The Clinic.Q. Bundle Branch Block Bundle Branch Block Definition
Bundle branch block (BBB) is a disruption in the normal flow of electrical pulses that drive the heart beat.
I am a 50-year-old male. I have been running for over 20 years and have completed several marathons. In spite of my exercise and a good diet, I have high cholesterol Cholesterol, High Definition
Cholesterol is a fatty substance found in animal tissue and is an important component to the human body. It is manufactured in the liver and carried throughout the body in the bloodstream. (250) and have been taking between 1,000 and 1,500 micrograms of niacin niacin: see coenzyme; vitamin.
or nicotinic acid or vitamin B3
Water-soluble vitamin of the vitamin B complex, essential to growth and health in animals, including humans. per day, which has worked well.
At my last physical examination and EKG EKG: see electrocardiography. my doctor told me that I have an incomplete right bundle branch block right bundle branch block Cardiology A condition in which the electrical impulse from the bundle of His to the ventricles is delayed or fails to conduct along the right bundle branch, resulting in right ventricular depolarization by cell-to-cell conduction and a mild sinus arrhythmia sinus arrhythmia
Irregularity of the heartbeat due to a variation in the sinus rhythm. . My physician was not concerned about either finding, but I have a few questions. Will this cause future problems? Is it just a natural part of aging? Do diet or other factors I can control affect these conditions? Do you have any suggestions, or should I just forget all about it?
A. The development of sinus arrhythmia is totally benign. I doubt that it is an age-related phenomenon, and it is unlikely to develop into problems in the future. It is certainly not likely to be affected by diet or anything else that you can control. In general terms, the presence of a mild sinus arrhythmia is really a finding of increased vagal vagal /va·gal/ (va´gal) pertaining to the vagus nerve.
Of or relating to the vagus nerve.
pertaining to the vagus nerve. tone. This can be a feature of athletes' hearts. It is probably a good sign and reflects your 20 years of running.
Incomplete right bundle branch block is a common normal variant found on electrocardiogram electrocardiogram /elec·tro·car·dio·gram/ (-kahr´de-o-gram?) a graphic tracing of the variations in electrical potential caused by the excitation of the heart muscle and detected at the body surface. and is also another finding that is often associated with an athletic heart ath·let·ic heart
Enlargement of the heart observed in some athletes. and is of no consequence. My only concern is that it sounds as if you are having serial evaluations and if your electrocardiogram changes with time and evolves into a complete right bundle branch block in the future, then it needs further examination. In about 70% of people, a complete right bundle branch block also has no association with any structural heart disease. Yet, in a small proportion it may indicate some underlying heart disease. If your EKG evolves into a complete right bundle branch block then it may be necessary to do some further investigating with an exercise stress test or a nuclear stress test. But this does not seem to be the case at this time.
Overall, the findings of an incomplete right bundle branch block and mild sinus arrhythmia are signs of an athletic heart, and they are not likely to develop into an unhealthy condition. I believe you should not worry about it and continue with your excellent running. However, a 50-year-old male with high cholesterol should work toward healthy lipid profiles. If your family history includes heart disease, your doctor may want to consider using cholesterol-lowering drugs in addition to diet and exercise. It is certainly reasonable to get a complete check up once a year to catch any changes that may need attention.
Anthony P Goldman, MD.
Q. Knee Clicking and Pain
Whenever I run, climb stairs, work out with weights, or bend my knee I hear a clicking or grinding sound. When I run or climb stairs, my knee will start to hurt after about five minutes. I have heard that this means there is cartilage damage. Is this true? Should I be concerned?
A. Pain in the anterior or front of the knee is a very common condition, which is often due to changes in the mechanics of the joint between the knee cap and the thigh bone, known as the patellofemoral joint. This may progress to a condition called chondromalacia chondromalacia /chon·dro·ma·la·cia/ (kon?dro-mah-la´shah) abnormal softening of cartilage.
n. of the patella patella (pətĕl`ə): see kneecap. , which is damage to the surface cartilage of this joint.
Many people experience some popping sounds in the knee with certain activities, which may not be very significant, but if there is pain you should see a doctor for diagnosis and treatment.
