicator is the presence of small farts that have a metallic or smoky scent: That's the iron in the blood being oxidized in the rectum.  I also had those, but they only made me wonder about my diet.

Now, if you followed the links above, you'll know that hemorrhoids are really just rectal tissue that has become swollen with excess blood.  Most often the weakened tissue will heal on its own, and the excess blood will be reabsorbed by the body.  But this process has failed to happen in hemorrhoids that become problems, especially in those that leak.

At this point, there are two basic choices: Remove the blood, or remove the tissue (which also removes the blood).

The most direct way to remove the blood is to shut it off at its source, to tie-off the vessel supplying the blood, which is called a ligature (latin for "knot").  The process of applying a ligature is called a "ligation".  And for leaking internal hemorrhoids, the easiest way to apply a ligation is to put a rubber band around the hemorrhoid, a "rubber-band ligation".  Which also removes the tissue.

When I saw that blood in my toilet, I immediately got a referral to a lower-GI specialist, who then performed a series of rubber-band ligations.  It turned out there are around six blood vessels that feed the lower rectum, and I had a hemorrhoid over each of them.  So I needed a total of six rubber-bands, each of which was about the size of those used in kids braces.  We did 1-2 on each subsequent appointment.

The procedure itself is quite painless, with no anesthesia required.  As the rubber-band does its job during the following days, the tissue will start to complain, and some pinching or cramp-like sensations will likely occur.  Eventually the tissue will die and fall off, unnoticed, during a bowel movement.

After my last rubber-band ligation, I was hemorrhoid-free for almost 2 years.  During this time I also stopped doing heavy lifts, focusing more on building muscle density and strength rather than bulk.

Then I started getting "pop-outs" again, which soon were happening with each bowel movement.  Every. Single. One.  But they always went back in, and stayed in, and they weren't leaking, so I monitored them, but didn't worry about them.

During this time I had started triathlon, and was getting ready to step up from sprints to the Olympic distance.  Which meant I needed to run a 10K, something I hadn't done in at least two decades.  As I increased the distance of my training runs, the oddest thing started to happen: My "pop-outs" would occur after about 3 miles.  If I didn't stop and put them back immediately, I knew they would get irritated, so it made doing continuous longer runs a bit of a problem.

Rather than deal with the hemorrhoids, I instead decided that my anus wasn't doing its job, and was weakening under the pounding of the longer runs, so I started doing Kegels.  (Yes, they work for men too!)  But in my case, they didn't do much to prevent the pop-outs, mainly just postponed them for another mile or so.

I finally did my my first Olympic race, and to my surprise, I had no pop-outs during the run!  The difference, of course, was that I was wearing a tri-suit during the race, while I normally trained in running shorts.  Clearly, compression is also useful for preventing pop-outs!

So, I still had my pop-outs with every poop, though they always went back in nicely.  And I did my long runs in my tri-shorts, which kept them in.  The problem wasn't "solved", but it wasn't really a problem any more.

Then I decided I wanted to step up to the half-iron distance.  And a 13 mile run.  Since none of my prior runs were ever longer than 6.2 miles, I started planning to increase my run distance during last winter (2012-2013).  But before my plan started, I injured my foot during the Tri Classic, and didn't return to running until less than a month ago.  With tri-shorts on, I had a pop-out after the first mile.  I did Kegels for a couple days, but it happened again on my next run.

Finally, I accepted the simple truth that it was time for my hemorrhoids to get repaired.  Since it was already clear to me that this wasn't a case for more rubber-band ligations, I got a referral to a surgeon.  The scheduling worked out perfectly, and I had an appointment the next day.

If you ever want to make a lower-GI surgeon happy, just show up with hemorrhoids like mine!  She asked me to "push them out", and when I did, her eyes lit up like it was Christmas morning.  She asked me if I had seen them, and I said no, I generally went by feel back there.  So she ran off to find a medical book, and returned to show me some truly surprising photos, to which she added, "Yours are like these, only better!".

You know, you just have to love people who really love their jobs.

She next told me I was an ideal candidate for a new procedure called THD, or "Transanal Hemorrhoidal Dearterialization".  That "dearterialization"?  It's just a kind of ligation.  And "transanal" means they don't need to cut their way in.  The best part of all is that it is surgery that doesn't involve a scalpel: Only very careful stitching is required.

This looked like an obvious winner to me, since even if it went poorly, it left open all the more traditional (and more invasive) surgical procedures.  We immediately scheduled my pre-op appointment and the surgery, and I had my procedure last Friday, March 22nd.

I won't go into the details of the procedure (which is cool) or my recovery (which has had its ups and downs), other than to say:
  1. Coming out of general anesthesia was the best chemically-induced feeling I've had since the '70's.
  2. I was immediately up and about, the main limitation being an inability to sit for very long (which improves every day).
  3. The tissue swelling that occurs makes it feel like you always need to "go".   So you try, get a little leakage, and wipe.  Over 20 times a day.  Which produces extreme irritation if you  forget to PAT instead of wipe!

I'll add to this story as my recover completes and I return to work and running.