Temporary pain relief can usually be obtained with heat, ice, acetaminophen acetaminophen (əsēt'əmĭn`əfĭn), an analgesic and fever-reducing medicine similar in effect to aspirin. It is an active ingredient in many over-the-counter medicines, including Tylenol and Midol. , or over-the-counter anti-inflammatory medications like ibuprofen ibuprofen (ī`byprō'fən), nonsteroidal anti-inflammatory drug (NSAID) that reduces pain, fever, and inflammation. . However, be cautious of these medications, particularly if you have a medical history of stomach, liver, or kidney problems. In any case, unsupervised use of the medications should be limited to no more than one or two weeks.
Treatment for a runner must include examination of the shoes. They should be supportive of the arch and not have been used for more than about 300 to 500 miles. You should stretch the muscles in your legs very carefully including your heel cords, your hamstrings, and your quadriceps as tightness of all of these can increase the pressure on the front of the knee.
Finally, you need to strengthen your quadriceps, particularly the vastus medialis vastus me·di·a·lis
A muscle with origin from the shaft of the femur, with insertion into the tibial tuberosity, with nerve supply from the femoral nerve, and whose action extends the leg. , which is the prominent muscle just above the patella on the inner side of the thigh. There are a number of ways in which this muscle group may be strengthened. You should start with isometric exercises Isometric exercises
Exercises which strengthen through muscle resistance.
Mentioned in: Chondromalacia Patellae or quad sets in which the quadriceps is contracted and held for several seconds repetitively for three sets of 10 to 20 reps, concentrating on recruiting the vastus medialis. Runners need this muscle to be active during forceful weight bearing activity. Once the initial pain subsides, you can start doing partial (quarter) squats keeping the knee in a neutral or straight position over the foot.
If these measures are not effective, see an orthopedist who can evaluate your knees and provide accurate recommendations.
Stuart Weinstein, MD.
A. A physical therapy program can be very helpful in treating anterior knee pain. Strengthening of the quadriceps, as well as flexibility of the hip and thigh muscles, is needed to dynamically control the way the kneecap kneecap (patella), saucer-shaped bone at the front of the knee joint; it protects the ends of the femur, or thighbone, and the tibia, the large bone of the foreleg. The kneecap is embedded in the tendon tissue of the quadriceps femoris, a large thigh muscle. glides or tracks. Sometimes orthotics orthotics /or·thot·ics/ (-iks) the field of knowledge relating to orthoses and their use.
n. are needed to improve foot alignment, and usually training adaptations need to be made to avoid pain. I suggest a sports physical therapy exam and sports medicine sports medicine, branch of medicine concerned with physical fitness and with the treatment and prevention of injuries and other disorders related to sports. Knee, leg, back, and shoulder injuries; stiffness and pain in joints; tendinitis; "tennis elbow"; and orthopedic assessment.
Steven Hoffman, L.P.T.
A patellar-stabilizing neoprene neoprene: see rubber.
Any of a class of elastomers (rubberlike synthetic organic compounds of high molecular weight) made by polymerization of the monomer 2-chloro-1,3-butadiene and vulcanized (cross-linked, like rubber), by sulfur, wrap can help maintain proper tracking of the patella in the femoral femoral /fem·o·ral/ (fem´or-al) pertaining to the femur or to the thigh.
Of or relating to the femur or thigh. groove. (-Ed)
Q. Really Cold Running
After 10 years in Hawaii I have relocated to Alaska--from tropical to 13 degrees at high noon--what a switch. As a runner for over 20 years, I'm at the gym every day wondering, "can I brave the cold?" The local running store advises to layer my clothing and I'm good to go. I don't see any runners on the roads to reassure me that my lungs would survive. Is there a minimum temperature or wind chill below which I should stay indoors?
A. Welcome to Alaska. I have been living and running in Fairbanks for the past 36 years. According to the records, I'm the oldest competing male runner in the interior of Alaska at nearly 72. I have run in weather as cold as 50 degrees below zero.
Covering your face protects against frostbite frostbite (chilblains), injury to the tissue caused by exposure to cold, usually affecting the extremities of the body, such as the hands, feet, ears, or nose. Extreme cold causes the small blood vessels in the extremities to constrict. and warms the air you breathe as well. I use a two piece set that includes a stocking cap for my head and a balaclava Balaclava
fought between Russians and British during Crimean War (1854). [Russ. Hist.: Harbottle Battles, 25–26]
See : Battle for my neck and face, which can be pulled up over my nose. These come in various materials but I like the polypropylene and acrylic better than wool or cotton. I use lightweight rubber slipons over my shoes, which are equipped with four stainless steel spikes (check with climbing suppliers for these) to keep from slipping on the ice. You will need to gain experience with what works best for you. Start out close to home running loops without getting more than 10 minutes away from shelter, just in case you haven't gotten it right. But I'm living proof that running is possible all year, even in Alaska. Enjoy.
A. Your hardest task will probably be to put your foot out the door. You can mix inside workouts with outside to disperse with boredom, and link up with some pals.
Q. Surgery for an Inguinal Hernia
I have surgery scheduled to repair a right inguinal hernia and would like your advice about recovery and rehabilitation. When can I resume running? When can I begin abdominal exercises like crunches? When should I begin stretching? How about hill work and speed work? How long should I keep distances short and paces slow? I can be patient during my recovery. I really want to keep myself healthy and not get hurt by coming back too soon. On the other hand, I certainly don't want to prolong inactivity.
Gary J. Raby
A. An inguinal hernia is the result of a defect in the abdominal wall at the groin allowing a loop of intestines to protrude pro·trude
1. To push or thrust outward.
2. To jut out; project. . It can be painful, certainly annoying, and sometimes dangerous if the loop of bowel twists preventing normal bowel function. It can usually be repaired using a laparoscope laparoscope /lap·a·ro·scope/ (lap´ah-rah-skop?) an endoscope for examining the peritoneal cavity.
n. in which case your hospital stay is short, the surgery is minor, and recovery is relatively quick. Sometimes hernias are repaired with a larger abdominal incision.
It is very important to know whether your repair will be performed laparoscopically or through a larger abdominal incision. Recovery for the two procedures is very different. I will assume you are having a laparoscopic Laparoscopic
A minimally-invasive surgical or diagnostic procedure that uses a flexible endoscope (laparoscope) to view and operate on structures in the abdomen.
Mentioned in: Obstetrical Emergencies repair since that is the more common approach and is usually an outpatient procedure. Running can probably be attempted within two to four weeks but at a much lower intensity than you are used to, even beginning with a walk/jog. (An open, abdominal repair would require at least six to eight weeks of recovery before running could be attempted.)
You may want to consider some non-impact cross training such as pool work or stationary cycling to help maintain your cardio-respiratory fitness at the beginning. Then use a slow but sure approach of increasing your running stress from a comfortable pace over a much-reduced mileage and then increase 5% to 10% per week. Once you are running comfortably at slow paces and on easy terrain for a few weeks, you can begin a gradual increase to faster, more intense training adding hill work and speed work over a several week period. You should listen to feedback from your body and remember there are two considerations: healing from your surgery and reconditioning after a layoff. No matter how good you are feeling, always keep the 10% rule at hand--never increase speed or intensity by more than 10% per week and never increase both at the same time. Establish an endurance base and follow with speed or power workouts when you are totally comfortable.
Stretching the lower extremities can begin right after surgery, even the very next day. But weight training, abdominal crunches, or leg lifts should be held off for three or four weeks after surgery. It always makes sense to err on the side of caution. A gradual comeback will re-train your muscles and cardiorespiratory car·di·o·res·pi·ra·to·ry
Of or relating to the heart and the respiratory system.
Adj. 1. cardiorespiratory - of or pertaining to or affecting both the heart and the lungs and their functions; "cardiopulmonary system without risk of injury. The end result will find you as fit, strong, and fast as you were before. You will be surprised how fast your return is by taking the slower approach.
Edward Vivoda, MD.
Ask the Clinic!
Are you bothered by an injury? Do you have a training or diet question? If so, ask The Clinic, in care of American Running Association, 4405 East West Highway, Suite 405, Bethesda, MD 20814, FAX (301)913-9520, e-mail firstname.lastname@example.org. Free personalized sports medicine, training, and diet advice is an exclusive benefit for American Running Association and AMAA AMAA Agricultural Marketing Agreement Act of 1937
AMAA American Medical Athletic Association
AMAA American Maine-Anjou Association
AMAA Afghan Medical Association of America
AMAA Armenian Missionary Association of America, Inc. Members only. American Running has more than 255 Clinic Advisors representing more than 27 specialities. Include as much relevant information as possible about you (age, weight, etc.) and your injury (type and location of pain), training schedule (typical weekly workouts, pace, surface), athletic and medical history, sole wear, recent changes in training, etc. Type or print your letters. Hand-written FAXed letters will not be accepted. Include your name, address and phone number (even in e-mail). Letters cannot be processed without your name and mailing address. Responses usually take three to four weeks, but can take as long as five.